Musical Stuttering: Similar to Speech Stuttering?

vandevorstAbout the author: Robert van de Vorst (Netherlands, b. 1985) has completed his Master degrees in Musicology and piano (both with distinction) at the University and Conservatory of Amsterdam. He currently works at the Vrije Universiteit of Amsterdam, besides teaching piano privately in his home town. As a musician and person who stutters, he is interested in exploring the relationships between music, language and human behavior.

Introduction

Music and stuttering are both powerful, enigmatic and sometimes even mysterious phenomena. One contains obviously a great positive force, pure joy and often making people cry of happiness, while the other is usually associated with struggle, fear and even despair. I have personal experience with both. As I began to see the similarities between what ‘struggling at the instrument’ and stuttering were about, I started to gain insights I would probably not be able to gain in the absence of ‘the other’. In this paper I would like to share some similarities between the two.

Most people experience only the beautiful, enjoyable side of music, often when they listen to their favorite songs and artistic heroes. Many people also get ‘moved’ in a literal sense when they spontaneously tap with their feet or begin to dance. And yet, besides all the glory music has to offer, many amateurs and professionals experience limitations, struggle, nervousness pain, injury, anxiety and frustration as a result of their musical practice. Through my own experiences and observing those of others, I came to the conclusion that these symptoms have partly to do with the innate presence (or lack thereof) of talent – the ability to naturally communicate musical ideas through the ‘instrument’. However, lack of talent may not cause injury, pain or frustration, similar to that a predisposition to stutter doesn’t necessarily mean that a person is condemned to stutter his entire life. Important as well is how the person reacts to his own limitations, his self-image, what he expects from his self, possible environmental pressure as well as personal characteristics such as perfectionism, compulsiveness, obsessiveness and anxiety.

This may explain why there are musicians who are extremely passionate, musically brilliant and excellent artists, and yet suffering from a distorted relationship with the instrument, music and themselves. More concretely, it is often about a mismatch between the – not seldom idealistic – ideas, concepts and intentions in the mind of the artist and the (lack of) innate knowledge and ability to realize these intentions. By comparison, this would roughly parallel the demands and capacities model that is used for stuttering (Starkweather, 1987). A Person Who Stutters (PWS) may speak ‘fine’ (despite being neurobiologically impaired) when being alone, or when the social situation or language complexity is relatively low-demanding. However, when the demands exceed ones abilities, fluency mostly decreases.

Some of the things I mentioned above happened to me both at the piano and during speech conversations and I strongly believe that the roots of these phenomena were very similar; they just manifested themselves through different parts of the body.

However, one must be cautious comparing speech stuttering with ‘stammering at the instrument’ – as it is once called (Bluemel, 1930). First and foremost, speech stuttering itself is heterogeneous, with probably different causes and factors contributing to different individuals and groups (Yairi, 2007). And secondly, what is stuttering? Or, what makes stuttering really stuttering? Is it about the degree of disfluency or more about the feeling of loss of control? Despite these complexities, I think musical stuttering and speech stuttering share come interesting parallels which could be worthwhile to explore a bit further.

Music, language, stuttering and singing

Although musicologists don’t fully agree with each other about every detail within this subject, we can safely state that music and language share at least some remarkable similar characteristics (Patel, 2003). Virtually every existent human culture in today’s world contains the presence of both language and music. As the famous Polish composer Frédéric Chopin said: “we use sounds to make music just as we use words to make a language” (Eigeldinger, 1979).

Talking about stuttering, language and music, singing cannot be left out. Why do many PWS sing fluently? There is probably no single clear-cut answer to that question. An often heard explanation is that, during singing, another part of the brain gets activated which temporarily by-passes problems in areas active during speech (Alm, 2005). This explains why so many stuttering treatment programs use prolonged and intonated speech as a tool to improve fluency. Besides, songs mostly have a definite structure from a temporal perspective: music provides a clear meter and rhythm.  Other than that, singing is generally considered to be less demanding from a linguistic, emotional and social communicative point of view, which may lead to more sense of ease, relaxation, flow and a reduction of anxiety and communicative pressure.

It is interesting to note that Frédéric Chopin, the composer who wrote almost exclusively for the piano, always advised the following principle to his students (Von Grewingk, 1928):

Il faut chanter avec les doigts!’ (Translated: “you have to sing with your fingers”)

It may indeed be the case that, also at the instrument, a ‘singing’ way of playing may help in solving problems and likely improve fluency of execution. An explanation on how to get this ‘singing sound’ out of the piano is beyond the scope of this article, but it is mainly about

creating a musical image which enables you to listen and follow with your inner ear how a tone continues to sound and connects with its subsequent tone (instead of ‘attacking’ each note percussively and independent from each other). It’s about experiencing and perceiving what is between the notes, which provides one a more ‘complete’ picture of the music. This can help tremendously relaxing the muscles of the playing mechanism, creating a condition for more fluency of execution. It then may at least partly explain why “choral reading” (speaking or singing in unison with others) and fluency devices like Delayed Auditory Feedback (DAF) dramatically decrease stuttering in (some) PWS. Because – especially in the initial stage – it almost automatically promotes a person to ‘actively listen’ to a secondary auditory signal (Armson & Kiefte, 2008).

Something remarkable I have discovered is that, by slowing down records of true virtuoso musicians, you will hear that they basically keep a ‘singing sound’ all the time, even during the fastest and trickiest passages. Their playing apparatus thus actually moves rather regular and quiet. However, their mind and ears work rapidly together which seems to point at their capacity to process many things simultaneously and quickly one after another. When someone is rushing, stumbling and missing notes, it is often said that the ‘fingers move faster than the mind and the ear’.

Cognitive neural processes

A PWS may then be more vulnerable and sensitive for processing complex information within a certain time-frame (Jones, Fox & Jacewicz, 2012; Weber-Fox, Spencer, Spruill & Smith, 2004), which is in line with the fact that PWS are slower in encoding semantic information (Bosshardt, 2006).

All this would also fit with scientific reports about deficiencies and under-activation of the left-hemisphere in PWS (Chang, 2011; Chang, Kenney, Loucks & Ludlow, 2009; Watkins, Smith, Davis & Howell, 2008), possible linguistic issues (Bloodstein, 2002; Ratner, 1997) and motor coordination problems not only restricted to the speech apparatus (Chang, Kenney, Loucks & Ludlow, 2009; Max, Caruso & Gracco, 2003), but for example also during finger-tap sequences (Smits-Bandstra , De Nil & Rochon, 2006) and bimanual tasks (Zelaznik, Smith, Franz & Ho, 1997; Webster, 1990).

Given this information, it may be exciting then to investigate more about the underlying neural mechanisms of people while playing the piano. A few brain imaging studies have been done with people playing the piano (Parsons, Sergent , Hodges & Fox, 2005; Sergent, Zuck, Terriah & McDonald, 1992). Interestingly, there seem to be some shared neural networks between piano playing, speech and singing. It is probably too premature to speak about a significant similarity but it may not be excluded that a deeper understanding of musical fluency and disfluency could possibly lead more insight about speech fluency and stuttering as well.

Partly related to this, is the fact that recovery of stuttering in adults, as concluded by Kell et al., seems to be critically dependent on left Brodmann Area  (BA) 47/12 in the orbitofrontal cortex, an area in the brain associated with higher processing of language (Kell et al., 2009). Strikingly, in a study from 2003, Levitin and Menon indicated BA 47/12 to be involved in processing temporal coherence in music, and by extension, those aspects of the musical signal that contain its meaning. And in another article from 2006, Vuust et al. concluded that the same area (BA 47/12) is activated when musicians keep the main meter in a polyrhythmic context and suggested that left lateralized processing in BA 47/12 may be linked to metrical competence.

If we transcribe this principle to speech, could it then be that the regular continuity of sound and airflow represents the main meter, and the specifically timed movements of the articulators the counter pulse, for example? And would a successful integration of these basically restore fluency?

Psychological reactions and personal temperament

Although these ‘mechanical’ issues may play an important role in stuttering, it must not be neglected that learned behaviors and reactions can be a big part of one’s (experience of) stuttering too. It is commonly acknowledged that stuttering is often triggered by psychological factors and can be maintained and worsened by one’s temperament and subjective beliefs, opinions and emotions. Anxiety and over-control are common among people who stutter and many musicians deal with similar issues such as stage-fright and fear of playing.

Interestingly, I witnessed quite some musicians, myself included, who seemed to be able executing certain passages without too much trouble when playing alone, but screwing them up during concert. How can this be explained? My experience is that while playing alone, these passages were not being played perfectly at all, but seemed somehow to get out quite well, despite a less than competent working mechanisms behind it. In stressful situations, the already weak system ‘breaks’ much sooner, causing trouble and even more fear and uncertainty. Observing this phenomenon in music, it once more confirmed my personal experience and scientific fact that, at least in the majority of cases, stuttering (during speech or at the instrument) is not caused by anxiety or psychological problems, only triggered or aggravated by it.

Another type of condition which can strongly affect and be affected by ones psychological state of mind is Focal Dystonia (FD), a task-specific movement disorder characterized by a loss of voluntary motor control in extensively trained movements. Its prevalence is about 1% of all professional musicians and in many cases it terminates a performance career, since there is no definite ‘cure’ (Altenmüller & Jabusch, 2010). Different types of dystonia have been characterized as stammering with walking, stammering with writing and stammering with instruments, … etc. (Bluemel, 1930). There are both similarities and differences from a cerebral point of view between stuttering and dystonia (Alm, 2005), but striking is that musicians with dystonia have more anxiety and perfectionist tendencies than healthy musicians. While anxiety and perfectionism do not cause stuttering, heightened social anxiety has been observed in PWS (Craig, 2000) and a link between perfectionism as a possible personality characteristic and the development and maintenance of stuttering has been suggested. (Riley & Riley, 2000; Amster, 1995). Interestingly, musicians’ dystonia usually starts relatively late (in contrast to stuttering, which onset is typically very early) and the person may therefore be better able reconstruct the circumstances which may have lead to the disorder. This in turn could shed more light on factors which could lead to persistent stuttering since it is unknown to this date why some people grow out of stuttering, while others continue to suffer from it (Chang, 2011).

Conclusion

Especially the last statement shows that still a lot about these issues is poorly understood. In my view a cross-disciplinary approach may enable us to gain more insight about how these complex phenomena work.

My personal progress of understanding about many of the things that I spoke about came largely through music. Future research about stuttering should not neglect this area, because if anything, music has the capacity to shed light on what could otherwise be eternally mysterious, hidden and indefinable.

References

Alm, PA. (2005). On the causal mechanisms of stuttering. Doctoral dissertation, Dept. of Clinical Neuroscience, Lund University, Sweden. http://theses.lub.lu.se/postgrad/.

Altenmüller E, Jabusch HC. (2010). Focal dystonia in musicians: Phenomenology,  pathophysiology, triggering factors, and treatment. Medical Problems of Performing Artists, 25: 3–9.

Amster, BJ. (1995). Perfectionism and stuttering. In C. Starkweather & H. Peters (Eds), Stuttering: Proceedings of First World Congress on Fluency Disorders, II: 540-543. Nijmegen, Netherlands: Nijmegen University Press.

Armson J, Kiefte M. (2008). The effect of SpeechEasy on stuttering frequency, speech rate, and speech naturalness. Journal of Fluency Disorders, 33: 120-134.

Bloodstein, O. (2002). Early stuttering as a type of language difficulty. Journal of Fluency Disorders, 27: 163-167.

Bluemel, CS. (1930). Mental aspects of stammering. Baltimore, Williams and Wilkins.

Bosshardt,  HG. (2006). Cognitive processing load as a determinant of stuttering: summary of a research programme.  Clinical Linguistics & Phonetics, 20 (5): 371–385.

Chang S-E, Kenney MK, Loucks TMJ, Ludlow CL. (2009). Brain activation abnormalities during speech and non-speech in stuttering speakers. NeuroImage, 46:  201–212.

Chang S-E. (2011). Unraveling the mysteries of stuttering with neuroimaging. (invited article). Cerebrum, Dana Foundation: http://dana.org/news/cerebrum/detail.aspx?id=33796

Craig A. (2000). The developmental nature and effective treatment of stuttering in children and adolescents. Journal of Developmental and Physical Disabilities, 12 (3): 173-186.

Eigeldinger J-J. (1979). Chopin vu par ses élèves. Édition révisée. Neuchâtel: La Baconnière.

Jones M, Fox E & Jacewicz E. (2012). The effects of concurrent cognitive load on phonological processing in adults who stutter. Journal of Speech, Language, and Hearing Research, 55 (6): 1862-1875.

Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H & Giraud, AL. (2009). How the brain repairs stuttering. Brain, 132 (10): 2747-2760.

Levitin, DJ, Menon V. (2003). Musical structure is processed in ‘‘language’’ areas of the brain: a possible role for Brodmann Area 47 in temporal coherence. NeuroImage, 20: 2142– 2152.

Max L, Caruso AJ, Gracco VL. (2003). Kinematic analyses of speech, orofacial nonspeech, and finger movements in stuttering and non-stuttering adults. Journal of Speech Language and Hearing Research, 46: 215–232.

Parsons LM, Sergent J, Hodges DA, Fox PT. (2005). The Brain Basis of Piano Performance. Neuropsychologia, 43: 199-215.

Patel A. (2003). Language, music, syntax and the brain. Nature Neuroscience, 6 (7): 674 – 681.

Ratner N. (1997). Stuttering: A psycholinguistic perspective. In R. F. Curlee and G. M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions. Boston: Allyn & Bacon.

Riley G & Riley J. (2000). A revised component model for diagnosing and treating children who stutter. Contemporary Issues in Communication Science and Disorders, 27: 188-199.

Sergent J, Zuck S, Terriah & McDonald B. (1992). Distributed neural network underlying musical sight-reading and keyboard performance. Science, 257: 106–109.

Smits-Bandstra S De Nil L & Rochon E. (2006). The transition to increased automaticity during finger sequence learning in adult males who stutter. Journal of Fluency Disorders, 31 (1): 22-42.

Starkweather, C.W. (1987). Fluency and stuttering. Englewood Cliffs, NJ: Prentice Hall.

Von Grewingk M. (1928). Eine Tochter, Alt-Rigas, Schülerin Chopins. Riga, Löffler.

Vuust P, Pallesen KJ, Bailey C, van Zuijen TL, Gjedde A, Roepstorff A & Østergaard L.  (2006). It don’t mean a thing… Keeping the rhythm during polyrhythmic tension, activates language areas (BA47). Neuroimage, 31 (2): 832-841.

Watkins KE, Smith SM, Davis S & Howell P. (2008). Structural and functional abnormalities of the motor system in developmental stuttering. Brain, 131: 50-59.

Weber-Fox C, Spencer R, Spruill III JE & Smith A. (2004). Phonological processing in adults who stutter: Electrophysiological and behavioral evidence. Journal of Speech, Language, and Hearing Research, 47: 1244-1258.

Webster WG. (1990). Evidence in bimanual finger-tapping of an attentional component to stuttering. Behavioural and Brain Research, 37 (2): 93-100.

Yairi E. (2007). Subtyping Stuttering I: A review. Journal of Fluency Disorders, 32: 165–196.

Zelaznik HN, Smith A, Franz EA, & Ho M. (1997). Differences in bimanual coordination associated with stuttering. Acta Psychologica (Amsterdam), 96 (3): 229-243.

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Comments

Musical Stuttering: Similar to Speech Stuttering? — 49 Comments

  1. Special message from me to professors and researchers:

    Dear professors and researchers,

    Thank you very much for reading my article. Currently I am interested in researching the relationship between fluency/stuttering, music and musical practice. I have written a proposal which is mainly about the question how musical context may influence fluency of complex (motor skill) activities, including speech. My proposal includes:

    • summary of the proposed research
    • description of the research topic
    • approach
    • motivation

    At the moment I am looking for opportunities to do a PhD around this topic. If you are interested in reading my proposal, you can send me an e-mail (robertvandevorst@gmail.com) or post a comment.

    Any possibility to carry out my proposal as well as any other kind of information or recommendation would be greatly appreciated.

    Thank you for your reply. Best wishes,

    Robert van de Vorst

  2. Hello Robert,

    This is an interesting paper! I am curious, when you suggest:”Other than that, singing is generally considered to be less demanding from a linguistic, emotional and social communicative point of view, which may lead to more sense of ease, relaxation, flow and a reduction of anxiety and communicative pressure.” does this include when singing in a language other than a person’s natural language? When singing in a foreign language, I found (initially) that it was much more difficult than my natural language. I wonder, would a PWS sing in a foreign language more fluently than singing in their natural language.

    What are your thoughts?
    Thank you for your time,
    Shannon Nesbit

    • Hi Shannon,
      Thank you very much for reading my paper. Your question is interesting. I am not sure if a PWS would sing significantly more fluent in a foreign language. I think it depends also on one’s degree of familiarity with the language, text and complexity of musical parameters.

      However, if I would parallel a new language with a new piece or idiom of music, I recall being remarkably more fluent in the initial stage of learning a new piece of music (especially if it contains new movement/sound patterns) than later on. I also remember that when learning Spanish nine years ago, I seemed to be initially more fluent than after a few months. This would then fit with people claiming to be more fluent when speaking with an accent or in a foreign language, although the fluency of many of these people also tends to decline when they are getting more used to this way of speaking.
      I actually do not exclude that the effect could be partly psychological too. When you speak a language you’re not used to, you probably allow yourself more disfluencies or mistakes which may, paradoxically, increase fluency.

      Per Alm further provides a quite convincing explanation for this effect (The dual premotor model of stuttering and cluttering: a framework, 2005):

      “Certain conditions shift the dominance from the medial to the lateral system, thereby temporarily by-passing the problem of the medial system. This mechanism is suggested to be relevant for the effects of choral reading, metronome-paced speech, singing, altered auditory feedback, imitation of a foreign accent or role play, or when using a consciously controlled speech rate.”

      So, if his explanation is correct, almost any consciously controlled speaking strategy will make a PWS temporarily more fluent.

      I hope this makes sense.

      Best regards,
      Robert

  3. Thank you for such an interesting article. I also read William Parry’s paper on how the Valsalva maneuver effects fluency, which, although not included in his paper, can also have an effect on brass players, causing the first note to blast out, lock up entirely, or have a stuttered quality to it. It is fascinating the many ways that speech and music overlap.

    Do you think that using a form of music therapy along with speech therapy could be more effective than speech therapy alone? I wonder if techniques (such as breathing or relaxation exercises) that help a person play an instrument could cross over and help create fluent speech as well.

    • Thank you for your reply. It is definitely true that the Valsava maneuver can effect brass players. There is even a dissertation on this very particular subject (which I couldn’t find so far, but recently I got the e-mail address of the author, so I will probably read and study it very soon):

      Cochran, Martin Edmond. “A Comparison of the Behavior and Characteristics of Speech Stuttering with Musical Stuttering (i.e. Valsalva Maneuver) in Brass Playing.” D. M. A. diss., University of Alabama, 2004.

      Your second question is very interesting and I address this in my own research activities. I think here, it would like to make a distinction between treatment of young children and that of adolescents and adults.

      There is evidence that musical training and practice has huge benefits for children. In fact, music expertise uniquely taps and refines a hierarchy of brain networks subserving a variety of auditory as well as domain-general cognitive mechanisms (see also Moreno & Bidelman, 2013). I therefore wouldn’t be surprised if combination of singing and musical training would stop stuttering in children who would otherwise probably continue stuttering.

      With adolescents/adults, the situation is different and very likely a wider variety of issues must be addressed. From my own experience, both with speech as at the instrument, strategies and excercises related to the physical mechanism (breathing/playing with arm weight, relaxation of the speech muscles/arm and fingers etc.) were initially helpful, but in the end had only a short-term effect. My major breakthrough came when I addressed what I call the ‘sound image’. What I actually did was planning very carefully the sequence of sounds, including all parameters (rhythm, meter, pitch, loudness, etc.). As a result, this relieved all tension (and stuttering).

      Of course, what helped me may not work at all for another person. However, I somehow have the notion that without a ‘clear mind’, change in speech or instrumental (and probably any other kind of) behavior will be limited.

      I hope I answered your question. Feel free to ask if anything is unclear.

  4. Robert,
    I am fascinated by your paper and, as an aspiring fiddler (as a fan of traditional American music, it wouldn’t be accurate to call myself a violinist) only having begun formal instruction one year ago, find myself connecting my musical experience to my studies in fluency as a graduate student. It seems to me that since stuttering is reduced while singing, incorporating singing-like techniques into speech and incorporating elements of singing into treatment to demonstrate that fluency can be attained are both important avenues to explore as a future clinician.

    I often feel like in practice I experience the phenomenon that you describe when you say, “When someone is rushing, stumbling and missing notes, it is often said that the ‘fingers move faster than the mind and the ear’.” I find that when I’m monitoring bow motion, intonation, tone, audience, and thinking about upcoming strokes and notes, I tend to “overthink” and make errors. Yet, when I reduce the stresses by focusing on one element of playing or simply attempt to make myself stop “overthinking” it, I play with fewer errors, or sometimes, no errors at all! Demands and capacities model makes perfect sense to me in these scenarios.

    I am interested in how singing and music has been incorporated into speech therapy. Have you been able to connect changes in fluency to playing a musical instrument? I’m wondering if treatment could be developed for children, especially, that demonstrates stuttering and fluent speech using instruments.

    Thanks for your thought-provoking paper!

    Best,
    Claire Wofford, Graduate Student
    Western Carolina University, North Carolina, USA

    • Hi Claire,

      Thanks for your reply! Very interesting to read that you are making a connection between your violin practice with your studies in fluency/stuttering!

      I completely agree with you that investigating singing could be a valuable contribution to our understanding of stuttering. In fact, this is how I started to address my stuttering-behavior at the piano. Rather than trying to control tension, avoiding mistakes and hesitaions, etc., I observed that the general sound which I produced at the piano was not natural and did not ‘sing’. I then imagined every sound resonating naturally and connecting it to the next one, resulting in a more ‘singing sound’. This also helped me tremendously with my speech.

      I recall as well the tendency to ‘overthink’. I kind of solved this problem with mental practice, meaning that before touching the instrument (or starting to speak), I carefully imagined the sound progression in my head. This way, during physcial execution, I didn’t have to think any more and could just concentrate on the flow of sounds that was coming out.

      The interesting thing is that this single approach worked for me both with speech and at the piano. So that convinced me even more that these phenomena must be related in some way.

      I think that some form of music therapy could be definitely be beneficial for children. There is an article which claims that playing the piano during childhood benefits cognitive abilities in non-musical domains, including vocabulary and verbal sequencing skills (Piro JM, Ortiz C. (2009).The effect of piano lessons on the vocabulary and verbal sequencing skills of primary grade students. Psychology of Music, 37 (3): 325–347.).
      So this might be an interesting area to explore further!

  5. Robert,
    I very much enjoyed reading your paper. I am fascinated by the role of music not only in the area of stuttering but also in other areas of speech-language pathology, such as aphasia.

    I’m especially interested in your comment about dystonia. I am currently working with a client who has spasmodic dysphonia, which has been called “stammering of the vocal folds,” and I know SD has been characterized as a focal dystonia of the larynx. Would you explain a bit more about the similarities between stuttering and dystonia?

    Thank you for a thought-provoking paper!

    • Hello Teresa,

      Thank you very much for your reply and question. I myself am unfortunately not an expert on dystonia. However, I had some lessons of a pianist with dystonia and observed some parallels with my own stuttering, especially from a psychological perspective.
      I remember that he once told me that he suffered from stage fright and the high expectations (he thought) other people had of him. When he was preparing for a concert performance, one passage didn’t come out as he wanted and he subsequently became obsessed with getting it right. He said that this was how his dystonia started. The famous Amercian classical pianist Leon Fleisher shares a similar kind of story in his book ‘My nine lives’.

      This is what I also observed with myself and many other PWS: an excessive intolerance and anxiety for any kind of disfluency, mistake, hesitation etc. I don’t know to which extent this holds true for other types of dystonia though.

      If you would like to know more about dystonia and music, check out the work of prof. dr. Eckart Altenmuller. He is an expert on this issue. And about singing/aphasia, you might be interested in this aricle: Racette A, Bard C & Peretz I. (2006). Making non-fluent aphasics speak: sing along! Brain, 129: 2571–2584.

  6. Robert,
    I am a graduate student at Idaho State University and have gained a better understanding of fluency, it’s relationship with the brain and parallels with music after reading your paper, that I had not previously considered. My curiosity had been increased and I have enjoyed the replies and your comments especially. I am interested to find out more about how music can enhance therapy and how it would relate to fluency. I appreciate your time and intense work on this subject.
    Summer
    Idaho State University Graduate Student

  7. Hi Summer,
    Thank you very much for reading my paper and your kind words. In my previous comments that I just posted I explain a bit how music therapy/practice may generally have a positive effect on speech fluency. If you have any particular question, feel free to ask.

  8. Robert,
    Thank you for your thought provoking paper. Being a singer myself I find the connection between speech and music very compelling. I have a question regarding dystonia. I am curious if the individuals you have studied with/read about with dystonia find a difference in a performance with a group vs. solo performances (paralleling, perhaps, choral speech with solo speech)?
    Thank You for your paper.
    Daniel Carnley
    Idaho State University

    • Hello Daniel,

      Thanks for your reply, you bring up a very interesting question! It would indeed be exciting to see what happens when muscians with dystonia play parallel with other musicians. I myself am not sure if this has ever been tested out. There is a video clip on youtube where Leon Fleisher (pianist with dystonia) plays with his wife two pianos, but his hands are not visible, so we can not see whether it has any effect or not. Furthermore, the comparison may not be fully valid because with choral reading you are saying the same words/sentences, while with ensemble playing, you complement and react on each other (this could be in fact even more complex and effortful than solo performance). However, two (or more) people playing in an unisono manner indeed shows many similarities with choral speech, so actually, it would be very interesting to see what happens then.
      Thank you very much for bringing this up!
      Best regards,
      Robert

  9. As a music enthusiast and as a future SLP, I greatly enjoyed your paper. I loved the connections you made about music and stuttering and the struggle that occurs with both. Your mention of how in the majority of cases, stuttering (during speech or at the instrument) is not caused by anxiety or psychological problems, but only triggered or aggravated by it really allowed me a visual onto how anxiety and social circumstances are intertwined with stuttering. Thank you for the time and effort you put into this paper, it was great to hear about the relation of music and stuttering from a PWS and a accomplished and devoted musician.
    Christian Keil
    Idaho State University

  10. Hi Robert,

    I am a Speech-Language Pathology graduate student from Wisconsin and also a fellow pianist. I’ve played piano since second grade, and considered pursuing a music degree in college. The fact that you integrated piano with my current field of study greatly intrigued me. This paper was extremely fascinating and thought-provoking; it resonated with me both as a musician and a future Speech-Language Pathologist.

    Because I speak and understand “the language of music,” I now have a new way of thinking about stuttering. Some of the comparisons that really stood out to me were: communicating musical ideas through the instrument just like communicating language through speech; music and speech both having a clear meter and rhythm, the presence and influence of emotions on music and communication, and how a tone continues to sound and connects with a subsequent tone, just as speech sounds are co-articulated into words. As a musician, these analogies make sense to me, and have given me new insight into stuttering.

    One idea that your paper made me think of is the concept of muscle memory, both in music and speech. I have memorized many musical pieces, but if I don’t keep playing them consistently, I cannot remember the “specifics” of the piece. I only have the muscle memory of where my fingers should go at each part, without my conscious awareness of what I’m playing. Furthermore, when I try to read the sheet music again (after having it memorized at one time), it’s even more difficult to regain the piece. I’ve heard that this is difficult because you’re using different parts of the brain to memorize vs. sight-read. I’m wondering if this sort of muscle-memory phenomenon occurs for speech: if early speech is encoded like a “memorized piano piece,” and when the person tries to retrieve it later on “using site-reading,” there is mismatch in muscle memory which causes dysfluency.

    I’d appreciate your insight into this, from a musical perspective, stuttering, or both. Overall, this paper caused me to think of stuttering in a new way, and the analogies will be well-remembered. Thank you!

    Bethany Bauer
    SLP Graduate Student
    University of Wisconsin

    • Hi Bethany,

      Thank you so much for your contribution and kind words about my paper! You bring up very interesting points about muscle memory and sight-reading. I think that it is true for most people that when memorizing something complex (whether it is a piece of music, a song, a speech or something else), after some time, certain details will sink down into a more subconscious level. Could it be that what you describe as ‘when I try to read the sheet music again (after having it memorized at one time), it’s even more difficult to regain the piece’, refers to some kind of ‘conflict’ between the conscious level (sight-reading) and the subconscious level (muscle memory)?

      The comparison with speech here is interesting. It may not be fully related to what you describe, but some time ago, a musician with extreme (both short- and long-term) memory skills told be about his way of learning and memorizing a piece. “How could you memorize such a big piece so fast?” I asked. “Well, in the beginning I couldn’t do it and I was actually rather slow, but when I start studying a piece, I don’t learn only the notes, but rather visualize and hear everything associated with it (i.e. rhythmical/melodical expression, intonation, mood, harmonical structure, polyphony, finger patterns, arm gestures, etc.)”, he replied.

      This made sense to me. You see, PWS are often concerned with their level of fluency and in stressful speaking situations, all their attention goes usually to this (little) aspect. Training programs mainly directed to ‘increase fluency’ often have only a short-term effect. But, if you are able to see the ‘bigger picture’ and work on all possible aspects involved with speech and communication, progress will initially be much slower, and you might stutter even more in the beginning, but in the end – at least this has been my experience – the results will be much more stable and longer-lasting. So a key feature for me was actually to focus not so much on the fluency itself.

      Just one word more about (sight)reading: this increases my fluency to quite some extent, maybe because I see the whole phrase in front of me and just follow the flow of my eyes and the sound.
      However, when playing the piano, I find it does make a difference if I try to sightread the piece including all details or just the main melodic and harmonic lines; the latter usually goes without struggling. What is your experience?

      Anyway, Thank you again for sharing your insightful response!
      Best regards,
      Robert

  11. Hi Robert,

    I am a second-year graduate student and an aspiring speech-language pathologist. I really enjoyed reading your article. You have clearly put a lot of time, effort, and passion into your work regarding this subject. I am so interested in your ideas about the potential (and likely) connections that exist between music and language, and particularly piano, singing, and stuttering.

    I absolutely love to sing and have been singing for as long as I can remember. Needless to say, that is why the title of your article immediately caught my eye and intrigued me. During the many voice lessons I have taken in the past, however, I could not tell you that I recall even one lesson that involved a focus on the explicit connection between sounds or the notion of continuous airflow. Thank you for introducing the idea of connecting the notes and sounds of a piano to the idea of a more fluid and connected, communicative message.

    I love your explanation of the ‘sound image’ in one of your discussion posts about how you tried to meticulously and cautiously link sound sequences together (both musically and communicatively) in your head to produce a more whole and effortless expression. Your careful planning allowed you to decrease overall tension, which, in turn, led to decreased stuttering. I found your technique to be insightful and creative, and certainly worth trying out with future clients!…(even though it is of course important to remember that every client is an individual and that something that works for one person will not always work for another).

    Recently, in my Fluency Disorders course, we were able to speak with a panel of PWS. It was an incredible experience for me. I loved being able to converse with those individuals and learn about the stories and experiences they had to share. Something that I will never forget from that night was when one man, in particular, decided to share a toast that he had written and memorized for the purpose of his son’s wedding in the coming weeks. Nearly the entire time he spoke during the panel discussion, his disfluencies were quite obvious and involved (notable secondary features), which is why what I’m about to say was so incredible.

    As the panel progressed, he decided to once again share his planned toast with us, only this time, he took out his iPhone and played a sound clip of a metronome rhythm for him to use during his speech. Although the speech he gave earlier during the lecture was the same one as the one he was reading aloud in that moment, the two speeches were drastically different. The first speech was choppy and dysrhythmic and the next speech he gave was performed in such a way that you would never know he was a PWS. It was amazing to me what a pre-recorded metronome beat could do for someone who stutters.
    Was it about pace or lack of nervousness or increased confidence that second time? I’m not really sure, and I don’t really think that he could explain it either, but what I do know was that the technique worked for him to an unbelievable degree.

    I hope that you enjoyed and appreciated that little side story. Thank you for sharing your thoughts and insightful knowledge on this subject. I look forward to learning more from you someday and wish you all the best in your future research.

    Best,
    Cara

    • Hi Cara,

      Thank you a lot for your kind words and sharing your nice story! I agree that it is incredible what music and musical features can do. The (inner) ear seems to be extremely senitive and intelligent.

      I have thought quite a bit why people who stutter can often change so drastically in terms of fluency behavior. I think it may have something to do with ‘context’. I explained this a bit in my previous response to Bethany. Rhythm and music could provide a certain ‘context’ to which it is relative easy to adapt. learning to adapt to a variety of contexts may have a positive impact on PWS long-term.

      Thank you again for your reply!

      All the best,
      Robert

  12. Robert,
    I am a graduate student in speech-language pathology and am currently taking a fluency disorders class. I found your article to be so interesting! I began learning piano at age 8 and always struggled with performing in front of others. My mom used to joke that if she or someone else wanted to listen to me play, they had to do it without me knowing that they were listening. I loved just playing by myself because the pressure to perform was not there. I remember being so excited to learn a new song and wanting to be able to share it with others (but just the way that I had played it when I was by myself). After a few experiences with public performance where my muscles tensed up, my mind froze, and I was unable to remember the next note and move my fingers fluently from key to key, I began to build up this fear of performance. I began to avoid performances as much as possible, only playing once or twice a year for required recitals and dreading the experience to the point of feeling sick. I began to consider myself as a “closet pianist” that played for my own pleasure only. I just learned about the demands and capacities model in class this semester and had not thought about in relation to my own experience with playing the piano. After reading your article and being exposed to this connection between music and stuttering that I had not thought about before, I feel that I have a small taste of insight into the experience of a PWS.
    I have a question about your statement “Interestingly, musicians’ dystonia usually starts relatively late (in contrast to stuttering, which onset is typically very early) and the person may therefore be better able reconstruct the circumstances which may have lead to the disorder.” What changes are you referring to that a musician with dystonia could make and would he/she be able to reverse the disorder? Do you mean techniques for reducing the musician’s anxiety towards performing and creating new positive experiences towards performing, similar to changing the personal construct of a PWS? If you could expand on this statement, I would appreciate your insight!
    Thank you so much for sharing! Best of luck!
    Kristin

  13. Hello Kristin,

    Thank you very much for sharing your experience! Your story about fear of playing in front of others would perhaps parallel with fear of public speaking. If you then feel like ‘having to do the impossible’ (which is to speak fluent for PWS or performing a music piece you you probably do not master completely) in presence of an audience, it can be a dreadful experience.

    About changes that a person with dystonia can make: it would depend of course on the individual, but there is one common thing I seem to see with people with dystonia (although I know only a few quite well) and also some PWS, which is a kind of rigidity or obsessiveness. This is of course not the cause of the disorder, but change can only happen – at least this is what I bevlieve – if you carefully observe your behaviors and analyse what (mostly hidden) intentions, ideas and emotions are underneath those surface behaviors.
    This process can be liberating, after which change will be much more profound and longer lasting. Someone who thinks a bit in a similar way is Joaquin Fabra (for more information, check out his youtube clips where he speaks about his experience and recovery proces: Focal dystonia – understanding and treatment as a emotional condition). His story shows many parallels with experiences of PWS. Although I don’t consider dystonia and stuttering as basically emotional conditions, positive attitude and emotional resiliance are important tools for probably anyone aiming at successful recovery.
    I hope this answers your question a bit. If anything is unclear, please feel free to ask.

    All the best, annd thanks again for sharing your own story!
    Robert

  14. Robert,
    I found it interesting how you mentioned through your personal experiences with music, stuttering and research that “stuttering is not caused by anxiety or psychological problems, but is only aggravated by it” and how you then compared it to some of the similar incidences seen in the music realm with anxiety, stage fright and Focal Dystonia. I agree with your statement with developmental stuttering, in that a lot of what laypersons perceive as “stuttering” is really a culmination of secondary behaviors as well as dysfluencies. It can also be hard to differentiate what is a contributing factor and what is a byproduct. Similar to your mention of concert performances, Caruso, Chodzko, Bidinger and Sommers (1994) also found that the presence of cognitive stress caused higher rates of dysfluencies in PWS than speed stress.
    Through a brief literature review, it appears some of the dysfluencies that can be seen in music can be caused by more stress and perfectionism then dysfluencies during speaking. According to Cochran (2004), it can be more difficult for an individual to become fluent with an instrument, and there can also be a lot of emotional involvement and stress when performing. Cochran (2004) mentioned that most stuttering in music occurs once the individual has met a high level of skill and performance, and rarely occurs in children. With this being said, I think it would be interested to observe more of the social anxieties associated with musical stuttering, and whether the stress levels of the individuals are higher than those of the average person with a developmental stutter. I believe this along with your information provided about neural similarities, similarities in stress levels could help to draw further conclusions about the relationship between dysfluencies in musical performance and in speech. From reading your article and reading up on further research pertaining to stuttering and musical stuttering, it appears to me that you are helping to strengthen the current notions that stuttering is not a single etiology, and that numerous factors contribute, including intrinsic factors and environmental factors (Starkweather & Givens-Ackerman, 1997 p.24).
    Thank you for your interesting article,
    Alexis

    • Hi Alexis,

      Thank you for sharing your thoughtful observations! I agree completely and also experienced myself that cognitive stress can cause higher rates of disfluencies in PWS than speed stress. I believe that when complexity demands increase, fluency mostly decreases.

      I think the observations made by Cochran (I assume you refer to: Cochran “A Comparison of the Behavior and Characteristics of Speech Stuttering with Musical Stuttering (i.e. Valsalva Maneuver) in Brass Playing.” D. M. A. diss., University ofAlabama, 2004) are very interesting and would love to get hold of this document. I would be delighted to read his ideas about muscial stuttering and to compare them with my own. This would definitely be a great source for me to explore further.
      Do you have any idea how to get into contact with dr. M. E. Cochran? I have found his e-mail address on the web but this one is not valid anymore. Maybe you could give me an advice about how to reach the author or university. You can contact me at robertvandevorst@gmail.com

      Thank you in advance for your help and your intelligent response!

      Best wishes,
      Robert

  15. Hi Robert,
    I am a graduate student in Speech-Language Pathology at San Jose State University and I’m currently enrolled in our program’s fluency class. I think it’s fascinating that stuttering is found in areas other than speech. I really appreciated all the examples of musical instruments that you gave and then looked at some more on my own.
    For example, I found a trumpet player who described, “stuttering on the trumpet [when] striking the first note” (Van Riper, 1952, p. 434). The musician said that these blocks happened on the first note of a musical phrase, which is consistent with developmental stuttering patterns occurring primarily at the beginning of words/phrases. His stuttering, however, appeared after he had been playing for 13 years.
    Another case I found was of a flute player who started having 15-30 second blocks at the first note of a song after 6 years of experience (Silverman & Bohlman, 1988). She also described secondary behaviors similar to those associated with developmental dysfluency. These cases made me think about the various types of stuttering (developmental, cluttering, acquired) and their particular characteristics and how each of those may relate to non-linguistic stuttering.
    I am also curious about the difference in musical stuttering among instruments that involve different parts of the body. For example, is stuttering on a trumpet or flute (instruments that use breath, the lips and mouth) different than that on a piano (an instrument without the use of breath, the lips or mouth)? There are motor similarities between speech and playing an instrument with breath (Askill, 1979; Lieberman, 1991), but would you expect the stuttering in non-wind instruments to vary in certain ways?
    Thanks! – Alison

    • Hi Alexis,

      Thank you so much for your comments and questions. The articles you mention are very interesting. Your questions strike me particularly because they resemble very much my own questions I pose in my current research work.

      I am not sure I can give you a reliable answer on the question to which extent ‘stuttering’ on wind instrument maybe similar or different than ‘stuttering’ on a piano, mostly because I have never touched a flute or trumpet myself (I hope to do so in the near future). But I can share you a bit of my own experience with ‘stuttering’ on a piano.

      Already in an early stage, I was playing quite demanding works and noticed a lot of tightness and tension in my fingers (which probably could be compared with the articulators), hands and arms (which probably could be compared to the respiratory system), which caused noticeable irregularity (rhythmically and dynamically) a lack of legato (connecting tones), and a lack of a resonant or ‘singing’ tone quality. I also knew that there were certain passages I just couldn’t play, no matter how much I practiced. On top of that, during practice sessions, I also observed spastic hesitations and even blocks (although the latter happened very rarely). I think that this had something to do with trying to move to fast to the next note (‘the fingers going faster than the mind and ears’).

      However, I also discovered that a clear musical image, taking distance, listing to myself and allowing myself to sing on the instrument caused significant relief, more pleasure in playing, less tension, more control and a nice sound coming out of the instrument. Similar things allow myself to speak (almost) without stuttering as well.

      This encouraged me to explore these matters a bit further. I am very interested in the experiences of wind (and other instrumental) players and how they might relate to my own observations.

      Thank you again for your response and bringing these questions up!

      Best regards,
      Robert

      • Hi Alison,
        Sorry for confusing your name with Alexis (the previous one)!
        Kind regards, Robert

  16. Hello Robert,

    Thank you for your article. As a second year graduate student in speech-language pathology and fellow piano player, I was intrigued by your research. Of particular interest was that there are some “shared neural networks between piano playing, speech, and singing” that may give some insight into the connections between musical fluency and disfluency. I agree that future research about stuttering should not neglect the connections to music as it most certainly has the power to unlock many answers to the questions we crave. I look forward to hearing more about this topic in the future.

    Sincerely,
    Jessica

    • Hello Jessica,
      Thank you a lot for reading my article and sharing your response!
      Best wishes,
      Robert

  17. Hi Robert,
    Thank you for posting this article. As a SLP grad student and former musician, I found it very interesting. One aspect I found particularly intriguing was your discussion of how musicians seem to be able to play passages fine alone, but are unable to do so during a concert. Your conclusion makes sense, that the stressful situation of performing for an audience would cause the weak underlying mechanisms involved to ‘break’ and cause mistakes to occur. I can account for that in my many auditions that weren’t half as good as when I had just practiced 5 minutes previously! I enjoyed how you tied this situation into the causes and provokers of stuttering.
    Thanks!
    Emma

  18. Thank you for an interesting and insightful paper! A couple of short comments – I’ve been interested not only in the relationship of music and stuttering, but also the use of singing in therapy with persons with aphasia. There is even a treatment approach called “melodic intonation therapy”. You also might find it interesting to put the following keywords into scholar.google.com – aphasia +singing.

    Finally, this week there is an online radio program that features some of the songs about stuttering. Information about accessing the program is posted in the ISAD 2013 Around the World section of this conference.

    Judy Kuster

  19. Dear Judy Kuster,
    Thank you so much for your nice words and suggestions!
    About aphasia and singing, I have read an interesting article about it: Racette A, Bard C & Peretz I. (2006). Making non-fluent aphasics speak: sing along! Brain, 129: 2571–2584.
    I believe, generally, that music has a potential for rehabilitation of a number of neurological disorders. Another article which is about the benefits of musical practice (although not specifically linked to neurological disorders): Moreno S & Bidelman G. M. (in press). Understanding neural plasticity and cognitive benefit through the unique lens of musical training. Hearing Research.
    Another interesting article is:
    Piro JM, Ortiz C. (2009).The effect of piano lessons on the vocabulary and verbal sequencing skills of primary grade students. Psychology of Music, 37 (3): 325–347.
    A next step perhaps would be to give a better definition of ‘musical practice’ and to explore which specific ingredients from music and muscial practice are beneficial to each specific (sub)group of people.

    Thank you for the link to the radio program. Thank you also for your tremendous work regarding the website and the online conferences, which have been great sources of knowledge and inspiration for me and many others!

    Kind regards,
    Robert

  20. I enjoyed your article immensely. I am a grad student in my final semester of Speech Language Pathology. One of my areas of interest is AD & pitch modification, and am currently working closely with a singing specialist who incorporates musical scales into her sessions. Would you recommend singing or musical lessons to all types of stuttering or just a specific type of dysfluency?

    Thank you,

    Victoria T.
    Long Island University-Brooklyn

    • Hi Victoria,
      Thank you for your kind words!
      I would recommend music/singing especially to childs, since musical practice seems to have huge benefits for kids (on many levels, not only speech/fluency). However, it is important that the teacher/instructor is knowledgeable in both the areas of stuttering and music(therapy).
      It may also be effective to some extent for adolescents and adults. The aim is not so much to improve fluency (directly), but rather to offer tools which enables one to sound more ‘expressively’. So music, in that sense, could have the capacity to link communication with artistry, with fluency as a beneficial side-effect.

      Of course, the most important thing is that the client, whoever it may be, loves/likes using the tool.

      Best wishes,
      Robert

  21. Hi Robert,
    Thank you for your insightful paper! As many of those, who commented earlier, I am a graduate student if speech pathology and am fascinated by the topic of the correlation between music and language in the brain. My classmates and I are currently working on a research project in which we are investigating the relationship between musical proficiency and ability of a person to imitate accent of a foreign language. I felt that your ideas are related to our topic. We have also used some of the sources you refer to in your paper. Do you have any thoughts regarding our topic?
    I am also taking a fluency course now, so I wanted to ask you which specific techniques or strategies used in therapy (fluency shaping) helped you the most? How can an instrument be used while teaching these strategies?
    Thank you,
    Chana

  22. Hi Chana,

    Thanks for reading and commenting on my article. Your own topic sounds interesting! It wouldn’t surprise me if you would find a correlation between musical proficiency and ability to imitate a foreign accent, since perceptually, musicians show 1) improved language specific abilities including better performance in the identification of lexical tones (Wong, P.C., Skoe, E., Russo, N.M., Dees, T., Kraus, N. (2007). Musical experience shapes human brainstem encoding of linguistic pitch patterns. Nat. Neurosci. 10, 420-422; Lee, C.Y., Hung, T.H. (2008). Identification of Mandarin tones by English-speaking musicians and nonmusicians. J. Acoust. Soc. Am. 124, 3235-3248.) and, 2) a higher sensitivity in detecting timbral changes in speech (Chartrand, J.P., Belin, P. (2006). Superior voice timbre processing in musicians. Neurosci. Lett. 405, 164-167.

    Regarding my own strategies, I am not sure if there was any strategy or factor that was particularly decisive. There are several things I like to do (I think they do not really belong to either fluency shaping or stuttering modification; I think more of it as options and tools to sound more expressive, rather than to be fluent):

    During physical warming up, I do diaphragmatic breathing exercises. For mental preparation, I try to hear and imagine connected syllables and words, sounding expressively, dynamically and rhythmically, quite similar to singing. I also like to improvise with sounds and words and to experiment with my voice.
    During actual speech, I try to stay as calm and as relaxed as possible (both physcially and mentally). I also like to conduct my speech by using elegant hand and arm gestures.
    But most importantly, I try to convey the message in a communicative way and being sincere in my intentions. I always hold myself on to the fact that there is not one good or bad way of speaking. Allowing myself to have multiple options for expression relieves stress a lot for me.

    If you have more questions, let me know; and success with your research activities!

    Robert

    • Thank you for your reply, I will definitely look into the sources you mentioned! We looked at some articles discussing the better language performance(#1) but we didn’t read anything about sensitivity to timbal changes (#2). So thank you for sharing it!
      I wanted to ask if we can use your words and list your article in our bibliography to support our ideas? If yes, what would be the appropriate citation?
      I am also wishing you good luck in your research and in your personal struggles!
      Sincerely,
      Chana
      P.S. Will it be possible to follow up on your research?

  23. Hi Robert,

    I so enjoyed reading your article! I am a graduate student at Idaho State University, studying to become an SLP and I am a serious music lover! I actually grew up playing the piano and still manage to sit down to play every now and then.

    I am fascinated with the connection of music and language. I appreciated your link between fluency of speech and fluency in performance. I remember practicing for recitals and being able to play a piece perfectly and then stumbling over a note and getting tripped up in a performance and feeling totally exposed. I wonder, is that what it feels like for a PWS when they have episodes of disfuency?

    I love the Chopin quote. I love playing his music (in the comfort and safety of my home, where I can stumble about, if need be!), he is one of my favorite composers.

    Thank you again, for your insightful article.

    • Thank you very much for your reply and sharing your experience!
      The example you give is indeed pretty much similar to what a PWS experiences when he/she is able to speak perfectly when being alone and then starts to struggle in front of other people. Especially the feeling of ‘being exposed’ could have a huge impact on PWS and their subsequent thoughts, emotions and behaviors.
      Thanks again for bringing this up.
      Kind regards, Robert

  24. Hi Robert,

    As an future SLP and former singer, I very much appreciated your article! I find the concept of a “singing” way of playing an instrument that creates “a condition for more fluency of execution” very interesting.
    Do you know of any resources on using singing during fluency therapy?

    Thank you,
    Brooke

    • Hi Brooke,

      Thanks for your reply and your question. I don’t know whether it will work for others or not, but this is what I did (and still do from time to time):

      – When preparing to say a (few) sentence(s), I tried to hear them in my mind as if somebody was ‘singing’ them, before I actually started speaking.

      – I actually don’t consider consonants and vowels as subsequent letters and syllables, but rather sounds which initiate very soft and light and then gradually transfer to the next sound. The sounds must really feel ‘connected’, rather than separate units.

      – I conduct the metrum and pulse with my hands. This seems to help to create a sense of continuous flow.

      – and perhaps most important: enjoy the ability to make sounds! make them expressive, exciting, creative and make yourself ethusiastic to share your vocie with others!

      Best wishes,
      Robert

  25. Hi Robert,

    I was very intrigued by the concept of “stammering” on an instrument. Since singing has been found to increase fluency, I was surprised to read about the connection to playing music. As a former vocal performance major and current SLP grad student, this article really made me curious about the neural pathways for stuttering, singing, and playing instruments and how they are connected. Thank you for sharing your experiences!

    Gina
    Idaho State University Graduate Student

  26. Robert,

    Thank you for sharing such an interesting paper. I never before had considered the parallels between musical stuttering and speech stuttering. Do you think deficits in working memory could also possibly affect both musical and speech stuttering?

    Thanks again,

    Laura

  27. Hi Laura,

    Thank you for your reading my paper and your question, which I find very interesting.

    I don’t know very much about the relationship between stuttering and working memory. However, a few months ago, I watched a piano competition online where I was particularly moved by one pianist who displayed an unusual muscial sensitivity and beauty. However, he consistently suffered from memory lapses throughout the whole competition. I later heard an interview with him and he turned out to be a PWS. That made me wonder if a relationship may exist between his stuttering and memory lapses.
    I also suspect my own short-term memory to be slightly inferior compared to others. I think this might definitely be an area to explore further!

    Thank you for sharing this.
    Kind regards,
    Robert

  28. Hi Robert,

    Wow! The way you connected music and stuttering just in the same way that pain and pleasure can be viewed as being two sides of the same coin is just very creative thinking. I also enjoyed how you explained the different fluency enhancing conditions that are used to improve fluency. I can definitely see your point in suggesting that music also be studied to improve fluency. Being Asian I see a lot of parents insist that their children take up a musical instrument in order to further develop their intellect and talents. I know that you probably have a preference for the piano, but what would you suggest as the best instrument for CWS to try an learn? Lastly, would you suggest a PWS to speak in a more musical manner to improve fluency. Personally I really love musicals and wouldn’t mind if people sang around me all the time. Thanks in advance.

    Paul Gutierrez

    • Hi Paul,

      Thanks for your kind words. For CWS, besides singing, I indeed would have a preference for piano, because unlike many other instruments (string instruments, wind instruments, guitar, etc.), piano playing actually feels very natural and easy. Also important is that the teacher has sufficient knowledge not only about the music, but also about how to deal with people who might learn differently.

      The reason why I like to practise speaking expressively and musically is because it feels much more natural and easy. However, the price you have to pay is that it takes quite some mental effort. So if one would be willing to put the work in, I would definitely give it a chance.

      Hope this answers your question.
      Best regards,
      Robert