Stutter — the sudorogopodobny movements articulation and guttural , arising more often in the beginning than the speech (is more rare in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms of stutter are very similar to clonic and tonic spasms. At clonic stutter repeated word formation, syllables and sounds is observed. Tonic stutter does not allow the patient to move from a sound stop to pass to an articulation of other sound. Stutter passes 4 phases from rare attacks of periodically arising stutter to the serious personal problem limiting ability of the person to communication in the development.
Stutter — the sudorogopodobny movements articulation and guttural , arising more often in the beginning than the speech (is more rare in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms of stutter are very similar to clonic and tonic spasms. At clonic stutter repeated word formation, syllables and sounds is observed. Tonic stutter does not allow the patient to move from a sound stop to pass to an articulation of other sound.
Allocate neurotic and nevrozopodobny forms of stutter. Neurotic stutter arises at healthy children as result of stresses and neurosises. Nevrozopodobny stutter is peculiar to children with diseases of nervous system (both hereditary, and acquired).
Etiology and pathogenesis
Allocate two groups of the causes of stutter: contributing and provoking. It is necessary to distinguish from the contributing causes of stutter:
- hereditary otyagoshchennost;
- the diseases causing entsefalopatichesky consequences;
- pre-natal, patrimonial injuries;
- overfatigue and nervous breakdown (as a result of infectious diseases).
The conditions promoting developing of stutter vystupat:narusheny development of motility and feeling of a rhythm can; scarcity of emotional development; increase in reactivity as a result of an anormalnost of the relations with people around; hidden mental violations (for example, ushchemlennost). Existence of one of above-mentioned conditions is enough for a nervous breakdown and, as a result, stutter. Treat the reasons provoking developing of stutter: one-stage mental trauma (fear, fright); bilingualism or multilingualism in a family; imitation; a takhilaliya (the accelerated speech).
The pathogenesis of stutter is similar to the mechanism of a subcrustal dizartriya. In its structure — an incoordination of respiratory process, an articulation and harmonization of themes. Therefore stutter is often designated as a dizritmichesky dizartriya. Failure of induction interactions of a cerebral cortex and subcrustal structures leads to bark regulation violation. In this regard there are shifts in work of striopallidarny system which is responsible for "predugotovnost" to commission of the movement.
Two groups of muscles participate in the movement — one are reduced, others — relax. Thanks to the exact and coordinated redistribution of a tone of muscles, commission of bystry, exact and strictly differentiable movements is possible. Striopallidarny system exercises control over rational redistribution of a tone of muscles. Blocking of the striopallidarny regulator of the speech owing to emotional overexcitation or anatomo-pathological injuries of a brain leads to clonic repetitions (tic) or to a tonic spasm. Over time the pathological reflex — violation of speech automatism and a hyper tone of muscles of organs of articulation – develops into a conditioned reflex.
Breath. Among violations of respiratory process at stutter the enormous consumption of air on a breath and an exhalation is noted that is caused by frustration of resistance in the field of an articulation. Violation of speech breath at stutter consists in formation of inspiratory and public or pro-even sounds by the patient. In other words, for the movement of vocal chords and formation of pro-even noise the patient uses the inhaled air. The shortened exhalation is observed not only during the speech, but also at rest.
Voice. The attempt of a pronunciation of a sound at stutter is followed by sudorogopodobny short circuit of a glottis that interferes with emergence of a sound. During an attack the throat quickly and sharply moves up, down and is pushed forward. Because of not ability on a smooth pronunciation patients try to say vowels firmly. Mitigation of symptomatology of stutter during the singing and whisper up to full normalization of the speech is observed.
Articulation. Except functional violations in the articulation device at stutter also somatic violations are observed. For example, the high arch of the sky, a deviation of the put-out language aside, in a nasal cavity — the bent nasal partition, a hypertrophy of sinks.
The accompanying movements are the movements accompanying the speech at stutter, not being necessary, but, at the same time, made by the patient as the conscious movement. During a stutter attack patients can throw back the head back, incline it, close eyes, clench a fist, shrug shoulders, stamp a leg, shift from one foot to the other. In a word, to make the movements which can be designated as tonic or clonic spasms.
Mentality. With development of stutter these or those mental disorders are inevitable. Most often the fear of some letters, syllables and words, namely their pronunciation meets. In the speech the patients having stutter intentionally avoid such letters and words, whenever possible look for them replacement. At aggravations there can be absolute dumbness. Thoughts of impossibility of normal communication can bring home of inferiority and in the relation of all "I".
Phases of development of stutter
1st phase. Small episodes of stutter, reduction of the periods of the fluent measured speech are observed. The termination of the first phase of stutter is determined by the following symptoms:
- difficulties in a pronunciation arise more often in initial words of offers;
- episodes of stutter arise when pronouncing the unions, pretexts and other short parts of speech;
- "communicative pressure" aggravates stutter;
- the child does not react to the difficulties with pronouncing words in any way, talks without confusion. There is no concern, fear of the speech. The momentary emotional flash is capable to provoke stutter.
2nd phase. There are problems in engagement, some accompanying movements. Gradually the number of the situations difficult in respect of communication raises.
- stutter gains chronic character, but weight of attacks differs;
- problems with pronouncing arise more often in multisyllables, during fluent speech and are much more rare in short parts of speech;
- the child realizes violations of the speech, but does not consider himself stammering. Speaks easy in any situation.
3rd phase. Fixing of a convulsive syndrome. However patients do not feel fear of the speech and any awkwardness. They use any opportunity for communication. The offer on treatment does not cause any support or enthusiasm from the patient. They as though give themselves installation on tranquility.
- patients realize that because of stutter some situations become difficult in respect of communication;
- there are difficulties in connection with pronouncing certain sounds, words;
- attempts to replace "problem" words with others.
4th phase. At this stage stutter — a big personal problem. There are expressed emotional reactions to stutter and, as a result, avoiding of speech situations. If earlier the patient resorted to replacement of "problem" sounds (words) periodically, then now he does it constantly. He begins to pay attention to reaction of people around to his stutter. Characteristic features of the 4th phase of stutter:
- expectation of stutter (antitsipation);
- difficulties when pronouncing certain sounds (words) accept chronic character;
- logofobiya (fear of the speech);
- answers to questions become evasive.
Existence of stutter forces the child to avoid speech situations therefore the circle of his communication and, as a result, the general development is narrowed. There is a suspiciousness, vigilance, feeling of a difference among themselves and peers. As a result of misunderstanding between the child and his parents (schoolmates, peers) the feeling of an ushchemlennost, own inferiority develops. Irritability increases, there is a fearfulness which can lead to oppression of mentality and aggravation of stutter. Stutter can lead to decrease in progress at school because of awkwardness, shyness and isolation of the child. Development of stutter can prevent in choice of profession, and also in creation of a family.
Diagnosis of stutter
Diagnosing of stutter requires existence of the following signs:
- violation of rhythm of the speech (scraps of words, phrases, repetition of syllables, extension of certain sounds);
- difficulties and halts at the beginning of the speech;
- attempts to cope with stutter by means of collateral movements (grimaces, a tic).
In case of duration of above-mentioned frustration more than 3 months stutter is diagnosed. Consultation not only of the neurologist, but also the logopedist is necessary for such patients. For an exception of organic diseases of nervous system carry out a rheoencephalography, brain EEG, MRT-diagnostics.
Treatment of stutter
Success of treatment of neurotic stutter in many respects depends on timeliness of diagnosing. In a type of low-efficiency of traditional psychotherapeutic methods of treatment of stutter (behavioural, hypnotic etc.) preference is given to special therapeutic approaches which include elements of several methods of treatment in modern medicine. Such combined psychotherapeutic methods of treatment of stutter apply both in individual, and in a group form. Correction of violations of the speech is carried out by logopedic classes in correction of stutter and the accelerated speech.
Neurotic stutter at children of younger age will well respond to treatment in logopedic kindergartens and groups. Here place emphasis on collective game psychotherapy, logopedic rhythmics. Not small significance is attached also to family psychotherapy where suggestion, derivation of attention, a relaxation is used. Children are learned to talk in a step to the rhythmical movements of fingers of hands or monotonously and drawlingly. At the heart of a self-control method installation that stutter — the certain behavior subject to change. In its structure — desensitization, autogenic trainings. The purpose of auxiliary drug treatment is removal of symptoms of fear, alarm, depressions. Appointment sedative (including phytotherapeutic) and the all-strengthening means is recommended.
In drug treatment of the nevrozopodobny stutter arising in connection with organic damage of a brain apply spazmolitik (, ), with care tranquilizers (in the minimum doses). Efficiency of carrying out a course of dehydration is proved. In case of clonic stutter purpose of several rates (from 1 to 3 months) of gopantenovy acid is recommended. Besides, it is recommended to include physical therapy, and also massage in complex treatment of stutter (as the general, and logopedic).
The forecast favorable more than in 70% of cases of stutter among children.
Prevention of stutter
Methods of prevention of stutter divide into two groups. One of them is aimed at maintenance and strengthening of children's health, the second — at the organization of speech development of the child. Good nutrition, permanent care, observance of a day regimen and hygiene are important components of mental and speech development of the child, preservation and strengthening of his health. Normal functioning of nervous system and its protection from overloads are promoted by the correct alternation of wakefulness and a dream. It is necessary to protect mentality of children from excessive information loading (viewing of "adult" telecasts, reading before going to bed hyper emotional fairy tales), the situations capable to cause a fright.
Full speech development of the child has to include three directions. The first — expansion of an outlook, concept and idea of the world around, phenomena and objects (games, walks, reading books). The second — prevention and the prevention of halts in speeches of the child, training of smoothness and slowness of the speech, to ability logically and consistently to state the thoughts, desires. The third — formation of the correct sound pronunciation, to rhythmics and tempo of speech. However it is necessary to give the child new information gradually, it is dosed.
Having corrected stutter, in order to avoid a recurrence the child needs to create the corresponding situation and the mode which will promote maintenance of a favorable psychological situation.