Abstract

All over the world extra than 70 pile human beings whichever stutter, who is in relation to 1% on the population (Bloodstein & Bernstein-Ratner, 2008).  Recent research bear referred to troubling findings related to the cognitive, affective, and communal blessing over human beings who stutter people who stutters. The level of understanding among adult stutters in Pakistan concerning the problem of stuttering Awareness and speech therapy. For this study, cross sectional study design was used. Research has been conducted in Govt. and private sector tertiary care Hospitals in Lahore Pakistan. The study is completed within four months from December 2018 to February 2019. Between the ages of Dec 2018 to March 2019, adult stuttering clients were taken, over 15 years of age. Inclusion requirements included all the males and females above 15 years of age who were stuttering. This involves pupils, males and females with blockage, delay, prolongation or any other primary or secondary signs stuttering. Both congenital or chronic disease stutters were ruled out. All patients were briefly interviewed before they were considered as part of the study to ensure that they met the criteria for inclusion. A Performa was established and validated by 10 experts after literature review and expert opinion (having a minimum of 5 years of field experience). There is a significant correlation between Understanding regarding the Stuttering issues and understanding of Stuttering Self Therapy. Awareness on the issue of Stuttering on the understanding of speech therapy for Stutter individuals is shown to be substantially successful. These approaches of speech therapy differ by individual because of the differences between them. It was also found that the more stutter has knowledge of his question with expression the more he performs and utilizes psychological self-help strategies. The study was conducted only on adult stutters. It was a short-run analysis. Sample was taken from a single Pakistani city. Large-scale analysis should be performed for large sample size. The research should include more than in Pakistani city population. Research may also involve children who stutter in future research.

Introduction

Stuttering is a speech pattern, which affects the fluency of one's speech. It is also known as disfluencies. There are many approaches to the treatment of stuttering in both children and adults, however, Speech therapy is a rather recent and very effective technique. Good speech therapy increases the likelihood of successfully achieving a given task. Speech therapy definitely helps stutter to overcome his speech problem and helps improve contact with others. In Psychology, Warren defines stuttering as "A disturbance in the rhythm of speech, either an intermittent blocking or the convulsive repetition of a sound. [1] “Webster’s New International Dictionary differentiates stuttering and stammering with a slight difference. They define stuttering as" To speak in a hasty and stumbling way, with spasmodic repetition of syllables and consonants; to hesitate or stumble in uttering words; to utter with spasmodic repetitions or pauses. [2] "They define Stammering as " To make involuntary stops in uttering syllables or words; to hesitate, falter, or block one’s self in speaking. [3]" Commonly we use both terms, stammering and stuttering interchangeably, with a difference that stuttering is usually used to a severe form of fluency or communication disorder than stammering. It has been discussed widely that what actually causes stammering.

There are many theories and views that describe the causes of stammering. Among all of them, the major cause is a libidinal fixation at oral-erotic level of development. It has been assumed that prolongation at this stage leads to pleasure seeking in sucking and other oral gratification and get the child away from the real source of satisfaction through speaking. Stutters are basically positive and egotistic. Freudian Psychoanalytic treatment was failed to deal with this cause of speech disorder and basically it focuses first and foremost on the stage of oral libido.

Another cause that has been discussed is that stuttering is basically not caused by physical issues. It is not something physical but only psychological. This view believes that stutter basically suffers from the word amnesia and this causes them to suffer and speech results as an interrupted non fluent production. This forgetfulness breaks the thought process that is important in speech production. Those who believe in this school of thought focused to work on thought process training of the individual, to lessen the word forgetfulness during speech production rather than speech production correction. [4] This training of thought process includes training by signals, speaking in harmony, soundless speech, relaxation, unhurried speech and breathing training. All school of thoughts are agreed that there is no single or particular cause of stuttering but various most important, influential, underneath and predisposing causes are there. The main and most important cause of stammering is familial patterns of anxiety, annoyance, and over-guidance or domination by a proficient parent. [5] Well known predisposing reasons are physical limitation and undernourishment. Emotional upset is also a predisposing cause of problem. It has been seen that gender ratio are also different being about 1 female to 20 males. Those who belong to this school of thought believes on working with negative practice is more fruitful than other therapeutic techniques.

Usually stutters are being reported lately and there are variations in the nature of cause, therapy procedures and prognosis levels. When detailed information was taken from adult stutters from various parts of the region in America, it was concluded that no matter from which region one belongs, all stutters share common causes, etiologies of stammering, therapeutic applications, outcome and prognosis level is almost the same for all. Many psychologists and therapists confuse the foundation of stuttering in children and adults. Many believe that it is the result of malnutrition or mal nourishment and many consider that it runs in the family and is in the blood of the child. While, there are many who have strong belief in neurological causation of stuttering. Sometimes, culture barriers, language barriers also play an important role in provoking the stuttering. Anxiety, problematic relationships, parent child poor interactions, violence, restricted behaviors, emotions, social dysfunctions, learning problems, language problems and grammatical issues are important provokers of the stuttering in children as well as in adults. Few Emotional and Psychological behaviors are so problematic that they cause inner conflict and inner breakdown in an individual.

That unresolved conflicts complicate the personality to the extent that an individual start stuttering to escape these conflicts. Left handedness has been seen in majority of the stutters and gender-based severity level has also been observed commonly. Males have been rated as severe stutters. It might be due to the manipulation of testosterone and hypo pigmentation factors.

There are researches who claim chemical changes and breathing pattern irregularity causes stuttering. Vibrant capacity of carbon dioxide (CO₂) is present when we produce speech in the air. There is a major difference in those who don’t stutter and in those who stutter, of normal absorption of CO₂ in exhaled air. Stutters are 1/5 lower than the absorption of CO₂ during effortless speaking. There are researches that indicate the left hemisphere dysfunction in stutters. Their level of being anxiousness is also heightened. As it is believed to be psychogenic in nature by most of the experts, and many other experts are there who are against this categorization who follow psychogenic causation, and focuses more on neurological, hereditary and other reasons, Mahr and Leith recommended three criteria’s to diagnose the stuttering including non-appearance of organic etiology, distorted speech patterns and perceptible psychosomatic factors.

This study is important for knowing whether people have understanding regarding their problematic speech patterns and have knowledge what are the signs and symptoms of stuttering and what does they really mean and do in production of speech and how they cause problem in speech production. This study also covers how students use self-therapeutic techniques and the effect of self-therapeutic techniques on their lives and on speech patterns.

Methodology

The Inclusion criteria incorporated men and women between the ages of 15 years to 37 years, having stuttering. The study includes students (working or unworked), men and women, who have blocked, repeated or continued stuttering or any other primary or secondary symptom. Information taken from participants shows that the minimum age at the beginning was 3 years and the maximum age at the beginning was 12 years. For the current study, purposive sampling technique was used. The sample size was calculated with the help of biostatisticians using the following formula. The confidence interval was 95% with a precision of 5%:

Sample of 110 patients was taken. Data shows that maximum participants were taking therapy from last one year, most participants were taking therapy from four years to five years and only 1 was reported for taking therapy for the longer period of 10 years. Interview and history taking reveals that patients were taking therapy but that was not usually on regular basis. Time gaps were reported usually by those who have been taken therapy for longer periods.

In order to ensure that they meet the inclusion criteria, all patients were interviewed shortly before being considered a study part. After literary examination and expert opinions, a Performa was created and validated by ten experts with a minimum of five years ' experience. These included details regarding the demographic data, people's age and information about their learning or job status, the severity of problem, the start of treatment, length of therapy and type of therapy whether they take therapy once, twice or three times in a week.

Results

The assumptions of the multiple regression were satisfactory as in present study no tolerance value was below the cut-off (i.e. 0.2), however, the values closer to one indicate there is no multi co-linearity among the predictors (Table 1). It has been also found that per variable (IV) 10 participants were considered, for optimal sample for the regression analysis. It has been found that the understand subscale 2 is a significant predictor of awareness for self-therapy of stuttering (B=0.45, p<0.05) (Tables 2, 3). In the present model, R2 explained the 7% variation in the criterion variable due to the predictors. The value of positive B indicates that as the predictor increases, the odds of the outcome occurring increase, and it also shows that one standard deviation unit change in the outcome variable. It has been found that the overall understand of the therapy significantly predicts awareness for speech therapy of stuttering (B=0.18, p<0.05). In this model, R2 explained the 5% variation in the criterion variable due to the predictor. The value of positive B indicates that as the predictor increases, the odds of the outcome occurring increase, and it also shows that one standard deviation unit change in the outcome variable.

• There is a significant correlation between understanding of the Stuttering problem and Stuttering speech therapy awareness.

• There is significant improvement in recognizing the Stuttering issue on speech therapy awareness for stuttering

Discussion

Different types of therapeutic strategies have been studied, to see which strategy helps stutters more. It has been seen that relapse rate was quite high in those patients who had fluency shaping treatment methods but those who had been taken stuttering modification technique along with self-help groups, were having lower relapse rate. They also had positive self-beliefs and higher satisfaction level because of their treatment plan, and this satisfaction was actually the reason of lower relapse rate in these patients.

In a research, stutters were observed quarterly during the year. Observations were made to see the effects of concentrated treatment plans on adult stutterers. Results showed 69% stutters were at satisfactory level of post-treatment fluency, and only 7% were maintaining a point that was just satisfactory. 80% stutters had their fluency near to normal after one year of treatment. [6] In present research, it has been proved too, that there is correlation between the awareness of stuttering and the treatment they have been receiving. The more satisfaction individual has in therapy plan, the better and early results will be shown.

Self-help therapy books for stuttering, cassettes and other extra resources are usually not scientific, but sometimes they have many unyielding compensations and benefits. [7] They have been helping many people to change their habits and also personality traits that are causing problems in their fluency as well as in intelligibility of speech. Many individuals who think that they have some problems that must need to be resolve follow such material, even without the guidance of any therapist. Although without guidance, such material is helping the stutter, but if they seek proper guidance provided by therapists, it would be more helpful in minimizing the problematic speech utterances and prognosis will be better. Moreover, the more comforting therapeutic technique patient would have, the earlier and better prognosis he would get.

Internet has been used widely to help and guide individuals with emotional, anxiety, depression and stuttering problems. [8] Self-help resources have been given, that are available online, all the time and all protocols and methodologies are given. It has been common practice these days that stutters go online and study all relevant material and use and apply them as a self-help therapy. Although it is common practice these days but ethically it is wrong to practice and apply these techniques without any recommendations.

Although with proper guidance and with the help of a therapist, self-help therapy plans have better prognosis rate than other therapeutic techniques. [9] There have been researches discussing which method of treatment is more beneficial for the long-term benefit of stuttering. Many reports that symptom reduction treatment is beneficial in all cases but there is an incidence that claims prolongation and airflow techniques are more beneficial. Other claims that self-help therapy is more beneficial and long-lasting prognosis has also been reported in self-help therapy.

Research has shown that most patient who has awareness of their problem, feel ease in applying self-help therapeutic strategies and these are helping them more than traditional treatment plan of stuttering. Psychotherapy or speech therapy, both focuses on the concept that there are no single criteria which can be employed to treat the speech problems of stutter. [10] Individual differences are considered to choose the therapeutic plan. Although few things are considered as common, that includes self-judgment, individual’s self interest in treatment, comfort level in application of treatment plan and techniques of self-therapies which he thinks will work for him the best. Self-therapy techniques are being taught by psychotherapists and also by speech therapists, to guide the patient to choose among them the best he thinks is for him. Then results are being observed and analyzed by observing changes in personality and changes in speech pattern of the individual.

The substitution of stuttering with normal speech pattern needs more than accomplishment of fluency. Supplementary mechanism that seems essential and adequate for shaping of normal speech stream comprises rate of speech, breath stream management, prosody, and self-confidence.

The perfect program for adult stutterers is not possible to fit absolutely within operant concepts, motor-linguistic concepts, or psychotherapeutic concepts. It includes all three concepts along with self-help skills in all situations. Self-help skills helps individual with stuttering not only in these situations but in every situation, they have to face in daily routine life.

Conclusion

The study was conducted to see the level of awareness of stuttering and level of awareness of self-therapy among stutters, and to see the co relation between two of them. Results show that there is significant correlation between Understanding regarding the problem of stuttering and awareness of self-therapy for stuttering. There is significant effectiveness found of understanding regarding the problem of Stuttering on Awareness of Self therapy for Stuttering.

Study has contributed to the literature by adding the evidence that self-therapeutic techniques for adult stutters really helps them a lot in coping with their speech problems. This proofs that awareness regarding one’s own speech problem enables him to search out for its coping strategies and when adult stutter finds a technique helpful for him, he uses it to make his speech clear and intelligible.

References

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