And we will go now for the next speaker
from Mexico, Dr.
Gina Chavez.
She's an EMT specialist for Newt fanatics,
a director of the Fanatics and Audiology Center in Mexico City,
and the current president of Colegio Medical Theater.
She was awarded a fellowship, a special government
invitation at the Charity Hospital University.
Aleksander von Humboldt Berlin in Germany.
Over the years, she has been invited to present conferences, courses
and workshops in different cities of Mexican Republic, US,
Canada, Brazil, Venezuela,
Argentina, Egypt, China, Korea,
India, Turkey, Italy, Germany, Austria,
Czech Republic, France, Spain, Portugal, Holland and Belgium.
Her research publications include Respiratory and Food
Allergies, Environmental Pollution in direct surgery
for singers, voice, care, singing, voice and voice pathology.
And today, she will be talking about children's stuttering.
Welcome, Dr.
Eugenia Chavez.
It's a pleasure to have you here with us.
Thank you very much.
The the Philly Ballet, it's it's for me, an honor
to share with these distinguished audience and distinguished colleagues
and speakers as to to have these 15 year
anniversary of the university, then national discussion and stands
here and also congratulate us for the first international symposium.
So I'm going to share a screen with you,
and I shall make my presence
so it's as I said,
it's wonderful to be with you
in this international symposium because as we have heard
for the last speakers, the common
human communication is very important
and the scientists and the therapists and the music
school teachers and the teachers themselves, well,
everybody is very interested in knowing more about
what is happening in the human communication world.
So I'm going to talk and I thank you very much for this theme.
I'm going to talk about stuttering in children and teenagers.
Well, this is a very interesting theme.
Because as we know, there are many causes that can develop
this problem in children, teenagers, and of course, adults.
Now, I'm going to talk about children and teenagers.
And the causes are genetic, cause we know neurogenic
stress induced environment,
but the exact cause of stuttering is unknown.
That's why we are thinking of a multifactorial causes.
The incidence, as we know in the international publications,
is higher in males and females.
And you read your ranking is to come up three
to one, and the highest is five, five,
two to one.
But as we know from many ulcers, some have made
the research like Andrews and collaborators.
70% of this is stuttering pathology
is caused by genetic diversity.
And like Susan said,
we have a family position
of five to 15% of the members of the family
when we have in our family this this problem.
So the family predisposition is there.
That's why it is very important that the pediatricians and of course,
the parents are very aware of
what's happening with their children.
Like Graham Professor Graham said
some minutes ago.
So it's very important to be careful
and to take care of our own children.
The normal population, according to kids in us,
it's about 5% of the normal population presenting stuttering.
But also, there are some studies that are showing that
the linkage to chromosome nine and the women to chromosome
21 is a very important issue.
There have been many research over the years
and they have found, for example, according to the to Katherine Newman,
that these structural abnormalities lift atmospheric speech
more to announce the auditory literacy collation.
So it's it is going to be
problematic thing.
But there have been also many is studies
like the inclusion of sensor imaging by
Navy can diminish fractional anisotropy of diffusion
representing in the tongue and the larynx indicating that we have
associated figures pathways in
not in a very proper way functioning
and also the impurity adiposity through an emissions tomography.
Having and looking for changes in these kind of patients
and the background as we know that we have extensive neuro
functional correlation of stuttering patients in front and prefrontal
in areas of our speech
motor planning execution in speech, arbitrary limbic
and in some other areas of our brain.
And as we know, for example, the issue in this
kind of problems is stuttering
speech fluency inducing measures are reduced
with the cerebral activation
and and the increase in the right
atmospheric activations in motor language regions.
Are persistent.
So that is a in, in simple words
that we are having at this imbalance, an imbalance in the production
of the cerebral activity in in these patients.
And also, this is interesting that
a group note this, that in this increase activation
among stutterers, they also observe that the
silent
inner speaking is also more active.
So this is quite interesting.
And of course, due to the
and thanks to the researchers and all the groups that are working
so hard in these in these researchers and analyzes,
we found that this imbalance
we find more activation of the motor regions in the primary areas
but also in the supplementary motor areas.
So that can bring us to explain
why these kind of patients can have more problems.
So in this schema,
I want to emphasize that we have
in these patients predisposition from the birth,
but also in the first four years of the language development,
we can have triggering mechanism that can bring the
the child to unstable and chronic conditions
and that can bring us to a worse problem due to stop doing
the speech signs as we know.
And it is in the literature
and everybody knows about that is that this fluency speech
without issues in rhythm,
with the repetitions of sound syllables
and words, prolongation and sometimes of sounds
and also interruptions in speech
blocking the fluency as we know, they can also have a process
and they can use a word or sentence as expression, for example,
or things like that.
And for example, in the examination,
we do use these kind of.
Intermediate
to do.
This kind of examination.
And also we use and those copies, as you see here,
in order to examine properly
all all the structures that are so important by the human communication,
not only voice but also speech and of course, language.
Another signs that we find in these in
these patients are the breathing difficulties
and these plastic movements of tongue and pharynx.
But also, as we see here, we can have
a ventricular flow problem.
For example, in this this child
that we are having all these hard boiled beginning.
And as we know in this resonance from the
our wonderful
friends, Professor Bednarek sent from Freiburg.
We do know that the breathing is a very important
function in all these patients.
Also, some signs that we have to examine.
It's not only the near
bell tongue and larynx, but also ear, nose and throat,
because we do have this spastic movements,
but also we can have many problems, for example, in the nose
that is avoiding to have a proper breathing through the nose.
And that means that the oral respiration
that these kind of children stutter is stutters and children have
they can be worse when we have no problems like we see here,
we examine all these details
because sometimes if you only think about language and speech,
you are not thinking about complete diagnosis.
For example, respiratory allergies, as you see here in this scan,
we can have serious problems.
We can have other noise problems.
And of course, strawberry needs hypertrophy.
That means that all these very important plays
for a proper breathing of the children is not correct.
And that's why you cannot have a proper breathing
and you are making more
and more problems to a correct speech
in these kind of patients in their hearing problems.
Are also very important to be examined,
not only when they are born
with the auto emissions and and also electrocardiography,
but also with hearing test that you can perform
since two years old with all of your in front of the tree.
And also depending on the edge of your patient,
you can examine the central processing
of the outer tube perception.
And of course, in children after four years old,
you can also make different examination of the auditory perception
because the discrimination memory and how does the child
receive the information
through hearing sense with noise background.
Is this important?
And now, as we know, there are many pathological behaviors.
We do know from these so wonderful in presentation
is repeated by our dearest professor, Johansson said
with the recordings from when they reached the extent that have ruined it
that the speech is a very complex
a function where you have different
kind of movements and very complicated movements.
As you see here in this wonderful
this kind of resonance is is built
and I blinks tremors of the lips
movements of the of the face abnormal breathing movements,
most of them of legs and fists clenching
are also very
frequent signs in these doctors, patients.
And we can have the trigger mechanism.
For example, when when the patient is speaking
before a group, that is, of course, when the child is going to the school
or is in a social group face to face
habitually now with the teenagers
because he or she are speaking to other persons.
So they don't feel safe.
Their self-esteem is very low,
but also they don't feel safe
when they are talking for example, on the telephone.
They don't see the person, what they hear or do voice of the other persons,
or even when they send a message and they don't have any communication
with other person, they have this trigger mechanism.
So it is also important to see other pathologies
like oral breathing, as I say, snoring.
Even this the the very young
children, they can have this kind of tubular
that it is not
allowing the person, the child to breathe properly.
And also the firing can be implemented.
We have to think about the food allergies
because of the very, very close contact from the digestive
esophagus to the vocal cords and to disrupt.
And the risk factors as we know, are in these
three areas emotional, social and of course, proximity.
But there are also automatic mechanisms
that can be examined, like, for example, singing reading,
memorizing
paragraphs like poems or speaking in unison.
So we can examine these mechanisms, but also
we can work with this mechanism as we see here.
For example, with this,
he can use
to make some exercises that you hear now
in E community.
And dissipating
that.
It is indeed, indeed
interesting.
So we use these strategies in the therapy for example, in speech
therapy is very important to have rhythm in breathing.
What also we exercise
breathing with sounds, which syllables with the words
we use, different programs we use, of course, very interesting
and abstract for materials for for the children.
And very important we make hearing therapy
even though the hearing examination is good and bad,
we need to emphasize the alternative memory and also the
this creaminess version of the time, the differences between consonants
with similar articulatory point with similar articulatory mode.
And in this sequential
I would be more in memory and also in the noise environmental.
In we in our clinic we perform a lot of masking exercises
that the means that we take away with cotton or with at least once
we take away the sound and this is interesting
because we gave to the children
for some other strategies in order to be sure of what they are.
Speaking of class, we are making a lot of the other virtual therapy
and we're in this hearing therapy.
We use music dancing movements, body movements by rhythm, for example.
We use dynamic it
dynamics and routines
in order to make language structure because we have now
this just as many other groups in the world that if you are
all the time with a consciousness about language structure,
then you forget about the quality and the movements of the body.
So if you makes movements of the body
with the language structure, it's going to help.
That child doesn't pay so much attention of the way
he is speaking, but he's also learning
what of course, we have to take care of the language structure.
As you see here,
we give a lot of senior names and antonyms and of course,
we have also these articulation therapy with the different
views that you have
here, because as we know, for example, the carpet
chairs are in Spanish and there and in some other languages,
the the very explosive consonants
that can make also the problems by stuttering exercises
like low voice, long and loud in three years.
Of lower light, legato speaking, special rate
speech fluency, naturalness.
This is also very important in all of these exercises.
And in our group, in our patients,
we design a methodology according to the age of the child.
And of course, the situation in the social area,
in the emotional area, and we use many biofeedback.
We use different kind of programs.
And of course we are in our group.
We have also psychologists that they can begin to make
and this is a distraction to stuttering events.
And sometimes, for example, there and far later
they propose that the therapist and the psychologist and also the
the parents, they try to do in order
that the child doesn't feel alone in their own stuttering.
And this can help a lot to the child that they don't feel
they are different
and they are like in their bullying situation in the school
because the mystification from stuttering is also a very
important issue in this psychological and medical treatment.
And of course, he tests he
or she the the child has to be as relaxed
as possible and also in a relaxed atmosphere.
That is why many times we need to make also a family
therapy session with the group in order to
to give some
emotional support to the child.
There are also some other treatments like biofeedback with different
there is hearing and they and different stimulations
hypnosis also and also programs to communicate and treat
the psychological treatment for teenagers in what is more complicated.
Of course, teenagers need also all the support
that I said before for children,
but also they need a psychological treatment
because the psychological reactions
of the teenagers are different than for the children because of the age.
And these are ones and situations that they are dealing with.
And because they don't have the self-esteem that we have been
putting all this time, so they have the psychologist,
they have to emphasize joy for speaking in this teenager
in self-confidence, isolation, and of course, corrective
corrective experience is making
that they don't feel as taboo teenagers
because the groups of the teenagers are sometimes very aggressive,
as we know.
So the methods that they usually use are this is a vicious
method knowledge management, permission to work.
And we have to to
to think about the communication skills
because as we know, this kind of problem
is a communication problem is not only speech,
it is also the way of sending the message.
So the quality of life is quite is affected
by these stuttering problems.
And they can affect, of course, job labor opportunities
and financial woes.
And in this study made in 2014
they measure many of these situations of the quality of life
and they found a very high level
of problems in this group.
So the emotional disturbances in general,
the untreated clear helplessness.
So they are suffer they are not only not active in the short
term group or family group, but they are suffering.
And that's why some of the limitations in the personal,
social and occupational and the personal experiences are very bad.
And the main problems in the teenager are depression.
Guilt and anxiety.
And of course, these strategies for the psychologist
I are to to talk about avoiding conversion
in many situations because if you know your symptoms, they say, no,
I prefer not to speak, not communicate because I'm going to do it
in a wrong way and everybody's going to laugh at me.
So they are becoming shy
and and they are often withheld from social gathering.
And this is also frustrating because of the situation,
because they don't have the ability to express their anger
in an open seat, in an open situation, as we usually try to do.
The social feedback is sometimes very difficult to deal with.
So they are nervous and since and sometimes they are looking
at the family or friends reaction because they they feel great.
You act when they are stuttering
that they are impacting the group and this is described
as an impairment or disability so depression
strategies can be avoidance behavior, changeable speech behavior.
But if we go and tell them
I mean, we the group that is treating
and the family also that they need
more linguists structure and self-awareness
so the reason for this speech process is going to be very good.
And of course, depression possibility in the school
is to talk of low articulation
and the psychological factor of making aware and dismantle
the problems the conclusion as medical treatment is, of course,
to take
care of all the multidisciplinary group
we have different medical fellows like neurologist or psychiatrist.
Of course, the very important anthropological group
with speech therapist or local Buddhist
or with music therapist and of course also the
that a single therapy group that it is important.
But in this kind of patients, the family contribution is crucial.
The school support is very, very important and the patient needs
to be aware that he or she needs help
but she are going to succeed at last.
And in many research it is shown, for example, with such
when you when you get that the effective therapy
can reorganize the alternative communication
between all the areas of the speech mothers and auditory regions.
That's why I emphasize very much auditory regions
and of course many of the year greetings.
When you see that it is
a level of love was LA musical in working the love of God?
I believe that is a group to the faculty of education
and of course many, many great things for the 50 years.
I never say they never see them as another because you are here
and happy life with world boys they are all over the places and
and of course in Mexico we are having since 2000 every year
so still in our 22 years
there was Boise which has grass.
Yes easily see that is.
It which has grass.
Yes yes.
Thank you very much for your wonderful presentation.
I just have a question for you
that you know and that there's these papers
about melodic chant therapy for people with aphasia.
Do you think that including singing in these sessions
we the stuttering children were being potent and
I guess the earlier the intervention the best the results, right?
Yes. Yes, I agree completely with you, obviously.
But because as we know, we have a rhythm in music
and singing and the melodic therapy is helping a lot.
So I think these all these contribution to the
to the body and to the knowledge, another rhythm that we usually have
is going to give more awareness and more self-esteem to the patients.
And even though the the child is a very young child,
let's say two or three years old, we need to use these
these tools are very important for the development
of of all of the connections between the different parts of the brain.
And because of the neuroplasticity that this is it
small children are having.
We need to emphasize that even though where, for example,
we are making hearing stimulation in languages simulation
also in a normal developed children also if they don't
they do not have any any predisposition
in the family for stuttering because as we know,
the development of the language and of the speech in these very early
times, of the children is very important to have this stimulation
once again.
Eugenia, thank you very much for your presentation.
And then you have a wonderful day there in Mexico.