Stuttering onset after laryngectomy

Two cases of onset of stuttering subsequent to laryngectomy are reported. These patients demonstrate that the existence of a larynx is not necessary for the generation of stuttering. The findings support the hypothesis that neuromotor control of sound source (laryngeal or alaryngeal) plays a critical role in the generation of stuttering-type dysfluencies and, perhaps, even in the onset of stuttering. They also suggest that dramatic alteration in sound source has the potential for dramatically altering fluency.     

Stuttering following brain damage

This paper describes the neurological, language, and speech status of seven brain-damaged patients with symptoms of cortical stuttering. We compare data from our seven patients to data presented on other brain-damaged stutterers, review theories of cortical stuttering's etiology, advance alternative hypotheses about mechanisms underlying such dy sfluencies, and compare cortical stuttering to stuttering in childhood.     

Stuttering and syllable stress

Eighteen adult stutterers read two lists each of 16 bisyllabic words. In one list, stress appeared on the first syllable; in the second, the “same” words carried second syllable stress. There proved to be no significant difference in proportion between stressed and unstressed syllables associated with stuttering. This investigation appears to dispute the proposition that stressed syllables provide the focal points of stuttering (Wingate, 1976).     

Age and type of crossed aphasia in dextrals due to stroke

Thirty-nine cases (37 from the literature and 2 personal) of crossed aphasia in dextrals due to stroke were reviewed concerning age, sex, and type of aphasia. Results showed that Broca's aphasics are younger than the remaining group, males predominate, and several types of aphasia have been described similarly to the aphasias due to left-hemisphere lesions in dextrals.     

Stuttering and social anxiety

The aim of the present study was to investigate the presence of social anxiety in adults who stutter. This was done by administering the Inventory of Interpersonal Situations (IIS) (Van Dam-Baggen & Kraaimaat, 1999), a social anxiety inventory, to a group of 89 people who stuttered and 131 people who did not stutter. Two components of social anxiety were measured by the ISS, the extent to which emotional tension or discomfort is perceived in social situations and the frequency with which social responses are executed. The people who stuttered displayed significantly higher levels of emotional tension or discomfort in social situations. They also reported a significantly lower frequency of social responses compared to their nonstuttering peers. In addition, about 50% of the scores of the people who stuttered fell within the range of a group of highly socially anxious psychiatric patients. The results of the study suggest that the measurement of social anxiety is an important element in the assessment of adults who stutter. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) the IIS as an assessment procedure for evaluating social anxiety, (2) the level of discomfort expressed by adult stutterers in social situations, and (3) the effect of social anxiety on stutterers' responsiveness in social situations.     

Risk factors for arterial ischemic stroke in childhood

Stroke affects up to 13 of 100,000 children, is more common in boys and African Americans, and is associated with considerable cognitive and psychiatric morbidity, as well as motor disability. Around half are hemorrhagic and half are ischemic. Underlying conditions include sickle cell disease, cardiac abnormalities, chromosomal abnormalities (eg, Down syndrome), and neurocutaneous conditions (eg, neurofibromatosis), but up to half the patients with ischemic stroke have no previously diagnosed condition. Although there is almost certainly an important genetic component to stroke risk, head trauma, infections, drugs and radiation appear to play an etiological role in some patients. The majority of the patients with infarction in an arterial distribution have associated cerebrovascular disease. Vascular pathologies include carotid or vertebrobasilar dissection, intracranial vasculopathy affecting the middle and anterior cerebral arteries, which is often transient, and moyamoya. Intermediate risk factors may include hypertension, hypoxia, and poor nutrition leading, for example, to iron deficiency and hyperhomocysteinemia. Some chronic conditions may directly influence the child's behavior and stroke recurrence risk, although large cohorts and randomized controlled trials will be needed before strategies for modification can be evidence-based.     

Speech Motor Skill and Stuttering

The authors review converging lines of evidence from behavioral, kinematic, and neuroimaging data that point to limitations in speech motor skills in people who stutter (PWS). From their review, they conclude that PWS differ from those who do not in terms of their ability to improve with practice and retain practiced changes in the long term, and that they are less efficient and less flexible in their adaptation to lower (motor) and higher (cognitive–linguistic) order requirements that impact on speech motor functions. These findings in general provide empirical support for the position that PWS may occupy the low end of the speech motor skill continuum as argued in the Speech Motor Skills approach (Van Lieshout, Hulstijn, & Peters, 2004).     

Assessing Efficacy of Stuttering Treatments

Efficacy has been defined as the extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideally controlled conditions when administered or monitored by experts. Studies on efficacy can be divided into those that study methods of conducting treatment (i.e., treatment process research) and those that are concerned with the effects of treatments (i.e., treatment outcome research). This review covers both areas, emphasizes the former, and considers such key determinants of efficacy as measurement, treatment integrity, and design issues. A set of criteria is given and a meta-analysis of whether studies published since 1993 meet these criteria is reported (incorporating some pragmatic and ethical considerations). The review ends by considering directions that warrant further investigation in the future.

Educational objectives: The reader will learn about and be able to describe (1) measurements appropriate for evaluating treatment efficacy studies; (2) how to evaluate reports of stuttering treatment programs; and (3) different designs used in treatment efficacy studies.     

Stuttering: Training the therapist

In order to sensitize therapists in training to the dynamics of helping others change, eight members of a graduate seminar in fluency disorders were asked to develop and maintain a program of personal behavioral change for a period of 4 wk. Their reflections on several features of this experience are discussed under the following categories: (1) Selecting the behavior for modification; (2) developing the contract; (3) motivational factors; (4) personal reflections, and (5) implications for working with stutterers.     

Successful escape of acute ischemic stroke patients from hospital to home: clinical note

I describe four patients who successfully escaped from the hospital to their own home during the acute phase of ischemic stroke. This is a very rare phenomenon (seen in 0.35% of 1150 consecutive patients with first ischemic stroke within 24 h after onset), but the patients had rather uniform clinical characteristics. All were male, around 60 years old, had moderate to severe aphasia (Wernicke's in 2 patients, Broca's in 1, and transcortical motor in 1), and cerebral infarction of the left middle cerebral artery territory. None had significant motor weakness, hemispatial neglect, or hemianopia at the time of escape. Overall functional outcome was good for all but one patient, but aphasia persisted in three. Although none of the four patients sustained serious injury during the escape, patients with such clinical characteristics must be managed cautiously to prevent serious consequences.     

Stuttering severity and educational attainment

Purpose

This study investigated the relationship between self-reported stuttering severity ratings and educational attainment.

Method

Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address.

Results

There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations.

Conclusions

Future research is needed to investigate how this result should be addressed in educational institutions.Educational objectives: The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment.     

Dual Diathesis-Stressor Model of Emotional and Linguistic Contributions to Developmental Stuttering

This study assessed emotional and speech-language contributions to childhood stuttering. A dual diathesis-stressor framework guided this study, in which both linguistic requirements and skills, and emotion and its regulation, are hypothesized to contribute to stuttering. The language diathesis consists of expressive and receptive language skills. The emotion diathesis consists of proclivities to emotional reactivity and regulation of emotion, and the emotion stressor consists of experimentally manipulated emotional inductions prior to narrative speaking tasks. Preschool-age children who do and do not stutter were exposed to three emotion-producing overheard conversations—neutral, positive, and angry. Emotion and emotion-regulatory behaviors were coded while participants listened to each conversation and while telling a story after each overheard conversation. Instances of stuttering during each story were counted. Although there was no main effect of conversation type, results indicated that stuttering in preschool-age children is influenced by emotion and language diatheses, as well as coping strategies and situational emotional stressors. Findings support the dual diathesis-stressor model of stuttering.