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