Atypical cerebral laterality in adults with persistent developmental stuttering

Evidence for planning and motor subtypes of stuttering based on resting state functional connectivity

We tested the hypothesis, generated from the Gradient Order Directions Into Velocities of Articulators (GODIVA) model, that adults who stutter (AWS) may comprise subtypes based on differing connectivity within the cortico-basal ganglia planning or motor loop. Resting state functional connectivity from 91 AWS and 79 controls was measured for all GODIVA model connections. Based on a principal components analysis, two connections accounted for most of the connectivity variability in AWS: left thalamus - left posterior inferior frontal sulcus (planning loop component) and left supplementary motor area - left ventral premotor cortex (motor loop component). A k-means clustering algorithm using the two connections revealed three clusters of AWS. Cluster 1 was significantly different from controls in both connections; Cluster 2 was significantly different in only the planning loop; and Cluster 3 was significantly different in only the motor loop. These findings suggest the presence of planning and motor subtypes of stuttering.

Autism-associated brain differences can be observed in utero using MRI

Developmental changes that occur before birth are thought to be associated with the development of autism spectrum disorders. Identifying anatomical predictors of early brain development may contribute to our understanding of the neurobiology of autism spectrum disorders and allow for earlier and more effective identification and treatment of autism spectrum disorders. In this study, we used retrospective clinical brain magnetic resonance imaging data from fetuses who were diagnosed with autism spectrum disorders later in life (prospective autism spectrum disorders) in order to identify the earliest magnetic resonance imaging-based regional volumetric biomarkers. Our results showed that magnetic resonance imaging-based autism spectrum disorder biomarkers can be found as early as in the fetal period and suggested that the increased volume of the insular cortex may be the most promising magnetic resonance imaging-based fetal biomarker for the future emergence of autism spectrum disorders, along with some additional, potentially useful changes in regional volumes and hemispheric asymmetries.

Brain asymmetry is globally different in males and females: exploring cortical volume, area, thickness, and mean curvature

Brain asymmetry is a cornerstone in the development of higher-level cognition, but it is unclear whether and how it differs in males and females. Asymmetry has been investigated using the laterality index, which compares homologous regions as pairwise weighted differences between the left and the right hemisphere. However, if asymmetry differences between males and females are global instead of pairwise, involving proportions between multiple brain areas, novel methodological tools are needed to evaluate them. Here, we used the Amsterdam Open MRI collection to investigate sexual dimorphism in brain asymmetry by comparing laterality index with the distance index, which is a global measure of differences within and across hemispheres, and with the subtraction index, which compares pairwise raw values in the left and right hemisphere. Machine learning models, robustness tests, and group analyses of cortical volume, area, thickness, and mean curvature revealed that, of the three indices, distance index was the most successful biomarker of sexual dimorphism. These findings suggest that left-right asymmetry in males and females involves global coherence rather than pairwise contrasts. Further studies are needed to investigate the biological basis of local and global asymmetry based on growth patterns under genetic, hormonal, and environmental factors.

Tree representations of brain structural connectivity via persistent homology

The brain structural connectome is generated by a collection of white matter fiber bundles constructed from diffusion weighted MRI (dMRI), acting as highways for neural activity. There has been abundant interest in studying how the structural connectome varies across individuals in relation to their traits, ranging from age and gender to neuropsychiatric outcomes. After applying tractography to dMRI to get white matter fiber bundles, a key question is how to represent the brain connectome to facilitate statistical analyses relating connectomes to traits. The current standard divides the brain into regions of interest (ROIs), and then relies on an adjacency matrix (AM) representation. Each cell in the AM is a measure of connectivity, e.g., number of fiber curves, between a pair of ROIs. Although the AM representation is intuitive, a disadvantage is the high-dimensionality due to the large number of cells in the matrix. This article proposes a simpler tree representation of the brain connectome, which is motivated by ideas in computational topology and takes topological and biological information on the cortical surface into consideration. We demonstrate that our tree representation preserves useful information and interpretability, while reducing dimensionality to improve statistical and computational efficiency. Applications to data from the Human Connectome Project (HCP) are considered and code is provided for reproducing our analyses.

Diagnostic challenge of Creutzfeldt-Jakob disease in a patient with multimorbidity: a case-report

BACKGROUND

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its subtype, and may include dementia, visual hallucinations, myoclonus, ataxia, (extra)pyramidal signs and akinetic mutism. In the early course of disease however, several clinical symptoms of CJD may mimic those of co-existing morbidities.

CASE PRESENTATION

We report a male in his 60s with a history of situs inversus totalis and Churg Strauss syndrome, who presented with speech fluency disturbances, neuropsychiatric symptoms and allodynia, a few months after becoming a widower. Initially presumed a bereavement disorder along with a flare-up of Churg Strauss, his symptoms gradually worsened with apraxia, myoclonic jerks and eventually, akinetic mutism. MRI revealed hyperintensities at the caudate nucleus and thalami, while the cerebrospinal fluid was positive for the 14-3-3 protein and the real-time quick test, making the diagnosis of CJD highly probable. This case illustrates the complexities that may arise in diagnosing CJD when pre-existing multimorbidity may cloud the clinical presentation. We also discuss the potential mechanisms underlying the co-occurrence of three rare conditions (situs inversus totalis, Churg Strauss syndrome, CJD) in one patient, taking into consideration the possibility of coincidence as well as common underlying factors.

CONCLUSIONS

The diagnosis of CJD may be easily missed when its clinical symptoms are obscured by those of pre-existing (rare) multimorbidity. This case highlights that when the multimorbidity has neurological manifestations, an extensive evaluation remains crucial to establish the diagnosis, minimize the risk of prion-transmission and provide appropriate guidance to patients and their caregivers.

Asymmetry in the Central Nervous System: A Clinical Neuroscience Perspective

Recent large-scale neuroimaging studies suggest that most parts of the human brain show structural differences between the left and the right hemisphere. Such structural hemispheric asymmetries have been reported for both cortical and subcortical structures. Interestingly, many neurodevelopmental and psychiatric disorders have been associated with altered functional hemispheric asymmetries. However, findings concerning the relation between structural hemispheric asymmetries and disorders have largely been inconsistent, both within specific disorders as well as between disorders. In the present review, we compare structural asymmetries from a clinical neuroscience perspective across different disorders. We focus especially on recent large-scale neuroimaging studies, to concentrate on replicable effects. With the notable exception of major depressive disorder, all reviewed disorders were associated with distinct patterns of alterations in structural hemispheric asymmetries. While autism spectrum disorder was associated with altered structural hemispheric asymmetries in a broader range of brain areas, most other disorders were linked to more specific alterations in brain areas related to cognitive functions that have been associated with the symptomology of these disorders. The implications of these findings are highlighted in the context of transdiagnostic approaches to psychopathology.

Infant study of hemispheric asymmetry after long-gap esophageal atresia repair

OBJECTIVES

Previous studies have demonstrated that infants are typically born with a left-greater-than-right forebrain asymmetry that reverses throughout the first year of life. We hypothesized that critically ill term-born and premature patients following surgical and critical care for long-gap esophageal atresia (LGEA) would exhibit alteration in expected forebrain asymmetry.

METHODS

Term-born (n = 13) and premature (n = 13) patients, and term-born controls (n = 23) <1 year corrected age underwent non-sedated research MRI following completion of LGEA treatment via Foker process. Structural T1- and T2-weighted images were collected, and ITK-SNAP was used for forebrain tissue segmentation and volume acquisition. Data were presented as absolute (cm³ ) and normalized (% total forebrain) volumes of the hemispheres. All measures were checked for normality, and group status was assessed using a general linear model with age at scan as a covariate.

RESULTS

Absolute volumes of both forebrain hemispheres were smaller in term-born and premature patients in comparison to controls (p < 0.001). Normalized hemispheric volume group differences were detected by T1-weighted analysis, with premature patients demonstrating right-greater-than-left hemisphere volumes in comparison to term-born patients and controls (p < 0.01). While normalized group differences were very subtle (a right hemispheric predominance of roughly 2% of forebrain volume), they represent a deviation from the expected pattern of hemispheric brain asymmetry.

INTERPRETATION

Our pilot quantitative MRI study of hemispheric volumes suggests that premature patients might be at risk of altered expected left-greater-than-right forebrain asymmetry following repair of LGEA. Future neurobehavioral studies in infants born with LGEA are needed to elucidate the functional significance of presented anatomical findings.

Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence

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.

Speech planning and execution in children who stutter: Preliminary findings from a fNIRS investigation

Few studies have investigated the neural mechanisms underlying speech production in children who stutter (CWS), despite the critical importance of understanding these mechanisms closer to the time of stuttering onset. The relative contributions of speech planning and execution in CWS therefore are also unknown. Using functional near-infrared spectroscopy, the current study investigated neural mechanisms of planning and execution in a small sample of 9-12 year-old CWS and controls (N = 12) by implementing two tasks that manipulated speech planning and execution loads. Planning was associated with atypical activation in bilateral inferior frontal gyrus and right supramarginal gyrus. Execution was associated with atypical activation in bilateral precentral gyrus and inferior frontal gyrus, as well as right supramarginal gyrus and superior temporal gyrus. The CWS exhibited some activation patterns that were similar to the adults who stutter (AWS) as reported in our previous study: atypical planning in frontal areas including left inferior frontal gyrus and atypical execution in fronto-temporo-parietal regions including left precentral gyrus, and right inferior frontal, superior temporal, and supramarginal gyri. However, differences also emerged. Whereas CWS and AWS both appear to exhibit atypical activation in right inferior and supramarginal gyri during execution, only CWS appear to exhibit this same pattern during planning. In addition, the CWS appear to exhibit atypical activation in left inferior frontal and right precentral gyri related to execution, whereas AWS do not. These preliminary results are discussed in the context of possible impairments in sensorimotor integration and inhibitory control for CWS.

Bilinguals who stutter: A cognitive perspective

PURPOSE

Brain differences, both in structure and executive functioning, have been found in both developmental stuttering and bilingualism. However, the etiology of stuttering remains unknown. The early suggestion that stuttering is a result of brain dysfunction has since received support from various behavioral and neuroimaging studies that have revealed functional and structural brain changes in monolinguals who stutter (MWS). In addition, MWS appear to show deficits in executive control. However, there is a lack of data on bilinguals who stutter (BWS). This literature review is intended to provide an overview of both stuttering and bilingualism as well as synthesize areas of overlap among both lines of research and highlight knowledge gaps in the current literature.

METHODS

A systematic literature review on both stuttering and bilingualism studies was conducted, searching for articles containing "stuttering" and/or "bilingualism" and either "brain", "executive functions", "executive control", "motor control", "cognitive reserve", or "brain reserve" in the PubMed database. Additional studies were found by examining the reference list of studies that met the inclusion criteria.

RESULTS

A total of 148 references that met the criteria for inclusion in this paper were used in the review. A comparison of the impact of stuttering or bilingualism on the brain are discussed.

CONCLUSION

Previous research examining a potential bilingual advantage for BWS is mixed. However, if such an advantage does exist, it appears to offset potential deficits in executive functioning that may be associated with stuttering.

Amino acids profiles of children who stutter compared to their fluent sibling

Purpose: This study scrutinises the abundances of 9 neurological-related amino acids of the scalp hair of 35 (5 females, 30 males) children who stutter and 30 normally fluent children (age and sex matched).Methods: Samples of hair from children who stutter aged (5-9 years) were collected from Speech Clinic at King Abdullah Hospital. The control subjects were selected from the same families of children who stutter to exclude the effect of nutritional, environmental, and biological factors. Amino Acid Analyser was used to measure the concentrations of amino acids in acid hydrolysed hair samples.Results: results indicated that the concentrations of threonine, tyrosine, and isoleucine (p = 0.001, 0.001, 0.02 respectively) are lower in hair samples of people who stutter compared with samples of normal fluent speakers.Conclusion: The findings of this study could introduce a new treatment protocol including the supplementation of reduced nutritional elements.KEY POINTSConcentrations of amino acids (threonine, isoleucine, and tyrosine) in the hair samples of people who stutter were significantly lower than the concentrations in the hair samples of control group.Concentrations of amino acids (histidine and glutamate) in hair samples of people who stutter were lower than control group with low significant values.The concentrations of amino acids (phenylalanine, serine, glycine, aspartate, glutamate) were not significantly different between hair samples of stuttering group and control group.The findings of the current study will be helpful in designing a new treatment method based on the supplementation of deficient amino acids.

Evolution of cerebral asymmetry

The human brain is often characterized in terms of a duality, with the left and right brains serving complementary functions, and even individuals are sometimes classified as either "left-brained" or "right-brained." Recent evidence from brain imaging shows that hemispheric asymmetry is multidimensional, comprised of independent lateralized circuits. Cerebral asymmetries, which include handedness, probably arise in phylogenesis through the fissioning of ancestral systems that divided and lateralized with increasing demand for specialization. They also vary between individuals, with some showing absent or reversed asymmetries. It is unlikely that this variation is controlled by a single gene, as sometimes assumed, but depends rather on complex interplay among several, perhaps many, genes. Hemispheric asymmetry has often been regarded as a unique mark of being human, but it has also become evident that behavioral and cerebral asymmetries are not confined to humans, and are widespread among animal species. They nevertheless exist against a fundamental background of bilateral symmetry, suggesting a tradeoff between the two. Individual differences in asymmetry, moreover, are themselves adaptive, contributing to the cognitive and behavioral specializations necessary for societies to operate efficiently.

Automatic analysis of cross-sectional cerebral asymmetry on 3D in vivo MRI scans of human and chimpanzee

One prominent feature of human brain asymmetry is the cerebral torque. To investigate whether this characteristic is shared with chimpanzees who are our closest extant relative, we developed an automatic method to compute cerebral hemisphere width and perimeter length on consecutive 2D sections through 3D MR images obtained in vivo for 91 human and 78 chimpanzee brains. In brief, contiguous inter-hemispheric width and perimeter asymmetries were calculated on coronal sections, which in profile allow us to examine asymmetry in relation to speciation. The right frontal and left occipital asymmetry (greater posteriorly in females) distinguishes humans from chimpanzees. This result is consistent with a major saltational (discontinuity) event occurring at some point after the separation of humanity and the great apes in the last 6 million years.

Anomalous network architecture of the resting brain in children who stutter

PURPOSE

We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years.

METHODS

A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps ("components") as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups' first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering.

RESULTS

Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control.

CONCLUSIONS

This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.

A systematic literature review of neuroimaging research on developmental stuttering between 1995 and 2016

PURPOSE

Stuttering is a disorder that affects millions of people all over the world. Over the past two decades, there has been a great deal of interest in investigating the neural basis of the disorder. This systematic literature review is intended to provide a comprehensive summary of the neuroimaging literature on developmental stuttering. It is a resource for researchers to quickly and easily identify relevant studies for their areas of interest and enable them to determine the most appropriate methodology to utilize in their work. The review also highlights gaps in the literature in terms of methodology and areas of research.

METHODS

We conducted a systematic literature review on neuroimaging studies on developmental stuttering according to the PRISMA guidelines. We searched for articles in the pubmed database containing "stuttering" OR "stammering" AND either "MRI", "PET", "EEG", "MEG", "TMS"or "brain" that were published between 1995/​01/​01 and 2016/​01/​01.

RESULTS

The search returned a total of 359 items with an additional 26 identified from a manual search. Of these, there were a total of 111 full text articles that met criteria for inclusion in the systematic literature review. We also discuss neuroimaging studies on developmental stuttering published throughout 2016. The discussion of the results is organized first by methodology and second by population (i.e., adults or children) and includes tables that contain all items returned by the search.

CONCLUSIONS

There are widespread abnormalities in the structural architecture and functional organization of the brains of adults and children who stutter. These are evident not only in speech tasks, but also non-speech tasks. Future research should make greater use of functional neuroimaging and noninvasive brain stimulation, and employ structural methodologies that have greater sensitivity. Newly planned studies should also investigate sex differences, focus on augmenting treatment, examine moments of dysfluency and longitudinally or cross-sectionally investigate developmental trajectories in stuttering.

Sex steroid hormones and sex hormone binding globulin levels, CYP17 MSP AI (-34T:C) and CYP19 codon 39 (Trp:Arg) variants in children with developmental stuttering

Developmental stuttering is known to be a sexually dimorphic and male-biased speech motor control disorder. In the present case-control study, we investigated the relationship between developmental stuttering and steroid hormones. Serum levels of testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), oestradiol, progesterone, cortisol, and sex hormone binding globulin (SHBG), as well as the 2nd/4th digit ratio (2D:4D), an indicator of prenatal testosterone level, were compared between children who stutter (CWS) and children who do not stutter (CWNS). Moreover, two SNPs (CYP17 -34 T:C (MSP AI) and CYP19 T:C (Trp:Arg)) of cytochrome P450, which is involved in steroid metabolism pathways, were analysed between the groups. Our results showed significantly higher levels of testosterone, DHT, and oestradiol in CWS in comparison with CWNS. The severity of stuttering was positively correlated with the serum levels of testosterone, DHEA, and cortisol, whereas no association was seen between the stuttering and digit ratio, progesterone, or SHBG. The CYP17CC genotype was significantly associated with the disorder.

Human torque is not present in chimpanzee brain

We searched for positional brain surface asymmetries measured as displacements between corresponding vertex pairs in relation to a mid-sagittal plane in Magnetic Resonance (MR) images of the brains of 223 humans and 70 chimpanzees. In humans deviations from symmetry were observed: 1) a Torque pattern comprising right-frontal and left-occipital "petalia" together with downward and rightward "bending" of the occipital extremity, 2) leftward displacement of the anterior temporal lobe and the anterior and central segments of superior temporal sulcus (STS), and 3) posteriorly in the position of left occipito-temporal surface accompanied by a clockwise rotation of the left Sylvian Fissure around the left-right axis. None of these asymmetries was detected in the chimpanzee, nor was associated with a sex difference. However, 4) an area of cortex with its long axis parallel to the olfactory tract in the orbital surface of the frontal lobe was found in humans to be located higher on the left in females and higher on the right in males. In addition whereas the two hemispheres of the chimpanzee brain are equal in extent in each of the three dimensions of space, in the human brain the left hemisphere is longer (p = 3.6e-12), and of less height (p = 1.9e-3), but equal in width compared to the right. Thus the asymmetries in the human brain are potential correlates of the evolution of the faculty of language.

Functional neural circuits that underlie developmental stuttering

The aim of this study was to identify differences in functional and effective brain connectivity between persons who stutter (PWS) and typically developing (TD) fluent speakers, and to assess whether those differences can serve as biomarkers to distinguish PWS from TD controls. We acquired resting-state functional magnetic resonance imaging data in 44 PWS and 50 TD controls. We then used Independent Component Analysis (ICA) together with Hierarchical Partner Matching (HPM) to identify networks of robust, functionally connected brain regions that were highly reproducible across participants, and we assessed whether connectivity differed significantly across diagnostic groups. We then used Granger Causality (GC) to study the causal interactions (effective connectivity) between the regions that ICA and HPM identified. Finally, we used a kernel support vector machine to assess how well these measures of functional connectivity and granger causality discriminate PWS from TD controls. Functional connectivity was stronger in PWS compared with TD controls in the supplementary motor area (SMA) and primary motor cortices, but weaker in inferior frontal cortex (IFG, Broca’s area), caudate, putamen, and thalamus. Additionally, causal influences were significantly weaker in PWS from the IFG to SMA, and from the basal ganglia to IFG through the thalamus, compared to TD controls. ICA and GC indices together yielded an accuracy of 92.7% in classifying PWS from TD controls. Our findings suggest the presence of dysfunctional circuits that support speech planning and timing cues for the initiation and execution of motor sequences in PWS. Our high accuracy of classification further suggests that these aberrant brain features may serve as robust biomarkers for PWS.

Cortical auditory evoked potentials in children who stutter

INTRODUCTION

It has been hypothesized that impaired auditory processing influence the occurrence of stuttering. Also, it is suggested that speech perception in children who stutter differed from normal. Auditory processing should be investigated in children who stutter shortly after the onset of stuttering in order to evaluate the extent to which impaired auditory processing contributes to the development of stuttering. CAEPs provide the necessary temporal and spatial resolution to detect differences in auditory processing and the neural activity that is related or time-locked to the auditory stimulus. The primary goal of the present study was to determine the difference in latency and amplitude of P1-N2 complex between children who stutter and non-stuttering children in response to speech stimuli.

MATERIAL & METHODS

This case-control study was performed over 60children, 30were non-stuttering children (control group) and 30were children who stutter (study group) ranging in severity from Bloodstien I to Bloodstien IV in the age range of 8-18 years.

RESULTS

CAEPs of children who stutter with stuttering severity Bloodstien IV showed significant prolonged latencies and reduced amplitudes when blocks and IPDs were the most predominant core behaviors. P1 and N1 were prolonged in concomitant behaviors.

CONCLUSION

It could be speculated that speech processing was affected in children who stutter with stuttering severity Bloodstien IV at the level of early perceptual auditory cortex.

Beyond production: Brain responses during speech perception in adults who stutter

Developmental stuttering is a speech disorder that disrupts the ability to produce speech fluently. While stuttering is typically diagnosed based on one's behavior during speech production, some models suggest that it involves more central representations of language, and thus may affect language perception as well. Here we tested the hypothesis that developmental stuttering implicates neural systems involved in language perception, in a task that manipulates comprehensibility without an overt speech production component. We used functional magnetic resonance imaging to measure blood oxygenation level dependent (BOLD) signals in adults who do and do not stutter, while they were engaged in an incidental speech perception task. We found that speech perception evokes stronger activation in adults who stutter (AWS) compared to controls, specifically in the right inferior frontal gyrus (RIFG) and in left Heschl's gyrus (LHG). Significant differences were additionally found in the lateralization of response in the inferior frontal cortex: AWS showed bilateral inferior frontal activity, while controls showed a left lateralized pattern of activation. These findings suggest that developmental stuttering is associated with an imbalanced neural network for speech processing, which is not limited to speech production, but also affects cortical responses during speech perception.

Anomalous white matter morphology in adults who stutter

AIMS

Developmental stuttering is now generally considered to arise from genetic determinants interacting with neurologic function. Changes within speech-motor white matter (WM) connections may also be implicated. These connections can now be studied in great detail by high-angular-resolution diffusion magnetic resonance imaging. Therefore, diffusion spectrum imaging was used to reconstruct streamlines to examine white matter connections in people who stutter (PWS) and in people who do not stutter (PWNS).

METHOD

WM morphology of the entire brain was assayed in 8 right-handed male PWS and 8 similarly aged right-handed male PWNS. WM was exhaustively searched using a deterministic algorithm that identifies missing or largely misshapen tracts. To be abnormal, a tract (defined as all streamlines connecting a pair of gray matter regions) was required to be at least one 3rd missing, in 7 out of 8 subjects in one group and not in the other group.

RESULTS

Large portions of bilateral arcuate fasciculi, a heavily researched speech pathway, were abnormal in PWS. Conversely, all PWS had a prominent connection in the left temporo-striatal tract connecting frontal and temporal cortex that was not observed in PWNS.

CONCLUSION

These previously unseen structural differences of WM morphology in classical speech-language circuits may underlie developmental stuttering.

Reduced fractional anisotropy in the anterior corpus callosum is associated with reduced speech fluency in persistent developmental stuttering

Developmental stuttering is a speech disorder that severely limits one's ability to communicate. White matter anomalies were reported in stuttering, but their functional significance is unclear. We analyzed the relation between white matter properties and speech fluency in adults who stutter (AWS). We used diffusion tensor imaging with tract-based spatial statistics, and examined group differences as well as correlations with behavioral fluency measures. We detected a region in the anterior corpus callosum with significantly lower fractional anisotropy in AWS relative to controls. Within the AWS group, reduced anisotropy in that region is associated with reduced fluency. A statistically significant interaction was found between group and age in two additional regions: the left Rolandic operculum and the left posterior corpus callosum. Our findings suggest that anterior callosal anomaly in stuttering may represent a maladaptive reduction in interhemispheric inhibition, possibly leading to a disadvantageous recruitment of right frontal cortex in speech production.

Modulation of auditory processing during speech movement planning is limited in adults who stutter

Stuttering is associated with atypical structural and functional connectivity in sensorimotor brain areas, in particular premotor, motor, and auditory regions. It remains unknown, however, which specific mechanisms of speech planning and execution are affected by these neurological abnormalities. To investigate pre-movement sensory modulation, we recorded 12 stuttering and 12 nonstuttering adults' auditory evoked potentials in response to probe tones presented prior to speech onset in a delayed-response speaking condition vs. no-speaking control conditions (silent reading; seeing nonlinguistic symbols). Findings indicate that, during speech movement planning, the nonstuttering group showed a statistically significant modulation of auditory processing (reduced N1 amplitude) that was not observed in the stuttering group. Thus, the obtained results provide electrophysiological evidence in support of the hypothesis that stuttering is associated with deficiencies in modulating the cortical auditory system during speech movement planning. This specific sensorimotor integration deficiency may contribute to inefficient feedback monitoring and, consequently, speech dysfluencies.

Control and prediction components of movement planning in stuttering versus nonstuttering adults

PURPOSE

Stuttering individuals show speech and nonspeech sensorimotor deficiencies. To perform accurate movements, the sensorimotor system needs to generate appropriate control signals and correctly predict their sensory consequences. Using a reaching task, we examined the integrity of these control and prediction components separately for movements unrelated to the speech motor system.

METHOD

Nine stuttering and 9 nonstuttering adults made fast reaching movements to visual targets while sliding an object under the index finger. To quantify control, we determined initial direction error and end point error. To quantify prediction, we calculated the correlation between vertical and horizontal forces applied to the object-an index of how well vertical force (preventing slip) anticipated direction-dependent variations in horizontal force (moving the object).

RESULTS

Directional and end point error were significantly larger for the stuttering group. Both groups performed similarly in scaling vertical force with horizontal force.

CONCLUSIONS

The stuttering group's reduced reaching accuracy suggests limitations in generating control signals for voluntary movements, even for nonorofacial effectors. Typical scaling of vertical force with horizontal force suggests an intact ability to predict the consequences of planned control signals. Stuttering may be associated with generalized deficiencies in planning control signals rather than predicting the consequences of those signals.

Absolute and relative reliability of percentage of syllables stuttered and severity rating scales

PURPOSE

Percentage of syllables stuttered (%SS) and severity rating (SR) scales are measures in common use to quantify stuttering severity and its changes during basic and clinical research conditions. However, their reliability has not been assessed with indices measuring both relative and absolute reliability. This study was designed to provide such information. Relative reliability deals with the rank order of participants in a sample, whereas absolute reliability measures the closeness of scores to one other and to a hypothetical true score.

METHOD

Eighty-seven adult participants who stutter received a 10-min unscheduled telephone call. Three experienced judges measured %SS and also used a 9-point SR scale to measure stuttering severity from recordings of the telephone calls.

RESULTS

Relative intrajudge and interjudge reliability were satisfactory for both scales. However, absolute intrajudge and interjudge reliability were not satisfactory. Results showed that paired-judge SR and %SS procedures improved absolute reliability compared with single-judge measures. Additionally, the paired-judge procedure improved relative reliability from high to very high levels.

CONCLUSION

Measurement of group changes of stuttering severity can be done in research contexts using either %SS or SR. However, for detecting changes within individuals using such measures, a paired-judge procedure is a more reliable method.

Research updates in neuroimaging studies of children who stutter

In the past two decades, neuroimaging investigations of stuttering have led to important discoveries of structural and functional brain differences in people who stutter, providing significant clues to the neurological basis of stuttering. One major limitation, however, has been that most studies so far have only examined adults who stutter, whose brain and behavior likely would have adopted compensatory reactions to their stuttering; these confounding factors have made interpretations of the findings difficult. Developmental stuttering is a neurodevelopmental condition, and like many other neurodevelopmental disorders, stuttering is associated with an early childhood onset of symptoms and greater incidence in males relative to females. More recent studies have begun to examine children who stutter using various neuroimaging techniques that allow examination of functional neuroanatomy and interaction of major brain areas that differentiate children who stutter compared with age-matched controls. In this article, I review these more recent neuroimaging investigations of children who stutter, in the context of what we know about typical brain development, neuroplasticity, and sex differences relevant to speech and language development. Although the picture is still far from complete, these studies have potential to provide information that can be used as early objective markers, or prognostic indicators, for persistent stuttering in the future. Furthermore, these studies are the first steps in finding potential neural targets for novel therapies that may involve modulating neuroplastic growth conducive to developing and maintaining fluent speech, which can be applied to treatment of young children who stutter.

Disrupted white matter in language and motor tracts in developmental stuttering

White matter tracts connecting areas involved in speech and motor control were examined using diffusion-tensor imaging in a sample of people who stutter (n=29) who were heterogeneous with respect to age, sex, handedness and stuttering severity. The goals were to replicate previous findings in developmental stuttering and to extend our knowledge by evaluating the relationship between white matter differences in people who stutter and factors such as age, sex, handedness and stuttering severity. We replicated previous findings that showed reduced integrity in white matter underlying ventral premotor cortex, cerebral peduncles and posterior corpus callosum in people who stutter relative to controls. Tractography analysis additionally revealed significantly reduced white matter integrity in the arcuate fasciculus bilaterally and the left corticospinal tract and significantly reduced connectivity within the left corticobulbar tract in people who stutter. Region-of-interest analyses revealed reduced white matter integrity in people who stutter in the three pairs of cerebellar peduncles that carry the afferent and efferent fibers of the cerebellum. Within the group of people who stutter, the higher the stuttering severity index, the lower the white matter integrity in the left angular gyrus, but the greater the white matter connectivity in the left corticobulbar tract. Also, in people who stutter, handedness and age predicted the integrity of the corticospinal tract and peduncles, respectively. Further studies are needed to determine which of these white matter differences relate to the neural basis of stuttering and which reflect experience-dependent plasticity.

Neural network connectivity differences in children who stutter

Affecting 1% of the general population, stuttering impairs the normally effortless process of speech production, which requires precise coordination of sequential movement occurring among the articulatory, respiratory, and resonance systems, all within millisecond time scales. Those afflicted experience frequent disfluencies during ongoing speech, often leading to negative psychosocial consequences. The aetiology of stuttering remains unclear; compared to other neurodevelopmental disorders, few studies to date have examined the neural bases of childhood stuttering. Here we report, for the first time, results from functional (resting state functional magnetic resonance imaging) and structural connectivity analyses (probabilistic tractography) of multimodal neuroimaging data examining neural networks in children who stutter. We examined how synchronized brain activity occurring among brain areas associated with speech production, and white matter tracts that interconnect them, differ in young children who stutter (aged 3-9 years) compared with age-matched peers. Results showed that children who stutter have attenuated connectivity in neural networks that support timing of self-paced movement control. The results suggest that auditory-motor and basal ganglia-thalamocortical networks develop differently in stuttering children, which may in turn affect speech planning and execution processes needed to achieve fluent speech motor control. These results provide important initial evidence of neurological differences in the early phases of symptom onset in children who stutter.

An exploration of dichotic listening among adults who stutter

A pilot investigation of dichotic listening of CV stimuli was undertaken using seven adults who stutter (AWS) and a comparison group of seven adults who do not stutter (AWNS). The aim of this research was to investigate whether AWS show a difference in the strength of the right ear advantage (REA) in both undirected and directed attention tasks when compared to AWNS. The undirected attention task involved manipulating the interaural intensity difference (IID) of the CV stimuli presented to each ear. The CV stimuli were presented with equal intensity for the directed attention task. The undirected attention results indicated that both AWS and AWNS have a REA for processing speech information, with a primary difference observed between groups in regard to the IID point at which a REA shifts to a LEA. This crossing-over point occurred earlier for AWS, indicating a stronger right hemisphere involvement for the processing of speech compared to AWNS. No differences were found between groups in the directed attention task. The differences and similarities observed in dichotic listening between the two groups are discussed in regard to hemispheric specialization in the processing of speech.

Novel tactile feedback to reduce overt stuttering

Stuttering is generally considered to be a speech disorder that affects ∼1% of the global population. Various forms of speech feedback have been shown to reduce overt stuttered speaking, and in particular, second speech signal through speech feedback has drastically reduced utterances of stuttered speech in adults with persistent stuttering. This study reports data for increased overt fluency of speech in an adult stuttering population, whereby the vocalization of the speaker is captured by a microphone or an accelerometer, signal processed, and returned as mechanical tactile speech feedback to the speaker's skin. A repeated measures analysis of variance was used to show that both the microphone and the accelerometer speaking conditions were significantly more fluent than a control (no feedback) condition, with the microphone-driven tactile feedback reducing instances of stuttering by 71% and the accelerometer-driven tactile feedback reducing instances of stuttering by 80%. It is apparent that self-generated tactile feedback can be used to enhance fluency significantly in those who stutter.

A voxel-based morphometry (VBM) analysis of regional grey and white matter volume abnormalities within the speech production network of children who stutter

It is well documented that neuroanatomical differences exist between adults who stutter and their fluently speaking peers. Specifically, adults who stutter have been found to have more grey matter volume (GMV) in speech relevant regions including inferior frontal gyrus, insula and superior temporal gyrus (Beal et al., 2007; Song et al., 2007). Despite stuttering having its onset in childhood only one study has investigated the neuroanatomical differences between children who do and do not stutter. Chang et al. (2008) reported children who stutter had less GMV in the bilateral inferior frontal gyri and middle temporal gyrus relative to fluently speaking children. Thus it appears that children who stutter present with unique neuroanatomical abnormalities as compared to those of adults who stutter. In order to better understand the neuroanatomical correlates of stuttering earlier in its development, near the time of onset, we used voxel-based morphometry to examine volumetric differences between 11 children who stutter and 11 fluent children. Children who stutter had less GMV in the bilateral inferior frontal gyri and left putamen but more GMV in right Rolandic operculum and superior temporal gyrus relative to fluent children. Children who stutter also had less white matter volume bilaterally in the forceps minor of the corpus callosum. We discuss our findings of widespread anatomic abnormalities throughout the cortical network for speech motor control within the context of the speech motor skill limitations identified in people who stutter (Namasivayam and van Lieshout, 2008; Smits-Bandstra et al., 2006).

Self-initiation and temporal cueing of monaural tones reduce the auditory N1 and P2

Event-related potentials (ERPs) to tones that are self-initiated are reduced in their magnitude in comparison with ERPs to tones that are externally generated. This phenomenon has been taken as evidence for an efference copy of the motor command acting to suppress the sensory response. However, self-initiation provides a strong temporal cue for the stimulus which might also contribute to the ERP suppression for self-initiated tones. The current experiment sought to investigate the suppression of monaural tones by temporal cueing and also whether the addition of self-initiation enhanced this suppression. Lastly, the experiment sought to investigate the lateralisation of the ERP suppression via presenting these monaural tones to each ear respectively. We examined source waveforms extracted from the lateralised auditory cortices and measured the modulation of the N1 and P2 components by cueing and self-initiation. Self-initiation significantly reduced the amplitude of the N1 component. Temporal cueing without self-initiation significantly reduced the P2 component. There were no significant differences in the amplitude of either the N1 or the P2 between self-initiation and temporal cuing. There was a significant lateralisation effect on the N1—it being significantly larger contralateral to the ear of stimulation. There was no interaction between lateralisation and side of the temporal cue or side of self-initiation suggesting that the effects of self-initiation and temporal cuing are equal bilaterally. We conclude that a significant proportion of ERP suppression by self-initiation is a result of inherent temporal cueing.

Resting-state brain activity in adult males who stutter

Although developmental stuttering has been extensively studied with structural and task-based functional magnetic resonance imaging (fMRI), few studies have focused on resting-state brain activity in this disorder. We investigated resting-state brain activity of stuttering subjects by analyzing the amplitude of low-frequency fluctuation (ALFF), region of interest (ROI)-based functional connectivity (FC) and independent component analysis (ICA)-based FC. Forty-four adult males with developmental stuttering and 46 age-matched fluent male controls were scanned using resting-state fMRI. ALFF, ROI-based FCs and ICA-based FCs were compared between male stuttering subjects and fluent controls in a voxel-wise manner. Compared with fluent controls, stuttering subjects showed increased ALFF in left brain areas related to speech motor and auditory functions and bilateral prefrontal cortices related to cognitive control. However, stuttering subjects showed decreased ALFF in the left posterior language reception area and bilateral non-speech motor areas. ROI-based FC analysis revealed decreased FC between the posterior language area involved in the perception and decoding of sensory information and anterior brain area involved in the initiation of speech motor function, as well as increased FC within anterior or posterior speech- and language-associated areas and between the prefrontal areas and default-mode network (DMN) in stuttering subjects. ICA showed that stuttering subjects had decreased FC in the DMN and increased FC in the sensorimotor network. Our findings support the concept that stuttering subjects have deficits in multiple functional systems (motor, language, auditory and DMN) and in the connections between them.

Atypical brain torque in boys with developmental stuttering

The counterclockwise brain torque, defined as a larger right prefrontal and left parietal-occipital lobe, is a consistent brain asymmetry. Reduced or reversed lobar asymmetries are markers of atypical cerebral laterality and have been found in adults who stutter. It was hypothesized that atypical brain torque would be more common in children who stutter. Magnetic resonance imaging-based morphology measures were completed in boys who stutter (n = 14) and controls (n = 14), ages 8-13. The controls had the expected brain torque configurations whereas the boys who stutter were atypical. These results support the hypothesis that developmental stuttering is associated with atypical prefrontal and parietal-occipital lobe asymmetries.

Corpus callosum differences associated with persistent stuttering in adults

Recent studies have implicated anatomical differences in speech-relevant brain regions of adults who stutter (AWS) compared to normally fluent adults (NFA). The present study focused on the region of the corpus callosum (CC) which is involved in interhemispheric processing between the left and right cerebral hemispheres. Two-dimensional segmentation of area and voxel-based morphometry were used to evaluate the corpus callosum. Results revealed that the rostrum and anterior midbody of the CC were larger in AWS than NFA. In addition, the overall callosa area was larger in AWS than NFA. The group comparison of white matter volume showed a cluster of increased white matter volume predominantly encompassing the rostrum across the midline portion in AWS. These results potentially reflect anatomical changes associated with differences in the hemispheric distribution of language processes that have been reported previously in AWS.

Functional lateralization of speech processing in adults and children who stutter

Developmental stuttering is a speech disorder in fluency characterized by repetitions, prolongations, and silent blocks, especially in the initial parts of utterances. Although their symptoms are motor related, people who stutter show abnormal patterns of cerebral hemispheric dominance in both anterior and posterior language areas. It is unknown whether the abnormal functional lateralization in the posterior language area starts during childhood or emerges as a consequence of many years of stuttering. In order to address this issue, we measured the lateralization of hemodynamic responses in the auditory cortex during auditory speech processing in adults and children who stutter, including preschoolers, with near-infrared spectroscopy. We used the analysis–resynthesis technique to prepare two types of stimuli: (i) a phonemic contrast embedded in Japanese spoken words (/itta/ vs. /itte/) and (ii) a prosodic contrast (/itta/ vs. /itta?/). In the baseline blocks, only /itta/ tokens were presented. In phonemic contrast blocks, /itta/ and /itte/ tokens were presented pseudo-randomly, and /itta/ and /itta?/ tokens in prosodic contrast blocks. In adults and children who do not stutter, there was a clear left-hemispheric advantage for the phonemic contrast compared to the prosodic contrast. Adults and children who stutter, however, showed no significant difference between the two stimulus conditions. A subject-by-subject analysis revealed that not a single subject who stutters showed a left advantage in the phonemic contrast over the prosodic contrast condition. These results indicate that the functional lateralization for auditory speech processing is in disarray among those who stutter, even at preschool age. These results shed light on the neural pathophysiology of developmental stuttering.

Evidence of left inferior frontal-premotor structural and functional connectivity deficits in adults who stutter

The neurophysiological basis for stuttering may involve deficits that affect dynamic interactions among neural structures supporting fluid speech processing. Here, we examined functional and structural connectivity within corticocortical and thalamocortical loops in adults who stutter. For functional connectivity, we placed seeds in the left and right inferior frontal Brodmann area 44 (BA44) and in the ventral lateral nucleus (VLN) of the thalamus. Subject-specific seeds were based on peak activation voxels captured during speech and nonspeech tasks using functional magnetic resonance imaging. Psychophysiological interaction (PPI) was used to find brain regions with heightened functional connectivity with these cortical and subcortical seeds during speech and nonspeech tasks. Probabilistic tractography was used to track white matter tracts in each hemisphere using the same seeds. Both PPI and tractrography supported connectivity deficits between the left BA44 and the left premotor regions, while connectivity among homologous right hemisphere structures was significantly increased in the stuttering group. No functional connectivity differences between BA44 and auditory regions were found between groups. The functional connectivity results derived from the VLN seeds were less definitive and were not supported by the tractography results. Our data provide strongest support for deficient left hemisphere inferior frontal to premotor connectivity as a neural correlate of stuttering.

Motor proficiency of 6- to 9-year-old children with speech and language problems

AIM

This study compared the gross motor skills of school-age children (mean age 7 y 8 mo, range 6-9 y) with developmental speech and language disorders (DSLDs; n=105; 76 males, 29 females) and typically developing children (n=105; 76 males, 29 females). The relationship between the performance parameters and the children's age was investigated as well as the role of the type of DSLD.

METHOD

The children with DSLDs were classified by their schools' speech and language therapists into three subgroups: children with speech disorders (n=16), those with language disorders (n=41), or those with both (n=48). They were tested with the Test of Gross Motor Development, 2nd edition.

RESULTS

Compared with their typically developing peers, all three DSLD subgroups scored lower on the locomotor (all p values<0.001) and object control sub tests (all p values<0.001). Significant performance differences were found between the three types of DSLD (all p values<0.01) where the children with language disorders only performed better. Older children performed better than the younger ones (plocomotor=0.029, pobject control<0.001), but the magnitude of differences between the children with DSLDs and their peers did not change with increasing age.

INTERPRETATION

Children with DSLDs have poor gross motor skills. Although the performance of children with DSLDs improves with increasing age, it lags behind that of typically developing children. The present results emphasize the importance of early diagnosis and intervention for children with motor deficits.

Assessing quality of life in stuttering treatment outcomes research

Stuttering can affect many aspects of a person's life. People who stutter report that they experience negative reactions to stuttering, difficulty communicating in key situations, diminished satisfaction with life, and a reduced ability to achieve their goals in life. Unfortunately, most treatment outcomes studies have focused on changes in the observable characteristics of stuttering, with significantly fewer studies examining the broader consequences of stuttering. This paper proposes that evaluation of stuttering treatment outcomes can be enhanced through assessment of impact of stuttering on a speaker's quality of life. A means of assessing quality of life is described, based on the Overall Assessment of the Speaker's Experience of Stuttering (OASES; Yaruss & Quesal, 2006, 2008). The OASES is a multi-dimensional assessment instrument built upon the World Health Organization's International Classification of Functioning, Disability, and Health (ICF; WHO, 2001; see also Yaruss & Quesal, 2004). One section of the OASES is designed to assess specific aspects of quality of life in individuals who stutter. Preliminary data from two ongoing studies involving the OASES are briefly summarized in order to demonstrate: (a) that individuals who stutter do report an adverse impact on their quality of life as a result of stuttering and (b) that quality of life can improve following treatment for stuttering. It is recommended that future stuttering treatment outcomes studies directly examine the broader consequence of stuttering by focusing, in part, on quality of life.

EDUCATIONAL OBJECTIVES

After reading this article, the participant will be able to: (1) describe some of the adverse consequences of stuttering reported by individuals who stutter; (2) define quality of life as it relates to the study of the stuttering disorder; (3) explain the value of assessing quality of life in stuttering treatment outcomes research.

A study of the reproducibility and etiology of diffusion anisotropy differences in developmental stuttering: a potential role for impaired myelination

Several diffusion tensor imaging (DTI) studies have reported fractional anisotropy (FA) reductions within the left perisylvian white matter (WM) of persistent developmental stutterers (PSs). However, these studies have not reached the same conclusions in regard to the presence, spatial distribution (focal/diffuse), and directionality (elevated/reduced) of FA differences outside of the left perisylvian region. In addition, supplemental DTI measures (axial and radial diffusivities, diffusion trace) have yet to be utilized to examine the potential etiology of these FA reductions. Therefore, the present study sought to reexamine earlier findings through a sex- and age-controlled replication analysis and then to extend these findings with the aforementioned non-FA measures. The replication analysis showed that robust FA reductions in PSs were largely focal, left hemispheric, and within late-myelinating associative and commissural fibers (division III of the left superior longitudinal fasciculus, callosal body, forceps minor of the corpus callosum). Additional DTI measures revealed that these FA reductions were attributable to an increase in diffusion perpendicular to the affected fiber tracts (elevated radial diffusivity). These findings suggest a hypothesis that will be testable in future studies: that myelogenesis may be abnormal in PSs within left-hemispheric fiber tracts that begin a prolonged course of myelination in the first postnatal year.

Morphometry of human insular cortex and insular volume reduction in Williams syndrome

Functional imaging in humans and anatomical data in monkeys have implicated the insula as a multimodal sensory integrative brain region. The topography of insular connections is organized by its cytoarchitectonic regions. Previous attempts to measure the insula have utilized either indirect or automated methods. This study was designed to develop a reliable method for obtaining volumetric magnetic resonance imaging (MRI) measurements of the human insular cortex, and to validate that method by examining the anatomy of insular cortex in adults with Williams syndrome (WS) and healthy age-matched controls. Statistical reliability was obtained among three raters for this method, supporting its reproducibility not only across raters, but within different software packages. The procedure described here utilizes native-space morphometry as well as a method for dividing the insula into connectivity-based sub-regions estimated from cytoarchitectonics. Reliability was calculated in both ANALYZE (N=3) and BrainImageJava (N=10) where brain scans were measured once in each hemisphere by each rater. This highly reliable method revealed total, anterior, and posterior insular volume reduction bilaterally (all p's<.002) in WS, after accounting for reduced total brain volumes in these participants. Although speculative, the reduced insular volumes in WS may represent a neural risk for the development of hyperaffiliative social behavior with increased specific phobias, and implicate the insula as a critical limbic integrative region. Native-space quantification of the insula may be valuable in the study of neurodevelopmental or neuropsychiatric disorders related to anxiety and social behavior.