NEW the Valsalva Stuttering Network

7/26/2019 NEW the Valsalva Stuttering Network

1/13

The Valsalva Stuttering Network

STUTTERING AND THE VALSALVAMECHANISM

A !E" T# UNDERSTANDING ANDC#NTR#LLING

STUTTERING $L#C!S$%&illia' D( )arr%* Es+(* M(A(* CCC,SL)

A licensed Speech-Language Pathologist and Trial Lawyer, Founderand Chapter Leader of the Philadelphia Area Chapter of the National

Stuttering Association, and former member of the NationalStuttering Association oard of !irectors

NOTE: The following article was written prior to my recent clinical trials of Valsalva

Control Therapy, which produced important re"nements to the #alsal$a %ypothesis andimpro$ed therapy techni&ues' Therefore, please see my new articles(

Valsalva Control Stuttering Therapy: A Brief Introduction, and

New Insights and Tools To Beat Stuttering Blocs! based on my presentation at theNational Stuttering Association conference in Ft' )orth, Te*as, on +uly , .//,including the results of my "rst clinical study of #alsal$a Control Therapy and $ideos frommy current trial of intensi$e #alsal$a Control Therapy'

"hy is stuttering usually worst when the words are #ost i#portant$ This articleshows how a natural %odily function & the Valsalva #echanis# & #ay turn oure'orts to spea into the very %locs we are trying so hard to avoid( It e)plainshow a co#%ination of physical and psychological factors #ay trap us in a*Valsalva&Stuttering Cycle* & a vicious circle that #ay trigger and perpetuatestuttering! as well as sa%otaging our e'orts at +uency #aintenance(

This article is adapted from a presentation gi$en by the author at the )orld Congress forPeople )ho Stutter, in Lin01ping, Sweden, on +uly 2, /223' 4t pro$ides a brief introduction
http://www.stutteringtherapist.com/index.htmhttp://www.stutteringtherapist.com/valsalvacontrol.htmhttp://www.valsalva.org/NSA2011.htmhttp://www.stutteringtherapist.com/index.htmhttp://www.stutteringtherapist.com/valsalvacontrol.htmhttp://www.valsalva.org/NSA2011.htmhttp://www.stutteringtherapist.com/index.htm


2/13

to the 5#alsal$a %ypothesis'5 6For further information, see 7nderstanding and ControllingStuttering( A Comprehensi$e New Approach ased on the #alsal$a %ypothesis'8

N9T:( This article discusses stuttering in its most common form, often called 5persistent

de$elopmental stuttering'5 4t may not apply to other types of dis;uencies'

I( Intro-u.tion

It is a great honor to be invited to speak at this World Congress in Sweden. As you know, Icome from the United States, where I lead the hiladelphia Area Chapter of the !ationalStuttering ro"ect. #y profession, I am a lawyer. #ut the great obsession of my life has beenthe mystery of stuttering $ a condition with which I have struggled since I was four years ol

%ver the years, I submitted to a wide range of therapies, without lasting success. &inally,about 'fteen years ago, I gave up on therapy altogether and began doing my own research

into the problem.

It seemed obvious that my speech mechanism was basically all right. #ack in high school, Ihad taken elocution lessons, and had learned to act out roles in front of an audience withperfect (uency. )owever, in other situations, it seemed as if a powerful force clamped dowon my speech like a vise, causing me to block. *y problem was not any lack of abilitytospeak, but rather an interferencewith that ability. I suspected that the interference wasphysiological in nature, but that it might be activated by psychological factors.
http://www.stutteringtherapist.com/book.htmhttp://www.stutteringtherapist.com/book.htmhttp://www.stutteringtherapist.com/book.htmhttp://www.stutteringtherapist.com/book.htm


3/13

After e+tensive review of medical literature, consultations with professional researchers, anpersonal e+perimentation, I believe that I have found the force behind that interference. It a normal bodily mechanism that we instinctively use every day, without even thinking abouit. It is called the#alsal$a mechanism. he -alsalva mechanism is a neurologically

coordinated team of muscles throughout the body which act together in the performance oa -alsalva maneuver.

II( The Valsalva Maneuver

A( De'onstration

ou can e+perience what a -alsalvamaneuver is by performing the followinge+ercise. Stand up. Curl your 'ngers, andlink both hands together in front of yourchest. ake a deep breath. !ow try to pullyour hands apart, as hard as you can,without letting go. ull really hard.

What do you notice while you are pulling/0o you notice how the muscles in yourchest and abdomen tighten up/ What doyou notice about your throat/ 0o you noticethat your throat closes up/

ry the e+ercise again. ull really hard andsee if you can feel it. 0o you notice that,the harder you pull, the more tightly yourthroat closes/ his closure occurs in thesame place that your voice is produced $the laryn+.

!ow try the same e+ercise again. his time,start by putting your lips together andpretend you are going to say apsound.!ow pull your hands apart as hard as you

can. What do you notice about your lips/0o you 'nd your lips pressing tightly together/

!ow see what happens when you press the tip of your tongue to the ridge behind your uppfront teeth, and pretend you are going to say the t sound. ake a deep breath and startpulling. 0o you feel the tip of tongue pressing forcefully/ 0o these forceful closures feelfamiliar/


4/13

ou were performing a -alsalva maneuver. It takes its name from Anton *aria -alsalva, anItalian anatomist who lived from 1222 to 1345. Although it has been known to medicalscience for more than 466 years, it has been almost totally ignored by speech pathologists

$( The /un.tion o0 the ValsalvaManeuver

he purpose of a -alsalva maneuver is toincrease air pressure in the lungs, in order tohelp a person e+ert physical e7ort or forcethings out of the body.

his is how it works8 our abdominal musclestighten up, s9uee:ing the intestines and organsin the abdominal cavity, so that they press

upward against the diaphragm$ the dome$shaped muscle that separates the abdominalcavity from the chest cavity. his causes thediaphragm to bulge upward, compressing thechest cavity. Certain chest muscles also tightento bring the rib cage down, which compressesthe chest cavity even more.

*eanwhile, the laryn*is neurologicallyprogrammed to close tightly around the upperairway to keep the air in the lungs from

escaping. he more the abdominal muscless9uee:e, the greater the air pressure becomesin the lungs, and the tighter the laryn+ closes. he laryn+ is doing one of the basic tasks forwhich it is designed. It is callede


5/13

lifting the weight. %therwise, some of that energy would be wasted as his chest andshoulders sagged.

he -alsalva maneuver also helps us to force

things out of the body. he most commone+amples are defecation, urination, and childbirthIn these activities, the air pressure helps tostabili:e the diaphragm, so that the abdominalmuscles can s9uee:e things out of the abdominalcavity more e;ciently. When defecation isintended, the rectal and anal muscles rela+,permitting the bowel movement to be e+pelled.)owever, when defecation is not intended $ fore+ample, when we are lifting weights $ thesemuscles tighten up to prevent an accidental

evacuation of the bowels.

All these muscles comprise the -alsalva mechanism. hey are linked together as a


6/13

whom we feel we have to please or impress. When certain words must be said e+actly rightlike saying our name or the punch line of a "oke, stuttering usually hits the hardest.

In my own e+perience, I always found it easier to say the wrong word, whatever it was, tha

the precise word that was most appropriate. In answering the telephone, I could not simplysay


7/13

)ow might such confusion between speech and the -alsalva mechanism take place/Scienti'c studies show that all physical activity, including speech, is preceded bya neurological tuningof themotor neuronsthat control the muscles to be used in theparticular movement. he tuning makes some neurons more e+citable, and others less

e+citable, to the triggering impulse that actually starts the movement.

In e7ect, the brain says to some neurons, ?et ready to contract your musclewhen the ne+t command comes>< o others it says, < which is like the triggering signalB as you make a 'st yourself.

@epeat this e+ercise a few times, so that everyone has gotten into the habit of making a 'sas fast as they can. hen, after again instructing them,


8/13

built up, the brain would signal the lips to let go. hat is what is supposed to happen. !owlet=s see what might go wrong, according to the -alsalva )ypothesis.

&irst, let us assume that you have been blocking on yourp=s lately. When you see that

apword is coming, your brain anticipates that saying the word will be di;cult. It decidesthat e+tra e7ort will be needed and tunes up the -alsalva mechanism. All the nerves andmuscles of the -alsalva mechanism are now geared up to perform a -alsalva maneuver theinstant a triggering stimulus comes down the line.

%ne kind of triggering stimulus could be the increase in air pressure that normally occursduring articulation $ for e+ample, when you close your lips to say thepsound. !ormally, thincreased air pressure would tell the lips to open. )owever, if the -alsalva mechanism isoverly e+citable, it could have "ust the oppositee7ect. he increased air pressure could bemisinterpreted as the beginning of a -alsalva maneuver $ triggering a reaction by the entire-alsalva mechanism. his would stimulate the lips to close more tightly, to keep the air fromescaping. he more you contract your abdominal muscles and build up air pressure, thetighter your lips will close. Suddenly, you 'nd yourself in a stuttering block, whichautomatically gets worse the more you try to force through it.

Similar types of blocking might be stimulated whenever articulation involves an obstructionof air(ow by the lips, tongue, or laryn+, causing increased air pressure. he -alsalvahypothesis might therefore e+plain why stuttering is often reduced when the speaker uses


9/13

his may also help us understand why we stutterers are usually (uent when we sing. )aveyou ever wondered why that might be/ When we sing, our mind concentrates on themelody, rather than trying to force the words out. herefore, our laryn+ is constantly tunedfor phonation, and is always ready to phonate at the proper time.

V( #rigins an- )er2etuation o0 Stuttering

A( Earl% Dis3uen.ies

et us now consider how the confusion between speech and the -alsalva mechanism mighthave started.

I don>t think that the -alsalva mechanism causes a child=s earliest dis(uencies. In thebeginning, a child=s dis(uencies are usually e7ortless, whole$word repetitions, without the

force and struggle that we later see. hose dis(uencies may arise from a number of di7erefactors, such as delays in the neurological development of speaking skills, emotional stressor e+cessive demands for good speech placed upon him by adults. he underlying factorsmay be di7erent for each individual.

he one thing these factors have in common, however, is thatthey tend to ma0e speechmore di=cult'he child may perceive this di;culty as a kind of


10/13

Ste2 8 Valsalva Tuning(he brain responds by neurologically preparing the laryn+ andother parts of the body=s -alsalva mechanism to perform a -alsalva maneuver in which airpressure is built up by forcefully closing the laryn+ or mouth while the chest and abdomina

muscles s9uee:e the chest cavityB, in the mistaken belief that this may help to force thewords out.

Ste2 9 Vo.al Dela%s an- /or.e0ul Closures(As we have "ust discussed, there may bedi;culty or delays in phonation, because the laryn+ is neurologically prepared to performe7ort closure rather than phonation. -alsalva tuning may also lead to e+cessively forcefulclosures of the mouth or laryn+ during articulation, resulting in the blocking of speech.

Ste2 : Avoi-an.e $ehavior( In an attempt to avoid, postpone, or hide our blocks, we maresort to a wide variety of behaviors. hese might include hesitations, repetitions, the use ostarters, 'llers, and other unnecessary words and sounds, word substitutions, breathing

irregularities, teeth gnashing, and other tactics.

Ste2 ; Mental Rea.tion to Stuttering(We may interpret our stuttering as con'rmingour original belief that speech is di;cult, or that particular words are hard to say. We maythink,


11/13

Understanding the -alsalva mechanism may also help us 'nd more e7ective ways toimprove our (uency. oday we are confronted by a wide range of competing therapies,(uency devices, and techni9ues $ many appearing to be totally di7erent and evencontradictory to one another in their approaches.

)owever, when I analy:ed all these approaches, I came to a startling conclusion8 o thee+tent that they were successful, they all could be e+plained in terms of the e7ect they hadin disrupting one or more of the steps in the -alsalva$Stuttering Cycle. In various ways, theyeach reduced to some e+tent the stutterer=s tendency to activate the -alsalva mechanismduring speech. Unfortunately, the e+isting therapies seemed relatively ine;cient andincomplete, because they failed to deal directly with the -alsalva mechanism itself.

I suspect that this failure to cope with the -alsalva mechanism may be one factor behind thgreat tendency for people to relapse after successfully completing a (uency program. Suchperson might inadvertently activate his -alsalva mechanism while


12/13

by each individual who stutters.

!evertheless, I feel that by understanding the -alsalva mechanism, we can free ourselvesfrom a lot of frustration and physical struggle in our attempt to speak. As I see it, the goal o

self$help should not be the attainment of perfect (uency $ for that is unrealistic,unnecessary, and ultimately self$defeating. Instead, I think our ob"ective should be to makeour speech easier and more en"oyable, so we can more freely communicate and interactwith other people.

hat has been my approach in -alsalva Control $ not to e+pend a lot of e7ort in monitoringmy speech, but to rela+ and have fun talking.

Copyright , -../! 01-1 %y "illia# 2( 3arry

Conta.t In0or'ation

&illia' D( )arr%* Es+uire* CCC,SL)A licensed speech-language pathologist and trial lawyer, o


13/13

AssociationorAma:on.com.

&or information concerning stuttering self$help and support, pleasecontact8

National Stuttering Asso.iation11F West H6th Street, 1Hth &loor, !ew ork, ! 1661E

elephone8 E66B 52H$1233 or E66B WD SUD@&a+8 414B FHH$E4HH

e$mail8 infoWeStutter.org
http://www.westutter.org/http://www.amazon.com/exec/obidos/ASIN/1929773013/qid=958479320/sr=1-1/002-9419490-8267421http://www.westutter.org/mailto:[email protected]://www.westutter.org/http://www.westutter.org/http://www.amazon.com/exec/obidos/ASIN/1929773013/qid=958479320/sr=1-1/002-9419490-8267421http://www.westutter.org/mailto:[email protected]

Documents

NEW the Valsalva Stuttering Network