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Re: Research proving that stuttering is located in pre-motor ...

From: Gunars
Date: 10/12/00
Time: 4:43:43 PM
Remote Name: 12.13.226.13

Comments

Firstly, thank you for the prompt reply. In reading your response I found out that we do not differ that greatly in our opinions except for my exuberance, enthusiasm, optimism and persistence.:-)

I have promised myself never to outgrow these characteristics of optimism, enthusiasm etc. Without these I would not have tried sixteen different stuttering therapies before I found Rational Emotive Behavior Therapy which helped me to manage my stuttering and my attitude toward stuttering to the point that it has no impact, whatsoever, on my daily life. Although I do have some disfluencies from time to time they do not impede my communication either in person or on the telephone. This I contrast to the many members of National Stuttering Association who a) either have given up on improving their severity and struggle associated with their stuttering or b), more sadly, are persisting on doing the same therapeutically suggested things but expecting different results, i.e. they swear by some stuttering therapy techniques and yet show no improvement over a long period of time either in terms of forward moving, less struggling, less forced speech or improvement in how they feel about themselves and their feelings of anxiety, shame and guilt.

Another example of visionary optimism, enthusiasm, and persistence was the German rocket scientist Dr. von Braun who was instrumental in putting the man on the moon. He started dreaming and working toward this goal while he was still a youth and succeeded only after decades of dedicated effort (and luck).

What we are talking here is about misplaced optimism and enthusiasm. The next couple decades will either bear me out or prove me wrong. No arguments or debates will influence the future, they can only either inspire others to pursue this area of study or discourage them. I am 100% for vigorously following this avenue of research.

Dr. Nan Bernstein-Ratner reminded me yesterday, when talking about scientific hypothesis, I should make sure that they are falsifiable. The other statements I make are purely speculative and, probably, I should indicate from the context, at least, which are which. She made a very good point, so in the following discussion I will try to follow it.

1) By no means do the authors or I imply that brain surgery is an option. (Maybe we should include a little bit on the nature of brain in our books on stuttering so as to inform the students, practicing SLPs, and professors how the brain is organized and why surgical cure is total absurdity.)

2) I agree with you whole heartedly that we can learn a lot from sports psychologists, cognitive psycholgists who, for example, use Rational Emotive Imagery. It is exactly the point that I wanted to emphasize, that we now have hard evidence that the same areas of brain are used during stuttering and during imagined stuttering. Whole new protocols of stuttering therapy could be evolved around this, but, again, I have not read about any of them in the textbooks that were published through 1999. In fact, I know of no stuttering therapists except the ones practicing REBT that use imagery as part of the stuttering therapy protocol. Neither have I read any papers that deal with "What can stuttering therapy learn from sports psychology." I call this a breakthrough, because now we can have some scientific justification for using the imagery exercises during therapy process.

When we get down to the meat of what this paper means, we agree completely. If the authors did not follow through and do a good job, you have suggested the topics for at least a half a dozen good Ph.D. thesis. The scientific (falsifiable) hypotheses that are open to PET type of investigation include:

A) Stuttering causing anxiety exists (possibly, due to our sizing up a speaking situation) before we start to talk, carries through the speech process waxing and waning (even if this in a virtual space, i.e. vividly imagined stuttering).

Thus, it is indeed independent albeit at some times coexistent with the "speech motor disorder". Possibly it is an anticipatory anxiety syndrome that interferes with the speech motor disorder. (Nan, how am I doing so far?)

B) Before a non-stuttering person has done voluntary stuttering exercises in public there is no anticipatory anxiety syndrome invocation. This can be falsified by PET studies when a subject is voluntarily stuttering for the first time when hooked up to the PET.

C) In a non-stuttering person the anticipatory anxiety syndrome, if it was proved to exist for people who are not stutterers, does not interfere with "speech motor functioning".

D) The voluntary stuttering in by a stutterer minimizes the strength of the anticipatory anxiety syndrome.

E) Given sufficient voluntary stuttering in public by a non-stuttering person the anticipatory anxiety syndrome is invoked. Or the converse, no amount of voluntary stuttering invokes this response.

F) The reduction of overt stuttering symptoms is inversely proportional to the anticipatory anxiety syndrome.

etc. etc. (including some of Sheehan's hypotheses).

If we can establish the existence of anticipatory anxiety syndrome and in time can quantify it, I suggest we call the units of measurements "woodies" :-), since, he was instrumental in the definition of this concept. Then, at some future time we might be able to say, "Before the treatment client X had a measure of 5 woodies :-). At the end of the treatment regimen the client only had had 1.2 woodies :-).

All kidding aside, you have asked some very good questions about the quality of the research. I hope that all of us get a hold of the paper and do some detailed analysis of both the methodology and the conclusions.

My real concern, however, is the question of finding some type of marker indicator for this phenomena to reduce the cost of the research, such as combination of brainwaves when the biofeedback electrodes are placed in the right position on the head. Otherwise, the replication of Ingham's research will be prohibitively expensive and new directions based on his research will be few and far between.

Respectfully,

Gunars


Last changed: September 12, 2005