# Speech-Language Pathology/Stuttering/Fluency-Shaping Therapy/Fluency-Shaping Techniques

Fluency shaping therapy programs typically begin with slow speech with stretched vowels, then work on relaxed, diaphragmatic breathing, then work on vocal fold awareness and control, and finally work on relaxed articulation (lips, jaw, and tongue).
These techniques are all abnormal. They all produce "weird"-sounding speech. The idea is to go to extremes when practicing (in the speech clinic or at home), and then in "real world" conversations you reduce the techniques so that you sound normal, and speak fluently.

## Slow Speech with Stretched Vowels

Slow speech enables you to learn the other fluency skills. The goal is not to use slow speech in every conversation for the rest of your life. Like a novice golfer, you learn the correct forms and muscle movements slowly at first. Then, as you master these muscle movements gradually increase your speed. See the section Slow Speech Is Not the Goal of Stuttering Therapy.
Let's start with how not to do slow speech with stretched vowels:
   "I" <long pause> "am" <long pause> "an" <long pause> "American."
Saying "I am an American" normally takes about 1.5 seconds (seven syllables at about five syllables per second). By silently pausing two seconds between words, and saying each word normally, the phrase would take about eight seconds. That would not improve your fluency.
Instead, stretch each vowel for a second or two. Also stretch voiced consonants (e.g., /m/, /n/, /r/) a little longer then normal, but not as long as vowels. Articulate voiceless consonants (e.g., /k/) lightly and quickly, just touching your lips or tongue and then moving to the next voiced sound.
Join the syllables together, with no breaks or pauses between words. The result should sound like (where each letter is one-fifth of a second):
   "IIIIIIIIIIaaaaaaammmaaaaaaannnAAAAAAAmmmeeeeeeerrriiiiiiiiiikaaaaaaannn."
Be sure that each syllable is held equally. In other words, "American" should take four times longer to say than "I." Don't make "American" the same length as "I."
Should you hold each syllable for one second or for two seconds? Some speech clinics start with one-second stretched syllables, when other speech clinics start with two seconds per syllable. No research has investigated which is more effective. If you are 100% fluent at one second per syllable, then that is slow enough. But if you're not 100% fluent at one second per syllable, use two seconds per syllable. According to motor learning theory, you need to move slow enough that your form is perfect, but there's no reason to move slower.
Use a stopwatch to check that each syllable is the same length.
If you have a DAF device, set the delay to 200 milliseconds. Then hold each syllable until you hear yourself in the headphones. Check your stopwatch and you should see that each syllable is between one and two seconds.

## Relaxed Breathing

Place one hand on your stomach. Breathe so that your hand moves out when you inhale, and in when you exhale.
Notice that you're taking many small breaths. Your inhalation and exhalation are equal in time duration.
This is called relaxed or diaphragmatic breathing. Many people breathe this way.
Now switch to upper-chest breathing or thoracic breathing. Take a big breath, using your upper chest muscles to expand your lungs. Release the air slowly, while maintaining this upper chest muscle tension to hold air in your lungs as long as possible. When you've released the air, quickly take another breath, filling your lungs as rapidly as possible.
Practice switching between thoracic and diaphragmatic breathing.
Thoracic breathing increases our lung capacity. It enables us to maximize our physical exertion. Our "fight or flight" instinct switches us to thoracic breathing. We're then better able to run or fight.
Some individuals hyperventilate or switch to thoracic breathing when experiencing non-physical stress. Stress reduction classes help students learn to relax by consciously switching to diaphragmatic breathing.
Thoracic vs. Diaphragmatic Breathing
We also use thoracic breathing when talking. A large breath with a long, slow exhale enable us to speak many words before pausing for another breath.
Well-meaning people who know nothing about stuttering may tell you to "take a deep breath" before talking. But the opposite is better advice. Diaphragmatic breathing is the foundation of many stuttering therapy programs. Taking smaller breaths with your diaphragm can help you relax and may help you speak more fluently.
Try it. Using relaxed breathing will relax your entire body. Most importantly, it will relax your vocal folds, and then your lips, jaw, and tongue. Your voice will deepen and sound confident - maybe even "sexy." You'll feel relaxed and confident.
Practice a word list using diaphragmatic breathing. Read a magazine page aloud using diaphragmatic breathing.
You'll soon discover a few problems trying to speak with diaphragmatic breathing. Each breath is small, so you're able to say only a few words on each breath. Inhalation and exhalation time lengths are equal, so you will speak in shorter phrases that are produced between longer pauses. You're less able to speak loudly.
As with other fluency-enhancing speech motor techniques, speaking with diaphragmatic breathing is somewhat abnormal, but can also be useful. Include speaking with diaphragmatic breathing in your stuttering therapy practice exercises. Mastering this skill has helped many speak short phrases fluently during stressful situations (e.g., when a police officer pulls you over for speeding!) You may not need to say much besides, "Yes, officer," and "No, officer."
And as you master speaking with diaphragmatic breathing, you'll develop something in between thoracic and diaphragmatic breathing. This "in between" breathing will be more relaxed than thoracic breathing, yet your phrase length and vocal volume will be within the normal range.

## Phonation

Your vocal folds are flaps of muscle in your throat. Making your vocal folds vibrate produces sound. This sound then becomes your voice. Vocal fold vibration is called phonation.
Two conditions produce phonation. First, you release air from your lungs. Next, you tension or tighten your vocal folds.
Place your fingers on your throat. Exhale and hum. Your fingers should feel a vibration. This is your vocal folds vibrating.
Stop humming, and feel the vibration stop. Practice switching your phonation on and off.
Now vary your phonation in two ways. Change your volume by humming louder, then quieter. Change your pitch by humming up and down a musical scale.
How did you do that? You varied your volume of exhalation, i.e., you increased or decreased the air releasing from your lungs by tensing or relaxing your thoracic (upper chest) muscles. More exhalation enabled you to produce more volume.
You also varied your vocal fold tension. Tense vocal folds produce a higher-pitched voice. Relaxed vocal folds produce a deeper or lower-pitched voice.
Tense your vocal folds as hard as you can. You'll completely block your throat, not allowing any air to escape. If you take a deep breath and then block your throat, your increased lung pressure makes your chest stronger. Like inflating a tire to carry a heavier load, this is effective for lifting a heavy weight. But it's not a good way to talk!
Practice one more aspect of phonation. Take a breath and hold it, tense your vocal folds, then release air. Switch to the other way: take a breath, release a little air, then tense your vocal folds. Note that the former produced a croak. The latter produced a nice hum. This shows that phonation requires timing two muscle movements: exhaling a little air, and then starting to tense your vocal folds.
You now see that three things can go wrong with phonation:
* Releasing too much or too little air (inadequate breath support).
* Overtensing your vocal folds. Under stress, you may try too hard to talk, tense your vocal folds too much, and block off air flow. This results in a silent block.
* Mistiming exhalation and vocal fold tension. A goal of stuttering therapy is train the stutterer to consciously take a breath, release a little air, gently tense his vocal folds, and then begin to talk. This exercise is called gentle onset or easy onset.

### Gentle Onsets with Vowels

To hit a baseball home run, you use all of your arm muscle strength. In contrast, to putt a golf ball a few feet, your arm muscles are more relaxed than tense. Phonation is like putting a golf ball, not like hitting a home run.
To use gentle onsets (also called easy onsets), take a relaxed breath with your diaphragm. Release a little air. Make an ah sound as you gradually increase your vocal fold tension. Feel your vocal folds begin to vibrate. Increase your vocal fold tension, until you reach normal speaking volume. Gradually reduce vocal fold tension, until you reach silence. Time this to take about two seconds. You should be able to do this on one breath, without reaching residual air.
If you were to see your vocal volume charted, it would look like this:
You can use a computer application that displays your phonation contour on the screen.
Practice fifteen gentle onsets with the fifteen vowel sounds (say the vowel, not the word):
Front Vowels:
* long e, as in beet
* short i, as in bit
* long a, as in bait
* short e, as in bet
* short a, as in at
Back Vowels:
* long u, as in boot
* short o, as in book
* long o, as in boat
* aw, as in cause
* ah, as in cot
Central Vowels:
* ow, as in about
* short u, as in but
Dipthongs:
* long i, as in bite
* oy, as in boy
* au, as in bough

### Gentle Onsets with Words

Gentle Onset with Words
Now say "dog," stretched over two seconds, with gentle onset. Begin with a quiet, gentle /d/ sound. Switch to the /aw/ vowel sound and gradually increase vocal volume. After one second, gradually reduce vocal volume. Switch to the /g/ sound, and stop vocal fold vibration.

### Voice and Voiceless Consonants

All vowels use phonation. Some consonants use phonation, i.e., are voiced. Other consonants are produced without phonation, i.e., are voiceless. You can whisper these consonants.
Place your fingers on your throat. Say ah to feel your vocal folds vibrating. Say the following words and decide whether the initial consonant is voice or voiceless:
| /h/ | hail | /w/ | whale |
| /f/ | famous | /v/ | vacant |
| /s/ | saber | /z/ | zany |
| /sh/ | chenille | /zh/ | jeté |
| /ch/ | chive | /j/ | jive |
| /thr/ | throw | /th/ | those |
| /p/ | pipeline | /b/ | bison |
| /t/ | tie-dye | /d/ | diner |
| /k/ | kindness | /g/ | guide |
The first column was voiceless. The second column was voiced.
Did you notice that these sounds were pairs? /h/ and /w/ have your lips, jaw, and tongue in the same positions. The difference is that your vocal folds vibrate to produce /w/, but don't vibrate to produce /h/.
To say a word with voiceless consonant, take a breath, let out a little air, shape the consonant with your lips, jaw, and tongue, then switch to the vowel and gently start your vocal fold vibration.
Practice a word list. Keep your fingers on your throat to feel your vocal folds switching on and off as you go from voiced to voiceless sounds. Stretch each word to two seconds.
Because most words contain both voiced and voiceless sounds, we switch our vocal folds on and off many times each second while talking. A core behavior of stuttering is an inability to switch phonation on at the right moments. The timing can be as precise as one one-hundredth (1/100) of a second.
Normal speech is about five syllables per second, or 0.2 seconds per syllable. For this practice you're using two seconds per syllable stretched speech, or ten times slower than a normal speaking rate. Slowing down your speech helps you develop awareness and control of speech elements that are otherwise too fast to notice or control. If you play a sport, such as tennis or golf, your coach might videotape your swing and then replay it back in slow motion. This improves your awareness and control of the motor skill.

#### Continuous Phonation

Stuttering therapy sometimes teaches techniques that produce fluency, but sound abnormal. E.g., speech with diaphragmatic breathing produces fluency, but shortens phrase length and makes you pause between phrases. The immediate goal is to use these techniques to produce fluent speech, and over time reduce the degree of exaggeration, until your speech sounds normal. Another goal is have a "trick" to use in stressful situations, such as speaking to a police officer.
Continuous phonation is such a technique or trick. Recall that consonants come in voiced/voiceless pairs. Simple substitute a voiced consonant whenever you need to say a voiceless consonant.
E.g., "Patty" becomes "Baddy." Say each word slowly, with your fingers on your throat to feel your phonation. You'll feel your vocal folds switch on and off for "Patty," but stay on for "Baddy."
If you shorten the consonants and stretch your vowels (producing a slower speaking rate), listeners won't hear the difference between "Patty" and "Baddy."

### Gentle Onsets with Multisyllabic Words

Practice using a gentle onset on each syllable. Go loud on each vowel. On the consonants, relax, go quiet, and lightly and quickly articulate the sounds. E.g., on "American," you start with a gentle onset on the initial /uh/. Open your mouth wide at the loudest point in the phonation contour.
Take the /uh/ sound down in volume, while at the same time closing your mouth to articulate the voiced /m/. Bring the /eh/ sound up in volume. Again, open your mouth wide at the loudest point in the phonation contour.
Take the /eh/ sound down in volume, while at the same time reduce your jaw opening (but don’t close your lips) to articulate the voiced /r/.
Open your mouth wide again for the /ih/ vowel on the third syllable.
Now you get to the only voiceless sound in "American." Before the /k/ sound, take the down the volume of the /ih/ vowel. Whisper the /k/. If you block, you dropped the /ih/ volume too fast. Try again with a long, slow decline in volume on the /ih/. Articulate the /k/ lightly, for just a moment.
If you still block on the /k/, change it to a voiced /g/. In other words, say "Amerigan."
Use another gentle onset on the final /eh/ vowel. Reduce your volume on the final voiced /n/ consonant.
The result is an abnormal-sounding "sing-song" speech pattern. Your jaw opens and closes noticeably on each syllable. While you won’t want to talk like this for the rest of your life, for practice or in stressful situations this technique helps you use gentle onsets, continuous phonation, and a slower speaking rate.

## Reduced Articulatory Pressure

The third set of speech muscles (after respiration and phonation) are your articulators: lips, jaw, and tongue. These muscles form your vocal fold humming into sounds and words. If you phonate without moving your lips, jaw, and tongue, all that comes out of your mouth is humming. The goal of this last target is to relax these muscles.
Reduced articulatory pressure is also called "soft targets."
Lightly touch your tongue for the /t/. Lightly close your lips for the /b/. Keep your speech production muscles relaxed for all sounds.
The wrong way is to tense your lips and tongue and jaw too much, and hold this tension too long.
You've learned to stretch and emphasize vowels. Now work on de-emphasizing consonants. If you stretch and emphasize vowels, and de-emphasize consonants, you should be able to speak fluently.
Read another word list aloud. Feel how your lips, jaw, and tongue move to change sounds. Say each word with normal articulation tension. Then say the word again with tense articulation. Then say the word again with relaxed articulation.
This section is short because most stutterers can easily do the reduced articulation target with little or no training. There's no need to include pages and pages of diagrams showing the correct positions of the lips, jaw, and tongue for each of the 40+ sounds of English. Most stutterers know the correct positions to produce sounds, we just have to do it with less force.
However, if you speak with a foreign accent, or if you have an articulation disorder (e.g., lisping), you may want to do articulation therapy along with stuttering therapy. Articulation therapy will train you to place your lips, jaw, and tongue in the correct positions.