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Dysfluency, also known as stuttering is a speech disorder in which sounds, syllables, or words are repeated or prolonged, disrupting the normal flow of speech. These speech disruptions may be accompanied by struggling behaviors, such as rapid eye blinks or tremors of the lips. Stuttering may make it difficult to communicate with other people, which often affects a person’s quality of life.

 

What causes dysfluency?

Although the precise mechanisms are not understood, there are two types of stuttering that are more common:  Developmental Stuttering and Neurogenic Stuttering

 

Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands. Developmental stuttering also run in families.

How is dysfluency treated?

 

Although there is currently no cure for stuttering, there are a variety of treatments available. The nature of the treatment will differ, based upon a person’s age, communication goals, and other factors. If you stutter, it is important to work with a speech-language pathologist to determine the best treatment options.

For very young children, early treatment may prevent developmental stuttering from becoming a lifelong problem. Certain strategies may help children learn to improve their speech fluency while developing positive attitudes toward communication. Treatment often involves teaching parents about ways to support their child’s production of fluent speech.

 

Parents may be encouraged to:

  • Provide a relaxed home environment that allows many opportunities for the child to speak. This includes setting aside time to talk to one another, especially when the child is excited and has a lot to say.

  • Refrain from reacting negatively when the child stutters. Instead, parents should react to the stuttering as they would any other difficulty the child may experience in life. This may involve gentle corrections of the child’s stuttering and praise for the child’s fluent speech.

  • Be less demanding on the child relative to speaking in certain ways and/or performing verbally for people, particularly if the child experiences increased difficulty with speaking during periods of high pressure.

  • Speak in a slightly slowed and relaxed manner. This may help reduce time pressures the child may be experiencing.

  • Listen attentively when the child speaks and wait for him or her to say the intended word. Don’t try to complete the child’s sentences. Also, help the child learn that a person can communicate successfully even when stuttering occurs.

  • Talk openly and honestly to the child about stuttering if he or she brings up the subject. Let the child know that it is okay for some disruptions to occur.

Neurogenic Stuttering

 

Neurogenic stuttering is a type of fluency disorder in which a person has difficulty in producing speech in a normal, smooth fashion. Individuals with fluency disorders may have speech that sounds fragmented or halting, with frequent interruptions and difficulty producing words without effort or struggle. 

 

Neurogenic stuttering typically appears following some sort of injury or disease to the central nervous system (i.e. the brain and spinal cord, including cortex, sub-cortex, cerebellar, and even the neural pathway regions).

 

These injuries or diseases include:

  • Cerebrovascular accident (stroke), with or without aphasia

  • Head trauma (TBI)

  • Ischemic attacks (temporary obstruction of blood flow in the brain)

  • Tumors, cysts, and other neoplasms

  • Degenerative diseases, such as Parkinson’s disease or Multiple sclerosis

  • Other diseases, such as meningitis, Guillain-Barré Syndrome, and AIDS

  • Drug-related causes such as side-effects of some medications

Neurogenic stuttering vs. other types of fluency disorders?

 

The symptoms of neurogenic stuttering may be similar to those seen in other fluency disorders. Some communication disorders such as dysarthria, apraxia of speech, palilalia, and aphasia may impair the speaker’s ability to produce smooth and flowing speech production. These problems result from the same types of neurological injury or disease as neurogenic stuttering, and the disorders often co-exist. A diagnosis of neurogenic stuttering might be considered when the disfluency pattern includes the symptoms described below.

 

Primary symptoms of neurogenic stuttering?

The symptoms of neurogenic stuttering may vary widely between different individuals.

Neurogenic stuttering might be considered as a possible diagnosis if one or more of the following symptoms are observed:

  • Interjections (um, like, uh) and/or revisions.

  • Repetitions of phrases, words, and parts of words.

  • Prolongations of sounds or syllables.

  • Hesitations and pauses in unexpected or inappropriate locations when speaking

  • Termination of speech during the production of a word without finishing the word.

  • Variable speaking rate causing speech to be unintelligible

  • Secondary characteristics, or accessory behaviors such as: eye blinks, muscle tension in the articulators (lips tongue) or elsewhere in the body.

 

Treatment of Neurogenic Stuttering.

 

There is no single treatment approach that is effective in alleviating its symptoms because many conditions may cause neurogenic stuttering and affect the frequency with which it co-exists with other communication impairments such as aphasia, apraxia or dysarthria.

Treatment is often carried out by a speech-language pathologist working in conjunction with the patients’ physicians.   Having an understanding of the disorder may help families and caregivers structure communication situations to best help the patient. This may have a significant impact on reducing their concerns and improving communication. 

 

Strategies may include: 

  • Simplifying one’s speech

  • Allowing more time for responses

  • Modeling slow, easy speaking patterns

  • Reducing communication demands and expectations

 

Some therapy techniques that help reduce the symptoms of developmental stuttering may also be effective with neurogenic stuttering.

 

These may include:

  • Slowing speech rate (saying fewer words on each breath by increasing the duration of the sounds and words).

  • Emphasizing a gentle onset of the start of each phrase (use a relaxed posture for speech muscles, adequate breath support and slow, easy initiation of exhalation along with gentle onset of the first sound). 

  • Emphasizing a smooth flow of speech production and use of relaxed posture, both in terms of general body posture and for specific speech production muscles.

  • Identifying the disruptions in the speech patterns and instructing the client in the use of more appropriate patterns.

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