DYNAMIC ASPECTS OF RESPIRATORY CONTROL IN STUTTERING

自1931年以来，就有关于口吃者呼吸中断的记录(7)；它们与感知流利和口吃的言语以及非言语任务有关。然而，最近对PWS患者呼吸控制的研究很少，其对口吃病因的影响尚不清楚。这里提出的研究旨在增加对呼吸在口吃多因素模型中的作用的理解（80,81,83,104）。识别呼吸控制与言语不流畅高风险相关的方面被视为描述呼吸与其他变量的相互作用的先决条件，这些变量也在口吃的发展和维持中发挥作用。这里提出的研究旨在解决三个广泛的问题：1)在正常说话者中，当开始说话时，已知的生命维持呼吸控制的不稳定性会发生什么？这些不稳定性是如何影响口吃者的呢？2)口吃者的运动系统是否普遍不能控制呼吸？3) PWS患者的呼吸控制是否对认知和情绪处理相关的觉醒反应更强？对于所有这些问题，初步数据涉及动态过程，因此，强调施加时间限制的任务，以及超越长期平均水平的分析，以观察正常和口吃者的呼吸控制过程如何随时间变化。在目前使用的治疗方法中，呼吸控制的地位从主要关注到不存在（20）。改善对呼吸在口吃中的作用的理解有可能对这种疾病的治疗实践产生重大影响，这种疾病影响着全世界大约1%的成年人。

Disruptions of breathing in persons who stutter (PWS) have been documented since 1931 (7); they have been associated with perceptually fluent and stuttered speech and with nonspeech tasks. Yet there has been little recent investigation of respiratory control in PWS, and its contribution to the etiology of stuttering is unknown. The research proposed here is designed to increase understanding of the place of respiration within a multifactorial model of stuttering (80, 81, 83, 104). Identification of aspects of respiratory control associated with high risk for disfluency is seen as prerequisite for delineating the interaction of respiration with other variables which also play a role in the development and maintenance of stuttering. The research proposed here is designed to address three broad questions: 1) In normal speakers, what happens to known instabilities in the control of life-support breathing when speech is initiated? How do these instabilities affect stuttering speakers? 2) Does a general inability to take control of respiration characterize the motor systems of persons who stutter? 3) Is respiratory control in PWS more reactive to arousal associated with cognitive and emotional processing? For all of these questions, preliminary data implicate dynamic processes, thus, there is an emphasis on tasks that impose timing constraints, and on analyses that go beyond long-term averages to look at how respiratory control processes change over time in both normal and stuttering speakers. Among therapies in current use, the status of respiratory control ranges from major focus to nonexistent (20). Improved understanding of the role of respiration in stuttering has the potential to effect major change in the practice of therapy for this disorder, which affects approximately 1 percent of the adult population worldwide.