Ben Knight
From Singing to Speaking:
An examination of two different therapeutic musical approaches that improve and enhance speech motors and disfluency in stammering.
Dedication
I would like to thank Cherry Hughes of the British Stammer Association, Ingrid Del Ferro and David Truran for their participation in this project. I would also like to thank Three Ways Special Needs school for allowing me to observe the work of music therapist Adrian Schnell.
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Introduction This paper examines the four multifactorial factors of stammering. It outlines the cause of stammering and explores the various methods and therapies currently available to stammerers to aid them overcome disfluencies in speech. These methods and therapist include, the Del Ferro Method, The Accent Method, Melodic Intonation Therapy and The Speech Project. Finally it outlines my own approach developed through research into these methods describing exercises designed to help stammerers with speech through singing techniques.
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1 Stammering: How it Affects the Brain. Stammering is a divergence of speech which adversely aects or distracts the speaker or listener due to an interference in the rhythm of speech caused by spontaneous, involuntary repetition and pro-longation of words and syllables, creating disfluency in the speech (Espir, Rose, 1983: 93). The incidence of stammering varies depending on age of onset but 85% of stammerers begin to stammer by the age of eight (Espir 1983: 94). There are two age ranges in which children develop their stammer, namely ages 2-3, when motor speech patterns begin to develop in speech and ages 6-8 when children learn to read at school. Most children that develop a stammer between the ages of 2-3 are able to overcome it by the age of five. Stammerers are confronted with plentiful negative psychological emotions that can hinder progress in natural speech rhythm; 'fear and anticipation of stammering, and other diďŹƒcult - often strong - feelings about stammering such as frustration, anger, sadness, embarrassment, and shame' (British Stammer Association, 2014). It is these negative emotions together with a lack of confidence that contribute to the proliferation of the disfluencies. Research suggests that the intervention of disfluencies at a young age is vital as; 'stammering for more than three years... likely to persist with stammering throughout their lives', the earlier interception 'is not only desirable but essential' (The British Stammer Association, 2009). There are two types of stammering; overt stammering (one that stammers clearly) and covert or interiorised stammering. Covert stammerers avoid certain vowels and consonants as it triggers disfluency in natural rhythmic speech patterns, instead one uses similar meaning words or phrases to avoid these triggers. A small percentage (1%) of stammerers continue to be aected by the condition into adulthood (Prasse, Kikano, 2008).
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In human beings, 97% of right-handed people use the left hemisphere of the brain as their specialised language area. However 19% of left-handed people have their language areas in the right hemisphere, and up to 68% of left-handed people have language abilities in both the left and the right hemispheres (Boeree: Online). The Cerebrum is the largest part of the human brain and is divided into four lobes, these being: Frontal Lobe, Parietal Lobe, Occipital Lobe and Temporal Lobe. A ratio of 3:4 men stammer for every woman who stammers (Sirona Care & Health). Furthermore, Foundas (2001) suggested that stammerers are twice as likely to be left handed. See interactive example 1.0 below:
INTERACTIVE EXAMPLE 1.0: Cerebrum Structure
Frontal Lobe Temporal Lobe !
Parietal Lobe! !
Cerebellum ! !
!
! !
Occipital Lobe Brain Stem
Use one finger to rotate the cerebrum structure 360º.
During stammering, there is a correlative deactivation of the left hemispheres lateralised auditory areas which are considered to support self-monitoring speech production (Kehoe: Online). In particular the Broca of the Frontal Lobe and the Wernicke's area of the Temporal Lobe are areas that are considered to effect this. Kehoe suggests it is 'an overactivation of motor system areas in both cerebrum and cerebellum areas' that contribute to stammering (Kehoe 2004: Online). Foundas conducted an experiment that compared the Broca's and rear Wernicke's areas of sixteen stammerers and sixteen non-stammerers
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to spot consistences in the anatomy of stammerers. Foundas discovered that the stammerers had a considerably larger and greater symmetric planum temporale; a coinciding region in the Wernicke's area that is linked with language and music processing. See the areas of the planum temporale highlighted in the interactive example 1.2 below. INTERACTIVE EXAMPLE 1.2: Planum Temporale
Primary Motor Cortex
Broca’s Area
Wernicke’s Area
Use one finger to tap on cerebrum structure area to zoom in, then anywhere out of the text box to zoom back out.
Foundas further observed that stammerers had increased folds on the surface of the Broca's area, thus suggesting that this may create additional disruption between the connections of the auditory and motor areas of the brain (Foundas 2001: Online). The evolution of technology such as CAT scans has allowed for extensive research to be conducted and has resulted in the growing understanding of the lateralisation of the brain. The right frontal lobe hemisphere is exclusively dominant in musical purposes, for example; pitch, melody, timbre, emotional responses to music and performance. This theory evidences why you cannot stammer when you sing as singing utilises the right hemisphere, and this is different to the Brocca's area that is affected by the stammer. The video 5
example on the following page shows Roger Highfield, the science editor of the Daily Telegraph using a transcranial magnetic stimulation (TMS) to create a motor response in the left primary motor cortex linked with the lip area of the mouth. The diagram below shows the process of the transcanial magnetic stimulation. See example 1.3 below:
This process temporarily disrupts the activity in the lip area which meant that Roger Highfield could not articulate the words "fall" and "wall" when reciting the nursery rhyme Humpy Dumpty. However when the transcranial magnetic coil was placed in the same area, Highfield did not have the disfluency when he sung the nursery rhyme. This is due to the right hemisphere being activated and not the Broca's area. This experiment evidences the theory that the Broca's area is primarily used for speech and the right hemisphere is used for singing. See the experiment carried out in video example 1.4 on the following page:
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VIDEO EXAMPLE 1.4
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icon above to play the video.
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2 Multifactoral Factors of Stammering.
There are multiple factors that have an eect on stammerers when they speak. These include; environmental factors, speech and language factors, physiological factors and psychological factors. Â
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Environmental Factors Environmental factors can increase disfluency when the person who stammers is speaking in a demanding situation. Conversely some people's fluency in speaking is increased by stress (Sirona Care & Health, 2011). Stammering may vary depending on the environment of the situation, for example the stammerer may speak fluently at home, yet at school they may stammer. This is why it is vital to identify the environmental situation in which the person who stammers is, as it can hinder further progress. Research suggests that to counter this the stammerer should practice speaking or singing in chorus with others. As Espir and Rose agrees; 'Factors that improve stammering are: (a) speaking in unison, (b) modifying the voice by singing, (c) repetition of rhymes, stories and choral singing' (Espir, Rose, 1983: 95). I explored this phenomenon when observing children at Threeways Special Needs School in Bath. I saw first hand how important environmental factors are and in the case of one child who stammers named Joe he felt comfortable due to environmental factors. The music therapist took various measures to ensure a safe environment, including having very specific music playing as the children entered the room; but more than this he set this up by telling the students before even entering the room they would be hearing some music. The music was various bell sounds, once the students were in the room they were asked in turn what the sounds reminded them of. This worked very well because it facilitated a communal experience helping the participants feel comfortable with one another as they were experiencing the same thing. The music therapist then asked the students what the music represented to them and what it made them feel. This activity created a safe environment in which the children felt confident to express themselves. The use of a song that was familiar to them, helped mediate psychological factors as it again helped them to feel comfortable as it was a song that they sing each week at the end of the session. What surprised me is that when it came to singing Joe felt a lot more confident and he was the first to volunteer to sing a solo and was able to fully phonate and not stammer. Clearly this was as a result of the safe environment created by the music therapist. Â
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Speech and Language Factors The person who stammers is more likely to stammer at the beginning of words or sentences and 96% of incidences are associated with the initial onset word. Stammering occurs more frequently on consonants rather than on vowels, the proportion being 5:1 (Espir, Rose, 1983: 95). David Turan, a Commercial Music Masters student at Bath Spa University took part in a short questionnaire that was prepared by myself. See scrolling questionnaire below: Questionnaire with David Truran
Name: David Truran
Age: 29
1. Are you left or right handed? Please circle or underline (please do so for the remainder of the multiple choice questions): Left
Right
2. Age that you first noticed the stammer?
David became disfluent in speech at the start of sentences on the vowel /a/ and constants /w/r/n/d. However David did not stammer at the start of phrases when singing and explains that ‘Singing puts me in a good mood, and in touch with feelings- I feel more ‘together’ after spending time singing.’ See video of David singing on the following page.
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VIDEO EXAMPLE 2.0
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icon above to play the video.
Physiological Factors ‘Stuttering is caused by uncontrolled movements in the diaphragm’ (Del Ferro, Online). The diaphragm has uncontrollable movement where physically the respiratory breath is not consistent enough through the diaphragm as ‘the flow or air reaches the vocal chords unevenly.’(Del Ferro, Online) See interactive video example 2.1 below: VIDEO EXAMPLE 2.1
Press the
icon above to play the video. 11
In the video the the uncoordinated movements in the diaphragm are demonstrated at 0:03-0:05. The natural balanced movement of the diaphragm is demonstrated at 0:05-0:10. My research suggests that pre-forming in the mouth and the tongue are in fact psychological factors and not physiological as the mouth formation and tongue tension are the result of psychological factors and these can be controlled with diaphragmatic exercises. Here the basis of the issue is the breath and this will be discussed in more detail later. Research has been carried out into the physiological factors of stammering, these involve receptors in the larynx, namely; '(a) in the mucosa which alter reflexly the tone of vocal cord muscles, (b) in the muscles augmenting tone of opposing muscles, and (c) in the joints which reflexly alter the tone of laryngeal muscles'( Espir, Rose, 1983: 96). The laryngeal mechanics are correlated with voluntary action of speech so that they are preset half a second before the phonation of sound produced by the airflow through the vocal folds. A physical fault in this onset explains why most disfluencies lie at the beginning of speech and why stammering does not occur with recitation or singing (Espir, Rose, 1983: 96). Psychological Factors Speech in stammerers becomes more disfluent in certain social situations as psychological factors can impact speech. Both environmental factors and social factors can affect this. Stress and anxiety are also psychological factors that can hinder speech.
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3 The Subsystems of Voice Production Respiration Where respiration is incorrect there may be difficulties with phonation and resonance. The sub-system itself requires an even balance of breath and phonation. If one has lots of breath but is unable to phonate, no resonance is created. When one become anxious breathing moves to the thorax of the chest as in the case of a panic attack, when one hyperventilates this breathing becomes thoratic.
Phonation With the support of the respiration of the diaphragm, air is passed through the vocal folds. When air passes through the vocal folds they vibrate and create an oscillation of the vocal folds which creates vibrations called phonation. Phonation relies upon the timing of two muscle movements: exhaling air with support from the diaphragm and the engagement of the vocal folds. Poor breath support could create too much or too little air release, resulting in a loss of phonation. Furthermore, over-tensing the vocal folds when anxious or attempting to form words can block off the airflow which results in disfluency in speech. Resonance Resonance describes the way in which the voice carries. It is created by frequencies that oscillate the chest cavity. However without balanced breath and phonation this cannot occur.
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INTERACTIVE EXAMPLE 3.0
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icon above to play the video.
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4 Therapies - Melodic Intontation Therapy Melodic Intonation Therapy A therapeutic process used by music therapists and speech-language pathologists called Melodic Intonation Therapy is used to develop the right hemisphere to take the pressure off the Broca's area. Melodic Intonation Therapy is not only used to aid aphasia, it is also used to assist stammerers with their disfluencies (Marchina 2009). The therapy is designed to encourage intoning within the speaking voice to activate the right hemisphere’s speech motors, with difficulty ranging between simple two-three syllable phrases, to speaking phrases of five or more syllables across three levels of treatment (Marchina, 2009: 431). See example 4.0 below.
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Phrases are spoken using two pitches, the starting pitch should be positioned comfortably in the speaking range of the patient, the second pitch should be three semitones above the starting note (minor 3rd). The stressed syllables should be on the higher pitch while the patient uses their left hand to tap once per syllable as a visual cue. The patient tapping the left hand could engage the right hemispheres sensorimotor networks that control the mouth movements. Marchina further explains; 'it may also facilitate sound-motor mapping, which is a critical component of meaningful vocal communication' (Marchina 2009: 435). The tempo at which the patient taps their left hand is vital as the slower the rate of articulation, the stronger the connection between the syllables, words and phonation. This further reduces the reliance on the left hemisphere of the Broca's area (Marchina 2009). In the video below the music therapist Greg Woods uses this technique with a Broca’s aphasia patient called Ann.
VIDEO EXAMPLE 4.0
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icon above to play the video.
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This process can be developed further, for some music therapists use melodic contours with phrases consisting of up to eight pitches and using specific keys. Some music therapists use piano accompaniment as well as familiar melodies for this exercise (Marchina, 2009). One might observe the variety in this process of melodic intonation, however the use of the piano may complicate the process for the patient, even though it activates the right hemisphere regions. The aim of this process is to expose the intrinsic contour of speech, to achieve fluency and to create a means of speech output for the patient that will have psychological as well as neurological plasticity benefits for speech motors in stammerers. In the example 4.1 below it is evident that melodic intonation therapy and singing has a pronounced difference in the development of the right hemispheric fibres (arcuate fasciculus) that are connected to auditory and speech motor regions (Wan, 2010: 288) Example 4.1
Example 4.1 highlights the arcuate fasciculus fiber bundles of: a healthy non-musician (a); a healthy professional singer (b); a patient with Broca’s aphasia before treatment (c) and after (d) intensive melodic intonation therapy. This patient has no left arcuate fasciculus due to a left hemispheric stroke.
It is clear from the example above that singing and intensive melodic intonation therapy can develop the right hemisphere and further advance the fasciculus fibres. This same approach can be applied to not only Broca's aphasia patients but stammering patients also. Melodic intonation and singing further allows stammering patients to increase phonation in
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the voice; 'Singing, or the act of producing musical sounds with the voice, has the potential to treat speech abnormalities because it directly stimulates the musculature associated with respiration, phonation, articulation, and resonance' (Wan, 2010). 'Inner rehearsal' is a feature of melodic intonation therapy. This process allows patients to practice the therapy covertly and to 'think' singing to benefit their speech. Marchina (2009) comments on the benefits of thinking speech; 'Those who master this technique can eventually transfer the skill from practiced Melodic Intonation Therapy phrases to expressive speech initiated with little or no assistance' (Marchina 2009: 435). Therefore melodic intonation therapy and the psychological approach to the thought of singing when speaking is one of interest when approaching the treatment of stammering.
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The Speech Project The Speech Project (2012) is an album by Gerry Diver that takes a sequence of interviews with well known Irish musicians, and then composes an instrumental work around the rhythmic and melodic contour of their speech (Denselow, 2012). This is not a therapeutic approach but a compositional technique that can be modified to have potential therapeutic effects on a person who stammers. One of the interviewees in The Speech Project album was traditional Irish fiddle player Martin Hayes. Track 5 of the album 'Sincerely Felt' uses the melodic contour of Hayes’ natural voice and this is directly mirrored as a melody which is played on a cello by Francesca Ter-Berg. Gerry Diver transcribes the pitch and rhythm of words and composes around it. Music example 5.0 below is Track 5, 'Sincerely Felt', which begins off with the natural speech of Hayes, this is then shadowed by the cello. (n.b. It is recommended to listen to musical example 5.0).
MUSIC EXAMPLE 5.0 Speech Project (2012) Gerry Diver. Track 5. Sincerely Felt.
Clearly the compositional approach to Diver's Speech Project could be adapted to create therapeutic benefits for stammerers. Music therapist Adrian from the Three Way Special
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needs school suggested that The Speech Project takes a similar approach to Melodic Intonation Therapy, in that it uses interiorised singing. It seems that there are clear similarities in approach to be drawn between interiorised singing and the compositional approach taken by The Speech Project. In this way we can view the thought process that precedes speaking (0.5 secs) as described earlier, as very similar to the way in which the spoken word precedes the cellos shadowing as in the case of The Speech Project. Research suggests that if patients are able to utilise the melodic contour of the voice it has therapeutic benefits. However these benefits may be because physiologically, more air is being released to allow the vocal chords to evenly vibrate. This further supports the idea that  a person who stammers is more likely to become disfluent in speech when anxious, as the colour and contour in the voice is lost, which means respiratory output is at a lower speed. Research into the The Speech Project has informed my own approach which might involve exercises in which given text is initially delivered as pitches in song as melody, and then gradually morphed into speech.
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5 The Accent Method Accent method is a breathing technique taught by speech and language therapists as part of a treatment for a person with a voice disorder. The method was developed by Danish speech therapist and vocal researcher Svend Smith (1907-1985) a Danish professor who taught and researched at The Danish Institute for Speech and Hearing. The basis for Smith’s method was breathing exercises that were; ‘transferred from expiration at rest to expiration for phonation’ (Chapman 2012: 50). Various exercises are incorporated and further practiced with the natural prosody of the patients speech. The basic principles of the accent method are ‘that during the breathing cycle contraction of the diaphragm alternates with the contraction of the abdominal muscles’ (Chapman 2012: 50). These principles are applicable for speech as well as singing. The intercostal muscles and diaphragm are the dominant muscles for taking in a breath, ‘with the diaphragm by far the most important’. Kenoe elaborates; ‘Well-meaning people who know nothing about stuttering may tell you to “take a deep breath” before talking. But the opposite is better advice. Diaphragmatic breathing is the foundation of many stuttering therapy programs. Taking smaller breaths with your diaphragm can help you relax and talk fluently’ (Kenoe n.d: 57) However it is important to comment on the relevance of posture as it can tense and compress the abdominal wall. Chapman (2012) comments on the importance of posture; ‘When a singer has developed good postural alignment, it is easier to use the abdominal muscles for breath management’ (Chapman 2012: 25). See example 5.0 on the following page:
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Example 5.0
A
(A) Excellent (B) Lordotic (C) Militaristic (tense)
Chapman describes that the singer of the accent method should be conscious of the following : •
‘Voluntary control of breathing, so that the singer can use supported breath flow
at will. Once this is motor learned it becomes unconscious, and driven by the
music/ text.’
•
‘Efficient and flexible use of the respiratory physiology.’
•
‘Maintenance of good postural alignment.’
•
‘The natural functions and actions of both the inspiratory and expiratory mus
cles.’
•
‘Training of respiratory muscles in terms of strength, coordination, and
endurance.’
(Chapman 2012: 52)
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The use of controlled respiration can be combined with repetitive rhythmic exercises that focus on abdominodiaphragmatic breathing for the patient, the Accent Method fulfills these requirements. One of these is the SPLAT method, this onomatopoeic term means; Singers Please Loosen your Abdominal Tension. In practice this technique takes the air into the lowest and largest part of the lungs. This creates a release of tension in the thorax, and benefits a person with a stammer because their breathing is now more supported. An example of the SPLAT exercise can be seen below from Chapman’s Singing and Teaching Singing (2012): Example 5.1
A
B
Example 5.1 (A) and (B) The participant putting their hands on their waistband (A), and Lower Abdominal Pubic Synthesis (B), and feeling the activation of abdominal tension being released.
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6 The Del Ferro Method The Del Ferro Technique was established by dramatic tenor Leonard Del Ferro. Del Ferro performed professionally in the United States before he eventually became a singing teacher in Amsterdam. While teaching in Amsterdam he encountered a German tenor with a severe stammer who wanted technical assistance with his singing technique. Del Ferro applied techniques used in classical singing to solve this. Throughout this process his theory was that when people stammer there are uncontrollable, uncoordinated movements in the diaphragm. As a result, the air reaches the vocal chords unevenly and creates disfluency. See interactive example 6.0 below:
INTERACTIVE EXAMPLE 6.0
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icon above to play the video.
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In a three year study undertaken by Canadian respiratory specialist, Professor Peter T. Macklem of the McGill University in Montreal, Canada, confirmed Del Ferro’s hypothesis that there are uncontrollable movements in the diaphragm when a stammerer becomes disfluent. Macklem is ‘one of the most renowned specialists in lung physiology and the diaphragm’ (Del Ferro, Online) E mail correspondence with the late Del Ferros’ daughter describes a ten day Del Ferro course: ‘The students will learn to control their diaphragm, starting at the first day by using their hands on the ribs. On the third day they will learn how to control their diaphragm by visualizing it. All themes which includes ’difficult’ situations will be practiced; such as making telephone call, speaking clear and self-confident for a group in shops and so on. It is a very practical training with the aim to speak fluent in every speaking situation’ (Del Ferro-Wong, 2015). Below is a transcription of a Skype conversation that Ingrid Del Ferro-Wong; Leonard’s daughter, who is the director and tutor of the Del Ferro Method in Amsterdam. Below is an edited recording of Skype call with Ingrid Del Ferro-Wong: (20th April 2015. 9:21AM UK Time: Skype) SKYPE EXAMPLE
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One of the methods Ingrid Del Ferro-Wong mentioned is the participant putting their hands on the waistband area (apex of sternum and ribs). For the purpose of this paper I will name the exercise, the onset exercise. Ingrid discusses the importance of the timing of the breath at the beginning of the first word of the sentence (the onset). This exercise aids the onset of the speech and language of the participant by the use of physiological diaphragmatic exercise which supports their constants at the start of the onset. See video example 6.1 below. (Keppler, R. Hilfe bei Stottern - Del Ferro Methode] .
VIDEO EXAMPLE 6.1
.
Press the
icon above to play the video.
The Del Ferro Method uses a motor learning process in which these exercises are applied to stressful situations to psychologically prepare stammerers for social situations. These social exercises in which participants trial the exercises of the Del Ferro method are carried out in everyday situations that may be challenging. An example being, answering the phone or ordering a coee at the shop. This challenging stage is named the transfer stage, this ultimately leads to the autonomous stage of this technique.
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7 Motor Learning Process When approaching speech and language factors in stammering, the motor learning process describes that phonological issues with the onset of speech in a person that stammers should be approached with this conceptual intervention. There are three stages of motor learning process:
1.
A cognitive stage in which a demonstration is carried out by the instructor.
2.
An associative stage, Â the stammerer learns to practice and perform the motor
skill with plentiful repetition.
3.
The autonomous stage, the motor learning technique is mastered and the skill be
comes automatic. 

Kenoe (n.d) explains how speech and language pathologists follow the same process: 'A Speech-language pathologist can show you the fluency skills; relaxed, diaphragmatic breathing; vocal fold relaxation (gentle onsets); and relaxed articulation muscles (lips, jaw, and tongue) in ten minutes. Teaching you to execute these skills takes a few hours. You can then speak fluently in the speech clinic, when you mentally concentrate on each skill' (Kenoe, n.d : 55). Kenoe explains that the majority of stammering patients are successful at  the cognitive and associative stage but fail at the autonomous stage; speech clinics call this the transfer
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stage. The transfer stage is a highly stressful process that will physiologically hinder the process of fluency and phonation if stammerers habitually avoid such situations in real life.
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8 My Method: An Introduction Through my research I have combined current therapies and research to develop my own ten day speech and music therapy course. It is suitable for every motivated person, young or old. The aim is to provide a supportive and safe environment for stammerers of all ages to meet others, and create the freedom to vocalise their own speech problems. My method will follow the motor learning process to examine the multifactorial elements of stammering. There is still no cure for stammering but my course will teach participants to manage their disfluencies and be comfortable with their own voice. The three days centre around the cognitive stage and involves setting up a safe learning environment. It is important for participants to firstly understand the multifactorial aspects of stammering that contribute to disfluency in speech. Once this is understood time will need to taken to demonstrate the exercises, and for the participants to be able to learn them and fully execute them eectively. One of the psychological techniques identified as having therapeutic potential is singing. Singing allows the stammerer to not only enhance the plasticity in the brain, but allows the stammerer to fully phonate and give them a means of expressing themselves. Kristina James, a professional classical singer and stammerer since birth commented that 'singing has given me an outlet and a way to express myself'. (James, Facebook) Solutions to environmental factors would be regular group session and regular choir attendances. It is hoped that by creating a mutually supportive community this will have a positive psychological eect. The transfer stage will be approached by re-creating diďŹƒcult social situations such as the phone call, and applying physiological exercises. Speech and language will be addressed via the Accent Method where various onset word exercises that involve engaging the diaphragm and creating a consistent flow of air through the vocal folds will be used.
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In the following chapter I have chosen three exercises from my therapeutic program designed for a person who stammers. It approaches each individual multifactorial factor of stammering separately. This method is based around modified Accent Method exercises as well as Del Ferro approaches all which balance the subsystems of voice production.
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9 The Method The SPLAT exercise Equipment needed: 1x pinwheel. Notes: For this exercise participants will work in pairs. This will create an environment of support and encouragement. Diaphragmatic/ belly release or Singers Please Loosen Abdominal Tension, also referred to as “SPLAT” in regard to breath (Chapman, 2012) is an approach that would be appropriate for both adults and children as the belly is easily visualised and the fun terminology effective.The exercise releases the abdominal wall allowing there to be no abdominal tension in the expiratory muscles during the in-breath. This would be an appropriate starting point as the participants would not have to vocalise straight away, but focus on the importance of the in-breath. The exhalation of breath will be made visible by one of the pair holding a pinwheel five inches away from the lips of the other person. Their mouth is formed into the shape of an ‘Oo’, as if they have a straw in their mouth. The participant will then be asked to release any air left in their lungs; this is to expel any unused air allowing the SPLAT movement to be natural. Chapman agrees on the importance of the out-breath; ‘Initially, I encourage the student to breathe out maximally without loss of posture alignment. Following this, the in-breath will be a reflex action rather than something conscious and complicated’ (Chapman, 2012: 44). The participant will then use the SPLAT in-breath (visualising the abdominal wall splatting on the floor), this is followed by a consistent and even release of breath (belly button to spine) to make the pinwheel spin for as long as possible until the participant runs out of air and this is repeated five times. While doing this I would combine both the Del Ferro Method, this being one hand placed on the waistband (hand on hip with thumb to the back), and the other using the Accent Method, this being,
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one hand on the Lower Abdominal Pubic Synthesis (pubic bone). See video example 9.0 below.
VIDEO EXAMPLE 9.0
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icon above to play the video.
As much as it is important to keep the pinwheel spinning evenly it is not the main focus of the exercise, this being the visualisation of the abdominal wall splatting on the floor and tension being released. Abdominal tension contributes to stammering as it restricts the diaphragm. The pinwheel not only sets up a fun environment but also facilitates a communal experience in which everyone is participating in unison. This exercise will be preceded by the therapist demonstrating the technique during the cognitive stage. This SPLAT therapeutic exercise aids both the psychological and the physiological factors of stammering. The Gentle Onset Exercise Equipment needed: None The above respiratory treatment exercise is followed by an exercise which focuses on the next subsystem of voice production; the onset of phonation. ‘Phonation is like putting a golf ball, not like hitting a home run’ (Kenoe, n.d: 59). An easy onset will focus on the speech and language factor of stammering and target the beginning of the words. Apply32
ing the same technique of the SPLAT method, (using one hand on the pubic bone and the other on the waistband), the participant will apply the following onset vowels with the absence of the pinwheel. For the purposes of these exercises vowels can be categorised as either: front, back, central and diphthongs (Kenoe n.d: 60). Front Vowels:
•
long e, as in beet
•
short i, as in bit
•
long a, as in bait
•
short e, as in bet
•
short a, as in at
Front vowels would be an appropriate open vowel to start with as it will release the tongue forward so it is positioned on the bottom front teeth. This will release any tongue root tension and allow air to pass evenly through the vocal folds. Back Vowels:
•
long u, as in boot
•
short o, as in book
•
long o, as in boat
•
aw, as in course
•
ah, as in cot
Back vowels are beneficial to the participant who stammers as they naturally shape the lips into a gentle onset position.
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Central Vowels:
•
ow, as in about
•
short u, as in but
Central vowels are a comfortable mixture of both front and back vowels. Diphthongs:
•
long i, as in bite
•
oy, as in boy
•
au, as in bough
A diphthong is a combination of two vowels that morph from one into the other. See an example 9.2 of the process below:
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Voice and Voiceless Consonants Research suggests that, the voice and voiceless consonants will prove to be challenging for participants. The participant will have their own particular consonants that they struggle with. The exercise follows on from the gentle onset exercise as it builds positive psychology in preparation for the more challenging part. Below is a list of voice and voiceless vowels that Kenoe suggests: Voiceless
Voiced
/h/
hail
/w/ whale
/f/
famous
/v/ vacant
/s/
saber
/z/ zany
/sh/
shower
/zh/ jete
/ch/
chive
/j/ jive
/thr/
throw
/th/ those
/p/
pipeline
/b/ bison
/t/
tie-dye
/d/ dinner
/k/
kind
/g/ guide
Kenoe grouped the vowels that have similar positions on the lips, tongue and jaw. What differentiates the two types of consonants is that the vocal folds do not vibrate in the case of voiceless consonants. The participant will practice the words while singing the voiceless consonant on a minor third with a piano accompaniment. This process is repeated using voiced consonants.
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As with all the exercises this will be carried out with one hand on the pubic bone and the other on the waistband (SPLAT method) to encourage good posture and rib flexibility. It uses elements of melodic intonation therapy and creates a relaxed, fun environment due to the use of the piano. The participant will then silent practice these methods using the vowels and consonants that they particularly struggle with. This exercise is developed by using the same technique but with gentle onsets on multisyllabic words.The participant should then notice and comment on what onset sounds relax their throat and then practice these ones daily until speech becomes progressively more fluent and vocal subsystems become balanced autonomously. A solution to physiological tension would be regular workshops with an Alexander Technique and Feldenkrais specialist, as they ‘offer good guidelines for singing’ (Chapman n.d.). The technique would also apply to a stammerer as it will strengthen the abdominal muscles and align the body to allow the diaphragm to descend naturally. The choir will act as a vehicle for practicing Melodic Intonation Therapy, to psychologically build confidence through music and singing by creating a united community. As well as this environmental benefit, the choir session would also develop the right hemisphere of the brain by using melodic intonation therapy methods in warm-ups. However the choir will primarily give participants a means to express their voice. The approach to the autonomous stage of my exercises is based on the Del Ferro Method, by which the participants will put themselves in stressful social situations and apply the techniques practiced. This will be carried out in the last two days of the course, and is known as the transfer stage. On completing the ten day course, there would be after-care support for participants. Furthermore, I would encourage attendance to an on-going choir in order that techniques can continue to be practiced. My method targets the four multifactorial factors of stammering and uses therapies and methods researched to create therapeutic benefits in fluent speech. As a result of this assignment I am having discussions with Ingrid Del Ferro-Wong about bringing the method to the UK.
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References Boeree, G. (2004) Speech and the Brain. [Online] Available from: http://webspace.ship.edu/cgboer/speechbrain.html [Accessed: 21.02.2015] British Stammer Association (2014) British Stammer Association: What is Stammering. [Online] Available from: http://www.stammering.org/help-information/topics/what-stammering/basic-information-s tammering. [Accessed: 20.02.2015] Chapman, J. (2012) Singing and Teaching Singing: A Holistic Approach to Classical Voice. Second Edition. Abingdon: Plural Publishing Inc. Curing Hopeless Voices (2011) Secret of Stuttering: Dr. Mort Cooper on Curing Stuttering Naturally with Direct Voice Rehab. [YouTube] Available from: https://www.youtube.com/watch?v=5gjPNBugBVg [Accessed: 20.02.2015] Del Ferro-Wong, I. (2015) Email conversation. New submission from Contact. 17 April 2015. Del Ferro. (2012) Del Ferro: Information Video. [Online] Available from: http://www.delferro.co.uk/english/information-video.php [Accessed 27.02.2015] Denselow, R (2012) Gerry Driver: The Speech Project - review. [Online] Available from: http://www.theguardian.com/music/2012/feb/02/gerry-diver-the-speech-project-review [Accessed 27.02.2015] Espir, M. and Rose, C. (1983) The Basic Neurology of Speech and Language. London: Blackwell Scientific Publications. Foundas, A. (2001) The Stammering Brain. [Online] Available from: http://news.sciencemag.org/2001/07/stammering-brain [Accessed 27.02..2015] James, K. (2015) Facebook Contact through the British Association. 21 February 2015.
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Kehoe, T. (2004) Casa Futura Technologies: Technology for treating stuttering and Parkinson's speech. [Online] Available from: http://www.casafuturatech.com/neurology-of-stuttering/ [Accessed: 22: 02.2015] Keppler, R. (2013) Hilfe bei Stottern - Del Ferro Methode. [Youtube] Available from: https://www.youtube.com/watch?v=RqB3BPlag6g [21.04.2015]. Khan Academy Medicine (2013) Language and the brain: Aphasia and split-brain patients. [YouTube] Available from: https://www.youtube.com/watch?v=lBqShvm4QRA [Accessed: 22.02.2015) Malki, K. (Unknown) Voice and Swallowing Disorders. [Online] Available from: http://www.phoniatrics-uep.org/downloads/voicecourse_accent-method.pdf [Accessed 28.02.2015] Marchina, S, Norton, A, Schlaug, G and Zipse, L. (2009) ‘The neurosciences and music III: Disorder and Plasticity’. Shared Insights on How It Is Done and Why It Might Help (1): 431436. Prasse, J and Kikano, G. (2008) Stuttering: An Overview. [Online] Available from: http://www.aafp.org/afp/2008/0501/p1271.html [Accessed 24.02.2015] Sirona Care & Health (2011) General information on stammering from the British Stammering Association: Speech and Language Therapy Service. [Online] Available from: www.sirona-cic.org.uk [Accessed 27.03.2015] The British Stammer Association (2009) Young Children who Stammer: The Case for Early Intervention. [Online] Available from: http://www.stammering.org/sites/default/files/eccf_appendix1_case_for_early_intervention .pdf [Accessed 29.03.2015] Wan, C. Rüber, T. Hohmann, A. and Schlaug, G. (2010) 'The Therapeutic Effects of Singing in Neurological Disorders.' Music Perception: An Interdisciplinary Journal, 27 (4): 287-295.
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