Speech and language

Stuttering anticipation in persons with stuttering: a preliminary study

P. Arya, A. Kumar
doi: 10.48095/ccorl2025S1_20

SPEAKwell Speech and Hearing Clinic, Delhi, India

Introduction: People who stutter experience the phenomenon of anticipation-the sense that stuttering will occur before it is physically and overtly realized. However, the “anticipation effect,” is poorly understood despite much investigation into this phenomenon. There are evidences that some people who stutter have the ability to anticipate a stuttering moment and are important for many currently used treatment techniques having maximum effectiveness. A systematic investigation of how people who stutter respond to anticipation has not been previously reported. In the present paper, possible neurological mechanisms involved in generating conscious anticipation are also discussed, along with directions for future research. Aim and Objectives: a) To find out qualitative analysis of experience of anticipation of stuttering; b) To analyze self-report evidence of what people do in response to anticipation of stuttering; c) To determine the extent to which this anticipation occurs. Method: Thirty adults who stutter (age range 19 to 40 years) indicated on a Likert rating scale the extent to which they anticipate stuttering and answered three open-ended (written) questions regarding how they respond to anticipation. Results: Results revealed that all participants experienced anticipation at least sometimes and more than half of the participants reported experiencing anticipation often or always. The extent to which participants reported experiencing anticipation was not related to stuttering severity, impact, or treatment history. Participants were just as likely to view anticipation as helpful as they were to view it as harmful. Conclusion: This can be concluding that adult persons who stutter (PWS) experience anticipation, and the majority of them report doing so at least often. PWS respond to this anticipation by altering the speech production process in various ways. It has been highlighted that the that anticipation plays an important role in how stuttering behavior evident itself.

Biomechanical evaluation of vocal function in head-neck postures: implications for voice

​​​​​​​Bianchino1, L. Fiorani2, C. Miglianti3, A. L. Malena4, L. Cufari4, M. Setola5  
doi: 10.48095/ccorl2025S1_21

1 Voice Research, Voice Evolution Institute, Ferrara, Italy

2 Voice Research, Voice Evolution Institute, Roma, Italy

3 Voice Teaching, Voice Evolution Institute, Poggibonsi, Italy

4 Speech Therapy, Voice Evolution Institute, Ortona, Italy

5 Voice, Voice Evolution Institute, Napoli, Italy

Head-neck positions significantly impact various parameters such as lateralization, rotation, elevation, depression, and compression of the vocal tract and its intrinsic structures, including the true vocal folds. This workshop aims to examine and experiment with the biomechanical effects of different head-neck postures on the larynx and vocal tract, using recorded endoscopic demonstrations to illustrate these exercises. Biomechanical assessments of laryngeal function and anatomy were conducted using simple maneuvers like head extension, flexion, and rotation, as well as combined movements involving rotation and flexion, or rotation and extension. These tests were designed to evaluate the different biomechanical compartments of the glottic plane. The postural constraints of the head-neck, coupled with phonation, were analyzed through specific mechanisms and predetermined parameters, such as vowels, frequency, intensity, timbre, duration, and vibratory mechanics. These parameters allowed for the assessment of vocal fold symmetry, edge-to-edge closure quality, tensioning, vibration of the vocal fold cover, laryngeal elevation, body-cover decoupling, and more. The perceptual evaluation of the outcomes from these tests is based on vocal qualities such as breathiness, roughness, instability, breaks, gaps, whistling, asthenia, tremor, and diplophonia. The proposed tests are both sensitive and specific, suitable for use in habilitative and rehabilitative settings. They are effective in assessing vocal health, determining the morpho-functional state of the vocal folds, and providing prognostic indicators for voice disorders. Practical exercises for evaluating these measures are included in the workshop, allowing participants to engage directly with the concepts.

Is bilingual acquisition advantageous or does it result in negative transfer?

H. Grech  
doi: 10.48095/ccorl2025S1_22

Human Communication Sciences and Disorders, University of Malta, Tal-Qroqq, Malta

Introduction: There are clear indications in gathered data that bilingual children’s speech acquisition differs from that of monolinguals, particularly in terms of phonological development. The possibility of two phonologies affects the course of acquisition. The claim that children in a bilingual learning context may be at an advantage for spoken phonological acquisition is supported many researchers who looked at children exposed to more than one language. However, Negative transfer has also been reported. Aim: This study gathered data from a sample of Maltese bilingual and monolingual children in order to compare results of the children‘s speech skills depending on whether they were primarily monolingual or bilingual speakers, with the aim of carrying out a cross-linguistic comparison to explore positive or negative transfer of bilingual acquisition. Materials and Methods: A sample size of over 200 children was used to gather data. Children, aged between 2.0–6.0 years of age were asked to name pictures that represent phonemes of Maltese and English by using a bilingual Maltese-English assessment. Results: Data was analyzed in terms of percentage consonants correct, percentage vowels correct, error patterns, consistency of production and oro-motor skills. Z scores, percentiles and standard scores were calculated for different age cohorts on a six-monthly basis and for different parameters used in assessing children’s speech. Results supported the claim of bilingual advantage for speech acquisition, particularly from 3.0 years of age onwards. Clinical implications were drawn up in relation to the interpretation of assessment in bilingual children.

Effectiveness of the “nature-method” using speech mentors in the context of self-help for adults who stutter

A. E. Hesping1, A. Kehail1, L. Werle2, B. Wauligmann3, T. Hesse4, A. Markmann5, R. Ostermeier6, C. Gietmann1, E. Konradi-Matis1, L. Fischer7, K. Neumann1
doi: 10.48095/ccorl2025S1_23

1 Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Münster, Germany

2 Stutterer Self-Help Group Daun, Daun, Germany

3 Stutterer Self-Help Group Münster, Münster, Germany

4 Stutterer Self-Help Group Magdeburg, Magdeburg, Germany

5 Stutterer Self-Help Group Weil am Rhein, Weil am Rhein, Germany

6 Stutterer Self-Help Group Augsburg, Augsburg, Germany

7 Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany

Introduction: For decades, many self-help groups for adults who stutter in Germany are practising a speech technique using the so-called “nature-method”, but evidence on the effectiveness of self-help and the “nature-method” is lacking. Core of the method is speech mentorship: people who have been helped by the “nature-method” train others. Building blocks are: 1. a different way of speaking (slower; shorter speech segments; breaks; flowing emphasis); 2. breathing technique; 3. mental training. Also central is the direct inclusion in self-help groups. Aims: This study aimed to examine the extent to which an improvement in fluency and a reduction in psycho-emotional stress can be achieved with help of the “nature method”. Methods: Seventeen participants trained the “nature-method” for 2 years, 17 participants in the control group did not. Before and after, videos were made in three speaking situations (reading aloud, conversation, lecture) and the stuttering-related quality of life was recorded using the Overall assessment of the speakers‘ experience with stuttering. Stuttering severity was assessed using the Stuttering severity instrument (SSI-4). Speech naturalness was rated on a 9-point scale. Results: While there was no significant difference in stuttering severity between the intervention and control groups pre-intervention, a significant reduction was achieved with the “nature-method”. Compared to the control group, the intervention group achieved a significantly lower percentage of stuttered syllables (P < 0.001), shorter stuttering events (P < 0.001) and less accompanying motor behavior (P < 0.001) after 2 years, and the naturalness of speech also improved. Socio-emotional complaints also decreased more in the intervention group than in the control group. Conclusion: Training methods in the context of self-help and the establishment of speech mentors can have positive effects on speaking skills and quality of life for adults who stutter. The “natural method” could therefore enrich the intervention repertoire for them.

Verification of the causes of speech development disorders in children

B. Maciejewska, A. Pilarska, B. Wolnowska, M. Nowak, M. Karlik
doi: 10.48095/ccorl2025S1_24

Department and Clinic of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznan, Poland

Introduction: Diagnosis of speech disorders in children requires a complex diagnostic procedure and some specialistic team. It is necessary to identify the causes of delayed language acquisition in the context of assessment auditory functioning, the child‘s development in the motor sphere, cognitive, emotional and social and observe the dynamics of the following changes Aim: To study the causes of speech-language delay among children aged 3–6 years. Material and Methods: 73 children with delayed speech development aged between 3 and 6 years were included in the study. The parents of these children were asked to complete a questionnaire. The child’s morbidity history and risk factors for speech delay were recorded. The speech level was assessed by a speech therapist. Objective audiological tests were performed to assess hearing levels. Dick‘s intellectual potential was also assessed in a psychological examination. Results: Children were referred with suspected: hearing loss (45%), autism (30%), auditory processing disorder APD (16%), dyslogia (5.5%). Verification of the primary diagnosis has resulted in a change of diagnosis and additional diagnoses: alalia prolongata, multilingual family environment, virtual autism. Conclusions: 1. Mental retardation is underestimated among children with delayed speech development; 2. Speech disorders caused by inadequate stimulation – virtual autism/multilingual environment – is an increasingly common diagnosis, which should be taken into account in the differential diagnosis; 3. Hearing impairment is still an important cause of speech disorders.

Intensive speech therapy for pediatric dysphonia: a collaborative approach for effective voice rehabilitation

A. Bianchino1, A. L. Malena2, L. Cufari2, L. Fiorani3, C. Miglianti4, M. Setola5  
doi: 10.48095/ccorl2025S1_25

1 Voice Therapy, Voice Evolution Institute, Ferrara, Italy

2 Voice Therapy, Voice Evolution Institute, Ortona, Italy

3 Voice, Voice Evolution Institute, Roma, Italy

4 Voice, Voice Evolution Institute, Poggibonsi, Italy

5 Voice, Voice Evolution Institute, Napoli, Italy

Vocal nodules are a leading cause of pediatric dysphonia. Dysphonia prevalence in school-age children ranges from 6 to 23%. A significant challenge in pediatric dysphonia therapy is identifying effective treatment, ensuring parental engagement, patient compliance, and skill generalization. We propose a novel, intensive approach for the pre-voice mutation stage. The model includes assessment, therapy with a physiological framework, individualized protocols, and a focus on learning transfer. It begins with an assessment session involving both the child and parents, followed by a 5-day group therapy program (8 hours per day) and 2–3 follow-up sessions spaced 1–2 weeks apart. Therapy exercises are practiced in the child’s natural environment to reduce the discrepancy between therapeutic and everyday contexts. Biomechanical exercises are introduced in a playful manner with active therapist involvement. The experiential methodology includes laughter exercises to break down communication barriers and vocal strain-reducing exercises targeting subglottic pressure, fold-fold impact stress, laryngeal constriction, and resonance optimization. Participants reflect on their individual experiences during exercises. This intensive model enhances parental involvement by reducing appointments, facilitating independent practice, and lightening the daily burden, allowing parents to focus on emotional support and recovery. The approach induces biomechanical improvements and fosters skill generalization, making therapy enjoyable in a positive, collaborative environment. All stages of the therapeutic model are explored during the workshop.

A pilot study of using the Complete vocal technique-voice therapy (CVT-VT), a pedagogic method to improve voice and vocal function in singers and actors, in the treatment of patients with primary muscle tension dysphonia (pMTD)

J. McGlashan1, M. Aaen2, A. White3, B. Saccante-Kennedy4, M. Tempesta5, C. Sadolin2
doi: 10.48095/ccorl2025S1_26

1 ENT, Nottingham University Hospitals, Nottingham, UK

2 Complete Vocal Institute, Copenhagen, Denmark

3 ENT Speech Therapy Department, Nottingham University Hospitals, Nottingham, UK

4 University College Hospitals NHS Foundation Trust, London, UK

5 University of North Texas College of Music, Denton, USA

Introduction and Aims: This study was designed to assess the feasibility and acceptability of using the Complete vocal technique, a pedagogic method to improve voice and vocal function in singers and actors, as a form of voice therapy (CVT-VT) in patients with primary Muscle tension dysphonia (pMTD type I–III). Methods: Patients were recruited from a Teaching hospital voice clinic during the 6-month trial period into this single-arm, prospective cohort designed study. Eligible patients were given up to 6 CVT-VT sessions delivered by a non-clinical CVT practitioner (CVT-P) using a video link. The first aim was to assess the feasibility of recruiting to an a priori target of 10 patients. The second aim was to measure preand post-therapy changes in the voice and voice function using a multidimensional assessment (self-evaluated Voice handicap index), patient goals for treatment, throat symptoms (VTDS – Vocal tract discomfort scale), Maximum phonation time (MPT), a range of acoustic and electroglottographic measures and blinded auditory-perceptual evaluation of the voice. The third aim was to assess the acceptability of the CVT-VT to the patients and the CVT-P using feedback questionnaires. Results: Fourteen patients consented to take part with 11 completing the study protocol exceeding the target. All measures, except the MPT, improved demonstrating better control, loudness, coherence, and clarity of the voice with reduced instability, variability, and perceived limitations and discomfort. 49.3% of 138 symptom goals resolved or were much improved. All patients and the CVT-P rated the therapy very satisfactory or satisfactory. Conclusions: It is feasible to recruit patients for CVT-VT and is an acceptable method to patients and the CVT-P. CVT-VT improves the voice and vocal function using a multidimensional range of measures and warrants further evaluation as a tool for voice therapy in patients with pMTD.

Optimizing arytenoid movement in vocal production: an exercise protocol

A. Bianchino1, C. Miglianti2, L. Fiorani3, A. L. Malena4, L. Cufari4, M. Setola5 
doi: 10.48095/ccorl2025S1_27

1 Otorhinolaryngology, Audiology and Phoniatrics, University of Ferrara, Ferrara, Italy

2 Voice, Voice Evolution Institute, Poggibonsi, Italy

3 Voice, Voice Evolution Institute, Roma, Italy

4 Voice Therapy, Voice Evolution Institute, Ortona, Italy

5 Voice, Voice Evolution Institute, Napoli, Italy

The cricoarytenoid joint plays a crucial role in vocal quality and endurance. However, it is often overlooked in vocal training and rehabilitation. Recent endoscopic observations have shown that even minor dysfunctions in arytenoid mobility can significantly impact the voice, particularly in high-performance contexts. This study proposes an innovative exercise protocol aimed at enhancing arytenoid movement, reducing functional asymmetries, and optimizing muscular coordination to improve vocal quality and prevent vocal fatigue. The protocol consists of five main phases with many exercises: 1. Relief breath and closure: An exercise designed to stimulate maximum arytenoid excursion, improving their joint mobility. 2. Fast opening and closing with /i/: Exercises focusing on optimizing neuromuscular coordination and improving symmetry in arytenoid movement. 3. Progressive twang: Gradual introduction of twang to improve arytenoid control and glottic closure. 4. Voluntary closure with force and maximum opening: Stimulating maximum joint excursion to enhance arytenoid mobility and prevent tension imbalances. 5. Low-

-resistance growl (/uà/): An exercise to train the amplitude of arytenoid movement, reducing rigidity and improving fluidity in glottic opening and closing. Application of this protocol to singers and vocal professionals has led to significant improvements in glottic closure management, reduction of asymmetries, and smoother arytenoid movement. Endoscopic observations revealed improved arytenoid symmetry and reduced muscular compensation. The exercises also proved effective in combating vocal fatigue, improving both the duration and efficiency of vocal performance. Additionally, this protocol can be beneficial for healthy voices to reduce fatigue and increase vocal endurance. It is also particularly valuable for patients with complex conditions such as rheumatoid arthritis, which affects the cricoarytenoid joint, offering an approach to improve joint mobility and alleviate associated vocal issues. This protocol provides an innovative solution for optimizing arytenoid control and preventing vocal fatigue, with positive implications for both healthy and compromised voices, as well as for clinical rehabilitation.

Effectiveness of therapy for developmental language disorders in different settings – a randomized controlled trial

S. Shahpasand1, D. Siemons-Lühring1, S. Alfakiani1, S. Koschmieder1, P. Mathmann1, C. Gietmann1, L. Meyer1, M. Scharpenberg2, K. Neumann1 
  doi: 10.48095/ccorl2025S1_28

1 Department of Phoniatrics and Pediatric Audiology, University Hospital Münster, Münster, Germany

2 Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany

Introduction: Research on the therapy of developmental language disorders (DLD) is increasingly focusing on their settings, dose, frequency, intensity and qualitative therapy components. Aim: In a randomized controlled trial (RCT) we investigated the effectiveness of DLD therapy in the settings a) extensive vs. intensive; b) individual vs. small group; c) face-to-face vs. tele-; d) outpatient vs. inpatient therapy compared to the usual extensive face-to-face individual therapy once a week (standard therapy). Material and Methods: After randomized allocation to 4 groups of 51 children each (standard therapy, extensive individual teletherapy, intensive inpatient therapy, intensive outpatient group therapy), 204 children (3.0–6.11 years; mos.) with at least moderate DLD received 20 sessions of language treatment. A waiting-contrast design was created by an intragroup second randomization. Speech test scores (vocabulary, grammar, speech perception, phonological working memory) and the percentage of correctly formed consonants were recorded at the start of the study (T0), 12 weeks later (T1), and one year after the start of therapy (T2). Results: The overall score of all language tests showed long-term (T2) progress for all settings; in the short term (T1), natural language progress exceeded the effect of standard therapy. The greatest progress in all language domains except for language comprehension was achieved by teletherapy, whose overall effectiveness significantly exceeded that of standard therapy. Outpatient group therapy, which performed best in language comprehension, fell just short of significance. Standard therapy had the best effect on speech sound production and phonological working memory and the least effect on vocabulary. Inpatient speech therapy for children with persistent DLD was also effective in the long term in all domains except grammar. Conclusion: Teletherapy and group intensive outpatient therapies, which have not been standard practice to date in Germany, should be given greater consideration in speech-language therapy practice and indications for inpatient therapies should be provided generously.

Vocal tract discomfort awareness among otolaryngologists and speech and language therapists

N. Snovak1, R. Shah2, C. Kenny1
doi: 10.48095/ccorl2025S1_29

1 Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland

2 ENT Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK

Introduction: Vocal tract discomfort (VTD) refers to sensations of discomfort, pain, or irritation in the throat, anterior neck, or vocal cords, often arising from vocal use. Aims: This study investigates the awareness and management practices of VTD among otolaryngologists and speech and language therapists (SLTs), aiming to guide future research on its assessment and management. Methods: An online survey was distributed to UK and Irish otolaryngologists and SLTs of all training levels, using relevant associations and social media for outreach. Participants were asked about their familiarity with the Vocal tract discomfort scale (VTDS), evaluation methods, and management recommendations. Results: Sixty-six participants (41 SLTs, 25 otolaryngologists) responded. 70% of otolaryngologists were unfamiliar with the VTDS, compared to 75% of SLTs who were familiar. Regarding evaluations, 95% of otolaryngologists used flexible transnasal endoscopy, and 70% referred patients to SLTs. Controversially, 72% SLTs would refer patients to otolaryngologist. Voice hygiene was the primary treatment recommendation for both groups (SLTs 95%, otolaryngologists 70%). Conclusions: VTD remains poorly understood, with uncertainty around its management. The low awareness among otolaryngologists suggests further research is needed to better define and treat VTD.