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

From: Gunars
Date: 10/13/00
Time: 12:27:56 AM
Remote Name: 206.63.39.147

Comments

Hi Scott,

Thanks for pointing me to Roger Ingham's article in Cordes and Ingham (1998). One advantage of having a good home library of the modern books on stuttering research and stuttering therapy is that one can be induced to waste a perfectly good evening reading a paper on stuttering. :-)

I can now see where Woody was coming from. On page 89 Ingham has a header TMS: Not Yet Time to Worry about What's Flying Over the Cuckoo's Nest, and then proceeds to scare the crap out of me. As much as I respect his research in the area, his breadth of scholastic knowledge, when in the application he suggests messing around with the brain by using repeated transcranial magnetic stimulation (rTMS) I get the visions of poor Murphy being given electro-shocks (reference One Flew Over the Cuckoo's Nest). I am totally opposed to experiments where "A brief electrical pulse through a wire coil placed on the scalp provides a magnetic field. The field passes unimpeded through the tissues of the head and induces an electrical current in the brain." My repulsion to this is extreme as I have studied the zombies produced by electro-shock therapy. Before I get myself into trouble with intemperate language and comparisons, let me stop.

If you have read Ingham's treatise recently (Chapter 4 in Treatment Efficacy for Stuttering Cordes & Ingham) you will have seen that Fox's et al 1996 study (referred to in the ASHA Leader) appears to have been rather well thought out. I expect Ingham's et al paper to be just as strong.

My uses for Ingham's study are totally different than his. With experiential and cognitive exercises and "overlearning" I propose to alter the "structure" of the brain. On page 83 Ingham states, "There is certainly considerable evidence that behavior change (i.e. therapy or fluency induction) may produce lasting neural reorganization." My suggestion is that we go this way! Not electro-magnetic manipulation.

The model I was proposing was much simpler and to me more elegant. There is a "path" or "activity center" in the brain that controls the speech production. The basic speech production mechanism areas are the same in both normal speakers and stutterers during choral reading where no anxiety is invoked. During stuttering other areas of activity are observed. These areas of activity are then correlated with stuttering. The question then arises what type of therapy cognitive and/or other can be used to desensitize these areas.

Other variations of my hypotheses can be found in my reply to Woody. The key, as Ingham indicates on page 85 in footnote is overlearning. This is one of the basic concepts in preparing an athlete for championship form (as a former All-American in soccer when it was a minor, minor sport I can have an appreciation for this). The overlearning can be done also using imagery exercises.

Another interesting point is Ingham's preoccupation, probably wise, with the auditory component of stuttering. See specifically pages 78 "(3) the lace of auditory factors in treatment", page 79 "auditory factors in stuttering" and "Numerous studies have suggested that stutterers do display unusual central auditory processing," and page 86 "However, the most surprising finding was that the primary auditory area (left and right superior temporal cortex) activations, so prominent in controls, was literally nonactivated during stuttering, while the associated auditory area (BA 22) was actually deactivated, mainly on the right. In many respects the latter finding is especially interesting because it might mean that stutterers simply do not self-monitor their speech to the same extent as nonstutterers during oral reading. That finding is also of added interest because it seems to be in conflict with theories that claim that stutterers monitor their speech excessively (e.g., Postma & Kolk) 1993)". Lou Heite and I independently observed that over a couple years ago when she chose her topic of Van Riper's petit mort. My conclusion, after introspection, as suggested by another "man without letters" :-) i.e. self taught scholar Leonardo da Vince (no I do NOT consider me being in his class :-) ) was that even a half-wit would try to adjust his body so as not to hear his stuttering voice for which he has caught so much heck :-) . It is just a survival mechanism, Dr. Ingham, that all of us who have been ultra severe stutterers space out, i.e. shut out our auditory feedback. On the other hand without the auditory, proprioceptive and other feedback we cannot get better. So we need to learn how to "stay in the moment."

Scott, enough for tonight. You and your suggestions to read Ingham's article have kept me from eating, walking the dogs, and talking to my wife. :-) With friends like you, who needs enemies. :-)

All kidding aside, I wish you could suggest to me some other good reading. I hope that the Human Subject Review Committee is alive and well at UCSB and UT. :-)

Sincerely,

Gunars

p.s. Would I pass your undergraduate course in stuttering therapy? :-)


Last changed: September 12, 2005