Swedish Comprehensive Stuttering Program (CSP)

Helena Forne-Wästlund in front of Selma Lagerlöf, the famous Swedish author 1858-1940, nobel prize award in 1911.

The Swedish project was initiated by The Swedish Stammerers Association, Annika Willfors and Per Alm in 1996, in cooperation with Helena Forne-Wästlund, SLP as a need for introduction of efficient speech training for people who stutter. The aim of the project was to introduce Precision Fluency Shaping Program (PFSP) to Sweden. The project comprised as well an evaluation of a computerized system, Dr Fluency, as a facilitator for the individual part of speech training. The project was forwarded to The Swedish institute for personal aids (Hjälpmedelsinstitutet) and the financial part by Allmänna Arvsfonden and Margot Wallström, at the time the Swedish minister of Social Affairs.

Helena Forne – Wästlund was in charge of the project. Her mission was to develop phonetic samples in Swedish for computer training with the software, check the technical standards of the system, to make a study design for evaluation of Precision Fluency Shaping Program (PFSP) in a clinical setting and to administer and train a pilot group of people who stutter. A final report of the project should be written and distributed by Hjälpmedelsinstitutet.

Phonetic development of PFSP in Swedish and Clinical training

The Swedish Project started in Autumn 1997 with an intense period of translations, development of phonetic samples in Swedish of the Dr Fluency system supervised by Mr. Eliezer Fetterman, Jerusalem. PhD Robert Kroll from The Speech and Stuttering Institute, University of Toronto was consulted for the Clinical training of Helena Forne-Wästlund, teaching the principles of speech training with Precision Fluency Shaping Program (PFSP) together with the problem solving strategies used in a Comprehensive Program setting. “Stuttering is behavior and problem, you have to deal with both in order to receive long-lasting treatment results, beneficial for your Clients”.

The Clinical part of project: Precision Fluency Shaping Program (PFSP)

The first ten persons who were interested in participating became included in the project. The studied pilot group comprised eight males and two females, aged 19 to 54 years of age with different levels of stuttering, from very mild to very severe accordingly to perceptual ratings of dysfluencies (Riley: SSI-3, Stuttering Severity Instrument) and self-reporting scales of level of problems related to Stuttering (Woolf: Perception of Stuttering Severity, PSI and Ericson: S-24 scale.)

The participators were divided into two groups for the three-week of intense Clinical training. The first group attended Stuttering intervention in August 1998, and the second two weeks later, in September.

The treatment comprised a 3-week intensive training session (Monday to Friday) combining individual speech training at the computer, speech training and teaching in groups of 5 participants, mainly phonetic principles and problem solving strategies.

During the last days of treatment when the participants had become familiar with the new skills, they were trained in everyday situations by outdoor transfers. In this way, the participants were used to employing the techniques before the end of the intensive treatment. Subsequently, a maintenance program with home-training followed consisting of exercises on the computer and personal support for a one-year period parallel with independent speech training for the purpose of using the speech techniques as a habit.

Results

Directly after the intensive training the following results were achieved: All ten fulfilled the training, 1 dropped out shortly after intense training. Results from the remaining 9: 8 of 9 increased fluency. 3 with no stutter, 4 very mild stutter and 1 mild stutter.

One year post-treatment: 4 of the Clients showed increased fluency varying from no stutter to mild stutter and elimination of stuttering problems. 4 with slight improvement of fluency in combination with persistent stuttering problems. 1 client relapse of therapy.

Two-year follow-up post-treatment: independent evaluator: After two years five of the participators had normal speech, no stutter. The same persons rated their communication of today positive, with significant reduction of stuttering problems.

For the Comprehensive Stuttering Program (CSP), the following results are available from a follow-up survey two years after the three-week intensive treatment (Forne-Wästlund 2001):

Independent perceptual ratings shows that five of eight persons have acquired normal fluent speech and no stuttering. According to the questionnaire, the same persons experience an improvement in their ability to communicate and an increased self-confidence. This fact underlines that a successive automatized use of the Speech Targets being learnt in treatment provides a normalized pattern for fluent speech, characterized by increased control of the coordination between breathing, voicing and articulation. Our experience has demonstrated that it requires extra time to develop it completely. The three persons that still stutter inform that they have not been diligent enough in their use of speech techniques which explains why they have not managed to maintain and support their motor skills. They feel they still have stuttering problems and difficulties of communication and therefore they desire additional training. We are thus able to make a summarising conclusion that the Comprehensive Stuttering Program (CSP) has promising results.

Today in 2010

So far, this is the first Swedish study introducing perceptual data in Stuttering.

Still today there exists no Swedish follow-up survey of the treatment results, comprising objective data such as perceptual ratings and self- rating scalesfrom clients of Non-Avoidance/ Stuttering Modification therapy/ Holistic approach to treatment (NA).

Ever since the end of project in 2001 the Clinical work continues, however in limited scale. Over the years 78 persons who stutter have experienced and fulfilled this one-year of treatment, mostly with increased fluency, decreased stuttering problems and an overall feeling of increased self-esteem, as a consequence improved Quality of Life.

Thanks to the Country Council of Värmland, we have received possibilities over a time period to fulfil the Thesis program for stuttering intervention and Quality of Life issues.

We are very grateful and hopeful for future cooperation with research institutions devoted to development of new insights in stuttering and clinical practise.