Saturday, August 30, 2008

A new treatment for stutterers?

Have a look at this interesting TED talk by Christopher deCharms. He adds a new way to change brain functions, neuroimaging therapy, to the traditional approaches of pschotherapy, pharmacology, and neuro-surgery. It is a bio-feedback mechanism: using real-time neuroimaging, the patient can see the brain activation as it happens and learn how to modify. Neuroimaging therapy is a novel concept which also promises to help people who stutter. And you heard the news first here, at TheStutteringBrain blog!

Fluency shaping therapies already use software to give stutterers feedback on their newly learned speech patterns like gentle onset. And, auditory feedback devices and recording phone calls are another biofeedback mechanism. We learn by seeing the results of our actions, and thereby learning to modify the actions.

Why not do the same with real-time neuroimaging? Imagine, you are sitting in an fMRI scanner and you are talking to your therapist at the same time. I am sure that after some practise you will see how the brain activates differently depending of whether you stutter or you speak fluently and controlling your tendency to stutter.Then, you can actively try to modify brain activation patterns. Intriguingly, you are focusing on normalised your brain function rather than normalising your speech, which must be more effective. Let me repeat: You are working on your true "internal" stuttering rather than modifying your speech caused by your "internal" stuttering.

Sure, the real-time is not as real-time as deCharms would like the method to be, and there is the noise of the scanner which might make practising difficult if not possible. However, I have no doubt that there will have silent workable real-time imaging systems, maybe in five years but definitely in ten years. Such a neuroimaging therapy is no quick-fix, but it would be much more effective way of changing behaviour, because you work on your internal issue and not use your external speech proxy as feedback.

Friday, August 29, 2008

Can a stutterer become vice-president?

A clear no! No-one with a noticeable stutter resulting in impaired communication can become vice-president or president. Can someone who stuttered as a child and is now fluent for all practical purposes? Yes! The mantra of the stuttering community is: Stutterers can do any job including being a politician or actor. And they parade in front of us Winston Churchill, Marilyn Monroe, or now Joe Biden. But have you ever heard them stutter severely in public? No, they are speaking fluently, and at best hesitantly. They are no stutterers in the eye of the public. At best, they have worked hard to minimize their stuttering so that it sounds like normal speech and does not impair communication, and at worst, they just happen to recover and attribute an event close to recovery for their recovery. But how many of us have worked hard but still stutter noticeably and have to endure the well-meaning but annoying sermons of the recovered?
Yes, stutterers can get into high power offices, but either by connections, an inherited power base or ability for background networking and dealing. And those offices are the hidden ones rather than in public view. It is a despite and not a because of.

Wednesday, August 27, 2008

No fluency but psychological turn around

This study confirms my suspicion and experience of stuttering therapies: no significant long-term improvement in fluency but improvements in psychological well-being:

An experimental clinical trial of a cognitive behaviour therapy package for chronic stuttering.
Menzies RG, O'Brian S, Onslow M, Packman A, St Clare T, Block S.
Australian Stuttering Research Centre, The University of Sydney.

PURPOSE: The aims of the present study were to: (1) examine the rate of Social Phobia among adults who stutter; (2) study the effects of speech restructuring treatment on social anxiety; (3) study the effects on anxiety and stuttering of a CBT package for social anxiety. METHOD: Thirty-two adults with chronic stuttering were randomly allocated to receive either: (1) speech restructuring following a CBT package for social anxiety, or; (2) speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post- CBT, post- speech restructuring and 12 months follow-up. RESULTS: Sixty percent of our cohort were diagnosed with Social Phobia. Speech restructuring treatment alone had no impact on the Social Phobia of our cohort at 12 months follow-up. At follow-up, participants who had received CBT showed: (1) no Social Phobia; (2) greater improvements than control subjects on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with Social Phobia. CONCLUSIONS: The CBT treatment was associated with significant and sustained improvements in psychological functioning, but did not improve fluency.

Tuesday, August 26, 2008

Biden on video on stuttering

And here. Biden is at 0:15, 3:00 and 5:25. It is good he is open about his stuttering in childhood. For my taste, he is a bit too American: Struggling evil and overcoming it... Of course the majority struggle hard but never overcome it! Was he just the lucky one or did he do something special to help overcome it?

Joe Biden

Joe Biden, the vice presidential candidate on the democractic ticket with Obama, was once a stutterer!
WHEN Joe Biden was a youngster he had a stutter, cruelly earning him the name Bi-Bi-Biden. He conquered that affliction to become one of the Senate's great talkers and Barack Obama's pick as his vice-presidential running mate.

As a child, Biden stuttered and was teased by his classmates. He practiced reading aloud in front of a mirror and worked hard to overcome it. During law school he befriended a stutterer and worked with him regularly on his speech. Now Biden is known as a loquacious orator.

In the Biden family, children were taught to respect Catholicsm, but not necessarily the person in it. As a boy, Biden took endless ribbing from classmates for a stutter he later overcame. Much of the time, the nuns tried to help. But when a seventh-grade teacher mimicked Bu-bu-bu-bu-bu-Biden's stutter in front of the class, his mother, Jean, demanded a meeting with the principal and the offending nun. "If you ever speak to my son like that again, I'll come back and rip that bonnet off your head," she said. Later, when then-Senator Biden told her he was going to visit the pope, she said: "Don't you kiss his ring."

Check out this NSA story. I can already see the stuttering associations world-wide salivating on the prospect of a golden opportunity to spread the message!

(Thanks to Ora for the story)

Monday, August 25, 2008

No tics when alone

I just saw a documentary on tic disorders. Interestingly, a women affecting by tics said that she is symptom free when she is alone, but the tics start when her husband comes home and gets worse in public social situations. Sounds awfully familiar to stuttering. I wouldn't be surprised if a similar mechanism is behind this phenomena.

Maguire talks on medication on StutterTalk

Check out StutterTalk's interview with Jerry Maguire on medication. Jerry is the main investigator of the Pagoclone study. He introduces the field, and talks about side effects. He said that he is guinea pig amd tried several compounds. He thinks that a combination of medication and speech therapy is more effective. Greg talks about his experience on medication: he said that secondaries reduced but he had significant side effects. Then Maguire talked about Pagoclone. He says that the Phase III is going to go ahead. In Phase III, they will play around more with dosis. Pagoclone seems to be more effective with longer use. He said that Phase II showed 20 to 40% improvements, (I DO NOT AGREE BECAUSE PLACEBO DID SIMILAR. THE DIFFERENCE BETWEEN BOTH WAS ONLY ABOUT 10% REDUCTION! THE OPEN LABEL DID BETTER BUT IT IS NOT PLACEBO CONTROLLED AND NOT ALL PARTICIPATED) They then talked about fluency shaping and it's unnormal speech unlike medication. Maguire says that it is not going to be a cure with all, but he believes in a combination of different approaches is the future. Then, they talk about different cocktails that some advertise. Jerry spoke about the use of telemedicine. So whereever you are in the world, you can get a consultation with Jerry and Dave at the Stuttering Center at Irvine in California.

Friday, August 22, 2008

StutterTalk interviews TheStutteringBrain

Yesterday, I got interviewed by Greg and Peter from Stutter Talk, the second best blog on the Internet! ;-) We talked about crackpots, medication, early intervention, outlook on research and treatment, and my view on the dormant and reactive phase. I will link once it's on-line.

Wednesday, August 20, 2008

Side effects very often kill benefits

A reader e-mailed me on his experience of someone taking medication:
On a different subject, I discovered tonight that someone in my group has tried Zyprexa (olanzapine) on several occasions. Most recently he’s been taking it for several months. I’ve noticed that he’s been gaining weight, but I didn’t know why till tonight. He’s gained about 30 pounds (20 kg), and is hungry all the time. He also feels tired. He’s was first on 5, now 10 mg per day, but has just decided to stop it because he doesn’t like the side effects. He took it for two previous periods, and it did have a beneficial effect on the stuttering those times, but this time, he’s not seeing much benefit. He was also in the pagoclone study. He thinks he was originally in the placebo arm. He continued with pagoclone after the end of the double-blind phase, for several months only. I didn’t get a clear sense why he discontinued; I think it was simply because he wasn’t seeing much benefit. He’s also being treated for OCD and sometimes anxiety (most recently Zoloft, I think), and he says that its hard to get the balance right because Zoloft definitely exacerbates his stuttering. I think he discontinued the Zoloft when he started Zyprexa, so he could isolate the effect of the Zyprexa.
I am getting consistently such reports. Side effects are outweighting benefits, and initial gain in fluency is gradually lost. Result: all that I know have stopped taking medication with 1-2exceptions. Pagoclone is somewhat different as it is better tolerated, but I haven't received any very positive report. Except long-term fluency gains in the open label trial. So if you have taken Pagoclone or other medication and experience stable fluency gains, let me know. I want to hear of your experiences

Monday, August 18, 2008

Christian Kell at the Paris workshop

Here is the last talk of the Paris workshop: a few weeks late. Christian Kell was the last speaker. He is a post-doc at Ecole Normale, and did his PhD in Frankfurt where he collaborated with Katrin Neumann on brain imaging studies on stuttering. I have already dedicated one post to him, to recapitulate: he is famous for finding the sensory location of the male penis in the brain!
Thank God then for Christian Kell of the University of Frankfurt who stuffed eight blokes into an MRI scanner and then tickled bits of their bods with a feather while (no doubt) keeping his eyes firmly fixed on the brain activity monitor. The NS notes: "Each man's penis was represented in the same place - flanked by the areas for the toes and abdomen - Kell told the Organisation of Human Brain Mapping annual meeting in Toronto." Kell went on to lament: "The only depressing thing is that the representation is very small."
Katrin scolded me for writing about this, saying that he was shocked to read about this on my blog. I asked him at the conference, and of course it was not true but her over-reaction as always. Chris said that he was surprised by the deluge of interest, that he got used to it, because after all it will stay with him for the rest of his life. To be honest, I think he enjoys his claim for fame. Chris seems multi-talented. He asked good questions. His French for being a German is quite good. He was a driving force behind the conference. And at the end of the workhop, he played the piano supporting a singer he recruited. So if he fails to get another job in neuroscience, I am sure he can make his money in a piano bar in Pigalle!
Chris spoke about research he has done in collaboration with Katrin in Frankfurt. I haven't found the article on PubMed, so it might not be out yet. They looked at people who recovered unassisted, who improved due to a fluency shaping therapy (before, just after, and one year after), and controls. What are the brain differences? It is an interesting question. Is there a difference between unassisted recovered stutterers and controls? Is there a difference between unassisted and assisted recovered?
(It is important to say a few words on unassisted recovered. I am not sure he said something about it his talk. But, I remember someone saying that many are not really like fluent speakers, but still have hesitations at times. When you ask them about this, they say that they are fluent for all practical purposes. They do stress that fluent speech is not always automatic and that they have to work to get it. This is even more true for people who undergo therapy and become fluent. The major difference is probably that unassisted recovered have managed to have lasting improvement, whereas people who become (more) fluent through therapy are likely to relapse fully or partially.)
As with all the other talks, I do not have access to the slides, so I can only rely on the abstract and my notes. They use functional and structural MRI. Not surprisingly, they find grey matter reduction and white matter anomaly on the left side in all stutterers. I think also in unassisted recovered stutterers. So constancy across groups. However, there were clear difference in activation. Stutterers activated several regions on the right side including the activation of the right analogue of the anomalous left brain region. After therapy, the right hand side activation was normal except again activation of the right analogue. And unassisted recovered stutterers show similar activation but additionally showed activation in the anomalous right region. He refers to the Brodman area 47/12. And they conclude that: "recruitment of the left posterior orbitofrontal cortical region (BA 41/12) appeared in this study as a unique and necessary feature of long-lasting repair of stuttering.
He further states that this region is probably involved in executive control of rhythmic tension. He actually talked a lot about rhythm, but I did not follow it all. I just have written down that the right side keeps rhythm and the rhythm competence (not sure exactly what it stands for, but this is probably understanding rhythm as opposed to executing rhythmic tasks) is on the left side.
I asked him a question on methodology. They used people from a fluency shaping therapy: the Kassel Stuttering Therapy. I have also attended the intensive course plus a one-year daily practise. One striking feature is the strong rhythm and gently onset of the newly learned speech pattern. It is quite funny. If you go to Kassel, everyone speaks the same way. Though I have to say that this is on purpose and the idea is to reduce the strong rhythm gradually: over-learning. I was concerned that the stutterers were just using this way of speaking and so you should see activation in rhythm areas, after all you speak in a rhythm! He replied that they told them to try to speak as natural as possible. However, I do not completely buy this argument, because when I was in this mode of speaking and tried to speak normally, I found it hard to do. In fact, some region in my brain kept me in the other mode, and I would only gradually shift and loose the restraining power of the new speech mode. Anyway, it is an interesting study! ;-)

Thursday, August 14, 2008

Facebook Group

I have created a facebook group for readers of my blog:

Readers of TheStutteringBrain Blog

I also have a facebook account: here. Become my friend! I have so few... :-)

Wednesday, August 13, 2008

Urban myth: more left-handed stutterers?

Check out this article on the Day of Left-handers: here. This is another urban myth.
Stuttering and dyslexia occur more often in left-handers (particularly if one is forced to change their writing hand as a child).
 Or are there more left-handers who stutter??? But I seriously doubt stuttering can be induced by changing writing hand?

Monday, August 11, 2008

Jaik Campbell

Well it is a bit late. The show was last week, but have a look at Jaik's comedy acts. He also stutters and is quite funny. Actually, he is already funny without teling a joke! We had some great time in Dubrovnik at the last IFA conference. He was chasing Russian girls. ;-) Check out some of his videos: here.

Thursday, August 07, 2008

News from one of my crackpots

You should have a look at Steve Hill's attempt at intellectual musings on the causes of stuttering: here. He has already received a Crackpot Award, but deserves more attention.
I have a number of e-mails from people who are worried that their children might in some way "catch or copy" their stutter and therefore develop a stutter in this way. We all know how damaging our own speech impediment has been and therefore would not wish a stutter on any person let alone our children.

Other people have told me that they developed a stutter after being involved in some form of scary incident, such as a car crash. The stutter seemingly developed due to some form of shock reaction.

He clearly has no understanding of the difference between correlation and causality, is relating on anecdotes, completely disregards genetic and brain imaging work.

Wednesday, August 06, 2008

Stuttering is colour blind

I am wondering whether this research was necessary. They looked at whether African American kids are stuttering more or less than "European American" (poor US whites they are now labelled after us Europeans!). I guess to see whether black kids are discriminated. I would not be surprised  (but I do not know for sure) if this was a clever move by the researchers to get funding for their stuttering research by tapping into the racial equality money, and use some of the overhead for other projects. I am wondering whether we could somehow link stuttering to global warming, and we could get more money for stuttering! Or, even better for terrorism, no lets make it bioterrorism (that's closer to stuttering which is also bio) because then we can kill any criticism to our stuttering-makes-terror theory by calling  our critics unpatriotic or liberals! Seriously, the matter of the fact is that lots of money is dedicated for research that 99% of the politicians know are ineffective but politicians need to show that they care for the topic. But what really happens is that neighbouring fields jump on the bandwagon by re-writing their grant proposals to fit the political dictat. So if we want to get more money for stuttering, we need to either make us important enough to get big pots of research money or to tap others.

Actually on a second glance, this piece of research is very interesting! So I am glad it was done. Why? Well, it confirms that stuttering is roughly similar across at least two races, which fits with what we have been known anecdotally for a long time: people stutter in any culture or race. But, I am actually struck by the fact that the numbers are so similar. Yes, I would have expected that kids stutter in all races, but that the numbers are so close is interesting. It is well-known (that is a phrase I use when I have heard it somewhere but I am too lazy to look for a reference!) that different races have illnesses at different prevalence. The fact that stuttering seems to be remarkably constant might well point to the interpretation that there are many ways to start stuttering (many gene combination and no single gene) unlike for some illnesses which depend on one gene which could easily be selected out in one race. You can also argue that the same culture made them stutter in same numbers, but I do not pay this because the frequencies of illnesses is different for different races even though they live in the same culture (well do they really? There are very distinct sub-cultures in the US.)

But wait, why don't we do the same for gender and see whether one of them is discriminated! Wow, four times more boys stutter than girls! So there is a clear discrimination by society here, isn't there? But of course because the discrimination goes against the common urban myth "that women are discriminated", no-one bothers about it. Just imagine more girls had stuttered, everyone would be talking about it....

Here is the abstract:

J Speech Lang Hear Res. 2008 Jul 29. [Epub ahead of print]Links

Prevalence of Stuttering in African American Preschoolers.

Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign.

PURPOSE: This study sought to determine the prevalence of stuttering in African American (AA) two to five year olds as compared to same age European Americans (EA).

METHOD: A total of 3,164 children participated, 2,223 AAs and 941 EAs. Data were collected using a three-pronged approach that included investigators' individual interaction with each child, teacher identification, and parent identification of stuttering.

RESULTS: No statistically significant difference for stuttering was found between AA and EA children. Using the investigator and teacher method of identification, the prevalence of stuttering was 2.52% for the entire sample. For both racial groups, boys exhibited a higher prevalence of stuttering than girls. Of the three predictors (age, race, sex) of stuttering, only sex was a significant predictor.

CONCLUSIONS: AA two to five year olds are not overrepresented in the stuttering population for this age group. When data are combined for both racial groups, the prevalence of stuttering is 2.52%. More boys than girls stuttered in this sample of preschoolers.
PMID: 18664698 [PubMed - as supplied by publisher]

One of my heroes

Have a look at this interview with Richard Feynman, Noble Prize Winner and guru of theoretical physics. He is definitely one of my heroes. Here he talks about Social Sciences. He might as well have talked about the general status in stuttering research!

Also, check out his superb explanation of what science is about using chess!

Monday, August 04, 2008

Reduction of stuttering severity

I am on the mailing list of STUTT-L, and I like this post by Gunnars Neiders. Especially, the Gaining insight alone does not help strikes me fatally!
I believe that reduction of all the significant dimensions of stuttering is a valid goal of stuttering therapy. The main dimensions of stuttering are:

1) Disruption of the communication process,

2) Secondaries (eye blinks, pursing of lips, head jerks, snapping fingers, etc.,

3) Distressing emotions of anxiety, shame, etc.,

4) Avoidances of sounds, words, situations,

5) Unhelpful ... attitudes, beliefs or self-talk ("I can't stand stuttering" instead of "I don't like it, that's OK, I can stand it anyway"; "Stuttering makes a person less worthwhile as a human being" instead of "There are inconveniences associated with stuttering and sometimes I may lose out on some of the goodies of life due to stuttering, but I can unconditionally accept myself, I am just as worthy to myself, whether I stutter or not", etc.),

6) Self-limitation in social and vocational settings. (not pursuing career of choice, limiting socializing, etc.)

There are techniques to reduce all of them. Gaining insight alone does not help. There are homework assignments that help; but learning exercises does not help if one is not inclined or does not find it cost effective to do massive practice. Some techniques are more efficient than others. Six things that hold back a persons are:

a) perfectionism/all or nothing thinking (I either succeed to completely change, or it is not worth my while),

b) not knowing what type of homework exercises to do,

c) learned helplessness ("Since I have failed in the past, I will always fail),

d) not experimentally trying all types of techniques to find out what works,

e) not having persistence and

f) the self- formal therapy not being cost efficient.

If the cost in time, energy, money, etc. is too big for the effective results, it just is not worth it. It would be silly to pursue a goal in life which is too expensive, too dear.