The Treatment of Fluency Disorders: Experience in Bulgaria

georgieva.jpeg About the presenter: Dobrinka Georgieva, Ph.D. is a lecturer in logopedics at Southwestern University in Blagoevgrad, Bulgaria. She is Vice-Dean of the faculty of Philosophy and Director of the University Stuttering Research Center. Dobrinka is a published author in Bularian, English, Finnish and French and is also fluent in Russian and has presented internationally. She is a member of the International Fluency Association, the International Association of Logopedics and Phoniatrics, the Bulgarian National Association of Logopedics and Phoniatrics and the Greek Association in Neurolinguistics.

The Treatment of Fluency Disorders: Experience in Bulgaria

by Dobrinka Georgieva
from Bulgaria

The first stuttering treatment in Bulgaria dates from 1898 when a German, F. Urbich, opened the first logopedics school in the capital Sophia. Sixty years later, in 1959 started the university student training in Speech Therapy in Bulgaria.

The first part of this presentation analyzes the 40 years period of stuttering treatment when the ex-Soviet Union Logopedics influence was dominant.

The general influence on fluency disorders is characterized by:

  • Research focusing on stuttering and cluttering assessment and differential therapies
  • Absence of research studies about data-based therapy of stuttering and/or cluttering
  • Specialty recognition stuttering and/or cluttering program.

The influence on treatment is characterized by:

  • The fluency shaping approach as being a dominant in Bulgaria
  • Absence of application of stuttering modification approach and desensitization
  • Unpopular Non avoidance approach
  • The dominance of the Russian complex methods both in stuttering and cluttering including Hvatzev method; Soviet complex system; Tcheveleva method; Vlasova method; Mironova method; Seliverstov method; Daskalov method (Hvatzev, 1959; Tcheveleva, 1962; Mironova, 1962; Daskalov, 1962; Kurshev, 1973; Vlasova, 1983; Missoulovin, 1988; Seliverstov, 1979).

The second part of the presentation deals with the development of fluency disorders therapy in Bulgaria in the last 15 years Transition period. It is a struggle of influence period, where many international scientific schools try to implement their methods and therapeutic programs in this field such as for instance - Craig's method, F. Le Huche method, stuttering modification approach methods (Van Riper, H. Gregory, E. Cooper), K.O. St. Louis and F. Myers cluttering synergetic method, Daly method etc. (A. Craig, 1999; F. Le Huche, 1979, 2000; Van Riper, 1973, 1982; H. Gregory, 1979, 1986; E. Cooper & C. Cooper, 1991; F. Myers & K. O. St. Louis, 1992; D. Daly, 1992)

I have tried to categorize the various methods for the both fluency disorders in a useful and creative way. Four categories of general approaches reflect the present practice of Bulgarian speech therapists:

  • Fluency shaping approach
  • Stuttering modification approach
  • Contingent management linguistic hierarchy
  • Desensitization and counseling approach.

In Bulgaria, nowadays, formal stuttering and cluttering therapy methods generally are combinations of a few approaches (and many techniques). The most popular methods are based on fluency shaping approach while stuttering modification approach methods, contingent management and desensitization and counseling are not quite popular. Self-help or support group are not becoming available yet.

On the other hand we notice a big interest in cluttering research studies.

Clinician's method

Year

Age

Therapy

schedule

and duration

Description of the main stages of the therapy

Speech techniques

Measures of effectiveness and results

Therapy approach

1. Vlassova, N. А., Rаu, Е. Ph.

1959

Preschool age

8 - 9 months

Complex therapy. For first time different degrees of speech independence are applied.

1.Accompanying speech

2.Reflective speech: the child repeats speech therapist’s speech

3. Answers of questions on pictures

4.Independent description of pictures

5.Retelling

6.Spontaneous speech

7.Normal speech

1. Breathing exercises

2. Articulation exercises

3. Voice exercises

There is no data for Bulgaria.

In Russia 70% effectiveness; 30% complementary effects ( Vlassova).

60% effectiveness; 19% considerable improvement; 13% failed; 8% - relapses (Rau).

Complex approach;

Fluency shaping approach

2. Cheveleva, N. А.

1965

Preschool age

8 - 9 months

Complex therapy in the situation of a game activity and manual activity! Transition from situational to complex speech.

1.Limited speech activity

2.Accompanying speech

3.Final speech: the child describes executed, past events and activities

4.Planned speech: the child talk about what he/she intents to do

5. Stabilization speech: the aim is to maintain the new fluency skills.

1. Breathing exercises

2. Articulation exercises

3. Voice exercises

4. Movement exercises

There is no data for Bulgaria.

The most applied method in Bulgaria

Modified for Bulgarian conditions by Stamov, Vurbanova, Stavrakova (1987).

Complex approach;

Fluency shaping approach

3. Mironova, S. А.

1969

Preschool age

8 - 9 m.

1. Plain situational speech: work over the Lexis

2. Repetition of speech habits for the situative speech and gradual transition toward plain context speech work over phrases

3. Independent context      speech work over stories

4.Independent speech with different degrees of complexity

1. Articulation exercises

2. Voice exercises

3. Breathing exercises

4. Prolonged speech

5. Airflow

 

There is no data for Bulgaria.

Complex approach;

Fluency shaping approach

4. Seliverstov, V. I.

1979

Preschool age

8 - 9 m.

1. Preparatory

2. Training

3. Repeating

The logopedic therapy is accomplished in the conditions of a game activity

Work over:

1.Prosodics

2.Rhythm

3.Voice strength

In different speech situations.

There is no data for Bulgaria.

39.7% without stammering;

47.8% considerable betterment;

12.5% inconsiderable betterment (Seliverstov)

Complex approach;

Fluency shaping approach

5. Volkova, G. А.

1983

Preschool age

2-4 years

4-7 years

8 - 9 m.

1.Diagnostic stage

2. Limited speech activity

3.Accompaning-reflected speech

4. Stage of questions and answers

5. Spontaneous independent speech

Partitions of the program for logopedic work:

1. System of games

2. Logorhythmics

3. Educational work

4. Influence upon the micro-social environment of children

1.Articulation exercises

2. Voice exercises

3. Breathing exercises

 

There is no data for Bulgaria.

70.2% without stuttering;

26.3% considerable betterment;

3.5% noticeable betterment;

(Volkova)

Complex approach;

Fluency shaping approach

6.Vigodskaya, I. G.,

Pelinger, Е. L.,

Uspenska, L. P.

1984

Preschool age

 

8 - 9 m.

1.Silence

2.Formation of speech breathing

3.Short phrases

4. Longer phrases

5. Speech in speech situations

6. Spontaneous speech

 

Relaxation exercises are leading through the games

1.Articulation exercises

2. Voice exercises

3. Breathing exercises

 

There is no data for Bulgaria.

 

Complex approach;

Fluency shaping approach

7. Cheveleva, N. А.

1978

Primary school age

9 m.

The logopedic work is carried out on the background of manual activity:

1. Accompanying speech

2. Final speech

3. Planned speech

4. Maintenance of the speech skills

 

1.Articulation exercises

2. Voice exercises

3. Breathing exercises

4. Prolonged speech

There is no data for Bulgaria.

 

Complex approach;

Fluency shaping approach

8. Yastrebova, А. V.

1979

Primary school age

8 - 9 m.

Method for stutterers with language impairment

1.Work over speech fluency, Lexis, grammar, development and   stabilization of the skills for word analysis

2. Stabilization of the skills for fluent speech

3. Work on the sound and the speech   intonation

 

Work over:

1. rate

2. rhythm

3. fluency

4. articulation

5. gentle onset

6. proper direction of airflow

There is no data for Bulgaria.

 

Complex approach;

Fluency shaping approach

9. Missulovni, L. Y.

1988

Adolescent and adults in the conditions of   psychoneurotic dispensary

3 - 4 m.

2 times per week

1. Diagnostic stage

2. Silence after a sitting of suggestion

3. Automation of speech habits

4. Stabilization of speech skills

The logopedic work is carried out together with the medicine therapy and psychotherapy

Gentle onset

Airflow

Systematic desensitization

There is no data for Bulgaria.

17.8% without stuttering

34.6% considerable betterment;

38.5% betterment;

9.1% without betterment (Missulovin)

 

Complex approach;

Fluency shaping approach

10. Bujanov, М. I.

1989

Adolescents in the conditions of clinics or dispensary

4 m.

1. Stage of speech technique formation: midriff breathing,   voice exercises, syllable exercises

2. Reading of texts and/or retellings with a different degree of complexity

3. Automation of speech habits in different speech situations and mastering of habits for autogenous training

The logopedic work is carried out parallel with the medical therapy, psychotherapy, physiotherapy ,occupational therapy and music therapy

1.Articulation exercises

2. Voice exercises

3. Breathing exercises

 

There is no data for Bulgaria.

 

 

Complex approach;

Fluency shaping approach

11. Shkolovski, V. М.

1974

Adolescents and adults

2.5 - 3 m.

1. Diagnostic stage

2. Reorganization of the pathologic speech skills

3. Stabilization of the skills for speech fluency

4. Prophylactics

5. Sanatorium and resort treatment

The logopedic work is carried out parallel to hypnotherapy, self suggestion, rational psychotherapy, suggestive psychotherapy, physiotherapy

1. Articulation exercises

2. Voice exercises

3. Breathing exercises

 

There is no data for Bulgaria.

 

Complex approach;

Fluency shaping approach

12. Hvatsev, М. Е.

1959

Adolescents and adults

45 days

1. Diagnostic stage

2. Work over breathing

3. Work over voice

4.Work over sound pronunciation

5. Work over the rhythmical speech (accompanying speech , reflected speech, reading, learning by heart of texts, independent speech in different speech situations)

1.Articulation exercises

2. Voice exercises

3. Breathing exercises

 

There is no data for Bulgaria.

 

Complex approach;

Fluency shaping approach

13. Daskalov, D.

(Bulgarian method)

1963

Adolescents and adults

45 days treatment program

 

Balneal-sanatorium treatment of stutterers.

1.Systematic breathing and speech exercises, rhythmic vocal exercises with musical accompaniment, singing

2.Auditory masker – for severe stuttering cases

(10-12 days subcutaneously inject at each of certain points in the Zakharin-Head zones of the speech organs – see Van Riper, 1973, p. 93)

Application of protracted sleep along with drugs; relaxation; healing effects of the naturally favorable climate and the baths; psychotherapy, gymnastic therapy, remedial exercises had air, sun and aqueous baths.

 

Temporary effectiveness during the pharmacy therapy

This method has been completely abandoned in Russia (Platonov, 1959)

Complex approach;

Fluency shaping approach

14. No specific method for cluttering treatment.

 

 

 

The treatment procedures are the same as in stuttering cases

 

 

 

September 2, 2005