Talk:Electronic fluency device

Citing studies presented at conferences.
An issue was raised whether to include two studies of SpeechEasy devices that were presented at professional conferences but not published. A discussion of this issue is at Wikipedia_talk:Reliable_sources. Based on the discussion I've included the two studies.--TDKehoe 17:48, 21 September 2007 (UTC)

Image sizes
Manual of Style says "Cases where specific image width are considered appropriate include: ...When using detailed maps, diagrams or charts...On a lead image that captures the essence of the article." These cases described the lead photo and the two charts, so I suggest setting them at 320px.--TDKehoe 21:45, 23 September 2007 (UTC)

Devices not linkable
The way the devices are listed, they can't be linked to. E.g., if another website wanted to refer to all of the studies of SpeechEasy devices, there's no way to link to just the SpeechEasy section. These should be changed to sub-sections.--TDKehoe 23:28, 23 September 2007 (UTC)

Third-party payment for anti-stuttering devices
User:Slp1 removed the following section because it was "US specific funding information." I disagree with that edit. IMHO, US-specific information can best be improved by adding information about other countries, not by removing information about the United States.--TDKehoe 15:07, 30 September 2007 (UTC) --

Most Americans who stutter qualify for free or subsidized anti-stuttering devices: In other countries, stutterers who want their national health programs to provide anti-stuttering devices should work with their national stuttering support organization.
 * About fifteen states provide anti-stuttering devices to qualified residents who stutter, via special telephone equipment distribution programs.
 * Almost all states provide anti-stuttering devices through vocational rehabilitation programs, for stutterers who are looking for a job.
 * Employers often pay for part of the cost of an anti-stuttering device, if improved speech enables the employee to perform more job-related tasks (such as calling customers).
 * When billing health insurance, the CPT/HCPCS procedure code for anti-stuttering devices is E1399-NU. The diagnosis code for stuttering is 307.0.


 * I do agree that balancing the article is the correct response in most cases of systematic bias, though obviously if information for every country in the world was given in such detail the article would be way too long (and very tedious);) However, in this case I also do not feel that this funding information is in itself encyclopedic, making the article seem more like an ad than it is already. Please note that similar articles such Hearing aids Artificial limbs do not have such a section on getting funding.  Given that TDKehoe is also a manufacturer of one of these devices review/Anti-stuttering devices/archive1, there is also the COI issue to be considered.--Slp1 17:10, 30 September 2007 (UTC)


 * Telecommunications Relay Service is an article about state programs that are similar to the special telephone equipment distribution programs (STEDP). In most states these are the same programs. Perhaps there should be an article about STEDP, with a link from the anti-stuttering devices article?--TDKehoe 20:46, 3 October 2007 (UTC)

Cleanup, advert, COI, and refimprove
TdKehoe, as you have acknowledged involvement with CasaFuturaTech, this article needs to carefully cited and held to all Wiki standards. I'm sure you've already aware of Wiki's conflict of interest guidelines.
 * Please explain the need for the advert list of devices, in relation to WP:NOT and WP:ADVERT.


 * Good point. My original intentional was that a NPOV would list every anti-stuttering device. But now that the list is complete I can see that the value in this section is in the studies. I'll change this section to "Studies of anti-stuttering devices" and delete the devices that don't have studies.--TDKehoe (talk) 15:26, 20 November 2007 (UTC)


 * Wiki is not an instruction manual. We do not give medical advice, for example, "Parents who are concerned about this issue may want to seek a non-device, non-medication stuttering treatment for their young child, or ... " (there are many more such samples).


 * I'll reword that section.--TDKehoe (talk) 15:26, 20 November 2007 (UTC)


 * Wiki is not an FAQ, and encyclopedic articles don't usually have sections with how-to FAQ questions (How does AAF affect stutterers' brains?, etc.).


 * That section isn't an FAQ because the questions are unanswered. But I'll rephrase the wording and change the title of the section.--TDKehoe (talk) 15:28, 20 November 2007 (UTC)


 * Cleanup:
 * Please see WP:MSH on section headings.


 * I've cleaned up the section headings.--TDKehoe (talk) 20:06, 20 November 2007 (UTC)


 * Please review WP:ITALICS


 * WP:ITALICS says to use italics for "words as words" so italics in the "terms used" section is correct.--TDKehoe (talk) 20:09, 20 November 2007 (UTC)


 * Would you mind putting spaces between the ends of one sentence (refs) and the beginning of the next?


 * Cleaned up, there was only one case of this.--TDKehoe (talk) 20:12, 20 November 2007 (UTC)

That's a start; I'll be glad to peek in periodically on your progress. Sandy Georgia (Talk) 02:28, 20 November 2007 (UTC)
 * There are broad swaths of uncited, unreferenced text. Because of your COI, I would like to see peer-reviewed citations on every claim.  I don't want to pepper the article with cn tags, but there are many claims here that need to be cited.  You might want to review WP:MEDMOS and WP:MEDRS.
 * This does not appear to be a peer-reviewed source, how do we know it's not marketing material from your company?  Hyde, L. (August). "Comparison of the SpeechEasy and Casa Futura/Jabra fluency devices.". presentation to the Canadian Association of Persons who Stutter conference.
 * This does not appear to be a peer-reviewed source: Grosser, J; Natke, U., Langefeld, S., & Kalveram, K. Th. (2001). "[ni-duesseldorf.de/abteilungen/km/sprechmo/grosser-2001.pdf Full version (PDF, 27 kb)] Reduction in stuttering by delayed and frequency shifted auditory feedback: Effects of adaptation and sex differences.]". Fluency Disorders: Theory, Research, Treatment and Self-help. Proceedings of the Third World Congress of Fluency Disorders in Nyborg, Denmark., Nijmegen: Nijmegen University Press.
 * Please provide PMIDs or DOIs so others can verify your text. They are easily available for legitimate journal-published research.  For example,   If you need an easy way to format peer-reviewed journal entries, see Diberri's tool (use the dropdown to get to PubMed).
 * The entire External links section is a self-reference.


 * By the way, you removed the previous advert and cleanup tags, with the edit summary: "I removed the 'cleanup' and 'advert' tags because this article was peer-reviewed two months ago and no changes have been made in over a month." The peer review had no input other than mention of your conflict of interest, and "no work done" is not a reason to remove tags.  Work done to correct issues would be a reason to remove tags.  The article is somewhat cleaner in terms of WP:MOS issues than it was months ago, but it still has a lack of peer-reviewed citations and what appears to be biased original research with an advert quality, including the types of issues raised on the stuttering FAR.  Sandy Georgia  (Talk) 03:17, 20 November 2007 (UTC)

I did all of the reference cleanup work I could, but 1) we should not be reporting on single case studies, 2) many of the sources don't have enough info to track them down, 3) many of the sources are conference presentations rather than peer-reviewed sources, and so on. I added an inline query because PubMed returned different information about one study than what was listed here.  In general, we should be reporting on peer-reviewed information that is available in PubMed.  You can search PubMed by entering the study name, locate the PMID number, and feed it into Diberri to get a complete and correct journal citation.  I'll check in again after you've had a chance to do more work here.  Sandy Georgia  (Talk) 18:05, 20 November 2007 (UTC)


 * I'm going to take a break and tackle the references later. I'm waiting for Amazon to deliver the new edition of Bloodstein's Handbook of Stuttering, which will help with the references.--TDKehoe (talk) 18:40, 21 November 2007 (UTC)
 * I may not be able to look in again until after holiday guests leave; will see how things go. Sandy Georgia  (Talk) 20:26, 21 November 2007 (UTC)

Other concerns
I was the one who originally notified you of conflict of interest concerns on this article and your contributions to it. While I agree completely with SandyGeorgia's comments above, I have other concerns on a complete lack of citations for much of the material in the article. Please see Wikipedia's policies and guidelines on no original research and verifiability.

Here are some more comments on the article as it now is (most of these are more sepecifics on Sandy's comments above):
 * The current lead paragraph does not meet the criteria in WP:LEAD. The lead needs to summarize the article, just as an abstract does in a scientific paper. No information should be solely in the lead and all major topics (headers and subheaders) should be mentioned in the lead paragraphs. References in the lead are not needed except for direct quotes or extraordinary claims.
 * In addition to the questionable references, many of the sections or subsections within them have no references at all. Specifically:
 * There are no references in the "Terms used" section - these all need citations.
 * Four of the eight bulleted points in "Types of altered-auditory feedback (AAF)" have no references - these all need citations.
 * Two of five bulleted points in "Unknown effects of altered auditory feedback (AAF)" have no references - these  all need citations.
 * Two of four bulleted points in "Other differences between anti-stuttering devices" have no references - these all need citations. The Manual of Style also says not to include the title of the article in section headers, so this and the nextsection need new section titles.
 * At least three references appear to be presentations that were not actually published. These are current numbers 4 (Brenaut, L., Morrison, S., Kainowski, J., Armson, J., Stuart, A. (1995). "Effect of Altered Auditory Feedback on Stuttering During Telephone Use. Dalhousie University, Halifax, Nova Scotia, Canada. Presentation at American Speech-Language Hearing Association convention, 1995".), 19 (Runyan, C., Runyan, Sara. (2006). "[The Speech Easy: A Two Year Study". presentation at the American Speech-Language Hearing Association convention, November 2005. A follow-up study was presented at the American Speech-Language Hearing Association convention, November 2006..), and 29 (Hyde L (August). "Comparison of the SpeechEasy and Casa Futura/Jabra fluency devices". presentation to the Canadian Association of Persons who Stutter conference.). Please see the policy on reliable sources, which says that they must be published. I am also leery of current reference #30 (Pollard, R., Ellis, J.. Ramig, P., Finan, D. (2007). "A longitudinal study of the effects of the SpeechEasy device in naturalistic environments" (PDF). presentation to American Speech-Language Hearing Association convention, November 2006; an updated study was presented at the International Stuttering Association conference, May 2007.) which does not appear to be peer reviewed, just the handout from the presentation.

Please address these concerns as soon as possible. thanks, Ruhrfisch &gt;&lt;&gt; &deg; &deg; 00:03, 24 November 2007 (UTC)

I've been busy with other projects and the new edition of A Handbook on Stuttering (the most respected secondary source in the field) just arrived. I'll try to add references in the next week or so. Regarding papers presented at conferences, they're either published later or were minor studies, so removing them makes no difference. The exception is studies that are "in press" with a peer-reviewed publication (a process that can take years) but have been presented at one or more conferences. The Pollard study is an example of this. I suggest including the Pollard study and when it is published it's easy enough to change the reference from the conferences to the publication.--TDKehoe 16:08, 3 December 2007 (UTC)

My comments
The article has certainly improved, which is a good start! I still have grave concerns about it, and I would echo the comments made above. In addition I would question the entire section "Studies of anti-stuttering devices" in its current form. I do not find it encyclopedic to have a listing of studies, and note that other similar articles about assistive technology do not include it e.g Hearing aid. I too do not believe that in this context presentations at conferences qualify as reliable sources (especially since I have presented at many of the same conferences, and wouldn't dream of using these as reliable sources for an article on WP!). I should also point out that many of the authors of these studies are directly involved in the companies that produce anti-stuttering devices including Kalinowski and Saltuklaroglu. They are involved with the SpeechEasy, and the methods they have used in their research and promotion of the device have been deemed "pseudoscience" by other members of the profession in a peer-reviewed journal article in the American Journal of Speech-Language Pathology. This has been followed by a lively correspondence on the subject. In addition, a systematic review of stuttering treatment methods found no studies of anti-stuttering devices that met minimal criteria for scientific control etc.

I do not feel that the current section, as written, is appropriate for all of these reasons. I suggest that it be replaced with a short summary paragraph about the efficacy of the devices, which could include overviews of the research on effectiveness as noted in books and review articles. The section would also include some of the of the criticisms noted above. Any feedback?.Slp1 (talk) 15:02, 24 November 2007 (UTC)
 * Concur, considering the sources you've presented above; the section should be reduced to a paragraph and all non-reliable or refuted sources removed. Sandy Georgia  (Talk) 15:15, 24 November 2007 (UTC)
 * If there are no further comments, I will make an edit of this sort in a few days when I have some resources available.Slp1 (talk) 02:12, 27 November 2007 (UTC)
 * Sounds good to me - thanks for doing this Ruhrfisch &gt;&lt;&gt; &deg; &deg; 03:38, 27 November 2007 (UTC)

The reason to use a list of studies is to avoid bias. Making generalizations invites mistakes and biases. On the other hand, a list of studies is more difficult to read, and some studies may contradict other studies, thus confusing readers. This is why encyclopedias make broad generalizations instead of listing studies. If unbiased, accurate generalizations can be made, then this is better than a list of studies. However, a list of studies is better than biased, inaccurate generalizations. For example:--TDKehoe 16:55, 3 December 2007 (UTC)
 * The reference "Ward (2006), p.296" isn't a proper reference. Please add the book or article title, the publication name, etc.
 * Please check the top of the reference section and you will see that the reference has been given in full
 * All the other references have references numbers. Please use the same referencing system as the other references. Also please sign your comments.--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * Since SandyGeorgia, who is one of WP's leading experts on Manual of Style issues, made the change to how the Ward article is currently referenced, I don't think I will be following your advice.--Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * "The effect of frequency altered feedback is not as powerful as delayed auditory feedback, but used in combination may bring about a 70 per cent increase in fluency according to some studies." This statement is incorrect, and there's no reference that can be checked.
 * The reference is given, actually. The exact quote from Ward is "However, research indicates that FAF is more effective when used in combination with DAF, as is possible with both the Fluency Master and Speech Easy devices. Generally speaking, available evidence suggests that this combination brings about a 70 percent increase in fluency."
 * The Ward quote is accurate, except for part about the Fluency Master, which has neither DAF nor FAF. But what you wrote isn't what Ward said. Ward said that the DAF/FAF combination is more effective than FAF alone, not that DAF alone is more effective than FAF alone.
 * I should also have included the preceeding sentence from Ward p. 297. "FAF on its own does not seem as powerful as DAF. One study found that only 50% of a group of people who stuttered improved wthier fluency under this condition as opposed to 100% whose fluency increased under DAF (Natke, 2000).  However, research indicates that FAF.... (as above)"--Slp1 (talk) 19:35, 9 December 2007 (UTC)
 * "Purchasers of an AAF device reported that the device reduced stuttering and had a positive effect on their conversational speech and telephone use." The word "purchasers" and "their" should be changed to "the developer of" and "his." IMHO that sentence should be removed or referenced to a study of users other than the person who developed the device in question.--TDKehoe 16:55, 3 December 2007 (UTC)
 * I don't understand you. The study cited reports data from 105 people.
 * I confused this with another paper in which Kalinowski discussed his personal experiences.--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * "However, the effects of altered feedback are highly individualistic, with some obtaining considerable increases in fluency, while others receive little or no benefit." This is an example of an too-broad generalization. The problem is that different users are different, different devices are different, different speaking situations are different. Imagine that the Acme Anti-Stuttering Device is 100% effective for all male user, but ineffective for female users; and the Primo Anti-Stuttering Device is 100% effective for all female users, but fails miserably for male users; and the Zuperduper Anti-Stuttering Device is of no benefit for anyone. You could make an accurate but misleading generalization that some users experience "increases in fluency, while others receive little or no benefit." A better generalization would be to say that some devices are more effective than other devices, some speaking situations are more conducive to using an anti-stuttering device than other situations, and some individuals benefit from anti-stuttering devices more than other individuals.--TDKehoe 16:55, 3 December 2007 (UTC)
 * "Individualistic" or variation thereof is term that has been specifically used by a number of authors/researchers, including Ward "The effects do appear to be highly individualistic"; Lincoln et al 2006, "Several authors have suggested that AAF devices may be most profitably used in combination with other strategies such as prolonged speech (Ingham et al., 1998; Kalinowski et al., 1998; Zimmerman et al., 1997). This suggestion has flowed from the recognition of highly individualized responses to AAF and the failure of AAF to reduce stuttering to levels that are acceptable to some clients." There are others, but that is enough for now. Your other suggestions are predicated on quality research in that has not yet been published following peer-review.
 * "Individualistic" is a vague term that seems to mean different things to different people. Are these secondary sources saying that there are differences in effectiveness when different individuals use different devices in different situations? If so, then let's say that, as it's more clear. If not, what are these secondary sources trying to say?--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * The sentence in the article makes this clear. "However, the effects of altered feedback are highly individualistic, with some obtaining considerable increases in fluency, while others receive little or no benefit."--Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * "The reasons behind these differences are not known." Another inaccurate too-broad generalization, without a proper reference. For example, reference #23 found that binaural anti-stuttering devices are more effective than monaural anti-stuttering devices. Reference #2 found that DAF and FAF were more effective than white-noise masking. Other studies found different effects in different speaking situations. Many reasons for these differences are known.--TDKehoe 16:55, 3 December 2007 (UTC)
 * The reference is properly cited, where the exact quote is: "That is, (the majority) respond favourably to the technique, but others do not, despite having had the opportunity to experiment with a range of delay settings on the altered feedback devices. As yet, we do not know why."
 * This quote seems to be talking specifically about DAF, when what you wrote generalized to all types of AAF. As I said, broad overgeneralization should be avoided, in general. :-)--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * You have a point here and I will correct as appropriate.--Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * "The longterm effects of altered feedback are also unclear: anecdotal reports suggest that over time users receive continued but lessened effects from their device." Another inaccurate too-broad generalization, without a proper reference. Several long-term studies have been published, such as references #16, #19, #20. I would also suggest not using anecdotal reports when published studies are available.
 * This is also well-cited from Ward, who is published. Perhaps you might want to get the book and check these out for yourself?
 * Is Ward's book based on anecdotal reports or on published, peer-reviewed studies? Perhaps it shouldn't be used as a source.--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * Ward is a leading British academic at the University of Reading, and specialist in fluency. His book is certainly not based on anecdotal reports.--Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * "Critiques have noted weaknesses in the many of the studies measuring the efficacy of electronic fluency devices" Another too-broad generalization. Some studies are weak, some are excellent. This is the case for any subject, in any field.--TDKehoe 16:55, 3 December 2007 (UTC)
 * This is not my opinion but the opinion of the authors cited. You may disagree, that is original research.  And I simply don't agree that this is the case for any subject in any field.
 * "criticized their high-profile promotion in the media as inappropriate given the scientific evidence for their effectiveness" Another too-broad generalization. I've seen criticism of one anti-stuttering device for being over-promoted and under-proven, but other anti-stuttering devices are well-proven and have little or no promotion in the popular media.--TDKehoe 16:55, 3 December 2007 (UTC)
 * Check out . I guess I should add it as a reference though.
 * "A review of stuttering treatments noted that none of the studies on altered auditory feedback met the criteria for experimental quality." The referenced article looked at less then 10% of the published studies in the field of anti-stuttering devices, so this statement is another over-broad generalization.--TDKehoe 16:55, 3 December 2007 (UTC)
 * The study did an exhaustive initial literature search to find published studies that met criteria. Check out pages 324-5 of the article. Many of the reports of studies you may be referring to were conference presentations, posters or were published post 2005, and so are not included. I also note Bothe et al's recent comments, which are related to this..."Kalinowski et al. (2007, p. 72) emphasized their “50 published peer-reviewed publications and 50 national and international presentations,” but the sheer number of publications about tangentially related topics is almost irrelevant. There are not 50 publications that provide socially, ecologically, and empirically valid clinical evidence supporting the use of the SpeechEasy, or anything like it, to improve the spontaneous, self-formulated speech of persons who stutter."
 * I read the article, it was anything but an exhaustive literature review. I detailed many reasons that article is a poor source, in the discussion page for the Stuttering article. The Bothe letter didn't say that Kalinowski's 50 published studies were poor quality, she just said that few were studies of the SpeechEasy device. Again, you're making broad overgeneralizations.--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * "It was anything but an exhaustive literature review": I thoroughly disagree and suggest you take up your opinion with the authors, as well as peer-reviewers of AJSLP. A good start would be to find some published studies meeting their criteria that they missed in their searches. But remember that would be original research.  The focus here is on verifiability, not truth.  Bothe et al says that there are few "socially, ecologically, and empirically valid clinical" studies of the the SpeechEasy, as noted above. --Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * "Others noted that studies have tended to be laboratory-based, and have examined the effects of AAF on short speech samples and in reading tasks. There has been limited investigation about the effects of the devices in everyday, conversational speaking situations." This is not inaccurate, but not accurate either. The first studies of AAF was laboratory-based, on short speech samples. Over time these studies have evolved to investigate more natural speaking situations. The Pollard study is an excellent example. In other words, the statement was true a few years ago, is questionable now, and likely will be wrong in another year or two.--TDKehoe 16:55, 3 December 2007 (UTC)
 * It is, actually, an accurate summary of Lincoln et al's comment, as you can check from the PubMed summary even if you don't have access to the full article.  The preliminary results of the Pollard study looks interesting, but the study hadn't even finished in May, let alone received the kind of peer-review required for inclusion here. 
 * The Pollard study was finished when it was presented in May.--TDKehoe (talk) 18:37, 9 December 2007 (UTC)
 * Um no it wasn't, based on the abstract.. --Slp1 (talk) 19:32, 9 December 2007 (UTC)
 * Response I have very limited time, but have responded to your concerns. They are interleaved in italics above.Slp1 18:56, 3 December 2007 (UTC)

Questions
Does this statement need five sources? Is there one source that is more comprehensive, or more of a review, than the others, so that it can be reduced to one or two definitive sources? Since the studies are disputed, I'm unclear why we include all of them? Also, there's an extra word in there. Something is goofed up in this sentence: The prose here needs re-working to avoid based, based, based. Sandy Georgia (Talk) 17:27, 1 December 2007 (UTC)
 * Studies have shown that altered auditory feedback (including delayed auditory feedback, frequency altered feedback) can reduce stuttering in by 40 to 80 per cent.[25][16][26][27][28]
 * The longterm effects of altered feedback are also unclear: anecdotal reports suggest that receive continued but lessened effects in the long term.
 * In particular, studies have tended to be based in a laboratory-based, and based on short speech samples and reading tasks.

Name Change
"Electronic fluency aids" is a poor choice of title because the field of fluency disorders includes stuttering (properly called developmental stuttering); cluttering; spastic dysphonia; a wide variety of neurogenic fluency disorders including speech disorders associated with Parkinson's disease, strokes, and head injuries; and psychogenic fluency disorders. While the same devices are often used to treat both stuttering and other fluency disorders, this article covers only the use of the devices with stuttering. I dislike the term "anti-stuttering device" because it suggests a device that you put on and your stuttering is instantly and completely gone. I would like the devices to be called "stuttering treatment devices" because this suggests that the devices are one way (among many) to treat stuttering, that the devices can be used with other stuttering treatments, etc. However this term hasn't caught on. My suggestion is to title the article "Stuttering treatment devices" but make "Anti-stuttering devices" a search phrase that links to this article.--TDKehoe 17:08, 3 December 2007 (UTC)
 * If this article covers only the use of devices with stuttering, it should be expanded to cover all devices. There is consensus established already against the term "anti-suttering devices", as it is not supported by the sources.  Sandy Georgia  (Talk) 01:25, 9 December 2007 (UTC)

Merger
delayed auditory feedback (DAF) merger... sure whatever. I've never read about Electronic fluency device but I'm not usually reading that stuff either. --CyclePat (talk) 06:46, 7 December 2007 (UTC)

Added references, removed generalizations
I added some references and removed some overbroad generalizations. I also added references for the two graphics. I was going to add references to some sections such as the size of devices or that some devices remove background noise, but these references would be to commercial websites (including my company's website); would that be a conflict of interest?--TDKehoe (talk) 20:22, 8 December 2007 (UTC)

I disagree with several of your recent edits:
 * You have deleted well-sourced content, as detailed above, (that perhaps not coincidentally doesn't put fluency devices in the best of lights) replacing it with information that is not sourced (there are no published experimental studies comparing different AAF devices)
 * I didn't see that you'd added the full reference to "Ward, 2006" because you listed this reference without a reference number, when all of the other references have reference numbers. Please put reference numbers on all your references. I didn't need to reference my statement that different AAF devices are different because the article has pages of material discussing the differences between AAF devices, with about 40 references. For example, reference #26 (Stuart, 1997) compared two types of AAF (monaural vs. binaural).--TDKehoe (talk) 18:09, 9 December 2007 (UTC)
 * See above for response re formatting of references. Yes you do need to specifically reference your edits, to the claims made.  --Slp1 (talk) 20:41, 9 December 2007 (UTC)


 * You did not "add references for the two graphics". You readded two images that put your product in a good light, without any reference to which study they come from. (Addendum: on further examination I note that you actually did cite the studies on the image page, at least.  However, I also note that you yourself created these graphs based on data from the study. Further investigation is probably warranted.)


 * The references are on the pages for the graphics.--TDKehoe (talk) 18:09, 9 December 2007 (UTC)
 * I had already noted this. But my main point, (that you did not describe your edits accurately: you did not add references, you added the graphics) still stands--Slp1 (talk) 20:41, 9 December 2007 (UTC)


 * You have readded a reference to a conference presentation of a study that was not even complete at the time of the presentation (Pollard et al) as well as information "cited" to it, that two editors have pointed out is not a reliable source.


 * The Pollard study was complete when it was presented at the ISA conference in May, 2007. Wikipedia policy allows citing studies presented at conference, see Template:Cite_conference. The Pollard study was presented at two of the most respected conferences. But if you don't like it I'll change the reference to the Armson study in which AAF devices where used in several speaking situations, including public speaking.--TDKehoe (talk) 18:09, 9 December 2007 (UTC)
 * Which Armson study are you talking about?--Slp1 (talk) 20:41, 9 December 2007 (UTC)


 * You have copied a great chunk of text from where you wrote it at Wikibooks .  I have already pointed out that this text is not an accurate reporting of the conclusions of the study.
 * You're confusing the results after one year and the results after four years. I reported the two studies accurately.--TDKehoe (talk) 18:09, 9 December 2007 (UTC)
 * Umm no. Your edit claimed "I.e., the computers were most effective, the parents next most effective, and the speech-language pathologists were least effective in the long term. At the 1% disfluency level, the computers and the parents were about four times more effective than the speech-language pathologists." The conclusion of the first, 1996 study says: "The results of the present study showed that all three treatments were reasonably successful for children aged 9-14 years who stutter and there were no statistically significant differences between, the treatment groups means in treatment efficacy as measured by stuttering frequency across time." The Hancock et all 1998 study confirms this saying "The 3-month results of the controlled trial showed all 3 experimental groups had substantially and significantly lower levels of stuttering in comparison to the no-treatment controls. There were no significant differences between the 3 treatments up to 1 year post-treatment in terms of treatment effectiveness", and "Results demonstrate that treatment gains were maintained in the long term, with rates of stuttering similar to the 1 -year postoutcomes.There were no significant differences among the 3 treatments in long-term effectiveness." Your claim that some treatments were better than others are not supported by the conclusions of the authors of either study,(see above) nor subsequent researchers who have quoted the study (e.g. Ward p. 241,).  You also include other original research and commentary: "This may have been due to the more dysfluent children receiving additional speech therapy."  Nowhere in Hancock's 1998 study is this suggestion made, and in fact, it is specifically stated that only 12% had received any additional therapy. So, overall, no, I do not believe that you have reported the study accurately.Slp1 (talk) 20:41, 9 December 2007 (UTC)

I have other concerns but that is enough for now. I am beginning to get a bit frustrated by this process of continually needing to give this kind of feedback, which seems to leave so little time for actual article editing.Slp1 (talk) 21:46, 8 December 2007 (UTC)


 * Commercial sources should not be used here under any circumstances. Tdkehoe, if you continue to oppose consensus here and ignore COI, I will request that you be blocked.  Let's not go there, please.  Sandy Georgia  (Talk) 01:26, 9 December 2007 (UTC)
 * Thanks for reverting Sandy - my intention was to mention this at the WP:COI/N page - any reason why I should not? Ruhrfisch &gt;&lt;&gt; &deg; &deg; 02:27, 9 December 2007 (UTC)
 * I've already mentioned that the COI concerns are ongoing; I hope we can avoid requesting a block, but I don't think wasted time is fair to Slp1. Sandy Georgia  (Talk) 02:37, 9 December 2007 (UTC)
 * Thanks for noting this ongoing behavior there and sorry that I missed the change on my watchlist (intervening edits) and I just didn't check. Ruhrfisch &gt;&lt;&gt; &deg; &deg; 03:15, 9 December 2007 (UTC)
 * Tdkehoe, I would like to propose that we try the suggestion at WP:COIC: you refrain from editing stuttering articles, and instead you post specific suggested edits on the talkpages, so that other editors can assess them first. I am sure that you have a lot to offer Wikipedia, but the current working method is not going very well, unfortunately for all of us. Just so you know, I have no particular opinion about the efficacy of these devices: in fact I currently have some of your products in my office to try with clients. However, I am in favour of a neutral, verifiable, informative set of articles here, and that is proving a bit of a challenge to achieve at present. I think that proposing any major edits on the talkpages first would help a lot.Slp1 (talk) 14:34, 9 December 2007 (UTC)


 * Thanks again for your feedback, it has been very helpful.--TDKehoe (talk) 18:09, 9 December 2007 (UTC)

Added biofeedback section
I've added a biofeedback section. When I have time I'll add studies of CAFET system and other non-EMG devices. Again, to add references for some items I'll need to reference commercial websites such as Dr. Fluency and Hollins. Is this acceptable?--TDKehoe (talk) 21:08, 8 December 2007 (UTC)

Mistakes (December 22, 2009)
1. "Electronic fluency devices (also known as..." The FDA uses the term "anti-stammering device." "Assistive devices" and "electronic aids" are too broad terms to be meaningful in this context.--TDKehoe (talk) 16:39, 23 December 2009 (UTC)

2. "Computerized feedback devices" This term is incorrect. The paragraph describes biofeedback devices, some of which are computerized and some aren't. Biofeedback is the measurement and display of a bodily process to improve the user's awareness and control of that process. The paragraph is correct that microphones are used for vocal volume (loudness) but neglects to mention that other instruments are sometimes used, such as the chest straps used by the CAFET and Dr. Fluency to monitor breathing, or electromyographs used to monitor speech motor activity. "Computerized feedback devices" described many devices that don't provide biofeedback, such as SpeechEasy, Casa Futura Technologies' SmallTalk, and VoiceAmp, which are computerized and provided altered-auditory feedback. This paragraph would be more clear if it mentioned biofeedback devices by name, such as CAFET and the Hollins FluencyNet. The sentence "No peer-reviewed studies have been published showing the effectiveness of commercial systems in a clinical context." is literally correct but misleading. The paragraph describes non-commerical devices as well as commercial devices, and then makes a specific statement about commercial devices while ignoring the many studies of non-commerical devices (some of which lead to the development of commercial devices). For example, Craig, A., et al. “A Controlled Clinical Trial for Stuttering in Persons Aged 9 to 14 Years,” Journal of Speech and Hearing Research, 39:4, 808-826, August 1996 and Hancock, et al. “Two- to Six-Year Controlled-Trial Stuttering Outcomes for Children and Adolescents,” Journal of Speech and Hearing Research, 41:1242-1252, December 1998 is an excellent study of an electromyographic biofeedback device. They studied 98 children between the ages of 9 and 14 years old, had a control group, and did follow-ups at one year and four years.--TDKehoe (talk) 16:39, 23 December 2009 (UTC)

3. "Altered auditory feedback devices...Edinburgh Makser." That should be "Masker." The device is not discontinued, it has been incorporated into the VoiceAmp. Also, this paragraph confuses two types of masking, white noise and sine wave. The latter is used in the Edinburgh Masker. --TDKehoe (talk) 04:50, 23 December 2009 (UTC)

4. "Frequency-altered feedback...most studies have noted that DAF is more powerful than FAF in reducing stuttering." The referenced paper says (Lincoln, page 73: "Howell et al. (1987) are credited with discovering the effect of FAF on stuttering and subsequently reported that FAF was more effective in reducing stuttering than DAF. While the effect of FAF has subsequently been replicated, the finding that it is more powerful in reducing stuttering when compared to DAF has not." Lincoln is saying that the subsequent studies found DAF and FAF to be more or less equally effective, i.e., that one has not been found to be consistently more effective than the other. Also, this paragraph describes pitch-shifting FAF, which is used in Casa Futura Technologies devices and the Yamaha rack-mounted effects processors, and all of the published studies investigated. The paragraph fails to mention that there is another type of FAF (frequency-shifting) which is used in SpeechEasy and VoiceAmp devices and has never been investigated in a peer-reviewed study.--TDKehoe (talk) 17:20, 23 December 2009 (UTC)

5. "Effectiveness...studies have been critiqued for failing to demonstrate ecological validity; in particular that AAF effects continue over the long term and in everyday speaking situations." The following studies (listed in the references) were either long-term or in everyday speaking situations or both: Zimmerman, 1997; Van Borsel, 2003; Radford, 2005; Stuart, 2006; O'Donnell, 2008; Pollard, 2009.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

6. "Effectiveness...Using AAF via the SpeechEasy was effective in reducing stuttering in scripted telephone calls and giving presentations according to two studies.[18][20]" Neither of these studies were of the SpeechEasy device. The SpeechEasy was introduced in 2001 and the studies were published in 1997. Study #18 used a Casa Futura Technologies Desktop Fluency System. I don't have a copy of study #20 but it was likely either the same Casa Futura Technologies device or Yamaha rack-mounted effects processor.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

7. "Effectiveness... There are few published studies on the effect of the AAF in the daily activities of life." The references list three such studies: Zimmerman, 1997; O'Donnell, 2008; Pollard, 2009.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

8. "Effectiveness...the longterm effects of altered feedback are unclear." The references list five long-term studies: Van Borsel, 2003; Radford, 2005; Stuart, 2004 and 2006; O'Donnell, 2008; Pollard, 2009. The five studies had different results because different devices were used, different speaking situations were tested, speech therapy was or wasn't used in conjunction with the devices, etc. It might be more accurate to say that "the long-term effects of altered-auditory feedback are different for different devices, different speaking tasks, whether the devices are used in conjunction with speech therapy, or other factors."--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

9. "Effectiveness...the effect of AAF may fade after a few minutes of exposure,[24]" The referenced study was of 10-minute exposure to AAF. I'm skeptical that a study lasting 10 minutes can be extrapolated out to months or years. I.e., I suggest moving this reference to the section on short-term studies.--TDKehoe (talk) 16:54, 23 December 2009 (UTC)

10. "Effectiveness...some anecdotal reports suggest that over time users receive continued but lessened effects from their device." Please reference the Wikipedia policy allowing anecdotal reports to be cited when scientific studies published in peer-reviewed journals are available that contradict the anecdotal reports. Why does this paragraph start with general statements apparently referring to all fluency devices, and then talk only about SpeechEasy devices, and not mention the long-term studies of other devices, e.g., Van Borsel, 2003; Radford, 2005? The way this paragraph is written it confuses the reader between general statements about all fluency devices and statements about specific devices, sometimes mentioning the devices by name but at other times not mentioning the devices by name.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

11. "Effectiveness...They reported that the device was difficult to use in noisy situations as the device amplifies all voices and sounds." This paragraph also starts with a general statement and then talks about a specific device without mentioning what device is being discussed. This confuses readers as to whether all devices have this issue or whether only one device has this issue.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

12. "Use with children...There is little experimental evaluation of the therapeutic effect of AAF on children who stutter." Radford (2005) is a long-term (one year) study of an eleven-year-old boy.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

Bias towards SpeechEasy?
13. There are 13 mentions of SpeechEasy devices in this article, one mention each of four other devices (three no longer on the market), and no mentions of VoiceAmp or Casa Futura Technologies devices (these three companies have more or less equal market share, with Fluency Master a more distant fourth). The reference list has three studies of Casa Futura Technologies devices (Zimmerman, 1997;Van Borsel, 2003; Radford, 2005) and four studies of SpeechEasy devices (Stuart 2004 and 2006; Armson, 2006; O'Donnell, 2008; Pollard, 2009). I'm aware of 14 other studies of Casa Futura Technologies devices, I'm not aware of any other studies of SpeechEasy devices. Also the sentence "Current devices may be similar in size and appearance to a hearing aid, including in-the-ear and completely-in-the-canal models" is another reference to SpeechEasy, which makes the only ITE and CIC devices. Vocaltech and Casa Futura Technologies devices don't look like hearing aids, they look more like iPods. Did a SpeechEasy employee or a dealer edit this article to promote SpeechEasy? Maybe someone could go through the edit history and see if one person made all 13 mentions of SpeechEasy.--TDKehoe (talk) 04:50, 23 December 2009 (UTC)

Clarity
14. In general this article is confusing. It makes general statements and then supports the general statement with a specific study of one device used in one speaking situation. It would be less confusing to readers if descriptions of studies specified what device was used, what the speaking situation was, whether speech therapy was used in conjunction with the device, etc. There are only seven studies in peer-reviewed scientific journals that I know of that investigated long-term and/or high-stress use of the devices (Zimmerman, 1997;Van Borsel, 2003; Radford, 2005; Stuart 2004 and 2006; Armson, 2006; O'Donnell, 2008; Pollard, 2009). It might be better to summarize the seven studies, then present the conclusions that can be drawn from a meta-analysis of the studies, e.g., the issues of "wearing off" of effectiveness over time, long-term carryover fluency (training the user to no longer need the device), high-stress vs. low-stress speaking situations, and using devices in conjunction with stuttering therapy vs. no therapy. Those four issues pretty much cover effectiveness. Another important issue is hearing loss (both temporary and permanent) but no studies have investigated this. I've written summaries of the seven studies at, I'll give permission to copy my summaries, although they may be too technical for Wikipedia standards. I believe that I uploaded the graphics to Wikipedia a few years ago. If an editor wishes to read the original studies, I have PDF versions of most of them.--TDKehoe (talk) 17:13, 23 December 2009 (UTC)

Response to Tdkehoe
Welcome back, Thomas, and I hope all is well with you. Thanks for your extensive comments and feedback on the article. I appreciate that you have chosen to comment rather than edit the article directly. I have added some numbers to your comments, and will attempt to respond them briefly using these as indicators.
 * 1. Per WP:V, we must reflect the peer-reviewed sources we cite, not our views on the "correct" term/interpretation. On a very simple level, as in 2. "Computerized feedback devices" is the actual term used by Ward. Also per your comment at 2.  Ingham et al says "As yet, no data have been published demonstrating the effectiveness of any of these commercial systems in a clinical context." In 3. you claim that the Edinburgh Masker is not discontinued.  But it was according to the sources given, and the VoiceAmp only has software to "emulate" it according to this. Do you have any reliable sources to support your claim? If so, please produce it.  I also don't believe that you correctly interpret the authors' intent in 4. And in your comment 10, this is precisely the view of the secondary source cited. e.g. p 296 "Anecdotal reports from those who have tried DAF devices over a period of time are equivocal. Some had reported a continued but lessened benefit over a period of a few months, others found little benefit to start with, and did not continue with the device." If you honestly feel that the article does not reflect the sources cited, you have a point.  If you don't agree with the sources, then we get into original research, my point 2.
 * 2. We cannot include our own personal research and opinion or meta analysis Your attempt to reinterpret the evidence of peer-reviewed authors is obvious in 8,9,14 in particular.  Unless there is a reliable source that states what you consider to be "more accurate", then we are stuck with reporting with what they do say.   We also cannot report on what has not been studied.  The suggestion in 4.  that "The paragraph fails to mention that there is another type of FAF (frequency-shifting) which is used in SpeechEasy and VoiceAmp devices and has never been investigated in a peer-reviewed study: is an absolute no-no of original research, fine on your website or but contrary to policy here.  In addition, you refer to Craig et al (1996), and Hancock et al (1998),(in 2.) but as I pointed out two years ago, the conclusions of the authors of these studies do not support your personal conclusions. These issues of reinterpretation of published data also covers your comments in 5,7,8,9,10,12. In 12, for example, the abstract specifically states that "no conclusions are possible", as multiple intervention approaches were used at the same time.
 * 3. Using Wikipedia to promote (or to reduce the negative view) of your product is a no-no. If you can prove that your products are less likely to have problems in noisy situations,(see 11.) let's see your sources. Ditto with your comments in 14 where you complain about the preponderance of SpeechEasy references. I did an extensive search of the journal literature in the spring of 2009. The new articles I found were for the most part about about the Speech-Easy. What I found has been included, and you might be thankful, as the news about long-term Speech-Easy effectiveness has not been very good. If you have suggestions of peer-reviewed studies about your products (or those of your competitors) that I have missed, I would be glad to see them listed here. This is particularly important if you are going to claim for example, per the suggestion in 8. that "the long-term effects of altered-auditory feedback are different for different devices,". This kind of statement requires a peer-reviewed study that actual shows that one product is more effective than another, a study, that as far as I know, does not exist. But if it does I would be glad to be pointed in its direction.


 * I'd like to say that some of your suggestions for improvement are useful. As the main editor here (and someone who has absolutely no connection to SpeechEasy or any other of these devices, despite allegations above), I will be happy to look into the more relevant critiques over the holiday season. --Slp1 (talk) 01:40, 24 December 2009 (UTC)


 * Thank you for posting the peer review request, and thus reminding me (albeit somewhat obliquely) of my promise to address your legitimate points above. As you will have seen I have made some changes in response to your posts above.  Those things I haven't changed are because I don't think policies and guidelines support your reasoning, as I have explained above.  If you still have questions or concerns, you could try asking me, or, if you want to get outside opinions, try posting a third opinion request. Peer review isn't actually used to sort out this kind of content dispute question, though I agree that one might think so based on the title. --Slp1 (talk) 23:14, 16 January 2010 (UTC)

Third-party payers
The article article about Hearing_aids has a section about third-party payers such as national health services that subsidize the cost of hearing aids. Is it allowable for the Electronic_fluency_devices to have a similar section?--TDKehoe (talk) 18:20, 19 January 2010 (UTC)
 * I don't think it is necessary or appropriate since we are not a how to manual. I'd also be concerned about finding reliable sources about the matter. I'm not actually in favour of the list on the hearing aid page either.  It will becoming totally unmanageable as increasing numbers of countries get added. --Slp1 (talk) 01:09, 25 January 2010 (UTC)

Edinburgh Masker
The paragraph on "Masking" contains several mistakes. The Edinburgh Masker did not produce white noise, it produced sine waves synchronized to the user's fundamental frequency of phonation; effectiveness did not fade with time; and no study compared its effectiveness to DAF or FAF. “The Long Term Use of an Automatically Triggered Auditory Feedback Masking Device in the Treatment of Stammering,” Ann Dewar, A.D. Dewar, W.T. S. Austin, H.M. Brash, British Journal of Disorders of Communication, Vol. 14, No. 3., winter 1979/80 stated: “The sound produced by the instrument is a ‘humming’ noise of mixed low frequencies and harmonics of up to approximately 500 Hz with peak frequencies of 125-250 Hz but varying with the mean frequency of the subject’s vocal cords.” (page 220) That study found that of 195 stutterers (144 classed as severe, 43 as moderate, and 8 as slight) 89% “responded well to the device.” Of the 21 who did not respond well initially, 9 had silent blocks, 2 of whom then received therapy and were able to use the device; 6 showed a “satisfactory response to the device” but refused to use the device for “cosmetic or other reasons”; 3 wore hearing aids; and the remainder had stuttering accompanied by other disorders (dysarthria, Parkinsonism, mentally retarded). 67 subjects were then followed for periods from 6 to 28 months (average, 12 months). All responded to a questionnaire, and some were contacted by telephone, mail or direct clinical observation. The result was that 42% reported that the device was of “great” benefit, 40% of “considerable” benefit, and 18% of “slight” benefit. 67% reported carryover fluency (“as a result of using the Masker, their unaided speech fluency had improved”). Five said that they had “become fully fluent as the result of the using the Masker and have not needed to use the device for some time.” 70% said that there was no adaptation or “wearing off” of effectiveness, 25% said it was “slightly less” effective and 5% said it was “much less” effective. The devices of 14 subjects who’d reported loss of effectiveness were examined and all were found to be faulty, e.g., low batteries or broken wires. The average user used the device 3.3 hours per day. The volume in the users’ ears was measured in ten subjects and found to average 77.6 dBA, with a range of 70 to 85 dBA. The hearing of 5 subjects was tested and no indications of hearing damage were found. Another study (Block, S., Ingham, R.J., & Bench, R.J. (1996). The effects of the Edinburgh Masker on stuttering. Australian Journal of Human Communication Disorders, 24, 11-18.) found that the device reduced stuttering 50% both in the speech clinic and beyond. Herb Goldberg, who provided nearly 3000 devices to American stutterers, wrote to me on September 9, 1994, “I am in contact with over 500 people who use or have used the Masker. In most cases the end result is the person uses the device less and less as time passes due to less need for it.”--TDKehoe (talk) 19:04, 22 February 2010 (UTC)

No one has responded to this request for a correction. I'll go ahead and make the changes.--TDKehoe (talk) 21:54, 25 December 2021 (UTC)

Edit request: Bothe (2006) review
This sentence is misleading:

A 2006 review of stuttering treatments noted that none of the treatment studies on altered auditory feedback met the criteria for experimental quality.

The above sentence should be removed or changed to:

A 2006 review of stuttering treatments noted that three treatment studies of the SpeechEasy device did not the criteria for experimental quality.

The sentence in question suggests that the Bothe (2006) article was a review of all altered auditory feedback (AAF) treatment studies. There are hundreds of such studies, many done in speech labs with large, heavy devices. For example, the original delayed auditory feedback (DAF) devices in the 1960s were modified reel-to-reel tape recorders. The Bothe (2006) article reviewed three studies, all of the wearable SpeechEasy device. The article stated why most AAF studies were excluded: “Laboratory-bound investigations of fluency-inducing conditions…were excluded as not meeting [the review] criterion.” In other words, they only wanted to review studies of wearable AAF devices.

The Lincoln (2006) article reviewed 17 treatment studies of wearable AAF devices from at least four companies. The Lincoln (2006) review is discussed in this article and is, in my opinion, a superior review article. This article only mentions the Bothe (2006) review once, and the sentence is misleading if not inaccurate. The sentence should be removed. Alternatively the sentence should be modified to clarify that only three studies, all of devices from the same company, were examined. The sentence shouldn't suggest that all studies of the SpeechEasy device were examined. This article references seven studies of SpeechEasy devices, plus two letters to editors about the devices.--TDKehoe (talk) 03:20, 30 December 2021 (UTC)
 * Yes check.svg Done  I made this edit for you. Edhaves (talk) 08:33, 17 October 2022 (UTC)

Specify devices please
Making broad generalizations such as "electronic fluency devices have this effect" or "electronic fluency devices don't have that effect" are misleading and confusing. It would be better to specify, "this device was shown to have this effect" or "that device was shown to have that effect." I went through the article and specified that Edinburgh Masker and SpeechEasy devices were used in studies of Edinburgh Masker and SpeechEasy devices. I don't have any financial connection to those devices. I didn't specify that studies about Casa Futura Technologies devices used Casa Futura Technologies devices, nor did I add any references to studies of Casa Futura Technologies devices, as I have a financial interest in this company. References [10] [19] [20] [24] [27] [37] [42] used Casa Futura Technologies devices. The article would be more clear if the sentences with these referenced that Casa Futura Technologies devices were used.--TDKehoe (talk) 22:26, 25 December 2021 (UTC)

No one has responded to this talk section so I went ahead and clarified that two studies used Casa Futura Technologies devices. The studies were independently done and not funded by Casa Futura Technologies.--71.211.157.117 (talk) 17:01, 27 December 2021 (UTC)
 * Based on this location, I presume that this ip is you, Thomas, editing logged out. That's fine. It is easy to do this by mistake.
 * Given your conflict of interest you should not add this information yourself. Please wait for other editors to make the edits, if they agree. It will take longer than a couple of days for sure.-Slp1 (talk) 21:34, 27 December 2021 (UTC)