Metronome Therapy - an accessible, self-directed option for speech therapy

Metronome Therapy - an accessible, self-directed option for speech therapy Hi r/stutter. I'm writing a book that translates the latest peer-reviewed research on stuttering into something a layperson can understand. There is an insane amount of information about stuttering - especially neuroscience! - that hasn't made it's way into the community. Contrary to what you may have heard, we actually know a lot about the causes of stuttering as disorder, and the neurological reasons for stuttered speech. Even more exciting, there has been a lot of research into interventions that increase fluency; not only that, but with modern brain-scanning technology, we can actually see the *why* and *how* behind these interventions. This is an excerpt about metronome therapy, an intervention that's been shown in peer-reviewed studies to increase fluency and create beneficial neuroplastic change. It's cheap and accessible, so anyone with a stutter can put it into action today. I hope it helps your fluency. ​ **Metronome Therapy** Previously, we showed that the human brain has two timing circuits; one internally-driven, the other tuned to external rhythms and cues. The internal timing circuit is compromised in stutterers, as was shown in behavioral experiments^(\[7\]), and from brain scans that showed under-activation of the basal ganglia^(\[4\]). Speech production is a very complex process, both in terms of the neurological processes, and motor execution. The deficit in internal timing disrupts the smooth operation of these processes, causing dysfluency. However, stutterers have a healthy external timing circuit^(\[4\]). This explains why stutterers are significantly more fluent when speaking along to external cues, like a metronome^(\[1\]). In a [2011 study](https://www.sciencedirect.com/science/article/abs/pii/S1053811911005477), Akira Toyomura showed that metronomic speech raised the basal ganglia activation of stutters to levels matching that of fluent speakers. He then took that one step further in a [2015 study](https://www.sciencedirect.com/science/article/abs/pii/S1053811915000385), examining whether a steady regimen of metronomic speech could improve fluency and speech production during self-paced speech. At the end of Toyomura's intervention, all participants - regardless of stuttering severity - had improved fluency during self-paced speech. Brain scans showed their basal ganglia activating at levels commensurate with fluent speakers. The program also lowered activation in the cerebellum, which can be interpreted as less of a need to correct faulty motor commands. These subjects received no instruction on speech technique, nor feedback from Toyomura or a speech therapist, yet the changes to their fluency and neurological speech production were on par with that of an intensive clinical program^(\[3, 6\]). Their speech naturalness was also improved, which is surprising considering that people do not usually speak with metronomic regularity, and because clinical speech therapy usually results in a temporary drop in speech naturalness^(\[5\]). A similar intervention conducted in 1971 by Paul John Brady produced similar gains in fluency, and participants retained their improved fluency at follow-up measurements up to forty-four months after the end of the metronomic regimen^(\[2\]). Toyomura's program is an incredible boon to stutterers, given how simple and accessible it is. Metronomes are relatively cheap, and some websites will perform that function for free. That means any stutterer with an internet connection can start improving their fluency today. ​ **The Program** Participants were tasked with reading aloud to the beat of a metronome for at least fifteen minutes a day, at least five days a week, for eight weeks. Subjects who did more than the minimum saw greater gains. Participants typically started around 90 beats per minute, but sped up over the course of the program, eventually peaking at 120 beats per minute. Participants were given reading material by Toyomura and his team, though the nature of the reading material does not appear to be important. Participants were also coached to think about metronomic speech when they encountered dysfluency in real life. ​ **References** \[1\] [Brady, John Paul. "Studies on the metronome effect on stuttering." Behaviour Research and Therapy 7.2 (1969): 197-204.](https://www.sciencedirect.com/science/article/abs/pii/0005796769900333) \[2\] [Brady, John Paul. "Metronome-conditioned speech retraining for stuttering." Behavior Therapy 2.2 (1971): 129-150.](https://www.sciencedirect.com/science/article/abs/pii/S0005789471800011) \[3\] [De Nil, Luc F., et al. "A positron emission tomography study of short-and long-term treatment effects on functional brain activation in adults who stutter." Journal of fluency disorders 28.4 (2003): 357-380.](https://www.sciencedirect.com/science/article/abs/pii/S0094730X03000597) \[4\] [Etchell, Andrew C., Blake W. Johnson, and Paul F. Sowman. "Behavioral and multimodal neuroimaging evidence for a deficit in brain timing networks in stuttering: a hypothesis and theory." Frontiers in human neuroscience 8 (2014): 467.](https://www.frontiersin.org/articles/10.3389/fnhum.2014.00467/full) \[5\] [Kalinowski, Joseph, et al. "Pretreatment and posttreatment speech naturalness ratings of adults with mild and severe stuttering." American Journal of Speech-Language Pathology 3.2 (1994): 61-66.](https://pubs.asha.org/doi/abs/10.1044/1058-0360.0302.61) \[6\] [Kell, Christian A., et al. "How the brain repairs stuttering." Brain 132.10 (2009): 2747-2760.](https://academic.oup.com/brain/article/132/10/2747/330765?login=true) \[7\] [Max, Ludo, Anthony J. Caruso, and Vincent L. Gracco. "Kinematic analyses of speech, orofacial nonspeech, and finger movements in stuttering and nonstuttering adults." (2003).](https://pubs.asha.org/doi/abs/10.1044/1092-4388%282003/017%29) If you would like to hear more about the book, please visit my profile.