Wednesday, November 29, 2006

The emperor's dsyfluent speech

I have done many therapies, and witnessed many doing therapies. I always find it hard to say whether someone has made some progress or not. Sure, you can see increased fluency for many, but we all know that such an effect is often short-lived. Often, I also hear people report that they "are making progress", but I do not see the progress at all, certainly not on the fluency level. What should I do? Say that I dont see progress? Especially in group sessions where everyone has to report their previous week, people feel the pressure to say positive things, and you can sense that everyone is just "admiring the emperor's speech" even though "he has not fluent speech to show for. (I am refering to the story where thiefs sold the emperor invisible clothes, he walks around "with" them, everyone admires his "clothes", and then a little boy shouts "but he is naked".
On the other hand, gauging progress within myself is difficult. I can get very fluent, but my speech varies a lot from time to time. Or, often people tell me you are much more fluent now, and I think I am not very fluent. And other times, it is the opposite. Well, actually they only tell me when I am more fluent than average, but not when I am less fluent than average.

Wednesday, November 22, 2006

I am lost.

For some time now, I have the feeling that I am a bit lost and have no really new ideas on stuttering. I also feel that the research has come to some kind of standstill, and I find thinking about new ways forward difficult. The easy things in brain research have been done, for example. My main concern is that the sheer complexity of the brain, the likely existence of sub-types, and the emotional and psychological part of stuttering smearing out any subtle signals, all these issues make it very difficult to dig deeper into stuttering, not to speak about the not-very-good researchers in the fields.

I believe that I can see the contours of what is going on, but I don't have a clear view. Something goes wrong at 3 (either encouraged or caused by genes, or some other incident), bad habits kicking in and so on. The dual path way theory would explain all the peculiarities like being able to sing, and so on. But identifying specific modules is much more tricky.

On the other hand, I don't spend a lot of time thinking about stuttering. I don't sit down and really think about it. I am just reading the abstracts and make judgements...

Monday, November 20, 2006

Spasmodic Dsyphonia a key to PDS?

Hugo sent me a very interesting email. The cartoonist and creator of Dilbert, Scott Adams, has been suffering from spamodic dysphonia after a bout with allergies. He discusses the illness in this post on his blog, see here:

The weirdest part of this phenomenon is that speech is processed in different parts of the brain depending on the context. So people with this problem can often sing but they can’t talk. In my case I could do my normal professional speaking to large crowds but I could barely whisper and grunt off stage. And most people with this condition report they have the most trouble talking on the telephone or when there is background noise. I can speak normally alone, but not around others. That makes it sound like a social anxiety problem, but it’s really just a different context, because I could easily sing to those same people.

Several symptoms are strikingly similar to stuttering, and supports the hypothesis that two systems are involved in speaking/singing. I spoke to Per Alm, and he believes that this effect supports his dual-pathway theory. Therefore, a closer study of spasmodic dysphonia might reveal more information about stuttering itself.

Sunday, November 19, 2006

Auditory abilities of recovered stutterers

I found an interesting article by Howell, Davis, and Williams. They claim that children who recover from stuttering have different auditory abilities in the broadband backward-masked stimulus (thresholds being higher for the persistent group). Here is the abstract. I will comment in my next post:
OBJECTIVE: The purpose of this study was to see whether participants who persist in their stutter have poorer sensitivity in a backward masking task compared to those participants who recover from their stutter. DESIGN: The auditory sensitivity of 30 children who stutter was tested on absolute threshold, simultaneous masking, backward masking with a broadband and with a notched noise masker... 12 speakers had persisted and 18 had recovered from stuttering. RESULTS: Thresholds differed significantly between persistent and recovered groups for the broadband backward-masked stimulus (thresholds being higher for the persistent group). CONCLUSIONS: Backward masking performance at teenage is one factor that distinguishes speakers who persist in their stutter from those who recover. Education objectives: Readers of this article should: (1) explain why auditory factors have been implicated in stuttering; (2) summarise the work that has examined whether peripheral, and/or central, hearing are problems in stuttering; (3) explain how the hearing ability of persistent and recovered stutterers may differ; (4) discuss how hearing disorders have been implicated in other language disorders.

Thursday, November 16, 2006

Factors increasing stuttering

In my previous post, I asked how to make a stutterer stutter more. Research / therapy always looks at how to increase fluency. But would knowing which factors increase dysfluency not also help to understand stuttering?

Here are a few factors that I came up with:
1) general tiredness,
2) multi-tasking,
3) stress,
4) nervousness,
5) fear,
6) triggers recalling past experiences.

I should probably distinguish between two aspects:
a) decreasing fundamental control of the speech system.
b) triggering behaviours and habits that cause secondary symptoms.

I think a) is impacted by 1) and 2), and to some degree 3), 4) and 5).
And b) is impacted by 3), 4), 5), 6).

This is just brainstorming. I might change my mind. If you have more ideas, pls post them.

Wednesday, November 15, 2006

How to make a stutterer stutter

I always discuss how to make us more fluent. But how about tricks to make us more dysfluent!!! Please post your best tricks! :-)

Repeated reading makes us more fluent

The more often we read a word or sentence, the more fluent we get. I am not sure exactly why, possibly because the signals to say the word are getting more prominence in the brain and cannot be locked by other signals??

I have seen dramatic effect with one very severe stutterer. He was unable to say the sentence without severe blocks and other symptoms. As this event happened during a therapy, we, the other patients, forced him to say it over and over again. And more and more he became fluent, and at the end he could say it without stuttering and tension...

This fluency-inducing method is different to the fluency-inducing singing, talking in rhythum, with a foreign accent, chorus reading and so on. For such tasks, the speaker only speaks the word/sentence once.

Tuesday, November 14, 2006

Is brain research brain dead?

For the last months, I have the impression that research relying on brain imaging technology has come to a standstill. No new articles, no new ideas. I find this lack of articles a bit strange, because many different teams are working on experiments, like groups around Ingham, Neumann, Sommer, NIH, and surely others.

Have they hit the complexity wall and are unable to get publishable results? It is pretty straightforward to let stutters speak or stutter in a scanner, look at their brain activities, and detect which brain regions are consistently under or over-activated within people who stutter but not in comparison to fluent people. They have seen differences in activation and structure, on which I have widely written.

However, this epoch is over, and the new theme must be to create experiments driven by theories. Create a theory, create an experimental setup to test the theory, and do the experiment. Such research requires much much more intellectual and theoretical work, as you need to know a lot about stuttering itself and past research.

Another reason is increased complexity. The first order effects have been studied, i.e. put them in a scans and look at the scans, but the second order effects like what is going on functionally is much much more complex, because different stutterers do different things, there might be 2-3 subgroups, stuttering fluctuates, too many interactions between brain regions, not all studies found the same regions and so on.

Thursday, November 09, 2006

And another anti-stuttering device...

The latest article published on PubMedLine is about a new device using delayed auditory feedback. The authors study a prototype device using a modification of a currently used bone conduction hearing device with delayed auditory feedback on adult patients with significant stuttering problems.

What have they found? Not surprisingly, they find a positive effect for the immediate 4-week period after the start of use, and a somewhat significant effect for the 2-week period. But no effect at the 6-week follow-up.

They somewhat desperatedly conclude that:

A new antistuttering prototype using a modification of a bone conduction device with delayed temporal feedback is effective in decreasing stuttering in patients over a short time course. Further studies need to be completed to evaluate the long-term effects of the device.

Just based on the abstract, I have the following comments. First, they cannot claim effectiveness, because they have not computed the effect size, but only talk about statistically significant difference (i.e. p-values). Second, the device might well show an effect, but the finding is a bit irrelevant. Every treatment shows some effectiveness over a short time course. What about the placebo effect? Third, I do not understand why they would want to conduct further studies on the long-term effect, because they have already found no effect at the 6-week follow-on?

Nevertheless, I believe that the research was worth conducting, but the authors should have been more honest in their conclusions and not spin them.

Sunday, November 05, 2006

Tongue Twisters for twisted tongues?

I am currently reading Stutter by Harvard Professor Shell. He claims that tongue twisters are all always impossible for people who stutter. Is this assertion true?

I can do tongue twisters when I concentrate: How about you?

Maybe, we could even use them to improve our speech control. The secret about tongue twisters is to switch between two very similar sounding words several times within a sentence. Practising switching accurately and maintaining concentration might re-train our speech system. I practised one tongue twister 100 times and afterwards I had the impression of far greater control of my speech. As usual this is temporary, but practising every day might help.

Pls post your tongue twisters! :-)

Friday, November 03, 2006

Out with the stuttering boys

I just came back from drinks with the stuttering boys of Luxembourg. We talked about stuttering, its causes, and how we handle stuttering in our daily life. I talked about the latest research results and about Pagoclone. Einar thought that a therapy is better than medication, but I replied that this is true if it works but many cannot keep the progress on a long term basis. Adrien wondered whether people should maintain eye contact when someone is stuttering or not. We werent sure what is best.