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NOTICE: Participants are no longer
needed for this research project, since the effectiveness of Valsalva
Control therapy has been sufficiently established.
During the past 9 months I
have conducted Phase 1 of a clinical trial of the effectiveness of
Valsalva Control in reducing stuttering blocks
in adults with persistent developmental stuttering. This
trial demonstrated that Valsalva Control is a valid approach to
understanding and treating stuttering, while preserving the individuals’
own natural-sounding speech. The results of the Phase 1 trial were
presented at the International Stuttering Association’s 9th
World Congress for People Who Stutter, on May 18, 2011, in Buenos Aires,
Argentina. An article based on my presentation,
"Reducing
Stuttering Blocks by Controlling the Body’s
Valsalva Mechanism," can be found at
www.valsalva.org/ISA2011.htm.
The Phase 1 trial also led
to the development of additional insights, techniques, and materials that
may make therapy faster and more effective. I am currently
beginning Phase 2 of my clinical research, which will incorporate these
modifications. This will be conducted
in Philadelphia, Pennsylvania, U.S.A., with remote
video access via Skype™. The
therapy in Phase 2 will also be more structured and more
intensive. Whereas Phase 1 involved only one hourly Skype session per
week, plus home assignments, Phase 2 will begin with approximately 18
hours of therapy during the first three weeks, before tapering off, for a
total of 25 hours of therapy over a period of 8 weeks. In addition,
participants must devote at least one hour a day to practice, plus other
homework assignments. Therefore, persons
interested in participating in the research must be willing to make this
commitment.
Valsalva
Control Therapy
Stuttering is a multi-faceted condition influenced by
many factors, depending on each individual. However, I
believe that the best way to understand and treat stuttering behavior is
to view it not in terms of “fluency” but rather in terms of effort. I believe that the
underlying mechanism for stuttering blocks boils down to the following:
a neurological confusion in the motor programming of the larynx, in
which effort is substituted for phonation of the vowel sound in specific
syllables. Depending on the individual, this substitution of
effort for phonation may be a response to anxiety or to the anticipation
of difficulty in speaking. Although it may instinctively feel
like the right thing to do, it actually makes fluent speech impossible.
The purpose of Valsalva
Control Therapy is to promote easy, natural, resonant speech by
eliminating interference from the body’s Valsalva mechanism and the urge
to exert effort. Its elements include education, Valsalva
relaxation, exercises in phonation, strengthening vowel production,
various speaking exercises, role playing, speaking situation hierarchies,
attitude changing, and individualized counseling. The goal is to
make speech easier not only during therapy therapy sessions, but in
ordinary speaking situations.
Valsalva Control intentionally does not emphasize fluency, because any effort to “stop stuttering”
would tend to activate the Valsalva mechanism and be self-defeating.
Instead, the goal is to communicate in an easy, effortless, and enjoyable
way. Likewise, the participants’ reactions to outside speaking situations are
analyzed and discussed in terms of their urge to exert or display
effort, rather than whether or not they stuttered.
Criteria
for Participation
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The onset
of your stuttering was not related to head trauma or disease
affecting the brain.
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Your stuttering is usually moderate to severe, but
sometimes you are fluent, such as when singing or speaking in unison with
other people.
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You know exactly
what you want to say, but you are sometimes blocked when trying
to say the words. |
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You are
age 18 or older, have at least an 8th grade education, and
speak, read, and understand English.
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You must
either
be able to attend weekly sessions in Philadelphia, Pennsylvania,
OR
you must have access to a webcam and a high-speed Internet connection in
order to participate by video conferencing using Skype™.
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In order to
qualify for the study, the following must not apply:
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Brain damage or other
significant neurological defects or deficits. |
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Physical defects that
affect speaking or breathing. |
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Onset of stuttering
related to head trauma or disease affecting the brain. |
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Severe coronary
artery disease, recent heart attack, or hernia, aneurysm, or
moderate-to-severe reduction in blood volume, which would preclude
participant from performing Valsalva maneuvers. |
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Currently receiving
other forms of stuttering therapy. |
In
addition, participants will be tested at the beginning of the study to
determine whether their stuttering is of the type and severity that would
be appropriate for this study.
What's
Involved
An initial session of approximate 30 minutes will be
devoted to an initial consultation and screening. Additional
sessions will be scheduled for persons who accepted into the study.
The Valsalva Control
Stuttering Therapy trial will include 25 hours of therapy over a period of
8 weeks. There will be 18 hours of intensive instruction and practice
during the first three weeks. This will be followed by individualized
counseling sessions to help transfer skills to ordinary speaking
situations. The therapy can be done either by Skype™
or in my Philadelphia office. In
addition to therapy sessions, participants must also do at least 30
minutes of practice every morning, plus an additional 30 minutes during
the day and other homework assignments. Participants must also practice
their speaking exercises when talking with therapy partners (e.g.,
spouse, friends, or family), and eventually with other people.
Time Duration of the Procedures and Study
Participants' involvement in the study will last approximately
8 weeks.
Costs and Compensation
Participants will not be charged any fees nor will
they receive any compensation for being
in this research study. Participants attending sessions in Center
City Philadelphia may incur expenses for travel and/or parking.
Participants at remote locations may incur expenses for obtaining a webcam
and a high-speed internet connection, if they do not already have them, to
allow for video conferencing.
Discomforts and Risks
The procedures and
techniques involved in this study are non-invasive and have minimal or no
risks, subject to the following precautions regarding demonstrations of
the Valsalva maneuver: In
learning about the Valsalva mechanism, participants will be asked to perform
ordinary Valsalva maneuvers of the type that people instinctively perform
every day, as well as Valsalva maneuvers that may occur in the blockage of
speech.
However, persons should not perform strong Valsalva maneuvers or excessive
straining (and will not be required to do so in this research),
especially if they have severe coronary artery disease, have
experienced a recent heart attack, or have hernias, aneurysms or a
moderate-to-severe reduction in blood volume. Persons having any of these conditions
should ask their physicians
whether it is safe for them to perform Valsalva maneuvers.
Potential Benefits
The possible benefits participants may experience from the techniques described in
this research include: speaking with less effort and struggle, reduction
of stuttering blocks, increased fluency, and improved attitudes and
expectations regarding speech. However, there is no guarantee that you
will benefit from being in this research. The results of this research may
also help to improve the future treatment of stuttering.
Documents for Participants
Persons interested in participating in this research study must review,
complete, execute, and submit the following documents:
Address any questions to William D. Parry,
Esq., CCC-SLP at contact@valsalva.org
Copyright © 2011 by William D. Parry, Esq., CCC-SLP. All rights reserved.
Revised:
07/17/11
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