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Intrinsic and extrinsic timing in stutterers' speech: data and implications.

This study examined interarticulator timing amongst stutterers and non-stutterers from the perspective of extrinsic and intrinsic timing models of speech motor control. Timing relationships were examined for an oral closure task across stress, rate, and vowel differences. Sequential aspects of extrinsic timing theories were analyzed by peak velocity sequence profiles of upper lip, lower lip, and jaw, and nonsequential aspects by sequence period (the time period covering all three of the articulator peak velocity onsets times irrespective of sequencing order). Intrinsic timing theory was modeled using phase portrait analyses of the same data. Consistently greater phase angle variability was seen amongst the stutterers, and variability was found to be significantly greater at a faster articulatory rate and when altered stress patterns were required. No group differences were found for peak velocity sequencing, but the (sequence independent) sequence period data somewhat mirrored the phase angle findings. This finding calls into question the notion that phase angle analyses reflect purely intrinsic timing phenomena.

Adult↗

Relative efficacy of intensive and spaced behavioral treatment of stuttering.

Twenty adult and adolescent stutterers were randomly assigned to two treatment formats consisting of either 16 two-hour sessions of fluency training administered within a concentrated period of four consecutive days (intensive treatment), or two two-hour sessions per week for eight weeks (spaced treatment). Frequency of stuttering and rate of speaking were repeatedly assessed from speech samples obtained in six different clinic and extra-clinic speech settings. The efficiency of treatment, subject compliance, and communication "attitudes" were also measured. Fluency training produced significant reductions in stuttering frequency, and significant improvements in speaking rate and communication attitudes for both treatment formats. Both formats were found equivalent on all measures. In addition, generalization of treatment effects was observed in all settings. However, maintenance of generalization effects was uneven across settings, suggesting the possible need for differential levels of training for different speaking situations.

Adult↗

Is stuttering a contraindication to psychotherapy?

This is a case report of a patient who stutters and was treated for problems of self-esteem with focused brief psychotherapy. The literature by and large is against the use of individual psychotherapy for neurotic problems in patients who stutter. The countertransference may account for the unwarranted pessimism in the literature about such patients. In this case the successful resolution of countertransference feelings facilitated the achievement of the goals of therapy. Further reports on such treatment attempts are warranted. Speech therapy may be facilitated by brief focused psychotherapy for the stutterer.

Adult↗

Landau-Kleffner syndrome beginning with stuttering: case report.

Landau-Kleffner syndrome is marked by an acquired aphasia in children who have had normal language and motor development. A 3.5-year-old girl was referred to our clinic with stuttering. She was diagnosed as having benign myoclonic epilepsy of infancy at 3.5 months of age and treated with valproic acid. Her electroencephalogram (EEG) returned to normal at the end of the first year. The therapy was stopped after a 2-year seizure-free period. She started to stutter prominently 3 months after the discontinuation of antiepilepsy drugs. She had no verbal agnosia. Her EEG revealed multiple spike and wave discharges. She was diagnosed as having Landau-Kleffner syndrome. Her previous epilepsy history had contributed to her having obtained an EEG in the early period. We suggest that if a child with normal language function starts to stutter, Landau-Kleffner syndrome must be considered in the differential diagnosis.

Adrenocorticotropic Hormone↗

Prediction of outcome after treatment for stuttering.

Predicting who will relapse after behavioural or dynamic psychotherapy is important. A search for variables likely to predict individuals at risk of relapse was conducted in two groups of successfully treated stutterers. The most powerful predictors were the attainment of three goals by the last day of treatment; namely, skill mastery as evidenced by no stuttering, normal attitudes to communication, and an internalisation of the locus of control. Of the subjects who achieved these three goals, 97% maintained their improved speech in the long term. No subject who failed to achieve any of these goals remained fluent, while those who achieved one or two goals had intermediate outcomes. No single goal was necessary and none alone was sufficient to maintain improvement. Both actual and perceived mastery over stuttering appear to be important if the long-term outcome is to be satisfactory.

Adolescent↗

Abnormal speech sound representation in persistent developmental stuttering.

OBJECTIVES: To determine whether adults with persistent developmental stuttering (PDS) have auditory perceptual deficits. METHODS: The authors compared the mismatch negativity (MMN) event-related brain potential elicited to simple tone (frequency and duration) and phonetic contrasts in a sample of PDS subjects with that recorded in a sample of paired fluent control subjects. RESULTS: Subjects with developmental stuttering had normal MMN to simple tone contrasts but a significant supratemporal left-lateralized enhancement of this electrophysiologic response to phonetic contrasts. In addition, the enhanced MMN correlated positively with speech disfluency as self-rated by the subjects. CONCLUSIONS: Individuals with persistent developmental stuttering have abnormal permanent traces for speech sounds, and their abnormal speech sound representation may underlie their speech disorder. The link between abnormal speech neural traces of the auditory cortex and speech disfluency supports the relevance of speech perception mechanisms to speech production.

Acoustic Stimulation↗

Stuttering: disappearance and reappearance with acquired brain lesions.

Despite 60 years of study, the brain mechanisms for stuttering are unknown. In an effort to shed light on these mechanisms, we studied two cases in which the fluency of speech changed after brain damage in adulthood. The first, an ambidextrous man, ceased to stutter after a head injury. The second, a converted left-handed man, experienced recurrence of childhood stuttering after a stroke.

Adolescent↗

Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering.

OBJECTIVE: The major aim of this study was to determine whether adults with persistent developmental stuttering (PDS) have anomalous anatomy in cortical speech-language areas. The major postulate was that anomalous cerebral dominance, reflected by anomalous cortical anatomy in various regions, may put an individual at increased risk for the development of stuttering. METHODS: Adults with PDS (n = 16) and controls (n = 16) matched for age, sex, hand preference, and education were studied. Volumetric MRI scans were completed. Frontal (pars triangularis, pars opercularis) and temporo-parietal areas (planum temporale, posterior ascending ramus) were measured in the left and right hemispheres and interhemispheric asymmetries were computed. Gyral variants were assessed within these perisylvian cortical speech-language areas. RESULTS: The right and left planum temporale were significantly larger in the adults with PDS (p = 0.045), and the magnitude of the planar asymmetry was reduced (p = 0.003). Some gyral variants were unique to the adults with PDS, including a second diagonal sulcus and extra gyri along the superior bank of the sylvian fossa. In addition, anatomic subgroups emerged based on sex and hand preference. Overall, the adults with PDS had significantly more gyral variants (mean = 4.19) than controls (mean = 1.31, p < 0.0005). CONCLUSIONS: These results provide strong evidence that adults with PDS have anomalous anatomy in perisylvian speech and language areas. No one anatomic feature distinguished the groups, but multiple loci within a widely distributed neural network differed between groups. These results provide the first evidence that anatomic anomalies within perisylvian speech-language areas may put an individual at risk for the development of stuttering.

Adult↗

Long-term follow-up of a behavioral treatment for stuttering in children.

We report 3.5-year follow-up data from children who participated in a study that evaluated a behavioral treatment for stuttering. Six of 7 subjects continued to be at or below the criterion of 3% stuttered words. Stuttering increased for 1 subject, but remained far below his baseline level. Social validity data are also reported.

Adolescent↗

Stuttering, speech rate, and the metronome effect.

Methodological inadequacies cast doubt on previous investigations of the hypothesis that metronome-paced speech reduces stuttering by slowing the rate of speech. In the present study, 6 stutterers' fluent speech rates were calculated by excluding the time occupied by stutters and pauses. The fluency-enhancing effect of metronome pacing was independent of speech rate.

Adult↗

Electromyographic tension levels in stutterers and normal speakers.

Electromyographic (EMG) recordings of masseter muscle tension during conversational speech by six adult stutterers were compared to EMG levels of 6 normal speakers. Stutterers' and normal speakers' tension levels were significantly different; however, there was no correlation found between level of tension and severity of stuttering.

Adult↗

Physiological factors related to delayed auditory feedback and stuttering: a review.

Delayed auditory feedback (DAF) generally produces speech disturbances in normal speakers and improved fluency in stutterers. Several theorists have proposed that the speech disruptions of normal persons under such delayed feedback are an analog of stuttering. Related research has linked delayed auditory feedback and stuttering to several physiological factors. A review of familial relationship, age, sex, stress, speech characteristics, and sound conduction is presented. A brief integration of the factors and directions for research is presented.

Age Factors↗

Central auditory function in young stutterers.

16 stutterers and 16 nonstutterers between the ages of 8 and 11 yr. were administered a battery of central auditory processing tests. The six audiological tests evaluated a range of auditory functions. Analysis indicated no significant differences between the two groups; however, inspection of the data showed 6 of the stuttering subjects performed consistently more poorly on four of the tests than the nonstuttering subjects. Results are discussed in relationship to subgroups of stutterers with auditory problems.

Auditory Perceptual Disorders↗

Simple motor and phonemic processing reaction times of stutterers.

Simple motor and phonemic processing reaction times were gathered for a group of stutterers and were compared to data obtained from normal speakers. The stutterers' responses were significantly more latent under both conditions. Such findings suggested that at least two neurophysiological factors influence stutterers' reaction-time latencies. These include aberrancies in both motor control and auditory processing capacity.

Adult↗

Onset and termination of accessory facial movements during stuttering.

In this study the onset and offset times of seven types of accessory facial movements during oral and silent prolongations were described in three severe stutterers. For each observed facial movement the onset and offset times were determined by means of slow motion analysis of video-recorded speech samples. For two of the three subjects significant differences in the onset and offset times at the various facial movements were found; however, no consistent patterns in the separate facial movements could be observed. On the contrary, the onset of most facial movements appeared to be located at the very start and their offset at the end of the stuttering moment. The implications of these findings with respect to the function of accessory facial movements in stuttering are discussed.

Adult↗

Midline and off-midline tongue and right- and left-hand vibrotactile thresholds of stutterers and normal-speaking individuals.

Vibrotactile thresholds for 7 male stutterers and 7 normal-speaking men (age range for both groups = 19 to 32 yr.) were obtained from the right, midline, and left sides of the lingual dorsum, and the thenar eminences of both hands. The stutterers showed slightly higher (less sensitive) mean thresholds than the normal speakers for all three lingual test sites. This was not the case for the thresholds obtained from both hands. The preliminary data suggest that oral peripheral sensory integrity might be somewhat different for stutterers than for normal-speaking individuals.

Adult↗

Manual reaction times and error rates in stutterers.

In this study 18 stutterers and 18 nonstutterers were presented trials on which they should press a button as fast as possible, intermixed with trials which required no responding. Stutterers had slightly faster reaction times but also made slightly more errors, that is, they tended to press the button when they should not have done so. As neither difference was significant, it was concluded that stutterers did not differ from normal speakers in manual reaction speed, nor did they choose a different speed-accuracy trade-off criterion for the given task.

Adult↗

Effect of instruction to sing on stuttering frequency at normal and fast rates.

Singing as a fluency-enhancing mechanism is well-established. The fluency derived by singing has been attributed to a reduced speech rate, memorized material, semantically reduced content, and an imposed rhythm. In this study, we attempted to address each of these explanations. 12 participants who stuttered were instructed to read or sing each of four different passages under the following conditions: reading at a normal rate, reading at a fast rate, singing at a normal rare, and singing at a fast rate. Participants exhibited a statistically significant increase in disfluencies while reading, i.e., participants displayed a 75% reduction in disfluency in the singing condition relative to the reading condition. There was no difference in stuttering frequency with rate conditions. Current findings suggest that stutterers are capable of internally generating fluent speech production by imposing idiosyncratic melodic structures or some derivation of melody when asked simply to sing. There is no claim that these participants were singing, as skills and capabilities varied tremendously, only that participants achieved dramatic enhancement of fluency after they were just asked to sing. Thus, the only intervening variable was the instruction to sing, which suggests the attempt to follow the instruction, no matter how futile, generated fluent speech. Since fluency was maintained in both the normal and fast rates of production, alternate central mechanisms must be held accountable for these findings.

Adolescent↗