Euler, H. A., Merkel, A., Hente, K., Neef, N., Wolff von Gudenberg, A., & Neumann, K. (in press). Speech restructuring group treatment for 6- to 9-year-old children who stutter: a therapeutic trial. Journal of Communication Disorders.

Abstract: For children who stutter (CWS), there is good evidence of the benefits of treatment for pre-school age, but an evidence gap for elementary school age. Here we report on the effectiveness of a fluency shaping treatment for 6- to 9-year old children. The main treatment component is the reinforcement of soft voice onsets. An intensive in-patient group treatment phase lasts 6 days, followed by a 6-month maintenance phase with 3 in-patient weekend group refresher courses. Child and a parent participate together in various treatment activities. In this controlled intervention study (waitlist control, intention-to-treat design) assessments were performed before treatment (T1), 4 weeks after the intensive phase (T2), at the end of the maintenance phase (T3), and 1 year later (T4). Participants were 119 children (108 boys, 11 girls, age 5.5 10.4 years). Control conditions included a subgroup with delayed treatment (N=25) as well as the assessment of complexity of utterances, inter-rater reliability, and speech naturalness. From before treatment to 1-year follow-up, percent stuttered syllables and OASES-S (Overall Assessment of the Speaker’s Experience with Stuttering - School-age) scores decreased with large effect size. Speech naturalness improved during this period but did not reach the level of non-stuttering children. Complexity of utterances increased during the intensive phase, but only temporarily. 20 Twenty children (16.8%, including dropouts) showed no demonstrable treatment benefit. Fluency shaping treatment can be effectively applied to young school children. It is assumed that parental support, group therapy, intensive treatment, and regular exercises at home are essential.

Neumann, K., Euler, H. A., Zens, R., Piskernik, B., Packman, A., St. Louis, K., Kell, C., Amir, O., Blomgren, M., Aumont-Boucand, V., Eggers, K., Fibiger, S., Fourches, A., Franken, M.-C., & Finn, P. (2019). "Spontaneous" late recovery from stuttering: Dimensions of reported techniques and causal attributions. Journal of Communication Disorders, Article Number 105915.

Abstract: Purpose: (1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components. Methods: 124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions. Results: A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained). Discussion: Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions. Conclusion: The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies.

Zaretsky, E., Lange, B. P., Euler, H. A., Robinson, F., & Neumann, K. (2017). Pre-schoolers who stutter score lower in verbal skills than their non-stuttering peers. The Buckingham Journal of Language and Linguistics, 10, 96-115.

Abstract: Purpose: The study aimed at the examination of a link between stuttering and verbal skills (speech comprehension, articulation, grammar, vocabulary, and phonological short-term memory) in three- to five-year-old children. Method: Two samples with a total of 7,217 unselected German children were tested with the validated speech and language test Marburger Sprachscreening – revised version (MSSrev). Linguistic domains were compared for pre-school children who stuttered (CWS; n=110) and those who did not (CWNS; n=7,107) by means of Mann-Whitney U tests, general linear models, Spearman correlations, and cross-tables. Results: In both samples, CWS scored lower in grammar, articulation, and overall performance on the MSSrev. Statistically significant associations between stuttering and (a) sex of the child, and (b) language disorders in the family were identified. Conclusions: Taking into account the effect sizes, there appears to be a weak, but statistically significant link between stuttering and verbal skills.

Neumann, K., Euler, H. A., Kob, M., Wolff von Gudenberg, A., Giraud, A.-L., & Kell, C. A. (2018). Assisted and unassisted recession of functional anomalies associated with dysprosody in adults who stutter. Journal of Fluency Disorders, 55, 120-134.

Abstract: Purpose: Speech in persons who stutter (PWS) is associated with disturbed prosody (speech melody and intonation), which may impact communication. The neural correlates of PWS’ altered prosody during speaking are not known, neither is how a speech-restructuring therapy affects prosody at both a behavioral and a cerebral level. Methods: In this fMRI study, we explored group differences in brain activation associated with the production of different kinds of prosody in 13 male adults who stutter (AWS) before, directly after, and at least 1 year after an effective intensive fluency-shaping treatment, in 13 typically fluent-speaking control participants (CP), and in 13 males who had spontaneously recovered from stuttering during adulthood (RAWS), while sentences were read aloud with 'neutral', instructed emotional (happy), and liguistically driven (questioning) prosody. These activations were related to speech production acoustics. Results: During pre-treatment prosody generation, the pars orbitalis of the left inferior frontal gyrus and the left anterior insula were activated less in AWS than in CP. The degree of hypo-activation correlated with acoustic measures of dysprosody. Paralleling the near-normalization of free speech melody following fluency-shaping therapy, AWS normalized the inferior frontal hypo-activation, sooner after treatment for generating emotional than linguistic prosody. Unassisted recovery was associated with an additional recruitment of cerebellar resources. Conclusions: Fluency shaping therapy may restructure prosody, which approaches that of typically fluent-speaking people. Such a process may benefit from additional training of instructed emotional and linguistic prosody by inducing plasticity in the inferior frontal region which has developed abnormally during childhood in PWS.

Neumann, K., Euler, H. A., Bosshardt, H.-G., Cook, S., Sandrieser, P. & Sommer, M. (2017). The pathogenesis, assessment and treatment of speech fluency disorders. Deutsches Arzteblatt International, 114, 383-390.

Abstract: Background: Approximately 1% of children and adolescents, 0.2% of women, and 0.8% of men suffer from stuttering, and lesser numbers from cluttering. Persistent speech fluency disorders often cause lifelong problems in communication and social participation. Methods: In an interdisciplinary, evidence and consensus based clinical practice guideline, the current understanding of the nature, identification, diagnosis, and treatment of stuttering and cluttering was summarized. A systematic review of the literature was carried out to assess the efficacy and effectiveness of treatments for stuttering. Evidence is lacking on the etiology, pathogenesis, evaluation, and treatment of cluttering. Results: In view of the fact that common (developmental, idiopathic) stuttering is associated with structural and functional changes of the brain, the guideline recommends that it should be called “originary neurogenic non-syndromic stuttering.” Heritability estimates for this disorder range from 70% to over 80%. For preschool children, the Lidcombe therapy has the best evidence of efficacy (Cohen’s d = 0.72–1.00). There is also strong evidence for an indirect treatment approach. For children aged 6 to 12, there is no solid evidence for the efficacy of any treatment. For adolescents and adults, there is good evidence with high effect sizes (Cohen’s d = 0.75–1.63) for speech restructuring methods such as fluency shaping; weak evidence with intermediate effect sizes for stuttering modification (Cohen’s d = 0.56–0.65); and weak evidence for combined speech restructuring and stuttering modification. The evidence does not support the efficacy of pharmacotherapy, rhythmic speaking, or breathing regulation as the sole or main form of treatment, or that of hypnosis or eclectic, unspecified stuttering therapies. Conclusion: Stuttering is often treated in Germany with therapies for which there is inadequate evidence, and the initiation of treatment is often unnecessarily delayed. The guideline presents treatment methods whose efficacy is supported by the current evidence.

Neumann, K., Euler, H. A., Bosshardt, H.-G., Cook, S., Sandrieser, P. & Sommer, M. (2017). Pathogenese, Diagnostik und Behandlung von Redeflussstörungen. Klinische Leitlinie. Deutsches Ärzteblatt, 114 (22-23), 383-390.

Zusammenfassung: Hintergrund: Etwa 1 % aller Kinder und Jugendlichen sowie 0,2 % der Frauen und 0,8 % der Männer leiden an Stottern, eine geringere Zahl an Poltern. Persistierende Redeflussstörungen stellen häufig ein lebenslanges Problem für die Kommunikation und die soziale Teilhabe dar. Methode: In einer interdisziplinären evidenz- und konsensbasierten S3-Leitlinie wurde das Wissen zu Wesen, Identifikation, Diagnostik und Behandlung von Stottern und Poltern zusammengetragen. Zur Wirksamkeit von Stottertherapien wurde ein systematischer Literaturreview durchgeführt. Für Poltern fehlen Evidenzen. Ergebnisse: Da das „gewöhnliche“ Stottern mit strukturellen und funktionellen Hirnveränderungen einhergeht, sollte es als „originäres neurogenes nicht-syndromales Stottern“ bezeichnet werden. Seine Erblichkeit liegt bei 70 bis > 80 %. Für das Kindergartenalter zeigt die Lidcombe-Therapie die höchste Evidenz für ihre Effektivität (Cohens d = 0,72–1,00). Eine starke Evidenz besteht auch für ein indirektes Verfahren. Für 6- bis 12-Jährige fehlen solide Therapie-Evidenzen. Für Jugendliche und Erwachsene existieren hohe Evidenzen und Effektstärken (Cohens d = 0,75–1,63) für sprechrestrukturierende Methoden (zum Beispiel Fluency Shaping), schwache Evidenzen und mittlere Effektstärken für Stottermodifikation (Cohens d = 0,56–0,65) sowie schwache Evidenzen für eine Kombination von Sprechrestrukturierung und Stottermodifikation. Negative Evidenzen bestehen für medikamentösen Behandlungen, rhythmisches Sprechen und Atemregulation als alleinige oder vorherrschende Therapieelemente sowie für Hypnose und unspezifizierte Stottertherapien. Schlussfolgerung: Häufig werden in Deutschland Stottertherapiemethoden ohne ausreichende Evidenz angewendet, und der Behandlungsbeginn wird unnötig verzögert. Die Leitlinie zeigt die verfügbaren evidenzbasierten Behandlungsverfahren auf.

Neef, N., Bütfering, C. Auer, T., Euler, H. A., Metzger, F. L., Frahm, J., Paulus, W., & Sommer, M. (2018). Altered morphology of the nucleus accumbens in persistent developmental stuttering Journal of Fluency Disorders, 55, 84-93.

Abstract: Purpose: Neuroimaging studies in persistent developmental stuttering repeatedly report altered basal ganglia functions. Together with thalamus and cerebellum, these structures mediate sensorimotor functions and thus represent a plausible link between stuttering and neuroanatomy. However, stuttering is a complex, multifactorial disorder. Besides sensorimotor functions, emotional and social-motivational factors constitute major aspects of the disorder. Here, we investigated cortical and subcortical grey matter regions to study whether persistent developmental stuttering is also linked to alterations of limbic structures. Methods: The study included 33 right-handed participants who stutter and 34 right-handed control participants matched for sex, age, and education. Structural images were acquired using magnetic resonance imaging to estimate volumetric characteristics of the nucleus accumbens, hippocampus, amygdala, pallidum, putamen, caudate nucleus, and thalamus. Results: Volumetric comparisons and vertex-based shape comparisons revealed structural differences. The right nucleus accumbens was larger in participants who stutter compared to controls. Conclusion: Recent theories of basal ganglia functions suggest that the nucleus accumbens is a motivation-to-movement interface. A speaker intends to reach communicative goals, but stuttering can derail these efforts. It is therefore highly plausible to find alterations in the motivation-to-movement interface in stuttering. While behavioral studies of stuttering sought to find links between the limbic and sensorimotor system, we provide the first neuroimaging evidence of alterations in the limbic system. Thus, our findings might initialize a unified neurobiological framework of persistent developmental stuttering that integrates sensorimotor and social-motivational neuroanatomical circuitries.

Ingham, R., Ingham, J. C., Euler, H. A., & Neumann, K. (2018). Stuttering treatment and brain research in adults: a still unfolding relationship. Journal of Fluency Disorders, 55, 106-119. http://dx.doi.org/10.1016/j.jfludis.2017.02.003

Abstract: Purpose: Brain imaging and brain stimulation procedures have now been used for more than two decades to investigate the neural systems that contribute to the occurrence of stuttering in adults, and to identify processes that might enhance recovery from stuttering. The purpose of this paper is to review the extent to which these dual lines of research with adults who stutter have intersected and whether they are contributing towards the alleviation of this impairment. Method: Several areas of research are reviewed in order to determine whether research on the neurology of stuttering is showing any potential for advancing the treatment of this communication disorder: (a) attempts to discover the neurology of stuttering, (b) neural changes associated with treated recovery, and (c) direct neural intervention. Results and conclusions: Although much has been learned about the neural underpinnings of stuttering, little research in any of the reviewed areas has thus far contributed to the advancement of stuttering treatment. Much of the research on the neurology of stuttering that does have therapy potential has been largely driven by a speech-motor model that is designed to account for the efficacy of fluency-inducing strategies and strategies that have been shown to yield therapy benefits. Investigations on methods that will induce neuroplasticity are overdue. Strategies profitable with other disorders have only occasionally been employed. However, there are signs that investigations on the neurology of adults who have recovered from stuttering are slowly being recognized for their potential in this regard.

Wolff von Gudenberg, A. & Euler, H. A. (2017) Telemedizinische Internetplattform in der Stottertherapie. In J. Mühlhaus, K. Bilda & U. Ritterfeld (Hrsg.), Neue Technologien in der Sprachtherapie (S. 92-101). Stuttgart: Georg Thieme.

Euler, H. A. (2016) Die Wirkung teletherapeutischer Stotterbehandlung im Vergleich zu herkömmlicher Präsenzbehandlung. Interner Forschungsbericht, Parlo-Institut. Download Paper

Abstract: Patients who opted for a teletherapeutic treatment of stuttering, as compared to the traditional face-to-face format, were 5 years older, but did not differ with respect to sex proportion, age, pre-treatment objective disfluencies, and pre-treatment appraised impairment by the disfluent speech. Teletreatment showed the same good effects as face-to-face treatment in both objective and subjective measures. As to stuttering frequencies both treatment formats showed moderate to high effect sizes, as to subjective measures very high effect sizes.

Zusammenfassung: Patienten, die eine teletherapeutische statt eine herkömmliche Präsenz-Stotterbehandlung wählten, waren 5 Jahre älter, unterschieden sich aber nicht hinsichtlich Geschlechterproporz, Alter, vortherapeutischer objektiver Stotterhäufigkeit und vortherapeutisch subjektiv eingeschätzter Beeinträchtigung durch die Stottersymptomatik. Die teletherapeutische Behandlung zeigte die gleiche gute Wirkung wie die Präsenzbehandlung, sowohl in objektiven wie in subjektiven Maßen. Hinsichtlich der Stotterhäufigkeiten zeigten beide Behandlungsformate eine Wirkung mit mäßig hoher bis hoher Effektstärke, hinsichtlich der subjektiven Beeinträchtigung mit sehr hoher Effektstärke.

Neumann, K., Euler, H. A., Bosshardt, H.-G., Cook, S., Sandrieser, P., Schneider, P., Sommer, M., & Thum, G. (2016) (Hrsg.: Deutsche Gesellschaft für Phoniatrie und Pädaudiologie). Pathogenese, Diagnostik und Behandlung von Redeflussstörungen. Evidenz- und konsensbasierte S3-Leitlinie, AWMF-Registernummer 049-013, Version 1. http://www.awmf.org/leitlinien/detail/ll/049-013.

Abstract: For the identification, diagnosis, and treatment of speech disfluencies an evidence-based guideline for stuttering and cluttering was developed by 17 German societies who are concerned with these speech disorders, and were published by the consortium of the Scientific Medical Societies (AWMF). The guideline takes up-to-date look at the genetic and neurological underpinnings, redefines stuttering and cluttering, and lists recommendable instruments for screening and diagnosis as well as effective treatments. The guidelines distinguishes between originary stuttering (neurogenic, non-syndromal and neurogenic syndromal) and acquired stuttering (neurogenic and psychogenic). Because the hitherto as 'ideopathic' called developmental stuttering is associated with structural and functional brain changes, it is recommended to use the term 'originary neurogenic non-syndromal stuttering', or in brief 'originary stuttering'. Its heritability lies between 70 and >80%. The guideline contains a systematic review of efficacious treatments of stuttering, based on a literature search in Web of Science, PubMed, PubPsych und Cochrane Library by three independent teams. 43 publications fulfilled the defined methodological criteria. For ages 3 – 6 years the Lidcombe treatment showed the best evidence of efficacy. A strong evidence was also found for indirect treatments which adapt parental communication requirements to the child's capacities. For 6- to 9-year olds no solid evidence of efficacy was found for any kind of treatment. For adolescents and adults a high evidence was found for methods of speech restructuring (e. g. Fluency Shaping, Camperdown) and a low evidence for stuttering modification and a combination of speech restructuring and stuttering modification. A clear negative evidence was attributed to pharmaceutical treatments. For the following treatments only an insufficient evidence was found: systematic change of utterance length, controlled breathing, hypnosis, Acceptance and Commitment Therapy, Speech Motor Training, and unspecific extensive logopedic treatment. Any treatment should show effects within 3 months; otherwise a change in treatment is indicated. The isolated training of speech techniques does not reduce speech-related negative emotions. Therefore it is recommended to integrated methods of cognitive behavior therapy. Although no sufficient evidence for the effectiveness of participation in self-help groups was found, the clinical consensus was to recommend it, as well as intensive therapies, the inclusion of group sessions into the treatment regimen, and systematic maintenance programs. The guideline received a large acclaim by societies concerned with speech disfluencies.

Zusammenfassung: Zur zeitgemäßen Identifikation, Diagnose und Behandlung von Redeflussstörungen wurde von den 17 in Deutschland damit maßgeblich befassten Fachgesellschaften eine evidenzbasierte Leitlinie zum Stottern und Poltern erarbeitet und als S3-Leitlinie bei der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) veröffentlicht. Sie öffnet einen neuen Blick auf die pathophysiologischen genetischen und neurologischen Grundlagen und Definition von Stottern und Poltern und listet empfohlene Screening- und Diagnostikinstrumente sowie effektive Therapieprinzipien auf. Die Leitlinie unterscheidet sie zwischen originärem (neurogenem, nicht-syndromalen und neurogenem syndromalen) und erworbenem (neurogenen und psychogenem) Stottern. Da das bislang als 'ideopathisches Stottern' benannte 'gewöhnliche' Stottern mit strukturellen und funktionellen Hirnveränderungen einhergeht, wird empfohlen, diesen Terminus durch 'originäres neurogenes nichtsyndromales Stottern', kurz 'originäres Stottern' zu ersetzen. Seine Erblichkeit liegt bei 70 bis >80%. Die Leilinie beinhaltet einen systematischen Review zur effektiven Behandlung von Stottern, basierend auf einer Literatursuche in den Datenbanken Web of Science, PubMed, PubPsych und Cochrane Library durch drei unabhängig voneinander arbeitende Teams. 43 Publikationen erfüllten die definierten methodologischen Kriterien. Für das Kindergartenalter zeigte die Lidcombe-Therapie die höchste Evidenz für ihre Effektivität. Eine starke Evidenz fand sich auch für indirekte Verfahren (an die Kapazitäten des Kindes adaptierte elterliche Kommunikationsanforderungen). Für 6- bis 12-Jährige fand sich bislang keine solide Evidenz für irgendeine Behandlung. Für Jugendliche und Erwachsene gab es eine hohe Evidenz für sprechrestrukturierende Methoden (z. B. Fluency Shaping, Camperdown) und schwache Evidenzen für Stottermodifikation sowie für eine Kombination von Sprechrestrukturierung und Stottermodifikation. Klar negative Evidenz wurde medikamentösen Behandlungen bescheinigt. Für folgende Methoden fanden sich keine ausreichenden Evidenzen: Systematische Änderung der Äußerungslänge, rhythmische Sprache, kontrollierte Atmung, Hypnose, Acceptance and Commitment Therapy, Speech Motor Training und unspezifizierte extensive logopädische Therapie. Jede Behandlung sollte einen Nutzen innerhalb von 3 Monaten zeigen; falls nicht, ist ein Behandlungswechsel angezeigt. Die alleinige Anwendung von Sprechtechniken kann stotterbegleitende negative Emotionen nicht beseitigen; daher wird empfohlen, Methoden der kognitiven Verhaltenstherapie hier zu integrieren. Auch wenn sich keine ausreichende Evidenz für die Effekte einer Teilnahme an Selbsthilfegruppen fand, empfahl der klinische Konsensus eine solche, ebenso Intensivtherapien, den Einschluss von Gruppensitzungen in die Behandlung und systematische Erhaltungsprogramme. Die Leitlinie hat eine große Zustimmung unter den deutschen Fachgesellschaften und international erhalten.

Euler, H. A., Anders, K., Merkel, A., Wolff von Gudenberg, A. (2016). Kann eine methodenintegrierende globale Sprechrestrukturierung wie die Kasseler Stottertherapie (KST) negative Emotionen mindern? Logos, 24, 84-94.

Abstract: According to prevalent opinion, a global speech restructuring treatment of stuttering such as fluency shaping does not reduce or only insufficiently decrease the negative, disturbing and communication impairing emotions related to stuttering. In addition to speech restructuring exercises, therapeutic procedures such as cognitive behavioural therapy are considered obligatory in order to secure fluency gains in daily situations and to reduce relapse. In the current study 122 adult and 58 adolescent persons who undertook a global integrative speech restructuring treatment of their stuttering (Kassel Stuttering Therapy) were administered a German version of the OASES questionnaire (Overall Assessment of the Speaker's Experience with Stuttering) before the intensive in-patient treatment, 12 months later at the end of the maintenance phase, and 24 months after the intensive treatment. From the first assessment (before therapy) to 24 months later (12 months after the last therapeutic intervention) the stuttering frequencies were reduced, as expected, with large effect sizes. The OASES scores, however, improved even more, also on items about negative emotions, anxiety-inducing speech situations, and fear of negative social evaluations. For the adolescent participants the reduction in OASES scores was numerically less than for adult participants. A partial relapse after the maintenance phase, which is common for fluency gains, was not observed in the OASES measures. A comprehensive fluency shaping treatment which integrates not only speech exercises but also group sessions and a variety of desensitizing in-vivo practices into daily life situations does not require an additional and explicit cognitive behaviour therapy, except for a small number of clients. Nonetheless, anxiety-reducing components ought to be an indispensable ingredient of any comprehensive stuttering treatment.

Zusammenfassung: Nach vorherrschender Meinung mindert eine globale Sprechrestrukturierung wie das Fluency Shaping die stotterbegleitenden negativen, belastenden und kommunikationsbeeinträchtigenden Emotionen nicht oder nur unzureichend. Vielmehr seien neben den sprechrestrukturierenden Übungsprogrammen zusätzlich therapeutische Maßnahmen erforderlich, etwa eine kognitive Verhaltenstherapie, um den therapie-induzierten Gewinn an Sprechflüssigkeit in der alltäglichen Anwendung abzusichern und Rückfälle zu mindern. In der vorliegenden Untersuchung wurden 122 erwachsene sowie 58 jugendliche Personen, die stotterten und eine Behandlung durch eine methodenintegrierende globale Sprechrestrukturierung aufgesucht hatten, vor der Intensivtherapie, nach Ende der 12-monatigen Erhaltungsphase sowie weitere 12 Monate später mit der deutschen Version des OASES-Fragebogen (Overall Assessment of Speaker's Experience with Stuttering) untersucht. Von Messzeitpunkt 1 (vor Intensivkurs) zu Messzeitpunkt 2 (Ende der Erhaltungsphase nach 12 Monaten) sowie zu Messzeitpunkt 3 (24 Monate nach Intensivkurs) reduzierten sich die Stotterhäufigkeiten wie erwartet mit großer Effektstärke. Die OASES-Werte jedoch verbesserten sich noch mehr, auch bei denjenigen Items, die speziell negative Emotionen sowie angst-induzierte Vermeidung von Sprechsituationen und Furcht vor negativer sozialer Bewertung betrafen. Bei den jugendlichen Klienten war die Reduktion der OASES-Werte etwas geringer als bei den Erwachsenen. Ein partieller Rückfall nach der Erhaltungsphase, wie in den Stotterhäufigkeiten üblich, war bei den OASES-Werten nicht zu beobachten. Eine umfassende methodenintegrierende Behandlung mit Fluency Shaping, die neben individuellen Sprechübungen auch Gruppensitzungen und verschiedene verhaltenstherapeutische In-vivo-Übungen in Alltagssituationen einbezieht, erfordert nicht zwingend beziehungsweise nur für einzelne Klienten eine zusätzliche explizite kognitive Verhaltenstherapie. Der Einbezug angstreduzierender Maßnahmen sollte aber selbstverständlicher Bestandteil jeder Übungstherapie des Stotterns sein.

Euler, H. A. Therapeutic concepts: evidence-based strategies in the treatment of stuttering A. am Zehnhoff-Dinnesen et al. (eds.) (in press). European manual of medicine, phoniatrics. Heidelberg, Germany: Springer.

Abstract: Evidence-based approaches to stuttering treatment have become state of the art, definitely so in research, hopefully also in practice in the near future. This standard means that only those treatments are accepted in the discourses about stuttering treatment which fulfill a number of criteria in order to be called effective and for which, additionally, methodologically accepted evidence for its effectiveness are published. There is no need for new and seemingly attractive treatments which just clutter the literature, but more and better evidence for the effectiveness of existing or for novel treatments. What counts is not how good a treatment appears to be or even is, but which level of evidence for the effectiveness of the treatment has been delivered. Applying these criteria, there are seemingly only a few treatments which are unequivocally recommendable: For young children the Lidcombe program, and for adolescents and adults speech restructuring programs, and - with some reservations - stuttering modification programs. All other treatments ought to be met with benign neglect until the required evidence for their effectiveness has been delivered.

Neumann, K. & Euler, H. A. Etiology of stuttering. In: Am Zehnhoff-Dinnesen A, Schindler A, Wiskirska-Woznica B, Zorowka P, Nawka T, Sopko S (eds) The European Manual of Medicine. Phoniatrics. Heidelberg: Springer, in press

Neumann, K., Euler, H. A., Schneider, P., & Sommer, M. (2015). An instrument for a universal screening for stuttering in preschoolers. Procedia - Social and Behavioral Sciences, 193, 322. Download Paper

Abstract: Screenings for preschool stuttering exist only for children with a suspicion of stuttering or with risk factors. A universal screening, however, might be advisable within regular medical checkups or screenings for developmental language abnormalities as performed routinely by local pediatricians or in kindergartens. The benefit criteria for such a screening are fulfilled for childhood stuttering (high prevalence, treatment availability, diminishing treatment effects with age, emotional burden of stuttering after school entrance). Participants were (a) 806 unselected children between 4.0 and 4.5 years, the age at which language screenings are performed in German kindergartens, and (b) 776 unselected children aged 5 to 7 years, during the school entrance medical examinations. Reference tests were for (a) the Test of Childhood Stuttering (TOCS), for (b) the Stuttering Severity Instrument (SSI-4). Sessions were audio recorded, and the recordings of children with any disfluencies additionally judged by 3 experienced stuttering specialists. Evaluated by classical test theory for the 4-year-olds were 20 items for a potential child questionnaire and 13 items for both a potential kindergarten teacher and parent questionnaire. For the older children, the same child and parent questionnaire items were administered, and additionally 7 items for physicians, 3 of which to be answered on the basis of the child's speech during the medical examination, and to be posed to the parent. Only the test for the pediatrician showed sufficient quality criteria (specificity 96%, sensitivity 58% for children requiring further examination; sensitivity 100% for children requiring treatment). Remarkably, 4 questions which occurred both in the parent and the paediatrician questionnaire had better external validities if posed verbally by the pediatrician to the parent than if answered on paper by the parent. Discussion: With the pediatrician instrument a useful and feasible screening is available, provided the performing doctors are sufficiently trained and sensitized.

Kettlitz, M., Westphal, L., Behrens, A., Jung, K., Wolff von Gudenberg, A. & Euler, H. A. (2015). Teletherapie Stottern. Die Online-Intensivtherapie der Kasseler Stottertherapie In F. Duesberg (Hrsg.), e-Health 2015 (S. 214 - 218). Solingen: medical future verlag..

Neumann, K., Euler, H. A. und Schneider, P. (2014). Identifikation von Stottern im Vorschulalter. Projektabschlussbericht. Köln: Demosthenes-Verlag der Bundesvereinigung Stottern & Selbsthifle e.V. ISBN 978-3-921897-74-4.

Euler, H. A., Lange, B. P., Schroeder, S., & Neumann, K. (2014). The effectiveness of stuttering treatments in Germany Journal of Fluency Disorders, 39, 1-11.

Abstract: Purpose: Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out. Method: The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering. Results: Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments. Conclusion: The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions.

Zusammenfassung: Zweck: Stotterer sollten die wirksamsten Behandlungen erhalten, die lokal oder regional verfügbar sind. Da eine vorausblickende vergleichende Behandlungsstudie für Deutschland nicht exisitiert, wurde eine rückblickende Befragung von behandelten Stotterern vorgenommen. Methode: Die 5 häufigsten Stottertherapien im deutschsprachigen Raum (231 einzelne Therapiefälle) wurden nach ihrer Wirksamkeit anhand eines strukturierten Fragebogens rückschauend bewertet. Die Teilnehmer hatten zwischen 1 und 7 Stotterbehandlungen erhalten. Ergebnisse: Zwei Behandlungsarten (Stottermodifikation, Fluency Shaping) zeigten positive Wirkung, 3 Behandlungsarten (Atemtherapie, Hypnose, unspezifizierte logopädische Therapie) unzureichende Wirkung. Die beiden wirksamen Stottertherapien waren nicht signifikant unterschiedlich in ihrer Wirksamkeit, die drei wenig wirksamen Therapien untereinander ebenfalls nicht unterschiedlich. Die Wirksamkeitslücke zwischen den besseren und den weniger guten Therapien war groß. Die typische Therapiekarriere eines Stotterers beginnt in der Kindheit mit einer unspezifischen logopädischen Behandlung, die extensiv (z. B. ein Mal wöchentlich) in Einzelsitzungen verabreicht wird. Im Vergleich waren intensive Verfahren besser als extensive Verfahren und Behandlung in Gruppen besser als Einzelbehandlung. Schlussfolgerung: Die am häufigsten verschriebene Stotterbehandlung, nämlich 1 wöchtliche Behandlungssitzung in logopädischer Einzeltherapie, ist von begrenzter Wirksamkeit. Mehr Erfolg versprechen Verfahren des Fluency Shaping oder der Stottermodifikation, die in einem intensiven Zeitplan (mindestens mehrere Tage hintereinander) und mit Anteilen von Gruppensitzungen verabreicht werden.

Euler, H. A. (2013) Evidenzbasierte Therapie des Stotterns in Forschung und Praxis. In M. Gross & R. Schönweiler (Hrsg.), Aktuelle phoniatrisch-pädaudiologische Aspekte 2013, Band 21 (S. 80 81). Krumbach: Frick Kreativbüro und Onlinedruckerei e.K.

Zusammenfassung: Welche methodischen Kriterien eine Stottertherapie erfüllen sollte, die sich erfolgreich nennen darf, wird von Bloodstein und Bernstein Ratner (2008) in ihrem Handbook of Stuttering vorgeschlagen. Neuere Meta-Analysen englischsprachiger Publikationen sind ernüchternd; nur ein Bruchteil der Veröffentlichungen erfüllt eine ausreichende Zahl von Kriterien. Deutschsprachige Veröffentlichungen bieten kein besseres Bild. Dabei kommt es weniger darauf an, wie gut eine Therapie zu sein scheint, sondern wie gut sie belegt ist. Die Kriterien für die Praxis sind notwendigerweise weniger streng, doch auch hier sollte der Behandlungserfolg jedes einzelnen Klienten dokumentiert werden. Dies erfordert zumindest eine möglichst objektive Erfassung des Stotterverhaltens (z. B. % gestotterter Silben) sowie der Einschätzung der Stotterschwere bzw. des Leidensdrucks durch den Klienten selbst, und zwar vor Beginn der Therapie sowie etwa 12 Monate nach der letzten therapeutischen Intervention. Wegen hoher Rückfallraten sind Therapieerfolge direkt nach der Therapie nicht aussagekräftig, und die Präsentation von ausgewählten Paradepatienten ist irreführend. Neuere Ergebnisse einer retrospektiven Klientenbefragung belegen, dass die häufigsten Stottertherapien in Deutschland, nämlich extensive Behandlung in Einzelsitzungen, nur unbefriedigende Erfolge hat. Es besteht kein Bedarf an neuen Therapieansätzen ohne Wirkungsbeleg, so kreativ und beeindruckend sie auch erscheinen mögen. Für den Fortschritt der Wissenschaft ist es unerlässlich, Theorien, Therapien und Ideen, die sich nicht bewährt haben, zu entsorgen.

Neumann K, Kob M, Euler HA, Weissgerber T, Wolff von Gudenberg A, Giraud AL, Kell C (2011). Wie verarbeitet das Gehirn Prosodie? Eine fMRT-Studie zum Stottern. In M. Gross & A. am Zehnhoff-Dinnesen (Hrsg.), Aktuelle phoniatrisch-pädaudiologische Aspekte, Band 19, S. 73-74. Warendorf: Darpe Industriedruck GmbH & Co Kg.

Neumann, K., & Euler, H. A. (2010) Neuroimaging and stuttering. In B. Guitar & R. McCauley (Eds.), Treatment of stuttering: established and emerging interventions (pp. 355 – 402). Baltimore, MD: Lippincott, Williams, & Wilkins.

Euler, H. A., Wolff v. Gudenberg, A., Jung, K. & Neumann, K. (2009). Computergestützte Therapie bei Redeflussstörungen: Die langfristige Wirksamkeit der Kasseler Stottertherapie (KST). Sprache•Stimme•Gehör, 33, 193-201.

Abstract: Abstract The Kassel Stuttering Therapy (KST) is a computer-assisted German adaptation of fluency shaping. 400 clients (aged 9 – 65 years) completed the 2- to 3-week in-patient intensive treatment. Long-term data 1 year (n = 238), 2 years (n = 69), and 3 years later (n = 69) are reported. Objective disfluency rates in 4 diff erent speech situations (% stuttered syllables, % SS) were reduced from before to after intensive treatment from 12.6 to 1.6 % SS and remained in the following 3 years between 3.2 and 3.8 % SS. The disfluency changes from before therapy to 1 year later or more showed effect sizes of d>1.1. Therapy eff ects were strongest for speech situations with the highest communi-cative demands (calling an unknown person by phone, inter-viewing passers-by on the street). Relapses were mostly temporary and most frequent within the fi rst 6 months after intensive treatment. Disfluencies 1 year after the intensive course correlated highly with those 2 years (ρ = .81) and 3 years (ρ = .76) after. Subjective stuttering data (self-rating of stuttering severity and of avoidance of speech or speech situations) showed, somewhat damped, the same approximately L-shaped progress as the objective disfluencies. Speech rates and speech naturalness increased slightly. Covert assessment of disfluency by telephone with a subsample of older children yielded higher rates than overt assessment. Monetary compliance incentives increased the rate of individual home practice after intensive treatment. The presented method fulfills almost all criteria required from a stuttering therapy which may be called effective. Permanent freedom from self- monitoring could be achieved only in a minority of clients. The behavioural data of the therapy effects are supported by parallel functional brain imaging findings in a small sample of clients.

Zusammenfassung: Die Kasseler Stottertherapie (KST) ist ein computergestütztes Fluency-Shaping-Verfahren. 400 Klienten absolvierten den 2- bis 3-wöchigen Intensivkurs. Von einem Teil dieses Kollektivs liegen langfristige Stotterdaten 1 Jahr (n = 238), 2 Jahre (n = 69) und 3 Jahre (n = 69) nach Kurs vor. Die objektiven Unflüssig-keiten in 4 verschiedenen Sprechsituation (% gestotterter Silben, % SS) wurden von vor zu nach Kurs von 12,6 auf 1,6 % SS reduziert und blieben in den folgenden 3 Jahren zwischen 3,2 und 3,8 % SS. Die Veränderungen von vor Kurs zu 1 Jahr später oder danach zeigten Effektstä ken von d > 1,1. Rückfälle waren meist vorübergehend und traten gehäuft in den ersten 6 Monaten auf. Subjektive Stotterdaten (Einschätzung der Stotter-schwere, Vermeiden von Sprechen / Sprechsituationen) zeigten etwas abgeschwächt über die Messzeitpunkte den gleichen annähernd L-f ö rmigen Verlauf. Sprechgeschwindigkeit und 1-dimensional eingeschätzte Sprechnatürlichkeit erhöhte sich leicht. Eine verdeckte telefonische Erfassung der Stotterhäufi gkeit bei einer Unterstichprobe von älteren Kindern zeigte höhere Werte als eine offene Erfassung. Die vorgelegte Dokumentation erfüllt fast alle methodischen Kriterien, die an eine als erfolgreich zu bewertende Stottertherapie zu stellen sind. Die behavioralen Therapiewirkungen werden durch begleitende hirnfunktionelle Neuroimaging-Befunde gestützt.

Kell, C. A., Neumann, K., von Kriegstein, K., Posenenske, C., Wolff von Gudenberg, A., Euler, H. A., Giraud, A.-L. (2009) How the brain repairs stuttering. Brain, 132, 2747-2760

Abstract: Stuttering is a neurodevelopmental disorder associated with left inferior frontal structural anomalies. While children often recover, stuttering may also spontaneously disappear much later after years of dysfluency. These rare cases of unassisted recovery in adulthood provide a model of optimal brain repair outside the classical windows of developmental plasticity. Here we explore what distinguishes this type of recovery from less optimal repair modes, i.e. therapy-induced assisted recovery and attempted compensation in subjects who are still affected. We show that persistent stuttering is associated with mobilization of brain regions contralateral to the structural anomalies for compensation attempt. In contrast, the only neural landmark of optimal repair is activation of the left BA 47/12 in the orbitofrontal cortex, adjacent to a region where a white matter anomaly is observed in persistent stutterers, but normalized in recovered subjects. These findings show that late repair of neurodevelopmental stuttering follows the principles of contralateral and perianomalous reorganization.

Lattermann, C., Euler, H. A. & Neumann, K. (2009) Das Lidcombe-Programm - Ein Interventionsverfahren zur Behandlung frühkindlichen Stotterns - auch für deutschsprachige Kinder. Forum Logopädie, 23(2), 16-23.

Zusammenfassung: Das Lidcombe-Programm (LP) zur Behandlung frühkindlichen Stotterns, eine hier beschriebene verhaltensmodifikatorische Methode mit den Eltern als Co-Therapeuten, wird bisher vor allem in englischsprachigen Ländern eingesetzt. Die bisherigen strikt evidenz-basierten Ergebnisse dieser Behandlung, einschließlich einer eigenen Untersuchung mit deutschen Kindern, belegen, dass das LP einen über Spontanerholung hinausgehenden dauerhaften Erfolg bewirkt und keine unerwünschten Nebenwirkungen hat. Allerdings sind bei der Anwendung elterliche Vorbehalte gegen diese verhaltenstherapeutische Methode zu berücksichtigen ebenso wie die anscheinend deutsche Neigung, verhaltenskontingente positive soziale Verstärkung eher sparsam einzusetzen.

Lattermann, C., Euler, H. A., Neumann, K. (2008). A randomised control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers. Journal of Fluency Disorders, 33, 52-65

Abstract: In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany.

Giraud, A.-L., Neumann, K. , Bachoud-Levi, A.-C., Wolff von Gudenberg, A., Euler, H. A., Lanfermann, H., & Preibisch, C. (2008) Severity of dysfluency correlates with basal ganglia activity in persistent developmental stuttering. Brain and Language, 104, 190-199

Abstract: Previous studies suggest that anatomical anomalies [Foundas, A. L., Bollich, A. M., Corey, D. M., Hurley, M., & Heilman, K. M. (2001). Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering. Neurology, 57, 207–215; Foundas, A. L., Corey, D. M., Angeles, V., Bollich, A. M., Crabtree-Hartman, E., & Heilman, K. M. (2003). Atypical cerebral laterality in adults with persistent developmental stuttering. Neurology, 61, 1378–1385; Foundas, A. L., Bollich, A. M., Feldman, J., Corey, D. M., Hurley, M., & Lemen, L. C. et al., (2004). Aberrant auditory processing and atypical planum temporale in developmental stuttering. Neurology, 63, 1640–1646; Jancke, L., Hanggi, J., & Steinmetz, H. (2004). Morphological brain differences between adult stutterers and non-stutterers. BMC Neurology, 4, 23], in particular a reduction of the white matter anisotropy underlying the left sensorimotor cortex [Sommer, M., Koch, M. A., Paulus, W., Weiller, C., & Buchel, C. (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet, 360, 380–383] could be at the origin of persistent developmental stuttering (PDS). Because neural connections between the motor cortex and basal ganglia are implicated in speech motor functions, PDS could also be associated with a dysfunction in basal ganglia activity [Alm, P. (2004). Stuttering and the basal ganglia circuits: a critical review of possible relations. Journal of Communication Disorders, 37, 325–369]. This fMRI study reports a correlation between severity of stuttering and activity in the basal ganglia and shows that this activity is modified by fluency shaping therapy through long-term therapy effects that reflect speech production improvement. A model of dysfunction in stuttering and possible repair modes is proposed that accommodates the data presented here and observations previously made by us and by others.

Fibiger, S., Peters, H., Euler, H. A., & Neumann, K. (2008). Health and human services for persons who stutter and education of logopedists in East-European countries. Journal of Fluency Disorders, 33, 66-71.

Comment: Auch 2008 erschienen in englischer Sprache in der polnischen Fachzeitschrift Logopeda, 6, 77-93; in der russischen Fachzeitschrift Logoped: Медицинское обслуживание и социальная поддержка лиц с заиканием, а также образование логопедов в странах Восточной Европы.

Abstract: The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems.

Wolff v. Gudenberg, A., Neumann, K., & Euler, H. A. (2006). Kasseler Stottertherapie für ältere Kinder schließt eine Behandlungslücke Forum Logopädie, 20(5), 24-29 Download Paper

Abstract: Ältere Kinder, die stottern, sind mit ambulanten Behandlungen eher schwer zu erreichen und weniger erfolgreich zu therapieren. Aus Elternsicht mangelt es häufi g an ausreichender Beratung und fehlender Transparenz des Therapieangebotes. Zweiunddreißig Kinder (9 bis 13 Jahre) wurden mit einer kindgemäßen Version der Kasseler Stottertherapie (KST) behandelt. Die Unfl üssigkeiten wurden in vier Situationen (Gespräch mit Therapeuten; lautes Vorlesen; aktives Telefonieren; Passanteninterview führen) gemessen. Zur Erhöhung der Gültigkeit der objektiven Langzeitdaten wurde auch eine telefonische Befragung der betroffenen Kinder und eines Elternteiles durchgeführt. Die ein Jahr nach Intensiv-therapie erhaltenen Reduktionen von Unflüssigkeiten sind im Mittelwert denen von Jugendlichen und Erwachsenen mit gleicher Therapie ähnlich, allerdings mit größeren Spannweiten. Eltern schätzen die Therapieerfolge geringer ein als die Kinder selbst. Die therapeutischen Erfahrungen lassen vermuten, dass die Stabilität der Therapieerfolge nicht allein mit einer gruppendynamisch eingebetteten Intensivtherapie unter PC-Einsatz erreicht werden kann, sondern es zusätzlich einer strukturierten Nachsorge bedarf.

Neumann, K., Preibisch, C., Euler, H. A., Wolff von Gudenberg, A., Lanfermann, H., Gall, V., & Giraud, A.-L. (2005). Cortical plasticity associated with stuttering therapy. Journal of Fluency Disorders, 30, 23-39.

Abstract: Neuroimaging studies have indicated that persistent developmental stuttering (PDS) may be associated both with an abnormality in white matter of left-hemispheric speech areas and a right-hemispheric hyperactivity. The latter may compensate for the deficient structural connectivity in the left hemisphere. To investigate the effects of stuttering therapy on brain activity nine male adults with PDS underwent functional magnetic resonance imaging (fMRI) before and within 12 weeks after fluency shaping therapy. Brain response differences during overt sentence reading before and after therapy were assessed by utilizing random effects analyses. After therapy, a more widespread activation was observed in frontal speech and language regions and temporal areas of both hemispheres, particularly and more pronounced on the left side. Interestingly, distinct posttreatment left-sided activation increases were located directly adjacent to a recently detected area of white matter anomaly [M. Sommer, M.A. Koch, W. Paulus, C. Weiller, C. Buchel (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. The Lancet, 360, 380-383] suggesting that fluency shaping techniques reorganize neuronal communication between left-sided speech motor planning, motor execution, and temporal areas. Hence, a therapeutic mechanism can be assumed to remodel brain circuitry close to the source of the dysfunction instead of reinforcing compensation via homologous contralateral brain networks.

Neumann, K., Euler, H. A., Preibisch, C., & Wolff v. Gudenberg, A. (2004) A within- and between-subject fMRI experiment before and after a fluency shaping therapy. In A. Packman, A. Meltzer, & H. F. M. Peters (Eds.), Proceedings of the 4th World Congress on Fluency Disorders, Montreal, Canada, August 11-15, 2003.

Neumann, K., Preibisch, C., Giraud, A.-L., Euler, H. A., & Wolff von Gudenberg, A. (2004). Der Einfluss einer Fluency Shaping Stottertherapie auf die kortikale Plastizität. In M. Gross & E. Kruse (Hrsg.), Aktuelle phoniatrisch-pädaudiologische Aspekte 2004/200, Bd. 12 (S. 192 - 195). Niebüll: Verlag videel.

Neumann K, Euler HA, Preibisch C, Wolff von Gudenberg A (2003). A within- and between-subject fMRI experiment before and after fluency shaping. In A Packman, A Meltzer, & HFM Peters (Eds.) Theory, research and therapy in fluency disorders: Proceedings of the Fourth World Congress of Fluency Disorders, Montreal 2003 (pp. 345-352). Nijmegen, The Netherlands: Nijmegen University Press.

Euler HA, & Wolff v. Gudenberg A. (2001). Stottertherapie mit Fluency Shaping Software. Deutsches Ärzteblatt, 98 (15), B 834.

Euler, H. A., & Wolff v. Gudenberg, A. (2001). The Kassel Stuttering Therapy: Do follow-up compliance incentives help maintain fluency shaping treatment effects? Gross und E. Kruse (2002), Aktuelle phoniatrisch-pädaudiologische Aspekte 2001/2002, Bd. 9 (S. 106-110. Heidelberg: Median-Verlag von Killisch-Horn GmbH.

Euler, H. A. & Wolff v. Gudenberg, A. (2000) Die Kasseler Stottertherapie (KST). Ergebnisse einer computergestützten Biofeedbacktherapie für Erwachsene. Sprache Stimme Gehör, 24, 71-79. Download Paper

Abstract: The Kassel Stuttering Therapy (KST) is a computer-based biofeedback therapy for adults which is founded on fluency shaping principles but integrates elements of other therapies, with a 3-week intensive therapy course and a 1-year maintenance phase. Short-term and longer-term effects on objective speech fluency and subjective stuttering evaluations are presented for 33 patients. For 21 of these patients, data of a 2-year-follow up are already available. Before and after the intensive course, 6 months, 1 year, and 2 years later the (1) disfluencies in 4 different daily speaking situations were assessed as was the subjective evaluation with four questionnaires. The large short-term improvements in fluency were maintained for most patients. Effect sizes were not only large directly after the intensive therapy, but with one exception also 1 year and two years later. Mean disfluencies (% disfluent syllables) were, depending on speech situation, before therapy between 9.3 and 15.0, directly after therapy between 1.0 and 3.1, after 6 months, between 3.4 and 6.0, after 1 year between 2.1 and 3.9, and after 2 years between 1.0 and 3.7. The partial relapse within the first 6 months after therapy did not continue but was recovered to some extent. The self-evaluations improved with large effect sizes. Undesirable side effects were not observed. It is assumed that the low relapse rate is due to self-controlled practice at the computer and participation at refreshers during the maintenance phase.

Zusammenfassung: Die Kasseler Stottertherapie (KST) ist eine computergestützte Biofeedbacktherapie für Erwachsene, die auf Prinzipien des fluency shaping gründet und Elemente anderer Therapien integriert. Sie umfasst einen 3-wöchigen Intensivkurs und eine 1-jährige Nachsorge. Kurz- und längerfristige Wirkungen der KST auf objektive Sprechunflüssigkeit und subjektive Stottereinschätzungen werden dargestellt. Bisher haben 33 Patienten den Kurs und die Nachsorgephase durchlaufen. Von 21 dieser Patienten sind zusätzlich die Daten einer 2-Jahres-Nachfolgeuntersuchung vorhanden. Vor und nach dem Intensivkurs, 6 Monate, 1 Jahr und 2 Jahre später wurden (1) die Sprechunflüssigkeit in 4 unterschiedlichen alltagsrele-vanten Sprechsituationen ausgezählt und (2) die Selbst-beurteilung des Sprechverhaltens mit 4 Fragebögen erfasst. Die erzielten großen Verbesserungen der Sprechflüssigkeit blieben bei den meisten Patienten längerfristig erhalten. Die Effektwerte waren nicht nur unmittelbar nach dem Intensivkurs, sondern mit einer Ausnahme auch 1 bzw. 2 Jahre später noch groß bis sehr groß. Die mittleren Sprechunflüssigkeiten (Prozent unflüssig gesprochener Silben) lagen vor der Behandlung je nach Sprechsituation zwischen 9.3 und 15.0, unmittelbar nach dem Kurs zwischen 1.0 und 3.1, nach einem halben Jahr zwischen 3.4 und 6.0, nach 1 Jahr zwischen 2.1 und 3.9 und nach 2 Jahren zwischen 1.0 und 3.7. Der partielle Rückfall im 1. Halbjahr nach dem Intensivkurs setzte sich danach nicht fort, sondern wurde zum Teil wieder aufgeholt. Die Selbstbeurteilung des Sprechverhaltens verbesserte sich mit großen Effektwerten. Unerwünschte Nebenwirkungen konnten nicht beobachtet werden. Es gibt begründete Hoffnung, mit dieser Therapie die hohe Rückfallrate der gängigen sprech-technischen Verfahren zu mindern. Die vergleichsweise geringe Rückfallrate könnte durch das selbstgesteuerte Üben am Computer nach dem Intensivkurs und die Teilnahme an Auffrischungskursen bedingt sein.

Euler, H. A. & Wolff v. Gudenberg, A. (2000). Die Kasseler Stottertherapie. Erste Ergebnisse einer computergestützten Biofeedbacktherapie für Erwachsene. In M. Gross (Hrsg.), Aktuelle phoniatrisch-pädaudiologische Aspekte 1999/2000, Bd. 7 (S. 201-208). Heidelberg: Median-Verlag von Killisch-Horn GmbH. Download Paper