E-learning and Fluency Disorders If you have worked with children, adolescents, or adults in fluency treatment, chances are you have given your patients assignments to work on at home. Yet it is not uncommon for clients to lose motivation or tire easily from the repeated practice that many fluency clinicians believe is required for ... Features
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Features  |   May 01, 2004
E-learning and Fluency Disorders
Author Notes
  • Anthony J. Caruso, professor emeritus, Kent State University, has written articles on the clinical management of children and adults who stutter. His current interest is the development of interactive, multimedia software for education and training in fluency disorders. Contact him at caruso_aj@yahoo.com.
    Anthony J. Caruso, professor emeritus, Kent State University, has written articles on the clinical management of children and adults who stutter. His current interest is the development of interactive, multimedia software for education and training in fluency disorders. Contact him at caruso_aj@yahoo.com.×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / Attention, Memory & Executive Functions / Features
Features   |   May 01, 2004
E-learning and Fluency Disorders
The ASHA Leader, May 2004, Vol. 9, 4-14. doi:10.1044/leader.FTR1.09102004.4
The ASHA Leader, May 2004, Vol. 9, 4-14. doi:10.1044/leader.FTR1.09102004.4
If you have worked with children, adolescents, or adults in fluency treatment, chances are you have given your patients assignments to work on at home. Yet it is not uncommon for clients to lose motivation or tire easily from the repeated practice that many fluency clinicians believe is required for fluency to be established and engrained.
Now imagine that the techniques you wish your clients would practice were included in a software application, with slick graphics and animations that provided fluency patients with instantaneous objective feedback about their performance. Or, imagine that the fluency skills you are teaching could be packaged as a game. Imagine a genie that appears on screen to perform tasks, for example, running a program or playing music, only if your fluency patients command him to do so with a speaking rate that is within the range set by you, the clinician. Now that is fun, and will hold the attention of this generation of children and young adults who have grown up with computers and MTV in a culture that barely promotes enough patience to wait for microwaveable meals in a minute!
The good news is that you do not have to imagine that software such as this is possible. It’s here, and if you don’t know how to program, you can have it custom designed for you at a reasonable cost. Welcome to the 21st century, the century in which e-learning is coming of age.
Definition
E-learning is defined as education via the Internet, network, or stand-alone computer. In brief, e-learning makes use of electronic applications and processes to facilitate learning. E-learning applications and processes include Web-based learning, computer-based learning, virtual classrooms, and digital collaboration. Content is delivered via the Internet, intranet/extranet, audio or videotape, satellite TV, and CD-ROM. Although some professionals in communication sciences and disorders have made ground-breaking contributions in the development of e-learning software, as a discipline, we appear not to be “e-lated” by e-learning.
By comparison, other rehabilitative and medically related professions are far ahead of us in exploiting this technology to advance classroom education and clinical treatment. In our discipline, there are several potential applications that would assist student-clinicians in developing their skills and confidence regarding the clinical management of fluency disorders. In light of reports that the current generation of professional clinicians believe they are not well trained and/or lack confidence in their abilities to treat individuals who stutter, it also seems reasonable to explore e-learning as a method to address clinical training in fluency disorders at the in-service level as well.
There are many advantages of e-learning for education of present and future service providers. First, it provides a cost-effective way to develop unique training experiences for virtually every learner. Second, it provides opportunities for novices in the field to learn new skills without compromising the well-being of themselves or consumers. Third, e-learning provides training opportunities with patients with low incidence disorders who may not be available in sufficient number for training at the pre-service level. In light of these advantages, the application of this technology in fluency disorders is compelling.
Patient Simulation Technology
Software that focuses on anchored instruction (that is, active learning) through the use of interactive multimedia holds much promise for pre-service and in-service education and training. Anchored learning is a process by which learners generate their own solutions to problems rather than being instructed as to what the solutions are. Patient simulation technology (PST) is a valuable tool that displays clinical scenarios in which learners must self-generate an appropriate solution. Because of the reliance of PST on a problem-solving approach to learning, learners who interact with it are thought to be much more likely to be able to apply learned information to other similar situations than individuals acquiring knowledge through lecture and readings.
The development of instructional software, and, more specifically, PST, in fluency disorders is timely as recent findings suggest that the use of interactive, multimedia programs has several positive effects on the learner’s understanding of new and complex concepts. A non-expository format that includes video, sound, and graphics can help learners construct a mental model more readily than they could using either the written word or lectures by a classroom instructor or clinical supervisor. Moreover, the use of interactive technology often results in students learning more and learning faster and with greater retention as compared to traditional avenues of learning.
It should be emphasized here that PST should be used to augment rather than replace traditional methods of teaching/learning theoretical constructs and clinical procedures. One major advantage of PST is that it encourages active learning during which the learner experiences direct awareness of developing constructions through self-regulation. Another unique advantage of PST is that, although many learners will view the same training program, it is likely that learners’ experiences will differ. The path of this interactional software will depend on how each learner answers questions. Different responses by the learners will take them along different paths such that each learner may see different “versions” of the training program based on individual responses.
Training Specific Fluency Skills
Interactive educational software can be used to train some of the following skills necessary for fluency clinicians to master: stuttering identification; administration of (in)formal and/or (non)standardized tests; as well as various techniques (e.g., slow speech rate) to facilitate fluency. Moreover, the potential of e-learning to enhance training with parents of children who stutter is particularly promising. Specific topics include: how parents can provide emotional supports to their children who stutter, and training parents to modify their communication to facilitate their children’s fluency development. For example, multimedia segments could be designed to teach parents of children who stutter how to slow down their rate of speech when talking to their child. One benefit of this software is that parents can work comfortably in their own home at their own computers, which may facilitate trying and persevering with new methods of speaking that are unusual for them or lead them to think that “that doesn’t sound like me.”
Classroom Applications
Other uses of software such as those described above include incorporating laboratory activities as part of an undergraduate or graduate course on stuttering. These labs are used to increase students’ abilities to consistently identify stuttering types, calculate stuttering and other speech-related measures (e.g., speech rate), and learn how to score and interpret tests. Students complete the lab, answer questions pertaining to the lab experience, and submit their work to the instructor via e-mail. An immediate confirmation documenting the time and date of the receipt of the student’s answers is provided.
These types of e-learning laboratories offer several advantages to both professors and students. First, the student can do the laboratory experience at a convenient time, rather than having a regularly scheduled lab time in a classroom on campus. Scheduling for communication disorders students is an important consideration because these students are not only scheduled for classes but also for clinic assignments. Thus, finding a convenient time to schedule a laboratory for everyone in the class-some of whom may also be enrolled in clinical practicum in the university speech and hearing clinic or at an extern site or in student teaching in an area school system-is often difficult. Second, professors can require that students e-mail their write-up of the lab to them. When all e-mails are received, the professor can have an answer key set up as an auto-response, thereby providing students with timely feedback.
Availability
Although possible, software specifically designed for fluency disorders is not yet readily available. It is likely that you will either have to write the program yourself, if you have the skills, or hire someone to develop the application for you. You can hire a consultant or alternately, most college students majoring in computer programming can write this kind of software for you at a very reasonable price.
The key to having your custom-designed software turn out as you envision it is to be very specific and exact in describing what you want to the programmer that you hire. You must tell the programmer information about every step of the process. For example, if you want the program to incorporate speech rate, you should inform the programmer how you would like speech rate calculated. Or, if you prefer articulatory rate, you will need to tell the programmer to factor out the duration of pauses between words.
Toward the Future
E-learning that incorporates interactive multimedia provides cost-effective pre-service and in-service training in fluency. Although the potential contributions of e-learning to fluency disorders may be considerable, it should augment rather than replace the traditional face-to-face supervised practica model and face-to-face treatment sessions with patients. Moreover, research on e-learning and fluency disorders is needed to verify that learning specific fluency skills is enhanced via interactive, multimedia software. This is an exciting period in the development of computer technology that has the potential to benefit students, clinicians, and consumers. Clearly, this technology cannot be ignored in our mission to develop well-trained fluency clinicians.
References

Fluency Disorders

Kelly, E. M., et al. (1997). Academic and clinical preparation and practices of school speech-language pathologists with people who stutter. Language, Speech, and Hearing Services in Schools, 28, 195–212. [Article]
Kelly, E. M., et al. (1997). Academic and clinical preparation and practices of school speech-language pathologists with people who stutter. Language, Speech, and Hearing Services in Schools, 28, 195–212. [Article] ×
Logan, K. J., & Caruso, A. J. (1997). Parents as partners in the treatment of childhood stuttering. Seminars in Speech and Language, 18(4), 309–326. [Article] [PubMed]
Logan, K. J., & Caruso, A. J. (1997). Parents as partners in the treatment of childhood stuttering. Seminars in Speech and Language, 18(4), 309–326. [Article] [PubMed]×
Max, L., & Caruso, A. J. (1997). Contemporary techniques for establishing fluency in the treatment of adults who stutter. Contemporary Issues in Communication Sciences and Disorders, 24, 45–52.
Max, L., & Caruso, A. J. (1997). Contemporary techniques for establishing fluency in the treatment of adults who stutter. Contemporary Issues in Communication Sciences and Disorders, 24, 45–52.×
Sommers, R. K., & Caruso, A. J. (1995). Inservice training in speech-language pathology: Are we meeting the needs for fluency training?, American Journal of Speech-Language Pathology, 4, 22–28.
Sommers, R. K., & Caruso, A. J. (1995). Inservice training in speech-language pathology: Are we meeting the needs for fluency training?, American Journal of Speech-Language Pathology, 4, 22–28.×
St. Louis, K. O., & Durrenberger, C. H. (1993). What communication disorders do experienced clinicians prefer to manage?, Asha, 35, 23–31. [PubMed]
St. Louis, K. O., & Durrenberger, C. H. (1993). What communication disorders do experienced clinicians prefer to manage?, Asha, 35, 23–31. [PubMed]×
Learning
Johnson, G. (1995). Fire in the mind. London: Viking.
Johnson, G. (1995). Fire in the mind. London: Viking.×
Jonassen, D. (1995). Supporting communities of learners with technologies: A vision for integrating technology with learning in schools. Educational Technology, 35(4), 60–63.
Jonassen, D. (1995). Supporting communities of learners with technologies: A vision for integrating technology with learning in schools. Educational Technology, 35(4), 60–63.×
Marsh, G. E., & Iran-Nejad, A. (1992). Intelligence: Beyond a monolithic concept. Bulletin of the Psychonomic Society. 30(4), 329–332. [Article]
Marsh, G. E., & Iran-Nejad, A. (1992). Intelligence: Beyond a monolithic concept. Bulletin of the Psychonomic Society. 30(4), 329–332. [Article] ×
Shuell, T. J. (1990). Phases of meaningful learning. Review of Educational Research, 60, 23–25.
Shuell, T. J. (1990). Phases of meaningful learning. Review of Educational Research, 60, 23–25.×
E-Learning in Other Disciplines
Gordon, J. A., Oriol, N. E., & Cooper, J. B. (2004) Bringing good teaching cases “to life”: A simulator-based medical education service. Academic Medicine 79(1), 23–27. [Article] [PubMed]
Gordon, J. A., Oriol, N. E., & Cooper, J. B. (2004) Bringing good teaching cases “to life”: A simulator-based medical education service. Academic Medicine 79(1), 23–27. [Article] [PubMed]×
Gray, S. A., Deem, L. P., Sisson, J. A., & Hammrich, P. L. (2003) The predictive utility of computer-simulated exercises for preclinical technique performance. Journal of Dental Education, 67(11), 1229–1233. [PubMed]
Gray, S. A., Deem, L. P., Sisson, J. A., & Hammrich, P. L. (2003) The predictive utility of computer-simulated exercises for preclinical technique performance. Journal of Dental Education, 67(11), 1229–1233. [PubMed]×
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May 2004
Volume 9, Issue 10