Abstract
Two groups of non-fluent adolescent and adult subjects were studied, twenty who attended regularly at the hospital clinic and one hundred and twenty six who used the electronic metronome for self-treatment with occasional visits to clinic or with one or two initial visits only.
SUMMARY
Fluent performance requires that a firm matrix of language and speech patterns be laid down, that a complete blue-print of speech activity be designed before utterance is commenced, that the mechanism be rendered capable of organizing the temporal distribution of stimuli. Among the influences which can inhibit the formation of the matrix are slow or irregular neuromuscular maturation, insufficient or unacceptable language stimulation, failure to equate visual and auditory feed-in, delay in feedback and misinformation or lack of feedback information.
It is argued therefore, that choice of focus depends upon this inadequacy of the matrix when neurovegetative influences, failure of the suppressor or inhibitory mechanisms, morbidity of the neuromuscular system, failure of the timing mechanisms, synaptic delay or other erratic influences are brought to bear.
A new classification of non-fluent utterance is offered, and it is suggested that the patient's deficits may be dysphasic, dysarthric, dyspraxic or compulsive in character.
Formal psychotherapy is contraindicated except for about 4% of patients.
Treatment of acquired non-fluency need not necessarily take account of language deficit.
The use of the electronic metronome relieves the clinician's and the relative's anxiety and is antagonistic to awareness and social distress.
Reinforcing the matrix by language relearning in historical sequence is the treatment of choice, timing of utterance the stabilizing influence. Clutterers require mainly timing practice.
Preliminary results of an evaluative study support these views and indicate that many can effectively use the instrument for self-treatment.
The intensive study of Group B subjects highlights the need for taking account of all physiological factors and of broadening the scope of therapeutic technique.