Rumbling - A Still Little Researched Flow Disorder

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Rumble

According to the current opinion of the professional world, rumbling is a flow disorder that can have a strong impact on interpersonal communication. Affected people speak irregularly quickly and / or not according to the norm. Rumbling often occurs in childhood, usually gets worse during puberty and remains a lifelong unpleasant companion for those affected. However, you can learn to live better with it and alleviate symptoms.

In contrast to stuttering, rumbling has been relatively little researched. It is also difficult to distinguish from stuttering at first glance. There is hardly any evidence (scientific evidence) for the causes, diagnosis or therapy. Here you will find an overview of the current state of knowledge according to evidence-based guidelines.

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• What is rumbling?
• What are the causes of rumbling?
• How is the diagnosis of rumbling made?
• How is rumination treated?
• Whom can I ask?
• How are the costs going to be covered?

What is rumbling?

Affected people speak irregularly, alternating between normal pace and very rapid speaking. In the process of speaking, words that have already been formed in thought are continuously inserted into the sentences in advance and sometimes cut off. There are no normal speaking pauses. Syllable stress and speaking rhythm are not fluent. Syllables, words or parts of sentences are repeated. Words and sentences are broken off. The language appears "slurred" and indistinct. For example, sound sequences are simplified, syllables are omitted or contracted. Depending on the everyday situation, the symptoms can be different. Affected people can be severely impaired in terms of comprehensibility and communication skills.

What are the causes of rumbling?

Why it comes to rumbling in the end has not been scientifically clarified. Theories assume that there are disturbances in the coordination between processes in the brain and the speaking apparatus or that the perception and control of temporal processes is disturbed. Among other things, there is a discrepancy between the speed of thinking and the conversion of thoughts into speech movements. Genetic causes cannot be ruled out either. Unfavorable developmental conditions in childhood can encourage the development of this flow disorder. The rumbling can also be caused by a neurologically emerging disease (e.g. after a traumatic brain injury).

How is the diagnosis of rumbling made?

Signs of rumbling

Rumbling cannot be recognized by a single characteristic. It is quite a complex flow disorder. The following symptoms can occur:

• Fast, irregular speaking

• Not fluent speaking:

  • Repetition of syllables, words and parts of sentences or sounds
  • Insertion of sounds or syllables (e.g. "uh") or recurring phrases (e.g. "somehow stop")
  • Sentence and word breaks
• Try to correct what is said as you speak
• Noticeable sound formations that are incomprehensible
• Monotonous speech, unusual intonations
• Grammatical errors, poor vocabulary, difficulty finding words
• Missing structure of what has been said in order to express it clearly
• Digression from speech content
• Disturbances of attention
• Disturbances in perception and processing of what is heard
• Lack of speech control
• Lack of or inadequate awareness of the existing fluency of speech (those affected often do not notice that the interlocutor does not understand them)
• Speaking anxiety, on the other hand, usually only occurs with a combination of rumbling and stuttering
• Bumpy alternation between listening and speaking in a dialogue
• Reading / writing difficulties

Note Some of the symptoms mentioned can also occur with other speech disorders. Organic diseases are also a possible cause. Therefore, the complaints should be clarified thoroughly.

For the diagnosis of rumbling, at least one of the following core symptoms should be present:

• high and / or unusual speaking speed,
• abnormal sound formation, indistinct speech,
• Abnormalities in the language content.

Diagnosis

The diagnosis is made by a specialist in ear, nose and throat medicine and phoniatrics, as well as by speech therapists. The child's development as well as the medical history (anamnesis) are asked. A special anamnesis questionnaire is also available for this (according to Sick). An initial screening for cluttering can be done using the Predictive Cluttering Inventory (PCI). It is recommended to take speech samples using audio and video recordings. The patient should speak spontaneously for at least ten minutes, read something out loud, retell something and write down a text. The so-called Fluency Assessment Battery is also used. Special measurements of the language as well as the recording of perception and feelings are carried out. Rumbling is coded in the ICD-10 with the number F98.6. It is important to distinguish rumbling from stuttering, although there are also mixed forms.

The so-called ICF model provides a good basis for diagnosis and treatment planning. It includes body functions and structures (e.g. fluency, speed, etc.), reading, writing as well as environmental factors (family, school) and personality.

How is rumination treated?

The therapy is based on the individual situation and usually combines different treatment approaches. It aims to improve the clarity of sound formation and syllable pronunciation, the control of the speaking speed and the improvement of the linguistic design. As a result of these measures, speaking fluency usually improves by itself. The reduction of possible stress from rumbling and effects on psyche, social life, quality of life and activity are also essential. Personal therapy goals are defined. Affected persons or their parents / guardians are informed and advised in detail about rumbling, therapy, relapses and how to cope with them. It is important to be able to practice at home and in the living environment (e.g. school).

Therapy includes:

• Working directly on the rumble through various methods - primarily through speech therapy. Work is done on the way those affected speak and / or on a specific event. For example, expressing your thoughts more slowly and with concentration. This is done for example through breathing technique, role play, reading training, retelling, expressive aid through gestures / facial expressions, etc. So-called fluency shaping strategies for changing speech and the modification of bumpy speech components have proven particularly effective.
• Even audio and video technology can be used for analysis. In addition, accompanying symptoms are dealt with: change in attitude to speaking, various changes in behavior, self-assessment, etc.
• Treatment of any underlying diseases or disorders: e.g. developmental delays, neurological diseases.
• Including the environment: The social environment (parents, legal guardians, school etc.) is essential for therapy or development. In addition to advice and guidance, practice at home is important. The implementation of what has been “worked out” in everyday situations is also part of the therapy.
• Self help.

Whom can I ask?

Contact points are - depending on the age of the person affected and the health situation - above all:

• Specialist in paediatrics and adolescent medicine
• Specialist in ENT (specialization in phoniatrics)
• Speech therapist

The family doctor can arrange examinations and initiate referrals. The following may also be involved in the diagnosis and therapy process:

• Neurologist
• (Child) psychiatrist
• Clinical psychologist
• Psychotherapist

Diagnosis and treatment are partly carried out in special departments of clinics, e.g. for phoniatrics and speech therapy as well as hearing, voice and language disorders.

How are the costs going to be covered?

The costs of a visit to a doctor for clarification as well as therapeutic measures are normally covered by the social security agencies.