SpeechEasy® Canadian Update

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SpeechEasy – Early Canadian Outcomes Data
By Janet Gibson SLP(C)/Aud(C)
Director of Speech-Language Pathology
Island Hearing

SpeechEasy, like any new treatment, continues to go through a process of acceptance. People Who Stutter and Speech-Language Pathologists have on the one hand embraced it as a welcome new tool to improve fluency, and on the other (rightfully so) have sought to learn more about it, and to know that its effects remain true over time, before fully integrating it amongst the many alternative treatments that exist for stuttering. Acceptance by the professional community is now taking place – for the first time, our profession in the fluency world appears to be taking SpeechEasy seriously. At the recent ASHA Special Interest Division 4 Conference on Fluency and Fluency Disorders in Portland, Oregon, a morning and an afternoon of concurrent sessions were dedicated to electronic fluency aids. Still not mainstream, this inclusion in such a prestigious academic lineup is testimony to the fact that indeed, there is a place in the treatment spectrum for electronic devices such as SpeechEasy for the treatment of stuttering. And that’s likely because they work – by no means for all, but certainly for some!

The above-mentioned need for outcomes data for SpeechEasy is steadily being met, and this in part can explain its progression to acceptance. Can we now begin to make assumptions based on clinical experience – can we start to use the early outcomes data to predict who will benefit? And how does the use of a fluency aid fit in with traditional treatment options?

Let’s look at some outcomes data from other places first: a recent article by Kalinowski et al. (2004), reporting survey findings of a self-report questionnaire of people who have worn SpeechEasy for at least six months, suggests that SpeechEasy offers “efficient and effective stuttering amelioration”. The words “efficient and effective” are chosen carefully to indicate that the fluency outcomes are achieved in a relatively short space of time, and maintained with relatively little ongoing intervention. Elaine Stevick, a clinical research S-LP and SpeechEasy Provider from California, presented at the ASHA conference her clinic’s findings after two years of SpeechEasy dispensing, based on telephone interviews with clients who have been wearing SpeechEasy for 12 to 18 months: 85% of respondents (N=27) report their fluency to have improved since they first started wearing SpeechEasy, 62% report they wear their SpeechEasy regularly, and interestingly, 67% of respondents report using active fluency techniques along with the device. Janus Development (the US distributor) engaged a marketing company to survey over 2000 SpeechEasy wearers. Their sample of 489 respondents to a mailed questionnaire revealed over 80% of people are satisfied with their decision to obtain a SpeechEasy device; over 85% of respondents reported a heightened sense of confidence, freedom and/or self-reliance, as well as an improvement in social and professional relationships; 66% of respondents reported a “good degree” to “dramatic” improvement in their fluency; and 70% wear their devices five to seven days a week.

What about the Canadian SpeechEasy data? The first SpeechEasy sales started in British Columbia in November 2003. Since then, Island Hearing and affiliated clinics dispensing SpeechEasy have grown to eight, including Halifax, Montreal, Hamilton, Sault Ste. Marie, Edmonton Vancouver and Vancouver Island.

Canadian SpeechEasy data, current as of July 15, 2004:

• 144 people have been assessed for SpeechEasy candidacy.
• Of these, 85 people purchased SpeechEasy. This means that on average across all clinics, 59% of people who have been assessed for SpeechEasy actually purchased it.
• Of the 85 people who purchased SpeechEasy,16 people returned their device within the allowable 30-day trial period – approximately 19%.
• The youngest person fit with SpeechEasy is eight years old, the oldest is 88.
• 70% of people fit with SpeechEasy are males.

A recent survey was conducted by Island Hearing in a phone-interview format. Only people who have been wearing SpeechEasy for four months or longer were contacted, and only responses from people 18 years or older were used. Eighteen responses were eligible for analysis based on the above criteria. Some interesting facts were gleaned:

1. Usage: 55.5% use their device between four to seven days a week; 27% use their device only when needed; 11% use it three days a week or less, and one respondent doesn't wear it at all any more.
2. Perceived Fluency Improvement: 50% described their fluency as “much improved”; 22% described their fluency as “minimally improved”. The remaining respondents felt their fluency outcomes with SpeechEasy were dependent on the situation.
3. Use of Active Techniques: 55.5% reported they use active fluency techniques in conjunction with SpeechEasy use.
4. Satisfaction with Assessment and Fitting processes: 80% of respondents were “very satisfied” with the SpeechEasy assessment and fitting procedures.
5. Satisfaction with the Follow-up process: 55.5% were “very satisfied” with the follow-up process.

Our study sample is small, yet it forms the beginning stages of a database of outcomes information, and gives us direction in areas we can improve: for example, the difference in perceived satisfaction between the assessment and fitting process and the follow-up process tells us we need to improve our follow-up procedures.

One of our challenges to follow-up has been distance – the great distances some people have had to travel to obtain their SpeechEasy devices have prevented adequate follow-up. Perhaps models in Telehealth should be considered in order to provide improved follow-up services; perhaps educating fellow professionals in Speech Therapy principles for people wearing SpeechEasy would be useful so that patients can access local Speech Therapy services. While not specifically stated in the survey, qualitative analysis of patient comments suggests that expectations of success need to be modified – the effects of Oprah are still present. Patients need to be reminded SpeechEasy is not a magic pill, that there is no easy answer to the problems of stuttering, and that there is still work involved in using SpeechEasy.

In conclusion, the above results and reports of other surveys indicate largely encouraging findings about SpeechEasy from those who have purchased it. Yet there remains much more to be learned about SpeechEasy so that people in our profession can more accurately predict which People Who Stutter would most likely benefit from it, and so that People Who Stutter themselves may more knowingly and confidently chose to embrace SpeechEasy as one of their treatments of choice in managing their fluency challenges.

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References:
Kalinowski, J., Guntupalli, V.J., Stuart, A., & Saltuklaroglu, T. (2004). Self-reported efficacy of an ear-level prosthetic device that delivers altered auditory feedback for the management of stuttering. International Journal of Rehabilitation Research, 27: 167-170
Stevick, E. (2004). A Clinician-Researcher’s Experience with the SpeechEasy Device. Paper presented at the SID-4 ASHA conference on Fluency and Fluency Disorders.
Janus Development. (2004). Customer Satisfaction Survey. (Rainmaker and Sun)