J. Behuv. Thu. d Exxp. Psychiot. Vol. 4, pp. 117-119. Pergamon I’rcs. 1973. Printed in Great Britain

MINIATURIZED METRONOMES IN THE TREATMENT OF STU’ITERING: A SURVEY OF CLINICIANS’ EXPERIENCE*

PERRY A. BERMAN

Philadelphia, Pennsylvania

and

JOHN PAUL BRADYt

Hospital of the University of Pennsylvania and Pastern Pennsylvania Psychiatric Institute, Philadelphia

Summary-Questionnaires were returned by 28 clinicians who had used a miniaturized, elec- tronic metronome in the treatment of one or more stutterers. Of 144 patients, the speech of 103 (72 per cent) had improved. Fifty-seven per cent of the respondents regarded the develop- ment of metronome-conditioned speech as a major advance in the treatment of stuttering. Those who gave evidence of using the metronome in a systematic program based on principles of learning tended to get better results than those who did not.

IN RECENT years a number of promising pro-

cedures have been described for the treatment of stuttering, based on principles of learning (Gray and England, 1969). Among these is the use of miniaturized, electronic metronomes, originally described by Meyer and Mair (1963) and elaborated by Brady (1971) in a procedure called Metronome Conditioned Speech Retrain- ing. A number of other clinicians have reported good results with devices of this kind, especially when used in conjunction with other behavior therapy procedures (Horan, 1968; Rothman, 1969; Wohl, 1968). However, the level of success obtained cannot be elicited from these accounts. This paper reports a survey of the results of clinicians who employed one commercially available miniaturized metronome on the basis of the report by Brady (1971) of its systematic use in the treatment of severe stuttering in adults.

THE SURVEY

In March, 1972, a questionnaire was mailed to each of 78 professional people who had or- dered one or more Pacemasters.$ Of 52 who responded, 21 stated that they had not yet used the instrument in the treatment of stuttering. Three respondents revealed that they had used the Pacemaster only to treat their own dys- fluency problems. The results given below relate the remaining 28 respondents, who re- ported treating a total of 148 patients.

Seventeen respondents were speech patholo- gists who had treated a total of 65 stutterers. Four psychologists and six psychiatrists reported on a total of 79 patients. The remaining clinician indentified himself as an audiologist, who had treated four stutterers with a Pacemaster. Thus, in this survey, the speech pathologists had treated an average of 3.8 patients each, and the psychologists/psychiatrists 7.9. Most of the

*This research was supported in part by a USPHS Research Scientist Award (K3-MH-22,682) from the National Institute of Mental Health. tRequests for reprints should be addressed to John Paul Brady, Hospital of the University of Pennsylvania, Philadelphia, Pa. 19104. fThis is a miniaturized, electronic metronome produced by Associated Auditory Instruments, 6796 Market Street, Upper Darby, Pennsylvania.

117

118 PERRY A. BERMAN and JOHN PAUL BRADY

patients were adolescents or young adults slightly higher percentage improvement but this (median age 23 yr), and there were about is not statistically significant at the 0.05 level four times as many males as females (120: 28). (x2 test).

RESULTS

Three sets of questions were applied to assess- ing the clinicians’ experience in treating stutter- ing with the Pacemaster. The first set concerned treatment results; the second, the clinicians’ judgment as to the usefulness of the procedure; and the third set related to the manner in which the clinicians had used the device.

The questionnaire asked the number of patients treated with a Pacemaster who (a) no longer used the device (had been weaned away), (b) used the Pacemaster only in difficult speaking situations or for reinforcement, (c) constantly used the device, (d) had dropped out of treatment (presumably unimproved) and (e) had returned to stuttering. Those patients who were in cate- gories (a) or (b) were regarded as generally successful (improved), whereas those in cate- gories (c), (d) or (e) were counted as treatment failures. Table 1 shows these data. The figures reported by the speech pathologists and the audiologist are placed in one column and those by the psychologists and psychiatrists in another, to examine for any ,differences between pro- fessional groups. The overall clinical results by these criteria are good-103 of 144 patients were judged to be improved (72 per cent). The speech pathologists-audiologist group reported a

Respondents were also asked for their opinion on the “overall usefulness of metronome-con- ditioned speech for the treatment of stuttering”. The three options given in this forced-choice question and the percentage of respondents who selected each were as follows: (a) “Not useful or detrimental” (7 per cent) ; (b) “Clearly of value, but only as an adjunct to more traditional methods” (36 per cent), and (c) “Major advance in treatment and at least equal to other tech- niques (57 per cent).

The third set of questions concerned the man- ner in which the clinicians used the Pacemaster. According to Brady (1971) good clinical results are obtained with a metronome if the device is used in a systematic manner based on principles of conditioning. The essential features of this program include having the stutterer (1) slowly increase the rate of pacing, (2) construct a hier- archy of increasingly difficult speaking situations and (3) avoid suing the pacer in difficult situa- tions until fluency is obtained in less difficult ones. Accordingly, respondents were asked whether they had had their patients follow such a regimen, and were regarded as using a con- ditioning program only if they had observed all three conditions. Of particular interest was the relationship between using the Pacemaster in this systematic manner and the answers to the previous two sets of questions (requesting

TABLE 1. PATIENTS REPORTED IN SAMPLE CLASSIFIED ACCORDING TO

TREATMENT OCTCOME AND PROFESSION OF THERAPIST

Treatment

Psychologists and Speech,pathologists psychiatrists and audiologist Totals

success (a or b)

T&me& Failure Cc, d, or e)

Totals

53 50 103

26 15 41 79 65 144*

*Note: The results of treatment with four patients were not reported so that this total is four less than the total sample.

MINIATURIZED METRONOMES IN THE TREATMENT OF STUTTERING 119

TABLE 2. RESPONDENTS CLASSIFIED ACCORDING TO WHETHER OR NOT THEY REPORTED A GREATER THAN 50 PER CENT SUCCESS RATE AND WHETHER THEY

USED A CONDITIONINa PROGRAM

Percentage of treatment

successes (a or b)

More than 50% 50%orless

Totals

Used conditioning

program

14 4

18

Did not use conditioning

program

5 5

10

Totals

19 9

28

rate of success and opinion on the clinical useful- ness of the miniaturized metronome). Table 2 shows the relationship between clinicians’ success rate (percent of patients regarded as improved as defined above) and the use of a systematic conditioning program. Note that though there appears to be such a relationship the trend in this small sample is not significant at the O-05 level (Fisher’s Test of Exact Probn- bility).

chased one or more Pacemasters were sent a questionnaire so that the sample is highly selec- tive. Secondly, only 28 of 49 returned the ques- tionnaire (57 per cent) which introduces another kind of bias. Given these limitations, the clini- cians who did respond gave generally favorable results.

TABLE~.CLINICIANSCLASSIFIEDACCORDINGTOTHEIROPINIONOFTHEOVERALL USEFULNESS OF METRONOME-CONDITIONED SPEECH AND WHETHER OR NOT THEY USED A CONDITIONING PROGRAM. SINCE FEW RESPONDENTS ANSWERED “A” (NOT USEFUL OR DETRIMENTAL)THEsE ARE COMBINED WITH THOSE WHO

ANSWERED “B"

Opinion as Used Did not use to usefulness conditioning conditioning of technique program program

(A) or (B) 4 8 (C) 14 2

Totals 18 10

Totals

12 16 28

Table 3 shows the relationship between clini- REFERENCES

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GRAY B. B. and ENGLAND G. (1969) Stutterina and the

and their use of a systematic conditioning pro- Conditioning Therapies, The -Monterey Ins&e for

gram. It is perhaps not surprising that such a Speech and Hearing, Monterey, California.

relationship does exist (by Fisher’s Test of Exact HORAN M. C. (1968) An improved device for inducing

rhythmic speech in stutterers, Amt. Psychologist 3,

Probability p=O*OO47). One might expect that 19-25.

clinicians who are sanguine about a treatment MEYER V.and MAIRJ.M. M.(1963) A newtechniqueto

technique tend to use it in a systematic manner control stammering: a preliminary report, Behav. Res. & Therapy 1, 251-254.

and vice versa. ROTHMAN-i. (1969) Stuttering: theory and treatment,

Two major limitations of this survey need to Exp. Med. Surg. 27, 336-349.

be pointed out. First, only clinicians who pur- WOHL M. T. (1968) The electronic metronome-an

evaluative study, Brit. J. Speech Hear. Res. 12,677-686

(Received 9 January 1973)