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From: Roger Ingham
Date: 10/17/02
Time: 2:37:50 PM
Remote Name: 128.111.217.138
Bob,
Thanks for your comments on our article.
Are persons who stutter capable of normally fluent speech? This reminds me so much of the argument that Johnson used to make; that is, that he could easily demonstrate to stuttering speakers that there was nothing amiss with their speech production system because they have the ability to speak without stuttering during fluency-inducing conditions. But of course demonstrating that speakers are capable of achieving stutter-free and effortless fluency during, say, chorus reading, is a far cry from the durable normal sounding and experienced speech that is the goal of therapy. My own position is that I believe that most persons who stutter are capable of normally fluent speech, but that capability is often impeded. The source of that impediment may be neurophysiological or neuroanatomical, but whatever the source it may well be modifiable (or offset) to a point where normally fluent speech is possible. Of course the crux of the issue is the definition of "normally fluent" and what individuals will regard as normally fluent. There is no satisfactory definition, but I suspect there would be general agreement that it is speech that is free of perceived stuttering and that the speaker judges to be effortless and durable across all manner of speaking conditions. It is perfectly logical to conceive of normally fluent speech being achieved in a person who still recalls what it was like to have stuttered in these different situations. Individuals recover from numerous conditions that leave them sensitized to what it was like to have that condition. I don't believe we should regard those memories as impediments to normally fluent speech. I certainly do believe that some individuals achieve normally fluent speech as a result of some current therapies. I do believe that this is much more likely in children than in adolescents or adults. However, there are some compelling data showing that it is achievable by some of the behavioral programs. If the only evidence that is acceptable is that post therapy speech is perceived to be fluent, is demonstrated to be sustained across demanding speaking situations, and is self judged to be effortless and normal, then evidence from at least 2 sources is persuasive. Some individuals assessed by Boberg and Kully in 1994 either always or almost always felt like a normal speaker and in our recent preliminary report on the MPI program 2/5 individuals met that criterion 12 months after completing evaluations that extended over 2 years. It is cases such as these, and the results from some programs with children that lead me to believe that it is entirely possible for persons who stutter to achieve normally fluent speech. The goal of much of our brain imaging research is most definitely to find means to increase the probability that treatments can achieve that objective.