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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-. asp.net pdf 417 ASP . NET PDF-417 Barcode Generator - Generate 2D PDF417 in ...
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