Stuttering

STUTTERING (balbuties), spasm of articulation, periodically occurring during speech function. It usually appears in childhood, most often from 2 to 7 years of age (most frequently at 4 years). According to Kapustin, the prevalence of stuttering among school-age children is 0.8%. In most stutterers, a hereditary-family predisposition and very often a specific aggravation can be found. Stuttering children most often belong to the male sex; they, sometimes with delayed development of the ability to speak independently, suffer from various pronunciation defects (e.g., lisping). When studying adult stutterers, some functional insufficiency in the area of the animal and autonomic nervous system or the endocrine glands can often be found; in approximately half of the cases, so-called physical signs of degeneration are noticeable. The influence of the environment can cause stuttering and worsen it (of course, in predisposed individuals). An inept approach by parents in dealing with a stuttering child, insufficient care, and generally difficult living conditions often serve as reasons for intensifying stuttering. Sudden emotional shocks can be the direct cause of the onset of stuttering. According to Gutzmann in 14%, and according to Mygind in 13% of cases, stuttering occurs following psychological trauma (fright, bad treatment, sexual trauma, etc.). Imitation of stutterers, for example, a stuttering schoolmate (according to Gutzmann in 9.5% of cases, and according to Tromner from 4% to 6% of cases), is also significant. Stuttering can arise in connection with organic damage to the brain, particularly after cerebral hemorrhage, traumatic or infectious encephalitis, etc. Much more often, stuttering occurs psychogenically, being a peculiar neurotic reaction of a psychopathic personality. In small children, stuttering easily develops as a pathological conditioned reflex. In the absence of organic brain damage in stutterers, i.e., noticeable cortical, striopallidal, and cerebellar phenomena, researchers attributed the appearance of stuttering to a violation of the functions of the motor speech apparatus (Sikorsky) or increased excitability of the entire motor apparatus from cortical centers to muscle bundles (according to Rossolimo, usually in the presence of a constitution of obsessive states) or saw the cause in the violation of the functions of the striatum (Foerster). The existence in most stutterers (especially adults) of cranial innervational asymmetry, for example, in relation to the facial and hypoglossal nerves and other hyperinnervation of central origin in the form of various accompanying movements, gives reason to seek an explanation for stuttering in the special properties of intracortical cerebral work (specifically: in relation to the processes of excitation, inhibition, their irradiation, induction, etc.). The visible distinctive features in stuttering are a) spasm of the speech musculature and b) periodicity of spasm attacks. In addition to general strengthening treatment, hydrotherapy in the form of warm baths is effective; cool baths and showers are not recommended. The method of exercises for breathing, voice, and articulation is applied. Breathing exercises consist of using deep inhalations, holding the inhaled air, performing inhalation and exhalation on command, etc. After applying breathing exercises, one proceeds to vocal exercises on vowel letters -a, e, i, etc.- and finally to exercises in pronouncing consonant letters with vowels. Simultaneously with speech orthopedics, treatment with Swedish therapeutic gymnastics can be conducted. Treatment is best conducted in special institutions under the guidance of a doctor experienced in speech re-education and with sufficient neuropsychiatric education, with the assistance of speech therapy specialists. In younger children, stuttering often heals through proper speech education without the use of speech therapy exercises, and most often passes without any intervention when a general routine is established. According to Froschels, the age of 12 is particularly favorable for conducting treatment. Systematic speech therapy is conducted for 2-3 months. The success of treatment is positive in 70-80% of cases. Preventively, for children with a family predisposition to stuttering, necessary hygienic care is recommended; such children should avoid contact with stutterers, oral answers before the class; for all stutterers, neuropsychiatric dispensarization is necessary.