لکنت زبان و آرام سازی: برنامه های کاربردی برای آموزش سوماتیک در درمان لکنت زبان

Relaxation techniques have been an integral part of many stuttering treatment approaches since the early part of the 19th century. The therapeutic use of relaxation has fallen out of favor in recent years, however, due to concerns that the sensation of being relaxed is difficult to generalize and so has limited efficacy outside the treatment environment. This paper reviews the history of relaxation techniques in stuttering therapy and proposes a means for viewing relaxation not as a passive process (e.g., a feeling of calmness), but rather as an active, dynamic process involving coordinated movement of the entire neuromusculoskeletal system. This balance is central to the theories of somatic education, such as those developed by Alexander, Rolf, and Feldenkrais. Accordingly, this paper argues that the use of somatic education in stuttering treatment may promote the perception of relaxation and facilitate the habituation of new behavior patterns, thereby leading to improved generalization of relaxation outside the treatment setting.

Relaxation techniques have been used to prevent or minimize the struggling behaviors of people who stutter since at least the early part of the 19th century Otto 1832 and Van Riper 1973. Unfortunately, the mechanism by which relaxation promotes fluency is not well understood (Bloodstein, 1995), and the beneficial effects of relaxation seen in treatment do not readily transfer outside of the treatment setting Bloodstein 1969, Shames 1986, Van Riper 1973, Webster 1980 and Williams 1979. Bloodstein (1995) and Van Riper (1973) argued that a speaker cannot employ relaxation techniques and maintain spoken social interaction at the same time. In other words, they believed that relaxation could not be sufficiently habituated in treatment for it to be of significant use as a tool to reduce stuttering. Because of this lack of a significant carry over effect, relaxation has fallen out of favor as a tool for the treatment of stuttering (Bloodstein, 1969). Although the long-term effects of relaxation in stuttering treatment have not been clearly demonstrated, relaxation has proven to be a useful means of helping speakers achieve a greater degree of fluency in specific situations (Bloodstein, 1995). Rather than completely dismissing relaxation as a viable therapy technique, therefore, it may be useful to examine the nature of commonly used approaches for achieving relaxation in stuttering treatment in order to better understand—and ultimately overcome—the roadblocks that limit the generalization of relaxation effects outside the treatment setting. One framework that seems particularly useful for such consideration is the notion of somatic education, or mobilization of the sensorimotor system, through touch, deep tissue massage or verbally directed movement to improve function. Implicit in the concept of somatic education is the idea that the “mind-body-brain” functions in an interdependent dynamic relationship (Damasio, 1994), rather than as three separate entities. When stuttering is viewed as a discoordination of the entire mind-body-brain, rather than as a discoordination of the body or a physical manifestation of mind, a new understanding of relaxation develops that may hold promise for improving the clinical usefulness of relaxation therapies in stuttering treatment. More specifically, recent advances in the understanding of somatic education suggest that the relationship between relaxation and stuttering should not be reviewed in terms of linear cause and effect (i.e., relaxation leads to improved fluency). Rather, this relationship should be seen as part of a dynamic system in which relaxation is an active process that is intertwined with improved fluency. The purpose of this paper is to review the definitions and use of relaxation exercises in stuttering treatment during the past two centuries and to propose a new definition of relaxation as a dynamic process based on the principles of somatic education. Inherent in this approach is the notion that the use of somatic education in treatment can promote the perception of relaxation through increased coordination, thus facilitating the habituation of new behavior patterns. These new behavior patterns then would lead to improved generalization of the beneficial effects of this altered perception outside the treatment setting.