Neurogenic Stuttering: Its Reticular Modulation

The role of temporal speech cues in facilitating the fluency of adults who stutter

PURPOSE

Adults who stutter speak more fluently during choral speech contexts than they do during solo speech contexts. The underlying mechanisms for this effect remain unclear, however. In this study, we examined the extent to which the choral speech effect depended on presentation of intact temporal speech cues. We also examined whether speakers who stutter followed choral signals more closely than typical speakers did.

METHOD

8 adults who stuttered and 8 adults who did not stutter read 60 sentences aloud during a solo speaking condition and three choral speaking conditions (240 total sentences), two of which featured either temporally altered or indeterminate word duration patterns. Effects of these manipulations on speech fluency, rate, and temporal entrainment with the choral speech signal were assessed.

RESULTS

Adults who stutter spoke more fluently in all choral speaking conditions than they did when speaking solo. They also spoke slower and exhibited closer temporal entrainment with the choral signal during the mid- to late-stages of sentence production than the adults who did not stutter. Both groups entrained more closely with unaltered choral signals than they did with altered choral signals.

CONCLUSIONS

Findings suggest that adults who stutter make greater use of speech-related information in choral signals when talking than adults with typical fluency do. The presence of fluency facilitation during temporally altered choral speech and conversation babble, however, suggests that temporal/gestural cueing alone cannot account for fluency facilitation in speakers who stutter. Other potential fluency enhancing mechanisms are discussed.

EDUCATIONAL OBJECTIVES

The reader will be able to (a) summarize competing views on stuttering as a speech timing disorder, (b) describe the extent to which adults who stutter depend on an accurate rendering of temporal information in order to benefit from choral speech, and (c) discuss possible explanations for fluency facilitation in the presence of inaccurate or indeterminate temporal cues.

Simulating the neural correlates of stuttering

For functional neuroimaging studies of stuttering, two challenges are (1) the elicitation of naturally stuttered versus fluent speech and (2) the separation of activation associated with abnormal motor execution from activation that reflects the cognitive substrates of stuttering. This paper reports on a proof-of-concept study, in which a single-subject approach was applied to address these two issues. A stuttering speaker used his insight into his own stuttering behavior to create a list of stutter-prone words versus a list of "fluent" words. He was then matched to a non-stuttering speaker, who imitated the specific articulatory and orofacial motor pattern of the stuttering speaker. Both study participants performed a functional MRI experiment of single word reading, each being presented with the same lexical items. Results suggest that the generally observed right-hemisphere lateralization appears to reflect a true neural correlate of stuttering. Some of the classically reported activation associated with stuttering appears to be driven more by nonspecific motor patterns than by cognitive substrates of stuttering, while anterior cingulate activation may reflect awareness of (upcoming) dysfluencies. This study shows that it is feasible to match stuttering speakers' utterances more closely to simulated stutters for the investigation of neural correlates of real stuttering. Significant main effects and contrast effects were obtained for the differences between fluent and stuttered speech, and right-hemisphere lateralization associated with real stuttered speech was shown in a single subject.

Effects of deep brain stimulation in the caudal zona incerta on verbal fluency

BACKGROUND

Deep brain stimulation (DBS) of the caudal zona incerta (cZi) is a relatively unexplored and promising treatment in patients with severe essential tremor (ET). Preliminary data further indicate that the ability to produce language may be slightly affected by the treatment.

OBJECTIVE

To evaluate the effects on verbal fluency following cZi DBS in patients with ET.

METHOD

Seventeen consecutive patients who had undergone DBS of the cZi for ET were tested regarding verbal fluency before surgery, 3 days after surgery and after 1 year. Ten patients were also evaluated by comparing performance on versus off stimulation after 1 year.

RESULTS

The total verbal fluency score decreased slightly, but significantly, from 22.7 (SD = 10.9) before surgery to 18.1 (SD = 7.5) 3 days after surgery (p = 0.036). After 1 year the score was nonsignificantly decreased to 20.1 (SD = 9.7, p = 0.2678). There was no detectable difference between stimulation on and off after 1 year.

CONCLUSION

There was a tendency of an immediate and mostly transient postoperative decline in verbal fluency following cZi DBS for ET. In some of the patients this reduction was, however, more pronounced and also sustained over time.