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delayed speech is often attributed to tongue-tie, ie, a short lingual frenulum, but we have never been convinced of this causal relationship Also, psychologists have attributed speech retardation to overprotectiveness or excessive pressure by the parents but these are almost certainly the result rather than the cause of the delay A fuller review of this subject can be found in the text The Child with Delayed Speech, edited by Rutter and Martin Stuttering and Stammering These dif culties occur in an estimated 1 to 2 percent of the school population Often the conditions disappear in late childhood and adolescence; by adulthood, only about 1 in every 300 individuals suffers from a persistent stammer or stutter Mild degrees are to some extent cultivated and permit a pause in speech for collecting one s thoughts, and stammering tends to be imitated in certain social circles, as among educated Englishmen (and some Americans) Stammering and stuttering are dif cult to classify In some respects they belong to and are customarily included in the developmental language disorders, but they differ in being largely centered in articulation Essentially they represent a disorder of rhythm an involuntary, repetitive prolongation of speech due to an insuppressible spasm of the articulatory muscles The spasm may be tonic and result in a complete blocking of speech (at one time referred to speci cally as stammering) or clonic speech, ie, a rapid series of spasms interrupting the emission of consonants, usually the rst letter or syllable of a word (stuttering) There is no valid reason to distinguish between these two forms of the disorder, since they are intermingled, and the terms stammer and stutter are now used synonymously Certain sounds, particularly p and b, offer greater dif culty than others; paperboy comes out p-p-paper b-bboy The problem is usually not apparent when single words are being spoken and dys uency tends to be worse at the beginning of a sentence or an idea The severity of the stutter is increased by excitement and stress, as when speaking before others, and is reduced when the stutterer is relaxed and alone or when singing in a chorus When severe, the spasms may over ow into other groups of muscles, mainly of the face and neck and even of the arms The muscles involved in stuttering show no fault in actions other than speaking, and all gnostic and semantic aspects of receptive language are intact Males are affected four times as often as females The time of onset of stuttering is mainly at two periods in life between 2 and 4 years of age, when speech and language are evolving, and between 6 and 8 years, when these functions extend to reciting and reading aloud in the classroom However, there may be a later onset Many af icted children have an associated dif culty in reading and writing If stuttering is mild, it tends to develop or to be present only during periods of emotional stress, and in four out of ve children it disappears entirely or almost so during adolescence or the early adult years (Andrews and Harris) If severe, it persists throughout life regardless of treatment but tends to improve as the patient grows older Theories of causation are legion Slowness in developing hand and eye preference, ambidexterity, or an enforced change from leftto right-hand use have been popular explanations of which Orton and Travis were leading advocates According to their theory, stuttering results from a lack of the necessary degree of unilateral control in the synchronization of bilaterally innervated speech mechanisms Fox and colleagues support a theory of failure of left hemisphere dominance By performing PET studies while a subject was reading, they found that the auditory and motor areas of the. birt data matrix Java Data Matrix Barcode Generator - BarcodeLib.com
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source code to generate barcode in vb.net Barcode for Eclipse BIRT which is designed to created 1D and 2D barcodes in Eclipse ... Barcode for Eclipse BIRT helps users generate standard Data Matrix ... word qr code right hemisphere are activated instead of those of the left hemisphere However, these explanations probably apply to only a minority of stutterers (Hecaen and de Ajuriaguerra) It is of interest that stutterers activate the motor cortex prematurely when reading words aloud and, as noted by Sandak and Fiez, affected individuals seem to initiate motor programs before the articulatory code is prepared Recently, several groups have reported subtle structural anomalies in the gray matter of the perisylvian region, but no common theme has emerged, and others are skeptical of these ndings (see editorial by Packman and Onslow) It has been commented in the literature on this subject that speech production is a highly distributed system and that compensatory mechanisms used by stutterers may confound interpretation of functional imaging studies The disappearance of mild stuttering with maturation has been attributed incorrectly to all manner of treatment (hypnosis, progressive relaxation, speaking in rhythms, etc) and used to bolster particular theories of causation Since stuttering may reappear at times of emotional strain, a psychogenesis has been proposed, but as pointed out by Orton and by Baker and colleagues if there are any psychologic abnormalities in the stutterer, they are secondary rather than primary We have observed that many stutterers, probably as a result of this impediment to free social interaction, do become increasingly fearful of talking and develop feelings of inferiority By the time adolescence and adulthood are reached, emotional factors are so prominent that many physicians have mistaken stuttering for neurosis Usually there is little or no evidence of any personality deviation before the onset of stuttering, and psychotherapy has not in our experience had a signi cant effect on the underlying defect A strong family history in many cases and male dominance point to a genetic origin, but the inheritance does not follow a readily discernible pattern Stuttering is not associated with any detectable weakness or ataxia of the speech musculature The muscles of speech go into spasm only when called upon to perform the speci c act of speaking The spasms are not invoked by other actions (which may not be as complex or voluntary as speaking), differing in this way from an apraxia and the intention spasm of athetosis Also, palilalia is a different condition in which a word or phrase, usually the last one in a sentence, is repeated many times with decreasing volume Perhaps stuttering represents a special category of extrapyramidal dystonic movement disorder, much like writer s cramp (page 94) Rarely, in adults as well as in children, stuttering may be acquired as a result of a lesion in the motor speech areas A distinction has been drawn between developmental and acquired stuttering The latter is said to interfere with the enunciation of any syllable of a word (not just the rst), to favor involvement of grammatical and substantive words, and to be unaccompanied by anxiety and facial grimacing Such distinctions are probably illusory The reported lesion sites in acquired stuttering are so variable (right frontal, corpus striatum, left temporal, left parietal) as to be dif cult to reconcile with proposed theories of developmental stuttering (Fleet and Heilman) Another form of acquired stuttering is manifestly an expression of an extrapyramidal disorder Here there occurs a prolonged repetition of syllables (vowel and consonant), which the patient cannot easily interrupt The abnormality involves throat-clearing and other vocalizations, similar to what is seen in tic disorders Treatment The therapy of stuttering is dif cult to evaluate and, on the whole, the therapy of speech- uency disorders has been a frustrating effort As remarked above, all speech- uency distur-. birt data matrix Eclipse Birt Barcode Component - J4L Components
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