Part I
This paper reflects a good number of ideas and assumptions that I have supported for
many years and that have been confirmed by studies by other authors and by clinical
practice.
Before 1991, stuttering was a psychological issue in Argentina. Paediatricians advised
the parents of stuttering children to "wait". Stuttering was not a subject within
the career of Speech Pathology and no statistics could be found in the hospitals.
This was so much so that people thought this was a pathology aimed at extinction. There
were no stutterers; it was a hidden issue.
Since there were no effective treatments (stutterers were only submitted to relaxation,
respiration or rhythm exercises), I started to incorporate the body as an instrument
for communication, when I was finishing my instruction as a corporal trainer under
the Milderman System, based on the stimulation of the right brain hemisphere functions.
My search was aimed at more integrated and encompassing approaches.
In 1988, I started with this corporal experience, on a weekly basis, within the framework
of the Local Mental Health Program of the Pirovano Hospital. Since then, we have
been always looking forward to new ways of attaining a more global communication
--not only from oral expression--, allowing for a more flexible expression. When, in the
same Hospital, we started the 1st. Self-Aid Group for people who stutter, those participating
in the latter became special guests to our corporal experiences.
Corporal workout is performed jointly by speech pathologists, people who stutter and
other people who were attracted by this activity because it stimulates expressiveness,
playing, gestures, singing and non-verbal communication.
Simultaneously, I went ahead with my research work on the functions of the right brain
hemisphere and its relationship with fluency disorders. When I learnt of the functions
of the RBH, I always thought that --in the case of speech disorders-- the latter should be able to perform activities that would offset the LBH's deficiencies.
Demonstrating this hypothesis and sustaining multitudinary corporal activities with
music in a hospital and for so many years is not an easy task. However, the results
obtained in every session did nothing but confirm my assumptions and that this was
a valuable experience.
It was then that I started getting further training in the specific field of stuttering,
with total support from Dr. Gregory. After highly-dedicated studies, I could enhance
my knowledge and also become certain of the validity of the hypothesis I had formulated years ago.
Many authors support the hypothesis that stuttering may be due to the fact that the
left hemisphere is "fragile" and susceptible to interferences, particularly those
from the right hemisphere (Webster W. 1997). My personal experience as a speech pathologist in clinical work led me to use expressive corporal elements based on right hemisphere
functions that behaved as a support to expression in communication and language use.
After 10 years of clinical observation, today I can say that we need both approaches
to arrive at a real recovery. In many cases, on one hand, we need to work with the
speech motor control system but, at the same time, we need an activity that allows
those who stutter to express their fears and apprehensions and to communicate freely.
On the basis of the hypothesis that the left brain hemisphere cannot sustain neuronal
language command by itself, we cannot disregard the need to use functions or styles
of the right brain hemisphere, looking forward to a more effective treatment in reducing verbal and corporal stress.
One of the last conclusions about RBH functions reveals its dominant aspects for language:
prosodic, emotional and gestures. The capacity to express emotions in language seems
to be one of the RBH functions.
As speech and language are movements, it may be easily assessed that verbal stress
takes place simultaneously with corporal stress and negative emotions in stuttering,
and the person who stutters needs to talk more easily but, at the same time, to increase communication with others and to have a place where he or she is not only a person
who needs to talk more fluently, but a person who needs to communicate, with his
or her whole body and feelings without the pressure of talking
In Buenos Aires (Argentina), we are applying the Milderman method, based on the stimulation
of RBH functions. When I incorporated this approach, my view of stuttering changed
significantly. Now, I am not only interested in speech motor, linguistics or emotional aspects; I am further interested in human communication.
Thus, this year, during the 5th World Congress for People who Stutter, in Johannesburg
(South Africa), we introduced our Argentinean communication workshop with many people
who stutter from all over the world and their clinicians; different cultures, different languages and only one communication: fluent communication..!
Indeed, all of us --fluent and dysfluent people-- have a good number of blockages when
we want to express our feelings!
Just one more communication workshop, as the ones we hold every week at the Pirovano
Hospital in Buenos Aires, Argentina.
The classes on expressive movement include:
Expression workshop involving joint integration games, with the participation of people
who stutter, speech therapists and other people.
We have found that our work in "communication workshops" provides a very important
communication tool in everyday life"
The corporal vocabulary has its own laws and we have to discover them to be able to
express our emotions
In Argentina we can help many people who stutter at the same time and, besides, it's
free.. Some people who stutter need to be treated but they have no money for this
and this is, at least, a way to help their global communication.
As we have two complementary brain hemispheres, I always think of an ideal treatment
based on our left hemisphere: speech motor controls system, and of a corporal activity
from our right brain to express ours fears, frustrations and apprehensions. To move
naturally, we have to recover our natural movements, awakening our reflexes to be
able to express our emotions.
A person who stutters, as every other person, has to discover --through the body-- many
other different ways of recognising himself or herself and not only as "the one who
stutters".
The communication workshop in South Africa allowed two hundred people of different
cultures and languages to communicate through the most essential features in each
one of us... and it was --indeed-- a very fluent experience.
The idea of an integrated brain functionality is becoming more and more popular as
a basic need for a major and a better performance.
In stuttering, the simultaneous stimulation of both brain hemispheres allows for an
integrated therapeutic framework and for people who stutter and speech pathologists
to work together time, because we all have blocks: people who stutter in their speech
and all the rest of us... in life, with regard to others things. And we learn from each
other to be aware of such blocks, to accept them and to modify them as much as we
can.
What I propose is integrating techniques from both the left and right brain hemisphere,
as well as the work performed by researchers and clinicians with actions by speech
therapists, people who stutter and parents of dysfluent children, not only as from
work but from our hearts.
After many years' work, I can say that it is indeed possible to perform speech treatments
based on motor skills. It is as well possible to attain linguistic skills and changes
in attitudes towards the limitations as a response to either "speak more fluently" or "stutter more fluently" programs.
Corporal workout is a very valuable tool for many people needing to express themselves,
whether they are fluent or dysfluent. It promotes a more open, free and sustained
communication by means of a plastic and flexible body.
People who get this training every week can:
Part II
It was a fluent Congress for dysfluent people; a big, big gathering in a circle found
us, hand-in-hand, in silence, looking at each other, feeling and smiling, listening
to the music.
Part III Some ideas to help our understanding of the RBH functions
and their relationship with stuttering problems
1) In the past, the classical neurological approach was:
a) Unable to talk and write (RBH).
b) Unable to understand reading and writing the language.
c) Distant from any activity dealing with knowledge and communication.
2) Now, we know that:
a) there is an increased understanding of the mind and of the cerebral functions.
b) new therapies devoted to certain types of cerebral damage are available;
c) the unilateral dominion of the Left Hemisphere over the Right one gives way to
complementary specialisation.
3) Right Hemisphere Processing Style:
a) Viso-spacial task specialisation.
b) Perceptive processes and direct information analysis from our body.
c) Emotional expression, musical and rhythm sense.
d) Daily events, persons, places, objects and familiar things, things outside our
environment.
4) Techniques based on the RBH functions:
- These techniques produce really deep corporal, mental, emotional and social changes
among those who apply and receive them.
- The therapists and people who stutter work together and --together-- they discover
the effects of this new way of communication through mutual exchange.
- Every effort to act on one of the cerebral hemispheres must be accompanied by the
specific language of that hemisphere.
- In certain learning processes, it is important to avoid the influence of the left
hemisphere to have access to the right hemisphere.
- We have two different ways of acquiring knowledge, which are, actually, different
ways of processing information.
- Our stimulation of one of the two hemispheres tends to interfere with the normal
performance of the other.
- Modern therapists make use of both hemisphere functions.
- Verbal communication is supported on body expression.
- There is an evolution in knowledge of about hemisphere specialisation.
- People who stutter use more their right hemispheres to speak.
- The RBH has viso-spatial skills, and it could provide the basis for a sophisticated
emotional and mental life.
- Both hemispheres participate in most intellectual activities, but they make separate
contributions to the final cognitive accomplishments.
- Language functions are mediated predominantly by the left hemisphere, but the right
hemisphere has significant linguistic communication.
- The right hemisphere appears to be most involved in providing external details and
general orientation, while the left hemisphere contributes to an essential analysis
of internal details.
- The two hemispheres are precisely complementary.
- Most treatment programs today include both hemispheres: the speech motor control
and one activity to work with fears and apprehensions.
Part IV Corporal workout method
Some ideas:
The Milderman method includes:
1. Consciousness (awareness) of one's own body
2. Joint mobilisation
3. Recognition of reflexes
4. Recognition of the various body heights
5. Recognition of respiratory pulses and rhythm
6. Voice release
7. Expression of emotions
8. Contact with others
9. Possibilities of relaxation
10. Observation and recognition of contractures
11. Consciousness of movements
12. Recognition of respiratory pulse
13. Awareness of every part of the body
All these elements are worked out, looking forward to natural, non-directed movements,
awakening the body and making it available for expression and for communication.
a) Rhythmic bar
The procedures:
b) The session itself:
1) Body movement reflexes
Elements used:
2) Respiratory pulse
3) Natural movements with music: advancing, walking backwards, going up, down, in
and out, rotation and fleeing.
4) Group work
c) Closure
1) Music
2) Bar
3) Floor
4) Voice
5) Yoga
6) Body
7) Respiration
8) Attitudes and postures
9) Gestures
10) Singing
Conclusions
1) Attain greater corporal consciousness that, in turn, allows them to have a greater
command of their corporal stress during blockages;
This contribution is not supposed to be taken as a model for therapy; it is not actually
a therapy. It is a valuable tool for anybody willing to express himself or herself
freely, without fear, and is especially devoted to people who stutter.
2) Develop an expressive body and easier and more comfortable communication;
3) Gain better relationships with the rest, by looking at each other, playing and
participating in the dynamics of group work;
4) Through music, express different emotional status: fear, panic, shame, impotence,
sadness, inferiority, insecurity, etc.;
5) Enjoy the pleasure of letting their voices go and singing;
6) Increase self-esteem and self-confidence, since corporal workout provides them
with support from their own.
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