Transfer Effect of Speech-sound Learning on Auditory-motor Processing of Perceived Vocal Pitch Errors

Multi-session training in the evening schedule exhibits enhanced speech learning

Speech learning can be influenced by a variety of factors. A growing body of literature suggests a significant influence of sleep on speech learning, i.e., those trained in the evening outperform those trained in the morning most probably due to consolidation of learning that happens during the sleep for the evening group. Since, learning, in general, may be a process that spans multiple sessions, in the current exploratory study, we aimed at investigating the effect of a multi-session training paradigm on the learning performance of the morning vs evening group. We compared young adults who were trained in the morning (8-10 am; n = 16) with those who were trained in the evening (6-8 pm; n = 16) on a Hindi dental-retroflex pseudoword-picture association training paradigm. Overall, we found that the evening group learned to a larger extent both for the identification (on trained items) and discrimination (on untrained items) tasks. The current findings, even with a multi-session paradigm, are consistent with the previous findings that support enhanced performance by training in the evening. These findings may have clinical implications toward scheduling of speech therapy.

Right, but not left, posterior superior temporal gyrus is causally involved in vocal feedback control

The posterior superior temporal gyrus (pSTG) has been implicated in the integration of auditory feedback and motor system for controlling vocal production. However, the question as to whether and how the pSTG is causally involved in vocal feedback control is currently unclear. To this end, the present study selectively stimulated the left or right pSTG with continuous theta burst stimulation (c-TBS) in healthy participants, then used event-related potentials to investigate neurobehavioral changes in response to altered auditory feedback during vocal pitch regulation. The results showed that, compared to control (vertex) stimulation, c-TBS over the right pSTG led to smaller vocal compensations for pitch perturbations accompanied by smaller cortical N1 and larger P2 responses. Enhanced P2 responses received contributions from the right-lateralized temporal and parietal regions as well as the insula, and were significantly correlated with suppressed vocal compensations. Surprisingly, these effects were not found when comparing c-TBS over the left pSTG with control stimulation. Our findings provide evidence, for the first time, that supports a causal relationship between right, but not left, pSTG and auditory-motor integration for vocal pitch regulation. This lends support to a right-lateralized contribution of the pSTG in not only the bottom-up detection of vocal feedback errors but also the involvement of driving motor commands for error correction in a top-down manner.

Transcranial direct current stimulation over left dorsolateral prefrontal cortex facilitates auditory-motor integration for vocal pitch regulation

Background

A growing body of literature has implicated the left dorsolateral prefrontal cortex (DLPFC) in the online monitoring of vocal production through auditory feedback. Specifically, disruption of or damage to the left DLPFC leads to exaggerated compensatory vocal responses to altered auditory feedback. It is conceivable that enhancing the cortical excitability of the left DLPFC may produce inhibitory influences on vocal feedback control by reducing vocal compensations.

Methods

We used anodal transcranial direct current stimulation (a-tDCS) to modulate cortical excitability of the left DLPFC and examined its effects on auditory-motor integration for vocal pitch regulation. Seventeen healthy young adults vocalized vowel sounds while hearing their voice pseudo-randomly pitch-shifted by ±50 or ±200 cents, either during (online) or after (offline) receiving active or sham a-tDCS over the left DLPFC.

Results

Active a-tDCS over the left DLPFC led to significantly smaller peak magnitudes and shorter peak times of vocal compensations for pitch perturbations than sham stimulation. In addition, this effect was consistent regardless of the timing of a-tDCS (online or offline stimulation) and the size and direction of the pitch perturbation.

Conclusion

These findings provide the first causal evidence that a-tDCS over the left DLPFC can facilitate auditory-motor integration for compensatory adjustment to errors in vocal output. Reduced and accelerated vocal compensations caused by a-tDCS over left DLPFC support the hypothesis of a top-down neural mechanism that exerts inhibitory control over vocal motor behavior through auditory feedback.

Assessing Candidacy for Conversation Training Therapy: The Role of Patient Perception

OBJECTIVE

Voice therapy is the primary treatment modality for voice rehabilitation. Specific patient-ability factors beyond patient-characteristic factors (eg, disorder diagnosis, age, etc.), that influence individual patient responses to voice treatment remain largely unknown. The goal of the current study was to determine the relationship between patient-perceived improvements in both the sound and feel of voice during stimulability assessment and voice therapy outcomes.

STUDY DESIGN

Prospective Cohort study.

METHODS

This study was a single-arm, single-center, prospective study. Fifty patients with primary muscle tension dysphonia and benign vocal fold lesions were enrolled. Patients read the first four sentences of the Rainbow Passage and were asked if they experienced a change in the feel or sound of their voice following the stimulability prompt. Patients then completed four sessions of conversation training therapy (CTT) voice therapy and followed up one-week and three-months after their last therapy session, for a total of six time-points. Demographic data were collected at baseline, and voice handicap index 10 (VHI-10) scores were collected at each follow-up time-point. The primary exposure variables were CTT intervention and patient perception of voice change to stimulability probes. The primary outcome was change in VHI-10 score.

RESULTS

On average, VHI-10 scores improved for all participants following CTT treatment. All participants heard a change in the sound of voice with stimulability prompts. Descriptively, patients who reported a positive change in the feel of their voice after stimulability testing recovered faster (ie, experienced a sharper decline in VHI-10) compared to those who did not note a change in feel of voice during stimulability testing. However, the rate of change over time was not significantly different between groups.

CONCLUSION

Patient self-perception of a change in the sound and feel of voice in response to stimulability probes during initial evaluation is an important factor in treatment outcomes. Patients who perceive an improved feel of their voice production after stimulability probes may respond to voice therapy more quickly.

The left inferior frontal gyrus is causally linked to vocal feedback control: evidence from high-definition transcranial alternating current stimulation

Current models of speech motor control propose a role for the left inferior frontal gyrus (IFG) in feedforward control of speech production. There is evidence, however, that has implicated the functional relevance of the left IFG for the neuromotor processing of vocal feedback errors. The present event-related potential (ERP) study examined whether the left IFG is causally linked to auditory feedback control of vocal production with high-definition transcranial alternating current stimulation (HD-tACS). After receiving active or sham HD-tACS over the left IFG at 6 or 70 Hz, 20 healthy adults vocalized the vowel sounds while hearing their voice unexpectedly pitch-shifted by ±200 cents. The results showed that 6 or 70 Hz HD-tACS over the left IFG led to larger magnitudes and longer latencies of vocal compensations for pitch perturbations paralleled by larger ERP P2 responses than sham HD-tACS. Moreover, there was a lack of frequency specificity that showed no significant differences between 6 and 70 Hz HD-tACS. These findings provide first causal evidence linking the left IFG to vocal pitch regulation, suggesting that the left IFG is an important part of the feedback control network that mediates vocal compensations for auditory feedback errors.

Cerebellar Continuous Theta Burst Stimulation Facilitates Auditory-Vocal Integration in Spinocerebellar Ataxia

Clinical studies have shown the efficacy of transcranial magnetic stimulation in treating movement disorders in patients with spinocerebellar ataxia (SCA). However, whether similar effects occur for their speech motor disorders remains largely unknown. The present event-related potential study investigated whether and how abnormalities in auditory-vocal integration associated with SCA can be modulated by neuronavigated continuous theta burst stimulation (c-TBS) over the right cerebellum. After receiving active or sham cerebellar c-TBS, 19 patients with SCA were instructed to produce sustained vowels while hearing their voice unexpectedly pitch-shifted by ±200 cents. Behaviorally, active cerebellar c-TBS led to smaller magnitudes of vocal compensations for pitch perturbations than sham stimulation. Parallel modulatory effects were also observed at the cortical level, as reflected by increased P1 and P2 responses but decreased N1 responses elicited by active cerebellar c-TBS. Moreover, smaller magnitudes of vocal compensations were predicted by larger amplitudes of cortical P1 and P2 responses. These findings provide the first neurobehavioral evidence that c-TBS over the right cerebellum produces modulatory effects on abnormal auditory-motor integration for vocal pitch regulation in patients with SCA, offering a starting point for the treatment of speech motor disorders associated with SCA with cerebellar c-TBS.

Neurobehavioral Effects of LSVT® LOUD on Auditory-Vocal Integration in Parkinson's Disease: A Preliminary Study

Individuals with Parkinson's disease (PD) are impaired in auditory-vocal integration, characterized by abnormal compensatory responses to auditory feedback errors during self-monitoring of vocal production. The present study examined whether auditory feedback control of vocal pitch production in PD can benefit from Lee Silverman voice treatment (LSVT® LOUD), a high effort, intensive speech treatment for hypokinetic dysarthria in PD. Before and immediately after LSVT LOUD, 12 individuals with PD were instructed to produce sustained vowel sounds while hearing their voice unexpectedly pitch-shifted by -200 cents. Their vocal responses and event-related potentials (ERPs) to pitch perturbations were measured to assess the treatment outcomes. A group of 12 healthy controls were one-to-one pair matched by age, sex, and language. Individuals with PD exhibited abnormally enhanced vocal and ERP P2 responses to pitch perturbations relative to healthy controls. Successful treatment with LSVT LOUD, however, led to significantly smaller and faster vocal compensations that were accompanied by significantly larger P2 responses. Moreover, improved vocal loudness during passage reading was significantly correlated with reduced vocal compensations for pitch perturbations. These preliminary findings provide the first neurobehavioral evidence for beneficial effects of LSVT LOUD on impaired auditory-vocal integration associated with PD, which may be related to improved laryngeal motor functions and a top-down modulation of the speech motor network by LSVT LOUD.

Conversation Training Therapy: Let's Talk It Through

This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy approach to remove the therapeutic hierarchy common in most treatment programs. Rather, CTT uses patient-driven conversation as the sole stimuli in therapy to increase perceptual awareness of voice production in conversational speech. The genesis as to why CTT was developed, as well as the conceptual, theoretical, and component parts of CTT, will be explained. In addition, this article will offer examples of the language of therapy, as it applies to CTT and how to trouble-shoot if problems arise. Medical documentation relevant to CTT will also be outlined. Last, results from a recent efficacy study on CTT will be reported.

Event-related potential correlates of auditory feedback control of vocal production in experienced singers

Considerable evidence has shown that experienced singers are capable of voluntarily suppressing vocal compensations for consistent pitch perturbations in auditory feedback. Our recent behavioral study found that singers also compensated for brief pitch perturbations to a lesser degree than nonsingers in an involuntary manner. In the present event-related potential study, we investigated the neural correlates of involuntary vocal pitch regulation in experienced singers. All participants were instructed to vocalize the vowel sounds while their voice was unexpectedly shifted in pitch by -50 and -200 cents. The results revealed decreased cortical N1 and P2 responses to pitch perturbations and reduced involuntary vocal compensations for singers when compared to nonsingers. Moreover, larger vocal responses were significantly correlated with smaller cortical P2 responses for nonsingers, whereas this brain-behavior relationship did not exist for singers. These findings demonstrate that the cortical processing of involuntary auditory-motor integration for vocal pitch regulation can be shaped as a function of singing experience, suggesting that experienced singers may be less influenced by auditory feedback and rely more on somatosensory feedback or feedforward control as a consequence of singing training as compared to nonsingers.

Aging and Sex Influence Cortical Auditory-Motor Integration for Speech Control

It is well known that acoustic change in speech production is subject to age-related declines. How aging alters cortical sensorimotor integration in speech control, however, remains poorly understood. The present event-related potential study examined the behavioral and neural effects of aging and sex on the auditory-motor processing of voice pitch errors. Behaviorally, older adults produced significantly larger vocal compensations for pitch perturbations than young adults across the sexes, while the effects of sex on vocal compensation did not exist for both young and older adults. At the cortical level, there was a significant interaction between aging and sex on the N1-P2 complex. Older males produced significantly smaller P2 amplitudes than young males, while young males produced significantly larger N1 and P2 amplitudes than young females. In addition, females produced faster N1 responses than males regardless of age, while young adults produced faster P2 responses than older adults across the sexes. These findings provide the first neurobehavioral evidence that demonstrates the aging influence on auditory feedback control of speech production, and highlight the importance of sex in understanding the aging of the neuromotor control of speech production.

Predicting auditory feedback control of speech production from subregional shape of subcortical structures

Although a growing body of research has focused on the cortical sensorimotor mechanisms that support auditory feedback control of speech production, much less is known about the subcortical contributions to this control process. This study examined whether subregional anatomy of subcortical structures assessed by statistical shape analysis is associated with vocal compensations and cortical event-related potentials in response to pitch feedback errors. The results revealed significant negative correlations between the magnitudes of vocal compensations and subregional shape of the right thalamus, between the latencies of vocal compensations and subregional shape of the left caudate and pallidum, and between the latencies of cortical N1 responses and subregional shape of the left putamen. These associations indicate that smaller local volumes of the basal ganglia and thalamus are predictive of slower and larger neurobehavioral responses to vocal pitch errors. Furthermore, increased local volumes of the left hippocampus and right amygdala were predictive of larger vocal compensations, suggesting that there is an interplay between the memory-related subcortical structures and auditory-vocal integration. These results, for the first time, provide evidence for differential associations of subregional morphology of the basal ganglia, thalamus, hippocampus, and amygdala with neurobehavioral processing of vocal pitch errors, suggesting that subregional shape measures of subcortical structures can predict behavioral outcome of auditory-vocal integration and associated neural features. Hum Brain Mapp 39:459-471, 2018. © 2017 Wiley Periodicals, Inc.

Top-Down Modulation of Auditory-Motor Integration during Speech Production: The Role of Working Memory

Although working memory (WM) is considered as an emergent property of the speech perception and production systems, the role of WM in sensorimotor integration during speech processing is largely unknown. We conducted two event-related potential experiments with female and male young adults to investigate the contribution of WM to the neurobehavioural processing of altered auditory feedback during vocal production. A delayed match-to-sample task that required participants to indicate whether the pitch feedback perturbations they heard during vocalizations in test and sample sequences matched, elicited significantly larger vocal compensations, larger N1 responses in the left middle and superior temporal gyrus, and smaller P2 responses in the left middle and superior temporal gyrus, inferior parietal lobule, somatosensory cortex, right inferior frontal gyrus, and insula compared with a control task that did not require memory retention of the sequence of pitch perturbations. On the other hand, participants who underwent extensive auditory WM training produced suppressed vocal compensations that were correlated with improved auditory WM capacity, and enhanced P2 responses in the left middle frontal gyrus, inferior parietal lobule, right inferior frontal gyrus, and insula that were predicted by pretraining auditory WM capacity. These findings indicate that WM can enhance the perception of voice auditory feedback errors while inhibiting compensatory vocal behavior to prevent voice control from being excessively influenced by auditory feedback. This study provides the first evidence that auditory-motor integration for voice control can be modulated by top-down influences arising from WM, rather than modulated exclusively by bottom-up and automatic processes.SIGNIFICANCE STATEMENT One outstanding question that remains unsolved in speech motor control is how the mismatch between predicted and actual voice auditory feedback is detected and corrected. The present study provides two lines of converging evidence, for the first time, that working memory cannot only enhance the perception of vocal feedback errors but also exert inhibitory control over vocal motor behavior. These findings represent a major advance in our understanding of the top-down modulatory mechanisms that support the detection and correction of prediction-feedback mismatches during sensorimotor control of speech production driven by working memory. Rather than being an exclusively bottom-up and automatic process, auditory-motor integration for voice control can be modulated by top-down influences arising from working memory.

Training of Working Memory Impacts Neural Processing of Vocal Pitch Regulation

Working memory training can improve the performance of tasks that were not trained. Whether auditory-motor integration for voice control can benefit from working memory training, however, remains unclear. The present event-related potential (ERP) study examined the impact of working memory training on the auditory-motor processing of vocal pitch. Trained participants underwent adaptive working memory training using a digit span backwards paradigm, while control participants did not receive any training. Before and after training, both trained and control participants were exposed to frequency-altered auditory feedback while producing vocalizations. After training, trained participants exhibited significantly decreased N1 amplitudes and increased P2 amplitudes in response to pitch errors in voice auditory feedback. In addition, there was a significant positive correlation between the degree of improvement in working memory capacity and the post-pre difference in P2 amplitudes. Training-related changes in the vocal compensation, however, were not observed. There was no systematic change in either vocal or cortical responses for control participants. These findings provide evidence that working memory training impacts the cortical processing of feedback errors in vocal pitch regulation. This enhanced cortical processing may be the result of increased neural efficiency in the detection of pitch errors between the intended and actual feedback.