Re: stuttering apraxic

[Guest guest]

Thanks Sherril!

Maybe I'll see you Monday at our next CHERAB meeting, and we can talk

live! (wasn't the conference great?!!) I know that stuttering is normal in

Tanner's age range (he only just turned 5 in June) I'm wondering out loud if

it's possible that there can be two types of stuttering. Is it possible that

there is any correlations at all between apraxia and stuttering? And since

stuttering is common, for apraxic and non apraxic children, why is there such

mixed information/opinions out there on how to treat an apraxic child who

enters the stuttering stage?

Here is an interesting article about stuttering that Rhonda from the

Canadian ECHO group sent me a few months ago that I meant to send out

with my post yesterday. I thought it's worth sending out still, and

maybe you (and others) will find this of interest.

" STUTTERING

Can Stuttering be cut short? by Helen Buttery, the National Post

Can stuttering be cut short?

New insights into how the brain processes speech may provide answers

Helen Buttery

National Post

Fox Broadcasting

Jim Rowlett found his stuttering dropped off after three weeks of

intensive therapy.

While he was growing up in the 1960s in northern Manitoba, Jim Row-

lett's parents were told, " He thinks faster than he can talk, he'll

grow out of it. " But he didn't, and for the first 30 years of his

life stuttering controlled almost every decision he made.

He wanted to be an RCMP officer, but in Grade 12 Rowlett

realized, " I'd have to talk and I wouldn't be able to. " So instead he

chose power engineering, which involves boilers and pressure

vessels. " Boilers and equipment don't talk, " he says.

Not only did stuttering direct the big choices in his life, it also

monopolized the small ones. Instead of asking for food he craved on a

menu, he would order what he could pronounce. His biggest fear was

the telephone. He would drive miles across town to see if a shop had

a part that he needed rather than call for the information. Rowlett

is among 300,000 Canadians who suffer from stuttering. No one knows

what causes it, but developments in brain-related technology are

helping researchers understand how it works. Eventually, this should

lead to better treatments.

" Technology has driven the interest, " says Ingham, professor of

speech and hearing sciences at the University of California in Santa

Barbara. " With the development of PET [Positron-Emission Tomography]

technology we've been able to get a much better picture of the neuro-

processes associated with speech than we could ever have done before.

We're now asking questions we couldn't ask before. "

The idea that there is a link between stuttering and the brain first

appeared in the 1920s. Building on discoveries linking the left side

of the brain to speech, it was hypothesized that stuttering was

caused by a lack of left-brain dominance, and that this was somehow

linked to handedness. Children were made to write with their right

hands to stimulate proper development of the speech centres of the

left side of the brain. It didn't work and, with no means to test

this notion, it was brushed aside until recently.

Now, scientists have confirmed the left side of the brain dominates

people's speech centres, but for a small percentage of the

population -- less than 5% -- speech is processed using both sides of

the brain. Among left-handed people this percentage is higher, an

estimated 30%. But left-handed stutterers will not improve their

speech by writing with the right hand. Handedness does not play a

role in stuttering, but how the brain processes speech, laterally or

bilaterally, does.

Three groups in North America (at the University of Toronto, the

National Institutes of Health in Washington, and the University of

Texas in San ) are trying to locate regions in the brain

crucial to the presence or absence of stuttering.

The group in Toronto, including Luc De Nil, a speech pathologist at

the University of Toronto, compared the brains of 10 stutterers with

the brains of 10 non-stutterers while they performed several tasks.

The stutterers were then asked to repeat the tests after three weeks

of intensive speech therapy, to see if this influenced the brain's

activity. The findings were published last summer in the Journal of

Speech, Language, and Hearing Research.

Both groups were asked to read words on a screen, first silently and

then aloud. For the non-stuttering subjects, as expected, brain

activity occurred during both activities, in the left hemisphere of

the brain and in the Broca's area (the left frontal lobe of the

brain, responsible for speech production).

The stutterers, however, showed an increase in activity throughout

the brain, including the right hemisphere. " There is no clear right-

left correlation, " says De Nil. The stutterers " were invoking many

different regions of the brain that are typically not involved [in

the speech of] non-stuttering subjects. " During the silent reading,

these areas were called upon to a lesser degree, but they were still

active.

One of these regions is the cerebellum. Located at the back of the

brain, it co-ordinates movements of large muscles in voluntary

motion. " If you are learning a new motor task or new movement, [the

cerebellum] is highly involved in error correction, " says De Nil. For

example, if you pick up a tennis racket for the first time, it will

take time and practice before you perfect your backhand. The

cerebellum will be activated to adjust your movement and speed until

it becomes a smooth, involuntary movement. Once this is accomplished,

the cerebellum's activity will significantly decrease.

The involvement of the cerebellum in the speech process of people who

stutter indicated to De Nil " that even saying those very simple

words, for stuttering subjects, is not automatic. "

Another unexpected area involved in the speech of stutterers is the

anterior cingulate cortex (ACC). This usually comes into play when

people perform cognitive tasks requiring concentration. " We didn't

see activation in our normal speakers, but in our stutterers it was

one of our most highly activated areas, " says De Nil.

The final task required the subjects to say an action word or verb

associated with the word on the screen. For example, " chair " might

invoke " sit. "

" When we look at just the verb generation task, we found no

differences between our stutterers and non-stutterers, " says De Nil.

The verb generation task, unlike the two previous exercises, was a

cognitive test, where both test groups had to come up with a word.

This indicates that where the stutterers differ from the non-

stutterers is at the level of controlling the movement of the tongue,

jaws and lips.

" It's not that they have difficulty coming up with the words ... it's

more the control of the physical movement that seems to create

difficulty, " says De Nil. This physical movement originates in the

brain. " This has strengthened the idea that stuttering has a

neurological foundation. It is not a psychological problem. People do

not stutter because they are nervous. "

Although treatment for stuttering has been available for more than 20

years, speech pathologists are only now seeing how the brain responds

to therapy.

Rowlett has experienced this help first-hand. With his 30th birthday

approaching, he realized his problem was not going away. He decided

to take a three-week therapy program at Edmonton's Institute for

Stuttering Treatment and Research, telling everyone he was going on

vacation in case it didn't work.

" You are literally in therapy for eight hours a day, five days a

week. They teach you a whole new way of forming your words, " says

Rowlett. This is similar to the treatment used with the subjects in

the Toronto study.

De Nil compares the process to learning to type with all fingers when

you have spent years typing with only one. " You're not going to start

typing at 60 words a minute. We're going to start very slowly. "

Stuttering, like other developmental disorders such as dyslexia and

Tourette's syndrome, are genetic and sex-linked. Boys are three times

more likely to stutter than girls. Rowlett probably inherited the

trait; his uncle stuttered.

Signs of improvement came quickly for Rowlett. After the first week

of therapy the group went to a bar. He had always wanted to order a

Labatt's Blue, but his stuttering prevented him. When the waiter

asked what he wanted, he said, " I'll have a Labatt's Blue, " and his

eyes welled up with tears. " This was the first time I could actually

order a Labatt's Blue, " he says.

After treatment, the stuttering subjects in De Nil's study show

reduced overactivation across the whole brain. " Still, it's not

highly automatic, they have to think about what they're doing when

they're speaking, " he says.

Therapy is very effective for most stutterers, especially children

whose systems are more susceptible to change. " Their brains are much

more plastic, more malleable, " says De Nil. It is not unusual for

children to stutter, especially between the ages of 2 and 5. Most

will outgrow the problem.

" One of the words I have trouble with is 'three,' and sometimes

the 'S' sounds get away from me. But overall, I'm in charge of it

now, " says Rowlett.

The Toronto studies have shown how the brains of stutterers behave,

and how therapy can change the way the brain functions, but

researchers still do not know exactly how the brain adjusts itself.

Where is the switch turning these areas on and off?

The research lab in San hopes to shed some light on this.

Scientists there have discovered that the same parts of the brain are

activated in people who stutter whether they are reading aloud or

reading silently while imagining that they are stuttering. The

findings were published in the November issue of the journal Brain

and Language.

" [stuttering occurs] in the pre-planning phase of speech, before you

actually open your mouth, before the utterance occurs. It's

independent of speech, and it's almost as though the neuro-system is

present to produce the problematic behaviour, " says Ingham, who

worked on the study in Texas.

The investigation found the auditory association area (part of the

temporal lobe located near the skull above and behind the ear)

is " literally turned off " in people who stutter, whereas in normal

speakers it is engaged while reading silently or aloud.

On the other hand, the area that was stimulated in stutterers was the

insula, which is between the Broca's area and Wernicke's area of the

left temporal lobe. " [The insula] is a crucial area in controlling

your articulatory skills, " says Ingham.

By increasing the activity in the auditory association area, it may

be possible to turn down this insula overactivity, and that might end

the stuttering.

Research investigating this possibility started a few weeks ago. The

scientists will deliver a brief magnetic charge to the auditory

association area of stutterers, which will increase the blood flow to

this region. They hope this will also deactivate the insula.

It is too early to tell whether this process will work. In the

meantime, Rowlett is using his new-found confidence to help others.

If he hears a child stuttering, he will approach the parents and

encourage them to seek diagnosis and treatment. " I'll go up and

say, 'Excuse me, I couldn't help but notice that your son or daughter

has something in common with me,' " he says. Jim Rowlett is not

running from stuttering anymore. "

Talk to you soon!

[Guest guest]

Our daughter, 7 1/2 years old, has been in speech therapy for

severe/profound verbal apraxia since her third birthday. Treatment

has consisted of intensive, one-to-one private therapy for 2 to 4

times a week for 4 1/2 years. She currently is classified with mild

to moderate verbal apraxia. Also noteworthy is a dual diagnosis of

severe disfluency.

Her disfluency has fluctuated over the years, but she has had

incidents of classic stuttering (her father is stutterer) that were

beyond typical apraxic " groping " . She has also struggled with

feeding issues around food textures and has dyslexia.

We began giving my daughter two ProEFA capsules a day, one in the

morning and one in the evening. She weighs 49 pounds and is 49

inches tall. On the seventh day of this regimen, she had an

unprecedented burst of fluency. During our family supper, she began

telling us stories at a hyper-rapid rate. It was as though she was

surprised by the flow of her words and was anxious to tell all that

she could, as fast as she was able to do so. I should note that we

had out-of-town visitors at the time, and my friend, an early-

intervention educational consultant who has observed my daughter

closely over the years, was stunned. We all were.

This increased fluency has continued for another week, at a steady

pace. The initial incident was more intense, but my daughter is now

engaging in quicker and more frequent dialogues with siblings and

peers. At this point, my daughter shows no markedly-improved

articulation. We are impressed by her vocabulary, however, and

wonder if she is experiencing less trouble with retrieval. Her

receptive language has always been very good. I have been struck

several times in the last few days with her creative expressions. For

example, she was describing her experience on a rollercoaster.

Contextually, she obviously wanted to say she was " anxious. " Instead

she said that the ride " haunted " her. It seems she has entered a new

relationship with expressive language.

Respectfully Submitted,

Judy Folkerts

[Guest guest]

Thank you for sharing your story. It is nice to hear about older children since

most of us here have very young ones. I have a 3 year old & fear the worst for

his future. He has about 20-30 words but only one at a time. And anyday we

loose some. I have had my son on the Pro EFA off & on for just a couple of

weeks. Mom to 4 kids can't always remember to give it to him! I am just

curious my son uses mostly vowel sounds, when did your daughter begin to add the

constanant sounds to the words?

We have not gotten to the stuttering stage alot of moms have been talking about,

but I worry since my second son stuttered severly as a child. He is now 16,

once in a while he will still stutter. To this day I still have trouble

understanding him. He talks very quiet & low. I think he does that thinking it

will keep him from doing it & if he does no one will realize??

Keep us posted....

Tammy mom to 3 apraxia, 5, 16, 20

>We began giving my daughter two ProEFA capsules a day, one in the

>morning and one in the evening. She weighs 49 pounds and is 49

>inches tall. On the seventh day of this regimen, she had an

>unprecedented burst of fluency. During our family supper, she began

>telling us stories at a hyper-rapid rate. It was as though she was

>surprised by the flow of her words and was anxious to tell all that

>she could, as fast as she was able to do so. I should note that we

>had out-of-town visitors at the time, and my friend, an early-

>intervention educational consultant who has observed my daughter

>closely over the years, was stunned. We all were.

>This increased fluency has continued for another week, at a steady

>pace. The initial incident was more intense, but my daughter is now

>engaging in quicker and more frequent dialogues with siblings and

>peers. At this point, my daughter shows no markedly-improved

>articulation. We are impressed by her vocabulary, however, and

>wonder if she is experiencing less trouble with retrieval. Her

>receptive language has always been very good. I have been struck

>several times in the last few days with her creative expressions. For

>example, she was describing her experience on a rollercoaster.

>Contextually, she obviously wanted to say she was " anxious. " Instead

>she said that the ride " haunted " her. It seems she has entered a new

>relationship with expressive language.

>Respectfully Submitted,

>Judy Folkerts