Scared silentStuttering studies search for root of debilitating speech disorderBy Catherine Duncan
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Although she felt guilty doing it, Diane Tijerina admits she often used her children to do the talking she was too afraid to attempt. When she did try to talk, the stammering and sputtering elicited looks that humiliated the young San Antonio woman. Instead, she asked her three young children to speak to the grocery clerk, waitress or other strangers encountered during everyday life. Stuttering, which affects 2.5 million Americans and 60 million people worldwide, has been a part of Tijerina’s life since she was 4 years old. In hopes of preventing future generations from suffering as she has, Tijerina is participating in a novel study being conducted at the Health Science Center’s Research Imaging Center (RIC). “I live with a constant fear of talking,” said Tijerina, 38. “You worry about talking every day. I hate the way people look at me when I start talking and they see that I have a problem.” Growing up as a stutterer is especially difficult, she said. “My teachers just accepted the fact that I had a speech problem. I never wanted to read in class and I never raised my hand, even when I knew the answer. I just tried not to talk at all.” As a child growing up on the West Side of San Antonio, Tijerina said speech therapy was not available during her early years. She took her first therapy session two years ago at Southwest Texas State University in San Marcos. Tijerina said she learned techniques in San Marcos that sometimes help her control her stuttering—and gained |
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Stuttering
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enough self-confidence to enroll in a physical therapy technician program. She previously worked at a baseball cap factory where her position in trimming and inspecting required little verbal communication. In her new job, Tijerina must greet patients and help them with their treatment and exercises. Although she still has problems answering the telephone at work, she said she has become comfortable and stutters less with her patients. Tijerina said she is fortunate to have a supportive family: husband, Juan, and children, Valerie, 20; J.T., 17; and Michael, 16. Tijerina said her children accompanied her to speech therapy and learned the techniques so they could remind her when her stuttering becomes worse. “My children will try to help me when I am on the phone. They will stand next to me and try to coach me. I just get so frustrated. The harder you try not to stutter, the worse it gets. That’s why I decided to participate in the study at the Research Imaging Center. “Even if it doesn’t help me, if it helps someone down the road so they won’t suffer like I do now, then my time will be worth it. I do not want others to live in fear,” she added. Roger J. Ingham, Ph.D., Health Science Center adjunct professor who is conducting the study, said stuttering usually develops in the preschool years and afflicts 1 percent of the population. About 4 percent have it during their lifetime but some are able to recover, he added. “Recovery is usually fairly easy in childhood with treatment. After childhood is over, it is much more difficult to treat,” he said. “The ultimate goal of this project is to develop more effective treatments, especially for adults.” Peter T. Fox, M.D., RIC director, said the stuttering study is the first of its kind anywhere. Funded by a three-year, $921,000 grant from the National Institutes of Health, the study involves testing 10 stuttering and 10 non-stuttering women. A similar study has already been conducted on 20 male participants. Roger and his wife, Janis Costello Ingham, Ph.D., both speech pathology researchers, are spending three summers in San Antonio conducting the research at RIC, which is the only site in the country with the rare combination of high-tech equipment and qualified support personnel. During the school year, they return to the University of California-Santa Barbara as professors of speech and hearing science. “This is the best place in the world to do this research. From Dr. Fox to the technicians to the students, the people here are the tops in their fields,” Dr. Janis Ingham said. “The Research Imaging Center is known all over the world. We consider ourselves very fortunate to have this liaison with Dr. Fox and the staff.” In the study, participants are placed in the positron emission tomography system (PET) where radiation traces the parts of the brain being used. PET images show brain activity, such as speech, while it is occurring. The Inghams will be able to map where brain activity occurs during normal and stuttered speech and then compare the maps for differences. Before the stuttering study with men was conducted at RIC, experts strongly believed there was a difference in the brains of stutterers and non-stutterers, Dr. Roger Ingham said. However, when the brain maps of the two groups at rest (when they were not speaking) were compared, there was no difference in their brain activity. This suggests that the neural malfunctioning behind stuttering is found only during speech. In earlier studies the research team found unusual activity in the premotor, motor and auditory association regions of the cortex. The current study is looking at speech activity in these areas. Study participants are examined while at rest, while reading a prepared text and then while reading the text during chorus reading. Chorus reading is when two individuals read the same text together. For reasons not fully understood, stutterers who read aloud while someone reads with them do not stutter. During this study, participants read a passage while the same text is played from a recording through an earpiece. “We decided to look at the brain using PET while the person is stuttering and then while they are not stuttering, which is during chorus reading,” Dr. Roger Ingham said. “During stuttered speech, we found that the pre-motor area of the brain was activated, but the auditory association area was deactivated. But during chorus reading, these two areas of the brain came toward more normal activation.” At one time, it was thought that the stutterer’s unusual mouth movements during stuttering were the cause of these unusual neural activities. But, it is now known that this is not true. “This was confirmed last year when we brought in four stuttering and four non-stuttering men from the first study. We had them repeat the entire study with one difference. Instead of reading the text, they had to imagine they were reading it. Then they had to imagine they were chorus reading. “We learned that almost the exact areas were activated during imagination of speech as activated in spoken stuttering. This proves that these unusual activations and deactivations may occur even before the act of speaking, or they simply accompany speech,” he said. “By identifying the areas, we can develop more rational treatments that are designed to minimize or eliminate stuttering,” said Dr. Roger Ingham. “We can look at behavioral and other procedures, including possible TMS (transcranial magnetic brain stimulation) treatment and drug treatment. Plainly speaking, these |
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new treatments would keep these abnormal processes from occurring in a stutterer’s brain.” A study on TMS and stuttering is being conducted through a grant from the Charles A. Dana Foundation. Dr. Fox said the study is focusing on the brain’s response to TMS, in which a magnetic field is used to stimulate a part of the brain. (For example, by stimulating a specific portion of the brain, the TMS can make a person’s thumb move because it activates the part of the brain that controls such movement.) “In stutterers, we’re trying to down-regulate an abnormal area. In earlier studies, we’ve identified a number of areas that are overactive in stuttering and a smaller number that are underactive. In this study, we will direct TMS therapy at a motor planning center near the top of the head. “The Research Imaging Center is the only place in the world approved to do this trial of TMS in stuttering. Other sites are conducting studies on the effects of treatments using prolonged speech [a strategy that teaches stutterers to prolong syllables slightly to control their stuttering], but none is investigating the physiology of treatment with TMS,” Dr. Fox said. Dr. Roger Ingham said those participating in the stuttering studies are playing key roles in the future treatment of stuttering. “Participants in the studies think it might help them personally, but they believe there is a greater chance it will help children in the future. They don’t want others to have to suffer as they have. They have very unselfish attitudes, perhaps because they have had to live with this constant struggle. “Speech is one of our fundamental features as human beings. Not being able to express yourself or explain your feelings is a terrible handicap,” he added. For more information about the stuttering studies, contact Dr. Fox at (210) 567-8150 or e-mail him at fox@uthscsa.edu. |
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