The Neuro-Physiological Perspective as the Grounds for Corporal Workout With People Who Stutter

About the presenter: Beatriz Biain de Touzet (MD) is Speech Pathologist and Professor of the University of Buenos Aires, with a post-graduate degree in Fluency Disorders. Since 1992, she has been holding Seminars for Specialization in Stuttering for speech pathologists from Buenos Aires and the rest of Argentina. She is the President of the Argentine Association on Stuttering and organized the Year of the Child who Stutter in Buenos Aires. In 1998, she organized the 1st. National Seminar on Dysfluencies. She has been the coordinator of the first Self-Aid Group for people who stutter, within the framework of the Local Program for Mental Health of the Pirovano Hospital in Buenos Aires, for which she is presently acting as an advisor. She is also devoted to research work on the functions of the right hemisphere and of their relationship with stuttering.

The neuro-physiological perspective as the grounds for corporal workout with people who stutter

by Beatriz Biain de Touzet

Part I

This paper reflects a good number of ideas and assumptions that I have supported for many years and that have been confirmed by studies by other authors and by clinical practice.

Before 1991, stuttering was a psychological issue in Argentina. Paediatricians advised the parents of stuttering children to "wait". Stuttering was not a subject within the career of Speech Pathology and no statistics could be found in the hospitals. This was so much so that people thought this was a pathology aimed at extinction. There were no stutterers; it was a hidden issue.

Since there were no effective treatments (stutterers were only submitted to relaxation, respiration or rhythm exercises), I started to incorporate the body as an instrument for communication, when I was finishing my instruction as a corporal trainer under the Milderman System, based on the stimulation of the right brain hemisphere functions. My search was aimed at more integrated and encompassing approaches.

In 1988, I started with this corporal experience, on a weekly basis, within the framework of the Local Mental Health Program of the Pirovano Hospital. Since then, we have been always looking forward to new ways of attaining a more global communication --not only from oral expression--, allowing for a more flexible expression. When, in the same Hospital, we started the 1st. Self-Aid Group for people who stutter, those participating in the latter became special guests to our corporal experiences.

Corporal workout is performed jointly by speech pathologists, people who stutter and other people who were attracted by this activity because it stimulates expressiveness, playing, gestures, singing and non-verbal communication.

Simultaneously, I went ahead with my research work on the functions of the right brain hemisphere and its relationship with fluency disorders. When I learnt of the functions of the RBH, I always thought that --in the case of speech disorders-- the latter should be able to perform activities that would offset the LBH's deficiencies.

Demonstrating this hypothesis and sustaining multitudinary corporal activities with music in a hospital and for so many years is not an easy task. However, the results obtained in every session did nothing but confirm my assumptions and that this was a valuable experience.

It was then that I started getting further training in the specific field of stuttering, with total support from Dr. Gregory. After highly-dedicated studies, I could enhance my knowledge and also become certain of the validity of the hypothesis I had formulated years ago.

Part II

Many authors support the hypothesis that stuttering may be due to the fact that the left hemisphere is "fragile" and susceptible to interferences, particularly those from the right hemisphere (Webster W. 1997). My personal experience as a speech pathologist in clinical work led me to use expressive corporal elements based on right hemisphere functions that behaved as a support to expression in communication and language use.

After 10 years of clinical observation, today I can say that we need both approaches to arrive at a real recovery. In many cases, on one hand, we need to work with the speech motor control system but, at the same time, we need an activity that allows those who stutter to express their fears and apprehensions and to communicate freely.

On the basis of the hypothesis that the left brain hemisphere cannot sustain neuronal language command by itself, we cannot disregard the need to use functions or styles of the right brain hemisphere, looking forward to a more effective treatment in reducing verbal and corporal stress.

One of the last conclusions about RBH functions reveals its dominant aspects for language: prosodic, emotional and gestures. The capacity to express emotions in language seems to be one of the RBH functions.

As speech and language are movements, it may be easily assessed that verbal stress takes place simultaneously with corporal stress and negative emotions in stuttering, and the person who stutters needs to talk more easily but, at the same time, to increase communication with others and to have a place where he or she is not only a person who needs to talk more fluently, but a person who needs to communicate, with his or her whole body and feelings without the pressure of talking

In Buenos Aires (Argentina), we are applying the Milderman method, based on the stimulation of RBH functions. When I incorporated this approach, my view of stuttering changed significantly. Now, I am not only interested in speech motor, linguistics or emotional aspects; I am further interested in human communication.

Thus, this year, during the 5th World Congress for People who Stutter, in Johannesburg (South Africa), we introduced our Argentinean communication workshop with many people who stutter from all over the world and their clinicians; different cultures, different languages and only one communication: fluent communication..!
It was a fluent Congress for dysfluent people; a big, big gathering in a circle found us, hand-in-hand, in silence, looking at each other, feeling and smiling, listening to the music.

Indeed, all of us --fluent and dysfluent people-- have a good number of blockages when we want to express our feelings!

Just one more communication workshop, as the ones we hold every week at the Pirovano Hospital in Buenos Aires, Argentina.

Part III Some ideas to help our understanding of the RBH functions and their relationship with stuttering problems

1) In the past, the classical neurological approach was:

a) Unable to talk and write (RBH).
b) Unable to understand reading and writing the language.
c) Distant from any activity dealing with knowledge and communication.

2) Now, we know that:

a) there is an increased understanding of the mind and of the cerebral functions.

b) new therapies devoted to certain types of cerebral damage are available;

c) the unilateral dominion of the Left Hemisphere over the Right one gives way to complementary specialisation.

3) Right Hemisphere Processing Style:

a) Viso-spacial task specialisation.

b) Perceptive processes and direct information analysis from our body.

c) Emotional expression, musical and rhythm sense.

d) Daily events, persons, places, objects and familiar things, things outside our environment.

4) Techniques based on the RBH functions:

- These techniques produce really deep corporal, mental, emotional and social changes among those who apply and receive them.

- The therapists and people who stutter work together and --together-- they discover the effects of this new way of communication through mutual exchange.

- Every effort to act on one of the cerebral hemispheres must be accompanied by the specific language of that hemisphere.

- In certain learning processes, it is important to avoid the influence of the left hemisphere to have access to the right hemisphere.

- We have two different ways of acquiring knowledge, which are, actually, different ways of processing information.

- Our stimulation of one of the two hemispheres tends to interfere with the normal performance of the other.

- Modern therapists make use of both hemisphere functions.

- Verbal communication is supported on body expression.

- There is an evolution in knowledge of about hemisphere specialisation.

- People who stutter use more their right hemispheres to speak.

- The RBH has viso-spatial skills, and it could provide the basis for a sophisticated emotional and mental life.

- Both hemispheres participate in most intellectual activities, but they make separate contributions to the final cognitive accomplishments.

- Language functions are mediated predominantly by the left hemisphere, but the right hemisphere has significant linguistic communication.

- The right hemisphere appears to be most involved in providing external details and general orientation, while the left hemisphere contributes to an essential analysis of internal details.

- The two hemispheres are precisely complementary.

- Most treatment programs today include both hemispheres: the speech motor control and one activity to work with fears and apprehensions.

Part IV Corporal workout method

Some ideas:

  • We include expressive corporal elements based on RBH functions that behave as an expressive support to communication.
  • This work has made it evident that communicative stress occurs simultaneously in the body.
  • Muscular armours or stress areas develop as protection or control barriers when faced with situations of fear or anguish.
  • People who stutter feel blockages also in their bodies.

The Milderman method includes:

1. Consciousness (awareness) of one's own body

2. Joint mobilisation

3. Recognition of reflexes

4. Recognition of the various body heights

5. Recognition of respiratory pulses and rhythm

6. Voice release

7. Expression of emotions

8. Contact with others

9. Possibilities of relaxation

10. Observation and recognition of contractures

11. Consciousness of movements

12. Recognition of respiratory pulse

13. Awareness of every part of the body

All these elements are worked out, looking forward to natural, non-directed movements, awakening the body and making it available for expression and for communication.

The classes on expressive movement include:

a) Rhythmic bar

b) The session itself:

1) Body movement reflexes

2) Respiratory pulse

3) Natural movements with music: advancing, walking backwards, going up, down, in and out, rotation and fleeing.

4) Group work

c) Closure

Elements used:

1) Music

2) Bar

3) Floor

4) Voice

5) Yoga

6) Body

7) Respiration

8) Attitudes and postures

9) Gestures

10) Singing

The procedures:

Expression workshop involving joint integration games, with the participation of people who stutter, speech therapists and other people.


We have found that our work in "communication workshops" provides a very important communication tool in everyday life"

The corporal vocabulary has its own laws and we have to discover them to be able to express our emotions

In Argentina we can help many people who stutter at the same time and, besides, it's free.. Some people who stutter need to be treated but they have no money for this and this is, at least, a way to help their global communication.

As we have two complementary brain hemispheres, I always think of an ideal treatment based on our left hemisphere: speech motor controls system, and of a corporal activity from our right brain to express ours fears, frustrations and apprehensions. To move naturally, we have to recover our natural movements, awakening our reflexes to be able to express our emotions.

A person who stutters, as every other person, has to discover --through the body-- many other different ways of recognising himself or herself and not only as "the one who stutters".

The communication workshop in South Africa allowed two hundred people of different cultures and languages to communicate through the most essential features in each one of us... and it was --indeed-- a very fluent experience.

The idea of an integrated brain functionality is becoming more and more popular as a basic need for a major and a better performance.

In stuttering, the simultaneous stimulation of both brain hemispheres allows for an integrated therapeutic framework and for people who stutter and speech pathologists to work together time, because we all have blocks: people who stutter in their speech and all the rest of us... in life, with regard to others things. And we learn from each other to be aware of such blocks, to accept them and to modify them as much as we can.

What I propose is integrating techniques from both the left and right brain hemisphere, as well as the work performed by researchers and clinicians with actions by speech therapists, people who stutter and parents of dysfluent children, not only as from work but from our hearts.

After many years' work, I can say that it is indeed possible to perform speech treatments based on motor skills. It is as well possible to attain linguistic skills and changes in attitudes towards the limitations as a response to either "speak more fluently" or "stutter more fluently" programs.

Corporal workout is a very valuable tool for many people needing to express themselves, whether they are fluent or dysfluent. It promotes a more open, free and sustained communication by means of a plastic and flexible body.

People who get this training every week can:

1) Attain greater corporal consciousness that, in turn, allows them to have a greater command of their corporal stress during blockages;

2) Develop an expressive body and easier and more comfortable communication;

3) Gain better relationships with the rest, by looking at each other, playing and participating in the dynamics of group work;

4) Through music, express different emotional status: fear, panic, shame, impotence, sadness, inferiority, insecurity, etc.;

5) Enjoy the pleasure of letting their voices go and singing;

6) Increase self-esteem and self-confidence, since corporal workout provides them with support from their own.

This contribution is not supposed to be taken as a model for therapy; it is not actually a therapy. It is a valuable tool for anybody willing to express himself or herself freely, without fear, and is especially devoted to people who stutter.


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