STUTTER (balbuties) — disturbance of a rhythm and smoothness of the expressional speech with preferential defeat of communicative function. The speech of stammering is followed by halts, stops (tonic spasms of speech muscles), repetitions of separate sounds, syllables, words (clonic spasms). Stammering introduction to the speech of additional words (embolofraziya), napr, «well» is also peculiar, «here», «means», the movements (nods, twitching, a zazhmurivaniye, rocking) accompanying the speech, substitution of «difficult» words «lungs» (a so-called trick), the aspiration to avoid difficult speech situations. At many stammering the fear of the speech in an official situation, in need of prompt and exact replies is observed and at the address.
The etiology and a pathogeny
Among etiol, factors have the greatest value genetic predisposition, influence of various harmful factors on an organism of a fruit during pregnancy of mother, somatopathies and mental Traumatization in the early childhood — in the period of most snowballing of the speech («a children's disease» according to I. A. Sikorsky). To thicket 3. it is noted at men.
Most of researchers considers that at the heart of 3. the reflex act which developed after a mental injury on the general neurotic background lies patol. Some researchers believe that 3. is a consequence of disturbance of afferent synthesis because of discrepancy in time of bone and air conductivity, instability of functional asymmetry of big parencephalons, disturbances of a phonation.
The clinical picture
the Speech stammering, especially in a situation of nervousness or expectation, proceeds against the background of disturbance of a respiratory rhythm, a cardiopalmus, reddening or blanching of the person, the strengthened sweating, etc. Degree of manifestation of all these phenomena reflects weight of actually speech defect in one cases, in others — is in close dependence on an emotional condition of patients in speech situations. Distinguish two look 3. — evolutionary and symptomatic, or secondary.
Evolutionary 3. there are from 2 to 5 years during formation of the speech. Depending on whether there is it on a neurotic basis or against the background of signs of organic lesion of a brain, distinguish neurotic and neurosis-like 3. On a current evolutionary 3. happens progreduated, regreduated and recurrent.
Evolutionary 3. can have as the acute, psychogenic and reactive, and gradual beginning. Quite often emergence of the first halts in the speech is preceded by somatic weakening and some neurotic disorders (a sleep disorder, tearfulness, fearfulness, an adynamy) of both somatic, and reactive genesis. In these cases happens enough sudden change of a situation, emergence of sharp sounds, etc. that the child had halts in the speech. Stronger influences causing reaction of a fright can cause a mutism (silence) and even the loss of consciousness preceding it with the subsequent convulsive manifestations in the speech.
Neurotic 3., often designated by the term «logoneurosis», usually begins on psychogenic reactive type, after reaction of a fright, at children impressionable, inclined to neurotic reactions. Dynamics a wedge, pictures in these cases is expressed in increase as speech disturbances (speech convulsiveness), and neurotic frustration (emergence of persuasive fears, irritable weakness, fatigue, in especially hard cases — night enuresis, lunacy). With age 3. becomes complicated speech tricks, embolofraziya, the accompanying movements and the increasing shyness before the speech. Usually by 11 — 13 years the child realizes speech defect, its fear of the speech is created and the active aspiration to avoid difficult speech situations is noted. By 15 — 16 years as 3., and all-neurotic frustration become the most expressed that is reflected in the general condition and social adaptation of patients. Influence of adverse factors and lack of timely treatment, especially at early stages of development 3., can promote emergence of heavy neurotic frustration with the increasing feeling of own inferiority and symptoms of a neurotic depression, with a tendency to weighting of speech convulsiveness, generalization of fear of the speech, stabilization of vazovegetativny disturbances and with gradual formation patol, traits of character (development of excessive sensitivity, hypochondria, irritable weakness).
Neurosis-like 3. has the gradual beginning more often and it is quite often noted from the moment of formation of the phrase speech. Polymorphism of both mental, and actually speech disturbances — existence, in addition to 3 is characteristic of these patients., tongue-ties, fast-speakings, insufficiency of modulation of a voice, etc. At the same time in comparison with neurotic 3.; tendency to big speech convulsiveness and bigger expressiveness is noted hyperkinesias (see) and the movements accompanying the speech, and also easier emergence of vazovegetativny disturbances. Lag and the general motor development is typical. In general later development of the speech and existence of signs of disturbance of mental activity already at children's age is characteristic of patients of this group. Their behavior since the childhood is characterized or the general motive and mental disinhibition, tendency to to dysphorias (see), or slackness, passivity, monotony in behavior. With age there are lines of rigidity in manifestations of cogitative activity and viscosity in affective reactions. In the most mild cases asthenic symptoms prevail (see. Asthenic syndrome ).
Despite the expressed convulsiveness of the speech, the logofobiya in these cases has the reduced character and fear of the speech disturbs patients a little. Nevrol, inspection usually reveals signs of diffusion organic lesion of c. N page and resistant phenomena of vazovegetativny disturbances. Social adaptation of adult patients of this group is defined by expressiveness of psychoorganic frustration.
Symptomatic, or secondary, 3. meets at different types of pathology of the speech — dyslalias (see. Tongue-tie ), aphasias (see) and at various diseases — craniocereberal injuries, epilepsy, encephalitis, reactive states at hysterical persons, etc.
At the patients suffering from any form 3., at electromyography (see) reveal chaoticity of reductions of articulation muscles and disturbance of breath during the convulsive speech, at electroencephalography (see) — mezhpolusharny asymmetry and paroxysmal categories. At neurosis-like 3. note, besides, insufficiency of motor functions.
It is necessary to differentiate 3. with other disturbances of a rhythm and tempo of speech (a dyslalia, aphasia, etc.)
Symptomatic to 3. the aftongiya is close. It is expressed in the long tonic myotonia of language arising both in attempts to the speech and during the speech. At suffering from an aftongiya intense language rests against these or those parts of an oral cavity, leans out of it. The speech at the same time becomes impossible. Neurotic frustration are absent. Aftongiya many authors treats an independent type of pathology of the speech.
at the beginning of the 30th V. A. Gilyarovsky and N. A. Vlasova suggested to treat 3. in the early childhood by a complex method uniform medico-pedagogically which includes not only impact on speech disturbances (medicamentous and logopedic), but also the correct education, moral and ethical, intellectual, motor and musical development of the stammering child. For the correct treatment 3. at adults as Yu. A. Florenskaya (1949) specifies, special value data full have a wedge, inspections of the patient. Treatment is carried out as in a hospital, and is out-patient.
From medicamentous means sick appoint tranquilizers and Muscle relaxants. At treatment of neurotic forms 3. the main attention is paid to psychotherapeutic influence (the explaining psychotherapy, hypnosis, a specialized autogenic training, functional trainings), fortifying and sedative treatment. Neurosis-like 3. demands usually massive medicamentous therapy (dehydrational, resorptional, removing mental and muscular irritability, etc.) and persistent logopedic work. The psychotherapy in these cases is of secondary importance. Therapy of long forms 3. in all cases is defined by those frustration against the background of which it proceeds (neurosises, psychopathies, organic lesions of c. N of page, schizophrenia), and weight 3. It is the most effective to carry out treatment at early stages of a disease with the subsequent medical examination of patients for the purpose of implementation of both a maintenance therapy, and prevention of a recurrence of a disease.
In the predictive relation a current evolutionary 3. it is closely connected with dynamics of those frustration against the background of which it takes place. With age (after 50 years) 3. spontaneous reduction is peculiar. Cases neurosis-like 3., as a rule, predictively are less favorable in comparison with neurotic forms.
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H. M. Asatiani.