Section 9 - Using Facilitator Metronomic Pacing

The Facilitator includes a metronome which is capable of pacing from 50 to 150 clicks per minute. The rate of metronomic clicks is controlled by the clinician.

Although there has long been interest in rate of speech in fluency disorders, such as stuttering, only recently has there been increased study on the effects of rate on overall speech improvement and on speech intelligibility (1, 2). Slowing down the rate of speech, often achieved in therapy for stuttering by prolonging vowels, is part of the easy-onset paradigm used frequently as a treatment of stuttering (3).

A slow rate of speech is typically found in dysarthrias related to such problems as CVA, multiple sclerosis, myasthenia gravis, and amyotrophic lateral sclerosis. It takes these dysarthric patients a longer time to say the same passage than it would take a normal speaker. Despite the slowness of articulation and frequent pausing (often for breath renewal) within the utterance, excessively slow speech in these dysarthrias can sometimes be accelerated by working with the patient to speed up speech production deliberately. Metronomic fast-pacing is often a helpful tool in achieving a faster speaking rate in dysarthria. Conversely, some patients with Parkinson’s disease often speak too rapidly, and setting the metronome to a slower rate may result in these patients developing a slower speaking rate (with a concomitant improvement in voice loudness and speech intelligibility).

Metronomic pacing has been found to be a useful tool in helping normal speakers become better speakers. For example, speakers who "attend more to how they are talking" with the help of a metronome tend to reduce the number of filler pauses (like "um" and "uh") that they use while speaking (4). It appears that the use of a metronome helps some speakers attend more to what they are saying. Broadcasters in training often use metronomic pacing to develop a speaking rate that seems more optimal for their listeners.

Perhaps with increased availability of both amplification of voice and metronomic pacing in the same instrument, the Facilitator will serve as a catalyst for more research in the use of pacing as a speech-improvement tool and as a speech therapy aid.

Examples of Cases Using Pacing

Eduardo, age 18, has stuttered since early childhood, several years before he began kindergarten. His conversational speech was bilingual. In both English and Spanish his conversational speech was characterized by vowel and consonant prolongations at the beginning of a phrase or sentence, often accompanied by facial grimacing and extended eye closing. He had received speech therapy for his stuttering off and on over his school years. Now as a high school senior, he was seen in a private practice clinic, which for the treatment of stuttering used an easy onset, forward airflow, slower speech approach. In speech therapy using DAF, his speech patterns slowed down considerably. This permitted fluency shaping using slower speech as a speaking guideline. Wearing a portable voice amplifier coupled with a metronome, he was able to practice controlled oral reading and speaking, usually setting the metronome pace at or near 100 clicks per minute. The metronomic pacing seems to allow Eduardo to speak with greater deliberation, prolonging his vowels and slowing down his speaking rate. He seemed to have better luck slowing down his Spanish than his English. At his request, he began to wear the amplifier-metronome in out-of-clinic situations, particularly in the classroom. By continuous wearing of the metronome, his speech improved both in the classroom and at home. At this writing, he has begun to wear the pacing instrument in social situations, reporting far less stuttering and facial grimacing.

Joe, age 29, read the news at a local rural TV station in a small mid-western city. He dreamed of being a newscaster in a major television market or perhaps one day working as an anchor for a major television network. The local station, however, began to receive phoned and written complaints about Joe’s speech, which typically said something like, "He speaks too fast and you can’t always understand what he says." Joe took these complaints seriously and consulted with a vocal coach in a large city several hundred miles from where he worked. It was found that when Joe appeared nervous, he would speed up his speech, often speaking close to 200 words per minute; under these rapid-talking conditions, he made some articulatory deletions and substitutions. As part of the speech evaluation, a metronome was used, and at slow values (100 pulsations per minute) Joe was able to match the clicks with his own speech, markedly slowing down his speaking rate. He began to use 150 words per minute as an optimum, target rate. When asked to speak in a slightly louder voice at the 150 rate, his articulatory errors vanished. He began a six-week, twice weekly, voice improvement regimen with the vocal coach, who used a metronome regularly as part of each session. Joe was able to temporarily use a metronome in his home-practice sessions, experiencing excellent carryover with the metronomic pacing. He found that speaking with greater deliberation (as he learned to do with pacing) gave him much better speech control which he was able to use on his newscasts.

Recommended Procedures for Using Pacing

1. The patient wears headphones attached to the Facilitator. The metronomic pacing unit on the Facilitator is activated by pressing the mode button until Pacer appears on the display window. The rate of the metronome clicks (a range of 50 to 150 clicks is available) is controlled by pressing the Adjust button until the desired rate appears in the window. For example, at 100 clicks per minute the display window would read, PACE 100.

2. The intensity of the clicks heard on the phones is the same level as set for amplification.

3. A small, blinking asterisk can be found in the display window on the Facilitator. It provides a visual feedback of the rate of clicks, as the light blinks with each metronome beat. By watching the pulsations of light, the clinician can monitor and regulate the number of clicks heard per minute on the headphones.

4. As part of a diagnostic evaluation, metronomic pacing is an excellent diagnostic probe to use with dysarthric patients, people who stutter, some children with articulation-fluency problems, and with anyone working on general speech improvement. The attention factor that the metronome demands in monitoring its clicks appears often to facilitate a better speech-voice response.

5. If metronomic pacing has been found to improve performance, the battery-powered Facilitator (and headphones) can be worn as a portable assistive device in both therapy and out-of-clinic situations. Trial and error usually determines the best pace setting. Once gains have been established using the instrument, determine if these gains can be maintained without further use of metronomic pacing.

6. For people who have marginal fluency problems, a clinic session that focuses on speech practice with the metronome will often improve overall fluency, at least, temporarily. Self-practice sessions with the metronome, also, have been observed to be helpful.

(1) Schwartz, R.G. and Goffman, L. (1995). Metrical patterns of words and production accuracy. J. Speech & Hearing Research, 38: 876-888.

(2) Campbell, T.F. and Dollaghan, C.A. (1995). Speaking rate, articulatory speed, and linguistic processing in children and adolescents with severe traumatic brain injury. J. Speech & Hearing Research, 38: 864-875.

(3) Onslow, M., Costa, L., Andrews, A., Harrison, E. and Packman, A. (1996). Speech outcomes of a prolonged-speech treatment for stuttering. J. Speech & Hearing Research, 39: 734-749.

(4) Christenfeld, N. (1996). Effects of a metronome on the filled pauses of fluent speakers. J. Speech & Hearing Research, 39: 1232-1238

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