RU2450835C1 - Method of treating stammering - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly methods of treating stammering. A speech system is self-controlled by means of connecting it with an external synchroniser. The first stage involves a session of imperative suggestion and emotional stress therapy followed by prescribing a pause 5-day silence treatment. Then sessions aiming at forming a correct speech exhalation, voice presentation and voice leading are conducted. Also, the first stage includes autogenic trainings. At the second stage there are conducted exercises which aim at teaching the patients to synchronise speech with tactile irritation of palms and fingers. Besides, the given stage includes sessions of relaxation massage, self-massage, and also sessions of group therapy for reformation of patients' relation to the speech defect and for intensified motivation to treatment. At the third stage, the speech synchronisation habit formed in the patients with tactile irritation of palms and fingers is used in artificially created difficult situations, in a 'public speech' mode, gradually replacing movements of two hands by movement of one leading hand, and then by speech not assisted by movement of a leading hand.

EFFECT: method provides higher clinical effectiveness for a short period of time, and also formation of the new voice-motor habit in the patients ensured by training of continuous self-control of speech by means of connecting it with movements of both hands.

7 cl

Description

A known therapeutic method for treating stuttering is described in the invention patent CN 101164509 (A), A61F 5/58, published April 23, 2008. This method is characterized in that it uses the correct functional pronunciation exercises. The disadvantages of this method include the fact that it is not sufficiently effective, because it does not carry out exercises involving self-regulation of the speech system through its connection with an external synchronizer.

A known method of exemption from stuttering described in the patent for invention RU 2199352 C1, A61M 21/00, A61H 1/00, A61H 7/00, published on 02.27.2003. The disadvantages of this method can also include the fact that it is not effective enough, because it does not carry out exercises involving self-regulation of the speech system through its connection with an external synchronizer.

As the closest analogue (prototype), the stuttering treatment method described in the patent for invention RU 2210395 C2, A61M 21/00, published on 08/20/2003, was selected. In this method, the patient is taught continuous self-regulation of speech through its connection with the sequential irritation of the fingers of the leading arm. First, they teach speech synchronization with tactile irritation of the fingers of the leading hand, and at the beginning of the syntagma, the duration and strength of the irritation is increased. At the same time, one is taught to associate a state of inner calm with finger irritation, then this condition is associated with an ideomotor act, deliberately caused by the representation of real movement. Then, tactile irritations are replaced by irritations from an ideomotor act. Subsequently, the generated and automated skill is used in normal communication, and they return to tactile irritation of the fingers of the leading hand with severe stress and long-term illnesses. However, in this method, the patient is taught continuous self-regulation of speech through its connection with consecutive irritation of the fingers of only one hand (leading), which reduces the effectiveness of speech binding to an external synchronizer.

We have proposed a method for treating stuttering, based on two movements in the palms of the hands, dictating the rhythmic-intonational pattern of the phrase. Being universal, this method allows you to simultaneously solve several important problems: elimination of speech spasms, fear of speech, correction of the prosodic side of speech and stuttering personality. When using this method, the principle of hemisphere is taken into account.

This method consists in the fact that on the selection of the first and stressed syllables in a word (the first syllable and logical stress in the syntagma) with two movements of the palms of the hands, namely, the palm surface of the elevation of the brush glides on the first syllable in the word (syntagma), and on the stressed syllable in a word (or logical stress in syntagma) the pads of four fingers (index, middle, ring and little fingers) are pressed on any surface with pads - pressure.

Hand movements are used not only as an external synchronizer, but also as a psychological anchor of calm and relaxation during speech.

The technical result achieved when using the claimed method of treatment for stuttering is to increase the effectiveness of treatment in a shorter time due to the fact that patients are taught continuous self-regulation of speech through its connection with the movements of both hands.

The claimed method is complex and includes 3 main stages.

The specified technical result is achieved by the fact that in the method of treating stuttering, which includes self-regulation of the speech system through its connection with an external synchronizer, the first stage is a session of imperative suggestion and emotional stress therapy, after which patients are prescribed a silent regimen for 5 days outside of classes, then classes on the formation of proper speech exhalation, voice supply and voice guidance, in addition, at the first stage, autogenic training is carried out, at the second stage, exercises are carried out on which patients NTs teach speech synchronization with tactile irritation of the palms and fingers, in addition, at this stage, relaxing massage, self-massage, and group therapy sessions are conducted to re-form patients' attitudes to speech impairments, to strengthen motivation for treatment, which was formed in patients at the third stage the skill of synchronizing speech with tactile irritation of the palms and fingers is used in artificially created difficult situations, for example, in the “public speaking” mode, gradually replacing the movements of two uk to the movement of one leading hand, and then to speech, without accompanying it with the movement of the leading hand.

In the classes on the formation of correct speech exhalation, voice delivery and voice guidance, patients, each on an individual threshold of free speech, practice pronunciation of available short words and phrases, no longer than one syntagma, with the subsequent development of this skill in an emotionally significant environment.

Exercises to synchronize speech with tactile irritation of the palms and fingers of the hands consist in the fact that the patient places his hand on his hips, on any flat surface, the palm has a shape similar to the shape of a computer mouse, pronouncing the first syllable in a word or syntagm is accompanied by a slip of the palm of the hand, and stressed syllable in a word or logical stress in syntagma are distinguished by the pressure of the pads of four fingers on the surface.

Exercises to synchronize speech with tactile irritation of the palms and fingers are performed in a relaxed state, with soft hand movements when opening the mouth on vowels.

The duration of the first stage is 4 days, the second - 10 days, the third stage consists of 16 lessons of 1 day per week.

The duration of one lesson, exercises is 5-6 hours.

In the classroom, exercises in the group, family members of patients work.

The course is designed for 30 group sessions.

Of these, 14 days is an immersion course with a break from work and study, and 16 days is a blitz course of a meeting once a week on weekends without interruption from study and work for about 4 months. The duration of one lesson, exercises 5-6 hours. At all stages, the family members of the client work in the group.

The entire course is designed for 4, 5 months.

Stage 1. Reforming a speech skill - 4 days.

The course begins with a session of imperative suggestion and emotional stress therapy, and a silence regimen outside the session for 5 days. At a slower rate of speech, with a full pronunciation style, speech cramps are removed. In the classroom, there is an active restructuring of speech and psychological state. First, customers learn, each at their own threshold of free speech (in conjugate, reflected, and choral forms of speech), pronounce accessible short words and phrases no longer than one syntagma. Practice this skill in the "functional training" mode in an emotionally significant environment. Active work is underway to formulate correct speech exhalation, voice delivery and voice guidance.

2 stage. Training - 10 days

Mastering the skill of speech in the technique of "wave". Clients learn to “start” speech using the movement of their hands. Exercises are performed on relaxation, with a gentle movement when opening the mouth on vowels. The pace of speech is slow, calm. Stuttering learn to determine the logical stress in syntagma and change it - to intonate. At this stage, a specialist in free movement and a masseur are connected to work. The techniques of relaxing massage and self-massage are actively used. The therapist continues to work. Group psychotherapy is carried out to reform the attitude to the defect, to strengthen the motivation for treatment.

Stage 3 - fixing - 4 months

Blitz courses with a group once a week on weekends without interruption from work and study. There are 16 such meetings 1 day a week.

At this stage, there is consolidation of the speech skill in the “wave” technique in difficult situations, in the “public speaking” mode. The techniques of body and dance therapy, free movement are actively used. There is a gradual "departure" from the movement of the hands of two hands to the movement of the hands of one hand (leading) and speech, without being accompanied by movements of the hand. The pace of speech is normalized to normal within 4 months.

As a result of treatment - speech without stuttering, calm, intonated, without accompaniment of movements by hands. In all situations.

More about the general principles of stuttering treatment according to our methodology:

1. First of all, the need for an integrated approach to the treatment of stuttering. By complexity we mean not just a combination of therapeutic, speech therapy and psychotherapeutic techniques, but the simultaneous impact on the entire spectrum of disorders, which together form an integral structure, striving for self-maintenance and self-healing. That is why a whole team of specialists should work: a speech therapist, a psychotherapist, a psychologist, a massage therapist, a rhetorician, an expert in free movement.

2. Based on the experience of Dubrovsky K.M. (session of emotional stress therapy), we believe that at the beginning of treatment, a stage of imperative suggestion, motivation for treatment is necessary. In our opinion, the mere conduct of such a session cannot guarantee a sustainable cure for stuttering. This fact is universally recognized. The problem, as you know, is how to consolidate and develop favorable personal changes and, against their background, develop a stuttering speech skill that is really resistant to stressful effects. For this, we use the "anchor" movements of the palms of two hands.

3. Together with imperative suggestion, work should be conducted on the formation of a new speech stereotype, a powerful separation from stuttering is necessary. Separation from stuttering occurs on the use of an extremely slow pace of speech in an emotionally significant environment.

4. One of the most important components of our developed methodology, which makes up its distinctive feature and the main core. We are talking about bringing to the act of speech the "second articulatory apparatus of man" palms of the hands. In this case, the movement is in two parts - the wave is used as an external rhythm sensor.

The stuttering hands should reproduce the rhythmic-intonational pattern of the pronounced phrase. To do this, the patient places his hands on his hips, and later on any flat surface. The palm is shaped like a computer mouse. Pronouncing the first syllable in a word or syntagm is accompanied by a slip of the palm of the hand, and the stressed syllable in the word or logical stress in the syntagm is distinguished by the pressure of the four pads on the surface.

According to M.M.Koltsova, who studies the motor activity and brain development of the child, the movement of the hands and fingers is so phylogenetically and ontogenetically associated with the movements of the vocal apparatus that there is every reason to consider them as a speech organ similar to an articulator apparatus. From here it is clear how important and natural the correlation of speech is with the movements of the palms of the hands.

Hand movements in the treatment of stuttering were also used by other authors. For example, N.I. Zhinkin recommended using gestures for liberation and distraction from the act of speech. Hand movements for the same purposes were proposed by A.I. Bogomolova, the development of a speech-manual reflex by A.G. Shembel and S.S. Lyapidevsky, Andronova L.Z. (synchronization of speech with the movements of the fingers of the leading hand).

The originality of our method lies in the fact that we use not one “leading hand”, but both palms in the light of the theory of hemisphere (Semenovich, Wiesel and others).

In our proposed method, the palms of the hands act as a “tug”. With their successively organized movements, they coordinate in time the work of all speech links and systems, establishing the mechanism of internal synchronization of the natural speech cycle that is disturbed in stuttering.

The movements of the palms, among other things, dictate the rhythmic-intonational pattern of the phrase to the speech apparatus. They help to cope with such speech-damaging consequences of stuttering as arrhythmia, the lack of proper merging of words in the syntagma, distortion of intonation.

Another important feature of the method is that a new speech stereotype is formed not only with the help of analyzers of the natural speech cycle, which can be broken in stutters, but also through a number of other preserved analyzers associated with the movements of the palms of the hands (motor kinesthesia, tactile sensitivity). This contributes, thanks to reverse afferentation, to a much faster formation of a speech motor skill that is resistant to stressful effects.

5. Completely restore the stuttering impaired communicative function of speech can only be in the process of normal natural communication. It follows that the most important stage in the treatment of stuttering is the stage when the patient leaves the speech therapy room for real life after completing an intensive two-week course of therapy. Our role is reduced to ensuring that this process is controlled at short blitz courses and directed.

The proposed method for correcting stuttering is universal and can be successfully used in the treatment of both neurotic and neurosis-like stuttering. In the first case, the advantage of the method lies in the fact that patients are significantly reduced fixity on the speech act, since the responsibility for the speech technique (pace, word fusion in the syntagma, intonation drawing of the phrase) is assumed by trained hands, and stutters can, finally, like all normally speaking people, first of all think about the meaning of the statement. They gradually leave obsessive thoughts, fear of speech, tricks. In other words, the proposed method in itself gives a pronounced psychotherapeutic effect.

In case of neurosis-like stuttering, this method of treatment allows filling in the physiological deficit, including a number of intact analyzers in alternative feedback chains. In speech therapy practice, mixed cases most often occur, combining both neurotic and residual-organic disorders, it is therefore easy to imagine how important the universality of the treatment technique is.

The technique also allows you to solve the problem of the automation of the skill of natural impulsive speech. The hands trained during the immersion course become a memory of a new stereotype, and with time, an “automatic controller” of the patient’s speech. A long process of automation of a new speech-motor skill proceeds under conditions of natural communication and is only supported through a system of blitz courses.

1. At the first stage, which lasts four days, the main task is to form a stuttering skill in free sound production, connect it with the state of muscle relaxation, calmness and, while developing fine motor skills, prepare your hands for the role of a natural speech synchronizer. The silence mode is set; if necessary, patients communicate in written and extremely slow speech, which guarantees them from the appearance of seizures. Actively used autogenic training (AT).

As you know, ATs are also used in other methods of stuttering correction, they offer to pronounce some coherent text, because the words in the spoken text have a great emotional significance for stutters, the state of calm acquired by them is very quickly lost, not being fixed by the mechanism of long-term memory. The difference of our technique is that the new mental sense of self that arose after AT is initially associated only with the correct relaxed voice extraction. First, on one vowel, then on a direct open syllable, and only then on a word. Our patient learns to “draw” relaxation not only in a pause, but also during speech.

Against the background of relaxation and calm associated with the word “wave”, each speech segment is pronounced (Sound, word, syntagma). Then again a signal for relaxation and calm. The head, arms, shoulders should really relax.

2. At the second stage, lasting two or three days, we focus on training the palms of the hands, the technique of correctly extracting sounds, work on elementary intonation skills, and continue to improve the relaxation technique. Actively used relaxing speech therapy massage and self-massage elements.

At this stage, we train patients to synchronize speech with the movements of the palms of the hands when pronouncing words and syntagmas.

Patients are extremely sensitive to the changes taking place with them. According to our observations, stutters become active participants in treatment, begin to really believe in the possibility of positive results only when they begin to feel calm and satisfied from the process of working on a speech, in particular on a syntagma. This becomes real in the first week of class. At the same time, we are intensely preparing our hands to help speech: we draw the attention of stutters to the hand during AT, cause a feeling of heaviness and warmth in the hands, a pulse in different fingers, etc. At the next stage, we continue to deepen and develop this connection, while at the same time complicating the algorithm of natural non-convulsive speech.

The “immersion” stage is associated with the automation of a stuttering new speech motor skill, a speech algorithm synchronized with the movements of the palms of the hands. Here, speech material of varying degrees of complexity is used, the primary consolidation of the skill takes place. Work continues on intonation. The resistance of speech to stress is tested through a system of functional training. Functional training allows you to get rid of the fear of speech. Obsessive thoughts and tricks go with him. There is confidence, relaxedness, the realization that ultimately everyone can only help himself. Such a conclusion was previously unavailable to the stutter, who, like the neurotic, was constantly dependent and was waiting for help from others.

When it is possible to achieve a new inner sensation - relaxation and tranquility, this state should be fixed and connected with a certain neutral signal-symbol (“anchor”). In the future, using this signal, you can, if necessary, cause a complex of these sensations. Such a signal in our methodology is the word “wave”.

The goal of the speech therapy session, which we call “immersion,” is: to develop a new speech motor skill in patients by synchronizing speech with the movements of the palms of the hands; associate speech with a sense of calm, correct intonation, facial expressions, gesture, confident posture, etc. and strengthen the new speech stereotype in functional training of varying complexity, thereby making a decisive break from stuttering.

After the end of the “immersion” course, as a result of 16 blitz courses, the accomplishment is consolidated, the results of adapting the new stereotype to real life conditions, the successes and failures of each member of the group are discussed. Finding out the causes of failures, analyzing common mistakes, we strive to develop a common strategy for the behavior of the group. Significant place is given to activating conversations, creating the group’s correct installation for further work. In the future, the condition of patients is more and more stabilized, the amount of independent work increases, since each patient already needs an individual exercise program. Some are more engaged in voice, others in the technique of synchronizing speech with the palms of the hands, still others in the skills of relaxation, fourth need a consultation with a psychologist or psychotherapist, some are shown classes in the psychotherapeutic group. Much attention is paid to blitz courses on the correction of the intonational side of speech at the level of syntagms and texts. At the same time, we try to obtain natural, intonationally colored speech from patients. Work on intonation involves both work on the correction of communication. A rhetorician joins the work. Over the course of 4, 5 months, which includes the “immersion” course and blitz-treatment courses, new speech skills are repeatedly tested in a wide variety of situations. Gradually, speech normalizes, the natural rate of speech, the correct intonation, are established.

When verifying verbal health with objective data, patients are removed from the clinical records 6 months after the start of speech therapy classes.

The basic principle of treatment is that we do not correct individual manifestations of the defect, but rather set as our goal the formation of a new speech motor skill in patients.

Our method has been successfully applied to more than 50 patients aged 10 to 45 years on the basis of CJSC Sanatorium Svetlana Moscow and in the speech center Logoped Plus Moscow. We worked with patients with neurotic and neurosis-like stuttering, varying degrees of severity and varying degrees of fixation on the defect.

Claims (7)

1. A method for treating stuttering, including self-regulation of the speech system through its connection with an external synchronizer, characterized in that the first stage is a session of imperative suggestion and emotional stress therapy, after which patients are prescribed a silent regimen out of class for 5 days, then conduct classes the formation of proper speech exhalation, voice delivery and voice guidance, in addition, at the first stage, autogenic training is carried out, at the second stage, exercises are performed at which patients are taught speech synchronization with tactile irritation of the palms and fingers, in addition, at this stage, relaxing massage and self-massage sessions are carried out, as well as group therapy sessions to re-form patients' attitudes towards a speech defect, to strengthen motivation for treatment, and at the third stage, the patient’s ability to synchronize speech with tactile irritation of the palms and fingers is used in artificially created difficult situations in the "public speaking" mode, gradually replacing the movements of two hands with the movement of one leading hand, and then, to speech, without accompanying her with a movement of her leading hand. 2. The method of treating stuttering according to claim 1, characterized in that in the classes for the formation of correct speech exhalation, voice delivery and voice guidance, patients, each at an individual threshold of free speech, practice pronunciation of available short words and phrases no longer than one syntagma, with subsequent working out this skill in an emotionally significant environment. 3. The method of treating stuttering according to claim 1, characterized in that the exercises for synchronizing speech with tactile irritation of the palms and fingers are that the patient places his hand on his hip, on any flat surface, the palm has a shape similar to that of a computer mouse , the pronunciation of the first syllable in a word or syntagm is accompanied by a slip of the palm of the hand, and the stressed syllable in a word or logical stress in the syntagm is highlighted by the pressure of the four pads on the surface. 4. A method for treating stuttering according to claims 1 and 3, characterized in that the exercises for synchronizing speech with tactile irritation of the palms and fingers are performed in a relaxed state, with soft hand movements when opening the mouth with vowels. 5. The method of treating stuttering according to claim 1, characterized in that the duration of the first stage is 4 days, the second is 10 days, the third stage consists of 16 lessons of 1 day per week. 6. The method of treating stuttering according to claim 1, characterized in that the duration of one session, exercise is 5-6 hours 7. A method for treating stuttering according to claims 1 and 6, characterized in that the family members of the patient work in the classroom and exercises in the group.