Effect of acoustical, visual and tactile echo on speech fluency of stutterers

Identification of neural structures involved in stuttering using vibrotactile feedback

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.

Effects of digital vibrotactile speech feedback on overt stuttering frequency

Fluency-enhancing speech feedback, originating from internally or externally generated sources via auditory or visual sensory modalities is not restricted to a specific sensory modality or signal origination. Research suggests that externally generated digital vibrotactile speech feedback serves as an effective fluency enhancer. The present purpose was to test the fluency-enhancing effects of self-generated digital vibrotactile speech feedback on stuttering frequency. Adults who stutter read passages aloud over the telephone, both with and without digital vibrotactile speech feedback. Digital vibrotactile speech feedback was operationally defined as feeling the vibrations of the thyroid cartilage with the thumb and index finger while speaking. Analysis indicated that self-generated digital vibrotactile speech feedback reduced overt stuttering frequency by an average of 72%. As the specific neural mechanisms associated with stuttering and fluency enhancement from tactile speech feedback remain unknown, theoretical implications and clinical applications were discussed.

The effects of self-generated synchronous and asynchronous visual speech feedback on overt stuttering frequency

PURPOSE

Relatively recent research documents that visual choral speech, which represents an externally generated form of synchronous visual speech feedback, significantly enhanced fluency in those who stutter. As a consequence, it was hypothesized that self-generated synchronous and asynchronous visual speech feedback would likewise enhance fluency. Therefore, the purpose of this study was to investigate the effects of self-generated visual feedback (i.e., synchronous speech feedback with a mirror and asynchronous speech feedback via delayed visual feedback) on overt stuttering frequency in those who stutter.

METHOD

Eight people who stutter (4 males, 4 females), ranging from 18 to 42 years of age participated in this study. Due to the nature of visual speech feedback, the speaking task required that participants recite memorized phrases in control and experimental speaking conditions so that visual attention could be focused on the speech feedback, rather than a written passage. During experimental conditions, participants recited memorized phrases while simultaneously focusing on the movement of their lips, mouth, and jaw within their own synchronous (i.e., mirror) and asynchronous (i.e., delayed video signal) visual speech feedback.

RESULTS

Results indicated that the self-generated visual feedback speaking conditions significantly decreased stuttering frequency (Greenhouse-Geisser p=.000); post hoc orthogonal comparisons revealed no significant differences in stuttering frequency reduction between the synchronous and asynchronous visual feedback speaking conditions (p=.2554).

CONCLUSIONS

These data suggest that synchronous and asynchronous self-generated visual speech feedback is associated with significant reductions in overt stuttering frequency. Study results were discussed relative to existing theoretical models of fluency-enhancement via speech feedback, such as the engagement of mirror neuron networks, the EXPLAN model, and the Dual Premotor System Hypothesis. Further research in the area of self-generated visual speech feedback, as well as theoretical constructs accounting for how exposure to a multi-sensory speech feedback enhances fluency, is warranted.

LEARNING OUTCOMES

: Readers will be able to (1) discuss the multi-sensory nature of fluency-enhancing speech feedback, (2) compare and contrast synchronous and asynchronous self-generated and externally generated visual speech feedback, and (3) compare and contrast self-generated and externally generated visual speech feedback.

The effects of gated speech on the fluency of speakers who stutter

It is known that the speech of people who stutter improves when the speaker's own vocalization is changed while the participant is speaking. One explanation of these effects is the disruptive rhythm hypothesis (DRH). The DRH maintains that the manipulated sound only needs to disturb timing to affect speech control. The experiment investigated whether speech that was gated on and off (interrupted) affected the speech control of speakers who stutter. Eight children who stutter read a passage when they heard their voice normally and when the speech was gated. Fluency was enhanced (fewer errors were made and time to read a set passage was reduced) when speech was interrupted in this way. The results support the DRH.

Auditory abilities of speakers who persisted, or recovered, from stuttering

OBJECTIVE

The purpose of this study was to see whether participants who persist in their stutter have poorer sensitivity in a backward masking task compared to those participants who recover from their stutter.

DESIGN

The auditory sensitivity of 30 children who stutter was tested on absolute threshold, simultaneous masking, backward masking with a broadband and with a notched noise masker. The participants had been seen and diagnosed as stuttering at least 1 year before their 12th birthday. The participants were assessed again at age 12 plus to establish whether their stutter had persisted or recovered. Persistence or recovery was based on participant's, parent's and researcher's assessment and Riley's [Riley, G. D. (1994). Stuttering severity instrument for children and adults (3rd ed.). Austin, TX: Pro-Ed.] Stuttering Severity Instrument-3. Based on this assessment, 12 speakers had persisted and 18 had recovered from stuttering.

RESULTS

Thresholds differed significantly between persistent and recovered groups for the broadband backward-masked stimulus (thresholds being higher for the persistent group).

CONCLUSIONS

Backward masking performance at teenage is one factor that distinguishes speakers who persist in their stutter from those who recover. Education objectives: Readers of this article should: (1) explain why auditory factors have been implicated in stuttering; (2) summarise the work that has examined whether peripheral, and/or central, hearing are problems in stuttering; (3) explain how the hearing ability of persistent and recovered stutterers may differ; (4) discuss how hearing disorders have been implicated in other language disorders.

The inhibition of stuttering via the presentation of natural speech and sinusoidal speech analogs

Sensory signals containing speech or gestural (articulatory) information (e.g., choral speech) have repeatedly been found to be highly effective inhibitors of stuttering. Sine wave analogs of speech consist of a trio of changing pure tones representative of formant frequencies. They are otherwise devoid of traditional speech cues, yet have proven to evoke consistent linguistic percepts in listeners. Thus, we investigated the potency of sinusoidal speech for inhibiting stuttering. Ten adults who stutter read while listening to (a) forward-flowing natural speech; (b) forward-flowing sinusoid analogs of natural speech; (c) reversed natural speech; (d) reversed sinusoid analogs of natural speech; and (e) a continuous 1000 Hz pure tone. The levels of stuttering inhibition achieved using the sinusoidal stimuli were potent and not significantly different from those achieved using natural speech (approximately 50% in forward conditions and approximately 25% in the reversed conditions), suggesting that the patterns of undulating pure tones are sufficient to endow sinusoidal sentences with 'quasi-gestural' qualities. These data highlight the sensitivity of a specialized 'phonetic module' for extracting gestural information from sensory stimuli. Stuttering inhibition is thought to occur when perceived gestural information facilitates fluent productions via the engagement of mirror neurons (e.g., in Broca's area), which appear to play a crucial role in our ability to perceive and produce speech.

Stutter-free and stutter-filled speech signals and their role in stuttering amelioration for English speaking adults

This study examined the power of an exogenously generated stuttered speech signal on stuttering frequency when compared to an exogenously generated normal speech signal. In addition, we examined the specific components of the second speech signal, which might be responsible for the inducement of fluency in people who stutter. Eight males and two females who stuttered participated in this study. Experiment I involved meaningful speech: normal continuous speech, normal interrupted speech, stuttered continuous speech, and stuttered interrupted speech, whereas Experiment II involved vowels and consonants: /a/, /a-i-u/, /s/, /s-sh-f/. The results indicated that stuttered and normal speech signals were equally effective in reducing stuttering frequency. Further, the vowels were more powerful than consonants in inducing fluency for people who stutter. It is suggested that acoustic manifestations of stuttering, rather than a problem, may be a natural compensatory mechanism to bypass or inhibit the 'involuntary block' at the neural level.

Inducement of fluent speech in persons who stutter via visual choral speech

A novel phenomenon of fluency enhancement via visual gestures of speech in the absence of traditional auditory feedback is reported herein. The effect on visual choral speech on stuttering frequency was investigated. Ten participants who stuttered recited memorized text aloud under two conditions. In a visual choral speech (VCS) condition participants were instructed to focus their gaze on the face, lips and jaw of a research assistant who 'silently mouthed' the text in unison. In a control condition, participants recited memorized text to the research assistant who sat motionless. A statistically significant (P=0.0025) reduction of approximately 80% in stuttering frequency was observed in the VCS condition. As visual linguistic cues are sufficient to activate the auditory cortex, one may speculate that VCS induces fluency in a similar yet undetermined manner as altered auditory feedback does.