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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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Miller HE, Garnett EO, Heller Murray ES, Nieto-Castañón A, Tourville JA, Chang SE, Guenther FH. A comparison of structural morphometry in children and adults with persistent developmental stuttering. Brain Commun 2023; 5:fcad301. [PMID: 38025273 PMCID: PMC10653153 DOI: 10.1093/braincomms/fcad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
This cross-sectional study aimed to differentiate earlier occurring neuroanatomical differences that may reflect core deficits in stuttering versus changes associated with a longer duration of stuttering by analysing structural morphometry in a large sample of children and adults who stutter and age-matched controls. Whole-brain T1-weighted structural scans were obtained from 166 individuals who stutter (74 children, 92 adults; ages 3-58) and 191 controls (92 children, 99 adults; ages 3-53) from eight prior studies in our laboratories. Mean size and gyrification measures were extracted using FreeSurfer software for each cortical region of interest. FreeSurfer software was also used to generate subcortical volumes for regions in the automatic subcortical segmentation. For cortical analyses, separate ANOVA analyses of size (surface area, cortical thickness) and gyrification (local gyrification index) measures were conducted to test for a main effect of diagnosis (stuttering, control) and the interaction of diagnosis-group with age-group (children, adults) across cortical regions. Cortical analyses were first conducted across a set of regions that comprise the speech network and then in a second whole-brain analysis. Next, separate ANOVA analyses of volume were conducted across subcortical regions in each hemisphere. False discovery rate corrections were applied for all analyses. Additionally, we tested for correlations between structural morphometry and stuttering severity. Analyses revealed thinner cortex in children who stutter compared with controls in several key speech-planning regions, with significant correlations between cortical thickness and stuttering severity. These differences in cortical size were not present in adults who stutter, who instead showed reduced gyrification in the right inferior frontal gyrus. Findings suggest that early cortical anomalies in key speech planning regions may be associated with stuttering onset. Persistent stuttering into adulthood may result from network-level dysfunction instead of focal differences in cortical morphometry. Adults who stutter may also have a more heterogeneous neural presentation than children who stutter due to their unique lived experiences.
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Affiliation(s)
- Hilary E Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Elizabeth S Heller Murray
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Communication Sciences & Disorders, Temple University, Philadelphia, PA 19122, USA
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Jason A Tourville
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Communication Disorders, Ewha Womans University, Seoul 03760, Korea
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Furlanis G, Busan P, Formaggio E, Menichelli A, Lunardelli A, Ajcevic M, Pesavento V, Manganotti P. Stuttering-Like Dysfluencies as a Consequence of Long COVID-19. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:415-430. [PMID: 36749838 DOI: 10.1044/2022_jslhr-22-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection. METHODS AND RESULTS Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery. CONCLUSIONS It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Italy
| | - Alina Menichelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Alberta Lunardelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, Italy
| | - Valentina Pesavento
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
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Novikova I, Krivonkin K. Contemporary Theories of Stuttering Development. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2022. [DOI: 10.17759/cpse.2022110301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The article presents a theoretical analysis of contemporary models of persistent stuttering development in children and adults at the current period of development of science. The accumulated amount of scientific knowledge suggests that stuttering has a neurological basis: it is associated with disorders in the structure and function of the brain. On this basis, there have been emerged models of stuttering that link the cause of a speech disorder with an unstable speech motor system. Theories and models of stuttering based on cognitive and language processing are likely to be useful in that they have explanatory power in relation to the mechanisms that play an important role in the production of key symptoms of stuttering. Considering that stuttering is a complex disorder, the logical result of this was the proposal of multifactorial models of impaired speech fluency. The presented overview may be useful to psychiatrists, clinical psychologists, speech therapists, teachers, and practitioners interacting with children and adults with stuttering and other speech fluency disorders.
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Affiliation(s)
- I.A. Novikova
- Northern (Arctic) Federal University named after M.V. Lomonosov
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Alm PA. Stuttering: A Disorder of Energy Supply to Neurons? Front Hum Neurosci 2021; 15:662204. [PMID: 34630054 PMCID: PMC8496059 DOI: 10.3389/fnhum.2021.662204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography (EEG), brain imaging, genetics, and biochemistry are reviewed: (1) Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. (2) Studies of the absolute level of regional cerebral blood flow (rCBF) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. (3) The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index (GI; Vaishnavi et al., 2010). High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. (4) Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. (5) It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. (6) Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory.
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Affiliation(s)
- Per A. Alm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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