Thursday, December 29, 2005

First evidence of brain anomalies in kids??

I am going to send a letter of complain to the editors of The Stuttering Foundation newsletter for being more up-to-date on PDS research than this blog!

The Winter edition has pretty interesting articles and reports on research I wasnt aware of! For example, Ehud Yairi reports on brain research with children:

Brain imaging studies of children should also enhance understanding of this issue. Our team members, Chang, Erickson, and Ambrose (2005) successfully obtained high resolution structural MRI data from stuttering and control children ages 8-13. Initial results indicate significant group differences in white and grey matter volume in brain areas involved in integrating sensory and motor aspects of speech. Testing younger children closer to onset should advance our knowledge.

Reference given: Chang, S., Erickson, K., & Ambrose, N. (2005). Regional white and grey matter volumetric growth differences in children with persistent versus recovered stuttering: An MRI (VBM) study. Presented at the annual meeting of the Society for Neuroscience, 2005, Washington, D.C. Program No. 565.5. 2005 Abstract Viewer/Itinerary Planner. Online

This research (if replicated) weakens the argument that structural anomalies in people with PDS is a consequence of PDS and not the cause. I guess due to the ages, from eight to thirteen, it is still possible that it is a consequence, but no-one can now claim "No wonder the brain is different after decades of stuttering"!

Sure, there will be some effect from stuttering even in younger kids, but I think it is mostly there from the start. Something in the developmental phase around 3 goes wrong. Another article comes to my mind (of which the editors of The Stuttering Foundation are surely not aware :-) from Japanese researchers, who found differences in processing in small children with disfluencies. I'll try to dig the article for you. I think he is called Mori.

Very interesting article

There is a very interesting article by Lisa Scott on a session "Genetic and neurological correlates of stuttering" at the last American Speech-Language-Hearing Association (ASHA) conference. All four of them have done good work, and let's hope they see the need and find ways for multi-disciplinary collaboration!

Here is the introduction:

In November, four of the leading scientists in stuttering presented their latest research at the American Speech-Language-Hearing Association convention in San Diego. Participating in a session entitled, “Genetic and Neurological Correlates of Stuttering,” were Drs. Dennis Drayna, NIDCD, Christine Weber-Fox, Purdue University, Ann Foundas, Tulane University, and Gerald Maguire, University of California-Irvine. In a session coordinated by Dr. Christy Ludlow, NIDCD, four presenters focused their discussions on state-of-the-art research in the understanding of genetic and neurological factors that contribute to stuttering. Three of the four researchers, Drs. Drayna, Weber-Fox, and Foundas, have previously contributed articles on their research to past issues of this newsletter.
You will find the full article: here.

Tuesday, December 27, 2005

Two types of factors for recovery

The factors increasing the chance of a positive therapy outcome are still largely unknown. The only sure factor is the severity of your stuttering. So if you are stuttering severely before therapy, you are more likely to keep on stuttering than someone who has stuttered mildly. So the bigger your problem with PDS, the more likely you are not becoming fluent after therapy. But that's it! No other factors are known. That is what I found looking at the KST data, and also what others seem to find.

I am still not sure what they are. But I conclude that the path to becoming a more fluent speaker, must be divided into two types of factors:

1. PDS-Specific factors: Severity of your stuttering. And then some guesses: How big is the physical anomaly? How strong are the secondary systems? Are you naturally a fast speaker? Is your PDS due to genetics or neurological incident in childhood?

2. Other factors: Some guesses are. Are you a bit obsessive and pedantic (when it comes to applying your techniques)? Are you often emotionally suffering (from PDS and have a strong motivation to change)? Have you undergone a life-changing experience like a car accident (that seriously affected you and you decided to work your stuttering?) Can you control your impulses well? A change in some neurotransmitter cycle? Are you in the right life situation (to foccus on therapy)?

Friday, December 23, 2005

New twist to stuttering genes

I have decided to spend a bit more time to read up on genetics during the Xmas and New Year period, and write a popular-scientific article about the genetics of stuttering. I have been encouraged in my endeavors by the Pennsylvania court decision that it is still OK to talk about and teach evolution without reference to intelligent design. :-)

Most research on genetics and stuttering has revolved around twin studies or looking for genes or combinations in samples like families where most members stutter: see a previous post. This new article on stuttering and genetics puts a new spin on the issue and in the right direction. A gene alone is not enough, it seems. You need the right combination of genes, or the right conditions for the gene to have important effects: read about the Epistasis effect. The researchers suggest that maternal age at birth might be such a epistatic factor.

Maternal age at the birth of the first child as an epistatic factor in polygenic disorders.

The identification of the genes for complex, polygenic disorders has proven difficult. This is due to the small effect size of each gene and genetic heterogeneity. An additional important factor could be the presence of unidentified epistatic factors. In the broad definition of epistasis, the effect of one unit is not predictable unless the value of another unit is known and one of the units may not be a gene. We have previously identified maternal age as an epistatic factor for the effect of the LEP gene on the age of onset of menarche. We report here the effect of maternal age and the age of the mother at the birth of her first child (maternal age 1st) as epistatic factors for the interaction of the dopamine D1 gene (DRD1) with obsessive-compulsive behaviors and with stuttering. The epistatic effects of maternal age 1st were stronger than maternal age. This type of epistatic factor may be generalizable to many other gene-trait interactions.

The science journal Science has named new research on genetics of other brain disorders like dyslexia and Tourette syndrom as a 2005 Breakthrough topic. I will talk about this in my next post, and be desperately trying to make a connection PDS.

Tuesday, December 20, 2005

Arty French stuttering blog

If you speak French, you should have a look at this French stuttering blog: Parole de Bègue.

If you dont speak French, still have a look! The design is beautiful.... :-)

Pebbles under the tongue

Here is a "rival" blog on stuttering: Pebbles Under The Tongue. John MacIntyre describes his efforts to become (more) fluent with a fluency shaping therapy. Currently John is in the maintenance phase after the intensive therapy phase. Of course, this phase is critical, and often relapse happens. And a lot of patience, courage, honesty-to-yourself and stamina is needed to keep on course. Qualities I think John shows admirably in his last post:

Up until last week I had done my daily shaping every day. But last week I missed 2 days, and this week I missed Monday, Tuesday, and Wednesday. I wasn’t happy that I missed it, but life just kind of took over. By mid week I had totally lost my ability to use my targets, increasingly using my previous spontaneous fluency pattern.

But Wednesday evening, I was stuttering like a maniac picking up a prescription at the drug store…I was blocking badly. And as reminiscent of old times, the guy behind me, just had to see my face as I attempted to shield myself from the embarrassment! He started off behind me, but when I started to stutter, he came around my right side leaning over to watch me. When I turned my back on him, leaning left, he moved completely around to my left side. I turned away again, and he again moved to my right. At this point, I realized he was determined to watch, so I stopped trying to get away from him and let him watch me make a fool out of myself!

Guess what … I came home and did my shaping! I did it yesterday and today. I don’t think I’ll miss it again for a while. ;-)

I don’t know what the heck that was, but before my therapy, I definitely would have stuttered and interpreted the hang up as some kind of rejection. Then I would have felt like crap for the rest of the day. At least now I know what ever the heck the problem was … it wasn’t my problem and I quickly moved on with my work.

In this post, he has made public his before and after video. The changes are amazing, and very similar to the ones I observed at the KST. There are also videos of myself at the KST. I'll see if I can get hold of them.

Here is John's talk given at Toastmasters.

Monday, December 19, 2005

Pagoclone results in Mid 2006

The results of the pagoclone study will be out Mid next year: "In July, the Company announced the initiation of a Phase II clinical trial with pagoclone, a product under development to treat stuttering. The Company is currently on track to have results from this trial by mid-year 2006."

My past posts on pagoclone are here, here, and here.

Monday, December 12, 2005

Off to Switzerland

Upps I posted this in my other blog.... :-)

I am off to Switzerland for a week, but might post if I have Internet access. I am going to meet up with someone from the Zurich self help group. He is regularly reading my blog, and I got to know him via email.

Strangely enough, when I try to speak German with a Swiss accent, I hardly stutter ... Maybe I (or we all) should consider moving to Switzerland as a good treatment approach... But then I am not quite sure why there are still Swiss people who stutter? :-)

Saturday, December 10, 2005

Picture of Tom

Some people commented that the blog is a bit boring... So I added my picture. If you cannot stand looking at me, please will you let me know and I take it off. Actually, maybe I get annoyed first about looking at my picture too often.. :-)

I plan to do a few more changes... If you have any suggestions, please let me know.

Biggest obstacles to better understanding

Here are Tom's Top obstacles to a better understanding of PDS.

Five removable obstacles:

1. missing paradigm to study brain disorders with many different interacting layers.
2. lack of rigorous scientific discussion in favour of a every-one-is-welcome and everyone's-thoughts-are-interesting-even-if-completely-wrong attitude.
3. no big money going into PDS research.
4. research field mostly populated by not-very-good or good-but-not-outstanding scientists, and by professors with money, power and good expertise but limited scientific insight. And outside researchers with insight have limited expertise in the complexity of PDS.
5. no good structure to do meta-analyis and unity all research.
6. researchers rarely replicate studies, but do different experiments.

Five obstacles you have to live with:

1. No-one dies from stuttering.
2. Brain is a complex system with many different interacting layers.
3. You can make little money from PDS.
4. Most people are victim to logical fallacies.
5. PDS is more like a high crime rate in a city than a broken down computer.

Friday, December 09, 2005

Nothing ado about hearing?

In a previous post, I described this article.

My view is very much in line with what Peter wrote: here. Actually, I am wondering who Peter is? :-) I googled "Peter stuttering". And I find a Prof Peter Ramig and a Peter Louw. I would guess it is Peter Ramig, but I have never met him.

Some more comments:

1. Their review is not very good. As you do not have the actual paper, here is one quote "individuals with PDS have... a cortical disconnection between the frontal operculum and ventral premotor cortex [reference: Sommer et al.]". Several issues here: 1) they present it as a fact, even though they only quote one source Sommer et al. 2) Sommer et al. never said such thing 3) They found a lower coherence in a fiber tract. This is either an experimental artefact or a structural weakness. But not a disconnection as such, more like a noisy phone line or a 1-lane motorway. 4) There is no direct connection between frontal operculum and ventral premotor cortex. To summarise, such reviewing practise is really annoying and encourages myth propagation. (Thx for input by Per Alm)

2. They find correlations by looking at many different variables and not by looking at the variables a-priori considered interesting. Looking at too many variables, there is a considerable chance that one variable is correlated to stuttering (for example) by chance. They used self-rated dysfluency as measure of stuttering.

As Peter says, the different reaction to changed sounds could just be a natural learned behaviour to their stuttering. But even if this is the case, does this observation not tell us that therapy needs to consider hearing issues? Or is it irrelevant?

Thursday, December 08, 2005

Battle with German titan

I am currently having a discussion with Andreas Starke, the titan of German stuttering therapy on a German discussion forum.

If you speak German, have a look here.

Wednesday, December 07, 2005

4000 visitors!

According to my webcounter, 4000 visitors have sofar visited my blog since May. And I have 22 different visitors per day, which is pretty OK considering the speciality of the topic, and my many technical / scientifically oriented posts.

Visitors come from Europe (55%), America (37%), and the rest.

The most visitors are from the US (33%) and Germany (21%). The Luxembourg (14%) is probably mostly myself! :-) The UK representation is pretty poor, but this is actually just a reflection of how little PDS research is done or discussed in the UK. From my experience, by far the most activity and good discussions are going on in the US and in Germany. France is no-where, confirming everyone's suspicion that they still live in a world of their own. They were unlucky (as opposed to the US and UK) in that their language did not become the world language... :-)

There are daily fluctuations in the number of visitors. Typically there are around 30 visitors by working day, and 10 visitors on a weekend day, confirming my suspicious that most of you are abusing your company's Internet access for private matters! :-)

I also noticed that the hits go up the more I post. So this observation is a good incentive for me to post more.

Monday, December 05, 2005

Not much ado about hearing?

There is a discussion going on in the PDS literature on whether deficiencies or malfunctioning in the auditory cortex (responsible for hearing) causes or aggravates stuttering, or whether it hinders therapy. For example, auditory feedback frequency-shifted (FAF) or delayed (DAD) enhance fluency. And in brain imaging studies, the auditory cortex shows a different (lower) activation that for controls. And check out my last post, where I have described my difficulty to realise that my speech has been much more fluent after therapy most times.

These phenomena seem to point to a crucial role for the auditory cortex. But I dont really believe that hearing has much to do with the PDS. In my opinion, the FAF and DAF enhances fluency, because the brain switches to non-automatic speech due to input that sounds unfamiliar. Ingham and others have explained the brain imaging results for the auditory cortex using the concept of efference copy: see here. But, there is certainly truth in the fact that people with PDS often dont notice the progress they have made. I do not believe, that this is a defficiency of the auditory cortex, rather the consequence of a normal functioning. The stuttering is just left out after years of stuttering as a background noise. And the absence of no stuttering sound is just not registered.

I could be wrong and I am open to be converted. This new article out in Neurology Abnormal speech sound representation in persistent developmental stuttering does not really convert me but have a look at their abstract:

OBJECTIVES: To determine whether adults with persistent developmental stuttering (PDS) have auditory perceptual deficits. METHODS: The authors compared the mismatch negativity (MMN) event-related brain potential elicited to simple tone (frequency and duration) and phonetic contrasts in a sample of PDS subjects with that recorded in a sample of paired fluent control subjects. RESULTS: Subjects with developmental stuttering had normal MMN to simple tone contrasts but a significant supratemporal left-lateralized enhancement of this electrophysiologic response to phonetic contrasts. In addition, the enhanced MMN correlated positively with speech disfluency as self-rated by the subjects. CONCLUSIONS: Individuals with persistent developmental stuttering have abnormal permanent traces for speech sounds, and their abnormal speech sound representation may underlie their speech disorder. The link between abnormal speech neural traces of the auditory cortex and speech disfluency supports the relevance of speech perception mechanisms to speech production.

In plain English, the authors have looked at the following phenomena: If you play the same sound to someone several times and then change the sound either for duration, frequency, or related phonemes (the sound units that make up our spoken language), a different brain signal is recorded. This signal is the brain detecting that something has changed. But of course you can only know that something changed if you know what has been before! So the brain must have a representation (or memory) of the preceding sound with which it can compare the current sound. And the authors claim that the signals for complicated sound changes is different to people without PDS. They speculate that the PDS brain does not have good representation of sounds amd is therefore not as efficient in quickly discriminating between more subtle sound changes, and this could encourage development of stuttering.

I had a discussion with Per Alm about their paper, and will post some comments in my next post.

Saturday, December 03, 2005

Oblivious to reality

PDS never stops surprising me. It is amazing just how complex humans are despite just being a bunch of cells made out of atoms. :-) Some days ago, I started with a draft for a new post called "Therapy results after 3 weeks". I did talk quite a bit about the therapy in my last posts, and people started asking me about the results. So I wanted to write this, admittedly not very positive statement:

"Last month, I was writing about the Kassel Stuttering Therapy, both from the perspective of a patient and of a researcher trying to improve its efficacy. I also said that I was pretty fluent in the second and third week of the therapy, and was giving talks in front of 50 people or so. So I guess some of you would like to know how I am doing three weeks after therapy. Well, I think it is fair to say that the last three weeks have been a desaster speech-wise. The first week I had several difficult speaking situation asking the tax office to give me back money, being a traffic jam for 3 hours, explaining the dentist in a foreign language, negotiations of a business deal on the phone and so on. So I effectively completely lost it. The real problem is that once I loose it, I have far less control the next time, and I also just forget or postpone practising. Anyway, now I am back practising again and today I started with making short phone calls."

But now compare this statement to a discussion I recently had with my parents:

"Parents: Can I ask you a question? You suddently speak much more fluently. What has happened?
Tom: What do you mean I speak more fluently? I dont think so.
Parents: Yes, you do. What have you done?
Tom: I also did the KST therapy again when I was in Kassel. But I dont think I speak more fluently.
Parents: Come on, Tom. You must be noticing that you have much less blocks and fillers. Why are you lying to us!
Tom: Eeehhh (I start stuttering again) Nnno, not really. I dont really notice this.
Parents: You are strange.."

Somehow those two statements do not really seem to fit well! On the one hand, I talk about the three weeks after being a desaster and they talk about me being much more fluent. Honestly, I did not realise that I had been much more fluent. I think both statements are true. I certainly was very dysfluent in some situations over the three weeks. I know this for sure, because I recorded the phone conversations and listened to them. But one the other hand, I have to believe my parent's statements that I have been much fluent, that is when I was talking to them. So I might well have been more fluent generally, but in very stressful situations dysfluent. The thing that puzzles me is my total ignorance of the fact that I speak more fluently generally. Why dont I realise this? I really must be strange.... :-)