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67-504: The objective of rehabilitation is to cure a patient completely. However, exact goals vary for each person. For instance, someone with a problem in their lungs might get pulmonary rehabilitation so that their breathing becomes better. On the other hand, someone with a spine injury may need physical therapy and rehab to help restrict more damage from happening to their backs. Various types of therapy can be offered at rehabilitation facilities vary: Rehabilitation hospitals were created to meet

134-510: A burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10). Galen 's humoral theories were influential in Europe in the Middle Ages for centuries afterward. In this theory, stuttering was attributed to an imbalance of the four bodily humors —yellow bile, blood, black bile, and phlegm. Hieronymus Mercurialis , writing in the sixteenth century, proposed to redress

201-601: A child has speech delay or disorder as part of a wider health condition. The Children's Commissioner for England reported in June 2019 that there was a postcode lottery ; £291.65 a year per head was spent on services in some areas, while the budget in some areas was £30.94 or less. In 2018, 193,971 children in English primary schools were on the special educational needs register needing speech-therapy services. Speech and language therapists work in acute settings and are often integrated into

268-493: A clinical doctorate in speech–language pathology, PhD , or EdD . Many approaches exist to assess language, communication, speech and swallowing. Two main aspects of assessment can be to determine the extent of breakdown (impairment-level), or how communication can be supported (functional level). When evaluating impairment-based level of breakdown, therapists are trained to use a cognitive neuropsychological approach to assessment, to precisely determine what aspect of communication

335-494: A family history of stuttering. There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties. For some people who stutter, congenital factors may play a role. In others, there could be added impact due to stressful situations. However there is not evidence to suggest this as a cause. Less common causes of stuttering include neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after

402-447: A negative self-concept and self-image. People who stutter may project their own attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program. The impact of discrimination against stuttering can be severe. This may result in fears of stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being

469-549: A perceived need for facilities which were less costly on a per diem basis than general hospitals but which provided a higher level of professional therapies such as speech therapy , occupational therapy , and physical therapy than can be obtained in a "skilled nursing care" facility. In the United States , rehabilitation hospitals are designed to meet the requirements imposed upon them by the Medicare administration, and to bill at

536-521: A possible target of bullying or discrimination, or feeling pressured to hide stuttering. In popular media, stuttering is sometimes seen as a symptom of anxiety, but there is no direct correlation in that direction. Alternatively, there are those who embrace stuttering pride and encourage other stutterers to take pride in their stutter and to find how it has been beneficial for them. Stuttering can co-occur with other disabilities. These associated disabilities include: The cause of developmental stuttering

603-464: A profession took different paths in the various regions of the world. Three identifiable trends influenced the evolution of speech-language pathology in the United States during the late 19th century to early 20th century: the elocution movement, scientific revolution, and the rise of professionalism. Groups of "speech correctionists" formed in the early 1900s. The American Academy of Speech Correction

670-686: A shared forum within which they can access resources and support from others facing the same challenges of stuttering. Among ages 3–5, the prognosis for spontaneously recovery is about 65% to 87.5%. By 7 years of age or within the first two years of stuttering, and about 74% recover by their early teens. In particular, girls are shown to recover more often. Prognosis is guarded with later age of onset: children who start stuttering at age 3½ years or later, and/or duration of greater than 6–12 months since onset, that is, once stuttering has become established, about 18% of children who stutter after five years recover spontaneously. Stuttering that persists after

737-543: A significant negative cognitive and affective impact on the person who stutters. Joseph Sheehan described this in terms of an analogy to an iceberg, with the immediately visible and audible symptoms of stuttering above the waterline and a broader set of symptoms such as negative emotions hidden below the surface. Feelings of embarrassment , shame , frustration , fear , anger , and guilt are frequent in people who stutter, and may increase tension and effort. With time, continued negative experiences may crystallize into

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804-904: A speech disfluency exists, and (2) assess if its severity warrants concern for further treatment. During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech ( Riley's Stuttering Severity Instrument Fourth Edition (SSI-4) ). They might also employ

871-491: A stroke) and psychogenic stuttering (stuttering related to a psychological condition). Auditory processing deficits were proposed as a cause of stuttering due to differences in stuttering for deaf or Hard of Hearing individuals, as well as the impact of auditory feedback machines on some stuttering cases. Some possibilities of linguistic processing between people who stutter and people who do not has been proposed. Brain scans of adult stutterers have found greater activation of

938-425: A test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future. Stuttering is a multifaceted, complex disorder that can impact an individual's life in

1005-472: A variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of

1072-574: Is variable , which means that in certain situations the stuttering might be more or less noticeable, such as speaking on the phone or in large groups. People who stutter often find that their stuttering fluctuates, sometimes at random. Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. People who stutter may have reactions, avoidance behaviors, or secondary behaviors related to their stuttering that may look like struggle and tension in

1139-471: Is a healthcare and academic discipline concerning the evaluation, treatment, and prevention of communication disorders , including expressive and mixed receptive-expressive language disorders , voice disorders , speech sound disorders , speech disfluency , pragmatic language impairments, and social communication difficulties, as well as swallowing disorders across the lifespan. It is an allied health profession regulated by professional bodies including

1206-418: Is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak. "Developmental stuttering" is stuttering that has on onset in early childhood, i.e. when a child is learning to speak. About 5-7% of children are said to stutter during this period. Despite its name, the onset itself is often sudden. This type of stutter may persists after the age of seven, which

1273-454: Is a paid service with more availability. Speech–language pathologists work with clients and patients who may present with a wide range of issues. In the US, some children are eligible to receive speech therapy services, including assessment and lessons through the public school system. If not, private therapy is readily available through personal lessons with a qualified speech–language pathologist or

1340-586: Is advised that children with SLCN can and should be actively involved as equal partners in decision-making about their communication needs. Building these skills is especially crucial for SLPs working in settings related to traditional education. SLPs conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions. Experimental, empirical, and scientific methodologies that build on hypothesis testing and logical, deductive reasoning have dominated research in speech-language pathology. Other types of research in

1407-477: Is also growing as an avenue to bring treatment into the home. In the UK, children are entitled to an assessment by local NHS speech- and language-therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly. If treatment is appropriate, an educational plan will be drawn up. Speech therapists often play a role in multi-disciplinary teams when

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1474-441: Is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type. Finally, "psychogenic stuttering", which is less than 1% of all stuttering conditions, may also arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous:

1541-415: Is classified as "persistent stuttering". "Neurogenic stuttering" (stuttering that occurs secondary to brain damage, such as after a stroke) and "psychogenic stuttering" (stuttering related to a psychological condition) are less common and classified separately from developmental. "Neurogenic stuttering" typically appears following some sort of injury or disease to the central nervous system. Injuries to

1608-539: Is complex. It is thought to be neurological with a genetic factor. Various hypotheses suggest multiple factors contributing to stuttering. There is strong evidence that stuttering has a genetic basis. Children who have first-degree relatives who stutter are three times as likely to develop a stutter. In a 2010 article, three genes were found by Dennis Drayna and team to correlate with stuttering: GNPTAB , GNPTG , and NAGPA . Researchers estimated that alterations in these three genes were present in 9% of those who have

1675-450: Is impaired. Some therapists use assessments that are based on historic anatomical models of language, that have since been shown to be unreliable. These tools are often preferred by therapists working within a medical model, where medics request a 'type' of impairment, and a 'severity' rating. The broad tools available allow clinicians to precisely select the aspect of communication that they wish to assess. Because school-based speech therapy

1742-493: Is no cure for stuttering, several treatment options exist and the best option is dependent on the individual. Therapy should be individualized and tailored to the specific and unique needs of the client. The speech–language pathologist and the client typically work together to create achievable and realistic goals that target communication confidence, autonomy, managing emotions and stress related to their stutter, and working on disclosure. Self-help groups provide people who stutter

1809-522: Is performed earlier. Another area of collaboration relates to auditory processing disorders , where SLPs can collaborate in assessments and provide intervention where there is evidence of speech, language, and/or other cognitive-communication disorders. SLPs work in a variety of clinical and educational settings. SLPs work in public and private hospitals , private practices, skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, hospice , and home healthcare. SLPs may also work as part of

1876-430: Is present in every culture and in every race, although the attitude towards the actual prevalence differs. Some believe stuttering occurs in all cultures and races at similar rates, about 1% of general population (and is about 5% among young children) all around the world. A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children. Different regions of

1943-443: Is run under state guidelines and funds, the process of assessment and qualification is more strict. To qualify for in-school speech therapy, students must meet the state's criteria on language testing and speech standardization. Due to such requirements, some students may not be assessed in an efficient time frame or their needs may be undermined by criteria. For a private clinic, students are more likely to qualify for therapy because it

2010-770: Is that speech–language pathology is restricted to the treatment of articulation disorders (e.g., helping English-speaking individuals enunciate the traditionally difficult r ) and/or the treatment of individuals who stutter but, in fact, speech–language pathology is concerned with a broad scope of speech, language, literacy, swallowing, and voice issues involved in communication, some of which include: Primary pediatric speech and language disorders include: receptive and expressive language disorders , speech sound disorders , childhood apraxia of speech (CAS), stuttering , and language-based learning disabilities . Speech-language pathologists (SLPs) work with people of all ages. Swallowing disorders include difficulties in any phase of

2077-407: Is the ability to speak two languages. Many bilingual people have been exposed to more than one language since birth and throughout childhood. Since language and culture are relatively fluid factors in a person's understanding and production of language, bilingualism may be a feature that impacts speech fluency. There are several ways during which stuttering may be noticed in bilingual children including

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2144-574: The American Speech-Language-Hearing Association (ASHA) and Speech Pathology Australia. The field of speech-language pathology is practiced by a clinician known as a speech-language pathologist ( SLP ) or a speech and language therapist (SLT) . SLPs also play an important role in the screening, diagnosis, and treatment of autism spectrum disorder (ASD), often in collaboration with pediatricians and psychologists . The development of speech-language pathology into

2211-551: The MDT in multiple areas of speciality for neonatal, children and adult services. Areas include but not limited to; neonatal care, respiratory, ENT, gastrointestinal, stroke, Neurology,ICU, oncology and geriatric care Creutzfeldt–Jakob disease Stutter Stuttering , also known as stammering , is a speech disorder characterized externally by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses called blocks in which

2278-399: The United States have begun to use this service model. Children with speech, language, and communication needs (SLCN) are particularly at risk of not being heard because of communication challenges. Speech-language pathologists (SLPs) can explain the significance of supporting communication as a tool for the child to shape and influence choices available to them in their lives, even though it

2345-435: The age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery. The lifetime prevalence , or the proportion of individuals expected to stutter at one time in their lives, is about 5–6%, and overall males are affected two to five times more often than females. As seen in children who have just begun stuttering, there is an equivalent number of boys and girls who stutter. Still,

2412-543: The body. Almost 80 million people worldwide stutter, about 1% of the world's population. Stuttering is not connected to the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress do not cause stuttering, but they may trigger increased stuttering in people who have the speech disorder, and living with a stigmatized disability can result in anxiety and high allostatic stress load . Neither acute nor chronic stress, however, itself creates any predisposition to stuttering. The disorder

2479-485: The body. These could range anywhere from tension in the head and neck, behaviors such as snapping or tapping, or facial grimacing. These behavioral reactions are those that might not be apparent to listeners and only be perceptible to people who stutter. Some people who stutter exhibit covert behaviors such as avoiding speaking situations, substituting words or phrases when they know they are going to stutter, or use other methods to hide their stutter. Stuttering could have

2546-420: The brain and spinal cord, including cortex, subcortex, cerebellum, and even the neural pathway regions. It may also be called "acquired stuttering" and it may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and

2613-595: The danger of bleeding to death and their failure to stop stuttering. Less drastically, Jean Marc Gaspard Itard placed a small forked golden plate under the tongue in order to support "weak" muscles. Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone , a conclusion he came to via autopsy . Blessed Notker of St. Gall ( c.  840 – 912), called Balbulus ("The Stutterer") and described by his biographer as being "delicate of body but not of mind, stuttering of tongue but not of intellect, pushing boldly forward in things Divine,"

2680-418: The disfluency is produced, described as a moment of "anticipation" - where the person who stutters knows which word they are going to stutter on. The sensation of losing control and anticipation of a stutter can lead people who stutter to react in different ways including behavioral and cognitive reactions. Some behavioral reactions can manifest outwardly and be observed as physical tension or struggle anywhere in

2747-571: The field are complemented by qualitative research. In the United States, speech–language pathologists must hold a master's degree from an ASHA-accredited program. Following graduation and passing a nation-wide board exam, SLPs typically begin their Clinical Fellowship Year, during which they are granted a provisional license and receive guidance from their supervisor. At the end of this process, SLPs may choose to apply for ASHA's Certificate of Clinical Competence and apply for full state licensure. SLPs may additionally choose to earn advanced degrees such as

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2814-415: The following. It was once believed that being bilingual would 'confuse' a child and cause stuttering, but research has debunked this myth. Stuttering may present differently depending on the languages the individual uses. For example, morphological and other linguistic differences between languages may make presentation of disfluency appear to be more or less depending on the individual case. Because of

2881-407: The growing field of telepractice. Teleconferencing tools such as Skype are being used more commonly as a means to access remote locations in private therapy practice, such as in the geographically diverse south island of New Zealand. More at-home or combination treatments have become readily available to address specific types of articulation disorders. The use of mobile applications in speech therapy

2948-462: The imbalance by changes in diet, reduced libido (in men only), and purging . Believing that fear aggravated stuttering, he suggested techniques to overcome this. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century. Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman emperor Claudius was initially shunned from

3015-410: The individual and information about the individual's background, through a case history. The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents. The overall goal of assessment for the SLP will be (1) to determine whether

3082-494: The individual client's needs. For example, the treatment for patients with cleft lip and palate often requires multidisciplinary collaboration. Speech–language pathologists can be very beneficial in helping resolve speech problems associated with cleft lip and palate. Research has indicated that children who receive early language intervention are less likely to develop compensatory error patterns later in life, although speech therapy outcomes are usually better when surgical treatment

3149-426: The influence of the works of Wendell Johnson , who claimed that the onset of stuttering was connected to the cultural expectations and the pressure put on young children by anxious parents, which has since been debunked. Later studies found that this claim was not supported by the facts, so the influence of cultural factors in stuttering research declined. It is generally accepted by contemporary scholars that stuttering

3216-476: The neurotransmitter dopamine . It was once thought that forcing a left-handed student to write with their right-hand caused stuttering due to bias against left-handed people , but this myth died out. Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed speech–language pathologist (SLP). Diagnosis of stuttering employs information both from direct observation of

3283-659: The patient is deemed to require a certain level of therapies. If a positive determination is made, a report concerning the patient's needs will be sent to the rehabilitation hospital, which has the discretion to admit or not admit the patient. If the patient is transferred to the rehabilitation hospital, his/her medical records and a recommended treatment plan will be transmitted with the patient. The treatment plan will include daily therapies except on weekends. Some rehabilitation hospitals have physicians on staff; others do not. Speech therapy Speech–language pathology (a.k.a. speech and language pathology or logopedics )

3350-473: The person by the speaking situation. Demands may be increased by internal factors or inadequate language skills or external factors. In stuttering, severity often increases when demands placed on the person's speech and language system increase. However, the precise nature of the capacity or incapacity has not been delineated. Stress, or demands, can impact many disorders without being a cause. Another theory has been that adults who stutter have elevated levels of

3417-442: The person who stutters is unable to produce sounds. According to adults who stutter, however, stuttering is defined as a "constellation of experiences" expanding beyond the external disfluencies that are apparent to the listener. Much of the experience of stuttering is internal and encompasses experiences beyond the external speech disfluencies, which are not observable by the listener. The moment of stuttering often begins before

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3484-424: The provision of advice regarding management, intervention, and treatment, and providing counseling and other followup services for these disorders. Services are provided in the following areas: Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional issues. A common misconception

3551-401: The public eye and excluded from public office. In and around eighteenth and nineteenth century Europe, surgical interventions for stuttering were recommended, including cutting the tongue with scissors, removing a triangular wedge from the posterior tongue, and cutting nerves, or neck and lip muscles. Others recommended shortening the uvula or removing the tonsils . All were abandoned due to

3618-454: The rates allowed by Medicare for such a facility. Medicare allows a lifetime total of 100 days' stay in a rehabilitation hospital per person. A rehabilitation hospital can only be accessed following a stay as an inpatient in a general hospital which has lasted for a certain number of days. The general hospital will evaluate the patient to determine if the patient will benefit from rehabilitation services. A positive determination will be made if

3685-405: The right hemisphere, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed. The 'capacities and demands model' has been proposed to account for the heterogeneity of the disorder. Speech performance varies depending on the 'capacity' that the individual has for producing fluent speech, and the 'demands' placed upon

3752-485: The sex ratio appears to widen as children grow: among preschoolers, boys who stutter outnumber girls who stutter by about a two to one ratio, or less. This ratio widens to three to one during first grade, and five to one during fifth grade, as girls have higher recovery rates. the overall prevalence of stuttering is generally considered to be approximately 1%. Cross-cultural studies of stuttering prevalence were very active in early and mid-20th century, particularly under

3819-471: The speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)). Clinical psychologists with adequate expertise can also diagnose stuttering per the DSM-5 diagnostic codes. The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However,

3886-560: The specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms fluency and disfluency . Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies"). This type of disfluency

3953-453: The stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker. Other disorders with symptoms resembling stuttering, or associated disorders include autism , cluttering , Parkinson's disease , essential tremor , palilalia , spasmodic dysphonia , selective mutism , and apraxia of speech . While there

4020-411: The support structure in the education system, working in both public and private schools , colleges , and universities. Some SLPs also work in community health, providing services at prisons and young offenders' institutions or providing expert testimony in applicable court cases. Following ASHA's 2005 approval of the delivery of speech/language services via video conference or telepractice, SLPs in

4087-593: The swallowing process (i.e., oral, pharyngeal, esophageal), as well as functional dysphagia and feeding disorders . Swallowing disorders can occur at any age and can stem from multiple causes. SLPs collaborate with other health care professionals, often working as part of a multidisciplinary team. They can provide information and referrals to audiologists , physicians , dentists , nurses , nurse practitioners , occupational therapists , rehabilitation psychologists , dietitians , educators , behavior consultants ( applied behavior analysis ), and parents as dictated by

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4154-449: The unusual-sounding speech that is produced and the behaviors and attitudes that accompany a stutter, it has long been a subject of scientific interest and speculation as well as discrimination and ridicule. People who stutter can be traced back centuries to Demosthenes , who tried to control his disfluency by speaking with pebbles in his mouth. The Talmud interprets Bible passages to indicate that Moses also stuttered, and that placing

4221-631: The world are researched unevenly. The largest number of studies has been conducted in European countries and in North America, where the experts agree on the mean estimate to be about 1% of the general population. African populations, particularly from West Africa, might have the highest stuttering prevalence in the world—reaching in some populations 5%, 6% and even over 9%. Many regions of the world are not researched sufficiently, and for some major regions there are no prevalence studies at all. Bilingualism

4288-459: Was born and grew up with a stutter" in her 1941 book I was Winston Churchill's Private Secretary . She related one example, "'It's s-s-simply s-s-splendid,' he stuttered—as he always did when excited." Louis J. Alber, who helped to arrange a lecture tour of the United States, wrote in Volume 55 of The American Mercury (1942) that "Churchill struggled to express his feelings but his stutter caught him in

4355-556: Was founded in 1925, which became ASHA in 1978. Speech-language pathologists (SLPs) provide a wide range of services, mainly on an individual basis, but also as support for families, support groups, and providing information for the general public. SLPs work to assess levels of communication needs, make diagnoses based on the assessments, and then treat the diagnoses or address the needs. Speech/language services begin with initial screening for communication and/or swallowing disorders and continue with assessment and diagnosis, consultation for

4422-496: Was invoked against stammering. A royal Briton who stammered was King George VI . He went through years of speech therapy, most successfully under Australian speech therapist Lionel Logue , for his stammer. The Academy Award-winning film The King's Speech (2010) in which Colin Firth plays George VI, tells his story. The film is based on an original screenplay by David Seidler , who also stuttered until age 16. Another British case

4489-447: Was that of Prime Minister Winston Churchill . Churchill claimed, perhaps not directly discussing himself, that "[s]ometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience ..." However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him. His secretary Phyllis Moir commented that "Winston Churchill

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