查看完整版本: 口吃研究的进展

荔荔雨 2007-7-16 23:25

口吃研究的进展

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[size=4][color=#006400][b]原载：北京协会论坛[/b][/color][/size] pr_4vE#Vz+u3Z
[size=4][color=#006400][b]原帖：自然[/b][/color][/size]#ktZm3i3I2PTm
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[size=4][color=darkgreen]这是一篇口吃的综述文章，可以说是比较全面的反映了口吃方方面面的情况，5e#VcYY7i.l#[*S)X
现将它翻译出来与大家分享，附上英文供英语水平高的吃友直接阅读原文。
　　口吃2A0^9o_K9K p/X
口吃是一种言语混乱，主要表现为：不由自主的语音的重复和拖长：不由自主的阻塞和被迫中断导致不能发音。[/color][/size]
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口吃最常见的表现是不由自主的语音重复，除此之外还包括言前不正常的犹豫或停顿，主要指口吃者的阻塞，某个特定音节（通常是元音）的拖长。还有许多口吃者的害怕特定的音和词，害怕场景，焦虑，紧张，自卑，压力，害羞
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在言语过程中失去控制感等等都不能被听者观察到。
口吃者对自己口吃的反应时的情绪状态是这种混乱的最难的方面。-q,ka}M,U
通常所指的口吃有很广的范围：除了特别严重的口吃者存在影响大部分有效口头交流的问题之外，-oxx[j0s-vy
还包括由于口吃者刻意的掩饰而表现的很少的口吃现象。

口吃不是语音生成的生理方面的问题，也不是思维到字词方面转换的问题，尽管大众不这么认为，口吃并不影响口吃者的智力。m'p:mt |5?E-B"p

口吃者除了言语受损外，其它一切正常。焦虑，低自信，神经紧张，压力等因素不是导致口吃的原因，
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尽管它们一度被认为是导致口吃的罪魁祸首。
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口吃者的口吃随特定的情景（比如打电话）中焦虑水平的高低而使自己的口吃或变轻或变重。TM`xUG"o
在唱歌和台词时流畅性会提高。
)_4O1`af!`!W
虽然许多严重的口吃者在他们的职业生涯和社会生活中面临着巨大的障碍，也有一些轻微的口吃者利用了自己的口吃。

虽然口吃的病因不明，通常认为与基因和神经生理方面的因素有关。
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虽然对于一些口吃者而言，一些治疗技巧能提高流畅度，但是目前还没有从根本上治疗口吃的方法。

内容
1.落下病根和流行5MBP*eB
2.其它类型的流畅障碍NTW\z/K7w
3.原因
3.1基因Xh0y6M,pH k
3.2成人口吃者的神经学 oQ5G Cum3e~^4g |#W
3.3压力相关的变化
4.发作与发展/[ONL];o&r3QOHD
5.特征
5.1核心行为和第二特征行为
5.2流畅度
5.3回避性行为/N7TG2c;S!@rN
5.4严重
5.4.1积极的条件
5.4.2消极的条件
6成人治疗
6.1流畅度塑造治疗 Q.n%J'~ WX*E
6.2口吃态度修正治疗
6.3抗口吃药物rO M@l\J`2prr
6.4抗口吃仪器
7.与口吃治疗有关的媒体报道
8.儿童治疗
8.1学前儿童的治疗{2WE0l2\;[3i,K
8.2小学儿童的治疗
8.3青少年的治疗;w2|;vC{8E,S
9口吃与社会Sk]O6t6D
9.1口吃的传统观点7eo4V*u3g/HPq$t
9.2媒体中的口吃NX(C#NR pRc I)H
9.2.1电影/h[;g0[^!^
9.2.2电视
9.2.3音乐1kU2W \;Ke$X?)u
9.2.4 "Stuttering John" 5fBTSIs$I
9.3歧视BUuY&Q:qIq
10 其它文章
11 注解
12 参考文献
13 外部链接
m K*\C8[!Y8H

英文原文

Stuttering
.N(i`G%\
Stuttering, also known as stammering in the United Kingdom,
is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds,7m TV.^J r6Cn~Q}
syllables, words or phrases; G{7|$bzcZ
and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds.
0i"X$f'fM fW:N+G
The term stuttering is most commonly associated with involuntary sound repetition,'WiL3?_._gf
but it also encompasses the abnormal hesitation or pausing before speech,
referred to by stutterers as blocks, and the prolongation of certain sounds, usually vowels.
Much of what constitutes "stuttering" cannot be observed by the listener;
this includes such things as sound and word fears, situational fears, anxiety, tension, self-pity, stress, shame,
and a feeling of "loss of control" during speech.
The emotional state of the individual who stutters in response to the stuttering often constitutes
the most difficult aspect of the disorder.
The term "stuttering", as popularly used, covers a wide spectrum of severity:
it may encompass individuals with barely perceptible impediments,
for whom the disorder is largely cosmetic,&T#p@6oRr@0a
as well as others with extremely severe symptoms,$hGHA6W)Bt
for whom the problem can effectively prevent most oral communication.

Stuttering is generally not a problem with the physical production of speech sounds
(see Speech sound disorders, Voice disorders) or putting thoughts into words (see Dyslexia, Cluttering).
Despite popular perceptions to the contrary,
stuttering does not affect and has no bearing on intelligence.
Apart from their speech impairment, people who stutter are normal.
Anxiety, low confidence, nervousness, and stress therefore do not cause stuttering,
although they are very often the result of living with a highly stigmatized disability.

The disorder is also variable, which means that in certain situations, such as talking on the telephone, ah Q5c"Y%nca
the stuttering might be more severe or less,G b#e!Fk|C|v
depending on the anxiety level connected with that activity. (be |xo2t3P Q
@j+{3rT4I%S O
In other situations, such as singing (as with country music star Mel Tillis or pop singer Gareth Gates) orq%F9Tr1xi7N
speaking alone (or reading from a script, as with actor James Earl Jones), fluency improves.

(It is thought that speech production in these situations, as opposed to normal spontaneous speech,&WTGmO
may involve a different neurological function.)
&D`X1F2{"o)V
Some very mild stutterers, such as Bob Newhart, have used the disorder to their advantage, ;R.D{| YLqDN
although more severe stutterers very often face serious hurdles in their social and professional lives.-AyuyjLIP(cDz

Although the exact etiology of stuttering is unknown,
both genetics and neurophysiology are thought to contribute.
{ X:E5~uU$U*N~
Although there are many treatments and speech therapy techniques available that may help increase fluency)c z"y-ubR,J5m
in some stutterers, there is essentially no "cure" for the disorder at present.tldz$Xp["n
u2wY0s`

Contents [hide]4X%RB y9J/CQ
1 Incidence and prevalence
2 Other fluency disorders %uy$mvS7r r `%O2|
3 Causes
3.1 Genetics 4@2~#},vc~MV3Q
3.2 Neurology of adult stuttering
3.3 Stress-related changes e#z%f;ne8^
4 Onset and development
5 Characteristics
5.1 Core and secondary behaviors
5.2 Fluency 6JSC;o4S
5.3 Avoidance behavior Bsda*W(l
5.4 Severity ,~(H vEN!Y
5.4.1 Positive conditions q$~}C%GC
5.4.2 Negative conditions

6 Adult treatments
6.1 Fluency shaping therapy Dn&l,y1e}:C
6.2 Stuttering modification therapy 'c#^%PVEo6tE7[m,U
6.3 Anti-stuttering medications
6.4 Anti-stuttering devices Pj0m7O&q2yy&Q;Vy
7 Media publicity about stuttering "cures"
8 Childhood treatments $eNzHd5F u
8.1 Therapies for pre-school children
8.2 Therapies for school-age children
8.3 Therapies for teenagers aR:ZL d1_
9 Stuttering and society
9.1 Ancient views of stuttering g!FH2Y hR.Fr:`
9.2 Stuttering in the media ~!u)Ze e6T/?$n
9.2.1 Film
9.2.2 Television
9.2.3 Music |t0p.F~0E?/@'Bi
9.2.4 "Stuttering John" ?p4m`@&h(yK7_
9.3 Discrimination
10 See also d$E'S9lM
11 Notes
12 References
13 External links
　　　　　　　　　　　　　　未完待续。。。。}~ Y:J A4Ww

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荔荔雨 2007-7-18 11:48

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[size=4][color=darkgreen]续上篇：

1.范围和流行
学前儿童的口吃流行大概是2.5％，就是说四十个中有一个是口吃。在儿童中这个范围大概是5％，即二十个儿童中有一个是口吃。

成人口吃的比例大约是1％。这个数字在最近的一个研究中发现为0.73％，即135个成人中就有一个口吃者。9p7L.RU(SKw*C;pR6{
在成人口吃者中大概80％是男性，女性占20％。
最近的研究表明不同的国家的口吃比例忽高忽低，在有的文化下根本没有口吃。这些研究一般会有点折扣，可能是由于有的国家的
成人口吃缺乏言语治疗。
CB'W/f!Y7c'TW
2.其它类型的流畅障碍;Q_n$["u^#]
这篇文章讨论的是发展性口吃，发展性口吃指的是从小孩学说话时就发生口吃，一直发展到成人，有一些其它的言语混乱与口吃很相似：
乱语
帕金森病人言语c1E(JeNR4o3vm
颤抖症（是一种由于有意识运动引起的神经混乱，其特征是手颤抖，有时头部等身体其它部分也颤抖）
fd-e?0c7]*p

3.原因,?Fs#@&D@(Y
口吃不是由单一的原因导致的，各种各样的假说和理论认为口吃是多因素导致的。cl1w!\s
;e:o"ci5H.Z
3.1基因
H/Tb'wk Zhf9Y-l
口吃与某种基因有关，但是，口吃的基因因素还没有被证明。许多调查口吃的家族的基因研究还只能把研究结果解释为N9nL1\G'E _
基因和社会环境交互的结果。（本性与教养）/On+Fpq7Wq9\$Y
3.2成人口吃者的神经学%s%z J-iD
成人口吃者的脑扫描研究发现几处神经学意义上的异常：X3t M%F:IjN\
在说话过程中，口吃者大脑的右半球比左半球更加激活，右半球与情绪有关，左半球与言语有关。
不口吃者在说话过程中左半球激活的更多。5|,L7r&Z\"]3Fd;?%{
现在还不知道口吃者这种异常的半球激活优势到底是由于口吃者左半球言语有关的区域出了问题还是右半球区域不适合加工语言； J#]O^:M+g1D
或者是由于这种不寻常的的右半球激活与口吃者说话时的害怕，焦虑等其它情绪有关。

在说话过程中，成人口吃者有中央听觉处理区域激活不够现象。一个研究猜测口吃者的整合听觉和肌肉运动的过程能力欠缺。例如
比较口吃者是如何听声音和如何感觉肌肉的运动。

一项脑扫描研究检查颞叶，颞叶是与大脑听觉有关的区域。一般的人的大脑颞叶左侧大于右侧（左侧优势）
这个研究发现口吃者的右侧颞叶大于左侧颞叶(右侧优势)]h,oy,X9V;C0E4_7w
[7I i_;tP ~Y$E
成人口吃者有左侧杏仁核言语运动控制区域过渡激活的现象。口吃主要是因为过渡紧张，过渡刺激的呼吸，声带，和其它发音器官肌肉'V*jBN'y+M'vJ
（唇，下巴，和舌头）
控制这些肌肉运动的脑部区域过渡激活就不足为奇了。
(AtdGQ6l9z3g&R.a
脑扫描研究还没有研究过儿童口吃，所以还不知道儿童口吃有没有这种神经学意义的异常。Jp^%J5fJ4zqT
还有一个观点认为口吃是由于大脑的同步问题导致的。最近的研究显示口吃或许与语言计划区域和执行区域的神经丛混乱有关
他们都在大脑的左半球。这种混乱可能是由于早期的脑损伤有关，也有可能与基因缺失有关。!MgnDE3t+n
W]t3I)b"L x
第一个口吃脑成像研究中有两个口吃被试，用spect扫描技术探测口吃被试服用氟哌啶醇 (一种强安定药) 后的变化。研究人员发现
口吃被试的Broca区和Wernicke区的血流减少，这两个区域与流畅度有关。他们发现氟哌啶醇.jw5D4S*kF
不仅可以减少口吃而且还回复脑区域的功能异常。pet和fmri研究的数据支持这个研究。u'y+ZW?VW*[D6@
lX"Fh!m/I4b
测量体积的脑成像研究发现口吃者的Broca区和Wernicke区要比较小，这两个区域的代谢减退能很好的说明这种侵蚀。f}&}9k/tJ
结构性核磁功能成像研究发现左半球的白质神经通路存在断开的地方，右半球的白质神经通路比左半球多。-Ix:D'dHA

3.3压力相关的变化
在某些情景下比如打电话，口吃者的口吃会增加或减少，到底是增加还是减少依赖于口吃者在情景中的焦虑水平的高低。
在紧张的情况下，人的声音会改变。,gB@-B.w4f
发音肌肉的紧张能增高音高，提高语速，重复词和短语会增多，会插入一些无意义的音。这些都是正常的不流畅。u1]b:xK]7@8o5I
一项研究发现在压力下完成简单的颜色命名任务，不口吃者的不流畅度从0％提高到4％，而口吃者的不流畅度从1％提高到9%f`/xCyv-|;C(^
口吃导致心脏收缩压降低10％，但是口吃引起听者的压力。口吃出现时暂时减少了压力，然后又引起压力，进入一个循环模式：MDq])Kq|
第一个词的第一个音节口吃，然后又流利的说出剩余的词的部分和接下来的几个词，然后又口吃，接着又几个词流畅，这样循环下去。

[1] Incidence and prevalenceV:[:Bc^|
The prevalence of stuttering in preschool children is about 2.5%, that is, about 1 young child in 40 now stutters.
The incidence is about 5%, or 1 in 20 children stutter at some point in childhood.26d6?~)NO;E`WW

About 1% of adults stutter. The figure found in a recent study was 0.73%, NOF_3A&F Z
or about one in 135 adults.27 About 80% of adult stutterers are men and about 20% are women.28
q1j9NB*Cq%a"g-W{
Studies in years past claimed that some countries had higher or lower rates of stuttering,
or that some cultures had no stutterers at all. These studies are generally discounted now,
although there are likely more adult stutterers in countries with less speech therapy.
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4Eu lo,hy4v"KSzl
,f^1q|g/w+m'D%R sO
[2] Other fluency disorders7Y#OtR)kD []
This article is about developmental stuttering, that is, stuttering that originates
when a child is learning to speak and develops as the child matures into adulthood.
Several other speech disorders resemble stuttering:7n+u8g s.h+x9c
O5P-Z$j8g3wC ?q ` P
Cluttering PP,S:m FV
Parkinson's speech
Essential tremor /?-iGw.oI0P yU2r
Spasmodic dysphonia
Social anxiety *t{8p2gz3P:Oi
Head injuries and strokes can cause repetitions, prolongations, and blocks.
Rarer still are stutters induced by specific medications. Medications such as antidepressants, antihistamines,
tranquilizers and selective serotonin reuptake inhibitors have been known to affect speech in this way.
While these afflictions create stutter-like conditions they do not create a stutter in the traditional sense.
However, these neurogenic stutterers lack the struggle behavior and fears and anxieties of developmental stuttering. @ e a)U!|B5Ig
Developmental stutterers can fluently speak certain memorized phrases, such as the "Pledge of Allegiance." 8v3]Y A9r6bM
Neurogenic stutterers are disfluent on everything. V)x7t*W2o-I
Developmental stutterers can speak fluently in certain (typically low-stress) situations.k$SD$tzq
Neurogenic stutterers are disfluent everywhere.T-Z#\"{X'zEx6|7N
'?([y#F4?/U}0vUn
Rarely, traumatic experiences caused an adult to begin stuttering.
Psychogenic stuttering typically involves rapid, effortless repetitions of initial sounds, without struggle behavior.5O C[$Z$I

[3] Causes8KU_n[0Fr-o M
No single, exclusive cause of stuttering is known.
A variety of hypotheses and theories suggest multiple factors contributing to stuttering.

[3.1] Genetics@0t*t-eI-Wo:e
Stuttering has been correlated with certain genes;29 however,
a genetic cause for stuttering has yet to be proven.)E.oJ.X l6u ^+BoI&I
Many studies have investigated stuttering in families, |k[_ b3Dd7u
yet typically have yielded results that could be interpreted as either genetic or
social environment ("nature" or "nurture").
K5B"oX,~K(^2sd

[3.2] Neurology of adult stutteringDA}Qt\ @K

Brain scans of adult stutterers have found several neurological abnormalities:!H#X9aej4nl~`cb?
p-vr DP
During speech adult stutterers have more activity in their right hemispheres,
which is associated with emotions, than in their left hemispheres,
which is associated with speech. a0ubWJw0wR
Non-stutterers have more left-hemisphere activity during speech.
It is unknown whether this abnormal hemispheric dominance results
from something wrong with stutterers' left-hemisphere speech areas,
with right-hemisphere area unsuited for speech taking over speech tasks;
or whether the unusual right-hemisphere activity is related to fears, anxieties,
or other emotions stutterers associate with speech. 4qIb]+BVjh7_
Sk*Bd~ F
During speech, adult stutterers have central auditory processing underactivity.F2[#ngc2O5i5m5lG
One study suggested that stutterers may have an inability to integrate auditory and somatic processing,
i.e., comparing how they hear their voices and how they feel their muscles moving.36 !u'u%L;A%w

KDoY.yW
A brain scan study examined the planum temporale (PT),
an anatomical feature in the auditory temporal brain region.
Typically people have a larger PT on the left side of their brains,
and smaller PT the right side (leftward asymmetry).
A brain scan study found that stutterers' right PT is larger than their left PT (rightward asymmetry).37

Adult stutterers have overactivity in the left caudate nucleus speech motor control area. |\N'f%\ zm;p
Because stuttering is primarily overtense, overstimulated respiration, vocal folds, WHGi+E} TA&}
and articulation (lips, jaw, and tongue) muscles,

it should be no surprise that the brain area that controls these muscles is overactive.[citation needed] O^l Pa$g$\
EUgtEK}&W;p

No brain scan studies have been done of stuttering children.
It is unknown whether stuttering children have neurological abnormalities.]6A:uT#}Ma u

Another prominent view is that stuttering is caused fv$g)qa#xJA2JQ
by neural synchronization problems in the brain. ,MV\`Q{
Recent research indicates that
stuttering may be correlated with disrupted fibers between the speech area and language planning area,.],x%K8}%}C2h `
both in the left hemisphere of the brain.
Such a disruption could potentially be due to early brain damage or to a genetic defect.0z#k&i"pXVe i

The first brain imaging studies in stuttering were done
on two subjects using SPECT scanning before and after the administration of haloperidol.
The researchers found that the subjects with stuttering had less blood flow in the Broca's
and Wernicke's area and associated this with dysfluency. )M;@!BR Sh u
They found that haloperidol not only reduced stuttering but reversed this functional abnormality. u;QT+AB6b4]U/Y8yW(d
Numerous PET and functional MRI studies have presented data that is in agreement with this first study.H0?)jxx

Volumetric MRI studies have found that portions of the Broca's and Wernicke's areas are smaller in people
who stutter and this corrolates well with the hypometabolism in these two brain regions.
New forms of structural MRI have found that there is a disconnection &B lFz\"_P
in white matter fiber tracts in the left hemisphere and greater numbers of white matter fiber tracts
in the right hemisphere.
@]bk1]t;Y%c
[3.3] Stress-related changes$fN-CH%t!}6[ v8k
In certain situations, such as talking on the telephone,/N0N5s(P b
stuttering might increase, or it might decrease, D4nu|&I#m H
depending on the anxiety level connected with that activity.
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Under stress, people's voices change. GZ qRM|&A
They tense their speech-production muscles,G3U r*|\"n@O
increasing their vocal pitch. They try to talk faster. They repeat words or phrases.
They add interjections, also known as "filler words", such as "uh." These are normal dysfluencies. @G$@'xIYf#s~
A study found that under stress, non-stutterers went from 0% to 4% dysfluencies,
for the simple task of saying colors.
Stutterers went from 1% to 9%.38 }-P(Vks

Stuttering reduces stress 10%, as measured by systolic blood pressure.39$]})YS4V.Kxx
But stuttering causes stress in listeners.40 Stuttering appears to reduce stress temporarily,7]rwRX*v(J1? U?
but then cause stress, creating a cyclical pattern in which the stutterer stutters
on the first syllable of the first word, then says the rest of the word and several more words fluently, VG AR$C}
then stutters again, then says a few more words fluently, and so on..ea9I|'F_8V3aF

One study found that developmental stuttering and Tourette syndrome 'Oc2uju,ti
may be pathogenetically related.41 Tics are exacerabated by stress, @_-Q9hNt s-{
and when the affected person tries harder to control the undesired movement, sK$Z4uh*PT't#}8Z:\
the conditions can become more pronounced.

未完待续.........[/color][/size]z,TfntHP0U8S
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