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Theys C, Jaakkola E, Melzer TR, De Nil LF, Guenther FH, Cohen AL, Fox MD, Joutsa J. Localization of stuttering based on causal brain lesions. Brain 2024; 147:2203-2213. [PMID: 38797521 PMCID: PMC11146419 DOI: 10.1093/brain/awae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 05/29/2024] Open
Abstract
Stuttering affects approximately 1 in 100 adults and can result in significant communication problems and social anxiety. It most often occurs as a developmental disorder but can also be caused by focal brain damage. These latter cases may lend unique insight into the brain regions causing stuttering. Here, we investigated the neuroanatomical substrate of stuttering using three independent datasets: (i) case reports from the published literature of acquired neurogenic stuttering following stroke (n = 20, 14 males/six females, 16-77 years); (ii) a clinical single study cohort with acquired neurogenic stuttering following stroke (n = 20, 13 males/seven females, 45-87 years); and (iii) adults with persistent developmental stuttering (n = 20, 14 males/six females, 18-43 years). We used the first two datasets and lesion network mapping to test whether lesions causing acquired stuttering map to a common brain network. We then used the third dataset to test whether this lesion-based network was relevant to developmental stuttering. In our literature dataset, we found that lesions causing stuttering occurred in multiple heterogeneous brain regions, but these lesion locations were all functionally connected to a common network centred around the left putamen, including the claustrum, amygdalostriatal transition area and other adjacent areas. This finding was shown to be specific for stuttering (PFWE < 0.05) and reproducible in our independent clinical cohort of patients with stroke-induced stuttering (PFWE < 0.05), resulting in a common acquired stuttering network across both stroke datasets. Within the common acquired stuttering network, we found a significant association between grey matter volume and stuttering impact for adults with persistent developmental stuttering in the left posteroventral putamen, extending into the adjacent claustrum and amygdalostriatal transition area (PFWE < 0.05). We conclude that lesions causing acquired neurogenic stuttering map to a common brain network, centred to the left putamen, claustrum and amygdalostriatal transition area. The association of this lesion-based network with symptom severity in developmental stuttering suggests a shared neuroanatomy across aetiologies.
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Affiliation(s)
- Catherine Theys
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Brain Research Institute, 8011 Christchurch, New Zealand
| | - Elina Jaakkola
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, 20014 Turku, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Tracy R Melzer
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Brain Research Institute, 8011 Christchurch, New Zealand
- Department of Medicine, University of Otago, 8011 Christchurch, New Zealand
- RHCNZ—Pacific Radiology Canterbury, 8031 Christchurch, New Zealand
| | - Luc F De Nil
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Frank H Guenther
- Departments of Speech, Language and Hearing Sciences and Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander L Cohen
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, 20014 Turku, Finland
- Turku PET Centre, Neurocenter, Turku University Hospital, 20014 Turku, Finland
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Neumann Y. A case study of bilingual neurogenic stuttering: Measures of fluency, emotion, and articulation rate. JOURNAL OF COMMUNICATION DISORDERS 2024; 107:106385. [PMID: 38065050 DOI: 10.1016/j.jcomdis.2023.106385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION This study explores the features of bilingual neurogenic stuttering and the potential connection between emotion and articulation rate on speech disfluencies. METHOD The participant is a 59-year old, Yiddish-English bilingual male with a moderate non-fluent aphasia. Thirty-two narratives (16 in each language), elicited using cue words, were analyzed for frequency of disfluency, type of disfluency (stuttering vs. non-stuttering-like), word-type (content vs. function), within-word location of disfluency, and occurrence of accessory behaviors. Additionally, the percentage and type of emotion (positive vs. negative) expressed, and articulation rate (fluent syllables spoken/duration of fluent utterances) was assessed. RESULTS Disfluency occurred in each language with approximately equal frequency. The most common stuttering-like disfluencies were repetitions (monosyllabic, sound, and syllable) and prolongations. The most common non-stuttering-like disfluencies were self-correction/revisions, phrase and multisyllabic word repetitions, and pauses (silent and filled). In both languages, disfluencies occurred on both content and function words, but primarily content words, and in any position of the word, although primarily initial position. No accessory behaviors were noted. There was a similar amount of emotion words used in each language although the first acquired language, L1/Yiddish, had an overall more positive tone, and his second acquired language, L2/English, had a more negative tone. Additionally, there was a negative relationship between emotion and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English. A faster articulation rate was found in his native and more proficient language, Yiddish, than English. There was a negative relationship between articulation rate and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English. CONCLUSIONS Cross-linguistics differences for emotion and articulation rate demonstrates that these aspects impact on fluency and contributes to the disfluencies in each language. Clinical implications of the study demonstrates the importance of assessment of bilingual (i.e., proficiency and dominance) and fluency features of each language in the diagnostic process and the significance of considering emotional processes and articulation rate as part of a comprehensive intervention plan for acquired stuttering.
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Affiliation(s)
- Yael Neumann
- Associate Professor, Director of the Undergraduate Program in Communication Sciences & Disorders, Department of Linguistics & Communication Disorders, Queens College, City University of New York, 65-30 Kissena Boulevard, Queens, NY 11367, United States.
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Saez-Calveras N, Tran N, Tran C, Upadhyaya P. Episodic stuttering as the presenting manifestation of acute ischemic stroke: A case report and systematic literature review. J Stroke Cerebrovasc Dis 2023; 32:107271. [PMID: 37516023 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature. CASE PRESENTATION We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex. SYSTEMATIC LITERATURE REVIEW We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution. CONCLUSION Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.
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Affiliation(s)
- Nil Saez-Calveras
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Memorial Hospital, Dallas, TX, USA.
| | - Nguyen Tran
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Memorial Hospital, Dallas, TX, USA.
| | - Conny Tran
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Memorial Hospital, Dallas, TX, USA.
| | - Parth Upadhyaya
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Memorial Hospital, Dallas, TX, USA.
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Gooch EA, Horne K, Melzer TR, McAuliffe MJ, MacAskill M, Dalrymple‐Alford JC, Anderson TJ, Theys C. Acquired Stuttering in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:956-966. [PMID: 37332649 PMCID: PMC10272914 DOI: 10.1002/mdc3.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Background Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new-onset stuttering is limited. Objectives To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease. Method Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function. Results Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P < 0.01). 21% of people with Parkinson's disease (n = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading (P < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset (P < 0.01), higher levodopa equivalent dosage (P < 0.01), and lower cognitive (P < 0.01) and motor scores (P < 0.01). Conclusion One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis.
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Affiliation(s)
- Eloïse A. Gooch
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
| | | | - Tracy R. Melzer
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Megan J. McAuliffe
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- Te Kāhu Roro Reo, New Zealand Institute of Language, Brain and BehaviourUniversity of CanterburyChristchurchNew Zealand
| | - Michael MacAskill
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - John C. Dalrymple‐Alford
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Tim J. Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
- Neurology DepartmentChristchurch Hospital, Te Whatu Ora Health New ZealandChristchurchNew Zealand
| | - Catherine Theys
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Te Kāhu Roro Reo, New Zealand Institute of Language, Brain and BehaviourUniversity of CanterburyChristchurchNew Zealand
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Frankford SA, Cai S, Nieto-Castañón A, Guenther FH. Auditory feedback control in adults who stutter during metronome-paced speech I. Timing Perturbation. JOURNAL OF FLUENCY DISORDERS 2023; 75:105943. [PMID: 36423506 PMCID: PMC9974758 DOI: 10.1016/j.jfludis.2022.105943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study determined whether adults who stutter (AWS) exhibit deficits in responding to an auditory feedback timing perturbation, and whether external timing cues, which increase fluency, attenuate any disruptions due to altered temporal auditory feedback. METHODS Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with normal pacing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback timing perturbation was applied, and timing responses were compared between groups and pacing conditions. RESULTS Both groups responded to the timing perturbation by delaying subsequent syllable boundaries, and there were no significant differences between groups in either pacing condition. Furthermore, no response differences were found between normally paced and metronome-paced conditions. CONCLUSION These findings are interpreted as showing that 1) AWS respond normally to pure timing perturbations, and 2) metronome-paced speech has no effect on online speech timing control as assessed in the present experiment.
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Affiliation(s)
- Saul A Frankford
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Shanqing Cai
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA; Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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Furlanis G, Busan P, Formaggio E, Menichelli A, Lunardelli A, Ajcevic M, Pesavento V, Manganotti P. Stuttering-Like Dysfluencies as a Consequence of Long COVID-19. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:415-430. [PMID: 36749838 DOI: 10.1044/2022_jslhr-22-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection. METHODS AND RESULTS Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery. CONCLUSIONS It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Italy
| | - Alina Menichelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Alberta Lunardelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, Italy
| | - Valentina Pesavento
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
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The Expansion of the Spectrum in Stuttering Disorders to a Novel ARMC Gene Family ( ARMC3). Genes (Basel) 2022; 13:genes13122299. [PMID: 36553564 PMCID: PMC9778410 DOI: 10.3390/genes13122299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Stuttering is a common neurodevelopment speech disorder that negatively affects the socio-psychological dimensions of people with disability. It displays many attributes of a complex genetic trait, and a few genetic loci have been identified through linkage studies. Stuttering is highly variable regarding its phenotypes and molecular etiology. However, all stutters have some common features, including blocks in speech, prolongation, and repetition of sounds, syllables, and words. The involuntary actions associated with stuttering often involve increased eye blinking, tremors of the lips or jaws, head jerks, clenched fists, perspiration, and cardiovascular changes. In the present study, we recruited a consanguineous Pakistani family showing an autosomal recessive mode of inheritance. The exome sequencing identified a homozygous splice site variant in ARMC3 (Armadillo Repeat Containing 3) in a consanguineous Pashtun family of Pakistani origin as the underlying genetic cause of non-syndromic stuttering. The homozygous splice site variant (NM_173081.5:c.916 + 1G > A) segregated with the stuttering phenotype in this family. The splice change leading to the skipping of exon-8 is a loss of function (LoF) variant, which is predicted to undergo NMD (Nonsense mediated decay). Here, we report ARMC3 as a novel candidate gene causing the stuttering phenotype. ARMC3 may lead to neurodevelopmental disorders, including stuttering in humans.
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G D, B H S, Gajbe U, Singh BR, Sawal A, Balwir T. The Role of Basal Ganglia and Its Neuronal Connections in the Development of Stuttering: A Review Article. Cureus 2022; 14:e28653. [PMID: 36196326 PMCID: PMC9525748 DOI: 10.7759/cureus.28653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
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Differences in implicit motor learning between adults who do and do not stutter. Neuropsychologia 2022; 174:108342. [PMID: 35931135 DOI: 10.1016/j.neuropsychologia.2022.108342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022]
Abstract
Implicit learning allows us to acquire complex motor skills through repeated exposure to sensory cues and repetition of motor behaviours, without awareness or effort. Implicit learning is also critical to the incremental fine-tuning of the perceptual-motor system. To understand how implicit learning and associated domain-general learning processes may contribute to motor learning differences in people who stutter, we investigated implicit finger-sequencing skills in adults who do (AWS) and do not stutter (ANS) on an Alternating Serial Reaction Time task. Our results demonstrated that, while all participants showed evidence of significant sequence-specific learning in their speed of performance, male AWS were slower and made fewer sequence-specific learning gains than their ANS counterparts. Although there were no learning gains evident in accuracy of performance, AWS performed the implicit learning task more accurately than ANS, overall. These findings may have implications for sex-based differences in the experience of developmental stuttering, for the successful acquisition of complex motor skills during development by individuals who stutter, and for the updating and automatization of speech motor plans during the therapeutic process.
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Motor speech disorders in the nonfluent, semantic and logopenic variants of primary progressive aphasia. Cortex 2021; 140:66-79. [PMID: 33933931 DOI: 10.1016/j.cortex.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Motor speech disorders (MSDs) are characteristic for nonfluent primary progressive aphasia (nfvPPA). In primary progressive aphasia (PPA) of the semantic (svPPA) and of the logopenic type (lvPPA), speech motor function is considered typically intact. However, knowledge on the prevalence of MSDs in svPPA and lvPPA is mainly based on studies with a priori knowledge of PPA syndrome diagnosis. This fully blinded retrospective study aims to provide data on the prevalence of all types of MSDs in a large sample of German-speaking patients with different subtypes of PPA. METHOD Two raters, blinded for PPA subtype, independently evaluated connected speech samples for MSD syndrome and severity from 161 patients diagnosed with nfvPPA, svPPA or lvPPA in the database of the German Consortium of Frontotemporal Lobar Degeneration (FTLDc). In case of disagreement, a third experienced rater re-evaluated the speech samples, followed by a consensus procedure. Consensus was reached for 160 patients (74 nfvPPA, 49 svPPA, 37 lvPPA). MAIN RESULTS Across all PPA syndromes, 43.8% of the patients showed MSDs. Patients with nfvPPA demonstrated the highest proportion of MSDs (62.2%), but MSDs were also identified in svPPA (26.5%) and lvPPA (29.7%), respectively. Overall, dysarthria was the most common class of MSDs, followed by apraxia of speech. In addition, we identified speech abnormalities presenting as "syllabic speech", "dysfluent speech", and "adynamic speech". DISCUSSION Our study confirmed MSDs as frequently occurring in PPA. The study also confirmed MSDs to be most common in patients with nfvPPA. However, MSDs were also found in substantial proportions of patients with svPPA and lvPPA. Furthermore, our study identified speech motor deficits that have not received attention in previous studies on PPA. The results are discussed against the background of the existing literature on MSDs in PPA, including theoretical considerations of the neuroanatomical conditions described for each of the different subtypes of PPA.
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Alm PA. Streptococcal Infection as a Major Historical Cause of Stuttering: Data, Mechanisms, and Current Importance. Front Hum Neurosci 2020; 14:569519. [PMID: 33304252 PMCID: PMC7693426 DOI: 10.3389/fnhum.2020.569519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 12/02/2022] Open
Abstract
Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.
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Affiliation(s)
- Per A. Alm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Chang SE, Guenther FH. Involvement of the Cortico-Basal Ganglia-Thalamocortical Loop in Developmental Stuttering. Front Psychol 2020; 10:3088. [PMID: 32047456 PMCID: PMC6997432 DOI: 10.3389/fpsyg.2019.03088] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023] Open
Abstract
Stuttering is a complex neurodevelopmental disorder that has to date eluded a clear explication of its pathophysiological bases. In this review, we utilize the Directions Into Velocities of Articulators (DIVA) neurocomputational modeling framework to mechanistically interpret relevant findings from the behavioral and neurological literatures on stuttering. Within this theoretical framework, we propose that the primary impairment underlying stuttering behavior is malfunction in the cortico-basal ganglia-thalamocortical (hereafter, cortico-BG) loop that is responsible for initiating speech motor programs. This theoretical perspective predicts three possible loci of impaired neural processing within the cortico-BG loop that could lead to stuttering behaviors: impairment within the basal ganglia proper; impairment of axonal projections between cerebral cortex, basal ganglia, and thalamus; and impairment in cortical processing. These theoretical perspectives are presented in detail, followed by a review of empirical data that make reference to these three possibilities. We also highlight any differences that are present in the literature based on examining adults versus children, which give important insights into potential core deficits associated with stuttering versus compensatory changes that occur in the brain as a result of having stuttered for many years in the case of adults who stutter. We conclude with outstanding questions in the field and promising areas for future studies that have the potential to further advance mechanistic understanding of neural deficits underlying persistent developmental stuttering.
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Affiliation(s)
- Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Radiology, Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Frank H. Guenther
- Department of Speech, Language and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
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Penttilä N, Korpijaakko-Huuhka AM, Kent RD. Disfluency clusters in speakers with and without neurogenic stuttering following traumatic brain injury. JOURNAL OF FLUENCY DISORDERS 2019; 59:33-51. [PMID: 30641458 DOI: 10.1016/j.jfludis.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/01/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Analyze the characteristics and rate of disfluency clusters in adults with and without neurogenic stuttering after traumatic brain injury (TBI). METHOD Twenty adults with TBI participated in this study, including 10 with neurogenic stuttering (Group B) and 10 without -stuttering (Group A). Disfluency clusters in speech samples were classified into three types: Stuttering-like (SLD), other (OD), and mixed (MIX). RESULTS Speakers with and without neurogenic stuttering produced the same mean number of disfluency clusters. In addition, the mean length of clusters did not differ between these speaker groups although the longest clusters did. The most frequently occurring cluster type for people with neurogenic stuttering was MIX and OD for people without stuttering. Although the speakers in Group A produced stuttering-like disfluencies, these never occurred together to form a SLD type cluster. For Group B, the starter units of the clusters were usually stuttering-like disfluencies, while for Group A, the starter units were mostly interruptions. CONCLUSIONS Compared to non-stuttering speakers, stuttering after TBI did not increase the number of clusters, but rather lengthened them. In speakers with neurogenic stuttering, the number and length of clusters were related to the manifestation of other communication deficits, not to the frequency of stuttering-like disfluencies. Still, SLD clusters occurred only in those people with neurogenic stuttering. These findings raise questions about the nature of both neurogenic stuttering and the dynamics of disfluency clustering.
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Affiliation(s)
- Nelly Penttilä
- Faculty of Social Sciences, University of Tampere, 33610 Tampere, Finland.
| | | | - Raymond D Kent
- Waisman Center, University of Wisconsin-Madison, 53705 Madison WI, United States
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Max L, Kadri M, Mitsuya T, Balasubramanian V. Similar within-utterance loci of dysfluency in acquired neurogenic and persistent developmental stuttering. BRAIN AND LANGUAGE 2019; 189:1-9. [PMID: 30593859 DOI: 10.1016/j.bandl.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/08/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
Although the underlying neural mechanisms remain unknown for both persistent developmental stuttering (PSD) and acquired neurogenic stuttering (ANS), few studies have examined similarities/differences between these two disorders. We evaluated in both PDS (n = 35) and ANS (n = 5) phonetic, word class, word length, and word position variables that are widely believed to influence at which loci within utterances PDS speakers' stuttering is most likely to occur. For both groups, (a) word weights based on the combination of variables were greater for stuttered vs. fluent words, and (b) stuttered words were loaded more by individual variables. However, contrary to long-standing views regarding PDS, greater loading for stuttered words was not found for the position variable. Findings suggest similar loci of stuttering in adults with PDS and ANS, and, for both groups, the probability of stuttering on a given word was more influenced by motor production variables than language variables.
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Affiliation(s)
- Ludo Max
- University of Washington, Seattle, WA, USA; Haskins Laboratories, New Haven, CT, USA.
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15
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Kearney E, Guenther FH. Articulating: The Neural Mechanisms of Speech Production. LANGUAGE, COGNITION AND NEUROSCIENCE 2019; 34:1214-1229. [PMID: 31777753 PMCID: PMC6880942 DOI: 10.1080/23273798.2019.1589541] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/21/2019] [Indexed: 05/19/2023]
Abstract
Speech production is a highly complex sensorimotor task involving tightly coordinated processing across large expanses of the cerebral cortex. Historically, the study of the neural underpinnings of speech suffered from the lack of an animal model. The development of non-invasive structural and functional neuroimaging techniques in the late 20th century has dramatically improved our understanding of the speech network. Techniques for measuring regional cerebral blood flow have illuminated the neural regions involved in various aspects of speech, including feedforward and feedback control mechanisms. In parallel, we have designed, experimentally tested, and refined a neural network model detailing the neural computations performed by specific neuroanatomical regions during speech. Computer simulations of the model account for a wide range of experimental findings, including data on articulatory kinematics and brain activity during normal and perturbed speech. Furthermore, the model is being used to investigate a wide range of communication disorders.
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Affiliation(s)
- Elaine Kearney
- Department of Speech, Language, and Hearing Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215
- Department of Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129
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Dinoto A, Busan P, Formaggio E, Bertolotti C, Menichelli A, Stokelj D, Manganotti P. Stuttering-like hesitation in speech during acute/post-acute phase of immune-mediated encephalitis. JOURNAL OF FLUENCY DISORDERS 2018; 58:70-76. [PMID: 30220403 DOI: 10.1016/j.jfludis.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Neurogenic stuttering may be evident after a lesion/dysfunction of wider neural networks. Here we present a case of acquired stuttering as the consequence of immune-mediated encephalitis. METHODS The case of a 71-year old male who complained about the progressive onset of stuttering and disequilibrium as the consequence of immune-mediated encephalitis, is here reported. Administration of corticosteroid methylprednisolone was useful to recover from impairments. An in depth analysis of the electroencephalography (relative power of brain rhythms and source localization) during different phases of the disease/treatment was also realized. RESULTS The patient showed a stuttering-like slowed speech with blocks and repetitions, especially at the beginning of words/sentences, with associated movements of the oro-facial muscles. Speech and general motor skills resulted slowed in their preparation/execution phases. Electroencephalography showed a "slowed" pattern, with delta/theta waves mainly in the prefrontal cortex and in sensorimotor networks. CONCLUSION This case reports a probable immune-mediated encephalitis that resulted in acquired stuttering. The effect of "slowed" oscillatory brain activity on motor skills requesting sequencing and fine coordination (e.g. speech) could result in less "synchronized" systems, easily prone to disruptions.
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Affiliation(s)
- Alessandro Dinoto
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Pierpaolo Busan
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venice, Italy.
| | - Emanuela Formaggio
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venice, Italy.
| | - Claudio Bertolotti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Alina Menichelli
- Neuropsychological Unit, Department of Rehabilitation Medicine, ASUI Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - David Stokelj
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Paolo Manganotti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
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17
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Kikuchi Y, Umezaki T, Uehara T, Yamaguchi H, Yamashita K, Hiwatashi A, Sawatsubashi M, Adachi K, Yamaguchi Y, Murakami D, Kira JI, Nakagawa T. A case of multiple system atrophy-parkinsonian type with stuttering- and palilalia-like dysfluencies and putaminal atrophy. JOURNAL OF FLUENCY DISORDERS 2018; 57:51-58. [PMID: 29157667 DOI: 10.1016/j.jfludis.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Both developmental and acquired stuttering are related to the function of the basal ganglia-thalamocortical loop, which includes the putamen. Here, we present a case of stuttering- and palilalia-like dysfluencies that manifested as an early symptom of multiple system atrophy-parkinsonian type (MSA-P) and bilateral atrophy of the putamen. The patient was a 72-year-old man with no history of developmental stuttering who presented with a stutter for consultation with our otorhinolaryngology department. The patient was diagnosed with MSA-P based on parkinsonism, autonomic dysfunction, and bilateral putaminal atrophy revealed by T2-weighted magnetic resonance imaging. Treatment with levodopa improved both the motor functional deficits related to MSA-P and stuttering-like dysfluencies while reading; however, the palilalia-like dysfluencies were much less responsive to levodopa therapy. The patient died of aspiration pneumonia two years after his first consultation at our hospital. In conclusion, adult-onset stuttering- and palilalia-like dysfluencies warrant careful examination of the basal ganglia-thalamocortical loop, and especially the putamen, using neuroimaging techniques. Acquired stuttering may be related to deficits in dopaminergic function.
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Affiliation(s)
- Yoshikazu Kikuchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Toshiro Umezaki
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan; International University of Health and Welfare, Fukuoka, Japan
| | - Taira Uehara
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroo Yamaguchi
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Sawatsubashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Adachi
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yumi Yamaguchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Chang SE, Angstadt M, Chow HM, Etchell AC, Garnett EO, Choo AL, Kessler D, Welsh RC, Sripada C. Anomalous network architecture of the resting brain in children who stutter. JOURNAL OF FLUENCY DISORDERS 2018; 55:46-67. [PMID: 28214015 PMCID: PMC5526749 DOI: 10.1016/j.jfludis.2017.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/28/2016] [Accepted: 01/14/2017] [Indexed: 05/14/2023]
Abstract
PURPOSE We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years. METHODS A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps ("components") as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups' first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering. RESULTS Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control. CONCLUSIONS This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.
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Affiliation(s)
- Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
| | - Michael Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ho Ming Chow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Andrew C Etchell
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ai Leen Choo
- Department of Communicative Sciences and Disorders, California State University East Bay, Hayward, CA, United States
| | - Daniel Kessler
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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19
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Poole ML, Brodtmann A, Darby D, Vogel AP. Motor Speech Phenotypes of Frontotemporal Dementia, Primary Progressive Aphasia, and Progressive Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:897-911. [PMID: 28289749 DOI: 10.1044/2016_jslhr-s-16-0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/11/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Our purpose was to create a comprehensive review of speech impairment in frontotemporal dementia (FTD), primary progressive aphasia (PPA), and progressive apraxia of speech in order to identify the most effective measures for diagnosis and monitoring, and to elucidate associations between speech and neuroimaging. METHOD Speech and neuroimaging data described in studies of FTD and PPA were systematically reviewed. A meta-analysis was conducted for speech measures that were used consistently in multiple studies. RESULTS The methods and nomenclature used to describe speech in these disorders varied between studies. Our meta-analysis identified 3 speech measures which differentiate variants or healthy control-group participants (e.g., nonfluent and logopenic variants of PPA from all other groups, behavioral-variant FTD from a control group). Deficits within the frontal-lobe speech networks are linked to motor speech profiles of the nonfluent variant of PPA and progressive apraxia of speech. Motor speech impairment is rarely reported in semantic and logopenic variants of PPA. Limited data are available on motor speech impairment in the behavioral variant of FTD. CONCLUSIONS Our review identified several measures of speech which may assist with diagnosis and classification, and consolidated the brain-behavior associations relating to speech in FTD, PPA, and progressive apraxia of speech.
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Affiliation(s)
- Matthew L Poole
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - David Darby
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaDepartment of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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20
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Sowman PF, Ryan M, Johnson BW, Savage G, Crain S, Harrison E, Martin E, Burianová H. Grey matter volume differences in the left caudate nucleus of people who stutter. BRAIN AND LANGUAGE 2017; 164:9-15. [PMID: 27693846 DOI: 10.1016/j.bandl.2016.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/22/2016] [Accepted: 08/28/2016] [Indexed: 06/06/2023]
Abstract
The cause of stuttering has many theoretical explanations. A number of research groups have suggested changes in the volume and/or function of the striatum as a causal agent. Two recent studies in children and one in adults who stutter (AWS) report differences in striatal volume compared that seen in controls; however, the laterality and nature of this anatomical volume difference is not consistent across studies. The current study investigated whether a reduction in striatal grey matter volume, comparable to that seen in children who stutter (CWS), would be found in AWS. Such a finding would support claims that an anatomical striatal anomaly plays a causal role in stuttering. We used voxel-based morphometry to examine the structure of the striatum in a group of AWS and compared it to that in a group of matched adult control subjects. Results showed a statistically significant group difference for the left caudate nucleus, with smaller mean volume in the group of AWS. The caudate nucleus, one of three main structures within the striatum, is thought to be critical for the planning and modulation of movement sequencing. The difference in striatal volume found here aligns with theoretical accounts of stuttering, which suggest it is a motor control disorder that arises from deficient articulatory movement selection and sequencing. Whilst the current study provides further evidence of a striatal volume difference in stuttering at the group level compared to controls, the significant overlap between AWS and controls suggests this difference is unlikely to be diagnostic of stuttering.
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Affiliation(s)
- Paul F Sowman
- Department of Cognitive Science, Macquarie University, New South Wales 2109, Australia; Australian Research Council Centre of Excellence in Cognition and Its Disorders, Australia; Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, New South Wales 2109, Australia.
| | - Margaret Ryan
- Department of Cognitive Science, Macquarie University, New South Wales 2109, Australia; Australian Research Council Centre of Excellence in Cognition and Its Disorders, Australia
| | - Blake W Johnson
- Department of Cognitive Science, Macquarie University, New South Wales 2109, Australia; Australian Research Council Centre of Excellence in Cognition and Its Disorders, Australia
| | - Greg Savage
- Australian Research Council Centre of Excellence in Cognition and Its Disorders, Australia; Department of Psychology, Macquarie University, New South Wales 2109, Australia
| | - Stephen Crain
- Australian Research Council Centre of Excellence in Cognition and Its Disorders, Australia; Department of Linguistics, Macquarie University, New South Wales 2109, Australia
| | - Elisabeth Harrison
- Department of Linguistics, Macquarie University, New South Wales 2109, Australia
| | - Erin Martin
- Department of Cognitive Science, Macquarie University, New South Wales 2109, Australia
| | - Hana Burianová
- Centre for Advanced Imaging, The University of Queensland, Queensland 4072, Australia
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Mawson AR, Radford NT, Jacob B. Toward a Theory of Stuttering. Eur Neurol 2016; 76:244-251. [PMID: 27750253 DOI: 10.1159/000452215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022]
Abstract
Stuttering affects about 1% of the general population and from 8 to 11% of children. The onset of persistent developmental stuttering (PDS) typically occurs between 2 and 4 years of age. The etiology of stuttering is unknown and a unifying hypothesis is lacking. Clues to the pathogenesis of stuttering include the following observations: PDS is associated with adverse perinatal outcomes and birth-associated trauma; stuttering can recur or develop in adulthood following traumatic events such as brain injury and stroke; PDS is associated with structural and functional abnormalities in the brain associated with speech and language; and stuttering resolves spontaneously in a high percentage of affected children. Evidence marshaled from the literature on stuttering and from related sources suggests the hypothesis that stuttering is a neuro-motor disorder resulting from perinatal or later-onset hypoxic-ischemic injury (HII), and that chronic stuttering and its behavioral correlates are manifestations of recurrent transient ischemic episodes affecting speech-motor pathways. The hypothesis could be tested by comparing children who stutter and nonstutterers (controls) in terms of the occurrence of perinatal trauma, based on birth records, and by determining rates of stuttering in children exposed to HII during the perinatal period. Subject to testing, the hypothesis suggests that interventions to increase brain perfusion directly could be effective both in the treatment of stuttering and its prevention at the time of birth or later trauma.
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Affiliation(s)
- Anthony R Mawson
- Department of Epidemiology and Biostatistics, School of Public Health (Initiative), Jackson State University, Jackson, Miss., USA
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Vanhoutte S, Santens P, Cosyns M, van Mierlo P, Batens K, Corthals P, De Letter M, Van Borsel J. Increased motor preparation activity during fluent single word production in DS: A correlate for stuttering frequency and severity. Neuropsychologia 2015; 75:1-10. [PMID: 26004061 DOI: 10.1016/j.neuropsychologia.2015.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Biesbroek JM, van Zandvoort MJE, Kappelle LJ, Velthuis BK, Biessels GJ, Postma A. Shared and distinct anatomical correlates of semantic and phonemic fluency revealed by lesion-symptom mapping in patients with ischemic stroke. Brain Struct Funct 2015; 221:2123-34. [PMID: 25939335 PMCID: PMC4853441 DOI: 10.1007/s00429-015-1033-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/17/2015] [Indexed: 11/27/2022]
Abstract
Semantic and phonemic fluency tasks are frequently used to test executive functioning, speed and attention, and access to the mental lexicon. In semantic fluency tasks, subjects are required to generate words belonging to a category (e.g., animals) within a limited time window, whereas in phonemic fluency tasks subjects have to generate words starting with a given letter. Anatomical correlates of semantic and phonemic fluency are currently assumed to overlap in left frontal structures, reflecting shared executive processes, and to be distinct in left temporal and right frontal structures, reflecting involvement of distinct memory processes and search strategies. Definite evidence for this assumption is lacking. To further establish the anatomical correlates of semantic and phonemic fluency, we applied assumption-free voxel-based and region-of-interest-based lesion-symptom mapping in 93 patients with ischemic stroke. Fluency was assessed by asking patients to name animals (semantic), and words starting with the letter N and A (phonemic). Our findings indicate that anatomical correlates of semantic and phonemic fluency overlap in the left inferior frontal gyrus and insula, reflecting shared underlying cognitive processes. Phonemic fluency additionally draws on the left rolandic operculum, which might reflect a search through phonological memory, and the middle frontal gyrus. Semantic fluency additionally draws on left medial temporal regions, probably reflecting a search through semantic memory, and the right inferior frontal gyrus, which might reflect the application of a visuospatial mental imagery strategy in semantic fluency. These findings establish shared and distinct anatomical correlates of semantic and phonemic fluency.
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Affiliation(s)
- J Matthijs Biesbroek
- Department of Neurology, Utrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA, Utrecht, The Netherlands.
| | - Martine J E van Zandvoort
- Department of Neurology, Utrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA, Utrecht, The Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Utrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Utrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA, Utrecht, The Netherlands
| | - Albert Postma
- Department of Neurology, Utrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA, Utrecht, The Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Biesbroek JM, van Zandvoort MJ, Kappelle LJ, Schoo L, Kuijf HJ, Velthuis BK, Biessels GJ, Postma A. Distinct anatomical correlates of discriminability and criterion setting in verbal recognition memory revealed by lesion-symptom mapping. Hum Brain Mapp 2015; 36:1292-303. [PMID: 25423892 PMCID: PMC6869440 DOI: 10.1002/hbm.22702] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 11/05/2014] [Accepted: 11/18/2014] [Indexed: 11/09/2022] Open
Abstract
Recognition memory, that is, the ability to judge whether an item has been previously encountered in a particular context, depends on two factors: discriminability and criterion setting. Discriminability draws on memory processes while criterion setting (i.e., the application of a threshold resulting in a yes/no response) is regarded as a process of cognitive control. Discriminability and criterion setting are assumed to draw on distinct anatomical structures, but definite evidence for this assumption is lacking. We applied voxel-based and region of interest-based lesion-symptom mapping to 83 patients in the acute phase of ischemic stroke to determine the anatomical correlates of discriminability and criterion setting in verbal recognition memory. Recognition memory was measured with the Rey Auditory Verbal Learning Test. Signal-detection theory was used to calculate measures for discriminability and criterion setting. Lesion-symptom mapping revealed that discriminability draws on left medial temporal and temporo-occipital structures, both thalami and the right hippocampus, while criterion setting draws on the right inferior frontal gyrus. Lesions in the right inferior frontal gyrus were associated with liberal response bias. These findings indicate that discriminability and criterion setting indeed depend on distinct anatomical structures and provide new insights in the anatomical correlates of these cognitive processes that underlie verbal recognition memory.
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Affiliation(s)
- J. Matthijs Biesbroek
- Department of NeurologyUtrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center UtrechtUtrechtthe Netherlands
| | - Martine J.E. van Zandvoort
- Department of NeurologyUtrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center UtrechtUtrechtthe Netherlands
- Experimental PsychologyHelmholtz Institute, Utrecht Universitythe Netherlands
| | - L. Jaap Kappelle
- Department of NeurologyUtrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center UtrechtUtrechtthe Netherlands
| | - Linda Schoo
- Experimental PsychologyHelmholtz Institute, Utrecht Universitythe Netherlands
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center UtrechtUtrechtthe Netherlands
| | | | - Geert Jan Biessels
- Department of NeurologyUtrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center UtrechtUtrechtthe Netherlands
| | - Albert Postma
- Department of NeurologyUtrecht Stroke Center, Brain Center Rudolf Magnus, University Medical Center UtrechtUtrechtthe Netherlands
- Experimental PsychologyHelmholtz Institute, Utrecht Universitythe Netherlands
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Chang SE, Zhu DC, Choo AL, Angstadt M. White matter neuroanatomical differences in young children who stutter. ACTA ACUST UNITED AC 2015; 138:694-711. [PMID: 25619509 DOI: 10.1093/brain/awu400] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ability to express thoughts through fluent speech production is a most human faculty, one that is often taken for granted. Stuttering, which disrupts the smooth flow of speech, affects 5% of preschool-age children and 1% of the general population, and can lead to significant communication difficulties and negative psychosocial consequences throughout one's lifetime. Despite the fact that symptom onset typically occurs during early childhood, few studies have yet examined the possible neural bases of developmental stuttering during childhood. Here we present a diffusion tensor imaging study that examined white matter measures reflecting neuroanatomical connectivity (fractional anisotropy) in 77 children [40 controls (20 females), 37 who stutter (16 females)] between 3 and 10 years of age. We asked whether previously reported anomalous white matter measures in adults and older children who stutter that were found primarily in major left hemisphere tracts (e.g. superior longitudinal fasciculus) are also present in younger children who stutter. All children exhibited normal speech, language, and cognitive development as assessed through a battery of assessments. The two groups were matched in chronological age and socioeconomic status. Voxel-wise whole brain comparisons using tract-based spatial statistics and region of interest analyses of fractional anisotropy were conducted to examine white matter changes associated with stuttering status, age, sex, and stuttering severity. Children who stutter exhibited significantly reduced fractional anisotropy relative to controls in white matter tracts that interconnect auditory and motor structures, corpus callosum, and in tracts interconnecting cortical and subcortical areas. In contrast to control subjects, fractional anisotropy changes with age were either stagnant or showed dissociated development among major perisylvian brain areas in children who stutter. These results provide first glimpses into the neuroanatomical bases of early childhood stuttering, and possible white matter developmental changes that may lead to recovery versus persistent stuttering. The white matter changes point to possible structural connectivity deficits in children who stutter, in interrelated neural circuits that enable skilled movement control through efficient sensorimotor integration and timing of movements.
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Affiliation(s)
- Soo-Eun Chang
- 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David C Zhu
- 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ai Leen Choo
- 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mike Angstadt
- 1 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Vanhoutte S, Van Borsel J, Cosyns M, Batens K, van Mierlo P, Hemelsoet D, Van Roost D, Corthals P, De Letter M, Santens P. CNV amplitude as a neural correlate for stuttering frequency: A case report of acquired stuttering. Neuropsychologia 2014; 64:349-59. [PMID: 25281310 DOI: 10.1016/j.neuropsychologia.2014.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Abstract
A neural hallmark of developmental stuttering is abnormal articulatory programming. One of the neurophysiological substrates of articulatory preparation is the contingent negative variation (CNV). Unfortunately, CNV tasks are rarely performed in persons who stutter and mainly focus on the effect of task variation rather than on interindividual variation in stutter related variables. However, variations in motor programming seem to be related to variation in stuttering frequency. The current study presents a case report of acquired stuttering following stroke and stroke related surgery in the left superior temporal gyrus. A speech related CNV task was administered at four points in time with differences in stuttering severity and frequency. Unexpectedly, CNV amplitudes at electrode sites approximating bilateral motor and left inferior frontal gyrus appeared to be inversely proportional to stuttering frequency. The higher the stuttering frequency, the lower the activity for articulatory preparation. Thus, the amount of disturbance in motor programming seems to determine stuttering frequency. At right frontal electrodes, a relative increase in CNV amplitude was seen at the test session with most severe stuttering. Right frontal overactivation is cautiously suggested to be a compensation strategy. In conclusion, late CNV amplitude elicited by a relatively simple speech task seems to be able to provide an objective, neural correlate of stuttering frequency. The present case report supports the hypothesis that motor preparation has an important role in stuttering.
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Affiliation(s)
- Sarah Vanhoutte
- Department of Internal Medicine, Neurology, Ghent University, Ghent University Hospital, De Pintelaan 185, 1K12A, B-9000 Ghent, Belgium.
| | - John Van Borsel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, 2P1, B-9000 Ghent, Belgium; Veiga de Almeida University, Rua Ibituruna, 108, Tijuca, Rio de Janeiro, Brazil.
| | - Marjan Cosyns
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, 2P1, B-9000 Ghent, Belgium.
| | - Katja Batens
- Department of Neurology, Ghent University Hospital, De Pintelaan 185,1K12A, B-9000 Ghent, Belgium; Department of physical therapy and motor rehabilitation, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Pieter van Mierlo
- MEDISIP, Department of Electronics and Information Systems, Ghent University - iMINDS Medical IT Department, Ghent University Hospital De Pintelaan 185, 5-Blok B, B-9000 Ghent, Belgium.
| | - Dimitri Hemelsoet
- Department of Neurology, Ghent University Hospital, De Pintelaan 185,1K12A, B-9000 Ghent, Belgium.
| | - Dirk Van Roost
- Department of Neurosurgery, Ghent University Hospital, De Pintelaan 185, 4K12E, B-9000 Ghent, Belgium; Department of Surgery, Ghent University, De Pintelaan 185, 4K12E, B-9000 Ghent, Belgium.
| | - Paul Corthals
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, 2P1, B-9000 Ghent, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Keramiekstraat 80, B-9000 Ghent, Belgium.
| | - Miet De Letter
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, 2P1, B-9000 Ghent, Belgium; Department of Neurology, Ghent University Hospital, De Pintelaan 185,1K12A, B-9000 Ghent, Belgium.
| | - Patrick Santens
- Department of Internal Medicine, Neurology, Ghent University, Ghent University Hospital, De Pintelaan 185, 1K12A, B-9000 Ghent, Belgium; Department of Neurology, Ghent University Hospital, De Pintelaan 185,1K12A, B-9000 Ghent, Belgium.
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Biesbroek JM, van Zandvoort MJE, Kuijf HJ, Weaver NA, Kappelle LJ, Vos PC, Velthuis BK, Biessels GJ, Postma A. The anatomy of visuospatial construction revealed by lesion-symptom mapping. Neuropsychologia 2014; 62:68-76. [PMID: 25062545 DOI: 10.1016/j.neuropsychologia.2014.07.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/09/2014] [Accepted: 07/14/2014] [Indexed: 12/01/2022]
Abstract
Visuospatial construction is a complex cognitive operation that is composed of a purely constructional component (visuoconstruction proper), and visuoperceptive, attentional, and decision-making components. The anatomical correlates of visuospatial construction and its cognitive subcomponents are poorly understood. The purpose of the present study was to determine the anatomical correlates of visuospatial construction by applying lesion-symptom mapping in a cohort of 111 patients with first-ever ischemic stroke. We employed the Rey-Osterrieth Complex Figure (ROCF) copy test and the Judgment of Line Orientation (JLO); both tests measure visuoperception, while only the ROCF has a constructional component. We first performed assumption-free voxel-based lesion-symptom mapping, which revealed large shared right hemispheric correlates for the ROCF and JLO in the frontal lobe, superior temporal lobe, and supramarginal gyrus. These shared anatomical correlates reflect the visuoperceptive component of the ROCF and JLO. Anatomical correlates were discordant in the right superior parietal lobule, and angular and middle occipital gyri: lesions in these regions were associated with poor performance on the ROCF, but not the JLO. Secondly, these findings were reproduced with a region of interest-based analysis that yielded a statistically significant correlation between infarct volume in the right inferior and superior parietal, angular and middle occipital cortices, and poor performance on the ROCF, but not the JLO. This discordance in anatomical correlates of the ROCF and JLO reflects the visuoconstructive component of the ROCF. These findings provide new insights in the anatomical correlates of the visuoperceptive and visuoconstructive components of the ROCF and provide evidence for a crucial role of the right inferior and superior parietal, angular and middle occipital gyri in visuoconstruction proper.
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Affiliation(s)
- J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA Utrecht, The Netherlands.
| | | | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA Utrecht, The Netherlands
| | - Pieter C Vos
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA Utrecht, The Netherlands
| | - Albert Postma
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO box 85500, G.03.232, 3508 GA Utrecht, The Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands
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Peters KB, Turner S. Acquired stuttering due to recurrent anaplastic astrocytoma. BMJ Case Rep 2013; 2013:bcr-2013-009562. [PMID: 24252834 DOI: 10.1136/bcr-2013-009562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acquired (neurogenic) stuttering is a rare phenomenon seen after cerebral infarction or brain injury. Aetiology of this symptom is unclear, but recent evidence supports that it is a disturbance in the left hemispheric neural network involving the interplay between the cortex and basal ganglia. We present the case of a patient who develops acquired stuttering after a recurrence of a right temporoparietal anaplastic astrocytoma (WHO grade III). We also review other cases of acquired stuttering and known anatomical correlates.
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Affiliation(s)
- Katherine B Peters
- Departments of Neurology and Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
Affecting 1% of the general population, stuttering impairs the normally effortless process of speech production, which requires precise coordination of sequential movement occurring among the articulatory, respiratory, and resonance systems, all within millisecond time scales. Those afflicted experience frequent disfluencies during ongoing speech, often leading to negative psychosocial consequences. The aetiology of stuttering remains unclear; compared to other neurodevelopmental disorders, few studies to date have examined the neural bases of childhood stuttering. Here we report, for the first time, results from functional (resting state functional magnetic resonance imaging) and structural connectivity analyses (probabilistic tractography) of multimodal neuroimaging data examining neural networks in children who stutter. We examined how synchronized brain activity occurring among brain areas associated with speech production, and white matter tracts that interconnect them, differ in young children who stutter (aged 3-9 years) compared with age-matched peers. Results showed that children who stutter have attenuated connectivity in neural networks that support timing of self-paced movement control. The results suggest that auditory-motor and basal ganglia-thalamocortical networks develop differently in stuttering children, which may in turn affect speech planning and execution processes needed to achieve fluent speech motor control. These results provide important initial evidence of neurological differences in the early phases of symptom onset in children who stutter.
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Affiliation(s)
- Soo-Eun Chang
- 1 Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA
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Civier O, Bullock D, Max L, Guenther FH. Computational modeling of stuttering caused by impairments in a basal ganglia thalamo-cortical circuit involved in syllable selection and initiation. BRAIN AND LANGUAGE 2013; 126:263-78. [PMID: 23872286 PMCID: PMC3775364 DOI: 10.1016/j.bandl.2013.05.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/13/2013] [Accepted: 05/25/2013] [Indexed: 05/11/2023]
Abstract
Atypical white-matter integrity and elevated dopamine levels have been reported for individuals who stutter. We investigated how such abnormalities may lead to speech dysfluencies due to their effects on a syllable-sequencing circuit that consists of basal ganglia (BG), thalamus, and left ventral premotor cortex (vPMC). "Neurally impaired" versions of the neurocomputational speech production model GODIVA were utilized to test two hypotheses: (1) that white-matter abnormalities disturb the circuit via corticostriatal projections carrying copies of executed motor commands and (2) that dopaminergic abnormalities disturb the circuit via the striatum. Simulation results support both hypotheses: in both scenarios, the neural abnormalities delay readout of the next syllable's motor program, leading to dysfluency. The results also account for brain imaging findings during dysfluent speech. It is concluded that each of the two abnormality types can cause stuttering moments, probably by affecting the same BG-thalamus-vPMC circuit.
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Affiliation(s)
- Oren Civier
- Center for Computational Neuroscience and Neural Technology, Boston University, 677 Beacon Street, Boston, MA 02215, United States
| | - Daniel Bullock
- Center for Computational Neuroscience and Neural Technology, Boston University, 677 Beacon Street, Boston, MA 02215, United States
- Department of Psychology, Boston University, Boston, MA 02215, United States
| | - Ludo Max
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA 98105, United States
- Haskins Laboratories, New Haven, CT 06511, United States
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA 02215, United States
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, United States
- Division of Health Sciences and Technology, Harvard University – Massachusetts Institute of Technology, Cambridge, MA 02139, United States
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A voxel-based morphometry (VBM) analysis of regional grey and white matter volume abnormalities within the speech production network of children who stutter. Cortex 2012; 49:2151-61. [PMID: 23140891 DOI: 10.1016/j.cortex.2012.08.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 06/23/2012] [Accepted: 08/09/2012] [Indexed: 12/12/2022]
Abstract
It is well documented that neuroanatomical differences exist between adults who stutter and their fluently speaking peers. Specifically, adults who stutter have been found to have more grey matter volume (GMV) in speech relevant regions including inferior frontal gyrus, insula and superior temporal gyrus (Beal et al., 2007; Song et al., 2007). Despite stuttering having its onset in childhood only one study has investigated the neuroanatomical differences between children who do and do not stutter. Chang et al. (2008) reported children who stutter had less GMV in the bilateral inferior frontal gyri and middle temporal gyrus relative to fluently speaking children. Thus it appears that children who stutter present with unique neuroanatomical abnormalities as compared to those of adults who stutter. In order to better understand the neuroanatomical correlates of stuttering earlier in its development, near the time of onset, we used voxel-based morphometry to examine volumetric differences between 11 children who stutter and 11 fluent children. Children who stutter had less GMV in the bilateral inferior frontal gyri and left putamen but more GMV in right Rolandic operculum and superior temporal gyrus relative to fluent children. Children who stutter also had less white matter volume bilaterally in the forceps minor of the corpus callosum. We discuss our findings of widespread anatomic abnormalities throughout the cortical network for speech motor control within the context of the speech motor skill limitations identified in people who stutter (Namasivayam and van Lieshout, 2008; Smits-Bandstra et al., 2006).
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