Early studies- breathing, motor capacities, and

heart rate
Turned to- investigations of the stutterers

- tissue chemistry - neuromuscular organization - handedness - cortical potentials

KUNNAMPALLIL GEJO JOHN, MASLP KUNNAMPALLIL GEJO JOHN

- eventually led to research on more subtle aspects of auditory perception - lateral dominance for cerebral processing of speech.

Most physiological measures are responsive to

muscular effort and autonomic arousal.

KUNNAMPALLIL GEJO JOHN

Cardiovascular Factors and Basal Metabolic Rate

McDowell (1928) compared stutterers and non stutterers in

average heart rate and blood pressure and found no difference.

Travis, Tuttle, and Cowan (1936) observed faster heart rates

than normal in stuttering subjects before and during speech.

Fletcher, attributed this chiefly to the emotional reactions and

respiratory abnormalities associated with stuttering.

KUNNAMPALLIL GEJO JOHN

 Ritzman (1943) found no differences between adult male stutterers and their controls in heart rate, sinus arrhythmia, blood pressure, and basal metabolic rate (BMR).
Among female stutterers, however, he found less marked sinus arrhythmia and higher pulse pressure and basal metabolic rate than in their controls and a definite tendency for them to resemble the male stutterers in these measures.

KUNNAMPALLIL GEJO JOHN

Biochemical Factors

For a brief period it appeared that clues in the etiology of stuttering might be found in the chemical make-up of the stutterers body.
Alveolar Carbon Dioxide and Salivary pH

Edwin B, found that the large majority of stutterers were shallow breathers suffering from fatigue or lethargy brought on by insufficient aeration of their blood.

KUNNAMPALLIL GEJO JOHN

 Starr reasoned sub breathing stutterers - a low

salivary pH as a consequence of their CO2 excess

the hyper excitable psychopath stutterers should

have low alveolar CO2 and high salivary pH.

Alveolar CO2

1 Salivary pH

KUNNAMPALLIL GEJO JOHN

 Trumper found that oxygen deficit in the arterial

blood results in a compensatory increase in the number and hemoglobin content of the red blood cells. Studied 101 cases of stuttering & identified one third as shallow breathers.
In blood studies of this group he found that there was an increased red blood cell count and relatively high hemoglobin.

KUNNAMPALLIL GEJO JOHN

Chemical Composition of the Blood

Kopp ( 1934 ) found that the blood chemistry of the stutterer was essentially

normal. Differences were observed when compared with non-stutterers

Stutterers: higher in,

serum calcium inorganic phosphorus blood sugar lower in, potassium total protein albumin globulin they seemed to differ as well in the degree of relationship between some of these components.
KUNNAMPALLIL GEJO JOHN

 Anderson and Whealdon (1941) found that stutterers did not

differ from the general population in distribution of blood types and therefore in the proteins controlling agglutination.
Lovett Doust (1956) reported stutterers to show more marked

changes than normals in oxygen saturation of capillary blood in response to the stress of breath-holding and interpreted this as a sign of less stable oxidative metabolism in the stutterers.
Rastatter and Harr (1988) measured neurotransmitter and

amino acid blood levels and reported high levels of glutamine in stutterers.

KUNNAMPALLIL GEJO JOHN

Reflex Activities

Evidences of lability, sensitivity, or irritability of the autonomic nervous system in stutterers. Sovak (1935) reported normal oculocardiac and positive solar plexus reflexes in the majority of a group of stuttering children and adults.

KUNNAMPALLIL GEJO JOHN

 Bruno, Camarda, and Curi (1965) found electronystagmographic abnormalities in 29 of 50

stutterers.
Castellini, Salami and Ottoboni (1972) observed them

in 14 of 30 cases. In none of these studies was a control group used.

Siroky, Langova, Moravek, and Svab (1978), using a control group, found a considerably greater number of saddle-shaped nystagmic jerks in the records of stutterers, whether in silence or speech.
KUNNAMPALLIL GEJO JOHN

 Neilson, Andrews, Guitar, and Quinn (1979) found no differences between 4 stutterers and 6 normal

speakers in stretch reflexes of the jaw closing muscles.

Nine stutterers did not differ from controls in reflex changes in biting force in response to loud noise and tactile stimulation of the lip, tongue, and teeth in research by Smith and Luschei (1983) and McFarland, Smith, Moore, and Weber (1986).

KUNNAMPALLIL GEJO JOHN

Tremors
Herren (1932) found that during silence as well as speech a

relatively rapid tremor, at the rate of 40 to 75 per second, occurred more frequently in the records of the stutterers.
Hill (1944) suggested that they might be traced in part to an

increased adrenalin output during stuttering.

McFarland, Smith, Moore, and Weber (1986) found no

differences in amplitude of tremor of the jaw closing muscles as subjects exerted a constant force on a bite block inserted between upper and lower teeth.
KUNNAMPALLIL GEJO JOHN

Muscular Tension
Travis and Fagan (1928) measured the resistance of the

pendant hand to 40-ounce blows.

They found that more resistance was offered by stutters than

by normal speakers during silence.

This might have resulted from either situational or chronic

nervous hypertension among the stutterers.

Shackson (1936) Faster muscle contraction - latent tetany.
KUNNAMPALLIL GEJO JOHN

 Brown and Schulman (1940) measured muscular tension by determining the pressure needed to inject

a minute amount of saline solution into the body of the biceps muscles.
They found no evidence that stutterers were tenser than non stutterers.

KUNNAMPALLIL GEJO JOHN

What is alpha wave?

Cerebral cortex was the site of concentration of electrical activity, or brain waves. One of these, the alpha wave.

KUNNAMPALLIL GEJO JOHN

Cortical Potentials of Stutterers and Non stutterers

Electrode Placement Travis & Bipolar Knot (1936) Brain Area Measures Conditions Results

Left Visual and motor

Amplitude duration

Silence, speech

Found small differences that they considered difficult to interpret. The waves during the nonstuttered speech of stutterers were larger and slower than those for the speech of normal speakers.

KUNNAMPALLIL GEJO JOHN

Moore and Monopolar Haynes (1980)

Left and Integrated right alpha temporoamplitude parietal

Stimulation The stutterers by pure showed less tones and alpha in the speech right hemisphere than the non stutterers for both verbal and nonverbal stimuli.

KUNNAMPALLIL GEJO JOHN

Moore and Mono Lorendo polar (1980)

Left and Integrated right alpha temporo- amplitude parietal

Auditory presentation of words

The non stutterers had less alpha in the left than the right hemisphere; the stutterers, just the reverse.

KUNNAMPALLIL GEJO JOHN

Moore (1986)

Mono polar

Left and Integrated right alpha temporo- amplitude parietal

Auditory presentation , recognition and recall of words and paragraph material

The stutterers showed right-hemisphere alpha suppression; the non stutterers, lefthemisphere alpha suppression.

KUNNAMPALLIL GEJO JOHN

Cerebral Blood Flow

Pool and Watson (1991) found reduced blood flow in the frontal lobes of 20 stutterers in recognized

cortical regions of speech-motor control, as well as in the left temporal lobe.

They concluded that their findings suggest that stuttering is a neurogenic disorder.
KUNNAMPALLIL GEJO JOHN

Journal articles Autonomic Correlates of Stuttering and Speech Assessed in a Range of Experimental Tasks [ Journal of Speech and Hearing Research Vol.33 690-706 December 1990 ] Christine M. Weber & Anne Smith
Electro dermal activity, peripheral blood flow, and heart rate

were recorded from 19 stutterers and 19 normal speakers during performance of jaw movements, a strenuous breathholding task, reading, and spontaneous speech. The tasks were selected to produce a range of autonomic activation and thus help scale autonomic activation for speech relative to other motor behaviors. Speaking was associated with relatively large increases in autonomic activity in both stutterers and normal speakers. There were no differences between the two groups of speakers, suggesting that the stutterers did not have abnormally high levels of autonomic activation in speech.
KUNNAMPALLIL GEJO JOHN

 Within the group of stutterers, the more extreme increases in

arousal were correlated with the occurrence and increased severity of disfluent speech.

Significant correlations were found for the intervals prior to,

during, and after speech. Measures of autonomic arousal accounted for small percentages of the variances of fluency and severity. arousal accompanies the breakdowns in speech motor processes characteristic of stuttering.

The results are consistent with the hypothesis that sympathetic

KUNNAMPALLIL GEJO JOHN

CO ORDINATION BETWEEN ARTIULATORY AND PHONATORY EVENTS:

Mis-coordinition.
VOT is a very useful measurement. Watson (1982) - longer VOT has been reported in both

perceptually dysfluent speech and fluent utterances of stutterers.

KUNNAMPALLIL GEJO JOHN

 Basu (1979) compared VOT of stutterers for voiced and

voiceless stop sounds of Kannada language in spontaneous reading and syllables.

Results showed that stutterers showed longer VOT for voiced and voiceless stop in both reading and syllable. Consistent increase in VOT with respect to position of articulatory constriction was observed for stutterers.
According to Metz et al (1979), Revathi (1989) there was

no significant difference between VOT of stutterers and non stutterers speech.

KUNNAMPALLIL GEJO JOHN

CO ORDINATION BETWEEN ARTIULATORY , LARYNGEAL AND RESPIRATORY EVENTS:

Mis-coordinition. Adams (1974) - fluency is dependent or smooth coordination of activities of the respiratory, laryngeal, articulatory system.

KUNNAMPALLIL GEJO JOHN

 Mohan Murthy(1988), studied acoustic, aerodynamic and laryngeal correlates of stuttering. Measurement was done through spectrograph, electroaerometer and electroglottograph respectively.

It was observed that inhalatory frictions of varying

duration, atypical CV and VC transition of vocal fold cycles and inappropriate timing .
KUNNAMPALLIL GEJO JOHN

 Raghunath on basis of descriptive analysis on different

spectrograms revealed the following errors Errors of aspiration Errors of coarticulation

-lack of formant transition, -longer transition time -shorter transition time Addition/ interjection Errors in manner of articulation Error on place of articulation Prolongation Errors in aspiration and coarticulation Errors of coarticulation and prolongation Errors of coordination of articulatory and glottal gestures.
KUNNAMPALLIL GEJO JOHN

Respiration
Breathing Movements
Breathing abnormality was a cause of stuttering. These anomalies are not present during silence. also found in the breathing of normal speakers during speech, although not to the same degree.

KUNNAMPALLIL GEJO JOHN

 In studies of stuttering children and adolescents without controls, Schilling (1960, 1962) observed abnormal diaphragmatic movements during silent breathing. Moore (1938) and Kurshev (1968), found that during silence stutterers and non stutterers did not differ in measures of breathing movement.
KUNNAMPALLIL GEJO JOHN

 Breathing curves during stuttering show a series of

abnormalities like..
Antagonisms between abdominal and thoracic breathing

Irregularity of consecutive respiratory cycles

Prolonged expirations or inspirations Complete cessation of breathing

Interruption of expiration by inspiration

Attempts to speak on intake of air.

KUNNAMPALLIL GEJO JOHN

Phonation
Common clinical observations that point to the larynx as a

site of abnormal activity during stuttering are.

Breath-holding Glottal fry Stutterers reports that their throat closes tightly Chevrie-Muller (1963) studied vocal folds during stuttering

by the technique of glottography.

Results showed many abnormalities including breaks in the rhythm of vocal fold vibration and a clonic fluttering of the folds in some but not all of her stutterers (cited by Van Riper, 1971)
KUNNAMPALLIL GEJO JOHN

 Janssen and Vaane (1983) studied 5 stutterers by using glottographic recording to test the assumption that stuttering blocks are associated with slowness in initiating phonation, relative to the start of articulatory activity.

Among five subjects this proved to be true for only two.

KUNNAMPALLIL GEJO JOHN

 Borden, Baer, and Kenney (1985) also noted evidence of rigidity of the vocal folds during stuttering, as well as tremors that coincided with visible tremors of the lip.
Bar, Singer and Feldman (1969) Electromyography study showed an increase in the action potentials just before and during stuttering.

KUNNAMPALLIL GEJO JOHN

 Freeman and Ushijima (1975, 1978) took electromyographic recordings simultaneously from intrinsic laryngeal muscles of four subjects.
Results: High levels of muscular activity during stuttering, as well as simultaneous contractions of adductor and abductor muscles.

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

 Conture, McCall, and Brewer (1977) used a fiber optic technique during stuttering in ten subjects.

In 60 percent of the part-word repetitions the vocal folds were in a state of abduction throughout the block, regardless of whether the repeated speech segment was voiced or unvoiced. During prolongations of sounds the position of the folds was always appropriate to the voicing characteristics of the sound.
KUNNAMPALLIL GEJO JOHN

 In a later fiber optic study, Conture, Schwartz, and Brewer (1985) found that during voiced prolongations the vocal folds were usually appropriately adducted, but that during sound or syllable repetitions and voiceless prolongations the folds were adducted, abducted, or in an intermediate position.

Their observations appeared to show that stutterers do not simply squeeze their vocal folds together during all instances of stuttering; the vocal folds may be inappropriately adducted or abducted.
KUNNAMPALLIL GEJO JOHN

Journal articles Laryngeal Behavior during Stuttering [ Journal of Speech and Hearing Research Vol.28 233-240 June 1985. ] Edward G. Conture & Goward D. Schwartz

The purpose of this study was to provide detailed, objective

descriptions of stutterers' laryngeal behavior during instances of stuttering within conversational speech. Subjects were 11 adult stutterers who produced stutterings (sound prolongations and sound/syllable repetitions) while their laryngeal behaviors were observed by means of a flexible fiber-optic nasolaryngoscope (fiberscope). Laryngeal behaviors 8 of the 11 stutterers stutterings were categorized as adducted, intermediate, or abducted.

KUNNAMPALLIL GEJO JOHN

 Results indicate that during sound prolongations the vocal

folds were more likely to be adducted and less variable in their movement than during sound/syllable repetitions.
Results further indicated that the voicing characteristics of the

stuttered sound (voiceless vs. voiced) and the type of stuttering (sound prolongation vs. sound/syllable repetition) interactively influenced laryngeal behavior.
It is hypothesized that a complex interaction among the

laryngeal, articulatory, and respiratory systems contribute to the occurrence of the inappropriate abductory and/or adductory laryngeal behavior, which characterizes prolonged or repeated (stuttered) speech segments.
KUNNAMPALLIL GEJO JOHN

Articulation
Shaffer (1940) found that stuttering was characterized. by longer time intervals between onset of jaw movement and

onset of phonation,
by more directional changes in jaw movement, by longer intervals between initiation and first directional

change of jaw movement.

KUNNAMPALLIL GEJO JOHN

 In Electromyographic studies of the masseter muscles by Travis

(1934), Morley (1937), Steer (1937), and Williams (1955) showed that in stuttering there is frequent evidence of defective synchronization, as well as other abnormalities of the action potentials of the paired musculatures.
Sheehan and Voas (1954) used unilateral masseter action

potentials to show that muscular tension appears to build up during stuttering, reaching its peak near the termination of the block.
KUNNAMPALLIL GEJO JOHN

 Shapiro (1980), four subjects with electrodes at the lip and

tongue showed excessive muscular activity on stuttered words, poor coordination of muscles, and inappropriate bursts of activity during silence.
Craig and Cleary (1982) observed high levels of activity in the

orbicularis oris in their three subjects during stuttering.

Kittel (1983) found excessive activity in the orbicularis oris and

tongue in forty-two subjects.

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

 Smith (1989) correlated the activity of neck, jaw, and lip

muscles during stuttering.

She found little indication that the coordination of these

muscles differed from that of normal speaking control subjects, but unlike any of the nonstutterers, 6 of 10 stutterers exhibited large rhythmic oscillations in muscle activity during stuttering. These occurred at the same frequency in all of the muscle groups, suggesting that they had a common source.
In the same muscles Smith, Denny, and Wood (1991) observed

tremor like oscillations and increased activity which were not timed precisely with perceived stutterings.

KUNNAMPALLIL GEJO JOHN

 Guitar, Guitar, Neilson and Andrews (1988). In articulating the initial p of the words peek, puck, and pack, the normal speakers typically activated the depressor anguli oris before the depressor labii

inferior.
The stutterers reversed this sequence most of the time when stuttering and half the time when not. The authors hypothesized that the stutterers were deliberately stiffening their lips in the expectation of stuttering.

KUNNAMPALLIL GEJO JOHN

Aerodynamic Studies
Hutchinson (1975) identified 7 distinctive aerodynamic

patterns.
1. Repeated peaks in intraoral air pressure were associated with

syllable repetitions. 2. A gradual elevation of intraoral air pressure occurred with prolongation of a sound, especially a stop consonant. 3. Multiple elevations of intraoral pressure without airflow were associated with a silent block on a stop consonant. 4. Prolonged airflow terminating in an excessive peak of airflow corresponded to a breathy articulation of a sound such as /w/ with an aspirated release.
KUNNAMPALLIL GEJO JOHN

5.

A sudden drop in air pressure and flow rate accompanied a brief silent interval. A prolonged peak of intraoral air pressure and absence of airflow signified the silent prolongation of an articulatory posture. Intraoral pressure elevations of low magnitude without airflow were observed on a prolonged pause between syllables

6.

7.

KUNNAMPALLIL GEJO JOHN

Spectrographic Studies
Van Riper (1971) speculated that the stutterers difficulty is not

with sounds but with the transitions between them (i.e.) more of part-word repetitions. sandwich) in place of the intended vowel that would be required by normal coarticulation. repetitions do not ordinarily contain the neutral vowel, but a vowel that often approximates that of the word being pronounced.
KUNNAMPALLIL GEJO JOHN

But the neutral vowel is almost universally heard (e.g. suh-suh-

Montgomery and Cooke (1976) found that stutterers part-word

 Van Wyk (1978) reported an absence of formant transitions in

the repetitions of eighteen stuttering children and adults, but perceptual and spectrographic analysis showed that the neutral vowel was not being used. coarticulation during stutterers sound repetitions. Spectrograms and electromyographic recordings were made from the upper lip of stutterers while reading a passage weighted with syllables revealing anticipatory coarticulation by labial movement (e.g. Europe, screw). The spectrograms showed less coarticulatory labial activity during repetitions than on stutterers fluent utterances or normal speakers utterances of the same words.
KUNNAMPALLIL GEJO JOHN

Stromsta and Fibiger (1981) found reduction of normal

 Hutchinson and Watkin (1976) studied the jaw movements

of four stutterers at the terminations of blocks.

They found that the articulatory movement was

abnormally rapid at the moment of release from the stuttering block.

In addition, in a number of instances the movement of the

jaw was not coordinated with the onset of vocalization, sometimes preceding and sometimes lagging behind it.
KUNNAMPALLIL GEJO JOHN

Journal articles SOME ACOUSTIC CORRELATES OF STUTTERING: A PRE-POST THERAPY COMPARISON [ S. R. Savithri ,1987 ]
This study aimed at evaluating the efficacy of prolongation therapy in establishing fluency by measuring acoustic parameters in the pre post therapy samples of persons who stutter. Five persons who stutter (4 males and 1 female) in the age group of 12 to 25 years participated in the experiment. For spectrographic analyses, words in the pre therapy reading/ speech samples on which stuttering occurred and the same words in the post therapy samples were used.
KUNNAMPALLIL GEJO JOHN

 RESULTS

The articulatory dis-co-ordinations included atypical/missing F2 transitions, errors in place and manner of articulations, production of nasal for nonnasals and vice-versa. Three types of laryngeal dis-co-ordinations were identified (a) usage of murmur instead of voicing which was indicated by voice bars superimposed by aspiration (b) absence of voicing in voiced sounds and (c) usage of voicing for unvoiced consonants as indicated by the presence of voice bars for unvoiced consonants. Aspiration was used for unaspirated stops, which was evidenced by the presence of low frequency noise.

KUNNAMPALLIL GEJO JOHN

 The word initial unaspirated stop /p/ was uttered as aspirated

/ph/. Inspiratory frications were audible and were identified as fills on the spectrogram. Both these were classified as aerodynamic disco-ordinations. Not all types of discoordinations were noticed in all stutterers, indicating a possibility of sub grouping of stutterers. No articulatory dis-coordinations were observed in the post therapy sample of any stutterer. eliminating articulatory disco-ordinations and not the laryngeal or the aerodynamic. It is possible that these discoordinations may be difficult to be eliminated or the prolongation therapy was not efficient in eliminating these or the training was insufficient.
KUNNAMPALLIL GEJO JOHN

It appears that the prolongation therapy was successful in

 The incomplete closure of the vocal folds for the voiced sounds

(murmur) and the opening of the vocal folds (absence of voicing) indicates difficulty in adjusting the laryngeal gestures. Results indicated several articulatory, laryngeal and aerodynamic disco-ordinations. The data supports the notion that stuttering is a disorder of disco-ordination in articulation, phonation and breathing.

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN