31 October, 2013
by Dr. ABHIJEET BHATIA
A person who stutters is often bombarded with likely causes of his/ her disorder by all and sundry. It causes a lot of confusion and misconception in the minds of those afflicted, thereby adding to the magnitude of the problem. Before one decides upon the treatment modality, it is essential to understand the mechanism of speech production and thereby, the mechanism of stuttering.
At the outset, I would like to state that there is no physiological abnormality in the speech organs of a person who stutters. This means that the condition of his/her lungs, vocal cords, mouth, nose etc is as normal as anybody else’s. If there is no physiological abnormality then there cannot be any medical or surgical treatment for the same. Hence, my first advice to all is do not waste your money and time on medication (Allopathic, Homeopathic, Ayurvedic, Unnani etc.). The only person who can help you is a qualified, experienced Speech Therapist.
What is speech? How is it produced? What goes wrong with a person who stutters?Lets try to answer these questions:Speech is the end result of coordination between four components:
1. Air reservoir: The lungs
The driving force for production of speech is the air from the lungs. Speech isproduced during expiration. No air, no speech. Less air, less speech. More air,more speech. Therefore, people who have lung disorders get out of breathwhile speaking. When one shouts, more volume of air per second is exhaledfrom the lungs. When speaking softly, less air is exhaled.
2. Phonators: The vocal cords
The vocal cords are like strings of a guitar. When they vibrate, sound is produced. The quality of sound depends upon the tautness of the strings,striking power and thickness of the strings. The strings of a guitar are set into motion by the musician’s fingers. Similarly, the vocal cords vibrate when the air from the lungs tries to pass through the gap between the vocal cords. The quality of sound thus produced is dependent upon the thickness, length and gap between the vocal cords, all of which can be altered by the individual himself to a large extent. Hence, each person’s voice is unique and helps in identifying the person. This sound is monotonous and needs processing to form speech. This function is performed by the articulators.
3. Articulators: Lips, tongue, hard palate and jaws
The raw sound produced by the vocal cords is processed into vowels by changing the shape of the lips. Pursed lips do not produce any vowel.Consonants are produced by various forms of contact between lips, tongue,hard palate and jaws and are always followed by vowels.
4. Resonators: Nasal passages and paranasal sinuses
The importance of the resonators can be gauged when one attempts to talk with the nose pinched or when one is suffering from cold. The voice becomes heavy and loses its quality. The resonators impart a nasal twang to the voice,thereby enriching it. During speaking, varying proportion of air passes through the nose. Some consonants are formed by a strong nasal component.For eg, words starting with N and M.
The four components that form the speech pathway are finally coordinated by the brain to form fluent, intelligible speech and language as we know it. Any incoordination among these components can lead to speech disorders. This is what happens in stuttering. The coordination among the four components is lost. This does not mean that something is wrong with the brain. This coordination is learnt behaviour. Hence, the roots most commonly lie in a faulty learning process during childhood. It can also be unlearnt by the brain if there is any extreme stress on the brain, like during an accident, or an illness. If speech is learnt behaviour which is learnt during childhood, then stutterers can learn in later on too. If speech coordination can be unlearnt, it can also be re-learnt. This is where the speech therapist steps in. He uses a combination of psychotherapy and speech exercises to train the brain to establish coordination. The analogy can be drawn with driving.Driving is to be learnt by establishing coordination between clutch, gear, brakes and accelerator. A novice driver will have poor coordination, thereby giving a poor driving experience. As he gains experience and confidence, the coordination improves and operating various components becomes second nature to the driver.The ride experience becomes pleasurable. The speech therapist also tries to establish similar coordination between various speech organs and make it a part of the stutterers second nature. With practice, this coordination becomes second nature and the speaking experience improves. The role of the speech therapist is similar to that of a driving instructor in such a situation. He can only initiate and guide. Training and practice is dependent upon the learner.
Dr Abhijeet Bhatia
Department of ENT,
Sikkim Manipal Institute of Medical Sciences,