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Article by prof L. Arutiunian
(The article was authorised by prof L. Arutiunian, given during the seminar in Radom on 27th 2004)
L. Z. ARUTIUNIAN
I will share with my program of the normalisation of the speech of the stammerers. The way to this achievement was long and not easy. It took me over forty years of research and practice. These were the years of constant search, mistakes being made, new ideas. However, now, I am happy because I can say that I know how to cure stammer. The methodology of the process is for adults, youths and pre-school children. The course is run in a group of 3-5 people. The first step, intensive course, lasts twelve days (five to six hours a day). After that stage, for the next seven months I meet with my patients once a month. The meetings last two or three days. The groups are mixed; patients are not allocated by the age, the intensity or type of the stammer. The experience shows, that this diversity can be approached in the same way, taking into account individual characteristics of each problem.
The results achieved after the intensive course are close to 100% of the cured patients, and the tests showed that results after the seven moth period were success in the scale no less than 70%. However, the examples of not fully cured patients depend on the individual characteristics as well the engagement of the patient in the therapy. The grading of the results of the therapy is not an easy task because the causes of the stammer are very often hidden, hard to be noticed and to categorise. There is great degree of instability in the stammer. The level of fluency of a stammerer in a situation can change once in a different situation arises. Therefore, the conversation at my work place, conversation over a phone and diaries run by the patients, do not give an objective view over the process of the cure. Over the years practice we found the diaries are indispensible to evaluate the process of curing stammer. The diaries were enhanced by the characteristics of the problems provided by the parents and the teachers. Over past two years, we have been carrying out detailed documentation of the results over the whole period of running the courses. That increased the quality of the outcomes, helped to avoid many mistakes during the therapy, allowed to shorten the time of running the therapy as well brought greater effectiveness. Also very important is to mention, that by documentation, we only made next step knowing that the previous ones gave positive results.
As a consequence, we decoded to take following factors while assessing the speech of the patients:
-The level of fluency measured by the number or stammers/blocks
- Self confidence while speaking
-Lack of bad thoughts leading to hiding the stammer
- Clearness of the speech
- Keeping the eye contact
- Ability to use sentences which are more complex
- Ability to talk about the starting of the therapy openly.
To characterise the patients’ speech we use the notebook with all the details describing the stammer, oral and written information provided by the parents, the family and friends. During the whole period of the therapy, the patients run their own notebooks willed with the descriptions of their feelings regarding the therapy itself. Also to special questionnaires are provided to help describe the patient’s speech in emotional and very important situations as well as the level of communicational activeness. During the whole period of the course, patients are to follow recommended exercises between the monthly meetings.
For us, it is of great importance to understand, when the satmmerer stopped to stammer. In my belief, the speech of a patient has been normalised for good, once the patient over the period of one year since the commencement of the therapy does not experience difficulties while pronouncing a word or logofobia and his speech is calm free from negative thoughts. The patient should not hide stammer and is able to speak without controlling himself. Once that is achieved, the patient is still being observed for another year where monthly meetings and exams at the same time are to be attended where the speech is examined in front of public of twenty people as a minimum. Taking these exams is of crucial importance because stammerers tend to create ‘black imagination’. Usually all the problems regarding the speech itself are exaggerated, even the smallest failure becomes a catastrophe.
What are the speech exams needed for?
During the year long therapy, the stammerer speaks well, but some of the patients just towards the end of the therapy when the time to separate from the therapist arrives, certain thoughts can appear.
For example: He is watching TV, listening to somebody else’s speech and all of the sudden starts thinking: I used be afraid of this word before, the therapy is about to terminate and I might be afraid of this word again’. Therefore, after finished therapy (the first step), patients still pass exams for a year after that, meeting the speech therapist and working on their speech in order to become confident while speaking.
Now I would like to briefly focus on the questions regarding the origin of the stammer, which directed my approach to cure the stammer. Apart from already known academic reasons for it I wish to introduce my personal point of view on these problems to make them clear and easily understood. Along with wide data and my own observations, I think that the cause of the stammer is a dysfunction of self regulation as well as inner synchronisation of the regular cycle of the speech.
It can be caused by modification in sending signals in the ear canal.
This hypothesis is backed up by the fact of introducing external synchronisation like metronome, choral speech, speaking under the observation of a specialist helps to avoid stammering.
It has been widely known that stammering can be due to stress but that is not always the case. It can be said that the speech problems are well placed in the memory depending on what made the stammer happen.
In the case where the stammer is not caused by stress, what stays in the memory are the cases where stammer appeared. That type of stammer evolves as a result of the delay of the development of the speech. Further problems in the communications do not depend on particular situations and can occur even talking to while being left alone. In all other cases, the memory captures stammer due to stress. If stress appears in the process of communication for second time, then it affects inner synchronisation the natural cycle of the speech, which leads to new difficulties while communicating. If the stammer was caused due to prolonged stress, then this stress can be erased from the memory.
When the stammerer realises that what his problem is, then the source of the negative emotions is the act of speaking itself. The thinking about it only changes the way the brain operates, which is followed by changes in the speech. With time, every person has its own hierarchy of difficulties caused by speech. That approach lets the person understand many paradoxical characteristics of the stammer, the aureole of this interesting problem is eliminated. Having said that, many teachers find it hard to understand why many students speak fluently during the class break, when there is no stress, but during the class on the other hand, they may not be able to say a word. In that case, the teacher may not be convinced about the problem of the student. The stammer can be compared to a chameleon, which can change every minute depending on the place, therefore the therapist who is observing the patients at his place of work, can be eventually very happy with the results he is achieving and may find it very hard to realise that the same patient can have great problems to speak just a minute after.
In addition, the central mechanism that triggers new stutter examples from the moment of defining the stammer, that speech has its own path. Gradually, neurotical problems worsen the speech problems and creating a closed, pathological circle. Apart from that, stammering negatively affects functioning of other body systems. According to the concept of prof. dr.hab N.P.Biechtierowoj we characterise the stammer as a constant pathological state. ‘This state is being created by rearranging of the activeness of many systems and structures of the brain, considered as not affected before’. One of the main characteristics of a good pathological state is its ability to self sustain. That explain the complexity to overcome the problem of stammer.
It can be assumed that in case of the stammer, the constant pathological state is created by hyperactive connection of limbic structures with the act of verbal communication. What means that since that moment, emotions are related with the speech. Stammeresrs themselves identify the problem not as lack of fluency while speaking but as constant anxiety caused while communicating verbally (problem with pronunciation of words and a chest pain). It is possible that due to that reason, they use a higher voice tone during personal contacts. In our opinion, since the very moment of incorporating of limbic structures in the act of verbal communication, stammering becomes a mechanism very hard to be reversed. While working with a patient, to make it easier for him/ her to understand what a pathological state is, it is proposed to imagine ‘ a small cave where a small ball lies’. Once that picture can be seen, the patient can understand that the work cannot be finished till that ‘ball’ is moved to another ‘cave- a normal speech cave’. Which translates: till a state of normal speech appears. If we don’t complete the work on our speech, the ‘ball’ will reverse to the old ‘cave’. It is understood that the stammer disappears when the normal state stays for ever. Ever since I realised that stammering is a constant pathological state, I changed my approach to the methodology of curetting that problem, the therapy itself and examination of the comeback of the problem. Is has become obvious, that the stammer cannot be overcome by dealing with only few aspects of this complex problem.
The most important in the therapy is to create a new, constant stereotype of the speech while active learning. A very important part of the methodology is an ability to think of very strong separation from stammering. There was a need to find a turning point. This point as well as the central source in the speech canals and any speech dysfunction is stammering ‘triad’.
The successful separation from stammering is achieved while the action is taken in those three dimensions and the whole tree is destroyed, with no leftovers.
While working with stammerers, I was constantly thinking why there are so many good academic works on the subject, but so far no methodology to deal with the matters of stammer is found.
Lets imagine the stammer as a mosaic. Every academic person investigates with a great detail only few elements of this mosaic without looking at the whole picture. Stammering, is a complex problem and that is how it should be looked at. In order to show the entire character of stammer and its elements as well as investigate the causes and results, it will be easier to introduce stammer in a form of a tree.
The most important are the three roots. Lets call the ‘triad of stammering’. First root represents lack of speech fluency. The second one, stands for anxiety while speaking (and stammering), getting tense during the act of verbal communication. The third one is the willingness to hide the problem once a person realises that stammers. That happened at different age level, at times at a very early stage. All three roots are get very close to each other creating an item, trunk, a trunk of fear of speaking, a trunk of logofobia, which is not proportional to the stammer that shows on the lips.
So far, we have been fighting against logophobia in few ways: pharmacologically, hypnosis etc. Logophobia will always be there till we eliminate its root. With years, this bad experience grows in scale, every ‘failure’ is registered in the brain which gives begging to negative thoughts, which are one of the strong branches of the tree which describes the stammer problem. In addition, many actions are taken in order to hide stammer, at times leading to hypochondria. However, it should be remembered that the most important is triad of the stammering. It (triad) exists in all of the forms of the stammer, regardless of intensity.
Visible signs like: lack of fluency of the speech and logofobia account only for the tip of the iceberg often are less meaningful when compared with the desire of hiding the problem and changed pathologically functioning state during the process of communication, of which the stammerer is not even aware.
The repetitive stutter over longer period of time has its destructive outcome affecting the rhythm of the speech. As always under the permanent pathological change of the state, many systems of the body add to this illness. The main rule of the methodology is creating the new verbal stereotype and implementation of it permanently in the brain rather than correcting various aspects of stammering.
Extremely important is the fact that created methodology allows the patients speak without the stammer from the first days of the therapy. Let’s make it clear what term ‘not to stammer’ means. I believe that the basis of the stammering is already mentioned triad: the willingness to hide the stammer, anxiety caused while attempt to talk is made and lack of fluency while speaking. Therefore, from my point of view, it can be said that a person does not stutter if during important and emotional situations is able to speak without stuttering, does not try to avoid complicated situations or words, does not hide the fact and is under the therapy, pronounces words easily and is calms in the process of verbal communication.
‘Not to stammer’ is the core of the success during the whole therapy.
The phrase: ‘I will never stutter again’ as a motto, appears in every stage of the therapy with the only difference that the speech of the patients becomes more natural, with regulated rhythm and intonation as well as complexity of the built sentences.
In order to exclude stammer at the very beginning, during the first ten days the classes are run with a very substantial constraints to speak. Spontaneous speaking doesn’t exist. For certain period of time the ‘old’ speech is stopped and the work is begun not with words or sentences but from the smallest part – syllable, as it is the part affected by stammer. It is understood, that if we omit working on syllable, we are exposed to building a house of bad quality bricks and we cannot take responsibility for the success of such a construction.
prof. L. Arutiunian