Speech-activated myoclonus masquerading as stuttering?

Ran across an interesting teaser article from pubmed entitled Speech-activated myoclonus masquerading as stuttering.  No, it has no abstract.  No, it’s not printed yet.  No, I can’t seem to download a digital pre-print.  No, I’ve not read the freakin’ article.  Yes, I’ll have to wait until it magically shows up at our library.  So what is myoclonus?  Well, I did a little reading on it–and it seems pretty interesting.  (Funny, pretty much all the online resources say the *same*exact*thing*; so there’s a whole lotta copy/pasting going on!)

So what is myoclonus?  Well, let’s break it apart.  Myo meaning “muscle”; clonus meaning “violent, confused motion”.  So we’re talking about confused muscle motion–such as involuntary jerks or spasms.  The most identifiable example is that body jerk that we all get from time to time *right* when we’re about to fall asleep.

Now–there are (behaviorally identified) subtypes of myoclonus out there…and the one that seems most stutter-esque is “action myoclonus”.  This is “characterized by muscular jerking triggered or intensified by voluntary movement or even the intention to move. It may be made worse by attempts at precise, coordinated movements.”  So I can see it… Maybe.  I’d like to read more about myoclonus and read the article as well.

The “cause” of myoclonus seems to be pretty wishy-washy.  The best description that I could gather is that there is “decreased inhibitory signaling from cranial neurons.”  And this could make a bit of sense relative to stuttering–as there have been a few long-standing theories suggesting that stuttered speech may stem from errors in physiological speech “feedforward” and “feedback”. (Postma & Kolk come to mind…)

Anyway–interesting to see what all comes from this…  And to get my grubby little paws on some data 🙂

Update 1:  A reader was kind of enough to pass along the article, and the format was more interesting than the paper itself.  It was a single page, 2 paragraph paper (with embedded video of the client).  Anyway–pretty interesting.  The client got sick around age 21 and “stuttered” ever since.  I’m suspecting that there was some viral infection that passed the blood/brain barrier and likely effected the basal ganglia-thalamocortical circuit–thereby resulting in the involuntary neural activations.  (But let’s get serious–I’ve got no clue..)  Further, the idea of linking speech myoclonus and stuttering isn’t new at all; Larry Molt wrote a good article on the concept for ISAD.

Update 2: Interesting.  I viewed the video of the client, and his speech does represent some aspects of “stuttering” in the textbok sense, but my stutter-senses weren’t tingling while watching the video.  Another nugget of trivia was revealed when the client said that stress and anxiety have an impact on his severity.  (This should give creedance to BGTC involvement.)

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Cluttering is not the same as stuttering

While most people at least recognize stuttered speech and pick it out from a line-up, most people (even SLPs) don’t have a clue about cluttering phenomenon.  This is a *great* resource that provides some of the basics. They ought have called it Cluttering 101.

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Marilyn Monroe struggled with stuttering

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Stuttering: Myths, Beliefs and Straight Talk

Some knuckleheads wrote this pamphlet; it may or may not be worth your time.

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How bad stuttering therapy teaches to the test

Over the years, I’ve come to realize that we only understand a concept after we teach it (effectively).  Until then, understanding may largely be an illusion.  Anyway, this past semester, I realized that much of traditional stuttering therapy is largely teaching to the test.  (In other words, the (a) therapist sets the goal as being some kind of fluency objective, (b) skills are taught that meet that objective, (c) treatment is measured in such a way such that the objective is met.)

So I just read a post over at the stuttering forum that describes this phenomenon very well:

I see a speech therapist on a regular basis. I am perfectly fluent during sessions and use my “skills” with no difficulty. The minute I step outside her office, all that goes out the window. I know exactly what to do but my stress level prevents me from doing what I need to. Should I continue therapy? I don’t know that I can benefit any further from it. It’s costly and I feel I’ve learned all I can about speaking fluently. The problem seems to be my negative thinking and poor stress management.

First off–despite my best efforts, I still can’t get an account over at Stuttering Forum.  So mods, feel like showing me some love?  Secondly, it’s time to change therapists–because we’ve got problems.  (1) What are the therapeutic principles?  (i.e., how is stuttering fundamentally viewed by both clinician and client?)  (2) What are the therapeutic values (i.e., what are the long term objectives?)  (3) What are the therapeutic goals? (i.e., what are the short term objectives?)  Just by reading this short post, I’m thinking that the clinician is confused at step 1, and thus has botched 2 and 3.  Sorry, I call them like I see them.

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What’s new in the online world of stuttering?

Read some pretty greaet posts this morning.  Pam writes “Sometimes I Just Stutter“; Danny posts a ‘cast on desensitization; and Steve writes about how choosing one’s life attitude impacts qualiy of life.

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Is keeping eye contact really such a great success?

(Note: This is a work in progress…  Updated 2009/6/1)

I ran across an interesting threat at the stuttering forum entitled Is keeping eye contact really such a great success? And I’d like to suggest that it categorically is. But there’s a couple of issues here:

(1a) Let’s define success.  Reading 7 Habits has (in many ways) changed the way I view the concept of success or effectiveness.  Success isn’t an end-product.  (That’s achieving an objective or meeting a goal.)  Success is a process; it’s a chronic state; it’s a way of life.  People live successful lives; they live in a state of success.  How we live contains 4 basic tenets, which include: (a) personal principles that (b) dictate personal values that (c) dictate behavior that (d) dictate (effective vs. ineffective) results.  In other words, it’s a transitive mathematical statement: our core principles ultimately impact how successful and effective we are in life.

[Side note:  Now–maybe I’m onto something here.  If someone is chasing the fluency god, they are seeking a (permanently fluent) result by trying to manage their behavior.  They are (trying) to manage their behavior because they value the idea of fluency over stuttering, because (in principle) they see stuttering as an unacceptable characteristic for life and living.  Maybe, at some point in the future, I’ll rebut this little thought-train and explain how it’s both flawed and counter-productive to one’s quality of life.]

(1b) In other words, success is not achieving a goal–because it will not ‘feel’ like success and will may result in happiness. (True) Success (resulting in tangible improvements to one’s quality of life) is a lifestyle (or personal culture) of living successfully.  (Remember: results dictated by behavior dictated by values dictated by principles.)

(1c) If success is a process (or personal culture) of living, is it possible to skip to the end?  (No–because there is no end!  The process of living successfully is only ended by loss of consciousness or death.  And I can see merit to the idea that a person’s success can live on, after their death.)

(2a) So let’s take another look at eye contact.  *But* let’s look at eye contact through the perspective of another rabbit trail: Dave Ramsey says that success in personal finances is 20% math and 80% behavior.  (And remember, behavior is ultimately dictated by personal values.)  And I think he’s hit a huge nugget of reality here: The way toward the result of financial peace is to live in accordance with the principles and values of financial peace.  So let’s extrapolate this to stuttering.  Regardless of if your goal is effective communication or the great white whale of ‘permanently fluent speech’, proper eye contact is a stepping stone toward either objective.

(2b) Another Dave Ramsey-ism is to hit the small challenges (i.e, debts) first.  Now–this makes no sense from a fiscal perspective; you’d want to take out the high-interest debt first, right?  But if financial peace is a behavior, it makes all kinds of sense.  If success is living successfully, then it makes every bit of sense to knock out the little annoying challenges (i.e., behaviors) that continue to nag and drag the soul.  And all these little “successes” reinforces the new lifestyle of living successfully.  It’s a snowball that gains inertia and size with every revolution.  Pretty soon, you’re knocking out debt like Mike Tyson in his prime.  For stutterers:  Today, eye contact; tomorrow, the word!

(3a) Now, let’s look at what eye contact can do for you.  First, losing eye contact reinforces personal shame, guilt and fear; that is *not* a win.  Turning your back on the ti-ger results in an ass-kicking.  We’ve got to stare that ti-ger down, whatever that ti-ger may be.  (And for us, it’s likely the societal ramifications of stuttered speech.)  Every client that I have known that veraciously stared down their ti-ger and by focusing on eye contact has resulted in reduced shame, reduced guilt, reduced fear, and a renewed ‘go-get-em’ attitude.  It seems to revive the soul via proactive personal empowerment.  The snowball has been formed and it’s beginning to roll down hill (gaining size and inertia).

(3b) And once this little “success” is reached, proper eye contact has other functions as well–it keeps us in the communicative moment.  It allows us (if not empowers us) through body language to complete communicative moments.  (In other words, people will dismiss us less.)  And after this little ‘success’ is reached, assertive (if not aggressive) eye contact can be used to draw personal boundaries and afford us our freedom and liberty to speak even with those who would otherwise try to disallow us to do so. (In other words, the stutterer (through proactive eye contact) dictates the rules of the communicative exchange with the listener.  We refuse to be refused.  We take our pet ti-ger out for a walk and show him with pride.)

In short (and nothing about this post has been short), eye contact is a pivotal step towards successfully living with stuttering.  Success begins with staring down your unkept ti-ger, and much of this is founded on eye-contact.  It helps thwart shame, fear, and guilt; it helps us face our ti-ger; it helps with desensitization; it helps with effective communication regardless of overt severity or speech-treatment goal/objective… I could go on and on, but this diatribe needs to stop somewhere.

Yes, eye contact is a great success–because it a cornerstone of living successfully with stuttering.

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He also was a stutterer. He didn’t have the problem of stuttering, he was just a stutterer.

I absolutely love this story; and in my little world, it’s what we all ought aspire to be.

“Back in my sales manager days with the insurance company I worked for, we attended a management development seminar in Chicago. This was a team building type of seminar in the early 1980’s. I remember this seminar vividly, as I was so influenced by the last person who spoke to our group. This man was a long term employee with our company. He was the Vice-President of Sales & Marketing. He had also been a vice-president in five other departments of our company. This man was a truly “down-to-earth” individual with tremendous people skills. He had developed self-awareness at its highest form, and had such a positive attitude about life in general. He also was a stutterer. He didn’t have the problem of stuttering, he was just a stutterer.”

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Renewed buzz on the not-so-new “new hypothesis” on stuttering

I had a number of people email or tweet this link to me over the past day, so it must have been posted on Stutt-L or the StutteringForum, etc.  In short, this is (part of) Conture‘s hypothesis on stuttering.

First off–this isn’t “new”.  The data is (at least) a number of years old.  Second off, even if it was “new”–it’s not really all that new because it’s an evolutionary spin-off of the psychological stuttering perspective.  In short, Conture is making the correlation between persistent developmental stuttering and emotional reactivity.  (To be honest, I’ve not read enough of their work to know if they try and deductively state that this emotional reactivity is causal to stuttering or not.  I certainly hope they didn’t though–as that would be an utterly irresponsible statement to make.)

Further, I’m not really impressed by the statistics.  Approximately 1/4 of stuttering kids are more emotionally reactive.  (What percentage of *all* kids are emotionally reactive?  I’ve spent some time w/ 3 year olds; it’s not hard to find emotional reactivity there!)  25% of anything doesn’t impress me much.  It wouldn’t surprise me to find that 25% of stuttering kids had delays in potty training, thereby supporting Sigmund Freud.  (Point being, 25% of any population is bound to have some common characteristic.)  (Example: let’s say that 25% of alcoholics prefer bourbon.  Any magic behind that statistic?  And what if I prefer bourbon?  Does that increase the likelihood of pending alcoholism?)

Now–let’s look at the origin of this ‘new hypothesis’.  First, the field of SLP has been blaming stuttering on the stutterer since (at least) the mid 1930s.  Wendell Johnson essentially bought into the fundamental attribution error, and makes the causal statement that stuttering is behaviorally conditioned response to speech-related anxiety.  (In other words, stutterers are weak people, can’t handle the normal pressures of life, and are more easily conditioned into stuttering than normal people.)

Since then, there’s been some data that try and support the assertion (above) by looking at how bad the parents are.  (In other words, bad parenting creates stuttering kids.)  And (if I recall correctly), a few studies found that parents of stuttering kids were indeed more “intense” (or whatever).  This is an interesting evolution of crap-science; when in doubt–blame mom.  (Much like Autism or even Tourette’s.)

Thus–to blame (either direclty or indirectly) stuttering on a kid’s emotional reacitvity is nothing “new”.  It’s definately not “new” to realize that emotionaly reactive kids/adults tend to be less-responsive to behavioral therapy.

But here’s my take.  This entire “new hypothesis” perspective is based on the same poor foundational understanding of what stuttering is.  This perspective assumes that stuttering is a behavior.  Stated differently, the concept of stuttering IS THE behavior.  So if kids are on the more emotionally reactive side of the spectrum, they are more likely to develop this speaking behavior.  And as long as we continue to limit ourselves with this perspective, we’re going to make the same mistakes that have always been made.

Instead, let’s look at it from a fresh perspective.  Perhaps the stuttering phenomenon INCLUDES this tendency toward emotional reactivity.  Stuttering (the phenomenon) includes physiological differences/abnormalities, a speech-related functional neurological signature, *and* other undetected neuro differences that *result* in behaviors such as emotional reactivity and overt stuttered speaking behaviors.  Stated differently, emotional reactivity and overt stuttering speaking behaviors are both symptoms of a common etiology.

As such, I’m not too impressed.  But I’ve not read tons of their research, so I could be wrong…

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A decent, quick read entitled “The tricks of stammering”

Pam sent me this article the other day.  Not too much to respond to, other than to suggest that citing “research” without any sources is a bad journalistic practice.  In any event, if you’ve got 2 minutes–it’s a decent, quick read.

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