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Electronic fluency device received a peer review by Misplaced Pages editors, which is now archived. It may contain ideas you can use to improve this article.

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#Are_papers_presented_at_scientific_conferences_reliable.3F. Based on the discussion I've included the two studies.--TDKehoe 17:48, 21 September 2007 (UTC)

Image sizes

Misplaced Pages:Manual of Style#Images 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:

• 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.

In other countries, stutterers who want their national health programs to provide anti-stuttering devices should work with their national stuttering support organization.

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 , 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)

• 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). " 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, PMID 16753207 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.

That's a start; I'll be glad to peek in periodically on your progress. SandyGeorgia (Talk) 02:28, 20 November 2007 (UTC)

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. SandyGeorgia (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. SandyGeorgia (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. SandyGeorgia (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 Misplaced Pages'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 _><>° 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. SandyGeorgia (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 _><>° 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

"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."

"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.

"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.

"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."

"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?

"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."

"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.

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.

• Studies have shown that altered auditory feedback (including delayed auditory feedback, frequency altered feedback) can reduce stuttering in by 40 to 80 per cent.

Something is goofed up in this sentence:

• The longterm effects of altered feedback are also unclear: anecdotal reports suggest that receive continued but lessened effects in the long term.

The prose here needs re-working to avoid based, based, based.

• In particular, studies have tended to be based in a laboratory-based, and based on short speech samples and reading tasks.

SandyGeorgia (Talk) 17:27, 1 December 2007 (UTC)

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)

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)
• 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.)
• 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.
• 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.

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)

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)

• Old requests for peer review