HCRI’s Technological Innovation Continues to Improve Stuttering Treatment Outcomes

Ronald L. Webster, Ph.D., Founder and President of the Hollins Communications Research Institute (HCRI), shares how the non-profit Institute has used technology over the years to enhance the treatment of stuttering and the ease with which fluency is achieved during therapy. In addition, Dr. Webster provides insights on how technology will be applied in the future to advance stuttering treatment and access.

Here at HCRI we have an informal motto, “We need to invent the future. If we don’t do it, then we may not care for the future we get.” Our use of technology to give power and utility to our work on the treatment of stuttering represents years of adherence to our motto. The results have been remarkable. We have learned how to continue improving the technologies used in our stuttering treatment programs.

We have steadily built upon our experience in treating more than 5,700 persons who stutter. Our most recent advancements in stuttering treatment are incorporated in the development of the Hollins Fluency Program: Advanced Speech Reconstruction for Stuttering. This new program provides testimony to the merits of our “We need to invent the future” approach. All of what we do in this arena works to the long-term benefit of the clients whom we serve.

We have developed stuttering therapy programs at HCRI to take advantage of technologies that could improve the quality of initial fluency skill learning and thereby foster better long-term retention of fluent speech. Here is a quick look at how HCRI has implemented various electronic or computer technologies over the years. And, there is also a hint about new tools that are now on the horizon.

The first computers available to us were called minicomputers and they had limited memories and relatively slow processing speeds. We did succeed in developing a rather primitive speech processing program that could estimate the extent to which utterances embodied the energy profiles that signified correct or incorrect fluency target values.

In an article dealing with stuttering treatment and computers published in the Hollins College alumni magazine, we introduced people to an example of how new computing developments could be used to help establish fluent speech in people who stuttered. The article gained national attention for our work. Public demand for our therapy led to the founding of the Hollins Communications Research Institute in 1972.

Certain limitations were soon encountered with the computer. First, we could only use it with one client at a time. And, for that to happen all others terminals that accessed the central processor had to be shut down. Since a microcomputer cost about $60,000 in those days, we soon understood that we needed to find a less expensive way to measure speech characteristics in therapy and to provide feedback to our clients.

We went ahead to design a set of analog electronic circuits that could measure energy profiles in spoken sounds, syllables and words. This device became part of our first  systematic stuttering therapy, the Precision Fluency Shaping Program. At first, the device, we called it the Voice Monitor, could only evaluate single words. With determined effort we soon achieved the goal of evaluating successive syllables in polysyllabic words and then sentences. The device signaled with a green light whenever a correct target was detected. Errors were signaled by a non-response from the device.

During continuous speech, the green indicator lamp remained on until the device detected an erroneous response and shut the light off. Clients had to press a control button to activate the Voice Monitor for each trial with single syllable utterances or to reset the green light when an error was made in connected speech. In addition, there were three levels of energy profiles used within the Voice Monitor. Each level was used within a specific week of the treatment program.

The Voice Monitor went through a number of versions. Each one improved the quality of measurement, used better electronics, and became more practical and reliable in daily use. Clearly, we were on the right track. We had invented, patented, and reduced to practice a speech measurement tool that improved the quality of treatment at a cost level we could afford. Our clients had an easier time of learning and retaining fluency skills than they had previously. Our clinicians now had a tool that relieved them from the burdensome task of listing to and judging each spoken syllable and communicating the result to the client. The practical benefits of cost effective technology implementation were striking.

In 1984 we decided to make a transition from the Voice Monitor to the new Apple Macintosh computer. We called the new therapy program the Hollins Fluency System. The Mac allowed us to advance the reliability of treatment by adding two new teaching components and a new speech processing protocol. We found that we could present certain facts about speech to our clients and evaluate their learning and retention of the facts by means of the computer.

We also used the computer to present examples of correct and incorrectly spoken targets in order for clients to practice identifying appropriate and inappropriate responses. We designed and built a speech preprocessor module that connected to the Mac and was used to measure speech profile data, to score the accuracy of the client’s spoken responses and to signal the results of each judgment to the client. Additionally, the computer was used to collect and store performance data on each client. Clinicians could thus review performance details and provide any adjustments to the client’s program that might be called for.

In 1997 we completely rebuilt the therapy program and added networking to our system. Again, the quality, stability and clinical utility of our program improved. The precision of speech monitoring also improved due to our development of improved electronic speech preprocessing circuits based on new, advanced microchip designs.

During 2003 we released FluencyNet, our computer based home practice system for use by our alumni in validating target use and for practicing fluency skills at home or in the office. Many, many of our alums have used FluencyNet and have provided us with feedback that we used to enhance the user’s experience. In fact, lessons learned from FluencyNet were useful as we to created a new, improved version of our therapy program.

In 2008 we revised and rebuilt the program, again with advanced electronics, better and faster computers, and we established the program using a web-based format. We named this version of our therapy, the Hollins Fluency Program: Advanced Speech Reconstruction for Stuttering. This program is now in daily use within our clinic and is working exceedingly well. Improvements in this version, have increased the power and utility of treatment.

The essential point is that, in the near future, we will be creating several different methods for implementing remote access fluency skill training. Our intention is to conduct the first trials with refresher courses and then to move on to full remote access. Tests of the remote access system will begin in early 2010. Numerous details of procedure will need to be worked out as we go along. However, we are prepared to meet the challenges that come with innovation.

Our newest technology innovations arrived during 2009. We created new stuttering therapy applications for the iPhone and iPod Touch that expand the correct use of technology for improved client learning and retention of fluency skills. The new Voice Monitor application allows the user to talk into the hand held device and receive feedback about target accuracy in real world situations. While talking, the device records the client’s speech, scores the speech, and displays the results of the scoring on the screen. After completing the speech sample, the data file can be emailed to a clinician for immediate review. We are currently working on how to implement controlled distribution of the new software through the Apple iTunes store.

If you had been present at each step along the way in our technology developments, you would have noticed subtle changes in what and how we measured speech, how we provided feedback and how well our clients were acquiring and using fluency skills. If you had been present at the time of our first use of computers in therapy, and then returned today, you would be astonished at the developments that have taken place. Fluency generating targets are defined more clearly and comprehensively. Therapy details have been spelled out with increased precision. Linkages between and among targets have been made explicit. The physical measurement of speech signals has been dramatically improved, as have the feedback procedures now in place.

One of the great benefits of our developing new technologies is that they can be evaluated against our substantial base of experience with our own previous technologies. Our knowledge about technology development as an integral component of therapy is substantial. It is quite probable that HCRI has used electronic and computer technologies within stuttering therapy more than the rest of the world combined!

We are now at a place where we have designed and are building advanced digital speech processing circuits that will dramatically increase the range and details of speech and speech associated behaviors that can be measured, evaluated and used to improve fluency skill training. In effect, our “speech microscope” will open a new world of technology innovations within our stuttering therapy program. New diagnostic tools, new types of training within therapy and new forms of treatment outreach will change major features in the treatment of stuttering. All of what is coming has been made possible through the depth and scope of our experiences in working directly with electronics, computers and speech. We are excited by the prospects!

About HCRI

Hollins Communications Research Institute, founded in 1972 by Ronald L. Webster, Ph.D., has grown into a world-leading center for the investigation and treatment of stuttering. The 501 (c) (3) nonprofit institute is unique from other stuttering organizations in that work focuses on developing scientifically based treatment methods, as well as administering stuttering therapy.

More than 6,000 people from 48 countries have come to HCRI for stuttering therapy. HCRI is located at 7851 Enon Drive, Roanoke, Virginia, 24019. Contact HCRI at admin@stuttering.org or 540-265-5650. For video speech samples and more information, visit www.stuttering.org.