Monday, March 26, 2012

Presentations are now on-line

The presentations from the Antwerp conference are on-line: here.

You can also find my workshop: here.

And the title, abstract and summary:
3. Title:
From genes to social context: Understanding and treating stuttering in a biopsychosocial framework

4. Abstract:
Genetic, neurobiological, behavioural, cognitive, and social factors contribute towards the dysfunction and handicap experienced by people who stutter, and are also key to an improvement of the condition. In an upcoming book, we propose an overarching

Wednesday, March 21, 2012

Meet up with TSB readers in Zuerich.

Yesterday, I met up with Lukas and other people in Zurich who stutter. They invited me for dinner. Thanks! We had a lot of discussions on stuttering, on my upcoming book, on disadvantages of covert and overt stuttering, and on finance.

I will soon put up a picture of three of us... unfortunately the others had already left.

Saturday, March 10, 2012

Joseph Agius: Using humour

Joseph Agius does what I want therapists to do, namely to talk about aspects of therapy. He chooses the topic of humour. His talk is quite funny. For example, he asked therapists whether they use humour in therapy (result: 95), and he asked patients (result: 20% use humour)

He then switched to gelotophobia, the fear of being laughed at, and how pws differ to fluent speakers. They only seem to be relevant to situations where stuttering is relevant.

He went too fast through the slides, so I cannot catch up, but he mostly shows how humour is affecting stuttering/psychosocial functioning and therapy. Some techniques are shifting perspective, exaggerating, word plays, and self deprecation.

Emergent topics, Neurogenic stuttering: Theys find that neurogenic stuttering is due to lessions across a network

She focuses on patients with neurogenic stuttering after strokes.

Many case studies are known.

She talked about prevalance, functioning, MRI scans, and aim to find the lession locations

She had N=37, 17 neurogenic stutterers and 20 controls.

9 areas of the left hemisphere showed differences between control strokes: all important for speech production. She suggest that the location lessions are part of a network that disintegrate and leads to stuttering.

Due to limited coverage, other area might not appear in this study. But her results are consistent with most current understanding of the neurobiological basis.

Interesting avenue, but i am not sure whether you can 100% relate to developmental stuttering. I asked whether there are differences in people who stutter since childhood and those due to a stroke. She said that some patients especially with Parkinson behave differently, but many are similar to "normal" stutterers.

After the talk, I had the opportunity to have an in-depth discussion on her research. An interesting aspect is that most patients are HAPPY to stutter as it is a sign that they improve because the stroke led to a temporal inability to speak.

Emergent topics, Vanhoutte: no results yet

She talked about speech motor, research done with her supervisor van Borsel.

She talks about preparatory loop and executive loop, and that timing is not right.

She studied temporal aspects of speech perception and production using EEG. They did silent reading of action words to get a clean experimental signal. These action words trigger a response in relevant motor/sensory regions, and that's how she can study motor perception...

She did not present any results... so it's a bit of a no talk... :-(

Emergent topics, Emotional reactivity & regulation: Ntourour finds difference

Katerina Ntourou talks about a similar topic than Haley. She wants to study emotional reactivity and regulation.

She tortured kids for science. She showed them toys, asked for the favourite one, and locked it away in a box! And she then gave them 10 keys to open the box, and they ALL didn't work!!! How did she pass through the ethics committee? :-)

Anyway, she then studied differences between fluent and non-fluent group. She found differences, but she went too fast at the end. I was a bit surprised that she said she found differences between the two groups look similar. I couldn't fully absorb it because it was all too fast..... :-(

I am somewhat concerned about the experimental set-up to measure emotional reactivity and regulation. It does not seem to be a very well controlled variable nor is the environment. As a past child who stuttered, I most likely suffered from social anxiety, and hated having to communicate with new people. Had I been tested in such a situation, the social anxiety would have made me more aroused quickly.So I am not sure about what exactly is measured. But as I said, it went too quickly, I would need to see it in detail.

Emerging topics from Antwerp, Autonomic arousal: Arnold finds nothing.

Hayley Arnold showed us research she conducted with MacPherson on the autonomic arousal in pws as compared to fluent subjects. We know that autonomic arousal may negatively impact speech motor control. So maybe pws have a higher arousal and so this might increase stuttering or might prevent them from recovering.

She did not find any significant differences between children who stutter and those who don't for different tasks elicitating autonomic arousal. Also, arousal seems to start BEFORE stuttering events. I don't find this surprising at all. Kids are getting anxious because they have to speak and then this makes their stuttering worse...

So CONGRATULATIONS for the courage of presenting NULL results! Signs of great science! Watch out those who always find something... :-)

Blogging from Antwerp

I am sitting in the lobby of Lessius College right now. Let me blog up the conference day of yesterday.

The conference started rather abruptly with Ludo Max's first slide showing us a typical box-arrow diagram of a brain function model: the standard model for motor control. Some people were probably a bit shelled shocked. In the past I spent some time understanding the different parts of the model, and I understood then after 20-30 minutes. But in the lecture, I didn't have enough time to regain complete understanding. But Ludo's strategy is pretty straight-forward. Test the different arrows of the model. And that's what he has done. Over the last years, he has rigorously tested the different parts of the system in people who stutter. I took part in one of them when I visited lab in Connecticut a few years ago. He explained the different experiments quite nicely. And he kept returning to the theme that pws learn slowly but they eventually get it. I liked his talk. But I am still not sure exactly what the results are telling us. Maybe the slow learning is a symptom for an on average inferior processing capacity in certain brain regions, but I am not sure slower learning caused stuttering to manifest itself. I asked about subtypes, and he agreed that this is an issue but it is not clear how to resolve this currently, on which I agree. He made an analogy with Eskimos' having tens of words for snow to discuss more subtle aspects of snow. But here, our great scientist is the victim of an urban myth: they don't! :-)

Marilyn Langevin's talk was a good example of what is wrong with clinician-turned-researcher research. She is a good, and foremost confident, speaker, and probably also a good therapist. But the informational content of her speech was low. She presented an outcome study of low standards and many potential flaws. I don't have time to list all the flaws, but here are a few: (a) low sample size, (b) highly biased overt measurements, (c) great fluctuation in sample (one person was highly dysfluent in year 1 sample and fluent in year 2 sample, so the fluency in year 2 is a result of treatment?? right... ) (d) potential sample bias (many did not reply to questionnaire) (e) focus on counting stuttering syllables. I challenged her on this, and she said that we should be happy with this due to the lack of funding and difficulty of getting data. Well, I never understand this pseudo-argument. Surely you cannot justify lowering standards, right? Either you can ensure good standards, or YOU JUST DON'T DO IT. I am especially sensitive to this area as I analysed the outcome data of a fluency shaping therapy with 300 or so patients: that is 300 not 10-15. And everything else was done more rigorously, and still I don't even fully trust these results. Unfortunately, this outcome got little exposure, and I am not even sure where Prof Euler published it. He did present it at an Oxford Dysfluency Conference.

The worst of it all was that she repeated words like "as a scientist", "the p-value", and "in science". Let me be clear, she is not a real scientist for me. She should have talked for 60 minutes about WHAT SHE DOES IN THERAPY, and not how badly she does research because a lack of funding and mishandling of statistics and set-up. I want to know about her experience as therapist.... drop "science" and focus on what you are good at!

Norbert Lieckfeldt spoke about clients' expectation of therapy. I was unable to attend, as I was preparing my own speech/workshop in the afternoon. He kept on saying after the speech that pws and parents want foremost better social functioning rather than fluency. He also supported this by some research from a communication research project. But I pointed out to him that in many other communication disorders parents KNOW that their kids' dysfunction is permanent and that's why they focus on better psychosocial adaptation. But in stuttering, parents and pws experience great fluctuations in fluency, and that's why their goal is also based on more fluency. Only later when many attempts of permanently more fluency failed do they switch to improving psychosocial adaptation.

Then we had the poster sessions. Unfortunately, I was busy with my talk.

The afternoon session was for young researchers. That was also one of the criticisms I gave for the last conference. I am happy they follow this path. All three speeches presented interesting topics. I am not going to discuss them here...

Then I had to go to my workshop. I had about 20 people in the audience. That's probably a good number because my room was on the third floor, and the others on the ground floor, first floor, and second floor. So I had to fight with gravity. I was not very happy with my delivery. I had too much to say in one hour, and left many concepts under-explained. I had two good questions at the end. I was happy they got my idea, namely to unify all frameworks into a single one. A Dutch researcher mentioned a similar model than mine, but when we talked afterwards, we realized that it was quite different.

After the day, I went to have drinks with Jelena, Paul, Max, and others who I am not sure want to be publicly associated to me! ;-) With one of them, I discussed the standards of research in the field. And we discussed the leaking of emails regarding the quality of PhDs from Australia. We also discussed my blogging style, and ways of changing it were gently suggested. ;-)

Then, two of them left for the official dinner for the conference VIPs. As Kurt Eggers noted this morning to the whole auditence: "I hope you all enjoyed yourself yesterday evening. We did, too!"

In the evening,

Friday, March 02, 2012

Battle of conferences?

Check out this new conference in Rome: website. I am not very impressed by the scientific committee and some of the key speakers. Looks like the Italian have gotten some funding and choose to invite the wrong people! ;-) We now have four conferences in the next four months. WOW. That never happened before. The one in Antwerp (I am attending), in Rome, in France, and in the US. I heard that this new conference is attracting some speakers that have cancelled for the other conferences. Are we starting to see a battle of the conferences? Might be a good thing..