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Franken MC, Oonk LC, Bast BJEG, Bouwen J, De Nil L. Erasmus clinical model of the onset and development of stuttering 2.0. JOURNAL OF FLUENCY DISORDERS 2024; 80:106040. [PMID: 38493582 DOI: 10.1016/j.jfludis.2024.106040] [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: 05/12/2023] [Revised: 12/25/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker's experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus.
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Affiliation(s)
- Marie-Christine Franken
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Leonoor C Oonk
- StotterFonds, Nijkerk, the Netherlands; University of Applied Sciences, Department of Speech-Language Therapy, Utrecht, the Netherlands
| | | | - Jan Bouwen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Luc De Nil
- Department of Speech-Language Pathology, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada.
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Lazzari G, van de Vorst R, van Vugt FT, Lega C. Subtle Patterns of Altered Responsiveness to Delayed Auditory Feedback during Finger Tapping in People Who Stutter. Brain Sci 2024; 14:472. [PMID: 38790451 PMCID: PMC11120293 DOI: 10.3390/brainsci14050472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Differences in sensorimotor integration mechanisms have been observed between people who stutter (PWS) and controls who do not. Delayed auditory feedback (DAF) introduces timing discrepancies between perception and action, disrupting sequence production in verbal and non-verbal domains. While DAF consistently enhances speech fluency in PWS, its impact on non-verbal sensorimotor synchronization abilities remains unexplored. A total of 11 PWS and 13 matched controls completed five tasks: (1) unpaced tapping; (2) synchronization-continuation task (SCT) without auditory feedback; (3) SCT with DAF, with instruction either to align the sound in time with the metronome; or (4) to ignore the sound and align their physical tap to the metronome. Additionally, we measured participants' sensitivity to detecting delayed feedback using a (5) delay discrimination task. Results showed that DAF significantly affected performance in controls as a function of delay duration, despite being irrelevant to the task. Conversely, PWS performance remained stable across delays. When auditory feedback was absent, no differences were found between PWS and controls. Moreover, PWS were less able to detect delays in speech and tapping tasks. These findings show subtle differences in non-verbal sensorimotor performance between PWS and controls, specifically when action-perception loops are disrupted by delays, contributing to models of sensorimotor integration in stuttering.
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Affiliation(s)
- Giorgio Lazzari
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Robert van de Vorst
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, QC H3A 1G1, Canada; (R.v.d.V.); (F.T.v.V.)
- School of Communication Sciences and Disorders, McGill University, Montreal, QC H3G 1Y6, Canada
| | - Floris T. van Vugt
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, QC H3A 1G1, Canada; (R.v.d.V.); (F.T.v.V.)
- Psychology Department, University of Montreal, Montreal, QC H3T 1J4, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, QC H3T 1J4, Canada
| | - Carlotta Lega
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
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Almudhi A, Gabr SA. Associations between glutamic acid decarboxylase antibodies, oxidative stress markers, and cognitive capacity in adolescents who stutter. Saudi J Biol Sci 2023; 30:103580. [PMID: 36844638 PMCID: PMC9943924 DOI: 10.1016/j.sjbs.2023.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/04/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
In this study, we amid to evaluate the correlation between the change in the expressed levels of anti-GAD antibodies titers, oxidative stress markers, cytokines markers, and cognitive capacity in adolescents with mild stuttering. Eighty participants (60 male/20 female) with the age range of 10-18 years with moderate stutteringparticipated in this study. To assess the stuttering and cognitive function, stutteringseverity instrument (SSI-4; 4th edit.)and the LOTCA-7 scores assessment were applied respectively in all subjects. In addition, serum GAD antibodies, cytokines like TNF-α, CRP,and IL-6 withtotal antioxidant capacity and nitric oxide as oxidative stress markers were estimated using calorimetry and immunoassay techniques.The results showed that good cognitive capacity was reported in about 56.25 % of the study population (n = 45) with a 117.52 ± 6.3 mean LOTCA-7 score. However, abnormal cognitive function was identified in 43.75 % of the study population (n = 35); they were categorized into moderate (score 62-92, n = 35), and poor (score 31-62; n = 10). There were significant associations between cognitive capacity reported and all biomarkers. The expression of GAD antibodies is significantly associated with the degree of cognitive capacity among students with stuttering. Significant association with the reduction (P = 0.01) in LOTCA-7 score domains, particularly orientation, thinking operations, attention, and concentration among students with variable cognitive capacity compared to controls. In addition, the expressed higher GAD antibodies in students with moderate and poor cognitive capacity showed to be significantly correlated with both elevated concentrations of cytokines; TNF-α, CRP, and IL-6, and the reduction of TAC and nitric oxide (NO) respectively. This study concludes that abnormality of cognitive capacity showed to be associated with higher expression of GAD antibodies, cytokines, and oxidative stress in school students with moderate stuttering.
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Affiliation(s)
- Abdulaziz Almudhi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia,Speech Language Pathology Unit, King Khalid University, Abha 61481, Saudi Arabia,Corresponding author at: Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
| | - Sami A. Gabr
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
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Moein N, Mohamadi R, Rostami R, Nitsche M, Zomorrodi R, Ostadi A. Investigation of the effect of delayed auditory feedback and transcranial direct current stimulation (DAF-tDCS) treatment for the enhancement of speech fluency in adults who stutter: A randomized controlled trial. JOURNAL OF FLUENCY DISORDERS 2022; 72:105907. [PMID: 35689904 DOI: 10.1016/j.jfludis.2022.105907] [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: 10/25/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stuttering is a disorder that begins in childhood and can persist into adulthood. In the present study, it was hypothesized that the combined intervention of transcranial direct current stimulation (tDCS) and Delayed Auditory Feedback (DAF) would cause greater improvement in speech fluency in comparison to the intervention with DAF alone. METHODS A randomized, double-blind, sham-controlled clinical trial was conducted to investigate the effects of the combined intervention. Fifty adults with moderate to severe stuttering (25 females, 25 males, Mean age=26.92, SD=6.23) were randomly allocated to the anodal or sham tDCS group. In the anodal tDCS group, participants received DAF combined with anodal tDCS (1 mA), while the sham tDCS group was exposed to sham tDCS simultaneously with DAF. In this study, a 60-ms delay was used for DAF intervention, and tDCS was applied over the left superior temporal gyrus. Each individual participated in six 20-minute intervention sessions (held on six consecutive days). Speech fluency was assessed before and after the intervention. RESULTS In the anodal tDCS group, the scores of the Stuttering Severity Instrument, Overall Assessment of the Speaker's Experience of Stuttering questionnaire, and the percentage of stuttered syllable reduced significantly (from average baseline rates of 8.45%, across three tasks, to 5.36% at the follow-up assessment) after the intervention. CONCLUSION The results of this study suggest that delivery of anodal tDCS when combined with DAF may enhance stuttering reduction effects for six weeks following the intervention.
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Affiliation(s)
- Narges Moein
- Department of Speech-Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St., Shahnazari Ave., Mirdamad Blvd., Madar Sq., Tehran, Iran.
| | - Reyhane Mohamadi
- Department of Speech-Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Rehabilitationresearch Center, Iran University of Medical Sciences, Madadkaran St., Shahnazari Ave., Mirdamad Blvd., Madar Sq., Tehran, Iran.
| | - Reza Rostami
- Faculty of Psychology and Education, University of Tehran, Dr. Kardan St., Jalal-Al-e-Ahmed Ave., Chamran Hwy., Tehran, Iran.
| | - Michael Nitsche
- Department of psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Ardeystrasse 67, Dortmund, Germany.
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, University of Toronto, Russell St., Toronto, Ontario, Canada.
| | - Amir Ostadi
- University of Waterloo, Waterloo, Ontario, Canada.
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Weerathunge HR, Tomassi NE, Stepp CE. What Can Altered Auditory Feedback Paradigms Tell Us About Vocal Motor Control in Individuals With Voice Disorders? PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:959-976. [PMID: 37397620 PMCID: PMC10312128 DOI: 10.1044/2022_persp-21-00195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Purpose The goal of this review article is to provide a summary of the progression of altered auditory feedback (AAF) as a method to understand the pathophysiology of voice disorders. This review article focuses on populations with voice disorders that have thus far been studied using AAF, including individuals with Parkinson's disease, cerebellar degeneration, hyperfunctional voice disorders, vocal fold paralysis, and laryngeal dystonia. Studies using AAF have found that individuals with Parkinson's disease, cerebellar degeneration, and laryngeal dystonia have hyperactive auditory feedback responses due to differing underlying causes. In persons with PD, the hyperactivity may be a compensatory mechanism for atypically weak feedforward motor control. In individuals with cerebellar degeneration and laryngeal dystonia, the reasons for hyperactivity remain unknown. Individuals with hyperfunctional voice disorders may have auditory-motor integration deficits, suggesting atypical updating of feedforward motor control. Conclusions These findings have the potential to provide critical insights to clinicians in selecting the most effective therapy techniques for individuals with voice disorders. Future collaboration between clinicians and researchers with the shared objective of improving AAF as an ecologically feasible and valid tool for clinical assessment may provide more personalized therapy targets for individuals with voice disorders.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Nicole E. Tomassi
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Graduate Program for Neuroscience, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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Almudhi A, Gabr S. Green tea consumption and the management of adrenal stress hormones in adolescents who stutter. Biomed Rep 2022; 16:32. [PMID: 35251619 PMCID: PMC8889529 DOI: 10.3892/br.2022.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Green tea and its polyphenolic compounds have been shown to exert positive effects in individuals with psychological disorders. The protective role of green tea against stuttering or its related consequences, depression, anxiety and stress, were evaluated in adolescents with moderate stuttering (MS). A total of 60 adolescents aged (12-18) years old were enrolled in this study. Patients were classified according to standardized test material Stuttering Severity Instrument, 4th Edition was used to estimate the severity of stuttering; participants were classified into two groups: a normal healthy group (n=30) and a MS group (n=30). The Depression Anxiety Stress Scale and General Health Questionnaire were used to estimate the degree of depression, anxiety and stress as well as general mental health. The physiological profile of stress hormones, as a measure of the response to green tea response, was also measured amongst participants. Adrenal stress hormones cortisol, dehydroepiandrosterone (DHEA), acetylcholine (ACTH), corticosterone and the cortisol:DHEA ratio were assayed. In addition, the constituent green tea polyphenols and their quantities were determined using liquid chromatography analysis. Decaffeinated green tea was administered six cups/day for 6 weeks, and this significantly improved the depression, anxiety, stress and mental health consequences associated with stuttering in adolescents. In addition, increased consumption of green tea significantly reduced elevated levels of adrenal stress hormones; cortisol, DHEA, ACTH and corticosterone, and increased the cortisol:DHEA ratio in the control and adolescents who stuttered. The data showed that drinking six cups of decaffeinated green tea, which is enriched in catechins (1,580 mg) and other related polyphenols, was sufficient to improve the consequences of mental health associated with stuttering in younger aged individuals.
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Affiliation(s)
- Abdulaziz Almudhi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61481, Saudi Arabia
| | - Sami Gabr
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
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Luo S, Rabbani Q, Crone NE. Brain-Computer Interface: Applications to Speech Decoding and Synthesis to Augment Communication. Neurotherapeutics 2022; 19:263-273. [PMID: 35099768 PMCID: PMC9130409 DOI: 10.1007/s13311-022-01190-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 01/03/2023] Open
Abstract
Damage or degeneration of motor pathways necessary for speech and other movements, as in brainstem strokes or amyotrophic lateral sclerosis (ALS), can interfere with efficient communication without affecting brain structures responsible for language or cognition. In the worst-case scenario, this can result in the locked in syndrome (LIS), a condition in which individuals cannot initiate communication and can only express themselves by answering yes/no questions with eye blinks or other rudimentary movements. Existing augmentative and alternative communication (AAC) devices that rely on eye tracking can improve the quality of life for people with this condition, but brain-computer interfaces (BCIs) are also increasingly being investigated as AAC devices, particularly when eye tracking is too slow or unreliable. Moreover, with recent and ongoing advances in machine learning and neural recording technologies, BCIs may offer the only means to go beyond cursor control and text generation on a computer, to allow real-time synthesis of speech, which would arguably offer the most efficient and expressive channel for communication. The potential for BCI speech synthesis has only recently been realized because of seminal studies of the neuroanatomical and neurophysiological underpinnings of speech production using intracranial electrocorticographic (ECoG) recordings in patients undergoing epilepsy surgery. These studies have shown that cortical areas responsible for vocalization and articulation are distributed over a large area of ventral sensorimotor cortex, and that it is possible to decode speech and reconstruct its acoustics from ECoG if these areas are recorded with sufficiently dense and comprehensive electrode arrays. In this article, we review these advances, including the latest neural decoding strategies that range from deep learning models to the direct concatenation of speech units. We also discuss state-of-the-art vocoders that are integral in constructing natural-sounding audio waveforms for speech BCIs. Finally, this review outlines some of the challenges ahead in directly synthesizing speech for patients with LIS.
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Affiliation(s)
- Shiyu Luo
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Qinwan Rabbani
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, USA
| | - Nathan E Crone
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jossinger S, Sares A, Zislis A, Sury D, Gracco V, Ben-Shachar M. White matter correlates of sensorimotor synchronization in persistent developmental stuttering. JOURNAL OF COMMUNICATION DISORDERS 2022; 95:106169. [PMID: 34856426 PMCID: PMC8821245 DOI: 10.1016/j.jcomdis.2021.106169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/25/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individuals with persistent developmental stuttering display deficits in aligning motor actions to external cues (i.e., sensorimotor synchronization). Diffusion imaging studies point to stuttering-associated differences in dorsal, not ventral, white matter pathways, and in the cerebellar peduncles. Here, we studied microstructural white matter differences between adults who stutter (AWS) and fluent speakers using two complementary approaches to: (a) assess previously reported group differences in white matter diffusivity, and (b) evaluate the relationship between white matter diffusivity and sensorimotor synchronization in each group. METHODS Participants completed a sensorimotor synchronization task and a diffusion MRI scan. We identified the cerebellar peduncles and major dorsal- and ventral-stream language pathways in each individual and assessed correlations between sensorimotor synchronization and diffusion measures along the tracts. RESULTS The results demonstrated group differences in dorsal, not ventral, language tracts, in alignment with prior reports. Specifically, AWS had significantly lower fractional anisotropy (FA) in the left arcuate fasciculus, and significantly higher mean diffusivity (MD) in the bilateral frontal aslant tract compared to fluent speakers, while no significant group difference was detected in the inferior fronto-occipital fasciculus. We also found significant group differences in both FA and MD of the left middle cerebellar peduncle. Comparing patterns of association with sensorimotor synchronization revealed a novel double dissociation: MD within the left inferior cerebellar peduncle was significantly correlated with mean asynchrony in AWS but not in fluent speakers, while FA within the left arcuate fasciculus was significantly correlated with mean asynchrony in fluent speakers, but not in AWS. CONCLUSIONS Our results support the view that stuttering involves altered connectivity in dorsal tracts and that AWS may rely more heavily on cerebellar tracts to process timing information. Evaluating microstructural associations with sensitive behavioral measures provides a powerful tool for discovering additional functional differences in the underlying connectivity in AWS.
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Affiliation(s)
- Sivan Jossinger
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.
| | - Anastasia Sares
- Department of Psychology, Concordia University, Montréal, Canada; Centre for Research on Brain, Language and Music, McGill University, Montréal, Canada
| | - Avital Zislis
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Dana Sury
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Vincent Gracco
- Centre for Research on Brain, Language and Music, McGill University, Montréal, Canada; School of Communication Sciences and Disorders, McGill University, Montréal, Canada; Haskins Laboratories, New Haven, CT, United States
| | - Michal Ben-Shachar
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel; The Department of English Literature and Linguistics, Bar-Ilan University, Ramat-Gan, Israel
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Brignell A, Krahe M, Downes M, Kefalianos E, Reilly S, Morgan A. Interventions for children and adolescents who stutter: A systematic review, meta-analysis, and evidence map. JOURNAL OF FLUENCY DISORDERS 2021; 70:105843. [PMID: 33743406 DOI: 10.1016/j.jfludis.2021.105843] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence. METHODS Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies. RESULTS Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention. CONCLUSION The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.
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Affiliation(s)
- Amanda Brignell
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Michelle Krahe
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, 4111, Australia
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Sheena Reilly
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Angela Morgan
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.
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Gattie M, Lieven EVM, Kluk K. Weak Vestibular Response in Persistent Developmental Stuttering. Front Integr Neurosci 2021; 15:662127. [PMID: 34594189 PMCID: PMC8477904 DOI: 10.3389/fnint.2021.662127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Vibrational energy created at the larynx during speech will deflect vestibular mechanoreceptors in humans (Todd et al., 2008; Curthoys, 2017; Curthoys et al., 2019). Vestibular-evoked myogenic potential (VEMP), an indirect measure of vestibular function, was assessed in 15 participants who stutter, with a non-stutter control group of 15 participants paired on age and sex. VEMP amplitude was 8.5 dB smaller in the stutter group than the non-stutter group (p = 0.035, 95% CI [−0.9, −16.1], t = −2.1, d = −0.8, conditional R2 = 0.88). The finding is subclinical as regards gravitoinertial function, and is interpreted with regard to speech-motor function in stuttering. There is overlap between brain areas receiving vestibular innervation, and brain areas identified as important in studies of persistent developmental stuttering. These include the auditory brainstem, cerebellar vermis, and the temporo-parietal junction. The finding supports the disruptive rhythm hypothesis (Howell et al., 1983; Howell, 2004) in which sensory inputs additional to own speech audition are fluency-enhancing when they coordinate with ongoing speech.
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Affiliation(s)
- Max Gattie
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, United Kingdom
| | - Elena V M Lieven
- Child Study Centre, The University of Manchester, Manchester, United Kingdom.,The ESRC International Centre for Language and Communicative Development (LuCiD), The University of Manchester, Manchester, United Kingdom
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, United Kingdom
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Bradshaw AR, Lametti DR, McGettigan C. The Role of Sensory Feedback in Developmental Stuttering: A Review. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2021; 2:308-334. [PMID: 37216145 PMCID: PMC10158644 DOI: 10.1162/nol_a_00036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/16/2021] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Abigail R. Bradshaw
- Department of Speech, Hearing & Phonetic Sciences, University College London, UK
| | | | - Carolyn McGettigan
- Department of Speech, Hearing & Phonetic Sciences, University College London, UK
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Fiorin M, Marconato E, Palharini TA, Picoloto LA, Frizzo ACF, Cardoso ACV, Oliveira CMCD. Impact of auditory feedback alterations in individuals with stuttering. Braz J Otorhinolaryngol 2021; 87:247-254. [PMID: 31648949 PMCID: PMC9422389 DOI: 10.1016/j.bjorl.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Electrophysiological evidence has reinforced the hypothesis that stuttering is associated with a deficit in modulation of the cortical auditory system during speech planning, contributing to an inefficient auditory feedback monitoring and, consequently, resulting in disfluencies. OBJECTIVE To verify the impact of auditory feedback modifications on the spontaneous speech of individuals with stuttering. METHODS Sixteen individuals, of both genders, aged 8-17 years and 11 months, with a diagnosis of persistent neurodevelopmental stuttering, were divided into two groups: Moderate Stuttering Group and Severe Stuttering Group. The testing procedures consisted of three stages: collection of identification data, audiological assessment and fluency evaluation of spontaneous speech in four auditory feedback conditions (non-altered, delayed, masked and amplified). The speech sample obtained in the non-altered feedback was considered the control; the others were considered as modified listening conditions. RESULTS Regarding the stuttering-like disfluencies, a statistically significant difference was observed in the intragroup analysis of the Moderate Stuttering Group between non-altered and masked auditory feedback (p = 0.042), as well as between non-altered and amplified (p = 0.042). There was a statistically significant difference in the Severe Stuttering Group for all auditory feedback modifications in relation to the non-altered (delayed p = 0.012, masked p = 0.025 and amplified p = 0.042). There was also a reduction in flows of syllables and words-per-minute in the Moderate Stuttering Group for the delayed auditory feedback, as compared to non-altered (p = 0.017 and p = 0.025, respectively). CONCLUSION The effect of delayed auditory feedback was favorable for the Severe Stuttering Group, promoting speech fluency. The conditions of masked and amplified auditory feedback resulted in speech benefits in both groups, decreasing the number of stuttering-like disfluencies. The speech rate was not impaired by any listening condition analyzed.
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Affiliation(s)
- Michele Fiorin
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Eduarda Marconato
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Talissa Almeida Palharini
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Luana Altran Picoloto
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Ana Cláudia Figueiredo Frizzo
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Ana Claudia Vieira Cardoso
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil
| | - Cristiane Moço Canhetti de Oliveira
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Faculdade de Filosofia e Ciências, Programa de Pós-Graduação em Fonoaudiologia, Marília, SP, Brazil.
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Jiang J, Benhamou E, Waters S, Johnson JCS, Volkmer A, Weil RS, Marshall CR, Warren JD, Hardy CJD. Processing of Degraded Speech in Brain Disorders. Brain Sci 2021; 11:394. [PMID: 33804653 PMCID: PMC8003678 DOI: 10.3390/brainsci11030394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
The speech we hear every day is typically "degraded" by competing sounds and the idiosyncratic vocal characteristics of individual speakers. While the comprehension of "degraded" speech is normally automatic, it depends on dynamic and adaptive processing across distributed neural networks. This presents the brain with an immense computational challenge, making degraded speech processing vulnerable to a range of brain disorders. Therefore, it is likely to be a sensitive marker of neural circuit dysfunction and an index of retained neural plasticity. Considering experimental methods for studying degraded speech and factors that affect its processing in healthy individuals, we review the evidence for altered degraded speech processing in major neurodegenerative diseases, traumatic brain injury and stroke. We develop a predictive coding framework for understanding deficits of degraded speech processing in these disorders, focussing on the "language-led dementias"-the primary progressive aphasias. We conclude by considering prospects for using degraded speech as a probe of language network pathophysiology, a diagnostic tool and a target for therapeutic intervention.
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Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK;
| | - Rimona S. Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Charles R. Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
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Effect of Maximally Relaxed Lying Posture on the Severity of Stuttering in Young Adults Who Stutter. Motor Control 2021; 25:337-347. [PMID: 33721838 DOI: 10.1123/mc.2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
The current study was carried out with the aim of investigating the effect of maximally relaxed lying posture on disfluencies in young adults who stutter. A total of 24 participants (17 males, seven females; mean age = 24.9 ± 6.2 years) with developmental stuttering were a part of the study. The participants were asked to perform spontaneous speaking and reading aloud tasks in standard sitting and maximally relaxed lying postures. The severity of stuttering for the studied postures was estimated by using the Stuttering Severity Instrument. The results on the Stuttering Severity Instrument showed that stuttering parameters improved during the maximally relaxed lying posture compared with the standard sitting position. The results are discussed in the light of motor control concepts. It is concluded that the maximally relaxed lying posture can facilitate improvement in stuttering scores during spontaneous speaking as well as reading aloud in young adults who stutter. Reduced stuttering scores in the maximally relaxed lying posture suggest that speech therapists can position participants in this position while treating people who stutter.
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15
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Verdurand M, Rossato S, Zmarich C. Coarticulatory Aspects of the Fluent Speech of French and Italian People Who Stutter Under Altered Auditory Feedback. Front Psychol 2020; 11:1745. [PMID: 32793069 PMCID: PMC7390966 DOI: 10.3389/fpsyg.2020.01745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 06/24/2020] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Marine Verdurand
- Speech Therapy Study, Cabestany, France.,Université Grenoble Alpes, CNRS, Grenoble INP, LIG, Grenoble, France
| | - Solange Rossato
- Université Grenoble Alpes, CNRS, Grenoble INP, LIG, Grenoble, France
| | - Claudio Zmarich
- Institute of Cognitive Sciences and Technologies, National Research Council, Padua, Italy
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Tobimatsu S. Neuromagnetic oscillations in the human sensory systems: A mini review of our series and literature. Neurosci Res 2020; 156:117-129. [PMID: 31874215 DOI: 10.1016/j.neures.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/06/2019] [Accepted: 11/27/2019] [Indexed: 11/19/2022]
Abstract
Oscillatory neuronal (electrical) activity in defined frequency ranges supports synchronous interactions between anatomically distinct regions of the human brain during cognitive tasks. Here, the author reviews our previous studies that focused on the neuromagnetic oscillations in the sensory systems in response to the external stimuli in normal healthy subjects and neurological disorders. A magnetoencephalography was applied to evaluate the neuromagnetic oscillations in humans. We have demonstrated that the oscillatory gamma synchronization binds the primary and secondary somatosensory areas (S1 and S2) in humans. This functional coupling is modulated by aging. In people who stutter, functional and structural reorganization of the right auditory cortex appears to be a compensatory mechanism for impaired left auditory cortex function. This may be partly caused by increased right hemispheric local phase synchronization and increased inter-hemispheric phase synchronization. We have also found that the hippocampus modulates auditory processing differently under normal conditions and in epileptic patients with hippocampal sclerosis. This indicates that altered neural synchronization may provide useful information about possible functional deterioration in patients with unilateral mesial temporal lobe epilepsy. Finally, supraspinal (cortical) mechanism is responsible for pain perception and pain relief via neural oscillations. Together, neuronal synchronization plays an important role in distributed cortico-cortical processing.
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Affiliation(s)
- Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Toyomura A, Miyashiro D, Kuriki S, Sowman PF. Speech-Induced Suppression for Delayed Auditory Feedback in Adults Who Do and Do Not Stutter. Front Hum Neurosci 2020; 14:150. [PMID: 32390816 PMCID: PMC7193705 DOI: 10.3389/fnhum.2020.00150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/06/2020] [Indexed: 12/04/2022] Open
Abstract
Speech-induced suppression is the normal, relative amplitude reduction of the auditory evoked potential for self-, compared to externally-generated, auditory stimulation. It remains controversial as to whether adults who stutter exhibit expected auditory modulation during speech; some studies have reported a significant difference between stuttering and fluent groups in speech-induced suppression during speech movement planning, while others have not. We compared auditory evoked potentials (N1 component) for auditory feedback arising from one’s own voice (Speaking condition) with passive listening to a recording of one’s own voice (Listening condition) in 24 normally-fluent speakers and 16 adults who stutter under various delayed auditory feedback (DAF) time conditions (100 ms, 200 ms, 500 ms, and 1,000 ms). We presented the participant’s own voice with a delay, immediately after presenting it without a delay. Our working hypothesis was that the shorter the delay time, the more likely the delayed sound is perceived as self-generated. Therefore, shorter delay time conditions are proposed to result in relatively enhanced suppression of the auditory system. Results showed that in fluent speakers, the shorter the delay time, the more the auditory evoked potential in the Speaking condition tended to be suppressed. In the Listening condition, there was a larger evoked potential with shorter delay times. As a result, speech-induced suppression was only significant at the short delay time conditions of 100 and 200 ms. Adults who stutter did not show the opposing changes in the Speaking and Listening conditions seen in the fluent group. Although the evoked potential in the Listening condition tended to decrease as the delay time increased, that in the Speaking condition did not show a distinct trend, and there was a significant suppression only at 200 ms delay. For the 200 ms delay condition, speakers with more severe stuttering showed significantly greater speech-induced suppression than those with less severe stuttering. This preliminary study suggests our methods for investigating evoked potentials by presenting own voice with a delay may provide a clue as to the nature of auditory modulation in stuttering.
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Affiliation(s)
- Akira Toyomura
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Daiki Miyashiro
- Faculty of Medicine, School of Health Sciences, Gunma University, Maebashi, Japan.,Gunma University Hospital, Maebashi, Japan
| | - Shinya Kuriki
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Paul F Sowman
- Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia.,Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia
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18
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Iimura D, Asakura N, Sasaoka T, Inui T. Abnormal Sensorimotor Integration in Adults Who Stutter: A Behavioral Study by Adaptation of Delayed Auditory Feedback. Front Psychol 2019; 10:2440. [PMID: 31736833 PMCID: PMC6834693 DOI: 10.3389/fpsyg.2019.02440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Daichi Iimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- Domo-Work (Specified Nonprofit Corporation), Tokyo, Japan
| | - Nobuhiko Asakura
- Center for Mathematical Modeling and Data Science, Osaka University, Osaka, Japan
| | - Takafumi Sasaoka
- Brain, Mind and KANSEI Sciences Research Center, Hiroshima University, Hiroshima, Japan
| | - Toshio Inui
- Department of Psychology, Otemon Gakuin University, Osaka, Japan
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Effect of Different Body Postures on the Severity of Stuttering in Young Adults with Developmental Stuttering. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1817906. [PMID: 31467870 PMCID: PMC6699346 DOI: 10.1155/2019/1817906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/11/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
Abstract
Objective The current study aimed to investigate the effects of body position on the level and severity of stuttering in young adults with developmental stuttering. Methods A total of 24 subjects (male: 17; female: 7; mean age: 24.9 ± 6.2 years) with developmental stuttering participated. The participants were asked to perform oral reading and spontaneous monologue-speaking tasks in different body postures while their speech was recorded. During reading and speaking tasks, the Stuttering Severity Instrument was used to quantify the severity of stuttering. The effects of different body postures on stuttering severity, reading task, and speaking task scores were analyzed. Results Significant differences in stuttering severity, reading task, and speaking task scores were found for different body postures. Post hoc analyses revealed a significant difference in stuttering severity, reading task, and speaking task scores when subjects were sitting on a chair with no arm support compared to lying down (p<0.05). Similarly, there were significant differences for two sitting positions (sitting on a chair with no arm support vs sitting on a chair with arm support (p<0.05)). Conclusions Body postures or body segment positions that relax and facilitate the muscles of the neck and shoulders may potentially improve speech fluency in young adults with developmental stuttering.
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21
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Hardy CJD, Bond RL, Jaisin K, Marshall CR, Russell LL, Dick K, Crutch SJ, Rohrer JD, Warren JD. Sensitivity of Speech Output to Delayed Auditory Feedback in Primary Progressive Aphasias. Front Neurol 2018; 9:894. [PMID: 30420829 PMCID: PMC6216253 DOI: 10.3389/fneur.2018.00894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022] Open
Abstract
Delayed auditory feedback (DAF) is a classical paradigm for probing sensori-motor interactions in speech output and has been studied in various disorders associated with speech dysfluency and aphasia. However, little information is available concerning the effects of DAF on degenerating language networks in primary progressive aphasia: the paradigmatic "language-led dementias." Here we studied two forms of speech output (reading aloud and propositional speech) under natural listening conditions (no feedback delay) and under DAF at 200 ms, in a cohort of 19 patients representing all major primary progressive aphasia syndromes vs. healthy older individuals and patients with other canonical dementia syndromes (typical Alzheimer's disease and behavioral variant frontotemporal dementia). Healthy controls and most syndromic groups showed a quantitatively or qualitatively similar profile of reduced speech output rate and increased speech error rate under DAF relative to natural auditory feedback. However, there was no group effect on propositional speech output rate under DAF in patients with nonfluent primary progressive aphasia and logopenic aphasia. Importantly, there was considerable individual variation in DAF sensitivity within syndromic groups and some patients in each group (though no healthy controls) apparently benefited from DAF, showing paradoxically increased speech output rate and/or reduced speech error rate under DAF. This work suggests that DAF may be an informative probe of pathophysiological mechanisms underpinning primary progressive aphasia: identification of "DAF responders" may open up an avenue to novel therapeutic applications.
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Affiliation(s)
- Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rebecca L Bond
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Kankamol Jaisin
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Charles R Marshall
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lucy L Russell
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katrina Dick
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Cheadle O, Sorger C, Howell P. Identification of neural structures involved in stuttering using vibrotactile feedback. BRAIN AND LANGUAGE 2018; 180-182:50-61. [PMID: 29747034 DOI: 10.1016/j.bandl.2018.03.002] [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: 06/02/2017] [Revised: 01/23/2018] [Accepted: 03/31/2018] [Indexed: 06/08/2023]
Abstract
Feedback delivered over auditory and vibratory afferent pathways has different effects on the fluency of people who stutter (PWS). These features were exploited to investigate the neural structures involved in stuttering. The speech signal vibrated locations on the body (vibrotactile feedback, VTF). Eleven PWS read passages under VTF and control (no-VTF) conditions. All combinations of vibration amplitude, synchronous or delayed VTF and vibrator position (hand, sternum or forehead) were presented. Control conditions were performed at the beginning, middle and end of test sessions. Stuttering rate, but not speaking rate, differed between the control and VTF conditions. Notably, speaking rate did not change between when VTF was delayed versus when it was synchronous in contrast with what happens with auditory feedback. This showed that cerebellar mechanisms, which are affected when auditory feedback is delayed, were not implicated in the fluency-enhancing effects of VTF, suggesting that there is a second fluency-enhancing mechanism.
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Affiliation(s)
- Oliver Cheadle
- Division of Psychology and Language Sciences, University College London, UK
| | - Clarissa Sorger
- Division of Psychology and Language Sciences, University College London, UK
| | - Peter Howell
- Division of Psychology and Language Sciences, University College London, UK.
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Escera C, López-Caballero F, Gorina-Careta N. The Potential Effect of Forbrain as an Altered Auditory Feedback Device. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:801-810. [PMID: 29554188 DOI: 10.1044/2017_jslhr-s-17-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/10/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to run a proof of concept on a new commercially available device, Forbrain® (Sound For Life Ltd/Soundev, Luxemburg, model UN38.3), to test whether it can modulate the speech of its users. METHOD Participants were instructed to read aloud a text of their choice during 3 experimental phases: baseline, test, and posttest, while wearing a Forbrain® headset. Critically, for half of the participants (Forbrain group), the device was turned on during the test phase, whereas for the other half (control group), the device was kept off. Voice recordings were analyzed to derive 6 quantitative measures of voice quality over each of the phases of the experiment. RESULTS A significant Group × Phase interaction was obtained for the smoothed cepstral peak prominence, a measure of voice harmony, and for the trendline of the long-term average spectrum, a measure of voice robustness, this latter surviving Bonferroni correction for multiple comparisons. CONCLUSIONS The results of this study indicate the effectiveness of Forbrain® in modifying the speech of its users. It is suggested that Forbrain® works as an altered auditory feedback device. It may hence be used as a clinical device in speech therapy clinics, yet further studies are warranted to test its usefulness in clinical groups.
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Affiliation(s)
- Carles Escera
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- The Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Catalonia, Spain
| | - Fran López-Caballero
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- The Institute of Neurosciences, University of Barcelona, Catalonia, Spain
| | - Natàlia Gorina-Careta
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- The Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Catalonia, Spain
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Daliri A, Wieland EA, Cai S, Guenther FH, Chang SE. Auditory-motor adaptation is reduced in adults who stutter but not in children who stutter. Dev Sci 2018; 21:10.1111/desc.12521. [PMID: 28256029 PMCID: PMC5581739 DOI: 10.1111/desc.12521] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/16/2016] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Ayoub Daliri
- Boston University, Boston, MA, United States
- Arizona State University, Tempe, AZ, United States
| | | | | | | | - Soo-Eun Chang
- University of Michigan, Ann Arbor, MI, United States
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Daliri A, Max L. Stuttering adults' lack of pre-speech auditory modulation normalizes when speaking with delayed auditory feedback. Cortex 2018; 99:55-68. [PMID: 29169049 PMCID: PMC5801108 DOI: 10.1016/j.cortex.2017.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/06/2017] [Accepted: 10/20/2017] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Ayoub Daliri
- Arizona State University, Tempe, AZ, United States.
| | - Ludo Max
- University of Washington, Seattle, WA, United States; Haskins Laboratories, New Haven, CT, United States
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van de Vorst R, Gracco VL. Atypical non-verbal sensorimotor synchronization in adults who stutter may be modulated by auditory feedback. JOURNAL OF FLUENCY DISORDERS 2017; 53:14-25. [PMID: 28870331 DOI: 10.1016/j.jfludis.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate if non-verbal sensorimotor synchronization abilities in adult individuals who stutter (IWS) differ from non-stuttering controls (NS) under various performance conditions (tempo, auditory feedback, use of hands [single/both] and rhythm). METHODS Participants were 11 IWS (5 males, 6 females, Mean age=25.8, SD=8.7) and 11 age- and gender-matched controls (Mean age=24.4, SD=8.4). During the experiment, participants were asked to prepare three melodies and subsequently perform them with a metronome at different rates and auditory feedback modalities (non-altered and suppressed). For each task/condition we tracked timing asynchrony related to the steady metronome beat. RESULTS AND CONCLUSIONS Overall, IWS displayed significantly higher timing asynchrony. Of all conditions, auditory-feedback distinguished IWS from NS most strongly, a subgroup of IWS significantly benefitting from the absence of auditory feedback. In addition, IWS showed a non-significant trend of higher negative mean asynchrony (NMA) and were more affected by the slower rate and increased rhythmic complexity and occasionally suggested poorer beat perception. These results suggest aberrant timing of sensorimotor network interaction associated with the origin of developmental stuttering.
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Affiliation(s)
- Robert van de Vorst
- Centre for Research on Brain, Language and Music, 3640 rue de la Montagne, Montreal, H3G 2A8, Canada; School of Communication Sciences and Disorders, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada.
| | - Vincent L Gracco
- Centre for Research on Brain, Language and Music, 3640 rue de la Montagne, Montreal, H3G 2A8, Canada; School of Communication Sciences and Disorders, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada; Haskins Laboratories, 300 George Street, New Haven, CT 06511, USA.
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Kikuchi Y, Okamoto T, Ogata K, Hagiwara K, Umezaki T, Kenjo M, Nakagawa T, Tobimatsu S. Abnormal auditory synchronization in stuttering: A magnetoencephalographic study. Hear Res 2017; 344:82-89. [DOI: 10.1016/j.heares.2016.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/31/2016] [Indexed: 02/01/2023]
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Chesters J, Watkins KE, Möttönen R. Investigating the feasibility of using transcranial direct current stimulation to enhance fluency in people who stutter. BRAIN AND LANGUAGE 2017; 164:68-76. [PMID: 27810647 PMCID: PMC5240850 DOI: 10.1016/j.bandl.2016.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 10/17/2016] [Accepted: 10/23/2016] [Indexed: 05/02/2023]
Abstract
Developmental stuttering is a disorder of speech fluency affecting 1% of the adult population. Long-term reductions in stuttering are difficult for adults to achieve with behavioural therapies. We investigated whether a single session of transcranial direct current stimulation (TDCS) could improve fluency in people who stutter (PWS). In separate sessions, either anodal TDCS (1mA for 20min) or sham stimulation was applied over the left inferior frontal cortex while PWS read sentences aloud. Fluency was induced during the stimulation period by using choral speech, that is, participants read in unison with another speaker. Stuttering frequency during sentence reading, paragraph reading and conversation was measured at baseline and at two outcome time points: immediately after the stimulation period and 1h later. Stuttering was reduced significantly at both outcome time points for the sentence-reading task, presumably due to practice, but not during the paragraph reading or conversation tasks. None of the outcome measures were significantly modulated by anodal TDCS. Although the results of this single-session study showed no significant TDCS-induced improvements in fluency, there were some indications that further research is warranted. We discuss factors that we believe may have obscured the expected positive effects of TDCS on fluency, such as heterogeneity in stuttering severity for the sample and variations across sessions. Consideration of such factors may inform future studies aimed at determining the potential of TDCS in the treatment of developmental stuttering.
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Affiliation(s)
- Jennifer Chesters
- Department of Experimental Psychology, South Parks Road, University of Oxford, Oxford, UK.
| | - Kate E Watkins
- Department of Experimental Psychology, South Parks Road, University of Oxford, Oxford, UK
| | - Riikka Möttönen
- Department of Experimental Psychology, South Parks Road, University of Oxford, Oxford, UK
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Mock JR, Foundas AL, Golob EJ. Cortical activity during cued picture naming predicts individual differences in stuttering frequency. Clin Neurophysiol 2016; 127:3093-3101. [PMID: 27472545 DOI: 10.1016/j.clinph.2016.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Developmental stuttering is characterized by fluent speech punctuated by stuttering events, the frequency of which varies among individuals and contexts. Most stuttering events occur at the beginning of an utterance, suggesting neural dynamics associated with stuttering may be evident during speech preparation. METHODS This study used EEG to measure cortical activity during speech preparation in men who stutter, and compared the EEG measures to individual differences in stuttering rate as well as to a fluent control group. Each trial contained a cue followed by an acoustic probe at one of two onset times (early or late), and then a picture. There were two conditions: a speech condition where cues induced speech preparation of the picture's name and a control condition that minimized speech preparation. RESULTS Across conditions stuttering frequency correlated to cue-related EEG beta power and auditory ERP slow waves from early onset acoustic probes. CONCLUSIONS The findings reveal two new cortical markers of stuttering frequency that were present in both conditions, manifest at different times, are elicited by different stimuli (visual cue, auditory probe), and have different EEG responses (beta power, ERP slow wave). SIGNIFICANCE The cue-target paradigm evoked brain responses that correlated to pre-experimental stuttering rate.
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Affiliation(s)
- Jeffrey R Mock
- Department of Psychology, Tulane University, New Orleans, LA 70118, USA.
| | - Anne L Foundas
- Department of Psychology, Tulane University, New Orleans, LA 70118, USA
| | - Edward J Golob
- Department of Psychology, Tulane University, New Orleans, LA 70118, USA; Program in Neuroscience, Tulane University, New Orleans, LA 70118, USA
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Ritto AP, Costa JB, Juste FS, de Andrade CRF. Comparison of different speech tasks among adults who stutter and adults who do not stutter. Clinics (Sao Paulo) 2016; 71:152-5. [PMID: 27074176 PMCID: PMC4785848 DOI: 10.6061/clinics/2016(03)06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In this study, we compared the performance of both fluent speakers and people who stutter in three different speaking situations: monologue speech, oral reading and choral reading. This study follows the assumption that the neuromotor control of speech can be influenced by external auditory stimuli in both speakers who stutter and speakers who do not stutter. METHOD Seventeen adults who stutter and seventeen adults who do not stutter were assessed in three speaking tasks: monologue, oral reading (solo reading aloud) and choral reading (reading in unison with the evaluator). Speech fluency and rate were measured for each task. RESULTS The participants who stuttered had a lower frequency of stuttering during choral reading than during monologue and oral reading. CONCLUSIONS According to the dual premotor system model, choral speech enhanced fluency by providing external cues for the timing of each syllable compensating for deficient internal cues.
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Affiliation(s)
- Ana Paula Ritto
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo/SP, Brazil
| | - Julia Biancalana Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo/SP, Brazil
| | - Fabiola Staróbole Juste
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo/SP, Brazil
| | - Claudia Regina Furquim de Andrade
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo/SP, Brazil
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Buzzeti PBMDM, Fiorin M, Martinelli NL, Cardoso ACV, Oliveira CMCD. Comparação da leitura de escolares com gagueira em duas condições de escuta: habitual e atrasada. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618114015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: comparar os efeitos imediatos do atraso na retroalimentação auditiva na tarefa de leitura oral em escolares com gagueira do desenvolvimento persistente. Métodos: estudo aprovado pelo Comitê de Ética da Instituição (n°0714/2013). Participaram 16 escolares, com idade de 8 a 17 anos, sendo 11 do gênero masculino e 5 do feminino, separados em dois Grupos Experimentais (GE1 e GE2) de 8 participantes cada; o GE1 composto de participantes com gagueira moderada e o GE2 com gagueira grave ou muito grave. Os procedimentos utilizados foram: avaliação audiológica, avaliação da fluência na fala espontânea e avaliação da fluência na leitura oral em duas condições de escuta: com Retroalimentação Auditiva Habitual - RAH e atrasada - RAA. O software Fono Tools junto com o Adaptador Andrea PureAudio USB-AS e microfone auricular Karsect HT-2 foram utilizados para provocar o efeito da RAA e gravar a fala. Resultados: o efeito da retroalimentação auditiva atrasada ocasionou redução das disfluências típicas da gagueira em ambos os grupos, porém a frequência de outras disfluências aumentou no grupo de gagueira moderada e diminuiu no grupo com gagueira grave/muito grave e, desta forma, o total de disfluências apresentou uma diminuição mais significativa no GE2. A diferença foi estatisticamente significante apenas na comparação intergrupos das disfluências típicas da gagueira, na situação de retroalimentação auditiva habitual. Conclusões: o atraso na retroalimentação auditiva não ocasionou efeitos significantes na leitura em ambos os grupos, entretanto há uma tendência do efeito ser considerado positivo para o grupo com gagueira grave/muito grave.
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Haitani T, Kumano H. The Relationship between Attentional Function and Stuttering Severity in Adults who Stutter. ACTA ACUST UNITED AC 2016. [DOI: 10.5112/jjlp.57.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mock JR, Foundas AL, Golob EJ. Speech preparation in adults with persistent developmental stuttering. BRAIN AND LANGUAGE 2015; 149:97-105. [PMID: 26197258 PMCID: PMC4586364 DOI: 10.1016/j.bandl.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 04/29/2015] [Accepted: 05/16/2015] [Indexed: 05/21/2023]
Abstract
Motor efference copy conveys movement information to sensory areas before and during vocalization. We hypothesized speech preparation would modulate auditory processing, via motor efference copy, differently in men who stutter (MWS) vs. fluent adults. Participants (n=12/group) had EEG recorded during a cue-target paradigm with two conditions: speech which allowed for speech preparation, while a control condition did not. Acoustic stimuli probed auditory responsiveness between the cue and target. MWS had longer vocal reaction times (p<0.01) when the cue-target differed (10% of trials), suggesting a difficulty of rapidly updating their speech plans. Acoustic probes elicited a negative slow wave indexing motor efference copy that was smaller in MWS vs. fluent adults (p<0.03). Current density responses in MWS showed smaller left prefrontal responses and auditory responses that were delayed and correlated to stuttering rate. Taken together, the results provide insight into the cortical mechanisms underlying atypical speech planning and dysfluencies in MWS.
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Affiliation(s)
- Jeffrey R Mock
- Department of Psychology, Tulane University, United States.
| | - Anne L Foundas
- Department of Neurology at University of Missouri, Kansas City School of Medicine, United States
| | - Edward J Golob
- Department of Psychology, Tulane University, United States; Program in Neuroscience, Tulane University, United States
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Baxter S, Johnson M, Blank L, Cantrell A, Brumfitt S, Enderby P, Goyder E. The state of the art in non-pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:676-718. [PMID: 26123259 PMCID: PMC4755200 DOI: 10.1111/1460-6984.12171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/13/2015] [Accepted: 02/16/2015] [Indexed: 05/13/2023]
Abstract
BACKGROUND The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad-based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities. AIMS To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non-pharmacological interventions for the management of developmental stuttering. METHODS & PROCEDURES A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed. MAIN CONTRIBUTION The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions). CONCLUSIONS This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention.
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Affiliation(s)
- Susan Baxter
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
| | - Maxine Johnson
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
| | - Lindsay Blank
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
| | - Anna Cantrell
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
| | - Shelagh Brumfitt
- Department of
Human Communication SciencesUniversity of SheffieldSheffieldUK
| | - Pam Enderby
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
| | - Elizabeth Goyder
- School of Health
and Related ResearchUniversity of SheffieldSheffieldUK
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Atkinson-Clement C, Sadat J, Pinto S. Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature. Neurodegener Dis Manag 2015; 5:233-48. [DOI: 10.2217/nmt.15.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARY Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Jasmin Sadat
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Serge Pinto
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
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Carrasco ER, Schiefer AM, Azevedo MFD. O efeito do feedback auditivo atrasado na gagueira. AUDIOLOGY: COMMUNICATION RESEARCH 2015. [DOI: 10.1590/s2317-64312015000200001397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Verificar o efeito do feedback auditivo atrasado (delay auditory feedback) e da retroalimentação com a frequência alterada (frequency altered feedback) em indivíduos que manifestam gagueira. Métodos Foram selecionados 16 indivíduos adultos com diagnóstico de gagueira, de ambos os gêneros, faixa etária entre 17 e 49 anos e com, no mínimo, 8 anos de escolaridade. Os indivíduos foram distribuídos em dois grupos, sendo um grupo (G1) formado por oito indivíduos gagos submetidos à terapia de fala com o uso do aparelho SpeechEasy® e o outro (G2), formado por oito indivíduos gagos submetidos à terapia sem o uso do aparelho. Todos os indivíduos passaram por avaliação fonoaudiológica convencional, avaliação específica da fluência da fala, avaliação audiológica básica e treinamento de fala com ou sem o uso do aparelho. Os dados obtidos foram submetidos à análise estatística pertinente. Resultados Nos grupos G1 e G2 houve diminuição significativa do grau de gagueira e das disfluências atípicas na avaliação final, quando comparada à inicial. Conclusão Houve melhora do grau da gagueira com o treinamento de fala em ambos os grupos, com tendência do G1, que utilizou o dispositivoSpeechEasy®,para apresentar maior redução no índice de disfluências e maior ganho nas taxas de velocidade articulatória e de produção de informação.
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Ritto AP, Juste FS, Andrade CRFD. Impacto do uso do SpeechEasy® nos parâmetros acústicos e motores da fala de indivíduos com gagueira. AUDIOLOGY: COMMUNICATION RESEARCH 2015. [DOI: 10.1590/s2317-64312015000100001440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objetivo Investigar variações nas habilidades motoras da fala em adultos com e sem gagueira, utilizando o dispositivo de alteração do feedback auditivo SpeechEasy®. Métodos Participaram 20 adultos, dez com gagueira (nove do gênero masculino e um do feminino – média 30,9 anos) e dez controles fluentes (nove do gênero masculino e um do feminino – média 25,2 anos). O estudo comparou o desempenho dos participantes em quatro tarefas: fala espontânea, diadococinesia alternada, diadococinesia sequencial e emissão de frase alvo, com e sem o dispositivo. Os aspectos analisados acusticamente foram: (1) tarefas de diadococinesia: duração das sílabas, período médio entre as sílabas, pico de intensidade e taxa de diadococinesia; (2) tarefa de emissão da frase alvo: tempo de reação, duração do voice onset time, duração total da emissão, frequência fundamental e intensidade. Resultados Tanto na comparação intragrupos quanto intergrupos, apenas a tarefa de fala espontânea apresentou diferenças significativas. Nesta tarefa, o uso do SpeechEasy® resultou em melhora significativa da fluência de fala, medida pela porcentagem de sílabas gaguejadas, para o grupo com gagueira. Para o grupo fluente, o dispositivo produziu o efeito oposto (aumento significativo na frequência de rupturas gagas com o dispositivo). Os resultados encontrados quanto aos aspectos acústicos das tarefas de diadococinesia e emissão da frase alvo não indicaram diferença significativa nas comparações intragrupos e intergrupos. Conclusão Os resultados indicaram que o uso do SpeechEasy® melhorou a fluência dos participantes com gagueira, sem parecer interferir na naturalidade de fala.
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Variations on a theme: Songbirds, variability, and sensorimotor error correction. Neuroscience 2014; 296:48-54. [PMID: 25305664 DOI: 10.1016/j.neuroscience.2014.09.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
Abstract
Songbirds provide a powerful animal model for investigating how the brain uses sensory feedback to correct behavioral errors. Here, we review a recent study in which we used online manipulations of auditory feedback to quantify the relationship between sensory error size, motor variability, and vocal plasticity. We found that although inducing small auditory errors evoked relatively large compensatory changes in behavior, as error size increased the magnitude of error correction declined. Furthermore, when we induced large errors such that auditory signals no longer overlapped with the baseline distribution of feedback, the magnitude of error correction approached zero. This pattern suggests a simple and robust strategy for the brain to maintain the accuracy of learned behaviors by evaluating sensory signals relative to the previously experienced distribution of feedback. Drawing from recent studies of auditory neurophysiology and song discrimination, we then speculate as to the mechanistic underpinnings of the results obtained in our behavioral experiments. Finally, we review how our own and other studies exploit the strengths of the songbird system, both in the specific context of vocal systems and more generally as a model of the neural control of complex behavior.
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Maruta C, Makhmood S, Downey LE, Golden HL, Fletcher PD, Witoonpanich P, Rohrer JD, Warren JD. Delayed auditory feedback simulates features of nonfluent primary progressive aphasia. J Neurol Sci 2014; 347:345-8. [PMID: 25305712 PMCID: PMC4267508 DOI: 10.1016/j.jns.2014.09.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/25/2022]
Abstract
The pathophysiology of nonfluent primary progressive aphasia (nfvPPA) remains poorly understood. Here, we compared quantitatively speech parameters in patients with nfvPPA versus healthy older individuals under altered auditory feedback, which has been shown to modulate normal speech output. Patients (n = 15) and healthy volunteers (n = 17) were recorded while reading aloud under delayed auditory feedback [DAF] with latency 0, 50 or 200 ms and under DAF at 200 ms plus 0.5 octave upward pitch shift. DAF in healthy older individuals was associated with reduced speech rate and emergence of speech sound errors, particularly at latency 200 ms. Up to a third of the healthy older group under DAF showed speech slowing and frequency of speech sound errors within the range of the nfvPPA cohort. Our findings suggest that (in addition to any anterior, primary language output disorder) these key features of nfvPPA may reflect distorted speech input signal processing, as simulated by DAF. DAF may constitute a novel candidate pathophysiological model of posterior dorsal cortical language pathway dysfunction in nfvPPA. The pathophysiology of nonfluent progressive aphasia (nfvPPA) is poorly understood. Delayed auditory feedback (DAF) disrupts speech output in some normal listeners. We compared quantitatively speech in nvfPPA with DAF in healthy older individuals. Around a third of healthy older individuals under DAF developed features of nvfPPA. DAF is a candidate pathophysiological model of dorsal pathway dysfunction in nfvPPA.
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Affiliation(s)
- Carolina Maruta
- Institute of Molecular Medicine and Faculty of Medicine, University of Lisbon, Portugal; Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Sonya Makhmood
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Laura E Downey
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Hannah L Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Phillip D Fletcher
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Pirada Witoonpanich
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom.
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40
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Foundas AL, Mock JR, Corey DM, Golob EJ, Conture EG. The SpeechEasy device in stuttering and nonstuttering adults: fluency effects while speaking and reading. BRAIN AND LANGUAGE 2013; 126:141-150. [PMID: 23712191 DOI: 10.1016/j.bandl.2013.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/16/2013] [Accepted: 04/26/2013] [Indexed: 06/02/2023]
Abstract
The SpeechEasy is an electronic device designed to alleviate stuttering by manipulating auditory feedback via time delays and frequency shifts. Device settings (control, default, custom), ear-placement (left, right), speaking task, and cognitive variables were examined in people who stutter (PWS) (n=14) compared to controls (n=10). Among the PWS there was a significantly greater reduction in stuttering (compared to baseline) with custom device settings compared to the non-altered feedback (control) condition. Stuttering was reduced the most during reading, followed by narrative and conversation. For the conversation task, stuttering was reduced more when the device was worn in the left ear. Those individuals with a more severe stuttering rate at baseline had a greater benefit from the use of the device compared to individuals with less severe stuttering. Our results support the view that overt stuttering is associated with defective speech-language monitoring that can be influenced by manipulating auditory feedback.
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Affiliation(s)
- Anne L Foundas
- Brain and Behavior Program at Children's Hospital, New Orleans, LA 70118, United States.
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Brocklehurst PH, Lickley RJ, Corley M. Revisiting Bloodstein's Anticipatory Struggle Hypothesis from a psycholinguistic perspective: a Variable Release Threshold hypothesis of stuttering. JOURNAL OF COMMUNICATION DISORDERS 2013; 46:217-237. [PMID: 23631932 DOI: 10.1016/j.jcomdis.2013.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED This paper reviews Bloodstein's (1975) Anticipatory Struggle Hypothesis of stuttering, identifies its weaknesses, and proposes modifications to bring it into line with recent advances in psycholinguistic theory. The review concludes that the Anticipatory Struggle Hypothesis provides a plausible explanation for the variation in the severity of stuttered disfluencies across speaking situations and conversation partners. However, it fails to explain the forms that stuttered disfluencies characteristically take or the subjective experience of loss of control that accompanies them. The paper then describes how the forms and subjective experiences of persistent stuttering can be accounted for by a threshold-based regulatory mechanism of the kind described in Howell's (2003) revision of the EXPLAN hypothesis. It then proposes that shortcomings of both the Anticipatory Struggle and EXPLAN hypotheses can be addressed by combining them together to create a 'Variable Release Threshold' hypothesis whereby the anticipation of upcoming difficulty leads to the setting of an excessively high threshold for the release of speech plans for motor execution. The paper also reconsiders the possibility that two stuttering subtypes exist: one related to formulation difficulty and other to difficulty initiating motor execution. It concludes that research findings that relate to the one may not necessarily apply to the other. LEARNING OUTCOMES After reading this article, the reader will be able to: (1) summarize the key strengths and weaknesses of Bloodstein's Anticipatory Struggle Hypothesis; (2) describe two hypothesized mechanisms behind the production of stuttered disfluencies (tension and fragmentation & release threshold mechanisms); and (3) discuss why the notion of anticipation is relevant to current hypotheses of stuttering.
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Affiliation(s)
- Paul H Brocklehurst
- School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, Scotland, UK.
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42
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Sasisekaran J. Effects of delayed auditory feedback on speech kinematics in fluent speakers. Percept Mot Skills 2013; 115:845-64. [PMID: 23409597 DOI: 10.2466/15.22.pms.115.6.845-864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effects of delayed auditory feedback on behavioral responses and speech kinematics were investigated. Participants were 10 men (M age = 22.2 yr., SD = 3.7) and 10 women (M age = 20.5 yr., SD = 2.2). Participants were required to repeat shorter (6 syllables) and longer (11 syllables) non-words in a reading task. Speech errors, lip movement variability, and movement duration of labial trajectories under delayed feedback were compared to effects under gated speech feedback and a control or synchronous auditory feedback condition. Repeated-measures analysis indicated a lower percent of correct productions, higher variability, and slower duration of lip movements in the delayed feedback condition compared to the gated feedback and control conditions. Implications for auditory feedback of movement control in continuous speech and for theories of delayed auditory feedback that attribute a role to movements are discussed.
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Packman A. Theory and therapy in stuttering: a complex relationship. JOURNAL OF FLUENCY DISORDERS 2012; 37:225-233. [PMID: 23218206 DOI: 10.1016/j.jfludis.2012.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 05/21/2012] [Accepted: 05/28/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED There are many treatments currently available for stuttering, for both children and adults. These range from direct interventions intended to reduce the severity and/or frequency of the speech behaviors of stuttering, to those intended to alleviate the anxiety and other mental health issues that can accompany the disorder. However, as there are little supporting data for many of these treatments, there is little consensus about which to use. Another way to evaluate stuttering treatments is to explore the extent to which they address the cause of the disorder. However, the cause of stuttering is not yet known. In this theoretical paper, a 3-factor causal model is presented, to which the mechanisms thought to be driving different treatments are then aligned. The model is innovative, in that it attempts to explain moments of stuttering. It is argued that all causal factors must be operating at each moment of stuttering. The model is intended as a new way of looking at cause, and how treatments may address cause. It is hoped this will stimulate discussion and lead to further lines of inquiry. EDUCATIONAL OBJECTIVES The reader will be able to: (a) describe the P&A 3-factor causal model of moments of stuttering; (b) state how indirect direct stuttering treatments relate to cause, according to the P&A model; (c) describe how direct stuttering treatments relate to cause, according to the P&A model; (d) state the purpose of cognitive behavior therapy; and (e) describe at least one suggestion for further research arising from the P&A model.
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Affiliation(s)
- Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Australia.
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44
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Gallop RF, Runyan CM. Long-term effectiveness of the SpeechEasy fluency-enhancement device. JOURNAL OF FLUENCY DISORDERS 2012; 37:334-343. [PMID: 23218216 DOI: 10.1016/j.jfludis.2012.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED The SpeechEasy has been found to be an effective device for reduction of stuttering frequency for many people who stutter (PWS); published studies typically have compared stuttering reduction at initial fitting of the device to results achieved up to one year later. This study examines long-term effectiveness by examining whether effects of the SpeechEasy were maintained for longer periods, from 13 to 59 months. Results indicated no significant change for seven device users from post-fitting to the time of the study (t=-.074, p=.943); however, findings varied greatly on a case-by-case basis. Most notably, when stuttering frequency for eleven users and former users, prior to device fitting, was compared to current stuttering frequency while not wearing the device, the change over time was found to be statistically significant (t=2.851, p=.017), suggesting a carry-over effect of the device. There was no significant difference in stuttering frequency when users were wearing versus not wearing the device currently (t=1.949, p=0.92). Examinations of these results, as well as direction for future research, are described herein. EDUCATIONAL OBJECTIVES The reader will be able to: (a) identify and briefly describe two types of altered auditory feedback which the SpeechEasy incorporates in order to help reduce stuttering; (b) describe the carry-over effect found in this study, suggest effectiveness associated with the device over a longer period of time than previously reported, as well as its implications, and (c) list factors that might be assessed in future research involving this device in order to more narrowly determine which prospective users are most likely to benefit from employing the SpeechEasy.
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Affiliation(s)
- Ronald F Gallop
- Loyola University Maryland, 4501 N. Charles Street, Baltimore, MD 21210, United States.
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45
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Unger JP, Glück CW, Cholewa J. Immediate effects of AAF devices on the characteristics of stuttering: a clinical analysis. JOURNAL OF FLUENCY DISORDERS 2012; 37:122-134. [PMID: 22531287 DOI: 10.1016/j.jfludis.2012.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 02/04/2012] [Accepted: 02/13/2012] [Indexed: 05/31/2023]
Abstract
UNLABELLED The present study investigated the immediate effects of altered auditory feedback (AAF) and one Inactive Condition (AAF parameters set to 0) on clinical attributes of stuttering during scripted and spontaneous speech. Two commercially available, portable AAF devices were used to create the combined delayed auditory feedback (DAF) and frequency altered feedback (FAF) effects. Thirty adults, who stutter, aged 18-68 years (M=36.5; SD=15.2), participated in this investigation. Each subject produced four sets of 5-min of oral reading, three sets of 5-min monologs as well as 10-min dialogs. These speech samples were analyzed to detect changes in descriptive features of stuttering (frequency, duration, speech/articulatory rate, core behaviors) across the various speech samples and within two SSI-4 (Riley, 2009) based severity ratings. A statistically significant difference was found in the frequency of stuttered syllables (%SS) during both Active Device conditions (p=.000) for all speech samples. The most sizable reductions in %SS occurred within scripted speech. In the analysis of stuttering type, it was found that blocks were reduced significantly (Device A: p=.017; Device B: p=.049). To evaluate the impact on severe and mild stuttering, participants were grouped into two SSI-4 based categories; mild and moderate-severe. During the Inactive Condition those participants within the moderate-severe group (p=.024) showed a statistically significant reduction in overall disfluencies. This result indicates, that active AAF parameters alone may not be the sole cause of a fluency-enhancement when using a technical speech aid. EDUCATIONAL OBJECTIVES The reader will learn and be able to describe: (1) currently available scientific evidence on the use of altered auditory feedback (AAF) during scripted and spontaneous speech, (2) which characteristics of stuttering are impacted by an AAF device (frequency, duration, core behaviors, speech & articulatory rate, stuttering severity), (3) the effects of an Inactive Condition on people who stutter (PWS) falling into two severity groups, and (4) how the examined participants perceived the use of AAF devices.
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Affiliation(s)
- Julia P Unger
- University of Education Heidelberg, Keplerstraße 87, 69120 Heidelberg, Germany.
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46
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Sassi FC, Matas CG, de Mendonça LIZ, de Andrade CRF. Reprint of: stuttering treatment control using P300 event-related potentials. JOURNAL OF FLUENCY DISORDERS 2011; 36:308-317. [PMID: 22133410 DOI: 10.1016/j.jfludis.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. EDUCATIONAL OBJECTIVES The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.
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Affiliation(s)
- Fernanda Chiarion Sassi
- Department of Physiotherapy, Speech-Language and Hearing Sciences and Occupational Therapy, School of Medicine, University of São Paulo, Brazil
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47
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Packman A, Meredith G. Reprint of: technology and the evolution of clinical methods for stuttering. JOURNAL OF FLUENCY DISORDERS 2011; 36:195-205. [PMID: 22118396 DOI: 10.1016/j.jfludis.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter. EDUCATIONAL OBJECTIVES The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.
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Affiliation(s)
- Ann Packman
- The Australian Stuttering Research Centre, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
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48
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Sassi FC, Matas CG, de Mendonça LIZ, de Andrade CRF. Stuttering treatment control using P300 event-related potentials. JOURNAL OF FLUENCY DISORDERS 2011; 36:130-138. [PMID: 21664531 DOI: 10.1016/j.jfludis.2011.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 05/30/2023]
Abstract
UNLABELLED Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. EDUCATIONAL OBJECTIVES The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.
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Affiliation(s)
- Fernanda Chiarion Sassi
- Department of Physiotherapy, Speech-Language and Hearing Sciences and Occupational Therapy, School of Medicine, University of São Paulo, Brazil
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49
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Packman A, Meredith G. Technology and the evolution of clinical methods for stuttering. JOURNAL OF FLUENCY DISORDERS 2011; 36:75-85. [PMID: 21664526 DOI: 10.1016/j.jfludis.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 01/17/2011] [Accepted: 02/10/2011] [Indexed: 05/30/2023]
Abstract
UNLABELLED The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter. EDUCATIONAL OBJECTIVES The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.
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Affiliation(s)
- Ann Packman
- Australian Stuttering Research Centre, University of Sydney, Lidcombe.
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50
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Spatiotemporal signatures of an abnormal auditory system in stuttering. Neuroimage 2011; 55:891-9. [PMID: 21232617 DOI: 10.1016/j.neuroimage.2010.12.083] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/23/2022] Open
Abstract
People who stutter (PWS) can reduce their stuttering rates under masking noise and altered auditory feedback; such a response can be attributed to altered auditory input, which suggests that abnormal speech processing in PWS results from abnormal processing of auditory input. However, the details of this abnormal processing of basic auditory information remain unclear. In order to characterize such abnormalities, we examined the functional and structural changes in the auditory cortices of PWS by using a 306-channel magnetoencephalography system to assess auditory sensory gating (P50m suppression) and tonotopic organization. Additionally, we employed voxel-based morphometry to compare cortical gray matter (GM) volumes on structural MR images. PWS exhibited impaired left auditory sensory gating. The tonotopic organization in the right hemisphere of PWS is expanded compared with that of the controls. Furthermore, PWS showed a significant increase in the GM volume of the right superior temporal gyrus, consistent with the right tonotopic expansion. Accordingly, we suggest that PWS have impaired left auditory sensory gating during basic auditory input processing and that some error signals in the auditory cortex could result in abnormal speech processing. Functional and structural reorganization of the right auditory cortex appears to be a compensatory mechanism for impaired left auditory cortex function in PWS.
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