A case of adult onset of stuttering

A 36-yr-old adult male was treated for stuttering after a “sudden onset” of disfluency according to the client, 3 yr before. The treatment method and results are described and the “awareness” feature of stuttering onset is discussed.     

A case report on the use of flooding in stuttering therapy

The last several years have seen the development and use of anxiety-reduction procedures in stuttering therapy. Among these types of methods, systematic desensitization and reciprocal inhibition have been employed almost exclusively. Emotional de-conditioning by means of flooding or implosive techniques has been attempted far less often. This article presents a case report on the utilization of the flooding tactic. Results are offered and discussed relative to the question of whether the elimination of anxiety is a realistic goal in therapy. The suggestion is offered that what many stutterers may really need to develop is the ability to generate fluency-enhancing behaviors in spite of the presence of heightened emotionality.     

A case of persistent neurogenic stuttering following a missile wound

Observational criteria that have been proposed to distinguish developmental from neurogenic stuttering are critically reviewed. It is concluded that both conditions may closely resemble each other. As an example, a case of neurogenic stuttering following a missile would is reported.     

Effects of delayed auditory feedback on acquired stuttering following head injury

This study examined the effects of Delayed Auditory Feedback (DAF) with three cases of acquired stuttering following head injury. To determine the effects of DAF on stuttering behavior a multiple baseline design across three speaking tasks was employed. All subjects reduced stuttering with application of DAF. Stuttering behavior on untreated tasks continuing in baseline was not affected by DAF. When treatment was applied to the untreated tasks, stuttering events decreased for all three subjects. Results indicate DAF has potential as a treatment procedure with cases of acquired stuttering in a way similar to cases of developmental stuttering.     

Case report of stuttering acquired in association with phenytoin use for post-head-injury seizures

Previous research indicates that stuttering and deficits in motor performance may be associated with the use of phenytoin (Dilantin). The present report concerns a case of stuttering acquired in association with phenytoin use for post-head-injury seizures. The extent and nature of dysfluencies and the motor performance of speech and nonspeech muscle systems were evaluated over an extended period during which changes in anticonvulsant medication were made. Reductions in dysfluency levels and improved motor performance were observed following a medication change from phenytoin to carbamazepine. Performance on tests assessing nonmotor functions, such as memory and attention, was equivalent before and after the medication change. The apparent association between dysfluency levels, motor performance deficits, and phenytoin suggest that in the present case stuttering resulted in part from a general impairment in motor control.     

A neuroscience model of stuttering

Using motor control systems analysis and a reductionist approach, we provide a unified model of stuttering. This model views stuttering as a momentary instability in a complex multiloop control system. The model predicts the temporal conditions under which this instability will occur. Furthermore, these temporal conditions account for the efficacy of fluency-evoking maneuvers, therapy, and the variability of speech output in stutterers.     

Sudden recovery from stuttering after an epileptic attack: A case report.

This case report concerns a boy 5.06 years of age, who began to stutter from about his fifth birthday. In the course of a six-month period, his disfluencies became more and more pronounced until a sudden and complete recovery took place following an epileptic attack. Some references are made to the literature on the relationship between stuttering and epilepsy. Some comparisons are made also with more-or-less-similar adult cases, as mentioned in the literature, but we have the strong feeling that these do not hold completely.     

Morphological errors in acquired dyslexia: A case of mistaken identity

Morphological errors in oral reading have been used to support theories of lexical access in which root morphemes and affixes are independently represented in the orthographic lexicon. No support for such theories was found in this study, which examined the morphological errors made by two patients with different patterns of acquired dyslexia. Instead, it was shown that the probability of making a morphological error depended upon the absolute levels of imageability and word frequency of the affixed word and the relative levels of its root morpheme. These properties also affected the oral reading of words without affixes. It was concluded that so-called “morphological” errors reflect the properties of the reading system which influence lexical orthographic access for both affixed and unaffixed words and further reflect the functional level of the lexical pathways available to the patient.     

An instrumented method for assessment and remediation of stuttering: A single-subject case study

A single-subject experimental design was used to investigate the feasibility of applying non-invasive laboratory instrumentation for examining speech physiology to assessment and biofeedback-based remediation of stuttering. Physiologic assessment facilitated the development of behavioral goals directed at changing respiratory and phonatory behaviors for this subject. Visual biofeedback therapy produced reduction in respiratory discontinuities and increased phonatory continuity, concomitant with reduced perceivable molar dysfluency. Methods used in this case illustrate a variety of options and problems related to clinical use of instrumentation. Results suggest that signals which represent respiratory, phonatory, and articulatory physiologic events may be clinically practical for evaluating and altering perceivable dysfluency.     

The relationship between locus of control and long-term stuttering treatment outcome in adult stutterers

The present study was designed to investigate the extent to which adult stutterers' scores on the Locus of Control of Behaviour (LCB) scale are predictive of their ability to maintain speech fluency immediately following intensive treatment and approximately 2 years later. Twenty-one subjects participated in a 3-week intensive treatment program based on the Precision Fluency Shaping Program. Thirteen subjects could be contacted again 2 years later to participate in a follow-up evaluation. While most subjects showed a significant long-term improvement in fluency, no predictive relationship was found between scores on the LCB scale and the level of fluency, measured in percentage of words stuttered, post-treatment or at follow-up. However, LCB scores were found to be predictive of the subjects' fluency self-evaluation measured post-treatment and at follow-up. Overall, the present study suggests that while the LCB scale may contribute to the prediction of long-term treatment outcome, particularly as perceived by the client, other client and process variables will need to be considered as well.     

Predictive factors of quality of life in acquired brain injury

Background/ObjectiveThe sequelae and the disability and dependence that follow an acquired brain injury (ABI) may result in a significant reduction in the quality of life (QoL) of those affected. The objective was to assess the QoL of a sample of Spanish patients with an ABI and analyze the influence of certain sociodemographic and injury-related variables on their QoL. Method: The sample comprised 421 adults (60% male; M_age = 53.12; SD = 14.87). Professionals and relatives assessed the patients’ QoL through the CAVIDACE scale, an ABI-specific tool based on the eight-domain QoL model. Results: Univariate analyses showed statistically significant differences in the QoL scores in several sociodemographic (age, civil status, education level, prior employment status, type of home, level of supports, loss of legal capacity, recognized dependence, and degree of dependence) and injury-related (time since the injury, location of the injury, and presence of post-traumatic amnesia) variables. The multiple linear regression showed that loss of legal capacity, time since the injury, prior employment status, location of the injury, and degree of dependence were significant QoL predictors. Conclusions: These findings provide knowledge for the development of programs aimed at reducing the negative impact of ABI on QoL.     

A welfare economic approach to measure outcomes in stuttering: Comparing willingness to pay and quality adjusted life years

PurposeThe purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering.MethodSeventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data.ResultsMean (median) WTP bids ranged from US$ 16,875 (8000), for an intervention resulting in improvement from severe stuttering to mild stuttering, to US$ 41,844 (10,000) for an intervention resulting in a cure of severe stuttering. These data were consistent with mean changes in QALYs for the same stuttering interventions ranging from 2.19 (using SG) to 18.42 (using TTO).ConclusionsThis study presents the first published WTP and QALY data for stuttering. Results were consistent with previous cost-of-illness data for stuttering. Both WTP and QALY measures were able to quantify the reduction in quality of life that occurs in stuttering, and both can be used to compare the gains that might be achieved by different interventions. It is widely believed that stuttering can cause reduced quality of life for some speakers; the introduction into this field of standardized metrics for measuring quality of life is a necessary step for transparently weighing the costs and consequences of stuttering interventions in economic analyses.Educational objectives: The reader will be able to (a) describe the underlying theoretical foundations for willingness to pay and quality adjusted life years, (b) describe the application of willingness to pay and quality adjusted life years for use in economic analyses, (c) compare and contrast the value of willingness to pay and quality adjusted life years in measuring the impact of stuttering treatment on quality of life, (d) interpret quality adjusted life years, and (e) interpret willingness to pay data.     

Emotional experience in everyday life across the adult life span

Age differences in emotional experience over the adult life span were explored, focusing on the frequency, intensity, complexity, and consistency of emotional experience in everyday life. One hundred eighty-four people, age 18 to 94 years, participated in an experience-sampling procedure in which emotions were recorded across a 1-week period. Age was unrelated to frequency of positive emotional experience. A curvilinear relationship best characterized negative emotional experience. Negative emotions declined in frequency until approximately age 60, at which point the decline ceased. Individual factor analyses computed for each participant revealed that age was associated with more differentiated emotional experience. In addition, periods of highly positive emotional experience were more likely to endure among older people and periods of highly negative emotional experience were less stable. Findings are interpreted within the theoretical framework of socioemotional selectivity theory.     

A phenomenological understanding of successful stuttering management

The purpose of this investigation was to understand, from the perspective of the speaker, how seven adults have been able to successfully manage their stuttering. Individual experiences were obtained across the three temporal stages (past, transitional, and current). Recurring themes were identified across participants in order to develop an essential structure of the phenomena at each stage. The ability to make the transition from unsuccessful to successful management of stuttering was associated with six recurring themes of: (1) support, (2) successful therapy, (3) self therapy and behavioral change, (4) cognitive change, (5) utilization of personal experience, and (6) high levels of motivation/determination. Six recurring themes associated with past experiences, when stuttering was unsuccessfully managed, included: (1) gradual awareness, (2) negative reactions of listeners, (3) negative emotions, (4) restrictive lifestyle, (5) avoidance, and (6) inadequate therapy. The five recurring themes identified for the current situation where stuttering continues to be successfully managed were: (1) continued management, (2) self acceptance and fear reduction, (3) unrestricted interactions, (4) sense of freedom, (5) and optimism. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the prospective of a select group of adults who stutter, the recurring themes associated with both unsuccessful and successful management of stuttering, (2) explain the recurring themes associated with how this group of seven adults achieved successful management of their stuttering, and (3) discuss the basic rationale and procedures associated with phenomenological analysis.     

Phonation in stuttering: A review of current research

Current research including studies which implicate the phonatory mechanism in stuttering as well as physiological studies offering direct evidence of abnormal laryngeal activity in stuttering are reviewed. It is concluded that while present research does not support claims for laryngeal causation of stuttering, the evidence is strong that abnormal laryngeal behaviors are an important aspect of the disrupted peripheral speech physiology that characterizes stuttering. Since this is true, it follows that abnormal laryngeal behavior deserves consideration in the diagnosis and management of stuttering.     

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

Background/ObjectiveAfter an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.     

Documenting changes in adult speakers' locus of causality during stuttering treatment using Origin and Pawn scaling

The concepts of locus of control and locus of causality are similar and refer to the degree to which a person perceives daily occurrences to be a consequence of his or her own behavior. Locus of control is considered to be a unidimensional construct indicating an inverse relationship between the polls of internality and externality. The locus of control is generally determined by using questionnaires with a limited number of items. Locus of causality is considered to be a two-dimensional construct where Origin and Pawn values, which are similar to internality and externality, respectively, are not necessarily inversely related. Locus of causality is determined by content analysis of freely spoken or written narratives. In the current study Origin and Pawn scores were obtained from twenty adults prior to and following a three-week intensive stuttering treatment program. Brief narratives written by the participants were analyzed to obtain Origin and Pawn values. These scores were compared with traditional measures of therapeutic outcome (Locus of Control, OASES, PSI, percentage of syllables stuttered). Results indicated statistically significant increases in pre- to post-treatment Origin scores (p = .001; Cohen's d = 1.44) and statistically significant decreases in pre- to post-treatment Pawn scores (p = .003; Cohen's d = 1.11). Origin and Pawn scores showed significant relationships with other measures of stuttering, indicating concurrent and construct validity. Origin and Pawn scaling procedures appear to provide a valid, sensitive, and nonreactive indicator of the speaker's locus of causality and ability to develop an autonomous and agentic lifestyle.Educational objectives: After reading this article, the readers will be able to: (1) distinguish between the concepts of locus of control and locus of causality, (2) describe the characteristics of individuals behaving as an Origin and a Pawn, (3) differentiate patterns of change for Origin and Pawn scores prior to and following treatment, and (4) describe the clinical advantages using Origin and Pawn scaling procedures for individuals who stutter.