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Orpella J, Flick G, Assaneo MF, Shroff R, Pylkkänen L, Poeppel D, Jackson ES. Reactive Inhibitory Control Precedes Overt Stuttering Events. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2024; 5:432-453. [PMID: 38911458 PMCID: PMC11192511 DOI: 10.1162/nol_a_00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/06/2024] [Indexed: 06/25/2024]
Abstract
Research points to neurofunctional differences underlying fluent speech between stutterers and non-stutterers. Considerably less work has focused on processes that underlie stuttered vs. fluent speech. Additionally, most of this research has focused on speech motor processes despite contributions from cognitive processes prior to the onset of stuttered speech. We used MEG to test the hypothesis that reactive inhibitory control is triggered prior to stuttered speech. Twenty-nine stutterers completed a delayed-response task that featured a cue (prior to a go cue) signaling the imminent requirement to produce a word that was either stuttered or fluent. Consistent with our hypothesis, we observed increased beta power likely emanating from the right pre-supplementary motor area (R-preSMA)-an area implicated in reactive inhibitory control-in response to the cue preceding stuttered vs. fluent productions. Beta power differences between stuttered and fluent trials correlated with stuttering severity and participants' percentage of trials stuttered increased exponentially with beta power in the R-preSMA. Trial-by-trial beta power modulations in the R-preSMA following the cue predicted whether a trial would be stuttered or fluent. Stuttered trials were also associated with delayed speech onset suggesting an overall slowing or freezing of the speech motor system that may be a consequence of inhibitory control. Post-hoc analyses revealed that independently generated anticipated words were associated with greater beta power and more stuttering than researcher-assisted anticipated words, pointing to a relationship between self-perceived likelihood of stuttering (i.e., anticipation) and inhibitory control. This work offers a neurocognitive account of stuttering by characterizing cognitive processes that precede overt stuttering events.
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Affiliation(s)
- Joan Orpella
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
- Department of Psychology, New York University, New York, NY, USA
- Department of Communicative Sciences and Disorders, New York University, New York, NY, USA
| | - Graham Flick
- Department of Psychology, New York University, New York, NY, USA
| | - M. Florencia Assaneo
- Institute of Neurobiology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ravi Shroff
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
| | - Liina Pylkkänen
- Department of Psychology, New York University, New York, NY, USA
- Department of Linguistics, New York University, New York, NY, USA
- NYUAD Institute, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - David Poeppel
- Department of Psychology, New York University, New York, NY, USA
- Center for Language, Music and Emotion (CLaME), New York University, New York, NY, USA
- Ernst Strüngmann Institute (ESI) for Neuroscience, Frankfurt, Germany
| | - Eric S. Jackson
- Department of Communicative Sciences and Disorders, New York University, New York, NY, USA
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Sun L, Xiao K, Shen XY, Wang S. Impact of transcranial electrical stimulation on serum neurotrophic factors and language function in patients with speech disorders. World J Clin Cases 2024; 12:1742-1749. [PMID: 38660085 PMCID: PMC11036479 DOI: 10.12998/wjcc.v12.i10.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Speech disorders have a substantial impact on communication abilities and quality of life. Traditional treatments such as speech and psychological therapies frequently demonstrate limited effectiveness and patient compliance. Transcranial electrical stimulation (TES) has emerged as a promising non-invasive treatment to improve neurological functions. However, its effectiveness in enhancing language functions and serum neurofactor levels in individuals with speech disorders requires further investigation. AIM To investigate the impact of TES in conjunction with standard therapies on serum neurotrophic factor levels and language function in patients with speech disorders. METHODS In a controlled study spanning from March 2019 to November 2021, 81 patients with speech disorders were divided into a control group (n = 40) receiving standard speech stimulation and psychological intervention, and an observation group (n = 41) receiving additional TES. The study assessed serum levels of ciliary neurotrophic factor (CNTF), glial cell-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF), as well as evaluations of motor function, language function, and development quotient scores. RESULTS After 3 wk of intervention, the observation group exhibited significantly higher serum levels of CNTF, GDNF, BDNF, and NGF compared to the control group. Moreover, improvements were noted in motor function, cognitive function, language skills, physical abilities, and overall development quotient scores. It is worth mentioning that the observation group also displayed superior performance in language-specific tasks such as writing, reading comprehension, retelling, and fluency. CONCLUSION This retrospective study concluded that TES combined with traditional speech and psychotherapy can effectively increase the levels of neurokines in the blood and enhance language function in patients with speech disorders. These results provide a promising avenue for integrating TES into standard treatment methods for speech disorders.
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Affiliation(s)
- Li Sun
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Kai Xiao
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Xiao-Yan Shen
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Shu Wang
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
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Medeiros W, Barros T, Caixeta FV. Bibliometric mapping of non-invasive brain stimulation techniques (NIBS) for fluent speech production. Front Hum Neurosci 2023; 17:1164890. [PMID: 37425291 PMCID: PMC10323431 DOI: 10.3389/fnhum.2023.1164890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Language production is a finely regulated process, with many aspects which still elude comprehension. From a motor perspective, speech involves over a hundred different muscles functioning in coordination. As science and technology evolve, new approaches are used to study speech production and treat its disorders, and there is growing interest in the use of non-invasive modulation by means of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Methods Here we analyzed data obtained from Scopus (Elsevier) using VOSViewer to provide an overview of bibliographic mapping of citation, co-occurrence of keywords, co-citation and bibliographic coupling of non-invasive brain stimulation (NIBS) use in speech research. Results In total, 253 documents were found, being 55% from only three countries (USA, Germany and Italy), with emerging economies such as Brazil and China becoming relevant in this topic recently. Most documents were published in this last decade, with 2022 being the most productive yet, showing brain stimulation has untapped potential for the speech research field. Discussion Keyword analysis indicates a move away from basic research on the motor control in healthy speech, toward clinical applications such as stuttering and aphasia treatment. We also observe a recent trend in cerebellar modulation for clinical treatment. Finally, we discuss how NIBS have established over the years and gained prominence as tools in speech therapy and research, and highlight potential methodological possibilities for future research.
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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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Busan P, Moret B, Masina F, Del Ben G, Campana G. Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence. Front Hum Neurosci 2021; 15:662016. [PMID: 34456692 PMCID: PMC8386014 DOI: 10.3389/fnhum.2021.662016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.
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Affiliation(s)
| | | | | | - Giovanni Del Ben
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Campana
- Department of General Psychology, University of Padua, Padua, Italy
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Tezel-Bayraktaroglu O, Bayraktaroglu Z, Demirtas-Tatlidede A, Demiralp T, Oge AE. Neuronavigated rTMS inhibition of right pars triangularis anterior in stuttering: Differential effects on reading and speaking. BRAIN AND LANGUAGE 2020; 210:104862. [PMID: 32979643 DOI: 10.1016/j.bandl.2020.104862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Functional neuroimaging studies show an overactivation of speech and language related homologous areas of the right hemisphere in persons who stutter. In this study, we inhibited Broca's homologues using 1 Hz repetitive transcranial magnetic stimulation (rTMS) and assessed its effects on stuttering severity. The investigated cortical areas included pars opercularis (BA44), anterior and posterior pars triangularis (BA45), mouth area on the primary motor cortex (BA4). We collected reading and speaking samples before and after rTMS sessions and calculated the percentage of syllables stuttered. Only right anterior pars triangularis stimulation induced significant changes in speech fluency. Notably, the effects were differential for reading and speaking conditions. Overall, our results provide supportive evidence that right anterior BA45 may be a critical region for stuttering. The observed differential effects following the inhibition of right anterior BA45 merits further study of contributions of this region on different language domains in persons who stutter.
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Affiliation(s)
| | - Zubeyir Bayraktaroglu
- Istanbul Medipol University, International School of Medicine, Department of Physiology, 34815 Beykoz, Istanbul, Turkey; Istanbul Medipol University, Research Institute for Health Sciences and Technologies (SABITA), Restorative and Regenerative Medicine Research Center (REMER), functional Imaging and Cognitive Affective Neuroscience Laboratory (fINCAN), 34810 Beykoz, Istanbul, Turkey
| | - Asli Demirtas-Tatlidede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34093 Capa, Istanbul, Turkey; Bahcesehir University, School of Medicine, Department of Neurology, 34734 Kadikoy, Istanbul, Turkey
| | - Tamer Demiralp
- Istanbul University, Hulusi Behcet Life Sciences Research Laboratory-Neuroimaging Unit, 34093 Capa, Istanbul, Turkey; Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, 34093 Capa, Istanbul, Turkey
| | - A Emre Oge
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34093 Capa, Istanbul, Turkey
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Garnett EO, Chow HM, Choo AL, Chang SE. Stuttering Severity Modulates Effects of Non-invasive Brain Stimulation in Adults Who Stutter. Front Hum Neurosci 2019; 13:411. [PMID: 31824276 PMCID: PMC6881273 DOI: 10.3389/fnhum.2019.00411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022] Open
Abstract
Stuttering is a neurodevelopmental disorder that manifests as frequent disruptions in the flow of speech, affecting 1% of adults. Treatments are limited to behavioral interventions with variable success and high relapse rates, particularly in adults. However, even in severe cases, fluency can be temporarily induced during conditions in which the speaker synchronizes his speech with external rhythmic cues, such as when reading in unison (choral speech) or with a metronome. Non-invasive neuromodulation techniques such as transcranial direct current stimulation (tDCS) have shown promise in augmenting the effects of behavioral treatment during motor and speech/language rehabilitation, but only one study to date has examined behavioral modulatory effects of tDCS in the context of stuttering. Using high-definition (HD)-tDCS electrodes, which improves focality of stimulation relative to conventional tDCS, we investigated the effects of tDCS on speech fluency and brain activation in 14 adults who stutter (AWS). Either anodal or sham stimulation was delivered on separate days over left supplementary motor area (SMA). During stimulation, participants read aloud in sync with a metronome. Measures of speech fluency and brain activity functional magnetic resonance imaging (fMRI) were collected before and after stimulation. No significant differences in brain activity or speech fluency were found when comparing active and sham stimulation. However, stuttering severity significantly modulated the effect of stimulation: active stimulation attenuated the atypically strong association between stuttering severity and right thalamocortical network activity, especially in more severe speakers. These preliminary results warrant additional research into potential application of HD-tDCS to modulate speech motor networks to enhance fluency in stuttering.
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Affiliation(s)
| | - Ho Ming Chow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, United States.,Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, United States
| | - Ai Leen Choo
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta, GA, United States
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Jackson ES, Wijeakumar S, Beal DS, Brown B, Zebrowski P, Spencer JP. A fNIRS Investigation of Speech Planning and Execution in Adults Who Stutter. Neuroscience 2019; 406:73-85. [DOI: 10.1016/j.neuroscience.2019.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 01/05/2023]
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Busan P, Del Ben G, Russo LR, Bernardini S, Natarelli G, Arcara G, Manganotti P, Battaglini PP. Stuttering as a matter of delay in neural activation: A combined TMS/EEG study. Clin Neurophysiol 2019; 130:61-76. [DOI: 10.1016/j.clinph.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/27/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
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