Early on in the award-winning film The King’s Speech, Colin Firth as the future King George VI struggles to deliver a speech to crowds in London. It’s a painful scene where he stutters and stumbles on almost every word,
The movie has shined a spotlight on stuttering and how debilitating it can be for those who suffer from it.
And no one knows better than Associate Professor of Speech and Hearing Science Shelley Brundage, who has made it her life’s work to help people manage their speech impediments.
Dr. Brundage, a board recognized specialist in fluency disorders, works with her clients in GW’s Speech and Hearing Center, which provides a variety of speech, language and hearing services for individuals of all ages. Staffed by GW faculty and graduate students, the center sees approximately 25 stuttering clients a semester at a discounted cost.
There’s also another space where Dr. Brundage hopes to treat patients, and it’s entirely virtual.
Dr. Brundage and her research team are currently developing virtual reality environments for people who stutter. Based on existing virtual environments that deal with substance cravings and commonplace fears like flying and heights, Dr. Brundage’s environments have her clients facing real-world situations where they might stutter, including public speaking scenarios.
Dr. Brundage got the idea for using virtual reality in her treatments at a conference in 2003, when she learned about virtual reality uses for people with brain damage.
“There is a behavioral aspect to stuttering—what people can see and hear—and affective aspects, such as increased anxiety and fear,” says Dr. Brundage, whose research was featured on a NBC4 special. “I got to wondering if we could engender those same reactions of anxiety and fear in virtual spaces rather than getting real audiences together or go out in the real world where things are less controlled and a little less safe. We found that we can elicit the same affective and behavioral reactions in virtual space. It has possibilities for treatment.”
To experience a “real-world” situation, a client puts on a helmet with attached headphones and special eyewear. Dr. Brundage communicates with the client through a headset and coaches them through the virtual situation by reminding them to use learned treatment techniques. Dr. Brundage also controls the response of the virtual audience and can make them respond positively by clapping or have the audience take phone calls or otherwise appear distracted.
Approximately 20 people—10 of whom are persons who stutter— have used the virtual reality environment so far, and their data will be used in a submission to NIH this summer.
If the virtual reality environment is funded, Dr. Brundage’s clients will be able to interact with her and the virtual audience at home.
“We will use an online virtual learning environment. It’s like a safe Second Life,” she says. “It’s a virtual world on the web where the therapist can control the interactions and where the client’s confidentiality is protected. The client and I do therapy in the virtual space, they can video themselves interacting with the virtual audience using a webcam and e-mail the video back to me. That way, I can see how they are progressing. It has a lot of potential.”
For now, Dr. Brundage and her student clinicians meet with clients one-on-one for treatments. She begins by learning how an individual’s stuttering affects them personally and then plans their treatment.
“We can offer treatments that focus on learning new ways of talking or treatments that focus on modifying stuttering to make it not as noticeable or anxiety-inducing,” says Dr. Brundage. “In general, when I do therapy, it’s not enough to work on stuttering behaviors; we also have to work on the fear and anxiety associated with talking.”
One method Dr. Brundage uses, called identification, involves working with the client to help them understand where they are producing physical tension when they talk. The idea is if the client is more relaxed, then they will stutter less. Dr. Brundage will ask her clients to speak and when they stutter, she asks them to point to the area in their face or neck where they feel tense.
“You can’t change behavior until you know what you’re doing,” she says. “I ask clients to key into where they feel tense and actively work to try and release the tension.”
Dr. Brundage says this method is “straight out of Psych 101”: “You confront your fear that you will stutter, force yourself to stay in the situation and work to control it and you will realize it’s not as scary as you thought it would be,” she says. “I often ask clients to stay in the stuttering ‘block’ and then just let their tension go. The more they do that, the less they will be fearful over time.”
Another technique, called a “slide out,” requires clients to slide into and out of problematic words, by elongating sounds.
“These techniques are all about managing stuttering,” she says. “I don’t tell people to talk in a different way but instead encourage them to approach these words in a different way when stuttering occurs.”
Dr. Brundage also helps clients work on erasing their stuttering all together, using techniques like rate control, or slowing down their speech.
But whatever the method, research has shown that treatment provides results. What experts like Dr. Brundage don’t know quite yet is how much anxiety affects people who stutter over time.
“We need more research to learn how anxiety starts, but we do know people who seek treatment almost always report some level of speaking-related anxiety, and that’s why many of our treatments deal directly with that fear.”
And that fear is exactly what Dr. Brundage hopes to conquer with her virtual reality environment.
“Techniques are fairly easy to learn in the clinic room, where you’re very supported, receive feedback and it’s not really real. But a lot of people who stutter go out in the real world and tell us, ‘I wish I could use my techniques but I can’t,’” she says. “One of the reasons I think that happens is because we don’t give folks enough time to practice these skills in places that look real. And that’s what I envision virtual reality helping with.”
“We’re hoping it can be a bridge into the real world.”