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Talking to Cris Muirhead of Searcy, Ark., it's easy to understand why the 38-year-old man who stutters has spent most of his adult life out of earshot.
''It's very frustrating,'' he says. ''Sometimes you go to a rah-rah-rah-rah-rah-rah . . . ''
His voice turns into a mechanical warble like a CD player that is stuck. Muscle spasms in his throat pump out bursts of air as he tries to will his vocal cords to defeat electrical impulses from his brain. The signals are to blame for the biological short-circuit that is largely a medical mystery.
Waiting for a person who stutters to finish delivering a thought can be awkward. There is a temptation to finish the sentence. But from the perspective of the person who stutters, interrupting is rude.
'' . . . rah-rah-rah-rah-restaurant and try to place your order,'' he continues with complete fluency. ''The waitress tries to finish your sentence for you, but that is not what you want. That's insulting.''
Muirhead's wife, Crystal, has watched in silence for years as her husband drank sodas and ate food he didn't want. But as one of 3 million Americans who stutter, takeout food is the least of his problems.
The bigger issue for Muirhead has been his livelihood. He has mostly worked in silence -- in a factory making dental bridges, in the fields with animals or in a truck hauling manure and fertilizer to golf courses.
''Normally, people who stut-stut-stut-stut-stut-stutter work in jobs where they don't have to talk to the public much,'' he says.
A tiny, hearing-aid-like device called Speech-Easy that fits inside Muirhead's ear changed his life in 2003. Muirhead now works as an emergency medical technician and is studying to be a paramedic. Lives depend on his ability to communicate with strangers in an emergency, and he's able to do that now.
SpeechEasy does not cure stuttering, but it has allowed him to go from verbally tripping on 85 of 100 words to struggling with fewer than 10 out of 100. ''It's such a big difference,'' he says. ''Things I thought I could not do, now I'm actually doing them.''
People helped by this kind of device are something of a medical mystery. A study is being launched this week by the Stuttering Foundation of America to try to determine why some benefit and others do not. The study could help scientists understand stuttering and allow therapists to better predict who might benefit.
SpeechEasy, manufactured by Janus Development Group of Greenville, N.C., is one of several similar models on the market, but it is different from others because of technological and cosmetic advantages.
Worn in the ear, the prosthetic device echoes the speaker's own words at a slight delay and different pitch. Other small devices either echo words at a delay or change the pitch, but only SpeechEasy does both and fits inside the ear.
The delayed echo causes what is known as the choral effect. Research has shown that when people who stutter sing or speak in unison with others, they become more fluent.
''Until recently, this has not been available in small devices,'' says Peter Ramig, a professor at the University of Colorado-Boulder who specializes in stuttering research and treatment. He has fitted patients with the SpeechEasy. ''Now this very tiny device is helpful for some people.''
The manufacturer says one-third of the people who try the SpeechEasy are helped significantly, and another third are helped somewhat.
Doctors don't know exactly why this kind of device works, because they don't yet know the neurological roots of stuttering. Scientists are using brain scans to try to pinpoint its origins, but progress has been slow, in part because spending for stuttering research has not been as robust as for deadly diseases.
Working out the problems
Balancing the testimonials for SpeechEasy are drawbacks that independent researchers and company-supported scientists are working to fix:
* The device echoes all voices and sounds, so users often must turn theirs down in noisy rooms or while others are talking during meetings.
* Some have reported that the device became less effective over time, although they appear to be in the minority.
* The $4,500 cost keeps many people from trying the device. The Stuttering Foundation found last year that 85% of those who requested information about SpeechEasy and similar devices decided against the purchase because of the expense and the possibility that insurance won't cover it.
The cost also is a factor in the Stuttering Foundation's decision to study why some people benefit more than others.
''We don't want people to needlessly spend money on something that doesn't work,'' says Jane Fraser, foundation president. She said the foundation is eager to finance a study that has ''even a vague chance of telling us who might benefit from this technology.''
Experts say speech therapy is the best solution for most people, especially when started in childhood.
''The people who want to be fitted with the Speech-Easy are the more severe cases,'' Ramig says. ''They haven't been helped by therapy.''
Most people who stutter begin before age 5. Boys are more likely to stutter than girls. And more than half of preschool-age children who stutter, especially girls, will outgrow the problem, though doctors cannot predict which ones will.
''We feel we can pull children out of stuttering if we get to them early,'' says Ramig, a speech therapist. ''The harder a child tries not to stutter -- the more they try to conceal it -- that is a red flag. The tension is becoming greater.''
When a person stutters, the tension builds in two ways. Emotionally, they feel embarrassed and frustrated. Physically, the muscles in and around the throat tense up, and the air that would carry the sound out of their mouth is literally choked off.
''People who stutter are teased and bullied a great deal during their lifetime,'' says Ramig, who overcame severe stuttering after serving in the Marine Corps in the Vietnam War. ''Then, the more you try to run from stuttering, the more the muscles tense up.''
Speech therapists help children increase their normal speech by teaching one or more strategies to minimize the stuttering. Like slowing down. Or starting a sentence with a different kind of breath.
For adults, understanding the vocal mechanics that interfere with speech helps the person avoid linguistic pitfalls. The therapy focuses on teaching the person to confront the stuttering and control how he or she enters into a troublesome word. It also teaches how to release that word with less tension and struggling.
Which treatment works best often depends on how long the person has been stuttering. Long struggles with stuttering can lead to speech habits that are deeply rooted and more difficult to break.
''Stuttering is an emotional danger,'' Ramig says. ''The body reacts with the fight-or-flight response.''
People who stutter have average to above-average intelligence, research has shown. Famous people who overcame their stuttering problems include Winston Churchill, author John Updike and actor James Earl Jones.
Dreams of being an actress
Julie-Ann Briggs, 15, of Canajoharie, N.Y., mostly tries to overcome her stuttering problem without relying on the SpeechEasy that her grandmother bought for her.
''My mother is always begging me to put it in,'' says Briggs, who was fitted with the device in May 2003. ''It was a fairly dramatic moment. I went from staccato to total fluency immediately.''
But Briggs, who wants to be a professional actress, says she wears the device for the most part only when on stage to avoid stuttering her lines. During her day-to-day activities, she says, she doesn't mind drawing a few stares. ''I live in a very small town, a very ru-ru-ru-rural town,'' she says. ''If I stutter, I don't mind laughing at it, and if my friends laugh at it I don't care, but if somebody who is not my friend laughs, that is extremely offensive.''
She says some days are, without warning, more of a struggle than others. ''It's hard not to feel sorry for myself,'' she says. '' 'Why me? Why did this happen to me?' I do get down on myself sometimes. But I don't let it stop me.''
Muirhead could barely say his name without stuttering. When he first wore the SpeechEasy, his wife Crystal says, ''I remember just sitting there crying. He said our address without stuttering. He said his place of birth and his date of birth. It was very dramatic.
''I had never heard my husband say a whole sentence without stuttering,'' says Crystal, an emergency room nurse.
When they first met online, Muirhead confessed that he had a stuttering problem. But at their first date, Crystal says she was ''not at all prepared for how bad it was. There was a moment where I thought, 'What am I doing here?,' '' she says. ''What did I get myself into?'' But, she said, his sweet nature and kindness made him a keeper.
Muirhead still struggles with vowels and any word that begins with the sound of a W. But even when rousted from bed in the middle of the night for a medical emergency, he can communicate with strangers and give them the medical care they need.
''Nor-nor-nor-nor-nor-nor-normally if I am talking to patients I try to concentrate real close to my speech so it does-does-does-does-doesn't cause a problem,'' he says. ''You can t-t-t-t-t-t-t-t-tell the SpeechEasy is not p-p-p-p-p-p-perfect. But it's night and day to me.''
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