"A clinician's dream" is how Dr. Daniel R. Boone, professor emeritus, Dept. of Speech and Hearing Sciences, Univ. of Arizona, Tucson, AZ, describes the Facilitator, Model 3500, introduced by Kay at ASHA ’97. And Boone should know. A former ASHA president, this world-renowned voice pathologist and scientist has more than 30 years of clinical experience to his credit.

Developed in collaboration with Dr. Boone, the Facilitator is a unique clinical device that provides five modes of auditory feedback that can be applied to a variety of communication disorders.

To Boone, the beauty of the Facilitator is that each of the five modes--speech voice amplification, looping, delayed auditory feedback (DAF), masking, and metronomic pacing--have been used clinically for years, but have never been put together in one instrument.

The Facilitator was designed from the outset as a clinical tool and as a portable wearable device that can enhance carryover of therapy goals. "What’s new," Boone explains, "is the combination of, and the ease of access to each of, the modalities."

The first modality is the solid-state, looping auditory playback. This mode allows recording of short tokens up to six seconds in duration, followed by immediate playback that can be repeated as desired.

"Prior to the Facilitator," Boone observed, "the only way for someone to hear what he just said was to use a cassette and rewind it. The problem was finding the right place to stop."

"I’ve waited for 30 years to have a good loop device," he adds. "With the Facilitator, you basically have instant replay, which you can play over and over." This is critical for anyone listening to his own pattern, and trying to change that pattern in some way, such as accent reduction, dialect training, articulation therapy, and voice therapy.

As for speech voice amplification, "we’ve known for years that you’ve really got to learn to listen to yourself as you speak and that listening to yourself through headphones as you speak can actually improve the way you sound." The Facilitator enables the client to hear himself very clearly. This feature is very useful for voice disorders, articulation disorders, fluency disorders, the development of the professional voice, and learning disabilities.

Individuals with speech, language, and voice disorders may benefit from either enhanced or degraded auditory feedback to assist with therapy goals. The type of feedback that is most effective, however, depends on the disorder and the patient/client.

"What DAF does is destroy the feedback system, unlike amplification and looping which augment feedback," explains Boone. The DAF mode in the Facilitator provides an array of delay settings from 50 to 500 msec.

"We use DAF with fluency and motor speech, and some people use it with voice," notes Boone. "For magical reasons, stutterers don’t stutter under DAF, but people who don’t normally stutter will. In fact, what we generally see is that a delay of 350 msec makes the best of us dysfluent."

The masking mode also degrades auditory feedback. "It wrecks it," states Boone. "You can’t hear yourself speak."

Unlike the white and pink noise that were often used in masking at intensity levels harmful to normal ears, the speech range masking of the Facilitator can be used at lower amplitude levels.

Boone uses masking in every voice evaluation. "I try masking," he said, "and if they sound better, then I record that good voice produced under masking as their model. It works very well."

The masking mode in the Facilitator can be continuous (i.e., on all the time) or voice-activated, so it turns on only when it detects the speaker’s voice.

Using an audible pacing device such as a metronome can often help to improve speech timing or rhythm problems. The Facilitator provides metronomic pacing in both an auditory and a visual display ranging from 10-150 beats per minute.

"I’ve found it useful with stutterers and in fluency and motor speech disorders," said Boone. For example, with Parkinson’s disease, presenting a metronome click at the lowest level can be very effective in slowing the patient down.

"The idea of getting people back to using the auditory system more in therapy is so essential," Boone theorizes, "and, suddenly, we have an avenue to do that."

An extensive applications manual written by Boone is supplied with the instrument. It presents the rationale for each mode as well as case studies and detailed tips on clinical use.