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Theys C, Jaakkola E, Melzer TR, De Nil LF, Guenther FH, Cohen AL, Fox MD, Joutsa J. Localization of stuttering based on causal brain lesions. Brain 2024; 147:2203-2213. [PMID: 38797521 PMCID: PMC11146419 DOI: 10.1093/brain/awae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 05/29/2024] Open
Abstract
Stuttering affects approximately 1 in 100 adults and can result in significant communication problems and social anxiety. It most often occurs as a developmental disorder but can also be caused by focal brain damage. These latter cases may lend unique insight into the brain regions causing stuttering. Here, we investigated the neuroanatomical substrate of stuttering using three independent datasets: (i) case reports from the published literature of acquired neurogenic stuttering following stroke (n = 20, 14 males/six females, 16-77 years); (ii) a clinical single study cohort with acquired neurogenic stuttering following stroke (n = 20, 13 males/seven females, 45-87 years); and (iii) adults with persistent developmental stuttering (n = 20, 14 males/six females, 18-43 years). We used the first two datasets and lesion network mapping to test whether lesions causing acquired stuttering map to a common brain network. We then used the third dataset to test whether this lesion-based network was relevant to developmental stuttering. In our literature dataset, we found that lesions causing stuttering occurred in multiple heterogeneous brain regions, but these lesion locations were all functionally connected to a common network centred around the left putamen, including the claustrum, amygdalostriatal transition area and other adjacent areas. This finding was shown to be specific for stuttering (PFWE < 0.05) and reproducible in our independent clinical cohort of patients with stroke-induced stuttering (PFWE < 0.05), resulting in a common acquired stuttering network across both stroke datasets. Within the common acquired stuttering network, we found a significant association between grey matter volume and stuttering impact for adults with persistent developmental stuttering in the left posteroventral putamen, extending into the adjacent claustrum and amygdalostriatal transition area (PFWE < 0.05). We conclude that lesions causing acquired neurogenic stuttering map to a common brain network, centred to the left putamen, claustrum and amygdalostriatal transition area. The association of this lesion-based network with symptom severity in developmental stuttering suggests a shared neuroanatomy across aetiologies.
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Affiliation(s)
- Catherine Theys
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Brain Research Institute, 8011 Christchurch, New Zealand
| | - Elina Jaakkola
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, 20014 Turku, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Tracy R Melzer
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
- New Zealand Brain Research Institute, 8011 Christchurch, New Zealand
- Department of Medicine, University of Otago, 8011 Christchurch, New Zealand
- RHCNZ—Pacific Radiology Canterbury, 8031 Christchurch, New Zealand
| | - Luc F De Nil
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Frank H Guenther
- Departments of Speech, Language and Hearing Sciences and Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander L Cohen
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, 20014 Turku, Finland
- Turku PET Centre, Neurocenter, Turku University Hospital, 20014 Turku, Finland
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Neel A, Krasilshchikova S, Richardson JD, Arenas R, Bennett L, Banks S, Ritter A, Bernick C. Articulation Rate, Pauses, and Disfluencies in Professional Fighters: Potential Speech Biomarkers for Repetitive Head Injury. J Head Trauma Rehabil 2023; 38:458-466. [PMID: 36701308 PMCID: PMC10368786 DOI: 10.1097/htr.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE As part of a larger study dedicated to identifying speech and language biomarkers of neurological decline associated with repetitive head injury (RHI) in professional boxers and mixed martial artists (MMAs), we examined articulation rate, pausing, and disfluency in passages read aloud by participants in the Professional Athletes Brain Health Study. SETTING A large outpatient medical center specializing in neurological care. PARTICIPANTS, DESIGN, AND MAIN MEASURES Passages read aloud by 60 boxers, 40 MMAs, and 55 controls were acoustically analyzed to determine articulation rate (the number of syllables produced per second), number and duration of pauses, and number and duration of disfluencies in this observational study. RESULTS Both boxers and MMAs differed from controls in articulation rate, producing syllables at a slower rate than controls by nearly half a syllable per second on average. Boxers produced significantly more pauses and disfluencies in passages read aloud than MMAs and controls. CONCLUSIONS Slower articulation rate in both boxers and MMA fighters compared with individuals with no history of RHI and the increased occurrence of pauses and disfluencies in the speech of boxers suggest changes in speech motor behavior that may relate to RHI. These speech characteristics can be measured in everyday speaking conditions and by automatic recognition systems, so they have the potential to serve as effective, noninvasive clinical indicators for RHI-associated neurological decline.
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Affiliation(s)
- Amy Neel
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque (Drs Neel, Richardson, and Arenas and Ms Krasilshchikova); Pickup Family Neurosciences Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California (Dr Bennett); Department of Neurosciences, University of California, San Diego, La Jolla (Dr Banks); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada (Drs Ritter and Bernick)
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Gooch EA, Horne K, Melzer TR, McAuliffe MJ, MacAskill M, Dalrymple‐Alford JC, Anderson TJ, Theys C. Acquired Stuttering in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:956-966. [PMID: 37332649 PMCID: PMC10272914 DOI: 10.1002/mdc3.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Background Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new-onset stuttering is limited. Objectives To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease. Method Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function. Results Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P < 0.01). 21% of people with Parkinson's disease (n = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading (P < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset (P < 0.01), higher levodopa equivalent dosage (P < 0.01), and lower cognitive (P < 0.01) and motor scores (P < 0.01). Conclusion One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis.
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Affiliation(s)
- Eloïse A. Gooch
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
| | | | - Tracy R. Melzer
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Megan J. McAuliffe
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- Te Kāhu Roro Reo, New Zealand Institute of Language, Brain and BehaviourUniversity of CanterburyChristchurchNew Zealand
| | - Michael MacAskill
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - John C. Dalrymple‐Alford
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Tim J. Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
- Neurology DepartmentChristchurch Hospital, Te Whatu Ora Health New ZealandChristchurchNew Zealand
| | - Catherine Theys
- Te Kura Mahi ā‐Hirikapo, School of Psychology, Speech, and HearingUniversity of CanterburyChristchurchNew Zealand
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Te Kāhu Roro Reo, New Zealand Institute of Language, Brain and BehaviourUniversity of CanterburyChristchurchNew Zealand
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Penttilä N, Korpijaakko-Huuhka AM, Bóna J. Disfluency clusters in typical and atypical finnish adult speech. A pilot study. CLINICAL LINGUISTICS & PHONETICS 2022; 36:1-16. [PMID: 33971787 DOI: 10.1080/02699206.2021.1924861] [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: 12/04/2020] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
This study first aimed to investigate disfluency clusters in typical and atypical Finnish adult speakers. Secondly, it aimed to observe possible fluency strategies in speakers representing different fluency levels. In addition to individual disfluency types, we examined different characteristics of disfluency clusters produced by 23 speakers in a fluency continuum. Three adult speaker groups participated in this study: typical speakers with high disfluency frequencies (GA), typical and atypical speakers with very high disfluency frequencies (GB) and atypical speakers with the highest disfluency frequencies (GC). Data were based on a narrative speech task, and disfluency clusters were analysed with both traditional methods and alternative methods. Two statistically significant differences between the speaker groups were found: 1) the length of the clusters was highest in GC compared to other groups, and 2) speakers in GC formulated their utterances more than other groups. Other results, although nonsignificant, were that 3) speakers in GA revised utterances more often than interrupted them compared to GB and GC speakers, and 4) clusters using repetitive words and phrases to maintain fluency were found in GA and GB only. In this study, different fluency levels revealed different strategies in both the production of single disfluencies and in disfluency clusters. It seems that more fluent speakers formulate their messages differently than less fluent speakers, and repetitions can be used to maintain fluency and possibly prevent difficult clusters, as noted with more fluent speakers.
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Affiliation(s)
- Nelly Penttilä
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Judit Bóna
- Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary
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Robertson SC, Diaz K. Case Report of Acquired Stuttering After Soccer-Related Concussion: Functional Magnetic Resonance Imaging as a Prognostic Tool. World Neurosurg 2020; 142:401-403. [DOI: 10.1016/j.wneu.2020.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
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