SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Stuttering is an abnormality in the fluency of speech, which is characterized by interruption of the normal rhythm due to involuntary repetition and prolongation, or arrest, of uttered letters or syllables. The aphasic syndrome and dysarthria can be associated with classic migraine, but, to our knowledge, no study has so far described stuttering as the only neurological symptom accompanying an attack.
This article offers principles to consider in developing therapy plans for school-age children who stutter. Goals of speech therapy should be individualized, educationally relevant, and lead to functional outcomes that last. Skills and experiences gained through speech therapy should help children communicate effectively and develop positive attitudes about themselves as communicators. A variety of collaborative planning tools are presented to help IEP team members prioritize needs based on relative importance of behavioral, cognitive, and affective aspects of the stuttering problem from the perspective of the child, parents, and teachers. Strategies are included for overcoming some of the specific challenges inherent in therapy planning and goal setting for this population.
School-aged children who stutter often present concomitant impairments in articulation and language that can complicate treatment. In this article, a framework is offered for designing intervention programs for such children. It is stressed that clinicians must first identify clinical priorities by determining the severity of the impairments, their impact on daily activities, others' reactions to the impairments, and the likelihood of unassisted recovery. Several potential treatment models are presented, as are general treatment principles and specific treatment strategies for three profiles of children who stutter. Suggestions are also provided for including parents and teachers in the intervention plan.
Self-regulation refers to a process by which individuals learn to direct and control their own behavior, thoughts, and feelings to manage or eliminate their stuttering. As a concept, it has been a vital and enduring component of most approaches to managing persistent and chronic stuttering. The theoretical basis for self-regulation is briefly reviewed and the main principles of self-regulation--goal setting, cue management, self-monitoring, and self-evaluation--are described and illustrated with clinical examples. Factors related to self-regulatory failure are also discussed.
This article assists school-based clinicians in developing partnerships with the families and teachers of youngsters who stutter. Suggestions for initiating this relationship are provided, and recommendations for the shared roles that families, teachers, and clinicians play are described. School-based clinicians face challenges as they attempt to more actively engage families and teachers, including securing administrative support, developing creative scheduling and service delivery methods, and addressing the feelings of family members and teachers about involvement in stuttering treatment. Strategies for meeting these challenges are provided.
Among the clinical technologies for the treatment of fluency disorders presented in this article are systems for assisting and automating feedback on stuttering severity, establishing speech changes that enhance fluency, and modifying speech-related sensory feedback for fluency enhancement. Some additional technologies, which have been implemented only in research but are expected to find their way to clinicians in the near future, are also discussed. The effectiveness of microcomputer applications for the treatment of stuttering has received little research; however, some answers about their effectiveness may be inferred from descriptions of their operational features and published specifications.
The possibility of chronic stuttering is investigated in a preschool boy with a brief history of intermittent fluency breaks. The variability of the behavior adds to the mystery and makes the diagnosis of unusual or stuttering-like fluency breaks particularly difficult. Clues for solving this mystery are obtained from both the child and his parents. Verbal and nonverbal behaviors are considered, and the child's capacity for producing fluent speech is stressed during a formal evaluation to determine the effect of communicative demands. Detective work by the investigator takes the reader through a series of diagnostic decisions that eventually leads to cracking the case.
A 30-year-old woman hit her head during an automobile accident and was admitted to the hospital. One week later magnetic resonance imaging (MRI) showed a right frontal/parietal lesion. Among the behavioral sequelae were mild ataxia with trunkal instability and dysfluent speech accompanied by prominent shaking of the right leg, face and neck tension, and facial twitching. The speech-language pathologist thought the patient was not aphasic but rather was stuttering and treated her for about a month with pacing and "easy onset" techniques to which she showed fair response. The diagnostic question in this case is whether the stuttering was the result of the brain damage (neurogenic) or of the stressful events she had experienced (psychogenic). In this article we review her case and the process we used in arriving at an "expert" opinion.
This article describes guidelines for developing an effective collaborative/consultative approach to the treatment of stuttering in an elementary school setting. Four primary areas of shared clinician/teacher responsibility are discussed, which include: education, observation, facilitation of fluent speech, and generalization of speech fluency. Although the speech-language pathologist should initiate the teacher's involvement in a child's therapy, both the clinician and teacher should work toward developing a mutually influential partnership, through which the specific needs of individual children who stutter can be addressed in a comprehensive manner.
Stuttering can be effectively inhibited via exogenous sensory signals (e.g., speaking in unison or using altered auditory feedback) or by using endogenous motoric strategies (e.g., singing or therapeutically implementing long vowel prolongations to reduce speech rates). We propose that these channels, which superficially appear to be diametrically opposite, centrally converge in the engagement of mirror neurons for fluent gestural productions. Sensory changes incurred via exogenous speech signals allow for direct engagement of mirror systems, while endogenous motor strategies appear to require significant departures from normal speech production (e.g., highly unnatural or droned speech) to engage mirror systems. Thus, paradoxically, stuttering is prone to resurface during attempts to impose naturalness upon therapeutic speech.
An almost two-year-old left-handed girl with a history of a left-hemisphere stroke at the age of one year developed a transient stutter with newly acquired white matter infarctions. Her course suggests that developmental stuttering may reflect anomalous dominance and/or atypical interhemispheric connectivity.
The vowel in part-word repetitions in stuttered speech often sounds neutralized. In the present article, measurements of the excitatory source made during such episodes of dysfluency are reported. These measurements show that, compared with fluent utterances, the glottal volume velocities are lower in amplitude and shorter in duration and that the energy occurs more towards the low-frequency end of the spectrum. In a first perceptual experiment, the effects of varying the amplitude and duration of the glottal source were assessed. The glottal volume velocity recordings of the /ae/ vowels used in the analyses were employed as driving sources for an articulatory synthesizer so that judgments about the vowel quality could be made. With dysfluent glottal sources (either as spoken or by editing a fluent source so that it was low in amplitude and brief), the vowels sounded more neutralized than with fluent glottal sources (as spoken or by editing a dysfluent source to increase its amplitude and lengthen it). In a second perceptual experiment, synthetic glottal volume velocities were used to verify these findings and to assess the influence of the low-frequency emphasis in the dysfluent speech. This experiment showed that spectral bias and duration both cause stuttered vowels to sound neutralized.
The syllable repetitions of 24 child and eight teenage stutterers were investigated to assess whether the vowels neutralize and, if so, what causes this. In both groups of speakers, the vowel in CV syllable repetitions and the following fluent vowel were excised from conversational speech samples. Acoustic analyses showed the formant frequencies of vowels in syllable repetitions to be appropriate for the intended vowel and the duration of the dysfluent vowels to be shorter than those of the fluent vowels for both groups of speakers. The intensity of the fluent vowels was greater than that of the dysfluent vowels for the teenagers but not the children: For both age groups, excitation waveforms obtained by inverse filtering showed that the excitation spectra associated with dysfluent vowels fell off more rapidly with frequency than did those associated with the fluent vowels. The fundamental frequency of the children's dysfluent speech was higher than their fluent speech while there was no difference in the teenager's speech. The relationship between the intensities of the glottal volume velocities was the same as that of the speech waveforms. Perceptual tests were also conducted to assess whether duration and the differences found in the source excitation would make children's vowels sound neutral. The experiments show that in children neither vowel duration nor fundamental frequency differences cause the vowels to be perceived as neutral. The results suggest that the low intensity and characteristics of the source of excitation which cause vowels to sound neutral may only occur in late childhood. Furthermore, monitoring stuttered speech for the emergence of neutral vowels may be a way of indexing the progress of the disorder.
Behavior of the middle ear muscle during speaking was observed in five stutterers by means of the Zwislocki acoustic impedance bridge. Change in impedance did not always parallel precisely the changes in speecli sound level. Impedance changed during the initiation and dluring the course of the stuttering block.
Previous studies have reported that the disfluent speech of stutterers is often associated with tremor in orofacial muscle systems. In the present report, spectral analyses of the amplitude envelopes of laryngeal and orofacial EMGs revealed that tremor-like oscillations of EMG activity, similar to those observed in orofacial muscles, are also present in laryngeal muscles during stuttered speech. Furthermore, tremor-like oscillations in orofacial and laryngeal muscles appear to be entrained in some subjects. It is speculated that autonomic systems may provide a mechanism whereby oscillations in different muscle groups may become entrained.
The syllable repetitions of 6 child and 6 adult stutterers were investigated to establish whether dysfluent speech had a higher noise-to-signal ratio than fluent speech and whether this differed between children and adults. As predicted, the stuttered speech had a higher noise level for both age groups. During dysfluencies, the level of the noise components in the children's speech was higher than in the adults.
This article explores a number of roads on the journey to improving stuttering intervention effectiveness. Roads discussed on this journey include: (1) revisiting the research-clinic paradigm; (2) improving definitions and descriptions of stuttering through standardized measurements, norms, and categorization; (3) developing and describing prognostic profiles; (4) documenting outcomes through improved designs and clinician preparation; (5) recognizing the merits and potential pitfalls of specialization; (6) embracing a global community, and (7) investing in future researchers and clinicians committed to improving treatment effectiveness.
This case study of acquired stuttering confirms the reality of acquired or neurogenic stuttering. It further shows that the syndrome can exist in its own right. It is not simply a secondary psychological consequence of brain damage but a direct result of the cerebral lesion.