Summary:
Stuttering is a serious disorder of speechfl uency. The manifestations include
a superfluous increase of muscular tension, which originates not only on vocal cords, but may be
generalized into skeletal muscles of the whole body and become manifest even by clonic spasms.
Some authors are of the opinion that increased tension of laryngealmuscles, leading to the occlusion
of glottis, corresponds to the mechanism of Valsalve maneuver, which participates in the development
of the stuttering. The opinion was coined by Perry, who had suffered from stuttering from his
childhood and was treated with various procedures without success. He elaborated, and claimed to
have experienced himself the method for the treatment of stuttering, which evokes fluent speech
by suppressing the mechanisms of the Valsalve maneuver. The method is based on suppressing the
activity of abdominal and thoracic muscles, which brings about a soft beginning, while practice of
speechena ble to bind individual words and syllables. In a clinical examination of the stuttering
patient withtonic manifestations in the speechres ulting even into long initial tones and speech
blocks clearly indicates that the mechanism of the Valsalve maneuver indeed becomes manifest
during the stuttering attack.We therefore decided tomake an objective study of the influence of the
Valsalve experiment on the motor activities by determining the effects of the Valsalve maneuver on
mono-synaptic reflex activity of spinal cord in the S1 segment by means of electrically evoked
mono-synaptic reflex of spinal cord (Hoffmann’s reflex, so called H-reflex). The amplitude of the
H-reflex was followed at rest as well as in the course of the Valsalve maneuver. It became obvious
that the H-reflex amplitude increased during the Valsalve experiment, the increase being statistically
significant at 5% probability level. The increase of H-reflex amplitude in the course of the
Valsalve maneuver is apparently due to increased flow of afferent impulses as a consequence of
generalized increase in muscular tension and muscular strain, which is the basis of the Valsalve
maneuver. This increased afferentation then follows to increased excitability of motor cells at the
spinal and supraspinal level. This kind of increased excitability then makes it possible to maintain
a high level of muscular tonus, which follows to improved muscular strength, consequently to
quantitative improvement of motor effectiveness. At the same time this increase deteriorates
a precise coordination of minute motions, and consequently the qualitative aspect of fine motor
activity, which is under great demands especially during motor realization of speech. The mechanisms
of the Valsalve maneuver therefore clearly participate in the evolution of stuttering attack,
although they are neither the cause nor decisive. An increased excitability of motor system and
decreased fine motor activity is muchmore pronounced as a consequence of spreading negative
emotion, which originates during the stuttering attack and influences the reflex motor activity more
than the Valsalve maneuver. The principles of therapeutic procedure based on intentional suppression
of themechanism of the Valsalve maneuver may have favorable results, though.A more detailed
analysis of the therapeutic method, as recommended by its supporters, indicate many common features shared with other methods. In particular, the principles are similar to a series of other
procedures including the Seemans method of complex traetment of stuttering.
Key words:
Valsalve maneuver, fluent speech, respiratory pathways, muscular activity.
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