Impaired timing adjustments in response to time-varying auditory perturbation during connected speech production in persons who stutter

Test-Retest Reliability of Behavioral Assays of Feedforward and Feedback Auditory-Motor Control of Voice and Articulation

PURPOSE

Behavioral assays of feedforward and feedback auditory-motor control of voice and articulation frequently are used to make inferences about underlying neural mechanisms and to study speech development and disorders. However, no studies have examined the test-retest reliability of such measures, which is critical for rigorous study of auditory-motor control. Thus, the purpose of the present study was to assess the reliability of assays of feedforward and feedback control in voice versus articulation domains.

METHOD

Twenty-eight participants (14 cisgender women, 12 cisgender men, one transgender man, one transmasculine/nonbinary) who denied any history of speech, hearing, or neurological impairment were measured for responses to predictable versus unexpected auditory feedback perturbations of vocal (fundamental frequency, fo) and articulatory (first formant, F1) acoustic parameters twice, with 3-6 weeks between sessions. Reliability was measured with intraclass correlations.

RESULTS

Opposite patterns of reliability were observed for fo and F1; fo reflexive responses showed good reliability and fo adaptive responses showed poor reliability, whereas F1 reflexive responses showed poor reliability and F1 adaptive responses showed moderate reliability. However, a criterion-referenced categorical measurement of fo adaptive responses as typical versus atypical showed substantial test-retest agreement.

CONCLUSIONS

Individual responses to some behavioral assays of auditory-motor control of speech should be interpreted with caution, which has implications for several fields of research. Additional research is needed to establish reliable criterion-referenced measures of F1 adaptive responses as well as fo and F1 reflexive responses. Furthermore, the opposite patterns of test-retest reliability observed for voice versus articulation add to growing evidence for differences in underlying neural control mechanisms.

DIVA Meets EEG: Model Validation Using Formant-Shift Reflex

The neurocomputational model 'Directions into Velocities of Articulators' (DIVA) was developed to account for various aspects of normal and disordered speech production and acquisition. The neural substrates of DIVA were established through functional magnetic resonance imaging (fMRI), providing physiological validation of the model. This study introduces DIVA_EEG an extension of DIVA that utilizes electroencephalography (EEG) to leverage the high temporal resolution and broad availability of EEG over fMRI. For the development of DIVA_EEG, EEG-like signals were derived from original equations describing the activity of the different DIVA maps. Synthetic EEG associated with the utterance of syllables was generated when both unperturbed and perturbed auditory feedback (first formant perturbations) were simulated. The cortical activation maps derived from synthetic EEG closely resembled those of the original DIVA model. To validate DIVA_EEG, the EEG of individuals with typical voices (N = 30) was acquired during an altered auditory feedback paradigm. The resulting empirical brain activity maps significantly overlapped with those predicted by DIVA_EEG. In conjunction with other recent model extensions, DIVA_EEG lays the foundations for constructing a complete neurocomputational framework to tackle vocal and speech disorders, which can guide model-driven personalized interventions.

Explicit benefits: Motor sequence acquisition and short-term retention in adults who do and do not stutter

Motor sequencing skills have been found to distinguish individuals who experience developmental stuttering from those who do not stutter, with these differences extending to non-verbal sequencing behaviour. Previous research has focused on measures of reaction time and practice under externally cued conditions to decipher the motor learning abilities of persons who stutter. Without the confounds of extraneous demands and sensorimotor processing, we investigated motor sequence learning under conditions of explicit awareness and focused practice among adults with persistent development stuttering. Across two consecutive practice sessions, 18 adults who stutter (AWS) and 18 adults who do not stutter (ANS) performed the finger-to-thumb opposition sequencing (FOS) task. Both groups demonstrated significant within-session performance improvements, as evidenced by fast on-line learning of finger sequences on day one. Additionally, neither participant group showed deterioration of their learning gains the following day, indicating a relative stabilization of finger sequencing performance during the off-line period. These findings suggest that under explicit and focused conditions, early motor learning gains and their short-term retention do not differ between AWS and ANS. Additional factors influencing motor sequencing performance, such as task complexity and saturation of learning, are also considered. Further research into explicit motor learning and its generalization following extended practice and follow-up in persons who stutter is warranted. The potential benefits of motor practice generalizability among individuals who stutter and its relevance to supporting treatment outcomes are suggested as future areas of investigation.

Auditory feedback control in adults who stutter during metronome-paced speech I. Timing Perturbation

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.

Auditory feedback control in adults who stutter during metronome-paced speech II. Formant Perturbation

PURPOSE

Prior work has shown that Adults who stutter (AWS) have reduced and delayed responses to auditory feedback perturbations. This study aimed to determine whether external timing cues, which increase fluency, resolve auditory feedback processing disruptions.

METHODS

Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with natural stress and timing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback formant perturbation was applied, and formant responses were compared between groups and pacing conditions.

RESULTS

During normally paced speech, ANS showed a significant compensatory response to the perturbation by the end of the perturbed vowel, while AWS did not. In the metronome-paced condition, which significantly reduced the disfluency rate, the opposite was true: AWS showed a significant response by the end of the vowel, while ANS did not.

CONCLUSION

These findings indicate a potential link between the reduction in stuttering found during metronome-paced speech and changes in auditory motor integration in AWS.

Differences in implicit motor learning between adults who do and do not stutter

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.

Neural activity during solo and choral reading: A functional magnetic resonance imaging study of overt continuous speech production in adults who stutter

Previous neuroimaging investigations of overt speech production in adults who stutter (AWS) found increased motor and decreased auditory activity compared to controls. Activity in the auditory cortex is heightened, however, under fluency-inducing conditions in which AWS temporarily become fluent while synchronizing their speech with an external rhythm, such as a metronome or another speaker. These findings suggest that stuttering is associated with disrupted auditory motor integration. Technical challenges in acquiring neuroimaging data during continuous overt speech production have limited experimental paradigms to short or covert speech tasks. Such paradigms are not ideal, as stuttering primarily occurs during longer speaking tasks. To address this gap, we used a validated spatial ICA technique designed to address speech movement artifacts during functional magnetic resonance imaging (fMRI) scanning. We compared brain activity and functional connectivity of the left auditory cortex during continuous speech production in two conditions: solo (stutter-prone) and choral (fluency-inducing) reading tasks. Overall, brain activity differences in AWS relative to controls in the two conditions were similar, showing expected patterns of hyperactivity in premotor/motor regions but underactivity in auditory regions. Functional connectivity of the left auditory cortex (STG) showed that within the AWS group there was increased correlated activity with the right insula and inferior frontal area during choral speech. The AWS also exhibited heightened connectivity between left STG and key regions of the default mode network (DMN) during solo speech. These findings indicate possible interference by the DMN during natural, stuttering-prone speech in AWS, and that enhanced coordination between auditory and motor regions may support fluent speech.

Tract profiles of the cerebellar peduncles in children who stutter

Cerebellar-cortical loops comprise critical neural circuitry that supports self-initiated movements and motor adjustments in response to perceived errors, functions that are affected in stuttering. It is unknown whether structural aspects of cerebellar circuitry are affected in stuttering, particularly in children close to symptom onset. Here we examined white matter diffusivity characteristics of the three cerebellar peduncles (CPs) based on diffusion MRI (dMRI) data collected from 41 children who stutter (CWS) and 42 controls in the 3-11 years range. We hypothesized that CWS would exhibit decreased fractional anisotropy (FA) in the right CPs given the contralateral connectivity of the cerebellar-cortical loops and past reports of structural differences in left cortical areas in stuttering speakers. Automatic Fiber Quantification (AFQ) was used to track and segment cerebellar white matter pathways and to extract diffusivity measures. We found significant group differences for FA in the right inferior CP (ICP) only: controls showed significantly higher FA in the right ventral ICP compared to CWS, controlling for age, sex, and verbal IQ. Furthermore, FA of right ICP was negatively correlated with stuttering frequency in CWS. These results suggest an early developmental difference in the right ICP for CWS compared to age-matched peers, which may indicate an alteration in error processing, a function previously linked to the ICP. Lower FA here may impact error monitoring and sensory input processing to guide motor corrections. Further longitudinal investigations in children may provide additional insights into how CP development links to stuttering persistence and recovery.

The Relationship Between Auditory-Motor Integration, Interoceptive Awareness, and Self-Reported Stuttering Severity

Stuttering is a neurodevelopmental speech disorder associated with motor timing that differs from non-stutterers. While neurodevelopmental disorders impacted by timing are associated with compromised auditory-motor integration and interoception, the interplay between those abilities and stuttering remains unexplored. Here, we studied the relationships between speech auditory-motor synchronization (a proxy for auditory-motor integration), interoceptive awareness, and self-reported stuttering severity using remotely delivered assessments. Results indicate that in general, stutterers and non-stutterers exhibit similar auditory-motor integration and interoceptive abilities. However, while speech auditory-motor synchrony (i.e., integration) and interoceptive awareness were not related, speech synchrony was inversely related to the speaker’s perception of stuttering severity as perceived by others, and interoceptive awareness was inversely related to self-reported stuttering impact. These findings support claims that stuttering is a heterogeneous, multi-faceted disorder such that uncorrelated auditory-motor integration and interoception measurements predicted different aspects of stuttering, suggesting two unrelated sources of timing differences associated with the disorder.

Atypical development of Broca's area in a large family with inherited stuttering

Developmental stuttering is a condition of speech dysfluency, characterized by pauses, blocks, prolongations and sound or syllable repetitions. It affects around 1% of the population, with potential detrimental effects on mental health and long-term employment. Accumulating evidence points to a genetic aetiology, yet gene-brain associations remain poorly understood due to a lack of MRI studies in affected families. Here we report the first neuroimaging study of developmental stuttering in a family with autosomal dominant inheritance of persistent stuttering. We studied a four-generation family, 16 family members were included in genotyping analysis. T1-weighted and diffusion-weighted MRI scans were conducted on seven family members (six male; aged 9-63 years) with two age and sex matched controls without stuttering (n = 14). Using Freesurfer, we analysed cortical morphology (cortical thickness, surface area and local gyrification index) and basal ganglia volumes. White matter integrity in key speech and language tracts (i.e. frontal aslant tract and arcuate fasciculus) was also analysed using MRtrix and probabilistic tractography. We identified a significant age by group interaction effect for cortical thickness in the left hemisphere pars opercularis (Broca's area). In affected family members this region failed to follow the typical trajectory of age-related thinning observed in controls. Surface area analysis revealed the middle frontal gyrus region was reduced bilaterally in the family (all cortical morphometry significance levels set at a vertex-wise threshold of P < 0.01, corrected for multiple comparisons). Both the left and right globus pallidus were larger in the family than in the control group (left P = 0.017; right P = 0.037), and a larger right globus pallidus was associated with more severe stuttering (rho = 0.86, P = 0.01). No white matter differences were identified. Genotyping identified novel loci on chromosomes 1 and 4 that map with the stuttering phenotype. Our findings denote disruption within the cortico-basal ganglia-thalamo-cortical network. The lack of typical development of these structures reflects the anatomical basis of the abnormal inhibitory control network between Broca's area and the striatum underpinning stuttering in these individuals. This is the first evidence of a neural phenotype in a family with an autosomal dominantly inherited stuttering.

Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence

Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.

Speech planning and execution in children who stutter: Preliminary findings from a fNIRS investigation

Few studies have investigated the neural mechanisms underlying speech production in children who stutter (CWS), despite the critical importance of understanding these mechanisms closer to the time of stuttering onset. The relative contributions of speech planning and execution in CWS therefore are also unknown. Using functional near-infrared spectroscopy, the current study investigated neural mechanisms of planning and execution in a small sample of 9-12 year-old CWS and controls (N = 12) by implementing two tasks that manipulated speech planning and execution loads. Planning was associated with atypical activation in bilateral inferior frontal gyrus and right supramarginal gyrus. Execution was associated with atypical activation in bilateral precentral gyrus and inferior frontal gyrus, as well as right supramarginal gyrus and superior temporal gyrus. The CWS exhibited some activation patterns that were similar to the adults who stutter (AWS) as reported in our previous study: atypical planning in frontal areas including left inferior frontal gyrus and atypical execution in fronto-temporo-parietal regions including left precentral gyrus, and right inferior frontal, superior temporal, and supramarginal gyri. However, differences also emerged. Whereas CWS and AWS both appear to exhibit atypical activation in right inferior and supramarginal gyri during execution, only CWS appear to exhibit this same pattern during planning. In addition, the CWS appear to exhibit atypical activation in left inferior frontal and right precentral gyri related to execution, whereas AWS do not. These preliminary results are discussed in the context of possible impairments in sensorimotor integration and inhibitory control for CWS.

The Role of Sensory Feedback in Developmental Stuttering: A Review

Developmental stuttering is a neurodevelopmental disorder that severely affects speech fluency. Multiple lines of evidence point to a role of sensory feedback in the disorder; this has led to a number of theories proposing different disruptions to the use of sensory feedback during speech motor control in people who stutter. The purpose of this review was to bring together evidence from studies using altered auditory feedback paradigms with people who stutter, in order to evaluate the predictions of these different theories. This review highlights converging evidence for particular patterns of differences in the responses of people who stutter to feedback perturbations. The implications for hypotheses on the nature of the disruption to sensorimotor control of speech in the disorder are discussed, with reference to neurocomputational models of speech control (predominantly, the DIVA model; Guenther et al., 2006; Tourville et al., 2008). While some consistent patterns are emerging from this evidence, it is clear that more work in this area is needed with developmental samples in particular, in order to tease apart differences related to symptom onset from those related to compensatory strategies that develop with experience of stuttering.

Compensatory Responses to Formant Perturbations Proportionally Decrease as Perturbations Increase

Purpose We continuously monitor our speech output to detect potential errors in our productions. When we encounter errors, we rapidly change our speech output to compensate for the errors. However, it remains unclear whether we adjust the magnitude of our compensatory responses based on the characteristics of errors. Method Participants (N = 30 adults) produced monosyllabic words containing /ɛ/ (/hɛp/, /hɛd/, /hɛk/) while receiving perturbed or unperturbed auditory feedback. In the perturbed trials, we applied two different types of formant perturbations: (a) the F1 shift, in which the first formant of /ɛ/ was increased, and (b) the F1-F2 shift, in which the first formant was increased and the second formant was decreased to make a participant's /ɛ/ sound like his or her /æ/. In each perturbation condition, we applied three participant-specific perturbation magnitudes (0.5, 1.0, and 1.5 ɛ-æ distance). Results Compensatory responses to perturbations with the magnitude of 1.5 ɛ-æ were proportionally smaller than responses to perturbation magnitudes of 0.5 ɛ-æ. Responses to the F1-F2 shift were larger than responses to the F1 shift regardless of the perturbation magnitude. Additionally, compensatory responses for /hɛd/ were smaller than responses for /hɛp/ and /hɛk/. Conclusions Overall, these results suggest that the brain uses its error evaluation to determine the extent of compensatory responses. The brain may also consider categorical errors and phonemic environments (e.g., articulatory configurations of the following phoneme) to determine the magnitude of its compensatory responses to auditory errors.

Coarticulatory Aspects of the Fluent Speech of French and Italian People Who Stutter Under Altered Auditory Feedback

A number of studies have shown that phonetic peculiarities, especially at the coarticulation level, exist in the disfluent as well as in the perceptively fluent speech of people who stutter (PWS). However, results from fluent speech are very disparate and not easily interpretable. Are the coarticulatory features observed in fluent speech of PWS a manifestation of the disorder, or rather a compensation for the disorder itself? The purpose of the present study is to investigate the coarticulatory behavior in the fluent speech of PWS in the attempt to answer the question on its symptomatic or adaptive nature. In order to achieve this, we have studied the speech of 21 adult PWS (10 French and 11 Italian) compared to that of 20 fluent adults (10 French and 10 Italian). The participants had to repeat simple CV syllables in short carrier sentences, where C = /b, d, g/ and V = /a, i, u/. Crucially, this repetition task was performed in order to compare fluent speech coarticulation of PWS to that of PWNS, and to compare the coarticulation of PWS under a condition with normal auditory feedback (NAF) and under a fluency-enhancing condition due to an altered auditory feedback (AAF). This is the first study, to our knowledge, to investigate the coarticulation behavior under AAF. The degree of coarticulation was measured by means of the Locus Equations (LE). The coarticulation degree observed in fluent PWS speech is lower than that of the PWNS, and, more importantly, in AAF condition, PWS coarticulation appears even weaker than in the NAF condition. The results allow to interpret the lower degree of coarticulation found in fluent speech of PWS under NAF condition as a compensation for the disorder, based on the fact that PWS’s coarticulation is weakening in fluency-enhancing conditions, further away from the degree of coarticulation observed in PWNS. Since a lower degree of coarticulation is associated to a greater separation between the places of articulation of the consonant and the vowel, these results are compatible with the hypothesis that larger articulatory movements could be responsible for the stabilization of the PWS speech motor system, increasing the kinesthetic feedback from the effector system. This interpretation shares with a number of relatively recent proposal the idea that stuttering derives from an impaired feedforward (open-loop) control system, which makes PWS rely more heavily on a feedback-based (closed loop) motor control strategy.

It's About Time: Minimizing Hardware and Software Latencies in Speech Research With Real-Time Auditory Feedback

Purpose Various aspects of speech production related to auditory-motor integration and learning have been examined through auditory feedback perturbation paradigms in which participants' acoustic speech output is experimentally altered and played back via earphones/headphones "in real time." Scientific rigor requires high precision in determining and reporting the involved hardware and software latencies. Many reports in the literature, however, are not consistent with the minimum achievable latency for a given experimental setup. Here, we focus specifically on this methodological issue associated with implementing real-time auditory feedback perturbations, and we offer concrete suggestions for increased reproducibility in this particular line of work. Method Hardware and software latencies as well as total feedback loop latency were measured for formant perturbation studies with the Audapter software. Measurements were conducted for various audio interfaces, desktop and laptop computers, and audio drivers. An approach for lowering Audapter's software latency through nondefault parameter specification was also tested. Results Oft-overlooked hardware-specific latencies were not negligible for some of the tested audio interfaces (adding up to 15 ms). Total feedback loop latencies (including both hardware and software latency) were also generally larger than claimed in the literature. Nondefault parameter values can improve Audapter's own processing latency without negative impact on formant tracking. Conclusions Audio interface selection and software parameter optimization substantially affect total feedback loop latency. Thus, the actual total latency (hardware plus software) needs to be correctly measured and described in all published reports. Future speech research with "real-time" auditory feedback perturbations should increase scientific rigor by minimizing this latency.

Neural Correlates of Vocal Pitch Compensation in Individuals Who Stutter

Stuttering is a disorder that impacts the smooth flow of speech production and is associated with a deficit in sensorimotor integration. In a previous experiment, individuals who stutter were able to vocally compensate for pitch shifts in their auditory feedback, but they exhibited more variability in the timing of their corrective responses. In the current study, we focused on the neural correlates of the task using functional MRI. Participants produced a vowel sound in the scanner while hearing their own voice in real time through headphones. On some trials, the audio was shifted up or down in pitch, eliciting a corrective vocal response. Contrasting pitch-shifted vs. unshifted trials revealed bilateral superior temporal activation over all the participants. However, the groups differed in the activation of middle temporal gyrus and superior frontal gyrus [Brodmann area 10 (BA 10)], with individuals who stutter displaying deactivation while controls displayed activation. In addition to the standard univariate general linear modeling approach, we employed a data-driven technique (independent component analysis, or ICA) to separate task activity into functional networks. Among the networks most correlated with the experimental time course, there was a combined auditory-motor network in controls, but the two networks remained separable for individuals who stuttered. The decoupling of these networks may account for temporal variability in pitch compensation reported in our previous work, and supports the idea that neural network coherence is disturbed in the stuttering brain.

Time and information in perceptual adaptation to speech

Perceptual adaptation to a talker enables listeners to efficiently resolve the many-to-many mapping between variable speech acoustics and abstract linguistic representations. However, models of speech perception have not delved into the variety or the quantity of information necessary for successful adaptation, nor how adaptation unfolds over time. In three experiments using speeded classification of spoken words, we explored how the quantity (duration), quality (phonetic detail), and temporal continuity of talker-specific context contribute to facilitating perceptual adaptation to speech. In single- and mixed-talker conditions, listeners identified phonetically-confusable target words in isolation or preceded by carrier phrases of varying lengths and phonetic content, spoken by the same talker as the target word. Word identification was always slower in mixed-talker conditions than single-talker ones. However, interference from talker variability decreased as the duration of preceding speech increased but was not affected by the amount of preceding talker-specific phonetic information. Furthermore, efficiency gains from adaptation depended on temporal continuity between preceding speech and the target word. These results suggest that perceptual adaptation to speech may be understood via models of auditory streaming, where perceptual continuity of an auditory object (e.g., a talker) facilitates allocation of attentional resources, resulting in more efficient perceptual processing.

Abnormal Sensorimotor Integration in Adults Who Stutter: A Behavioral Study by Adaptation of Delayed Auditory Feedback

Stuttering is a fluency disorder, partially alleviated during altered auditory feedback, suggesting abnormal sensorimotor integration in adults who stutter (AWS). As weighting of multiple integrating-information sources would be decided based on their reliabilities, the use of external (auditory feedback) and internal information (prediction of sensory consequences) could correlate with speech processing. We hypothesized that abnormal auditory-feedback processing in AWS could be related to decrease in internal processing precision. We used a perceptual-adaptation experiment of delayed auditory feedback (DAF) to verify the hypothesis. Seventeen AWS and 17 adults who do not stutter (ANS) were required to say "ah" and judge the simultaneity between their motor sensations and vocal sounds in each stimulus onset asynchrony (SOA) (0, 25, 50, 75, 100, 125, or 150 ms) after inducing adaptation of DAF (three conditions with 0-, 66-, or 133-ms delay). While no adaptation occurred during the 0 ms condition, perceptual change in simultaneity judgment (adaptation effect) occurred during the 66 and 133 ms conditions. The simultaneity judgments following exposure in each SOA were fitted to the psychometric function in each condition for the AWS and ANS groups. We calculated the μ (signifying the point of subjective simultaneity and adaptation-effect degree) and σ (signifying the detecting precision) of each function and analyzed them by parametric analyses. For the μ, participant groups and adaptation conditions showed a significant interaction; the adaptation effect was greater in the AWS than in the ANS group. Additionally, the μ and σ were only positively correlated in the AWS group. The point of subjective simultaneity for auditory delay by inducing DAF was higher in AWS than in ANS, indicating that perception of simultaneity in AWS was influenced by DAF to a greater extent. Moreover, the significant positive correlation between the μ and σ in AWS showed that the more imprecise the internal auditory processing, the more AWS relied on auditory feedback. It is suggested that the reliability of internal information differed within the AWS group, and AWS with reduced internal reliability appeared to compensate by relying to a great extent on auditory feedback information.

Limited Pre-Speech Auditory Modulation in Individuals Who Stutter: Data and Hypotheses

Purpose We review and interpret our recent series of studies investigating motor-to-auditory influences during speech movement planning in fluent speakers and speakers who stutter. In those studies, we recorded auditory evoked potentials in response to probe tones presented immediately prior to speaking or at the equivalent time in no-speaking control conditions. As a measure of pre-speech auditory modulation (PSAM), we calculated changes in auditory evoked potential amplitude in the speaking conditions relative to the no-speaking conditions. Whereas adults who do not stutter consistently showed PSAM, this phenomenon was greatly reduced or absent in adults who stutter. The same between-group difference was observed in conditions where participants expected to hear their prerecorded speech played back without actively producing it, suggesting that the speakers who stutter use inefficient forward modeling processes rather than inefficient motor command generation processes. Compared with fluent participants, adults who stutter showed both less PSAM and less auditory-motor adaptation when producing speech while exposed to formant-shifted auditory feedback. Across individual participants, however, PSAM and auditory-motor adaptation did not correlate in the typically fluent group, and they were negatively correlated in the stuttering group. Interestingly, speaking with a consistent 100-ms delay added to the auditory feedback signal-normalized PSAM in speakers who stutter, and there no longer was a between-group difference in this condition. Conclusions Combining our own data with human and animal neurophysiological evidence from other laboratories, we interpret the overall findings as suggesting that (a) speech movement planning modulates auditory processing in a manner that may optimize its tuning characteristics for monitoring feedback during speech production and, (b) in conditions with typical auditory feedback, adults who stutter do not appropriately modulate the auditory system prior to speech onset. Lack of modulation of speakers who stutter may lead to maladaptive feedback-driven movement corrections that manifest themselves as repetitive movements or postural fixations.

Anomalous morphology in left hemisphere motor and premotor cortex of children who stutter

Stuttering is a neurodevelopmental disorder that affects the smooth flow of speech production. Stuttering onset occurs during a dynamic period of development when children first start learning to formulate sentences. Although most children grow out of stuttering naturally, ∼1% of all children develop persistent stuttering that can lead to significant psychosocial consequences throughout one's life. To date, few studies have examined neural bases of stuttering in children who stutter, and even fewer have examined the basis for natural recovery versus persistence of stuttering. Here we report the first study to conduct surface-based analysis of the brain morphometric measures in children who stutter. We used FreeSurfer to extract cortical size and shape measures from structural MRI scans collected from the initial year of a longitudinal study involving 70 children (36 stuttering, 34 controls) in the 3-10-year range. The stuttering group was further divided into two groups: persistent and recovered, based on their later longitudinal visits that allowed determination of their eventual clinical outcome. A region of interest analysis that focused on the left hemisphere speech network and a whole-brain exploratory analysis were conducted to examine group differences and group × age interaction effects. We found that the persistent group could be differentiated from the control and recovered groups by reduced cortical thickness in left motor and lateral premotor cortical regions. The recovered group showed an age-related decrease in local gyrification in the left medial premotor cortex (supplementary motor area and and pre-supplementary motor area). These results provide strong evidence of a primary deficit in the left hemisphere speech network, specifically involving lateral premotor cortex and primary motor cortex, in persistent developmental stuttering. Results further point to a possible compensatory mechanism involving left medial premotor cortex in those who recover from childhood stuttering.

Auditory prediction during speaking and listening

In the present EEG study, the role of auditory prediction in speech was explored through the comparison of auditory cortical responses during active speaking and passive listening to the same acoustic speech signals. Two manipulations of sensory prediction accuracy were used during the speaking task: (1) a real-time change in vowel F1 feedback (reducing prediction accuracy relative to unaltered feedback) and (2) presenting a stable auditory target rather than a visual cue to speak (enhancing auditory prediction accuracy during baseline productions, and potentially enhancing the perturbing effect of altered feedback). While subjects compensated for the F1 manipulation, no difference between the auditory-cue and visual-cue conditions were found. Under visually-cued conditions, reduced N1/P2 amplitude was observed during speaking vs. listening, reflecting a motor-to-sensory prediction. In addition, a significant correlation was observed between the magnitude of behavioral compensatory F1 response and the magnitude of this speaking induced suppression (SIS) for P2 during the altered auditory feedback phase, where a stronger compensatory decrease in F1 was associated with a stronger the SIS effect. Finally, under the auditory-cued condition, an auditory repetition-suppression effect was observed in N1/P2 amplitude during the listening task but not active speaking, suggesting that auditory predictive processes during speaking and passive listening are functionally distinct.

Timing variability of sensorimotor integration during vocalization in individuals who stutter

Persistent developmental stuttering affects close to 1% of adults and is thought to be a problem of sensorimotor integration. Previous research has demonstrated that individuals who stutter respond differently to changes in their auditory feedback while speaking. Here we explore a number of changes that accompany alterations in the feedback of pitch during vocal production. Participants sustained the vowel /a/ while hearing on-line feedback of their own voice through headphones. In some trials, feedback was briefly shifted up or down by 100 cents to simulate a vocal production error. As previously shown, participants compensated for the auditory pitch change by altering their vocal production in the opposite direction of the shift. The average compensatory response was smaller for adults who stuttered than for adult controls. Detailed analyses revealed that adults who stuttered had fewer trials with a robust corrective response, and that within the trials showing compensation, the timing of their responses was more variable. These results support the idea that dysfunctional sensorimotor integration in stuttering is characterized by timing variability, reflecting reduced coupling of the auditory and speech motor systems.

Effects of ageing on orofacial fine force control and its relationship with parallel change in sensory perception

PURPOSE

Current theoretical models suggest the importance of a bidirectional relationship between sensation and production in the vocal tract to maintain lifelong speech skills. The purpose of this study was to assess age-related changes in orofacial skilled force production and to begin defining the orofacial perception-action relationship in healthy adults.

METHOD

Low-level orofacial force control measures (reaction time, rise time, peak force, mean hold force (N) and force hold SD) were collected from 60 adults (19-84 years). Non-parametric Kruskal Wallis tests were performed to identify statistical differences between force and group demographics. Non-parametric Spearman's rank correlations were completed to compare force measures against previously published sensory data from the same cohort of participants.

RESULT

Significant group differences in force control were found for age, sex, speech usage and smoking status. Significant correlational relationships were identified between labial vibrotactile thresholds and several low-level force control measures collected during step and ramp-and-hold conditions.

CONCLUSION

These findings demonstrate age-related alterations in orofacial force production. Furthermore, correlational analysis suggests as vibrotactile detection thresholds increase, the ability to maintain low-level force control accuracy decreases. Possible clinical applications and treatment consequences of these findings for speech disorders in the ageing population are provided.

Functional and Neuroanatomical Bases of Developmental Stuttering: Current Insights

Affecting 5% of all preschool-aged children and 1% of the general population, developmental stuttering-also called childhood-onset fluency disorder-is a complex, multifactorial neurodevelopmental disorder characterized by frequent disruption of the fluent flow of speech. Over the past two decades, neuroimaging studies of both children and adults who stutter have begun to provide significant insights into the neurobiological bases of stuttering. This review highlights convergent findings from this body of literature with a focus on functional and structural neuroimaging results that are supported by theoretically driven neurocomputational models of speech production. Updated views on possible mechanisms of stuttering onset and persistence, and perspectives on promising areas for future research into the mechanisms of stuttering, are discussed.

Auditory-motor adaptation is reduced in adults who stutter but not in children who stutter

Previous studies have shown that adults who stutter produce smaller corrective motor responses to compensate for unexpected auditory perturbations in comparison to adults who do not stutter, suggesting that stuttering may be associated with deficits in integration of auditory feedback for online speech monitoring. In this study, we examined whether stuttering is also associated with deficiencies in integrating and using discrepancies between expected and received auditory feedback to adaptively update motor programs for accurate speech production. Using a sensorimotor adaptation paradigm, we measured adaptive speech responses to auditory formant frequency perturbations in adults and children who stutter and their matched nonstuttering controls. We found that the magnitude of the speech adaptive response for children who stutter did not differ from that of fluent children. However, the adaptation magnitude of adults who stutter in response to auditory perturbation was significantly smaller than the adaptation magnitude of adults who do not stutter. Together these results indicate that stuttering is associated with deficits in integrating discrepancies between predicted and received auditory feedback to calibrate the speech production system in adults but not children. This auditory-motor integration deficit thus appears to be a compensatory effect that develops over years of stuttering.

Speaking-related changes in cortical functional connectivity associated with assisted and spontaneous recovery from developmental stuttering

We previously reported speaking-related activity changes associated with assisted recovery induced by a fluency shaping therapy program and unassisted recovery from developmental stuttering (Kell et al., Brain 2009). While assisted recovery re-lateralized activity to the left hemisphere, unassisted recovery was specifically associated with the activation of the left BA 47/12 in the lateral orbitofrontal cortex. These findings suggested plastic changes in speaking-related functional connectivity between left hemispheric speech network nodes. We reanalyzed these data involving 13 stuttering men before and after fluency shaping, 13 men who recovered spontaneously from their stuttering, and 13 male control participants, and examined functional connectivity during overt vs. covert reading by means of psychophysiological interactions computed across left cortical regions involved in articulation control. Persistent stuttering was associated with reduced auditory-motor coupling and enhanced integration of somatosensory feedback between the supramarginal gyrus and the prefrontal cortex. Assisted recovery reduced this hyper-connectivity and increased functional connectivity between the articulatory motor cortex and the auditory feedback processing anterior superior temporal gyrus. In spontaneous recovery, both auditory-motor coupling and integration of somatosensory feedback were normalized. In addition, activity in the left orbitofrontal cortex and superior cerebellum appeared uncoupled from the rest of the speech production network. These data suggest that therapy and spontaneous recovery normalizes the left hemispheric speaking-related activity via an improvement of auditory-motor mapping. By contrast, long-lasting unassisted recovery from stuttering is additionally supported by a functional isolation of the superior cerebellum from the rest of the speech production network, through the pivotal left BA 47/12.

Stuttering adults' lack of pre-speech auditory modulation normalizes when speaking with delayed auditory feedback

Auditory modulation during speech movement planning is limited in adults who stutter (AWS), but the functional relevance of the phenomenon itself remains unknown. We investigated for AWS and adults who do not stutter (AWNS) (a) a potential relationship between pre-speech auditory modulation and auditory feedback contributions to speech motor learning and (b) the effect on pre-speech auditory modulation of real-time versus delayed auditory feedback. Experiment I used a sensorimotor adaptation paradigm to estimate auditory-motor speech learning. Using acoustic speech recordings, we quantified subjects' formant frequency adjustments across trials when continually exposed to formant-shifted auditory feedback. In Experiment II, we used electroencephalography to determine the same subjects' extent of pre-speech auditory modulation (reductions in auditory evoked potential N1 amplitude) when probe tones were delivered prior to speaking versus not speaking. To manipulate subjects' ability to monitor real-time feedback, we included speaking conditions with non-altered auditory feedback (NAF) and delayed auditory feedback (DAF). Experiment I showed that auditory-motor learning was limited for AWS versus AWNS, and the extent of learning was negatively correlated with stuttering frequency. Experiment II yielded several key findings: (a) our prior finding of limited pre-speech auditory modulation in AWS was replicated; (b) DAF caused a decrease in auditory modulation for most AWNS but an increase for most AWS; and (c) for AWS, the amount of auditory modulation when speaking with DAF was positively correlated with stuttering frequency. Lastly, AWNS showed no correlation between pre-speech auditory modulation (Experiment II) and extent of auditory-motor learning (Experiment I) whereas AWS showed a negative correlation between these measures. Thus, findings suggest that AWS show deficits in both pre-speech auditory modulation and auditory-motor learning; however, limited pre-speech modulation is not directly related to limited auditory-motor adaptation; and in AWS, DAF paradoxically tends to normalize their otherwise limited pre-speech auditory modulation.

Efeito da retroalimentação auditiva atrasada na gagueira com e sem alteração do processamento auditivo central

RESUMO Objetivo Verificar o efeito da retroalimentação auditiva atrasada na fluência da fala de indivíduos que gaguejam, com e sem alteração do processamento auditivo central. Método Participaram 20 indivíduos com gagueira, de sete a 17 anos, divididos em dois grupos, cada um com 10 indivíduos: Grupo Gagueira com Transtorno do Processamento Auditivo (GGTPA) e Grupo Gagueira (GG) sem alteração de processamento auditivo central. Os procedimentos foram: avaliação da fluência com retroalimentação auditiva habitual (RAH) e atrasada (RAA), e avaliação da gravidade da gagueira e do processamento auditivo central (PAC). O software Fono Tools foi utilizado para provocar o atraso de 100 milissegundos na retroalimentação auditiva. O teste dos Postos Sinalizados de Wilcoxon foi utilizado na análise intragrupos, e o teste de Mann-Whitney, na análise intergrupos. Resultados A RAA ocasionou no GG redução estatisticamente significante: no escore da frequência das disfluências típicas da gagueira na análise do Instrumento de Gravidade da Gagueira, na quantidade de bloqueios e de repetições de palavras monossilábicas, e na frequência de disfluências típicas da gagueira de duração. O atraso na retroalimentação auditiva não provocou efeitos estatisticamente significantes na fluência do GGTPA, grupo dos indivíduos com gagueira com alteração do PAC. Conclusão O efeito da retroalimentação auditiva atrasada na fala de indivíduos com gagueira foi diferente nos indivíduos com e sem alteração do processamento auditivo central, pois houve melhora da fluência apenas nos indivíduos sem alteração do PAC.

The role of auditory temporal cues in the fluency of stuttering adults

ABSTRACT Purpose: to compare the frequency of disfluencies and speech rate in spontaneous speech and reading in adults with and without stuttering in non-altered and delayed auditory feedback (NAF, DAF). Methods: participants were 30 adults: 15 with Stuttering (Research Group - RG), and 15 without stuttering (Control Group - CG). The procedures were: audiological assessment and speech fluency evaluation in two listening conditions, normal and delayed auditory feedback (100 milliseconds delayed by Fono Tools software). Results: the DAF caused a significant improvement in the fluency of spontaneous speech in RG when compared to speech under NAF. The effect of DAF was different in CG, because it increased the common disfluencies and the total of disfluencies in spontaneous speech and reading, besides showing an increase in the frequency of stuttering-like disfluencies in reading. The intergroup analysis showed significant differences in the two speech tasks for the two listening conditions in the frequency of stuttering-like disfluencies and in the total of disfluencies, and in the flows of syllable and word-per-minute in the NAF. Conclusion: the results demonstrated that delayed auditory feedback promoted fluency in spontaneous speech of adults who stutter, without interfering in the speech rate. In non-stuttering adults an increase occurred in the number of common disfluencies and total of disfluencies as well as reduction of speech rate in spontaneous speech and reading.

Sensorimotor Oscillations Prior to Speech Onset Reflect Altered Motor Networks in Adults Who Stutter

Adults who stutter (AWS) have demonstrated atypical coordination of motor and sensory regions during speech production. Yet little is known of the speech-motor network in AWS in the brief time window preceding audible speech onset. The purpose of the current study was to characterize neural oscillations in the speech-motor network during preparation for and execution of overt speech production in AWS using magnetoencephalography (MEG). Twelve AWS and 12 age-matched controls were presented with 220 words, each word embedded in a carrier phrase. Controls were presented with the same word list as their matched AWS participant. Neural oscillatory activity was localized using minimum-variance beamforming during two time periods of interest: speech preparation (prior to speech onset) and speech execution (following speech onset). Compared to controls, AWS showed stronger beta (15–25 Hz) suppression in the speech preparation stage, followed by stronger beta synchronization in the bilateral mouth motor cortex. AWS also recruited the right mouth motor cortex significantly earlier in the speech preparation stage compared to controls. Exaggerated motor preparation is discussed in the context of reduced coordination in the speech-motor network of AWS. It is further proposed that exaggerated beta synchronization may reflect a more strongly inhibited motor system that requires a stronger beta suppression to disengage prior to speech initiation. These novel findings highlight critical differences in the speech-motor network of AWS that occur prior to speech onset and emphasize the need to investigate further the speech-motor assembly in the stuttering population.

Relationship between Speech Production and Perception in People Who Stutter

Speech production difficulties are apparent in people who stutter (PWS). PWS also have difficulties in speech perception compared to controls. It is unclear whether the speech perception difficulties in PWS are independent of, or related to, their speech production difficulties. To investigate this issue, functional MRI data were collected on 13 PWS and 13 controls whilst the participants performed a speech production task and a speech perception task. PWS performed poorer than controls in the perception task and the poorer performance was associated with a functional activity difference in the left anterior insula (part of the speech motor area) compared to controls. PWS also showed a functional activity difference in this and the surrounding area [left inferior frontal cortex (IFC)/anterior insula] in the production task compared to controls. Conjunction analysis showed that the functional activity differences between PWS and controls in the left IFC/anterior insula coincided across the perception and production tasks. Furthermore, Granger Causality Analysis on the resting-state fMRI data of the participants showed that the causal connection from the left IFC/anterior insula to an area in the left primary auditory cortex (Heschl's gyrus) differed significantly between PWS and controls. The strength of this connection correlated significantly with performance in the perception task. These results suggest that speech perception difficulties in PWS are associated with anomalous functional activity in the speech motor area, and the altered functional connectivity from this area to the auditory area plays a role in the speech perception difficulties of PWS.

Dissociations among linguistic, cognitive, and auditory-motor neuroanatomical domains in children who stutter

The onset of developmental stuttering typically occurs between 2 to 4 years of age, coinciding with a period of rapid development in speech, language, motor and cognitive domains. Previous studies have reported generally poorer performance and uneven, or "dissociated" development across speech and language domains in children who stutter (CWS) relative to children who do not stutter (CWNS) (Anderson, Pellowski, & Conture, 2005). The aim of this study was to replicate and expand previous findings by examining whether CWS exhibit dissociated development across speech-language, cognitive, and motor domains that are also reflected in measures of neuroanatomical development. Participants were 66CWS (23 females) and 53CWNS (26 females) ranging from 3 to 10 years. Standardized speech, language, cognitive, and motor skills measures, and fractional anisotropy (FA) values derived from diffusion tensor imaging from speech relevant "dorsal auditory" left perisylvian areas (Hickok & Poeppel, 2007) were analyzed using a correlation-based statistical procedure (Coulter, Anderson, & Conture, 2009) that quantified dissociations across domains. Overall, CWS scored consistently lower on speech, language, cognitive and motor measures, and exhibited dissociated development involving these same measures and white matter neuroanatomical indices relative to CWNS. Boys who stutter exhibited a greater number of dissociations compared to girls who stutter. Results suggest a subgroup of CWS may have incongruent development across multiple domains, and the resolution of this imbalance may be a factor in recovery from stuttering.

Beyond production: Brain responses during speech perception in adults who stutter

Developmental stuttering is a speech disorder that disrupts the ability to produce speech fluently. While stuttering is typically diagnosed based on one's behavior during speech production, some models suggest that it involves more central representations of language, and thus may affect language perception as well. Here we tested the hypothesis that developmental stuttering implicates neural systems involved in language perception, in a task that manipulates comprehensibility without an overt speech production component. We used functional magnetic resonance imaging to measure blood oxygenation level dependent (BOLD) signals in adults who do and do not stutter, while they were engaged in an incidental speech perception task. We found that speech perception evokes stronger activation in adults who stutter (AWS) compared to controls, specifically in the right inferior frontal gyrus (RIFG) and in left Heschl's gyrus (LHG). Significant differences were additionally found in the lateralization of response in the inferior frontal cortex: AWS showed bilateral inferior frontal activity, while controls showed a left lateralized pattern of activation. These findings suggest that developmental stuttering is associated with an imbalanced neural network for speech processing, which is not limited to speech production, but also affects cortical responses during speech perception.

Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback

PURPOSE

To study the effects of masked auditory feedback (MAF) on speech fluency in adults with aphasia and/or apraxia of speech (APH/AOS). We hypothesized that adults with AOS would increase speech fluency when speaking with noise. Altered auditory feedback (AAF; i.e., delayed/frequency-shifted feedback) was included as a control condition not expected to improve speech fluency.

METHOD

Ten participants with APH/AOS and 10 neurologically healthy (NH) participants were studied under both feedback conditions. To allow examination of individual responses, we used an ABACA design. Effects were examined on syllable rate, disfluency duration, and vocal intensity.

RESULTS

Seven of 10 APH/AOS participants increased fluency with masking by increasing rate, decreasing disfluency duration, or both. In contrast, none of the NH participants increased speaking rate with MAF. In the AAF condition, only 1 APH/AOS participant increased fluency. Four APH/AOS participants and 8 NH participants slowed their rate with AAF.

CONCLUSIONS

Speaking with MAF appears to increase fluency in a subset of individuals with APH/AOS, indicating that overreliance on auditory feedback monitoring may contribute to their disorder presentation. The distinction between responders and nonresponders was not linked to AOS diagnosis, so additional work is needed to develop hypotheses for candidacy and underlying control mechanisms.

Motor practice effects and sensorimotor integration in adults who stutter: Evidence from visuomotor tracking performance

PURPOSE

The purpose of this study was to utilize a visuomotor tracking task, with both the jaw and hand, to add to the literature regarding non-speech motor practice and sensorimotor integration (outside of auditory-motor integration domain) in adults who do (PWS) and do not (PWNS) stutter.

METHOD

Participants were 15 PWS (14 males, mean age = 27.0) and 15 PWNS (14 males, mean age = 27.2). Participants tracked both predictable and unpredictable moving targets separately with their jaw and their dominant hand, and accuracy was assessed by calculating phase and amplitude difference between the participant and the target. Motor practice effect was examined by comparing group performance over consecutive tracking trials of predictable conditions as well as within the first trial of same conditions.

RESULTS

Results showed that compared to PWNS, PWS were not significantly different in matching either the phase (timing) or the amplitude of the target in both jaw and hand tracking of predictable and unpredictable targets. Further, there were no significant between-group differences in motor practice effects for either jaw or hand tracking. Both groups showed improved tracking accuracy within and between the trials.

CONCLUSION

Our findings revealed no statistically significant differences in non-speech motor practice effects and integration of sensorimotor feedback between PWS and PWNS, at least in the context of the visuomotor tracking tasks employed in the study. In general, both talker groups exhibited practice effects (i.e., increased accuracy over time) within and between tracking trials during both jaw and hand tracking. Implications for these results are discussed.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) describe the importance of motor learning and sensory-motor integration for speech, (b) summarize past research on PWS's performance during speech and nonspeech motor tasks, and (c) describe the relation between different aspects of speech and non-speech motor control and stuttering.

Evidence for a rhythm perception deficit in children who stutter

Stuttering is a neurodevelopmental disorder that affects the timing and rhythmic flow of speech production. When speech is synchronized with an external rhythmic pacing signal (e.g., a metronome), even severe stuttering can be markedly alleviated, suggesting that people who stutter may have difficulty generating an internal rhythm to pace their speech. To investigate this possibility, children who stutter and typically-developing children (n=17 per group, aged 6-11 years) were compared in terms of their auditory rhythm discrimination abilities of simple and complex rhythms. Children who stutter showed worse rhythm discrimination than typically-developing children. These findings provide the first evidence of impaired rhythm perception in children who stutter, supporting the conclusion that developmental stuttering may be associated with a deficit in rhythm processing.

The trajectory of gray matter development in Broca's area is abnormal in people who stutter

The acquisition and mastery of speech-motor control requires years of practice spanning the course of development. People who stutter often perform poorly on speech-motor tasks thereby calling into question their ability to establish the stable neural motor programs required for masterful speech-motor control. There is evidence to support the assertion that these neural motor programs are represented in the posterior part of Broca’s area, specifically the left pars opercularis. Consequently, various theories of stuttering causation posit that the disorder is related to a breakdown in the formation of the neural motor programs for speech early in development and that this breakdown is maintained throughout life. To date, no study has examined the potential neurodevelopmental signatures of the disorder across pediatric and adult populations. The current study aimed to fill this gap in our knowledge. We hypothesized that the developmental trajectory of cortical thickness in people who stutter would differ across the lifespan in the left pars opercularis relative to a group of control participants. We collected structural magnetic resonance images from 116 males (55 people who stutter) ranging in age from 6 to 48 years old. Differences in cortical thickness across ages and between patients and controls were investigated in 30 brain regions previously implicated in speech-motor control. An interaction between age and group was found for the left pars opercularis only. In people who stutter, the pars opercularis did not demonstrate the typical maturational pattern of gradual gray matter thinning with age across the lifespan that we observed in control participants. In contrast, the developmental trajectory of gray matter thickness in other regions of interest within the neural network for speech-motor control was similar for both groups. Our findings indicate that the developmental trajectory of gray matter in left pars opercularis is abnormal in people who stutter.

White matter neuroanatomical differences in young children who stutter

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.

Temporal dynamics of sensorimotor integration in speech perception and production: independent component analysis of EEG data

Activity in anterior sensorimotor regions is found in speech production and some perception tasks. Yet, how sensorimotor integration supports these functions is unclear due to a lack of data examining the timing of activity from these regions. Beta (~20 Hz) and alpha (~10 Hz) spectral power within the EEG μ rhythm are considered indices of motor and somatosensory activity, respectively. In the current study, perception conditions required discrimination (same/different) of syllables pairs (/ba/ and /da/) in quiet and noisy conditions. Production conditions required covert and overt syllable productions and overt word production. Independent component analysis was performed on EEG data obtained during these conditions to (1) identify clusters of μ components common to all conditions and (2) examine real-time event-related spectral perturbations (ERSP) within alpha and beta bands. 17 and 15 out of 20 participants produced left and right μ-components, respectively, localized to precentral gyri. Discrimination conditions were characterized by significant (pFDR < 0.05) early alpha event-related synchronization (ERS) prior to and during stimulus presentation and later alpha event-related desynchronization (ERD) following stimulus offset. Beta ERD began early and gained strength across time. Differences were found between quiet and noisy discrimination conditions. Both overt syllable and word productions yielded similar alpha/beta ERD that began prior to production and was strongest during muscle activity. Findings during covert production were weaker than during overt production. One explanation for these findings is that μ-beta ERD indexes early predictive coding (e.g., internal modeling) and/or overt and covert attentional/motor processes. μ-alpha ERS may index inhibitory input to the premotor cortex from sensory regions prior to and during discrimination, while μ-alpha ERD may index sensory feedback during speech rehearsal and production.

Induction of plasticity in the human motor cortex by pairing an auditory stimulus with TMS

Acoustic stimuli can cause a transient increase in the excitability of the motor cortex. The current study leverages this phenomenon to develop a method for testing the integrity of auditorimotor integration and the capacity for auditorimotor plasticity. We demonstrate that appropriately timed transcranial magnetic stimulation (TMS) of the hand area, paired with auditorily mediated excitation of the motor cortex, induces an enhancement of motor cortex excitability that lasts beyond the time of stimulation. This result demonstrates for the first time that paired associative stimulation (PAS)-induced plasticity within the motor cortex is applicable with auditory stimuli. We propose that the method developed here might provide a useful tool for future studies that measure auditory-motor connectivity in communication disorders.