Equitable access to stuttering treatments: Developing distance and self managed treatment models

正常的语言交流对人类健康至关重要。口吃是一种普遍的疾病，严重干扰沟通。它可以毁容，通常会导致与语言相关的社交焦虑。大约一半的成年人患有社交恐惧症。它阻碍了职业潜力的实现，口吃的孩子通常在学校受到嘲笑和欺凌。在过去的十年中，NHMRC项目的资助使目前的团队能够在口吃方面进行世界级的基础研究和临床试验。这项研究取得了重大成果，特别是开发了具有重要证据基础的各年龄组治疗方法。然而，越来越明显的是，这些循证治疗的实施存在严重障碍，需要创新的治疗方法来解决这一问题。特别是，为农村和偏远地区的患者及其家人提供的言语病理学服务资金不足，甚至在城市环境中，工作场所的限制也导致言语病理学家提供不完整和零碎的治疗。该研究计划将开发以下创新治疗模式来解决这一问题：远程干预模式，为农村患者及其家人和其他与治疗服务隔离的人提供言语病理学服务。为口吃的儿童和成人提供自我管理的治疗模式，包括尽量减少成人普遍存在的复发问题的程序。人们普遍认为，社交焦虑是许多口吃者的一个重要问题，迫切需要研究来确定不同年龄组口吃者的社交焦虑程度及其对治疗效果的负面影响。因此，这项研究计划的另一个目的是：识别那些社交焦虑可能构成成功治疗障碍的患者。制定补充干预措施，以满足那些社交焦虑患者的需求。口吃的原因尚不清楚。了解有效行为治疗的机制将有助于理解口吃的因果因素。因此，这项研究计划的目的还在于：确定为什么行为治疗有效，从而产生有关因果因素的新知识。

The development of normal verbal communication is of the utmost importance to human health. Stuttering is a prevalent disorder that severely interferes with communication. It can be disfiguring and typically causes speech related social anxiety. Social phobia is present in around half of adults affected. It prevents attainment of occupational potential and children who stutter are typically teased and bullied at school. For the past decade NHMRC Project funding has enabled the present team to conduct world class basic research and clinical trials in stuttering. Significant gains have resulted from that research, in particular the development of treatments across the age groups that have a significant evidence base. However, it is becoming increasingly clear that there are serious barriers to the implementation of these evidence based treatments, and innovative treatment developments are needed to address this. In particular, speech pathology services for rural and remotely located patients and their families are incompletely funded, and even in urban settings workplace restrictions have resulted in speech pathologists delivering incomplete and piecemeal treatments. The program of research will develop the following innovative treatment models to solve this problem: �Distance intervention models for the delivery of speech pathology services to rural patients and their families and others who are isolated from treatment services. �Self-managed treatment models for children and adults who stutter, including procedures to minimise the ubiquitous problem of relapse in adults. It is widely understood that social anxiety is a significant problem for many stutterers and research is urgently needed to establish the extent of social anxiety in stutterers across the age groups and its negative effects on treatment effectiveness. Thus, a further aim of this program of research is to: �Identify those patients for whom social anxiety is likely to constitute a barrier to successful treatment. �Develop supplementary interventions to meet the needs of those socially anxious patients. The cause of stuttering is unknown. Understanding the mechanisms underpinning effective behavioural treatments would contribute to understanding causal factors in stuttering. Thus, this program of research also aims to: �Establish why behavioural treatments work, thereby generating new knowledge about causal factors.