Stuttering Therapy Reviews

iStutter iPhone App

• Why iStutter?
• iPhone/iPod touch
• Microphones and Earphones
• iStutter Overview
• iStutter Features
• Educational Discount
• Therapy With iStutter
• Comparison to SmallTalk

Why iStutter?

Modifying Phonated Interval (MPI) stuttering therapy may be the biggest advance in stuttering treatment in decades. MPI stuttering therapy trains stutterers to eliminate too-fast speech elements and speak fluently at a normal speaking rate. The first published study found that after 2-3 hours per day for 2-3 weeks all of the subjects had "near zero" stuttering on stressful telephone calls to local businesses. A year later all of the subjects had maintained this fluency. MPI therapy is now the subject of a six-year, $3 million study funded by the National Institute of Deafness and Communication Disorders (NIDCD).

The iStutter iPhone/iPod touch app moves MPI stuttering treatment out of the speech clinic and into your real life. Too many stutterers learn to speak fluently in their speech-language pathologist's office, then their speech collapses when they leave the speech clinic and get into a stressful situation. iStutter enables stutterers to do therapy anywhere, without their speech-language pathologist being present.

iStutter does more than MPI stuttering therapy. It also provides delayed auditory feedback (DAF) to immediately induce slower, relaxed, normal-sounding fluent speech without training, therapy, or mental effort. Unlike other DAF devices, iStutter switches on DAF only when you need it. When you talk too fast or stutter, DAF switches on. When you regain control of your speech the DAF switches off. And, unlike other DAF devices, the sound is off when you're not talking, leaving your hearing unimpaired.

Plus iStutter is the most visually attractive stuttering treatment device. The throat microphone and acoustic eartube are almost invisible when you don't want to draw attention to your speech, yet when you want to share with listeners what you're doing to improve your speech you can show them your iPhone or iPod touch. The colorful, lively graphics show precisely what your vocal folds do when you stutter, and show what you're doing to speak fluently.

iPhone/iPod touch

iStutter runs on Apple's iPhone and iPod touch. The iPod touch weighs only 3.5 ounces and costs only $199 with no monthly contract.

Microphones and Earphones

iStutter works best with the Iasus NT3 combination throat microphone and acoustic eartube. The Iasus NT3 can be hidden under a shirt or sweater. A clear plastic tube goes to your ear. A hearing aid store can make a comfortable, inconspicuous earmold to fit your ear. The clear plastic eartube is made for television announcers and is nearly invisible to listeners.

We are working on a more accurate phonation sensor that uses a single-axis accelerometer mounted in an elastic neckband. Our phonation sensor is as accurate as an electroglottograph.

iStutter can be used with any other microphone and earphones, including Bluetooth earsets. We recommend the Plantronics Voyager Pro.

iStutter Overview

iStutter measures the duration of phonated intervals, i.e., the length of time your vocal folds vibrate to produce vowels and voiced consonants, delineated by voiceless consonants and silent pauses. The app color-codes your phonated intervals with red for very short bursts of vocal fold activity, orange and yellow for slightly longer phonated intervals, green for normal phonated intervals, and blue and purple for abnormally slow, long phonated intervals.

iStutter switches on delayed auditory feedback (DAF) when your phonated intervals are too short. Rapid or stuttered speech indicated by red and orange phonated intervals switch on DAF. DAF induces a slower speaking rate with longer phonated intervals. When your speech is fluent at a normal speaking rate, indicated by green or blue phonated intervals, iStutter switches off the DAF.

As long as you stay fluent at a normal speaking rate, iStutter doesn't interfere with your speech. When your speech is fast or stuttered, iStutter makes you slow down and speak fluently.

DAF is also off when you aren't speaking. Your hearing is unimpaired. Unimpaired hearing is especially important to children in school.

iStutter can also support prolonged speech (fluency shaping) stuttering therapy with phonated intervals of two seconds, one second, half-second, etc.

iStutter Features

The main screen displays the last four seconds of your speech. The bar graph above the main screen displays the last ten minutes of the user's speech. The goal is to get tall green bars and short red bars.

The Cumulative screen displays your speech for the day. The white clock displays total speaking time. The goal is to get two to three hours of speaking time per day, while minimizing the percent too-short intervals in red in the upper right corner.

The Evaluation screen has a story ("Arthur the Young Rat") that contains every sound in the English language. You read the story aloud and iStutter calculates your syllables per second and displays your phonated intervals durations.

The Help screen provides detailed instructions.

The Settings screen allows adjustment of microphone gain; changes DAF between always on, always off, and voice activation; delay hold time; delay length (25 to 200 milliseconds); analysis time period; minimum phonated interval duration to switch on DAF; and number of too-short intervals needed to switch on DAF.

Educational Discount

An educational discount is available for purchases of 20 apps or more. Go to the App Store for details.

Therapy With iStutter

iStutter can be used to train stutterers to eliminate too-fast speech elements and speak fluently at a normal speaking rate. A speech-language pathologist first trains the stutterer to slow down and speak fluently using prolonged speech (fluency shaping) techniques. When the stutterer is speaking 100% fluently, use the iStutter to measure the stutterer's phonated interval length. Set the iStutter to switch on DAF when the stutterer exceeds this speaking rate (i.e., produces shorter phonated intervals). The stutterer then practices until he or she can consistently speak fluently without the DAF switching on. This practice should include both reading aloud and stressful conversations such as telephone calls. This practice can be done without the speech-language pathologist supervising, outside the speech clinic. When the stutterer can speak fluently at this speaking rate he or she then sets the iStutter one level faster and repeats the protocol. As the stutterer's speaking rate becomes more natural he or she should include more face-to-face conversations and telephone calls in his or her practice. When the stutterer is speaking fluently at a normal speaking he or she can discontinue using the iStutter.

A study [1] investigated Modifying Phonated Interval (MPI) therapy, running on a computer in a speech clinic (not using iStutter software or the iPhone or iPod touch), with five adult stutterers. After SLPs trained the subjects to use the computer the subjects practiced independently. The subjects practiced 2-3 hours per day for 2-3 weeks. All five reached "near zero" stuttering in telephone calls to local businesses (a stressful speaking situation). Therapy was then discontinued. One year later all five subjects had maintained this fluency. A larger six-year, $3 million study funded by the NIDCD is currently underway.

Comparison to SmallTalk

The SmallTalk is optimized for immediately reducing stuttering, with training carryover fluency the secondary goal. iStutter is optimized for training carryover fluency, with immediate stuttering reduction the secondary goal. The SmallTalk is more effective in some ways:

• The SmallTalk comes with binaural (two ears) and monaural (one ear) earphones. iStutter is typically used with the monaural (one ear) Iasus NT3 combination throat microphone and acoustic eartube. Binaural AAF is 25% more effective than monaural AAF. [2] iStutter can be used with binaural earphones if desired.
• The SmallTalk provides delayed auditory feedback (DAF) and pitch-shifting frequency altered auditory feedback (FAF). These two types of AAF increase effectiveness from about 70% to about 80%. iStutter only has DAF.
• The SmallTalk comes with microphones optimized to pick up your air-transmitted voice. iStutter works best with an Iasus NT3 throat microphone optimized to pick up phonation (vocal fold activity). Your phonation doesn't sound like your air-transmitted voice. You hear your voice clearly with the SmallTalk but your voice sounds muffled with iStutter and an Iasus NT3 throat microphone.
• The SmallTalk plugs into telephones. You can leave your SmallTalk plugged into your telephone; when someone calls you just pick up the phone and talk fluently. You hear the AAF and the caller's voice in both ears. The caller hears your fluent, unaltered voice. iStutter is more difficult to use on telephone calls because it takes a minute or two to put on the throat microphone and insert the earmold. You can use iStutter with one ear and hold the telephone to your other ear, but you can't hear both the DAF and the caller's voice in the same ear or ears. (The iPhone has a firewall between its cellphone features and apps. No third-party developer is allowed to develop apps that modify the iPhone's telephone functions.)
• The SmallTalk comes as a complete system ready to use. You can order a SmallTalk today and be speaking fluently tomorrow. iStutter requires buying an iPhone or iPod touch; then ordering an Iasus NT3 combination throat microphone and acoustic eartube; then going to a hearing aid store and getting an earmold made; then trying different cases, belt packs, or armbands to find what's most comfortable for you to carry your iPhone or iPod touch, etc. In other words, expect to spend several weeks getting iStutter set up before you can use it to its full capabilities.
• MPI stuttering therapy, like most stuttering therapies, requires a high level of cognitive function, i.e., self-awareness and self-control. AAF is one of the only stuttering treatments that doesn't demand high cognitive functioning. Developmentally delayed or mentally retarded stutterers may get better results with the SmallTalk.
• iStutter has no features for silent blocks. The Basic Fluency System has an optional masking (MAF) manual button to pull stutterers out of silent blocks.
• The SmallTalk's battery lasts 15-20 hours. To get an iPhone or iPod touch to run all day without recharging you may need to buy an external battery case such as a Mophie Juice.
• VERY IMPORTANT: Apple's App Store doesn't allow any returns of software. iStutter has no trial period or moneyback guaranty. After you buy iStutter there is absolutely no way to get a refund. The SmallTalk has our full trial period and warranty.

On the other hand, iStutter is more effective than the SmallTalk in other ways:

• Casa Futura Technologies DAF devices have been proven to produce more than 50% carryover fluency when used about 30 minutes per day for about three months [3]. MPI stuttering therapy has been proven to produce "near zero" stuttering in 2-3 hours per day for 2-3 weeks. [1] We believe that iStutter will produce more carryover fluency in a shorter time than the SmallTalk.
• The SmallTalk lacks voice-activated AAF. It has a push-to-talk mode to produce AAF only when you push a button; it also has noise-canceling microphones to reduce background noise in noisy environments. iStutter has voice-activation so when you're not talking your hearing is unimpaired. (Voice activation only works well with a throat microphone, which is why we didn't design the SmallTalk with voice activation.)
• The iPhone and iPod touch have the latest Bluetooth wireless technology. The SmallTalk uses first-generation Bluetooth technology.
• You can use your iPhone or iPod touch for thousands of other purposes, such as listening to music or taking photos. You're more likely to carry your iPhone or iPod touch, and a device that gets carried more gets used more.

References

[1] Ingham, R., Kilgo, M., Ingham, J., Moglia, R., Belknap, H., & Sanchez, T. (2001). Evaluation of a stuttering treatment based on reduction of short phonation intervals. Journal of Speech, Language, and Hearing Research, 44, 1229–1244.

[2] Stuart, A., Kalinowski, J., & Rastatter, M. (1997). Effect of monaural and binaural altered auditory feedback on stuttering frequency. Journal of the Acoustical Society of America, 111, 2237-2241.

[3] Van Borsel, J., Reunes, G., & Van den Bergh, N. (2003). Delayed auditory feedback in the treatment of stuttering: clients as consumers. Intl J Language Comm Dis, 38:2, 119-129.