Stuttering is convulsive movements of the articulatory and laryngeal muscles that occur more often at the beginning of speech (less often in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms are very similar to clonic and tonic seizures. With clonic stuttering, there is a re-formation of words, syllables and sounds. Tonic form does not allow the patient to move from a sound stop to move to articulating another sound. In its development, disease goes through 4 phases from rare bouts of intermittent stuttering to a serious personal problem that limits a person’s ability to communicate.
Stuttering is convulsive movements of the articulatory and laryngeal muscles that occur more often at the beginning of speech (less often in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms are very similar to clonic and tonic seizures. With clonic stuttering, there is a re-formation of words, syllables and sounds. Tonic stuttering does not allow the patient to move from a sound stop to move to articulating another sound.
There are neurotic and neurosis-like forms of stuttering. Neurotic stuttering occurs in healthy children as a result of stress and neurosis. Neurosis-like stuttering is characteristic of children with diseases of the nervous system (both hereditary and acquired).
There are two groups of causes of stuttering: predisposing and provoking. Among the predisposing causes of stuttering , it is necessary to distinguish:
- hereditary burden;
- diseases causing encephalopathic consequences;
- intrauterine, birth injuries;
- fatigue and exhaustion of the nervous system (as a consequence of infectious diseases).
Conditions contributing to the occurrence of stuttering can be:violation of the development of motor skills and a sense of rhythm; scarcity of emotional development; increased reactivity as a result of abnormal relationships with others; hidden mental disorders (for example, infringement). The presence of one of the above conditions is enough for a nervous breakdown and, as a result, stuttering. The causes that provoke the occurrence include: momentary mental trauma (fear, fright); bilingualism or multilingualism in the family; imitation; tachylalia (accelerated speech).
The pathogenesis is similar to the mechanism of subcortical dysarthria. It consists of a violation of the coordination of the respiratory process, articulation and vocalization. Therefore, stuttering is often referred to as dysrhythmic dysarthria. Disruption of the induction interactions of the cerebral cortex and subcortical structures leads to a violation of the regulation of the cortex. In this regard, there are shifts in the work of the striopallidar system, which is responsible for the “readiness” to commit movement.
Two groups of muscles participate in the movement — one contracts, the other relaxes. Thanks to the precise and coordinated redistribution of muscle tone, it is possible to perform fast, precise and strictly differentiated movements. It is the striopallidar system that controls the rational redistribution of muscle tone. Blocking of the striopallidar speech regulator due to emotional overexcitation or anatomical and pathological brain damage leads to clonic repetitions (tic) or tonic spasm. Over time, the pathological reflex — a violation of speech automatism and hypertonicity of the musculature of the speech apparatus – develops into a conditioned reflex.
Breath. Among the violations of the respiratory process during stuttering, there is a huge air consumption during inhalation and exhalation, which is due to a disorder of resistance in the articulation area. Violation of speech breathing during stuttering consists in the formation of inspiratory-vowel or protor sounds by the patient. In other words, the patient uses inhaled air for the movement of the vocal cords and the formation of tread noise. Shortened exhalation is observed not only during speech, but also at rest.
Voice. An attempt to pronounce a sound when stuttering is accompanied by a convulsive closure of the glottis, which prevents the occurrence of sound. During an attack, the larynx moves quickly and sharply up, down and moves forward. Due to the inability to smooth pronunciation, patients try to pronounce vowel sounds firmly. There is a softening of the symptoms when singing and whispering up to complete normalization of speech.
Articulation. In addition to functional disorders in the articulatory apparatus, somatic disorders are also observed during stuttering. For example, the high arch of the palate, the deviation of the protruding tongue to the side, in the nasal cavity — a curved nasal septum, hypertrophy of the shells.
Concomitant movements are movements accompanying speech when stuttering, which are not necessary, but, at the same time, produced by the patient as a conscious movement. During an attack of stuttering, patients can tilt their head back, tilt it, close their eyes, clench their fist, shrug their shoulders, stamp their foot, step from foot to foot. In a word, to make movements that can be designated as tonic or clonic convulsions.
Mentality. With the development of stuttering, certain mental disorders are inevitable. The most common fear is of certain sounds, syllables and words, namely their pronunciation. In their speech, patients suffering from stuttering deliberately avoid such sounds and words, if possible, look for a replacement for them. With exacerbations, absolute dumbness may occur. Thoughts about the impossibility of normal communication can bring to the consciousness of inferiority and in relation to the whole “I”.
Phase 1. There are small episodes of stuttering, a reduction in periods of smooth measured speech. The end of the first phase of stuttering is determined by the following symptoms:
- difficulties in pronunciation occur more often in the initial words of sentences;
- episodes of stuttering occur when pronouncing conjunctions, prepositions and other brief parts of speech;
- “communicative pressure” aggravates stuttering;
- the child does not react in any way to his difficulties with pronouncing words, talks without embarrassment. There is no anxiety, no fear of speech. A momentary emotional outburst can provoke stuttering.
Phase 2. There are problems in contacting, some accompanying movements. The number of difficult situations in terms of communication is gradually increasing.
- stuttering becomes chronic, but the severity of attacks varies;
- problems with pronunciation occur more often in polysyllabic words, during rapid speech and much less often in short parts of speech;
- the child is aware of violations of his speech, but does not consider himself stuttering. Speaks at ease in any situation.
Phase 3. Consolidation of convulsive syndrome. However, patients do not experience fear of speech and any awkwardness. They use every opportunity to communicate. The offer of treatment does not cause any support or enthusiasm on the part of the patient. It’s as if they are giving themselves a calm mindset.
- patients realize that due to stuttering, some situations become difficult in terms of communication;
- there are difficulties in connection with the pronunciation of certain sounds, words;
- attempts to replace “problematic” words with others.
Phase 4. At this stage, stuttering is a big personal problem. There are pronounced emotional reactions to stuttering and, as a result, avoidance of speech situations. If earlier the patient resorted to replacing “problematic” sounds (words) periodically, now he does it all the time. He begins to pay attention to the reaction of others to his stuttering. Characteristic features of the 4th phase of stuttering:
- expectation of stuttering (anticipation);
- difficulties in pronouncing certain sounds (words) take on a chronic character;
- logophobia (fear of speech);
- answers to questions become evasive.
The presence of stuttering forces the child to avoid speech situations, as a result of which the circle of his communication and, as a result, the general development is narrowed. There is suspiciousness, alertness, a sense of difference between oneself and peers. As a result of misunderstanding between the child and his parents (classmates, peers), a feeling of infringement, of his own inferiority develops. Irritability increases, fearfulness appears, which can lead to mental depression and aggravation of stuttering. Stuttering can lead to a decrease in school performance due to the awkwardness, shyness and isolation of the child. The development of stuttering can interfere with the choice of a profession, as well as with the creation of a family.
To diagnose stuttering, the following signs must be present:
- violation of the rhythm of speech (fragments of words, phrases, repetition of syllables, stretching of certain sounds);
- difficulties and hesitations at the beginning of speech;
- attempts to cope with stuttering with the help of side movements (grimaces, tic).
If the duration of the above disorders is more than 3 months, stuttering is diagnosed. Such patients need to consult not only a neurologist, but also a speech therapist. To exclude organic diseases of the nervous system, rheoencephalography, brain EEG, and MRI diagnostics are performed.
The success of the treatment of neurotic stuttering largely depends on the timeliness of diagnosis. Due to the ineffectiveness of traditional psychotherapeutic methods of treating stuttering (behavioral, hypnotic, etc.), in modern medicine, preference is given to special therapeutic approaches that include elements of several treatment methods. Such combined psychotherapeutic methods of treating stuttering are used both individually and in a group form. Correction of speech disorders is carried out by speech therapy classes to correct stuttering and accelerated speech.
Neurotic stuttering in young children responds well to treatment in speech therapy kindergartens and groups. Here they focus on collective game psychotherapy, speech therapy rhythmics. No small importance is attached to family psychotherapy, where suggestion, distraction, relaxation are used. Children are taught to talk in time with rhythmic movements of the fingers or monotonously and in a singsong. The self—regulation method is based on the assumption that stuttering is a certain behavior subject to change. It includes desensitization, autogenic training. The purpose of auxiliary drug treatment is to relieve symptoms of fear, anxiety, depression. It is recommended to prescribe sedatives (including phytotherapeutic) and general restorative agents.
In the medical treatment of neurosis-like stuttering that occurs in connection with organic brain damage, antispasmodics (tolperizone, benactisine) are used, tranquilizers (in minimal doses) are used with caution. The effectiveness of the dehydration course has been proven. In the case of clonic stuttering, the appointment of several courses (from 1 to 3 months) of hopanthenic acid is recommended. In addition, it is recommended to include physiotherapy, as well as massage (both general and speech therapy) in the comprehensive treatment of stuttering.
The prognosis is favorable in more than 70% of cases of stuttering among children.
Methods of prevention of stuttering are divided into two groups. One of them is aimed at maintaining and strengthening children’s health, the second is aimed at organizing the child’s speech development. Proper nutrition, constant care, observance of the daily routine and hygiene are important components of a child’s mental and speech development, preservation and strengthening of his health. Proper alternation of wakefulness and sleep contributes to the normal functioning of the nervous system and its protection from overloads. It is necessary to protect the psyche of children from excessive information load (watching “adult” TV shows, reading hyperemotional fairy tales before going to bed), situations that can cause fright.
A child’s full-fledged speech development should include three directions. The first is the expansion of horizons, concepts and ideas about the surrounding world, phenomena and objects (games, walks, reading books). The second is the prevention and prevention of stuttering in the child’s speech, teaching smoothness and slowness of speech, the ability to logically and consistently express their thoughts and desires. The third is the formation of the correct sound pronunciation, rhythm and tempo of speech. However, it is necessary to inform the child of new information gradually, dosed.
Having corrected stuttering, in order to avoid relapses, it is necessary to create an appropriate environment and regime for the child, which will contribute to maintaining a favorable psychological environment.