Announcing 'Stammering Research' - Stammering Research - UCL

TARGET ARTICLE
Stammering Research. Vol. 1.
How interviews with adults who stammer inform research directions
concerning what we think about our stammer: Participants views
from the Apple House Fluency Course, Oxford
Rosemary Sage
The Centre for Innovation in Raising Educational Achievement, School of Education, University of
Leicester, 21, University Rd., Leicester LE1 7RF
rs70@leicester.ac.uk
There is a pressing need to show how qualitative research can help change the world in positive ways.
(Denzin & Lincoln, 2000: x)
Abstract. Academic and political interests lead research and promote particular perspectives
generally measured in quantitative ways. A qualitative interview approach, arising out of the
real concerns for people who stammer, is employed to elicit priorities for investigation and
intervention that is client-led (Yaruss & Quesal, 2004). This is used to illustrate a study into
adult fluency management at the Apple House, Oxford. Courses have run for 32 years and one
participant for interview was selected at random from the 200 attending in each decade. There
are four case studies, therefore, from a total cohort of 800 adult course participants over this
period. The four interviews are transcribed and reviewed and reveal common concerns
amongst participants. The goal was to suggest a research and practice agenda, which is clientled
to enable outcomes that maintain improvements from intervention when compared with
current 50% relapse rates. The pros and cons of interview approaches are discussed in making
a judgement about their value in the research process. Keywords: Interview methods, case
studies, views of those who stammer, research agendas, fluency courses, adult treatment.
1. Background to stammering - interruptions in the speech flow rhythm
Folk beliefs have honourable status but they are not the same intellectual object as a
scientific analysis (Moerman, 1974:55).
Folk beliefs about stammering abound. My favourite reports a cure in the 1950s, after eating the
meat of a black tomcat at midnight, under a half moon, and drinking the urine from a virgin mare
(Sage, 1998). The shock provided the will never to stammer again! Since then, understanding of
stammering has been revolutionized by improved knowledge of inside and outside the person factors
that affect performance.
Inside the person factors
With regard to inside the person factors, the contribution of brain imaging techniques (PET –
positron emission tomography; fMRI – functional magnetic resonance imaging; DTI – diffusion tensor
imaging) has been important. Brain images suggest a structural weakness in rolandic operculum fibres
of the left-brain of those who stammer. The disturbed signal transmission through connecting parts
used for speech articulation and planning may impair the fast sensorimotor integration necessary for
fluent speech (Sommer et al., 2002). Studies by Webster (1996) indicated that the right brain of those
who stammer has higher activation than the left, which is the reverse of the pattern seen in fluent
speakers. Since high right-brain activation is shown when fear and anxiety is experienced, this may
overflow to the left and interfere with speech movements. This is one possible explanation of the
supposed higher right hemisphere activity. Fluency improves with dopaminergic medication (Brady,
1991; Lavid et al., 1999; Maguire et al., 2000) suggesting hyperactivity of the dopaminergic
neurotransmitter.
It has also been hypothesized that the normal temporal pattern of activation between premotor and
motor cortex is disturbed (Salmelin et al., 2000) with more left-brain activity in dysfluency, whereas
right activation correlates with smooth speech (Braun et al., 1997) Therefore, hemispheric language
areas (suggested by studies of cerebral vascular accident patients) may try to compensate for the deficit
(Fox et al., 1996). Language lateralisation is less pronounced in females, possibly accounting for their
lower dysfluency incidence and better recovery rate (McGlone, 1980).
Theories, like those just described, seek to explain brain function, support fluency methods such as
reading to a metronome, choral speaking and singing that reduce stammering by using an external
signal (metronome beat, choral speakers and song music). These act as pacemakers feeding into the
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