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Persons who have fluency disorders can be handicapped as much more by their reactions to their abnormal dysfluency than the dysfluency itself [Murray & Edwards, 1980; Van Riper, 1984]. Stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, syllable, or word, or by the speakers reactions thereto [Van Riper, 1982].
KUNNAMPALLIL GEJO JOHN,MASLP
Stuttering is the involuntary disruption of a continuing attempt to produce a spoken utterance [Perkins, 1990]. Moments of stuttering are accompanied by abnormal physiological events that intermittently influence the processes of respiration, phonation and/or articulation [Denny & Smith, 1992].
KUNNAMPALLIL GEJO JOHN,MASLP
Among the varied views regarding the etiology of stuttering, few of them consider stuttering as an articulatory disorder. The functioning of the articulators during the moments of stuttering has been studied extensively through the use of EMG, X-ray motion pictures and measures of intra-oral air pressure and rate of air flow. The various abnormalities observed are: Defective synchronization of the action potentials of the paired musculature - such as the masseter muscles [Williams, 1955].
A build up of muscular tension, reaching a peak near the termination of a block [Sheehan & Voas, 1954]. Excessive muscular activity [Shapiro, 1980]. Tremors [Van Riper, 1982]. Prolonged articulatory postures on stop consonants [Hutchinson, 1975]. Lack of coordination between articulatory movements and onset of phonation [Hutchinson & Watkin, 1976]. Abnormally rapid articulatory movements at the moment of release from a block [Hutchinson, 1976].
ZIMMERMANS MODEL:
Zimmerman (1980) suggested that stuttering should be regarded as a disorder of movement and that principles of motoric behaviour be brought to bear on the problem. At the level of motor neuron, a number of inputs from diverse sources are integrated and the sum of these inputs determine the background tones and triggering threshold for coordinated structures. This was the first physiological principle that could be used to explain a number of diverse stuttering phenomena that were explained early KUNNAMPALLIL GEJO JOHN,MASLP only psychologically.
The central commands for speech might exist as spatially coded targets, auditory targets or some hybrid. Whatever the representation of the code, the commands must be executed to achieve the critical spatial temporal relationship necessary for intelligible speech. The temporal and spatial coordination of the articulators must be achieved throughout a speech gesture and the fluent movement patterns are dependent on such relationships. These must be accomplished by the proper neuromotor input via the cranial nerve nuclei and motoneuron pools to proper muscles or muscle GEJO JOHN,MASLP system at KUNNAMPALLIL the proper time.
The movements involved in achieving these goals, the contacts made and the positions achieved results in stimulation of many intra-oral and perioral receptor sites. It is posited that when a person speaks, he usually operates the respiratory, laryngeal and supralaryngeal systems within certain ranges of variability i.e. he usually stays within certain limits in velocities, displacements, accelerations and inter-articulatory spatial and temporal relationships. When these normal ranges are exceeded the afferent nerve impulses generated are presumed to increase the gains at associated brainstem reflex pathways. KUNNAMPALLIL GEJO JOHN,MASLP
If excitation reaches a threshold level, then the oscillation or tonic behaviors occur. Such reflex connections have been shown to disrupt the ongoing pattern behavior by altering afferent input and changing muscle length and tension which affects the gains and phases of these pathways. If the velocity and displacement and the spatial relationships remain below threshold levels of variability so as not to increase reflex affects, fluent production occurs, the stability & integrity of the system is maintained, the visual feedback mechanisms are employed and the speech processesKUNNAMPALLIL continue. GEJO JOHN,MASLP
In addition, stutterers are thought to be deficient in their ability to time or integrate, long motor sequences.
Such timing is said to involve the imposition of higher order integration to achieve the proper serial order of a large number of discrete motor sequences.
Stutterers are intermittently unable to achieve such timing thereby producing sequences with inappropriate coarticulation. Van Riper also ruled out organic deficiencies in these speech related functions (underlying physiological difficulties). So he proposed that stuttering is the result of deficiencies in
The stability of motor patterns for syllables. The ability to integrate a large number of discrete events in correct temporal order and speech related respiration, phonations & KUNNAMPALLIL GEJO JOHN,MASLP articulations.
The combined result of these short comings is fractured syllables which is characterized by improper coarticulatory transitions between sounds. For e.g. early stuttered repetitions of CV syllables often contain the schwa vowel instead of the target vowel (eg sa-sa-sop). In such repetitions, it appears that the stutterer is searching for the appropriate coarticulatory features for the sound(s) he is attempting to say. When the correct features are achieved, the stuttering is terminated.
KUNNAMPALLIL GEJO JOHN,MASLP
In other stuttering movements, precise timing of transitional events between sounds is often lost due to breaks in airflow, excessive tension and inappropriate postures. Agnello also said that the primary feature of stuttering is essentially within the articulatory transition from phone to phone.
KUNNAMPALLIL GEJO JOHN,MASLP
Reason for this lack of transitions lies somewhere higher in the vocal tract resulting from articulatory constrictions, resulting in excessive supraglottal air pressure and causes phonatory difficulties. Van Ripers model of stuttering as a defect of co-articulatory timing is not concerned with most of the linguistic determinants. This model only gave a defect in timing which may explain some of the problems stutterers have in maintaining rhythmic repetitions of various speech and non speech tasks.
KUNNAMPALLIL GEJO JOHN,MASLP
ARTICULATORY ERRORS: It can be studied under 2 broad headings. Temporal Errors: Longer phoneme durations Shorter phoneme durations Longer durations between articulatory events Inaccurate timing
KUNNAMPALLIL GEJO JOHN,MASLP
Spatial Errors: Spatially restricted movements Inappropriate articulatory placements Excessive articulatory movements Static positioning of articulators Forceful articulatory patterns Low velocities of articulators Reverse muscle movements Difficulty in stabilizing the articulatory movements
KUNNAMPALLIL GEJO JOHN,MASLP
TEMPORAL ERRORS:Longer Phoneme Duration: Several studies have revealed increased phoneme duration in stutterers.
Authors
Disimoni (1974)
Method
6 stuttterers within age range of 18 to 39.
Results
Stutterers had significantly greater absolute vowel and consonant durations than non stutterers. Montgomery & Cooke Studied part word Results indicated a (1974) repetitions in the longer consonant speech of adult duration in the stutterers using initial segment of spectrography the stuttered KUNNAMPALLIL GEJO JOHN,MASLP
Results indicate that Measured duration stuttering group spoke of stressed vowels; with more pauses and with longer average extracted from Prosek & pause and vowel connected speech Runyan (1982) using spectrography duration than non stutterers. For stuttering group total duration of stressed vowel = 170.6msec and for non stuttering group- total duration of stressed vowel = 144.1msec.
KUNNAMPALLIL GEJO JOHN,MASLP
Kalveram & Jancke (1989) Studied vowel duration under DAF condition Revathi (1989) 2 normally non fluent and 2 stuttering children using spectrographic analysis for vowel duration
Longer vowel duration in stuttering group reported. Results indicated that stuttering group children had significantly longer vowel duration than normal non fluent group.
Shorter phoneme duration: A few authors have reported contradicting results compared to the above quoted studies. Reimann (1976) studied context dependence of vowel duration in German words. Results: Stuttering group had shorter vowels than controls. Also, the stuttering group altered the vowel duration depending on the consonant that followed (similar to normals).
KUNNAMPALLIL GEJO JOHN,MASLP
Article:Production of vowels by stuttering children and teenagers [Howell, Williams & Young, Journal of Fluency Disorders (1984)].
Purpose: To analyze the acoustic properties of vowels in childrens syllable repetition to establish whether there are differences between children and adults which might be indicative of the early characteristics and progress of the disorder.
Method: Twenty four children and eight teenage stutterers; sample was recorded for 10 min duration. From instances of syllable repetition..those which started with voiced plosives and where final repetition included a part of the vowel, was chosen. Acoustic analysis of speech waveforms for Formant frequency, duration, and intensity were carried out.
KUNNAMPALLIL GEJO JOHN,MASLP
Results: No marked differences between the formant frequency between the two groups was seen, indicating that both groups position the supra glottal articulators in an equivalent positioning in order to produce the intended vowel, whether spoken fluently or not. Durations of children's stuttered vowels are short in comparison with those of fluent vowels of teenagers. No difference in intensities for fluent vs dysfluent vowels in children; but in teenagers, fluent vowels were higher in intensity than the dysfluent vowels.
KUNNAMPALLIL GEJO JOHN,MASLP
No Significant Differences:-
A few authors have reported no significant difference between stuttering group and non-stuttering group in phoneme duration.
Klich & May (1982) studied vowels /i/, /a/, and /u/. They found no change in phoneme duration in different conditions in stutterers.
KUNNAMPALLIL GEJO JOHN,MASLP
Healy & Ramig (1986) studied fluency in stuttering and non-stuttering group during multiple productions of two dissimilar speech contexts using spectrography.
Results: Duration measures for the stuttering group remained relatively stable during multiple repetitions of both short phrase and the reading passage.
KUNNAMPALLIL GEJO JOHN,MASLP
Inaccurate timing
Cooper & Allen (1977) studied speech timing control accuracy of stuttering and non-stuttering group during speech and non-speech activities. Results: In general, the stuttering group tended to be less accurate in their timing abilities than the control group.
KUNNAMPALLIL GEJO JOHN,MASLP
Spatial Errors:
The various spatial errors are: Spatially restricted movements Inappropriate articulatory placements Excessive articulatory movements Static positioning of articulators Forceful articulatory patterns Lower velocities of articulators Reverse muscle movements Difficulty in stabilizing the articulatory movements
KUNNAMPALLIL GEJO JOHN,MASLP
Authors
Zimmerman (1980a)
Method
Used high speed cinematography to describe kinematics and spatial & temporal organization of the perceptually fluent speech gestures for 7 stutterers and 7 nonstutterers. He analyzed movements of the lower lip and jaw in cvc [/mam/, /pap/, /bab/].
KUNNAMPALLIL GEJO JOHN,MASLP
Results
Even in perceptually fluent utterances, the organization of events necessary for speech production differs between groups of stutterers and nonstutterers.
Studied formant frequency and rate of formant transitions of vowels in adult stutterers.
Authors
Zimmerman (1980a)
Method
Used high speed cineradiography to describe kinematics and spatial & temporal organization of the perceptually fluent speech gestures for 6 stutterers and 7 nonstutterers and analyzed movements of lower lip and jaw in CVC /mam/, /pap/, KUNNAMPALLIL GEJO JOHN,MASLP /bab/.
Results
Asymmetry between lip and jaw movements leading to inappropriate articulation.
Van Riper He studied stuttering (1982) as a temporal disruption of the simultaneous and successive programming of muscular movements required to produce a speech sound or its link to the next sound in a word.
Based on spectrographic and cineflurographic analysis, he suggested that during repetitions, highly inappropriate articulatory postures may be used; both in voiced and unvoiced sounds.
Lack of muscle coordination during periods of blocks, whose normal function is reciprocal action.
These findings strongly suggest that stutterers while speaking, experience many movements of disruption of normal coordination.
Depending on the number of factors including the nature, intensity, duration and timing of disruption, its effect may or may not result in audible or perceptible stuttering. In some cases, disruption occurring at the onset of a word may simply result in
A slight delay in word initiation or A pause, too brief to be identified as dysfluency
Method
Used high speed cineradiography
Results
Stutterers articulators stay in static position during the production of a phoneme.
Used high speed cineflurographic technique to record articulatory movements during fluent and dysfluent speech from 4 stutterers and control utterances from 1 normal speaker.
Inter-articular positions occurring in both perceptually fluent and dysfluent utterances of stutterers were unlike those nonfluent utterances of a normal speaker. Abberant interarticulator positions preceded repetitive movements and static posturing.
Pindzola (1987 a)
Reported that stutterers spend longer time in static articulatory position. In other words, the duration of steady state formant was found to be longer in stutterers.
Article:Correlation of stuttering severity and kinematics of lip closure (Michael, Mc Clean, Kroll; 1991)
Stutterers and non-stutterers differ in orofacial movements associated with perceptually fluent speech, however inconsistent results have been obtained in this area. Presence of some evidence that parameters of stutterers fluent speech are associated with stuttering severity encourages one to use correlation or regression analyses as approaches to understand anomalies in the movement characteristics of stutterers fluent speech.
KUNNAMPALLIL GEJO JOHN,MASLP
Aim: To evaluate possible relationship between stuttering severity and parameters of lip and jaw movement associated with lip closure in fluent speech.
Results: the parameters analyzed were velocity, duration & displacement. They noted the tendency for severe stutterers to show
Longer movement durations Reduced movement velocities
Because the fluent utterances were judged, interpretation was that the more severe stutterers achieved their fluency by executing motor compensations similar to those acquired during speech therapy. This may have involved adjustments in movement duration and/or velocity.
KUNNAMPALLIL GEJO JOHN,MASLP
Results: EMG records indicated that nonstutterers activated DAO prior to DLI for the production of initial /p/ whereas, stutterers reversed the sequence of onset, particularly when they stuttered. These onset reversals in stutterers support the view of stuttering as a disorder of timing. As these reversed onsets are disruptions of the succession of DAO & DLI the release of the sound may be delayed until the DAO activity is predominantly over DLI activity and hence it depicts an error that leads to a delay in the production of the sound
KUNNAMPALLIL GEJO JOHN,MASLP
Results: No significant difference between stuttering and non-stuttering in average interval times and in general stutterers were significantly more variable in their speech onset timing. From this study, it was interpreted that stutterers may have difficulty in stabilizing the articulatory movements and the act of speaking results in fluctuations in the speed of production of sounds and sound sequences.
KUNNAMPALLIL GEJO JOHN,MASLP
Spriesterbach (1940) found no statistically significant differences between stuttering and non-stuttering subjects in maximum rate of jaw opening, tongue protrusion, and lip closure. Experimental subjects were slightly superior in jaw and tongue movements but slightly inferior in lip movements. Strother & Kriegman (1943) also found stutterers DDK rates slightly higher for jaw openings, repeated /t/ productions (tongue tip to alveolar ridge), and lip closures.
KUNNAMPALLIL GEJO JOHN,MASLP
By contrast, Rickenberg (1956) found that stutterers were significantly slower than controls in repeatedly uttering CV syllables (/pa, ba,ma,ta,da,na,ka,ga/).
Rhythmic execution of jaw, tongue, and lip movements was investigated by Blackburn (1931) and Seth (1934) {except for tongue movements}. Their studies showed significant differences for stutterers from normals.
KUNNAMPALLIL GEJO JOHN,MASLP
Studies by Wulff (1935) and Strother & Kriegman (1944), however, found no significant differences between stutterers and non-stutterers on the task (uttering repetitive /pataka/ sequences). Zaleski (1965) found stuttering children deviated significantly more from a prior metronomic stimulus than non-stuttering children.
KUNNAMPALLIL GEJO JOHN,MASLP
Bloodstein (1944) and Johnson (1961) reported slower than normal reading rates in adult stutterers. Johnson & Rosen (1937) found that instructing stutterers to read faster than normal resulted in more stuttering, and slower than usual rate resulted in less stuttering. Fransella (1965) also found that stuttering was reduced when subjects were asked to reduce their reading rates.
KUNNAMPALLIL GEJO JOHN,MASLP
Ingham, Martin & Khul (1974) assessed the effects on stuttering in spontaneous speech of speaking in slower and faster rate than normal in 3 adult stutterers. By means of a series of lights, subjects were given feedback every minute regarding how successful they were in either speaking more slowly or more rapidly than baseline rates. The procedures were effective in reducing speech rate in all three subjects.
KUNNAMPALLIL GEJO JOHN,MASLP
Zinkin (1968) studied cinefluroscopic films of the pharynx taken during stuttering and reported considerable lack of coordination between pharyngeal movements that were relatively fixed while other articulators moved. The converse was also observed; i.e., for e.g., static articulatory gestures were observed during periods of pharyngeal movement.
KUNNAMPALLIL GEJO JOHN,MASLP
Coarticulatory errors:
A number of studies have focused upon coarticulatory characteristics of stuttered speech. Coarticulation refers to the normal phenomenon during speech whereby the production of a given sound is influenced by other sounds which occur before and after the sound in an utterance. Abnormal transitional movements were first described by Stromsta (1965).
Abnormal formant transition: Presence of abnormal formant transitions has been indicated in several studies. Stromsta (1965) demonstrated that the spectrogram of stuttered speech revealed a lack of usual falling or rising transitions seen in the spectrograms of normal speakers. The juncture formants were either different or absent. He also added that these children whose dysfluencies showed anomalies in Coarticulation failed to outgrow their stuttering, and those children whose spectrograms showed normal juncture formants had become fluent in the ten years span since the original KUNNAMPALLIL GEJO JOHN,MASLP recordings were made.
Author
Method
Results
Adams & Reiss Investigated the (1971) difference in the fluency in the frequency of dysfluencies of voiced and voiceless phonemes in stutterers.
Stated that increased stuttering is more likely to occur during voicelessvoiced phonation transition than voicedvoiceless transitions. They hypothesized that if the larynx was an important site in the breakdown of fluency, then conditions requiring increased laryngeal adjustment would KUNNAMPALLIL GEJO JOHN,MASLP
Webster (1974) Montgomery Analyzed & Cooke perceptually and (1976) acoustically a carefully selected set of part word repetitions from the speech of adult stutterers.
Spectrographic analysis revealed that abnormal formant transitions characterized the initial segment of the stuttered word and the remainder of the word was identical to its fluently produced counterpart.
From this they have concluded that if the articulatory breakdown was confined to the initial consonant to vowel, when present were due to deviant formation of consonant rather than to faulty transition dynamics.
Investigated the dysfluencies during voicedvoiced, voicedvoiceless, voiceless-voiceless phoneme to phoneme phonatory transitions. Speech of 11 adult stutterers and a matched group of non-stutterers KUNNAMPALLIL GEJO JOHN,MASLP were studied.
Both stutterers and non-stutterers group demonstrated a lower percentage of dysfluencies during voicedvoiced transitions than during voiced-voiceless, voiceless-voiceless phonatory transitions.
Revathi (1989)
Studied acoustic temporal parameters in the speech of 2 normally nonfluent and 2 stuttering children.
Spectrographic analysis revealed that transition duration of F2 and speed of transition of F1 showed a significant difference between stutterers and non-stutterers.
Other errors observed were:Lack of formant transition: The spectrogram of some dysfluent utterances were characterized by absence of formant transition. This indicates stutterers are unable to transit or move from one phoneme to another. Longer transition duration: The transition of F2 was longer for dysfluent utterances than the corresponding fluent utterances. This implies that the time lapse between the movement of articulator from one target to another is long (which explains the prolongation). Shorter transition durations: Shorter time lapse between movements of articulators from one KUNNAMPALLIL GEJO JOHN,MASLP target to another (repetitions).
Longer VOT:
Longer VOT has been reported in both perceptually dysfluent and fluent utterances of stutterers. Studies comparing the VOTs of stutterers and normals.
Author
Method
Subjects
Results
Age Stutterers, matched VOTs were groups of longer. 12 adult stutterers & 12 normals.
Zimmerman (1980)
Used X-ray 6 adult motion stutterers & picture 7 normals and voice recorder; 3 CVC words
KUNNAMPALLIL GEJO JOHN,MASLP
Because evidence of disrupted motor timing is found during stuttering (at all levels of speaking system) there is the possibility that events at each level could serve as a form of difficulty that triggers miscordination with the other levels of the system.
Mohan Murthy (1988) studied acoustic, aerodynamic, and laryngeal correlates of stuttering. Measurements were carried out through spectrograph, electroaerometer, and electroglottograph.
Observations: Inhalatory frications of varying durations Atypical CV & VC transition of vocal fold cycles Inappropriate timing of voicing He further commented that the dysfluencies seen during stuttering indicated several laryngeal, aerodynamic & articulatory abnormalities.
KUNNAMPALLIL GEJO JOHN,MASLP
The possibility of oral motor training improving fluency is compatible with the view that stuttering is the product of several poorly integrated and perhaps inadequate subsystems of which the speech motor control is one Oral motor therapy is designed to improve the syllable production so that stuttering is undermined. Current evidences suggest that a significant subgroup of those stutterers have a vulnerable speech motor system prior to the onset of perceived stuttering.
KUNNAMPALLIL GEJO JOHN,MASLP