Stutter theory from Sanjeeva’s (PhD) - Discussions and reflections

Stutter theory from Sanjeeva’s (PhD) - Discussions and reflections Many SLPs and researchers base their work on Charles Van Riper’s theory. Stuttering has clear genetic and neurological roots, and its onset can be triggered by stimuli. However, the stimulus–response account emphasized by Van Riper and others leaves an important explanatory gap. So much is yet to uncover. Maybe a tiny piece of that gap may be illuminated by **Sanjeeva’s (PhD)** ideas. Let's start a constructive discussion sharing our personal thoughts after reading his thoughts. **Sanjeeva Murthy (PhD)** has a stutter, and came to the United states as a student at the age of 22 in 1972. Oddly enough, his stuttering almost disappeared the instant he landed in the U.S., perhaps because no one in the U.S. knew him, but it reappeared without warning on many occasions. **Why?** He began to think about this intermittent stuttering and “normal” speech, and published a technical paper in 1980 describing his ideas in terms of a systems model. **Abstract** Classrooms are the biggest challenge for stutterers, awareness of stuttering and personalized support in schools would help stutters to be comfortable in their manner of speech and with the response of their listeners. Stuttering is thought to be due to subtle differences in neural pathways to and from the vocal mechanism. The model emphasizes the role of the listeners and the environment that cause mis-timed proactive signals and trigger unwarranted feedback in the stutterer’s neural network that processes speech. Stutterers can achieve a semblance of fluency by circumventing some of these pathways using distraction to substitute anticipatory thoughts about stuttering. But this practice is unreliable. More robust remedies take advantage of the neuroplasticity by progressively substituting: (1) impaired feedback pathways with fluency-promoting feedback, and (2) proactive stimuli with constructive forward control. **Introduction** It is not unusual that when a stutterer begins to speak, and the words don’t come out right, the positive impression that a new acquaintance or audience had about the stutterer quickly devolves into discomfort, tolerance, and even pity. Such occurrences repeated throughout a stutterer’s life determine his sociability, adversely affect relationships, scar the person, and determine his identity. Even at this late age in my 70’s, it is distressing not to be able to express one’s thoughts properly. Residuals of my life-long stuttering are obvious only to those who knew me till I was twentyish. Others think that I have an abnormal speech pattern because my speech is monotonous and labored, sounds unnatural with wrong intonations, is choppy with abrupt stops and starts. Occasionally, I show the classic stuttering characteristics such as part-word repetition, silent blocks and sound prolongation. Often, others in the room repeat exactly what I just said in a smooth, rhythmic and effortless delivery, and are more effective. With some level of controlled fluency that hides my stuttering, my speech is now tolerable. But I feel like an impostor, a stutterer masquerading as a fluent speaker. As an adult, I realized that I could change how I speak by understanding stuttering. I describe my experiences here by weaving them into a schematic model. **A systems model for stuttering** Suppose a motor is instructed by a controller to open an air pathway. If the motor fails to respond, the control system senses this failure and resends the instruction. The motor is now caught between its inability to open because of the mechanical fault and the unceasing inputs from the controller to open. This tug-o-war between the expected outcome and the existing state resembles stuttering. Following this analogy, speech can be thought of as being initiated by a hypothetical pattern generator in the brain that prepares a sequence of instructions for the vocal cords (left-third section in Figure 1), The right-third section represents the external factors including listeners that affect speech. The middle-third section represents the pathways that pass signals between the language processor and the vocal cord. Feedback loops are central to such models. **Impaired signaling pathways** A failure such as not being able to get word out, which does not perturb a fluent speaker in the least, causes destructive feedback that results in silence and pauses in a stutterer. This can be represented as an impairment of an unconscious feedback that modulates the speech, from the top open backward arrow in fluent speakers to the bottom filled backward arrow in stutterers. The impaired signal pathways are thought to be activated by anxiety. But I do not remember experiencing any moments of anxiety in my pre-teens while I stuttered away, including participating in debates, without considering how others would react to my stuttering. Only in my teens, I began to feel anxious about speaking and shied away from speaking. I devised ways to reduce my anxiety level to overcome stuttering. I began to substitute problem words to mask my handicap. In the words of Johnson, I just bumbled along, using techniques that seemed to work at that moment. Secondary behaviors exacerbate stuttering. This includes fear of certain words and situation, escape and avoidance, efforts to conceal the handicap by using starters, explaining the word, and by substitutions (circumlocution) that lead to bad syntax; sometimes what I said would be the exactly opposite of what I meant to say. The two stuttering pathways at the bottom of the figure represent the conflict during stuttering between urge to speak and not to speak, the opposing forces in a tug-o-war, disagreement between the director and the actor in a play. My stuttering began to diminish once I realized that pathways that cause blockages and unconscious mental inhibition to affect fluency can be overcome. My stuttering disappeared almost completely when I came to the U.S., where no one knew the old stuttering Me. But during my first visit to India after 4 years, I was taken aback to hear myself stutter as badly as before while talking to my family members and old friends as though mis-wired pathways remained waiting to be triggered by old memories. **Proactive stimulus and failure to launch** Proactive stimulus from the brain, based on anticipated action of the vocal cord can explain this inability to start. An imposed rhythm, as it occurs during singing, can replace this stimulus and thus help some stutterers by preventing them from getting ahead of themselves. **Mitigation of stuttering** Distraction, in essence, blocks the impaired pathways in Figure 1. Distraction can be brought about by thought substitution that relies on the left prefrontal cortex, or by direct suppression on the right. When I was about 7, I was asked to put a pebble in my mouth while speaking. This did not help; my stuttering got worse to such a degree I could not even say my name. In one stretch extending over months, I could not answer roll-call in my classes. One day during this period, I happened to crush my left thumb by a hammer, and was treated with iodine tincture. The next day, I happened to be smelling the iodine on my thumb when my name was called. To my and everybody’s surprise, I answered the roll call. This way, I discovered distraction as a means to avoid stuttering. Since my difficulty was always in starting a sentence, and because it got harder the more I thought, I tried not to think of the first syllable by distracting myself. I do not stutter in new situations such as speaking to a stranger at a bus stop, or in a critical situation such as angrily arguing with a landlord. Based on such experiences, I began to experiment by imagining or play-acting different scenarios, using a different tone, even pretending to be talking to child. Distraction and forgetting being a stutterer can be expedient for achieving fluency, but is not reliable. As stutterers grow older, they learn to bypass the impaired pathways, every person finding a unique way to rewire the brain. Borrowing from the computer terminology, this is the equivalent of installing a new software to fix a problem, while issues with hardware (vocalization) and operating system (code preparation in neural networks) over which a stutterer has little control remain. Because of neural plasticity, stutter can be mitigated by speech therapist in children and by self-help in adults. **Conclusions** Knowing that stuttering is often associated with anticipation, anxiety and avoidance, parents, teachers and peers can play an important role in helping a stutterer manage their stuttering. Stuttering can be thought of as mis-wired circuitry with malfunctioning pathways in the form of proactive stimulus and the speech-interrupting feedback. Distracting and making the stutterer forget that he is a stutterer can bypass these pathways, resulting in pretense of normal speech. Stuttering can be minimized by speaking slowly, reducing tension by proper breathing, maintaining proper eye contact to prevent avoidance, and by proper preparation to the point of rehearsing every sentence before it is uttered. Recognizing neural plasticity and acting on it provides a long-lasting solution. Many achieve fluency as they grow older; some for no obvious reasons, others because of conscious effort, or because of successful treatments. Treatments of stuttering need to be aimed at examining the personality traits and not just disorder in speech. \_\_\_\_\_\_\_ *Source:* [*https://isad.live/isad-2022/papers-presented-by/research-therapy-and-support/representation-of-stuttering-pathways-a-roadmap-to-normal-speech-sanjeeva-murthy*](https://isad.live/isad-2022/papers-presented-by/research-therapy-and-support/representation-of-stuttering-pathways-a-roadmap-to-normal-speech-sanjeeva-murthy) \~\~ Your thoughts?