LARYNGEAL DYNAMICS IN STUTTERING

LARYNGEAL ONSET AND REACTION TIME OF STUTTERERS: Historically, larynx has been considered to play a central role, if not exclusive role in stuttering (Yates, 1800/1839), Hunt, 1861; Kenyon, 1943). With recent advances in technology, new and more sophisticated measuring devices have been developed, the purpose being, to investigate into the laryngeal behaviors of stutterers and and the role of larynx in stuttering. This area of research has, taken 3 distinct directions: 1. Studies of stutterers voice onset time (VOT), voice initiation time (VIT) and speech initiation time (SIT). 2. Electromyographic investigation of stutterers laryngeal muscle activity. 3. Fiberoptic studies.

1. Voice onset time (VOT): VOT has been defined as the time that elapses from the release of the consonant burst to the onset of periodic glottal vibration for the production of the vowel that follows the production of the vowel that follows the consonant (Lisker and Abramson, 1964). METHODOLOGIES AND INSTRUMENTATION: VOT can thus be measured with any instrument that: 1. Reliably senses and records the end of consonantal implosion and the initiation of glottal vibration for phonation. 2. And provides means of determining the time lapsed between these 2 events.

Three main methods have emerged, over the years, which are well suited for such measurements: 1. Spectrography. 2. Detecting the sizeable rise in intraoral air pressure that occurs during the implosion phase of stop consonant production.

3. X-ray motion picture and voice recorder. The former, we can see the start of the consonantal release on the X-ray film and the latter tells us when phonation starts. The difference between these 2 events, expressed in temporal units, is VOT. Findings: The measurements and comparisons of the VOTs of stutterers and normal speaking control subjects mainly included investigation of fluent productions of simple, isolated CV syllables, during the generation of longer syllable sequences, and during the production of stop consonant plus vowel combinations in continuous oral reading. The results of studies of stutterers and normal VOTs are given in the following table: Authors Angello and Wingate (1972) Method Pressure-sensor and voice-recorder; CV utterances. Wendell (1973) Spectrographic analysis of CVs. Subjects Matched groups of 12 adult stutterers and 12 normals. Matched groups of 12 child stutterers and 12 normals. Metz, Conture, and Caruso (1979). Spectrographic analysis of 18 different sound clusters in words. Zimmerman (1980) X-ray motion picture and voice recorder; 3 CVC words. Watson and Alfonso (1982) Spectrographic analysis of 3 contiguous VCVC sequences. 8 adult stutterers, sex age-and-sex matched with 8 normals. No significant between group difference in VOT (p<0.05). 6-adults stutterers and 7 normals. 5-young adult stutterers and 5normals. Stutterers VOT were longer on only 6 of the 18 clusters (p<0.05). stutterers VOT were longer. Stutterers VOTs were longer. Results Stutterers VOT were longer.

VOICE AND SPEECH INITIAION TIMES (VIT and SIT) VIT is defined as the time lapse between the appearance of some experimenter-controlled external stimulus (e.g., a pure tone of flash of light), and the subjects initiation of glottal vibration for phonation. Thus, VIT represents the time lapse between the onset of nonspeech event and the starting of voicing. In similar fashion, some investigators have required subjects to utter a response of one word or longer, beginning with a voiced sound. These studies are viewed as measuring speech initiation time (SIT).
METHODOLOGIES AND INSTRUMENTATION:

Though there have been some minor variations across experiments, most VIT/SIT investigations have employed highly similar methods and designs. In a typical project, a subject is presented with a warning signal, waits for the appearance of a cueing stimulus, and then generates a desired response as soon as possible. The following table presents the summary of both the VIT and SIT studies: Authors Characteristics of subjects Adams and Hayden (1976) 10 adult stutterers and 10 age-and sex matched normals. Starkweather, Hirschman and Tannenbaum (1976). 11 adult stutterers and 11 age-and-sex matched normals. Green light presented on the screen. 26 test syllables reflecting a wide range in place and manner of articulation. Reardon (1977) 5 adult stutterers and 5 sex-matched Auditory stimulus. Phonated /a/ and 6 other test. Stutterers had longer VITs on every utterance. Stutterers longestVITs occurred on the External signal(s)used 1000Hz pure tone. Subjects response Phonated /a/. Both groups shortened VIT from the beginning to end of the experiment. Stutterers were slower on two of three comparisons made. Both groups shortened VIT from the beginning to end of the experiment. Stutterers were slower acroos all test trials and across all syllable types investigated. Findings

normals.

syllables.

six test syllables. Their shortest VITs appeared on the isolated vowel.

Cross, Shaden, and Luper (1979).

10 adult stutterers and 10 age-and-sex matched normals.

4000 Hz presented in each ear in separate condition.

Phonated / /. No difference in stutterers VIT when tested tone was presented to left as compared to the right ear. Overall, stutterers were slower than normals.

Cross and Luper (1979).

9 stutterers each, at ages 5 and 7 years+9 adults age-and sex matched with like numbers of normals.

1000 Hz pure tone.

Phonated / /. In both groups, VIT shortened as age inceased. At all age levels studied, stutterers were slower than normals.

Lewis, Ingham, and Gervens (1979)

10 adult stutterers and a like number of normals.

1000 Hz pure tone and a light flash; presented in separate condition.

Phonate an isolated vowel.

Stutterers were slower than normals in both the auditory and visual cueing.

Prosek, Montgomery, Walden (1979).

10 adult stutterers and 10 age-and-sex matched normals.

Light flash, a 1000 Hz pure, and spoken words; presented in separate conditions.

16 VC words (e.g, ape).

Stutterers were slower than normals in all cueing conditios.

Cross, and

8 adult

Visual

Phonate /a/

Stutterers were slower than

Cooke (1979)

stutterers and 8 normal speakers.

stimulus, and an auditory stimulus, presented in separate conditions.

normals across all experimental conditions. The greatest difference between groups appeared in the auditory-vocal response condition. A laryngeal gesture. The stutterers were slower than the control subjects in all experimental condition.

Adler and Starweather (1980)

A group of stutterers and a group of nonstutterers.

A visual stimulus.

Cullinan and Springer (1980).

11 child stutterers with articulation and language problems; 9 pure stutterers; and 20 age-and-sex matched normal children.

1000 Hz pure tone.

Phonate /a/.

The two groups of stutterers combined, had slower VITs than did normals. However, this difference was a function of the extreme slowness of the stutterers with the associated articulation and language problems. VIT did not differ between the pure stutterers and the normals.

Murphy and Baumgartner (1981)

6 child stutterers and 7 normal speaking children.

1000 Hz pure tone.

Phonated /a/.

No differences were found between the groups.

Reich, Till, and Goldsmith (1981)

13 adult stutterers and 13 age-and-sex matched normals.

1000 Hz pure tone.

Phonted /a/ and the word upper.

Stutterers were slower than normals on the isolated vowel production and on the words production.

Watson, and

8 adult

1000 Hz pure

Phonated

No differences were found

Alfonso (1982)

stutterers and 13 age-and-sex matched normals.

tone, and a light flash presented in separate conditions.

/a/, and a nonsense syllable phrase.

between groups in either condition, either the vowel or the nonsense syllable phrase response.

Hayden, Adams, and Jordahl (1982)

10 adult stutterers and 10 ex-matched normal adults.

1000 Hz pure tone.

Production of 9 sentences, all beginning with a vowel (e.g., Almonds are nuts)

Stutterers were slower than the normals.

INTERPRETATION:

In four of the six VOT studies, stutterers had longer (slower) scores than normal speaking control subjects. In the SIT/VIT investigations that were reviewed, significant slowness among the stutterers was noted unequivocally in 11 of 17 projects. Mixed findings were obtained in two studies. Non significant differences were observed between stutterers and control subjects in just 4 of the 17 experiments. From these outcomes we may conclude that stutterers as a group are likely to have slower VOTs and VIT/SITs than matched normal subjects.s Beyond the broad interpretation, these studies tell us even more. 1. Stutterers slowness in VOT cuts across productions of isolated CV syllables to prose material being read aloud (Hillman and Gilbert, 1977). 2. Stutterers slowness in producing isolated vowels (VIT) appears also to be present in the production of single words (Reich, Till and Goldsmith, 1981), and sentence length utterances that are initiated with vowels (SIT; Hayden, Adams, and Jordahl, 1982).

Shortly after the completion of the first several VOT and VIT experiments, there was considerable conjecture that the slowness was caused by an individuals history of stuttering. In other words, having spent years as a stutterer, a person would quite likely to approach speech or speech-acts with an excess of muscular tension in the larynx. Such muscular tension, a result of a history of stuttering, might then act to retard VOT and VIT. At two predictions can be drawn from this framework. 1. We could forecast that young stutterers, with relatively short histories of stuttering, would be less likely to approach to speech and speech-like acts with excess muscular tension. 2. it should also follow that young stutterers would have shorter VOT and VIT values as compared to adult stutterers because the children had briefer histories of stuttering, and hence had less time to develop higher levels of muscular tension in the larynx. The results of studies cited in the table, fail to bear out these predictions, both VOT and VIT scores for younger stutterers were slower than those of control subjects (Wendell, 1973, and Cross and Luper, 1979). It was also shown that stutterers VIT improved with age (Cross and Luper, 1979). Neither of these findings would be likely if stuttering were the cause of the slowness. Rather, such slowness probably coincided with the onset of the disorder. Indeed, it is even possible that difficulty in quickly initiating voicing is one of the immediate causes of stutterers repetitions and prolongations of articulatory gestures (Adams, 1974), viewed here and elsewhere as core characteristics of stuttering (Wingate, 1964). The next explanation that was developed pertained only to VIT. I this account, stutterers slowness is causally related to a specific defect in the auditory system that retards the reception or processing of stimuli used to cue vocal responses. Needless to say, this interpretation was abandoned when stutterers were found slower than normal VITs to visual signals as well (Starkweather, Hirschman, and Tannenbaum, 1976). Noting this slowness in both auditory and visual stimulation, thought was give to attributing it to some central disturbance that would reduce the speed with which stutterers organized and started transmitting neural signals to the periphery for voice

production. Inherent to this formulation is the idea that stutterers neural organization and transmission are both normal with the exception of the speech with which they take place. Recently, some experimenters have measured stutterers reaction times for nonspeech tasks, such as button pressing, by using lights and/or tones. Stutterers neural reaction times have also been assessed (McFarlane and Prins, 1978). There are only a few of these investigations and their findings are mixed. Therefore, it would be premature to interpret them at this point. Finally in review, Adams (1981) offered an elaboration on the position that stutterers may be slow to organize and transmit normal neural commands to their musculature. Specifically, it was suggested that in addition to integrating and sending commands more slowly, stutterers may also send inappropriate commands to the periphery. This would activate muscles in ways that could delay voicing. It is interesting to note that stutterers VIT and SITs improve when voicing and speech are initiated in synchrony with a rhythmic stimulus (Hayden, Adams, and Jordahl, 1982). This finding is procative because we have known for years that rhythmic speech improves fluency. Perhaps rhythm enhances fluency by helping a speaker with the timing of events that are integral to speech production (Brayton and Conture, 1978; Hayden, Jordahl and Adams, 1982). Such an event could be voice initiated. Suchitra (1985) conducted a study to find the acoustic parameters VOT, SIT, STT, Fo and rate of speech in stutterers in pre and post therapy condition and found: 1. Non stutterers values are smaller when compared to pre and post therapy VOT values of stutterers. 2. Speech initiation time less than that of Stutterer in pre and post therapy condition. 3. Stutterer post therapy VOT value smaller than pre-therapy value. 4. Reduced post therapy SIT value of Stutterer compared to pre-therapy. 5. Both show no difference in Fo does not vary as compared to pre-therapy.

Sebastian (1997) studied the acoustic parameter in stutterers and non-stutterers and came to the following conclusion. 1. The VOT values were less for non-stutterers compared to stutterers. 2. No significant difference between the stutterers and non-stutterers in terms of formant frequencies was found. 3. Significant differences were found between stutterers and non-stutterers in word duration and vowel duration.

Then she came to the conclusion that the laryngeal mechanisms during speech in different for stutterers to that of non-stutterers. LARYNGEAL MUSCLE ACTIVITY OF STUTTERERS Electromyographic (EMG) studies of stuttering are important because they provide information about a different level of the speech production process. The

electromyography amplifies and records the minute electrical voltages generated each time a motor unit fires in response to a neural impulse. As motor units fire more rapidly or as many motor units fire in close succession, electrical activity in a muscle or muscle group increases. EMG recordings reflect the level of contractile activity in muscle tissue and the variations in this activity over time. When EMG recordings are combined with other information, such as acoustic analyses of the speech produced, and knowledge of the anatomy and physiology of the muscles under study, some inferences may be made regarding movements and/or levels of muscle tension.

Electromyography in Stuttering Research Most of the early EMG studies conducted with stutterers were designed to investigate basic neurophysiological difference between stutterers and nonstutterers (Morley, 1937; Steer, 1937; Travis, 1934). More recent experiments have focused on the moment of stuttering and compared EMG patterns during fluent utterances with those generated during stuttering. A number of studies of stuttering have attempted to use electromyography as an index of psychological status, for example arousal, anxiety, vigilance, anticipation, or expectancy. One study, which did not directly measure intrinsic laryngeal muscle activity, does offer valuable insight into general throat area muscle activity related to stuttering. Shrum (1967) used silver disc surface electrodes to record from several sites including two bilateral masseter (jaw) muscle sites, two bilateral platysma (neck) muscle sites, and one leg muscle site. He measured the duration of muscle activity from moment A, when muscle activity was elevated over the resting state, to moment B when initiation of phonation was recorded. He found that the interval between moments A and B (duration

of prephonatory muscle activity) was significantly longer for stutterers than for nonstutterers. For stutterers, this interval was longest before words on which they stuttered, shorter before words on which they expected to stutter (but did not), and shortest before words spoken without anticipation or stuttering. Shrum interpreted these findings as indicating that stutterers began to tense earlier than nonstutterers. An

alternate interpretation is that initiation of phonation was delayed in stutterers. This second interpretation of Shrums findings is consistent with recent research demonstrating longer VOTs and slower initiation of phonation.

OBSERVING LARYNGEAL MOVEMENTS OF STUTTERERS Development of the flexible fiber optic endoscope (fiberscope) a flexible tube containing bundles of glass or plastic fibers has had a great impact on otolaryngology, speech science, and speech pathology. The fiberscope contains two bundles of optical glass or plastic strands / fibers with one bundle carrying a cold, bright light (e.g. xenon) to illuminate the area under investigation and the other bundle returning a color image back for visualization and / or recording (Boyd,1982).Because a fiberscope can be readily passed through a bodily orifice, routine activities of heretofore inaccessible parts of the body, such as the vocal folds, can be visualized. Its use in the study of laryngeal activity associated with stuttering is the basis of this discussion (Conture, 1977, 1982a, 1983; Conture, McCall & Brewer, 1977. 1979; Freeman, 1975. Fiberscope Investigations of Stuttering Ushijima et al. (1966) who filmed both inappropriate glottal openings as well as tightly adducted true/false vocal folds during different instances of stuttering. Fujita (1966), using posterior-anterior X-rays of the laryngeal area, also reported nonpredictable openings and closings of the pharyngolaryngeal cavity associated with stuttering. Shortly thereafter, Conture and associates in Syracuse and Freeman and associates at Haskins Laboratories publicly presented their fiberscopic and electromyographic observations of the larynx during stuttering. Conture and associates work focused on fiberscope observations, while that of Freeman and colleagues involved

electromyographic studies of stuttering.

Conture et als 1977 work indicated that the larynx is often (1) inappropriately, nonpredictably open or (2) inappropriately closed during instances of stuttering. These findings were consistent with those of Ushijima et al. (1966) and, coupled with Freeman and Ushijimas (1978) EMG findings, clearly implicated laryngeal involvement in the disrupted speech physiology that characterize stuttering. Conture (1982a), shows that laryngeal behavior was more variable during sound / syllable repetitions than sound prolongations. Moreover, sound/syllable repetitions also contained the greatest number of nonviewable/nonmeasurable videoframes. Still, these findings, which are consistent with previous reports, indicate that laryngeal behavior not only differs between stuttering and fluent productions but also between different types of stuttering as well. In a time-course description of laryngeal behavior from beginning to end of an adult stutterers sound / syllable repetition, it is apparent that during a sound/syllable repetition, laryngeal behavior is highly variable; the vocal fold open and closes throughout the repetition. The larynx is not static; it oscillates between abductory and adductory postures. Preliminary data also suggest that the height of the larynx during stuttering varies. In fact, videofluoroscopic observations of laryngeal height during

stuttering (Conture, Gould & Caruso, 1980) indicate that many repetitions are characterized by a descending or lowering of the larynx compared to its height during fluent productions of a vowel. For some sound prolongations, the ventricular folds are also compressed medially, above the adducted vocal folds, as the epiglottis is pulled posteriorly. Sound prolongations with some stutterers show constriction of the pharyngeal area at the level of the larynx. Stutterers, who point to their throat and say that the word got stuck here, may not only be sensing excessive laryngeal adduction but aerodynamic back pressure. Conversely, some sound prolongations, particularly those on /s/ and /f/, are associated with widely opened vocal folds. Of course, the vocal folds should be abducted during production of these sounds since they are voiceless; however, the degree of abduction is excessive and lasts far too long. Furthermore, a Stutterer who senses these extended laryngeal abductions may still describe them in much the same way as overly adducted laryngeal behavior; that is, the Stutterer may say the word got stuck.

Effect of binaural masking noise on stutteringa spectrographic analysis (NANDU 1982)

Masking does reduce the frequency and severity of stuttering and also alters the usual manner of initiating phonation. It makes the Stutterer to speak more slowly and loudly (Cherry and Sayers, 1953; Hanley and Steer, 1949; Adams and Hutchinson 1974). Auditory masking by noise brings about a reduction in secondary behavior, mostly while using automatic feedback masking. Expressionless speech and reduction in speech intelligibility observed. (Dewar et al 1976) Masking helps the stutterers to learn to monitor their speech primarily by proprioceptive, tactile and kinesthetic feed backs. It also distracts the subjects attention from his speech and reduces anxiety and also changes the manner of speech (Van Riper, 1973). The purpose of the study was to find out the effects of masking noise on rate of speech, fluency, fundamental frequency, voice onset time, vowel duration and vocal level in stutterers and normals. Subjects: Four stutters and four non stutters with age and sex matched All speech recordings were done using unidirectional microphone Subject read the passage in the presence and absence of masking noise. This reading was recorded using tape recorder. Results Both stutterers and non stutterers showed an increase in vocal intensity level under binaural masking noise, how ever, stutterers showed greater increase in vocal intensity than non stutterers. No significant difference in voice onset time (VOT) was observed in stutterers and non stutterers- both in the presence and absence of binaural masking noise. An increase in vowel duration was found in both stutterers and non stutterers under binaural masking. In a study, Geetha (1979) has attempted to find out the linguistic characteristics of stuttering, in Kannada language, of 15 stutterers by analyzing their spontaneous speech and reading samples. She has concluded that, The content words are stuttered ore often than the function words. The consonants in general were stuttered more often than vowels. However, stuttering was found on vowels also and in a minority of cases vowel stuttering was more than the consonant stuttering.

 There is no difference between the adult and child stutterers in terms of their repetition characteristics of various linguistic units as syllable, word, part word, phrases and sentences. With respect to syllable structure, maximum stuttering was observed on CV syllables and the next in the order was vowel syllable.

Analysis of speech of stutters (dissertation)

This study was taken up to find out the relationship between frequency of occurrence of stuttering and various linguistic factors and to note the relationship between voicing and stuttering in adult and children. Subjects: 71 adult stutterers age ranging from 12- 35 yrs and 11 children who were diagnosed as stutterers age ranging from 6- 12 yrs were made to read 2 passages (one passage consisted of both voiced and unvoiced sounds and another passage had only voiced sounds. The readings were recorded using tape recorder Most of the stutterers showed normal rate of speech. It is found that the initial syllable in the word is most frequently stuttered than the syllable in any other position. Stuttering was found most frequently on vowels than on consonants, both in the case of adults and children in the present study. The adult stutterers showed more stuttering while reading combined passage than the voiced passage. However, children did not show any such difference. Adams & Reis (1971, 1974) have found that there was greater frequency of stuttering in passage which had both voiced and unvoiced sounds than in the passage which had only voiced sounds. They also found that the adaptation rate was faster in the latter. They have concluded that the frequency of stuttering was related to the onset of phonation required. But Manning & Coufal (1976) found that the difficulty in both stutterers and non stutterers was during voiced to voiced transition than, during voiceless to voiced, voiced to voiceless and voiceless to voiceless phonatory transitions. Another investigation by manning and Coufal (1976) compared the speech of 11 adult stutterers and a matched group pf 11 non stutterers. Four types of phoneme to phoneme transitions were compared. The results indicated that both the groups had a lower percentage of disfluencies during voiced to voiced transition than during voiceless to voiced, voiced to voiceless and voiceless to voiceless phonatory transitions. Gayathri (1980) investigated some aspects of phonatory behavior in stutterers. The aim of her study was 1) to test if different degrees of voicing during repeated reading of a passage bring about difference in the amount of adaptation in stutterers. 2) to test if there is any relationship between the frequency of stuttering and the onset of phonation invaried contexts: syllables, word list and passages in stutterers. 3) to test if

there is any relationship between the frequency of stuttering and the occurrence of stressed syllables in stutterers. It was concluded from the three experiments that: 1) Varying degree of voicing during rehearsals bring about significant differences in the amount of adaptation. Greatest amount of adaptation occurs when there is involvement of voicing during the rehearsals as in aloud rehearsals and whispered rehearsals. 2) Stutterers have greater frequency of stuttering when transition from voiced to voiceless or voiceless to voiced consonants is required. This is indicated by greater frequency of stuttering in combined passage and combined word list when compared with the frequency of stuttering in voiced passage and voiced word list. The adaptation rate is also faster in a voiced passage. Therefore the stutterers have less lesser difficulty when transition from voiced to voiceless consonants are not required and vice versa. 3) Stutterer stutters more often on the non-stressed syllables preceding the stressed syllables. This may be because, the stutters have difficulty in moving on the following stressed syllables and keep repeating or prolonging the preceding syllable. Stuttering is rare during the transitions from the stressed syllables to the following non stressed syllables. Stuttering is also less frequent during the transition from non stressed syllables to non stressed syllables. Stuttering as a learnt extricatory response to a laryngeal abductor reflex (Schwartz): This is core of stuttering block model by Schwartz (1974, 1975a, 1975b). It was his discovery of that physical cause of the stuttering block that him enabled him to develop a relatively simple treatment. He stated that the core of the stuttering block is the tendency, under conditions of psychological stress, for the loss of supra medullar, inhibition controls upon the PCA in the presence of sub glottal air pressure associated with speech. Schwartz (1976) lists several kinds of stress which contributes to stuttering. Baseline stress consists of speakers amount of psychological and muscle tension. Physical stress (fatigue), external stress (bad news) and speed stress (need to talk in hurry) may add to Stutterer psychological stress. Finally other factors such as

situations of communicative stress, sound and word fears and verbal uncertainty, trigger anticipation of stuttering which adds to psychological stress. As the Stutterer acquires large repertoire of struggle and coping behaviors, anticipation of stuttering alone becomes

sufficient to evoke a laryngospasm or a set of distracting or avoidance behaviors to prevent its occurrence. Comments: 1. Schwartzs model of stuttering and his approach to therapy have been controversial. The question whether or not PCA is the strongest intrinsic muscle of the larynx as raised by Freeman, Ushijima and Hirose (1975). To support his statement, Schwartz conceded that it was at least one of the strongest laryngeal muscles. 2. Freeman et al (1975) raised an important question as to whether the PCA is reflexively active in controlling glottal width during exhalation. 3. Zimmerman and Allen (1975) wondered how the model could account for stuttering on voiceless sounds. for this Schwartz explained that an increase in subglottal air pressure associated with such sounds was responsible for conditioned laryngospasms. 4. This model does not account for the linguistic findings of stuttering and it was probably not meant to do so 5. It does not predict any general motor coordination deficits in stutterers. Most of the respiratory and articulatory errors are seen as learnt excitatory behaviors. M.F. Schwartz (1974) proposed that Agnello & Wingates (1972) finding that stutterers had longer than normal voice onset times in stop consonant vowel syllables was due to neural inhibition of the PCA. In summary, whereas any kind of laryngeal irregularities during stuttering could be explained by Schwartzs model, direct evidence of the reflexive contraction of the PCA prior to speech is lacking. Since his model hinges on that presumption, unqualified acceptance of the model must await further empirical verification.

REFERENCES: Analysis and Synthesis of Speech of stutterers. The Spectrographic analysis of Stutters Speech under delayed auditory feed back. Analysis of Speech of stutterers. Voice Onset Time for Stutterers and non Stutterers. Edward G.Conture, Stuttering Second Edition