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This Week In The Bmj

Stuttering can be treated by early intervention

BMJ 2005; 331 doi: (Published 22 September 2005) Cite this as: BMJ 2005;331:0

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Re: Stuttering can be treated by early intervention

Forms of stuttering:

1) Clonic stuttering, characterized by repetitions of syllables or words.
2) Tonic stuttering, characterized by blockage and disruptions of speech.
3) Mixed, containing elements of tonic and clonic stuttering.
4) 'Normal stuttering', presenting at ages of 3-4 years, is due to discrepancies between thinking and speaking. The child at this age thinks more than that it is able to express. He/she does not yet possess the appropriate vocabulary to express all of his thoughts.

This disorder disappears gradually in a few months, if the child does not get psychologically pressured from its parents. In such cases, simple parental counseling is enough.

Stammering has often psychogenic causes, but results in deficient breathing.

Whoever lacks air, has fear (angst).
Whoever has fear (angst), stutters.

Proper functioning of breathing is essential for proper phonation and articulation.

Disordered breathing leads to other symptoms: rapid breathing induces intense anxiety states (angst), with activation of the parasympathetic nervous system, hand sweating, facial flushing, shoulder tension, deficient duration in learning, emotional disorders.

For inducing proper breathing, we need flexibilisation revitalization and activation of the diaphragm, relaxation and tranquility.

To the child, soul-body-breathing-articulating organ, are all interrelated and interdependent. For this, stuttering should be treated holistically.

High breathing (hochatmung) is respiratory tension, with unilateral predominance of thoracic breathing, lifting of the shoulders, extreme burden of the neck muscles, ventilation of only a small portion of the lungs, creation of stretches, and is observed in almost every stutterer. [Becker and Sovak, Lehrbuch der Logopaedie, 1979 edition, page 269]

These accumulated tensions are fixed, creating contractions of the vocal and articulatory organs.

Primarily, we need to release methodically tension/stretches/tightness/contractions that have been established in stutterers, and induce training in relaxation.

This occurs with special pulsations, vibrations (resonanz), oscillations, that permeate the human body, and contain healing powers.

Relaxation occurs by slowly and periodically pulling and stretching isolated muscle groups by applying opposing forces, until harmony is brought. (Heraclitus therapeutic dipole)

The disorder of stuttering can not be addressed piecemeal, with only verbal exercises. In order to recuperate completely and permanently the stutterer, it is necessary to lay the foundations for the extinction and treatment of the causes and not just the symptoms of stuttering.

There should be a therapeutic approach for the entire body of the patient, not only for the articulating organs.

Proper, relaxed, diaphragmatic breathing is a prerequisite for the recovery of stuttering.

These myokinetic exercises are not imposed in military style, instead the therapist guides the patient with gentle and calm voice.

The best age for early restoration of stuttering is between 5-7 years, before the disorder gets established and consolidated.

At such a young age, the child has not yet realized he/she is a stammerer. Upon entering school, the child realizes that he/she speaks differently from other classmates, some of whom might also tease him.

At school, the child makes desperate efforts to improve, pressing itself even more, increasing the tension of the whole body, and exacerbating contractions in phonetic-articulating organs.

The situation gets worse, fear of speech grows, the child ends up completely avoiding speech or certain words.

Pioneering speech therapist Maria Summer would organize groups of stutterers, of up to 12 people, consisting of young children or adults, and engage in intensive group therapy of a few weeks.

She believed that the team creates additional potential, and mutual emotional support between stutterers.

These holistic therapy sessions in no way should remind school. Children should rather perceive them as games.

All exercises designed for flexibilisation, revitalization and activation of the diaphragm for inducing proper ventilation must be non-conscious to the child and the adult who stutters.

This because breathing process can not be affected positively by the child’s will. When exercises are performed consciously, after willful overexertion, it leads to stronger tensions of the entire body, extra contractions of the vocal and articulatory organs, additional ventilating tension.

During therapy sessions, absolute silence prevails and the exercises are repeated silently, like a ritual, even for hours.

Intermediate necessary rest breaks are included, for relaxation and recovery.

Without the consolidating break, all exercises are useless.

Only in advanced sessions, near the end of the treatment cycle, the psychologist/speech therapist/specialist trainer proceeds in rhythmic-verbal exercises.

In each session, the therapist politely and continually corrects posture, the position of the spine, breathing, tension at the shoulders, the movement of the lips, chin, etc., because the old strong clichés have become a habit.

Furthermore, the therapist must always remain calm, without any stress, with proper diaphragmatic breathing, correct spinal posture, in order to have a positive impact on the child.

Proper execution of these exercises is more important than quantity. Proper implementation is difficult to describe and must be experienced by each therapist in practical training sessions.

When psychological problems are detected, psychotherapy is used to improve the child’s self-esteem.

This holistic method, developed and perfected by Maria Summer in Rankweil Austria, many decades ago, is used for quick and effective treatment of disorders of speech, attention, breathing and learning, even in adults.

Only if the child has had meningitis or encephalitis in the past, leaving residual permanent neurological damage, attested in EEG, we fail to provide lasting recuperation of stuttering, after therapy sessions.


1) Maria Summer, Heilpeadagogin-Logopaede, gruenderin der Ganzheitlich Fundierten Logopädie, Sprachheilstaete und Ateminstitut in Rankweil, Austria. Fortbildungsseminare.
2) Klaus Peter Becker und Milos Sovak, Lehrbuch der Logopädie, Verlagsgruppe Athenäum, Hain scriptor Hanstein, 1979.
3) E.M. Pfau und H.G Streubel, Die Behandlung der gestoerten Sprechstimme. Stimmfunktionstherapie, Veb Georg Thieme Verlag, Leipzig, 1982.
4) Maria Montessori, The receptive mind, Glaros, Athens, 1980.
5) Goblenzer H. und Muhar, Atem und Stimme, Österreichischer Bundesverlag Fuer Unterricht Wissenschaft und Kunst, Wien, 1976.
6) Leo Kofler, Die Kunst des Atmens, Schaff Horst und Hedwig Andersen.
7) E.J. Kiphard, Erziehung durch Bewegung Verlag duerse Buchhandlung, Bonn, 1977.
8) E.J. Kiphard, Motopaedagogik, Modernes lernen, Dortmund, 1979.
9) Ditrich Eggert, Psychomotorisches Training, Beltz Praxis, 1979.

Competing interests: Chasapis Athanasios studied, for many years, at the speech therapist Center and Institute of breathing run by Mrs. Maria Summer, and participated in many seminars for Advanced Speech Therapy abroad. He then transferred and extensively used these practices of the holistic method (speech-voice-breathing-attention-learning disorders-etc.) in his speech therapy Practice in Greece, from 1982 until now. He is the author of a forthcoming book in German, which describes extensively the pioneering holistic method of Mrs. Maria Summer, who died in 2007, without leaving a textbook behind.

18 March 2014
Athanasios G. Chasapis
Psychologist-Specialist speech therapist
Stavros Saripanidis, Consultant in Obstetrics and Gynaecology
Thessaloniki, Greece