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Sihn D, Kim SP. A neural basis for learning sequential memory in brain loop structures. Front Comput Neurosci 2024; 18:1421458. [PMID: 39161702 PMCID: PMC11330804 DOI: 10.3389/fncom.2024.1421458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/12/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Behaviors often involve a sequence of events, and learning and reproducing it is essential for sequential memory. Brain loop structures refer to loop-shaped inter-regional connection structures in the brain such as cortico-basal ganglia-thalamic and cortico-cerebellar loops. They are thought to play a crucial role in supporting sequential memory, but it is unclear what properties of the loop structure are important and why. Methods In this study, we investigated conditions necessary for the learning of sequential memory in brain loop structures via computational modeling. We assumed that sequential memory emerges due to delayed information transmission in loop structures and presented a basic neural activity model and validated our theoretical considerations with spiking neural network simulations. Results Based on this model, we described the factors for the learning of sequential memory: first, the information transmission delay should decrease as the size of the loop structure increases; and second, the likelihood of the learning of sequential memory increases as the size of the loop structure increases and soon saturates. Combining these factors, we showed that moderate-sized brain loop structures are advantageous for the learning of sequential memory due to the physiological restrictions of information transmission delay. Discussion Our results will help us better understand the relationship between sequential memory and brain loop structures.
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Affiliation(s)
| | - Sung-Phil Kim
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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Marshall RD, Menniti FS, Tepper MA. A Novel PDE10A Inhibitor for Tourette Syndrome and Other Movement Disorders. Cells 2024; 13:1230. [PMID: 39056811 PMCID: PMC11274801 DOI: 10.3390/cells13141230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Tourette syndrome is a neurodevelopmental movement disorder involving basal ganglia dysfunction. PDE10A inhibitors modulate signaling in the striatal basal ganglia nuclei and are thus of interest as potential therapeutics in treating Tourette syndrome and other movement disorders. METHODS The preclinical pharmacology and toxicology, human safety and tolerability, and human PET striatal enzyme occupancy data for the PDE10A inhibitor EM-221 are presented. RESULTS EM-221 inhibited PDE10A with an in vitro IC50 of 9 pM and was >100,000 selective vs. other PDEs and other CNS receptors and enzymes. In rats, at doses of 0.05-0.50 mg/kg, EM-221 reduced hyperlocomotion and the disruption of prepulse inhibition induced by MK-801, attenuated conditioned avoidance, and facilitated novel object recognition, consistent with PDE10A's inhibition. EM-221 displayed no genotoxicity and was well tolerated up to 300 mg/kg in rats and 100 mg/kg in dogs. In single- and multiple-day ascending dose studies in healthy human volunteers, EM-221 was well tolerated up to 10 mg, with a maximum tolerated dose of 15 mg. PET imaging indicated that a PDE10A enzyme occupancy of up to 92.8% was achieved with a ~24 h half-life. CONCLUSIONS The preclinical and clinical data presented here support the study of EM-221 in phase 2 trials of Tourette syndrome and other movement disorders.
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Affiliation(s)
| | - Frank S. Menniti
- MindImmune Therapeutics, Inc., Kingston, RI 02881, USA;
- The George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI 02881, USA
| | - Mark A. Tepper
- EuMentis Therapeutics Inc., 275 Grove Street, 2-400, Newton, MA 02466, USA;
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Bowers A, Hudock D. Lower nonword syllable sequence repetition accuracy in adults who stutter is related to differences in audio-motor oscillations. Neuropsychologia 2024; 199:108906. [PMID: 38740180 DOI: 10.1016/j.neuropsychologia.2024.108906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/05/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The goal of this study was to use independent component analysis (ICA) of high-density electroencephalography (EEG) to investigate whether differences in audio-motor neural oscillations are related to nonword syllable repetition accuracy in a group of adults who stutter compared to typically fluent speakers. METHODS EEG was recorded using 128 channels from 23 typically fluent speakers and 23 adults who stutter matched for age, sex, and handedness. EEG was recorded during delayed, 2 and 4 bilabial nonword syllable repetition conditions. Scalp-topography, dipole source estimates, and power spectral density (PSD) were computed for each independent component (IC) and used to cluster similar ICs across participants. Event-related spectral perturbations (ERSPs) were computed for each IC cluster to examine changes over time in the repetition conditions and to examine how dynamic changes in ERSPs are related to syllable repetition accuracy. RESULTS Findings indicated significantly lower accuracy on a measure of percentage correct trials in the AWS group and for a normalized measure of syllable load performance across conditions. Analysis of ERSPs revealed significantly lower alpha/beta ERD in left and right μ ICs and in left and right posterior temporal lobe α ICs in AWS compared to TFS (CC p < 0.05). Pearson correlations with %CT for frequency across time showed strong relationships with accuracy (FWE<0.05) during maintenance in the TFS group and during execution in the AWS group. CONCLUSIONS Findings implicate lower alpha/beta ERD (8-30 Hz) during syllable encoding over posterior temporal ICs and execution in left temporal/sensorimotor components. Strong correlations with accuracy and interindividual differences in ∼6-8 Hz ERSPs during execution implicate differences in motor and auditory-sensory monitoring during syllable sequence execution in AWS.
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Affiliation(s)
- Andrew Bowers
- University of Arkansas, 275 Epley Center, 606 North Razorback Rd. Fayetteville AR, 72701, United States.
| | - Daniel Hudock
- Idaho State University, 921 S. 8th Ave, Mailstop 8116, Pocatello, ID 83209, United States
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Tabari F, Patron C, Cryer H, Johari K. HD-tDCS over left supplementary motor area differentially modulated neural correlates of motor planning for speech vs. limb movement. Int J Psychophysiol 2024; 201:112357. [PMID: 38701898 DOI: 10.1016/j.ijpsycho.2024.112357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024]
Abstract
The supplementary motor area (SMA) is implicated in planning, execution, and control of speech production and limb movement. The SMA is among putative generators of pre-movement EEG activity which is thought to be neural markers of motor planning. In neurological conditions such as Parkinson's disease, abnormal pre-movement neural activity within the SMA has been reported during speech production and limb movement. Therefore, this region can be a potential target for non-invasive brain stimulation for both speech and limb movement. The present study took an initial step in examining the application of high-definition transcranial direct current stimulation (HD-tDCS) over the left SMA in 24 neurologically intact adults. Subsequently, event-related potentials (ERPs) were recorded while participants performed speech and limb movement tasks. Participants' data were collected in three counterbalanced sessions: anodal, cathodal and sham HD-tDCS. Relative to sham stimulation, anodal, but not cathodal, HD-tDCS significantly attenuated ERPs prior to the onset of the speech production. In contrast, neither anodal nor cathodal HD-tDCS significantly modulated ERPs prior to the onset of limb movement compared to sham stimulation. These findings showed that neural correlates of motor planning can be modulated using HD-tDCS over the left SMA in neurotypical adults, with translational implications for neurological conditions that impair speech production. The absence of a stimulation effect on ERPs prior to the onset of limb movement was not expected in this study, and future studies are warranted to further explore this effect.
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Affiliation(s)
- Fatemeh Tabari
- Human Neurophysiology and Neuromodulation Lab, Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
| | - Celeste Patron
- Human Neurophysiology and Neuromodulation Lab, Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
| | - Hope Cryer
- Human Neurophysiology and Neuromodulation Lab, Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
| | - Karim Johari
- Human Neurophysiology and Neuromodulation Lab, Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA.
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Pasculli G, Busan P, Jackson ES, Alm PA, De Gregorio D, Maguire GA, Goodwin GM, Gobbi G, Erritzoe D, Carhart-Harris RL. Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective? Front Hum Neurosci 2024; 18:1402549. [PMID: 38962146 PMCID: PMC11221540 DOI: 10.3389/fnhum.2024.1402549] [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: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Developmental stuttering (DS) is a neurodevelopmental speech-motor disorder characterized by symptoms such as blocks, repetitions, and prolongations. Persistent DS often has a significant negative impact on quality of life, and interventions for it have limited efficacy. Herein, we briefly review existing research on the neurophysiological underpinnings of DS -specifically, brain metabolic and default mode/social-cognitive networks (DMN/SCN) anomalies- arguing that psychedelic compounds might be considered and investigated (e.g., in randomized clinical trials) for treatment of DS. The neural background of DS is likely to be heterogeneous, and some contribution from genetically determinants of metabolic deficiencies in the basal ganglia and speech-motor cortical regions are thought to play a role in appearance of DS symptoms, which possibly results in a cascade of events contributing to impairments in speech-motor execution. In persistent DS, the difficulties of speech are often linked to a series of associated aspects such as social anxiety and social avoidance. In this context, the SCN and DMN (also influencing a series of fronto-parietal, somato-motor, and attentional networks) may have a role in worsening dysfluencies. Interestingly, brain metabolism and SCN/DMN connectivity can be modified by psychedelics, which have been shown to improve clinical evidence of some psychiatric conditions (e.g., depression, post-traumatic stress disorder, etc.) associated with psychological constructs such as rumination and social anxiety, which also tend to be present in persistent DS. To date, while there have been no controlled trials on the effects of psychedelics in DS, anecdotal evidence suggests that these agents may have beneficial effects on stuttering and its associated characteristics. We suggest that psychedelics warrant investigation in DS.
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Affiliation(s)
- Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering (DIAG), La Sapienza University, Rome, Italy
- Italian Society of Psychedelic Medicine (Società Italiana di Medicina Psichedelica–SIMePsi), Bari, Italy
| | | | - Eric S. Jackson
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Per A. Alm
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Danilo De Gregorio
- IRCCS, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gerald A. Maguire
- School of Medicine, American University of Health Sciences, Signal Hill, CA, United States
- CenExel CIT Research, Riverside, CA, United States
| | - Guy M. Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - David Erritzoe
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Robin L. Carhart-Harris
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Psychedelics Division, Neuroscape, University of California, San Francisco, CA, United States
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Merlo S, Briley PM. Allergies, asthma, and sleep problems in adults who stutter. JOURNAL OF FLUENCY DISORDERS 2024; 81:106063. [PMID: 38851135 DOI: 10.1016/j.jfludis.2024.106063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Previous studies have suggested that allergies, asthma, and sleep problems are prevalent in those who stutter. This study analyzed similar data for a broad age group of adults who stutter (AWS). METHOD Data from the 2012 National Health Interview Survey were analyzed. Adults from 18 to 60 + years of age reported a) to have stuttered, b) to have had any allergy, asthma, or acid reflux, c) to have had insomnia/trouble sleeping and daytime negative consequences, and d) average sleeping hours per day in the past 12 months. RESULTS The sample included 320 AWS and 33,043 controls. AWS were at greater odds of respiratory, food, and skin allergies (OR = 2.38, 2.36, and 2.09, respectively), as well as asthma and acid reflux (OR = 2.30 and 2.01, respectively) than controls. AWS were at greater odds of insomnia/trouble sleeping, oversleeping, excessive sleepiness, and fatigue than controls (OR = 2.11, 1.71, 2.67, and 1.81, respectively). The subgroup of AWS with no allergy, asthma, and acid reflux were also at greater odds of insomnia/trouble sleeping and excessive sleepiness than controls (OR = 2.13 and 3.11, respectively). Differences were found in specific age groups: younger/middle-aged AWS reported more allergies, asthma, and acid reflux than controls, while older AWS did not; younger/middle-aged AWS reported more insomnia/trouble sleeping than controls, while older AWS reported more oversleeping. CONCLUSIONS Findings on younger and middle-aged AWS are similar to previous ones on children and adolescents who stutter. Differences regarding younger/middle-aged and older AWS could be consequence of environmental variables.
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Affiliation(s)
- Sandra Merlo
- Brazilian Fluency Institute, Sao Paulo, SP, Brazil.
| | - Patrick M Briley
- Department of Communication Sciences & Disorders, East Carolina University, Greenville, NC, United States
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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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Koca T, Belgin E, Ölçek G. Investigation of central auditory processing performance in individuals with and without stuttering. JOURNAL OF FLUENCY DISORDERS 2024; 80:106048. [PMID: 38452446 DOI: 10.1016/j.jfludis.2024.106048] [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: 07/30/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Differences in core auditory processing abilities, such as sound timing, frequency discrimination, auditory perception, and auditory memory, have been suggested in stutterers, despite the fact that the precise origin of stuttering is not entirely understood. It is suggested that these differences may play a role in the development of stuttering. The aim of our study is to assess the temporal central auditory processing performance in individuals with stuttering and compare it to individuals without stuttering to uncover potential differences stuttering and compare it to individuals without stuttering to reveal potential differences. METHOD In current study, a total of 60 right-handed participants between the ages of 8 and 17 were included, divided into two balanced groups based on age, education, and gender: individuals with stuttering (n = 30) and individuals without stuttering (n = 30). All participants underwent the Frequency Pattern Test, Duration Pattern Test, and Gaps-In-Noise test. RESULTS Individuals who stutter showed lower performance in the gap detection threshold and the percentage of total correct gap identification parameters of the Frequency Pattern Test, Duration Pattern Test, and Gaps-In-Noise test compared to fluent speakers. CONCLUSIONS The findings indicate a potential relationship between stuttering and central auditory processing. In this context, incorporating central auditory processing measures into the assessment and therapy processes for stuttering may enhance the likelihood of obtaining more accurate results.
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Affiliation(s)
- Tuğçe Koca
- Uskudar University, Institute of Health Sciences, Department of Language and Speech Therapy, Turkey; Istanbul Medipol University, Institute of Health Sciences, Department of Audiology, Turkey; Ankara Medipol University, Faculty of Health Sciences, Department of Audiology, Turkey.
| | - Erol Belgin
- Ankara Medipol University, Faculty of Health Sciences, Department of Audiology, Turkey
| | - Gül Ölçek
- Istanbul Medipol University, Faculty of Health Sciences, Department of Audiology, Turkey
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Johnson G, Onslow M, Carey B, Jones M, Kefalianos E. Lidcombe Program telehealth treatment for children 6-12 years of age: A Phase II trial. JOURNAL OF FLUENCY DISORDERS 2024; 80:106057. [PMID: 38613876 DOI: 10.1016/j.jfludis.2024.106057] [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: 06/15/2023] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age. PURPOSE To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children. METHODS Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude. RESULTS Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment. CONCLUSIONS The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.
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Affiliation(s)
- Georgina Johnson
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia.
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Brenda Carey
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Mark Jones
- Bond University, Institute for Evidence-Based Healthcare, QLD, Australia
| | - Elaina Kefalianos
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia; Murdoch Children's Research Institute, Speech and Language Group, VIC, Australia
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Rowe HP, Tourville JA, Nieto-Castanon A, Garnett EO, Chow HM, Chang SE, Guenther FH. Evidence for planning and motor subtypes of stuttering based on resting state functional connectivity. BRAIN AND LANGUAGE 2024; 253:105417. [PMID: 38703523 PMCID: PMC11147703 DOI: 10.1016/j.bandl.2024.105417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/20/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Soo-Eun Chang
- University of Michigan, Ann Arbor, MI, USA; Ewha Womans University, Seoul, South Korea.
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Gastaldon S, Bonfiglio N, Vespignani F, Peressotti F. Predictive language processing: integrating comprehension and production, and what atypical populations can tell us. Front Psychol 2024; 15:1369177. [PMID: 38836235 PMCID: PMC11148270 DOI: 10.3389/fpsyg.2024.1369177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Predictive processing, a crucial aspect of human cognition, is also relevant for language comprehension. In everyday situations, we exploit various sources of information to anticipate and therefore facilitate processing of upcoming linguistic input. In the literature, there are a variety of models that aim at accounting for such ability. One group of models propose a strict relationship between prediction and language production mechanisms. In this review, we first introduce very briefly the concept of predictive processing during language comprehension. Secondly, we focus on models that attribute a prominent role to language production and sensorimotor processing in language prediction ("prediction-by-production" models). Contextually, we provide a summary of studies that investigated the role of speech production and auditory perception on language comprehension/prediction tasks in healthy, typical participants. Then, we provide an overview of the limited existing literature on specific atypical/clinical populations that may represent suitable testing ground for such models-i.e., populations with impaired speech production and auditory perception mechanisms. Ultimately, we suggest a more widely and in-depth testing of prediction-by-production accounts, and the involvement of atypical populations both for model testing and as targets for possible novel speech/language treatment approaches.
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Affiliation(s)
- Simone Gastaldon
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Noemi Bonfiglio
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, University of Padua, Padua, Italy
- BCBL-Basque Center on Cognition, Brain and Language, Donostia-San Sebastián, Spain
| | - Francesco Vespignani
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, University of Padua, Padua, Italy
- Centro Interdipartimentale di Ricerca "I-APPROVE-International Auditory Processing Project in Venice", University of Padua, Padua, Italy
| | - Francesca Peressotti
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
- Centro Interdipartimentale di Ricerca "I-APPROVE-International Auditory Processing Project in Venice", University of Padua, Padua, Italy
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Bakhtiar M, Yeung TWY, Choi A. The application of neuronavigated rTMS of the supplementary motor area and rhythmic speech training for stuttering intervention. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38711376 DOI: 10.1111/1460-6984.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Stuttering, a neurodevelopmental speech fluency disorder, is associated with intermittent disruptions of speech-motor control. Behavioural treatments for adults who stutter (AWS) concentrate on adopting speech patterns that enhance fluency, such as speaking rhythmically or prolonging speech sounds. However, maintaining these treatment benefits can be challenging. Neuroimaging studies suggest that supplementary motor area (SMA) which play a crucial role in speech initiation, planning and internal timing shows aberrant activation in speech production of AWS and may contribute to stuttering. Preliminary evidence suggests that brain stimulation may impact responsiveness to behavioural treatments. AIMS The present study aims to investigate whether excitatory repetitive transcranial magnetic stimulation (rTMS) of the SMA and rhythmic speech can consistently reduce stuttering severity across various measures. METHODS AND PROCEDURES Ten self-identified Cantonese-speaking AWS participated in this double-blinded, sham-controlled clinical trial study (NCT05472181). The participants underwent 10 sessions of rhythmic speech training across two phases, combined with either neuronavigated rTMS or sham, with a 2-week washout period between phases. The stuttering severity was assessed through various outcome measures, including the percentage of syllables stuttered, self-perceived stuttering severity, and the brief version of Unhelpful Thoughts and Beliefs About Stuttering before and after each treatment phase. OUTCOMES AND RESULTS Results demonstrated improved speech fluency in various speaking contexts, with no significant difference between rTMS and sham conditions immediately and 1 week post-treatment. Notably, rTMS specifically led to less stuttering in tongue twister production (d = -0.70). Both treatment conditions effectively reduced self-perceived stuttering severity and negative thoughts and beliefs about stuttering. CONCLUSIONS AND IMPLICATIONS The findings of this study indicate that stimulating the SMA reduced stuttering, only in the production of tongue twisters that may require greater motor control and coordination. Furthermore, it indicates that rhythmic speech might help alleviate negative beliefs and anxiety related to stuttering. This research contributes to our understanding of neuromodulation in stuttering treatment and the role of the SMA in speech motor control and emphasises the need for more research on the potential benefits and limitations of applying rTMS in this condition. WHAT THIS PAPER ADDS What is already known on the subject Behavioural treatments for adults who stutter concentrate on adopting speech patterns that enhance fluency, such as speaking rhythmically or prolonging speech sounds. However, maintaining these treatment benefits can be challenging. Neuroimaging studies indicate that aberrant neural activation in speech production regions, like the supplementary motor area (SMA), is involved in stuttering. The SMA plays a crucial role in initiating, planning, and sequencing motor behaviours. Preliminary evidence suggests that brain stimulation (e.g., transcranial direct current stimulation or transcranial magnetic stimulation) may impact responsiveness to behavioural treatments. What this paper adds to existing knowledge There is limited knowledge regarding the potential effects of stimulating the SMA to enhance speech fluency in people who stutter. Existing research primarily consists of single case studies that lack proper control conditions or involve only a single stimulation session. Due to their limited scope and power, these studies may not provide sufficient evidence. The current study expands upon existing research by investigating whether multiple sessions of repetitive transcranial magnetic stimulation over the SMA, combined with rhythmic speech, improve speech fluency in adults who stutter. Furthermore, it addresses the limitations of brain stimulation methods and proposes directions for future research. What are the potential or actual clinical implications of this work? This study implies that the stimulation of SMA reduced stuttering only in speaking contexts that may require greater motor control and coordination such as tongue twisters. Additionally, the research suggests that using rhythmic speech could potentially alleviate negative beliefs and anxiety associated with stuttering.
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Affiliation(s)
- Mehdi Bakhtiar
- Speech and Neuromodulation Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Tegan Wai Yee Yeung
- Speech and Neuromodulation Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Angela Choi
- Speech Science Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong
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Bayat M, Boostani R, Sabeti M, Yadegari F, Pirmoradi M, Rao KS, Nami M. Source Localization and Spectrum Analyzing of EEG in Stuttering State upon Dysfluent Utterances. Clin EEG Neurosci 2024; 55:371-383. [PMID: 36627837 DOI: 10.1177/15500594221150638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: The present study which addressed adults who stutter (AWS) attempted to investigate power spectral dynamics in the stuttering state by answering the questions using quantitative electroencephalography (qEEG). Method: A 64-channel electroencephalography (EEG) setup was used for data acquisition at 20 AWS. Since the speech, especially stuttering, causes significant noise in the EEG, 2 conditions of speech preparation (SP) and imagined speech (IS) were considered. EEG signals were decomposed into 6 bands. The corresponding sources were localized using the standard low-resolution electromagnetic tomography (sLORETA) tool in both fluent and dysfluent states. Results: Significant differences were noted after analyzing the time-locked EEG signals in fluent and dysfluent utterances. Consistent with previous studies, poor alpha and beta suppression in SP and IS conditions were localized in the left frontotemporal areas in a dysfluent state. This was partly true for the right frontal regions. In the theta range, disfluency was concurrence with increased activation in the left and right motor areas. Increased delta power in the left and right motor areas as well as increased beta2 power over left parietal regions was notable EEG features upon fluent speech. Conclusion: Based on the present findings and those of earlier studies, explaining the neural circuitries involved in stuttering probably requires an examination of the entire frequency spectrum involved in speech.
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Affiliation(s)
- Masoumeh Bayat
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Boostani
- Department of Computer Sciences and Engineering, School of Engineering, Shiraz University, Shiraz, Iran
| | - Malihe Sabeti
- Department of Computer Engineering, Islamic Azad University, North Tehran Branch, Tehran, Iran
| | - Fariba Yadegari
- Department of Speech and Language Pathology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadreza Pirmoradi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - K S Rao
- Neuroscience Center, INDICASAT-AIP, Panama City, Republic of Panama
| | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Neuroscience Center, INDICASAT-AIP, Panama City, Republic of Panama
- Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
- Academy of Health, Senses Cultural Foundation, Sacramento, CA, USA
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Mollaei F, Basha Chinoor MA. Microstructural white matter changes underlying speech deficits in Parkinson's disease. BRAIN AND LANGUAGE 2024; 249:105378. [PMID: 38198905 DOI: 10.1016/j.bandl.2024.105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Speech impairments are one of the common symptoms of individuals with Parkinson's disease (PD). However, little is known about the underlying neuroanatomical structural deficits specifically in the basal ganglia-thalamocortical (BGTC) loop in the speech deficits of PD. Here we investigated white matter differences in PD using probabilistic tractography. Diffusion tensor imaging data were downloaded from the Parkinson's Progression Markers Initiative database. We included three groups of participants: 20 PD individuals with speech deficits, 20 PD individuals without speech deficits, and 20 age- and gender-matched control participants. Overall, PD individuals with speech deficits had higher mean diffusivity in the BGTC pathway in the left hemisphere compared with PD individuals without speech deficits. The present study exhibits that there may be a distinct pathophysiological profile of white matter for speech deficits in PD.
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Affiliation(s)
- Fatemeh Mollaei
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Early Gate, Whiteknights, RG6 6ES Reading, England, United Kingdom; Centre for Integrative Neuroscience and Neurodynamcis (CINN), University of Reading, Reading, United Kingdom, Early Gate, Whiteknights, RG6 6BE Reading, England, United Kingdom.
| | - Mohammed Asif Basha Chinoor
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Early Gate, Whiteknights, RG6 6ES Reading, England, United Kingdom; Centre for Integrative Neuroscience and Neurodynamcis (CINN), University of Reading, Reading, United Kingdom, Early Gate, Whiteknights, RG6 6BE Reading, England, United Kingdom
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Neef NE, Chang SE. Knowns and unknowns about the neurobiology of stuttering. PLoS Biol 2024; 22:e3002492. [PMID: 38386639 PMCID: PMC10883586 DOI: 10.1371/journal.pbio.3002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Stuttering occurs in early childhood during a dynamic phase of brain and behavioral development. The latest studies examining children at ages close to this critical developmental period have identified early brain alterations that are most likely linked to stuttering, while spontaneous recovery appears related to increased inter-area connectivity. By contrast, therapy-driven improvement in adults is associated with a functional reorganization within and beyond the speech network. The etiology of stuttering, however, remains enigmatic. This Unsolved Mystery highlights critical questions and points to neuroimaging findings that could inspire future research to uncover how genetics, interacting neural hierarchies, social context, and reward circuitry contribute to the many facets of stuttering.
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Affiliation(s)
- Nicole E. Neef
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Communication Disorders, Ewha Womans University, Seoul, Korea
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Arjmandi MK, Behroozmand R. On the interplay between speech perception and production: insights from research and theories. Front Neurosci 2024; 18:1347614. [PMID: 38332858 PMCID: PMC10850291 DOI: 10.3389/fnins.2024.1347614] [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: 12/01/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
The study of spoken communication has long been entrenched in a debate surrounding the interdependence of speech production and perception. This mini review summarizes findings from prior studies to elucidate the reciprocal relationships between speech production and perception. We also discuss key theoretical perspectives relevant to speech perception-production loop, including hyper-articulation and hypo-articulation (H&H) theory, speech motor theory, direct realism theory, articulatory phonology, the Directions into Velocities of Articulators (DIVA) and Gradient Order DIVA (GODIVA) models, and predictive coding. Building on prior findings, we propose a revised auditory-motor integration model of speech and provide insights for future research in speech perception and production, focusing on the effects of impaired peripheral auditory systems.
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Affiliation(s)
- Meisam K. Arjmandi
- Translational Auditory Neuroscience Lab, Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Roozbeh Behroozmand
- Speech Neuroscience Lab, Department of Speech, Language, and Hearing, Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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17
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Matsuhashi K, Itahashi T, Aoki R, Hashimoto RI. Meta-analysis of structural integrity of white matter and functional connectivity in developmental stuttering. Brain Res Bull 2023; 205:110827. [PMID: 38013029 DOI: 10.1016/j.brainresbull.2023.110827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
Developmental stuttering is a speech disfluency disorder characterized by repetitions, prolongations, and blocks of speech. While a number of neuroimaging studies have identified alterations in localized brain activation during speaking in persons with stuttering (PWS), it is unclear whether neuroimaging evidence converges on alterations in structural integrity of white matter and functional connectivity (FC) among multiple regions involved in supporting fluent speech. In the present study, we conducted coordinate-based meta-analyses according to the PRISMA guidelines for available publications that studied fractional anisotropy (FA) using tract-based spatial statistics (TBSS) for structural integrity and the seed-based voxel-wise FC analyses. The search retrieved 11 publications for the TBSS FA studies, 29 seed-based FC datasets from 6 publications for the resting-state, and 29 datasets from 6 publications for the task-based studies. The meta-analysis of TBSS FA revealed that PWS exhibited FA reductions in the middle and posterior segments of the left superior longitudinal fasciculus. Furthermore, the analysis of resting-state FC demonstrated that PWS had reduced FC in the right supplementary motor area and inferior parietal cortex, whereas an increase in FC was observed in the left cerebellum crus I. Conversely, we observed increased FC for task-based FC in regions implicated in speech production or sequential movements, including the anterior cingulate cortex, posterior insula, and bilateral cerebellum crus I in PWS. Functional network characterization of the altered FCs revealed that the sets of reduced resting-state and increased task-based FCs were largely distinct, but the somatomotor and striatum/thalamus networks were foci of alterations in both conditions. These observations indicate that developmental stuttering is characterized by structural and functional alterations in multiple brain networks that support speech fluency or sequential motor processes, including cortico-cortical and subcortical connections.
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Affiliation(s)
- Kengo Matsuhashi
- Department of Language Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Takashi Itahashi
- Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
| | - Ryuta Aoki
- Department of Language Sciences, Tokyo Metropolitan University, Tokyo, Japan; Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
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18
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Caruso VC, Wray AH, Lescht E, Chang SE. Neural oscillatory activity and connectivity in children who stutter during a non-speech motor task. J Neurodev Disord 2023; 15:40. [PMID: 37964200 PMCID: PMC10647051 DOI: 10.1186/s11689-023-09507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Neural motor control rests on the dynamic interaction of cortical and subcortical regions, which is reflected in the modulation of oscillatory activity and connectivity in multiple frequency bands. Motor control is thought to be compromised in developmental stuttering, particularly involving circuits in the left hemisphere that support speech, movement initiation, and timing control. However, to date, evidence comes from adult studies, with a limited understanding of motor processes in childhood, closer to the onset of stuttering. METHODS We investigated the neural control of movement initiation in children who stutter and children who do not stutter by evaluating transient changes in EEG oscillatory activity (power, phase locking to button press) and connectivity (phase synchronization) during a simple button press motor task. We compared temporal changes in these oscillatory dynamics between the left and right hemispheres and between children who stutter and children who do not stutter, using mixed-model analysis of variance. RESULTS We found reduced modulation of left hemisphere oscillatory power, phase locking to button press and phase connectivity in children who stutter compared to children who do not stutter, consistent with previous findings of dysfunction within the left sensorimotor circuits. Interhemispheric connectivity was weaker at lower frequencies (delta, theta) and stronger in the beta band in children who stutter than in children who do not stutter. CONCLUSIONS Taken together, these findings indicate weaker engagement of the contralateral left motor network in children who stutter even during low-demand non-speech tasks, and suggest that the right hemisphere might be recruited to support sensorimotor processing in childhood stuttering. Differences in oscillatory dynamics occurred despite comparable task performance between groups, indicating that an altered balance of cortical activity might be a core aspect of stuttering, observable during normal motor behavior.
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Affiliation(s)
- Valeria C Caruso
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Amanda Hampton Wray
- Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Lescht
- Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Communication Disorders, Ewha Womans University, Seoul, South Korea
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Miller HE, Garnett EO, Heller Murray ES, Nieto-Castañón A, Tourville JA, Chang SE, Guenther FH. A comparison of structural morphometry in children and adults with persistent developmental stuttering. Brain Commun 2023; 5:fcad301. [PMID: 38025273 PMCID: PMC10653153 DOI: 10.1093/braincomms/fcad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
This cross-sectional study aimed to differentiate earlier occurring neuroanatomical differences that may reflect core deficits in stuttering versus changes associated with a longer duration of stuttering by analysing structural morphometry in a large sample of children and adults who stutter and age-matched controls. Whole-brain T1-weighted structural scans were obtained from 166 individuals who stutter (74 children, 92 adults; ages 3-58) and 191 controls (92 children, 99 adults; ages 3-53) from eight prior studies in our laboratories. Mean size and gyrification measures were extracted using FreeSurfer software for each cortical region of interest. FreeSurfer software was also used to generate subcortical volumes for regions in the automatic subcortical segmentation. For cortical analyses, separate ANOVA analyses of size (surface area, cortical thickness) and gyrification (local gyrification index) measures were conducted to test for a main effect of diagnosis (stuttering, control) and the interaction of diagnosis-group with age-group (children, adults) across cortical regions. Cortical analyses were first conducted across a set of regions that comprise the speech network and then in a second whole-brain analysis. Next, separate ANOVA analyses of volume were conducted across subcortical regions in each hemisphere. False discovery rate corrections were applied for all analyses. Additionally, we tested for correlations between structural morphometry and stuttering severity. Analyses revealed thinner cortex in children who stutter compared with controls in several key speech-planning regions, with significant correlations between cortical thickness and stuttering severity. These differences in cortical size were not present in adults who stutter, who instead showed reduced gyrification in the right inferior frontal gyrus. Findings suggest that early cortical anomalies in key speech planning regions may be associated with stuttering onset. Persistent stuttering into adulthood may result from network-level dysfunction instead of focal differences in cortical morphometry. Adults who stutter may also have a more heterogeneous neural presentation than children who stutter due to their unique lived experiences.
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Affiliation(s)
- Hilary E Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Elizabeth S Heller Murray
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Communication Sciences & Disorders, Temple University, Philadelphia, PA 19122, USA
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Jason A Tourville
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Communication Disorders, Ewha Womans University, Seoul 03760, Korea
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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20
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SheikhBahaei S, Millwater M, Maguire GA. Stuttering as a spectrum disorder: A hypothesis. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100116. [PMID: 38020803 PMCID: PMC10663130 DOI: 10.1016/j.crneur.2023.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.
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Affiliation(s)
- Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Marissa Millwater
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Gerald A. Maguire
- CenExel Research/ American University of Health Sciences, Signal Hill, CA, 90755, USA
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21
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Eichorn N, Hall J, Marton K. Complex working memory in adults with and without stuttering disorders: Performance patterns and predictive relationships. JOURNAL OF FLUENCY DISORDERS 2023; 77:105993. [PMID: 37406551 DOI: 10.1016/j.jfludis.2023.105993] [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: 03/21/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Available studies of working memory (WM) in speakers who stutter tend to rely on parent report, focus on phonological WM, or measure WM in combination with other processes. The present research aimed to: (1) compare complex WM in adults who stutter (AWS) and adults who do not stutter (AWNS); (2) characterize group performance patterns; and (2) determine whether WM predicts stuttering severity. METHODS Eighteen AWS and 20 AWNS completed parallel verbal and spatial span tasks in which to-be-remembered items were interleaved with a distracting task across varying set sizes. Dependent variables included the number of correctly recalled items, accuracy on distraction tasks, and detailed analyses of item-level responses. We further examined whether span scores predicted subjective and objective measures of stuttering severity. RESULTS Relative to AWNS, AWS showed poorer recall, specifically on short set sizes in the spatial task. Groups performed similarly on distraction tasks and showed comparable error patterns. Predictive relationships differed by span task and severity measure. Lower verbal span scores predicted greater stuttering impact and more overt stuttering behaviors; lower spatial span scores predicted lower impact and was unrelated to overt behaviors. CONCLUSIONS Findings suggest that AWS differ subtly from AWNS in WM performance. Group differences became more apparent under certain task conditions but could not be attributed to specific underlying processes. Data further indicated a complex relationship between WM and stuttering severity. Overall, results corroborate previous studies linking stuttering to domain-general weaknesses, but highlight the need for additional research to clarify the nature of this relationship.
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Affiliation(s)
- Naomi Eichorn
- The University of Memphis, 4055 N. Park Loop, Memphis, TN, 38152, USA.
| | - Jessica Hall
- The University of Memphis, 4055 N. Park Loop, Memphis, TN, 38152, USA
| | - Klara Marton
- Graduate Center, City University of New York, 365 Fifth Ave, New York, NY 10016, USA; Brooklyn College, City University of New York, 2900 Bedford Ave, Brooklyn, NY 11210, USA; MTA-ELTE Language-Learning Disorders Research Group, Bárczi Gusztáv College of Special Needs Education, Eötvös Loránd University, Egyetem tér 1-3, Budapest 1053, Hungary
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Busan P, Moret B, Formaggio E, Riavis L, Pisciotta C, Masina F, Manganotti P, Campana G. High definition-transcranial random noise stimulation to improve speech fluency in persistent developmental stuttering: A case study. Clin Neurophysiol 2023; 152:71-74. [PMID: 37343446 DOI: 10.1016/j.clinph.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Affiliation(s)
| | - Beatrice Moret
- IRCCS Ospedale San Camillo, Venice, Italy; Department of General Psychology, University of Padua, Padua, Italy
| | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Padua, Italy
| | | | | | | | - Paolo Manganotti
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Campana
- Department of General Psychology, University of Padua, Padua, Italy
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Alarcão J, Lucas I, Lapa L, Monteiro J, Mota Castelo T. [Stuttering in Children: Review and Referral Criteria]. ACTA MEDICA PORT 2023; 36:434-439. [PMID: 37261913 DOI: 10.20344/amp.18909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/23/2023] [Indexed: 06/03/2023]
Abstract
Stuttering is a speech fluency disorder, in which people know perfectly well the message they want to convey, even though their speech is characterized by changes in rhythm, repetitions, prolongations, pauses and blocks, and may also be associated with states of anxiety or emotional tension. Up to one in every six children, typically between two and five years old, experience a period of transitory speech disfluency, with usual spontaneous recovery before reaching school age, with a prevalence rate of stuttering of up to 1% of the adult population, and a higher incidence rate in males (4:1). In Portugal, it is estimated that stuttering affects around 100 thousand people, acquiring importance due to its frequency and association with lower self-esteem, anxiety and social isolation, with negative impact on people's ability to communicate and on their well-being and social interactions. The aim of this article is to highlight the complexity of the diagnostic and therapeutic approach of stuttering in pediatrics, with a particular focus on differentiating between normal speech disfluencies and childhood-onset fluency disorder (stuttering) and referral criteria, in order to raise awareness and facilitate early detection of these cases.
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Affiliation(s)
- José Alarcão
- Centro do Desenvolvimento da Criança. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Isabel Lucas
- Centro do Desenvolvimento da Criança. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Lígia Lapa
- Centro do Desenvolvimento da Criança. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Joana Monteiro
- Centro do Desenvolvimento da Criança. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Teresa Mota Castelo
- Centro do Desenvolvimento da Criança. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Caldwell-Harris CL, MacWhinney B. Age effects in second language acquisition: Expanding the emergentist account. BRAIN AND LANGUAGE 2023; 241:105269. [PMID: 37150139 DOI: 10.1016/j.bandl.2023.105269] [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: 03/23/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
In 2005, Science magazine designated the problem of accounting for difficulties in L2 (second language) learning as one of the 125 outstanding challenges facing scientific research. A maturationally-based sensitive period has long been the favorite explanation for why ultimate foreign language attainment declines with age-of-acquisition. However, no genetic or neurobiological mechanisms for limiting language learning have yet been identified. At the same time, we know that cognitive, social, and motivational factors change in complex ways across the human lifespan. Emergentist theory provides a framework for relating these changes to variation in the success of L2 learning. The great variability in patterns of learning, attainment, and loss across ages, social groups, and linguistic levels provides the core motivation for the emergentist approach. Our synthesis incorporates three groups of factors which change systematically with age: environmental supports, cognitive abilities, and motivation for language learning. This extended emergentist account explains why and when second language succeeds for some children and adults and fails for others.
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Chow HM, Garnett EO, Ratner NB, Chang SE. Brain activity during the preparation and production of spontaneous speech in children with persistent stuttering. Neuroimage Clin 2023; 38:103413. [PMID: 37099876 PMCID: PMC10149502 DOI: 10.1016/j.nicl.2023.103413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/10/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Speech production forms the basis for human verbal communication. Though fluent speech production is effortless and automatic for most people, it is disrupted in speakers who stutter, who experience difficulties especially during spontaneous speech and at utterance onsets. Brain areas comprising the basal ganglia thalamocortical (BGTC) motor loop have been a focus of interest in the context of stuttering, given this circuit's critical role in initiating and sequencing connected speech. Despite the importance of better understanding the role of the BGTC motor loop in supporting overt, spontaneous speech production, capturing brain activity during speech has been challenging to date, due to fMRI artifacts associated with severe head motions during speech production. Here, using an advanced technique that removes speech-related artifacts from fMRI signals, we examined brain activity occurring immediately before, and during, overt spontaneous speech production in 22 children with persistent stuttering (CWS) and 18 children who do not stutter (controls) in the 5-to-12-year age range. Brain activity during speech production was compared in two conditions: spontaneous speech (i.e., requiring language formulation) and automatic speech (i.e., overlearned word sequences). Compared to controls, CWS exhibited significantly reduced left premotor activation during spontaneous speech production but not during automatic speech. Moreover, CWS showed an age-related reduction in left putamen and thalamus activation during speech preparation. These results provide further evidence that stuttering is associated with functional deficits in the BGTC motor loop, which are exacerbated during spontaneous speech production.
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Baladron J, Vitay J, Fietzek T, Hamker FH. The contribution of the basal ganglia and cerebellum to motor learning: A neuro-computational approach. PLoS Comput Biol 2023; 19:e1011024. [PMID: 37011086 PMCID: PMC10101648 DOI: 10.1371/journal.pcbi.1011024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/13/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Motor learning involves a widespread brain network including the basal ganglia, cerebellum, motor cortex, and brainstem. Despite its importance, little is known about how this network learns motor tasks and which role different parts of this network take. We designed a systems-level computational model of motor learning, including a cortex-basal ganglia motor loop and the cerebellum that both determine the response of central pattern generators in the brainstem. First, we demonstrate its ability to learn arm movements toward different motor goals. Second, we test the model in a motor adaptation task with cognitive control, where the model replicates human data. We conclude that the cortex-basal ganglia loop learns via a novelty-based motor prediction error to determine concrete actions given a desired outcome, and that the cerebellum minimizes the remaining aiming error.
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Affiliation(s)
- Javier Baladron
- Department of Computer Science, Chemnitz University of Technology, Chemnitz, Germany
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile
| | - Julien Vitay
- Department of Computer Science, Chemnitz University of Technology, Chemnitz, Germany
| | - Torsten Fietzek
- Department of Computer Science, Chemnitz University of Technology, Chemnitz, Germany
| | - Fred H Hamker
- Department of Computer Science, Chemnitz University of Technology, Chemnitz, Germany
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Chow HM, Garnett EO, Koenraads SPC, Chang SE. Brain developmental trajectories associated with childhood stuttering persistence and recovery. Dev Cogn Neurosci 2023; 60:101224. [PMID: 36863188 PMCID: PMC9986501 DOI: 10.1016/j.dcn.2023.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/11/2023] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Stuttering is a neurodevelopmental disorder affecting 5-8 % of preschool-age children, continuing into adulthood in 1 % of the population. The neural mechanisms underlying persistence and recovery from stuttering remain unclear and little information exists on neurodevelopmental anomalies in children who stutter (CWS) during preschool age, when stuttering symptoms typically first emerge. Here we present findings from the largest longitudinal study of childhood stuttering to date, comparing children with persistent stuttering (pCWS) and those who later recovered from stuttering (rCWS) with age-matched fluent peers, to examine the developmental trajectories of both gray matter volume (GMV) and white matter volume (WMV) using voxel-based morphometry. A total of 470 MRI scans were analyzed from 95 CWS (72 pCWS and 23 rCWS) and 95 fluent peers between 3 and 12 years of age. We examined overall group and group by age interactions in GMV and WMV in preschool age (3-5 years old) and school age (6-12 years old) CWS and controls, controlling for sex, IQ, intracranial volume, and socioeconomic status. The results provide broad support for a possible basal ganglia-thalamocortical (BGTC) network deficit starting in the earliest phases of the disorder and point to normalization or compensation of earlier occurring structural changes associated with stuttering recovery.
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Affiliation(s)
- Ho Ming Chow
- University of Delaware, Department of Communication Sciences and Disorders, Newark, DE 19713, USA
| | - Emily O Garnett
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Soo-Eun Chang
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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28
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Neef NE, Angstadt M, Koenraads SPC, Chang SE. Dissecting structural connectivity of the left and right inferior frontal cortex in children who stutter. Cereb Cortex 2023; 33:4085-4100. [PMID: 36057839 PMCID: PMC10068293 DOI: 10.1093/cercor/bhac328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
Inferior frontal cortex pars opercularis (IFCop) features a distinct cerebral dominance and vast functional heterogeneity. Left and right IFCop are implicated in developmental stuttering. Weak left IFCop connections and divergent connectivity of hyperactive right IFCop regions have been related to impeded speech. Here, we reanalyzed diffusion magnetic resonance imaging data from 83 children (41 stuttering). We generated connection probability maps of functionally segregated area 44 parcels and calculated hemisphere-wise analyses of variance. Children who stutter showed reduced connectivity of executive, rostral-motor, and caudal-motor corticostriatal projections from the left IFCop. We discuss this finding in the context of tracing studies from the macaque area 44, which leads to the need to reconsider current models of speech motor control. Unlike the left, the right IFCop revealed increased connectivity of the inferior posterior ventral parcel and decreased connectivity of the posterior dorsal parcel with the anterior insula, particularly in stuttering boys. This divergent connectivity pattern in young children adds to the debate on potential core deficits in stuttering and challenges the theory that right hemisphere differences might exclusively indicate compensatory changes that evolve from lifelong exposure. Instead, early right prefrontal connectivity differences may reflect additional brain signatures of aberrant cognition-emotion-action influencing speech motor control.
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Affiliation(s)
- Nicole E Neef
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Mike Angstadt
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48105, USA
| | - Simone P C Koenraads
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Wytemaweg 80, 3015 CNRotterdam, the Netherlands
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48105, USA
- Department of Communicative Sciences and Disorders, Michigan State University, 1026 Red Cedar Road, East Lansing, MI 48824, USA
- Cognitive Imaging Research Center, Department of Radiology, Michigan State University, 846 Service Road, East Lansing, MI 48824, USA
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Erdemir A, Walden TA, Tilsen S, Mefferd AS, Jones RM. A Preliminary Study of Speech Rhythm Differences as Markers of Stuttering Persistence in Preschool-Age Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:931-950. [PMID: 36827517 PMCID: PMC10205104 DOI: 10.1044/2022_jslhr-22-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE The purpose of this study was twofold: (a) to determine whether there are speech rhythm differences between preschool-age children who stutter that were eventually diagnosed as persisting (CWS-Per) or recovered (CWS-Rec) and children who do not stutter (CWNS), using empirical spectral analysis and empirical mode decomposition of the speech amplitude envelope, and (b) to determine whether speech rhythm characteristics close to onset are predictive of later persistence. METHOD Fifty children (3-4 years of age) participated in the study. Approximately 2-2.5 years after the experimental testing took place, children were assigned to the following groups: CWS-Per (nine boys, one girl), CWS-Rec (18 boys, two girls), and CWNS (18 boys, two girls). All children produced a narrative based on a text-free storybook. From the audio recordings of these narratives, fluent utterances were selected for each child from which seven envelope-based measures were extracted. Group-based differences on each measure as well as predictive analyses were conducted to identify measures that discriminate CWS-Per versus CWS-Rec. RESULTS CWS-Per were found to have a relatively higher degree of power in suprasyllabic oscillations and greater variability in the timing of syllabic rhythms especially for longer utterances. A logistic regression model using two speech rhythm measures was able to discriminate the eventual outcome of recovery versus persistence, with 80% sensitivity and 75% specificity. CONCLUSION Findings suggest that envelope-based speech rhythm measures are a promising approach to assess speech rhythm differences in developmental stuttering, and its potential for identification of children at risk of developing persistent stuttering should be investigated further.
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Affiliation(s)
- Aysu Erdemir
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Tedra A. Walden
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Sam Tilsen
- Department of Linguistics, Cornell University, Ithaca, NY
| | - Antje S. Mefferd
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Robin M. Jones
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Pirinen V, Loukusa S, Dindar K, Mäkinen L, Hurtig T, Jussila K, Mattila ML, Eggers K. A Comprehensive Analysis of Speech Disfluencies in Autistic Young Adults and Control Young Adults: Group Differences in Typical, Stuttering-Like, and Atypical Disfluencies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:832-848. [PMID: 36763844 DOI: 10.1044/2022_jslhr-22-00265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The purpose of this study was to examine the nature of speech disfluencies in autistic young adults and controls by using a wide-range disfluency classification of typical disfluencies (TD; i.e., filled pauses, revisions, abandoned utterances, and multisyllable word and phrase repetitions), stuttering-like disfluencies (SLD; i.e., sound and syllable repetitions, monosyllable word repetitions, prolongations, blocks, and broken words), and atypical disfluencies (AD; i.e., word-final prolongations and repetitions and atypical insertions). METHOD Thirty-two autistic young adults and 35 controls completed a narrative telling task based on socially complex events. Frequencies of total disfluencies, TD, SLD, AD and stuttering severity were compared between groups. RESULTS The overall frequency of disfluencies was significantly higher in the autistic group and significant between-group differences were found for all disfluency categories. The autistic group produced significantly more revisions, filled pauses, and abandoned utterances, and each subtype of SLD and AD than the control group. In total, approximately every fourth autistic participants scored at least a very mild severity of stuttering, and every fifth produced more than three SLD per 100 syllables. CONCLUSIONS Disfluent speech can be challenging for effective communication. This study revealed that the speech of autistic young adults was highly more disfluent than that of the controls. The findings provide information on speech disfluency characteristics in autistic young adults and highlight the importance of evaluating speech disfluency with a wide-range disfluency classification in autistic persons in order to understand their role in overall communication. The results of this study offer tools for SLPs to evaluate and understand the nature of disfluencies in autistic persons.
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Affiliation(s)
- Veera Pirinen
- Research Unit of Logopedics, University of Oulu, Finland
| | - Soile Loukusa
- Research Unit of Logopedics, University of Oulu, Finland
| | - Katja Dindar
- Research Unit of Logopedics, University of Oulu, Finland
| | - Leena Mäkinen
- Research Unit of Logopedics, University of Oulu, Finland
| | - Tuula Hurtig
- Research Unit of Clinical Medicine, Psychiatry, Child Psychiatry, University of Oulu, Finland
- Child Psychiatry, Oulu University Hospital, Finland
| | - Katja Jussila
- Child Psychiatry, Oulu University Hospital, Finland
- Division of Psychology, VISE, Faculty of Education, University of Oulu, Finland
- Research Unit of Clinical Medicine, Child Psychiatry, University of Oulu, Finland
| | - Marja-Leena Mattila
- Child Psychiatry, Oulu University Hospital, Finland
- Research Unit of Clinical Medicine, Child Psychiatry, University of Oulu, Finland
| | - Kurt Eggers
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology, Thomas More University College, Antwerp, Belgium
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
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31
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Frankford SA, Cai S, Nieto-Castañón A, Guenther FH. Auditory feedback control in adults who stutter during metronome-paced speech I. Timing Perturbation. JOURNAL OF FLUENCY DISORDERS 2023; 75:105943. [PMID: 36423506 PMCID: PMC9974758 DOI: 10.1016/j.jfludis.2022.105943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study determined whether adults who stutter (AWS) exhibit deficits in responding to an auditory feedback timing perturbation, and whether external timing cues, which increase fluency, attenuate any disruptions due to altered temporal auditory feedback. METHODS Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with normal pacing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback timing perturbation was applied, and timing responses were compared between groups and pacing conditions. RESULTS Both groups responded to the timing perturbation by delaying subsequent syllable boundaries, and there were no significant differences between groups in either pacing condition. Furthermore, no response differences were found between normally paced and metronome-paced conditions. CONCLUSION These findings are interpreted as showing that 1) AWS respond normally to pure timing perturbations, and 2) metronome-paced speech has no effect on online speech timing control as assessed in the present experiment.
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Affiliation(s)
- Saul A Frankford
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Shanqing Cai
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA; Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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32
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Furlanis G, Busan P, Formaggio E, Menichelli A, Lunardelli A, Ajcevic M, Pesavento V, Manganotti P. Stuttering-Like Dysfluencies as a Consequence of Long COVID-19. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:415-430. [PMID: 36749838 DOI: 10.1044/2022_jslhr-22-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection. METHODS AND RESULTS Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery. CONCLUSIONS It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Italy
| | - Alina Menichelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Alberta Lunardelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, Italy
| | - Valentina Pesavento
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
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Gastaldon S, Busan P, Arcara G, Peressotti F. Inefficient speech-motor control affects predictive speech comprehension: atypical electrophysiological correlates in stuttering. Cereb Cortex 2023:6995383. [PMID: 36682885 DOI: 10.1093/cercor/bhad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
Abstract
Listeners predict upcoming information during language comprehension. However, how this ability is implemented is still largely unknown. Here, we tested the hypothesis proposing that language production mechanisms have a role in prediction. We studied 2 electroencephalographic correlates of predictability during speech comprehension-pre-target alpha-beta (8-30 Hz) power decrease and the post-target N400 event-related potential effect-in a population with impaired speech-motor control, i.e. adults who stutter (AWS), compared to typically fluent adults (TFA). Participants listened to sentences that could either constrain towards a target word or not, modulating its predictability. As a complementary task, participants also performed context-driven word production. Compared to TFA, AWS not only displayed atypical neural responses in production, but, critically, they showed a different pattern also in comprehension. Specifically, while TFA showed the expected pre-target power decrease, AWS showed a power increase in frontal regions, associated with speech-motor control. In addition, the post-target N400 effect was reduced for AWS with respect to TFA. Finally, we found that production and comprehension power changes were positively correlated in TFA, but not in AWS. Overall, the results support the idea that processes and neural structures prominently devoted to speech planning also support prediction during speech comprehension.
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Affiliation(s)
- Simone Gastaldon
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione (DPSS), University of Padova, Via Venezia 8, Padova (PD) 35131, Italy.,Padova Neuroscience Center (PNC), University of Padova, Via Giuseppe Orus 2/B, Padova (PD) 35131, Italy
| | - Pierpaolo Busan
- IRCCS Ospedale San Camillo, Via Alberoni 70, Lido (VE) 30126, Italy
| | - Giorgio Arcara
- IRCCS Ospedale San Camillo, Via Alberoni 70, Lido (VE) 30126, Italy
| | - Francesca Peressotti
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione (DPSS), University of Padova, Via Venezia 8, Padova (PD) 35131, Italy.,Padova Neuroscience Center (PNC), University of Padova, Via Giuseppe Orus 2/B, Padova (PD) 35131, Italy.,Centro Interdipartimentale di Ricerca "I-APPROVE-International Auditory Processing Project in Venice", University of Padova, Via Belzoni 160, Padova (PD) 35121, Italy
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Sisskin V. Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room. Lang Speech Hear Serv Sch 2023; 54:114-119. [PMID: 36279203 DOI: 10.1044/2022_lshss-22-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Ableist messages are conveyed early in the life of a stutterer and are amplified throughout the school-age years. Increased recognition of the benefits of acceptance-based therapies for positive long-term outcomes has changed the narrative about stuttering and stutterers. Speech-language therapists are resonating with the ideas that "it is okay to stutter," socioemotional aspects of stuttering must be considered, and support and community are valuable. Despite the shift in understanding, messages conveyed to students and parents commonly encourage suppression of stuttering and masking of one's stuttering identity. The purpose of this article was to (a) expose unintentional ableist messages that perpetuate stigma and feeling "othered" in the therapy relationship and (b) offer suggestions for congruent messaging in stuttering therapy. CONCLUSIONS Ableism in stuttering therapy contributes to the physical struggle and socioemotional challenges experienced by stutterers. The author offers ideas for revisioning therapy outcomes, language, and messaging to students to encourage a congruent, disfluency-affirming culture in schools and community. Introspection and advocacy by both therapists and the broader professional community, in collaboration with young people who stutter, will serve to reduce the stigma that fuels many of the daily challenges faced by school-age children who stutter.
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Affiliation(s)
- Vivian Sisskin
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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35
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Garnett EO, McAuley JD, Wieland EA, Chow HM, Zhu DC, Dilley LC, Chang SE. Auditory rhythm discrimination in adults who stutter: An fMRI study. BRAIN AND LANGUAGE 2023; 236:105219. [PMID: 36577315 DOI: 10.1016/j.bandl.2022.105219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/09/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Rhythm perception deficits have been linked to neurodevelopmental disorders affecting speech and language. Children who stutter have shown poorer rhythm discrimination and attenuated functional connectivity in rhythm-related brain areas, which may negatively impact timing control required for speech. It is unclear whether adults who stutter (AWS), who are likely to have acquired compensatory adaptations in response to rhythm processing/timing deficits, are similarly affected. We compared rhythm discrimination in AWS and controls (total n = 36) during fMRI in two matched conditions: simple rhythms that consistently reinforced a periodic beat, and complex rhythms that did not (requiring greater reliance on internal timing). Consistent with an internal beat deficit hypothesis, behavioral results showed poorer complex rhythm discrimination for AWS than controls. In AWS, greater stuttering severity was associated with poorer rhythm discrimination. AWS showed increased activity within beat-based timing regions and increased functional connectivity between putamen and cerebellum (supporting interval-based timing) for simple rhythms.
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Affiliation(s)
- Emily O Garnett
- University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - J Devin McAuley
- Michigan State University, 619 Red Cedar Rd, East Lansing, MI 48864, USA
| | | | - Ho Ming Chow
- University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; University of Delaware, Tower at STAR, 100 Discovery Blvd, Newark, DE 19713, USA
| | - David C Zhu
- Michigan State University, Radiology Building, 846 Service Road, East Lansing, MI 48824, USA
| | - Laura C Dilley
- Michigan State University, 619 Red Cedar Rd, East Lansing, MI 48864, USA
| | - Soo-Eun Chang
- University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
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36
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Frankford SA, Cai S, Nieto-Castañón A, Guenther FH. Auditory feedback control in adults who stutter during metronome-paced speech II. Formant Perturbation. JOURNAL OF FLUENCY DISORDERS 2022; 74:105928. [PMID: 36063640 PMCID: PMC9930613 DOI: 10.1016/j.jfludis.2022.105928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Prior work has shown that Adults who stutter (AWS) have reduced and delayed responses to auditory feedback perturbations. This study aimed to determine whether external timing cues, which increase fluency, resolve auditory feedback processing disruptions. METHODS Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with natural stress and timing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback formant perturbation was applied, and formant responses were compared between groups and pacing conditions. RESULTS During normally paced speech, ANS showed a significant compensatory response to the perturbation by the end of the perturbed vowel, while AWS did not. In the metronome-paced condition, which significantly reduced the disfluency rate, the opposite was true: AWS showed a significant response by the end of the vowel, while ANS did not. CONCLUSION These findings indicate a potential link between the reduction in stuttering found during metronome-paced speech and changes in auditory motor integration in AWS.
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Affiliation(s)
- Saul A Frankford
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Shanqing Cai
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA.
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA; Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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37
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Bharadwaj AK. The NRMP residency match for the differently abled. Am J Med Sci 2022; 364:508-509. [PMID: 35605681 DOI: 10.1016/j.amjms.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Ashwin K Bharadwaj
- Internal Medicine PGY1, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Hospital, New Brunswick, NJ, USA.
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38
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Van Der Meulen I, Pangalila R. What are the effects of non-pharmacological treatments for stuttering in children up to 6 years of age? A Cochrane Review summary with commentary. Dev Med Child Neurol 2022; 64:1190-1192. [PMID: 35686607 DOI: 10.1111/dmcn.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ineke Van Der Meulen
- Erasmus MC, University Medical Center, dep. of Rehabilitation Medicine, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Robert Pangalila
- Erasmus MC, University Medical Center, dep. of Rehabilitation Medicine, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
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Reinvestigating the Neural Bases Involved in Speech Production of Stutterers: An ALE Meta-Analysis. Brain Sci 2022; 12:brainsci12081030. [PMID: 36009093 PMCID: PMC9406059 DOI: 10.3390/brainsci12081030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Stuttering is characterized by dysfluency and difficulty in speech production. Previous research has found abnormalities in the neural function of various brain areas during speech production tasks. However, the cognitive neural mechanism of stuttering has still not been fully determined. Method: Activation likelihood estimation analysis was performed to provide neural imaging evidence on neural bases by reanalyzing published studies. Results: Our analysis revealed overactivation in the bilateral posterior superior temporal gyrus, inferior frontal gyrus, medial frontal gyrus, precentral gyrus, postcentral gyrus, basal ganglia, and cerebellum, and deactivation in the anterior superior temporal gyrus and middle temporal gyrus among the stutterers. The overactivated regions might indicate a greater demand in feedforward planning in speech production, while the deactivated regions might indicate dysfunction in the auditory feedback system among stutterers. Conclusions: Our findings provide updated and direct evidence on the multi-level impairment (feedforward and feedback systems) of stutterers during speech production and show that the corresponding neural bases were differentiated.
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40
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Differences in implicit motor learning between adults who do and do not stutter. Neuropsychologia 2022; 174:108342. [PMID: 35931135 DOI: 10.1016/j.neuropsychologia.2022.108342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022]
Abstract
Implicit learning allows us to acquire complex motor skills through repeated exposure to sensory cues and repetition of motor behaviours, without awareness or effort. Implicit learning is also critical to the incremental fine-tuning of the perceptual-motor system. To understand how implicit learning and associated domain-general learning processes may contribute to motor learning differences in people who stutter, we investigated implicit finger-sequencing skills in adults who do (AWS) and do not stutter (ANS) on an Alternating Serial Reaction Time task. Our results demonstrated that, while all participants showed evidence of significant sequence-specific learning in their speed of performance, male AWS were slower and made fewer sequence-specific learning gains than their ANS counterparts. Although there were no learning gains evident in accuracy of performance, AWS performed the implicit learning task more accurately than ANS, overall. These findings may have implications for sex-based differences in the experience of developmental stuttering, for the successful acquisition of complex motor skills during development by individuals who stutter, and for the updating and automatization of speech motor plans during the therapeutic process.
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41
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Garnett EO, Chow HM, Limb S, Liu Y, Chang SE. Neural activity during solo and choral reading: A functional magnetic resonance imaging study of overt continuous speech production in adults who stutter. Front Hum Neurosci 2022; 16:894676. [PMID: 35937674 PMCID: PMC9353050 DOI: 10.3389/fnhum.2022.894676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/27/2022] [Indexed: 01/22/2023] Open
Abstract
Previous neuroimaging investigations of overt speech production in adults who stutter (AWS) found increased motor and decreased auditory activity compared to controls. Activity in the auditory cortex is heightened, however, under fluency-inducing conditions in which AWS temporarily become fluent while synchronizing their speech with an external rhythm, such as a metronome or another speaker. These findings suggest that stuttering is associated with disrupted auditory motor integration. Technical challenges in acquiring neuroimaging data during continuous overt speech production have limited experimental paradigms to short or covert speech tasks. Such paradigms are not ideal, as stuttering primarily occurs during longer speaking tasks. To address this gap, we used a validated spatial ICA technique designed to address speech movement artifacts during functional magnetic resonance imaging (fMRI) scanning. We compared brain activity and functional connectivity of the left auditory cortex during continuous speech production in two conditions: solo (stutter-prone) and choral (fluency-inducing) reading tasks. Overall, brain activity differences in AWS relative to controls in the two conditions were similar, showing expected patterns of hyperactivity in premotor/motor regions but underactivity in auditory regions. Functional connectivity of the left auditory cortex (STG) showed that within the AWS group there was increased correlated activity with the right insula and inferior frontal area during choral speech. The AWS also exhibited heightened connectivity between left STG and key regions of the default mode network (DMN) during solo speech. These findings indicate possible interference by the DMN during natural, stuttering-prone speech in AWS, and that enhanced coordination between auditory and motor regions may support fluent speech.
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Affiliation(s)
- Emily O. Garnett
- Michigan Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Emily O. Garnett,
| | - Ho Ming Chow
- Michigan Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, United States
| | - Sarah Limb
- Michigan Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Yanni Liu
- Michigan Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Soo-Eun Chang
- Michigan Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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42
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Johnson CA, Liu Y, Waller N, Chang SE. Tract profiles of the cerebellar peduncles in children who stutter. Brain Struct Funct 2022; 227:1773-1787. [PMID: 35220486 PMCID: PMC9743081 DOI: 10.1007/s00429-022-02471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
Cerebellar-cortical loops comprise critical neural circuitry that supports self-initiated movements and motor adjustments in response to perceived errors, functions that are affected in stuttering. It is unknown whether structural aspects of cerebellar circuitry are affected in stuttering, particularly in children close to symptom onset. Here we examined white matter diffusivity characteristics of the three cerebellar peduncles (CPs) based on diffusion MRI (dMRI) data collected from 41 children who stutter (CWS) and 42 controls in the 3-11 years range. We hypothesized that CWS would exhibit decreased fractional anisotropy (FA) in the right CPs given the contralateral connectivity of the cerebellar-cortical loops and past reports of structural differences in left cortical areas in stuttering speakers. Automatic Fiber Quantification (AFQ) was used to track and segment cerebellar white matter pathways and to extract diffusivity measures. We found significant group differences for FA in the right inferior CP (ICP) only: controls showed significantly higher FA in the right ventral ICP compared to CWS, controlling for age, sex, and verbal IQ. Furthermore, FA of right ICP was negatively correlated with stuttering frequency in CWS. These results suggest an early developmental difference in the right ICP for CWS compared to age-matched peers, which may indicate an alteration in error processing, a function previously linked to the ICP. Lower FA here may impact error monitoring and sensory input processing to guide motor corrections. Further longitudinal investigations in children may provide additional insights into how CP development links to stuttering persistence and recovery.
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Affiliation(s)
- Chelsea A Johnson
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Noah Waller
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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43
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Rombouts E, Borry P. The disabling nature of hope in discovering a biological explanation of stuttering. JOURNAL OF FLUENCY DISORDERS 2022; 72:105906. [PMID: 35421761 DOI: 10.1016/j.jfludis.2022.105906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
Discovering developmental stuttering's biological explanation has been an enduring concern. Novel advances in genomics and neuroscience are making it possible to isolate and pinpoint genetic and brain differences implicated in stuttering. This is giving rise to a hope that, in the future, dysfluency could be better managed if stuttering's biological basis could be better understood. Concurrent to this, there is another hope rising: a hope of a future where differing fluencies would not be viewed through a reductive lens of biology and associated pathologies. The central aim of this paper is to edge out ethical implications of novel research into stuttering's biological explanation. In doing so, the paper proposes to look beyond the bifurcation sketched by the medical and social model of disability. The paper demonstrates how the scientific hope of discovering stuttering's biological explanation acts as an accessory of disablement due to the language of 'lack' and 'deficit' employed in reporting scientific findings and proposes participatory research with people who stutter as an antidote to manage this disablement.
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Affiliation(s)
- Ellen Rombouts
- Department of Neurosciences, Experimental Otorinolaryngology, KU Leuven, Belgium.
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Belgium.
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44
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Neef NE, Korzeczek A, Primaßin A, Wolff von Gudenberg A, Dechent P, Riedel CH, Paulus W, Sommer M. White matter tract strength correlates with therapy outcome in persistent developmental stuttering. Hum Brain Mapp 2022; 43:3357-3374. [PMID: 35415866 PMCID: PMC9248304 DOI: 10.1002/hbm.25853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Persistent stuttering is a prevalent neurodevelopmental speech disorder, which presents with involuntary speech blocks, sound and syllable repetitions, and sound prolongations. Affected individuals often struggle with negative feelings, elevated anxiety, and low self-esteem. Neuroimaging studies frequently link persistent stuttering with cortical alterations and dysfunctional cortico-basal ganglia-thalamocortical loops; dMRI data also point toward connectivity changes of the superior longitudinal fasciculus (SLF) and the frontal aslant tract (FAT). Both tracts are involved in speech and language functions, and the FAT also supports inhibitory control and conflict monitoring. Whether the two tracts are involved in therapy-associated improvements and how they relate to therapeutic outcomes is currently unknown. Here, we analyzed dMRI data of 22 patients who participated in a fluency-shaping program, 18 patients not participating in therapy, and 27 fluent control participants, measured 1 year apart. We used diffusion tractography to segment the SLF and FAT bilaterally and to quantify their microstructural properties before and after a fluency-shaping program. Participants learned to speak with soft articulation, pitch, and voicing during a 2-week on-site boot camp and computer-assisted biofeedback-based daily training for 1 year. Therapy had no impact on the microstructural properties of the two tracts. Yet, after therapy, stuttering severity correlated positively with left SLF fractional anisotropy, whereas relief from the social-emotional burden to stutter correlated negatively with right FAT fractional anisotropy. Thus, posttreatment, speech motor performance relates to the left dorsal stream, while the experience of the adverse impact of stuttering relates to the structure recently associated with conflict monitoring and action inhibition.
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Affiliation(s)
- Nicole E Neef
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.,Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexandra Korzeczek
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Annika Primaßin
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.,Fachbereich Gesundheit, FH Münster University of Applied Sciences, Münster, Germany
| | | | - Peter Dechent
- Department of Cognitive Neurology, MR Research in Neurosciences, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Heiner Riedel
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Sommer
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Geriatrics, University Medical Center Göttingen, Göttingen, Germany
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45
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Nikvarz N, Sabouri S. Drug-induced stuttering: A comprehensive literature review. World J Psychiatry 2022; 12:236-263. [PMID: 35317340 PMCID: PMC8900588 DOI: 10.5498/wjp.v12.i2.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/29/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-induced stuttering (DIS) is a type of neurogenic stuttering (NS). Although DIS has not been reported as frequently as other cases of NS in the literature, it is not a negligible adverse drug reaction (ADR) which can significantly affect the quality of life if not treated. This literature review aims to evaluate the epidemiological and clinical characteristics of DIS and suggests some pathophysiological mechanisms for this ADR. Relevant English-language reports in Google Scholar, PubMed, Web of Science, and Scopus were identified and assessed without time restriction. Finally, a total of 62 reports were included. Twenty-seven drugs caused 86 episodes of stuttering in 82 cases. The most episodes of DIS were related to antipsychotic drugs (57%), mostly including clozapine, followed by central nervous system agents (11.6%) and anticonvulsant drugs (9.3%). The majority of the cases were male and between the ages of 31 and 40 years. Repetitions were the most frequent core manifestations of DIS. In 55.8% of the episodes of DIS, the offending drug was withdrawn to manage stuttering, which resulted in significant improvement or complete relief of stuttering in all cases. Based on the suggested pathophysiological mechanisms for developmental stuttering and neurotransmitters dysfunctions involved in speech dysfluency, it seems that the abnormalities of several neurotransmitters, especially dopamine and glutamate, in different circuits and areas of the brain, including cortico-basal ganglia-thalamocortical loop and white matter fiber tracts, may be engaged in the pathogenesis of DIS.
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Affiliation(s)
- Naemeh Nikvarz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman 7616911319, Iran
| | - Salehe Sabouri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman 7616911319, Iran
- Department of Pharmaceutical Biotechnology, Kerman University of Medical Sciences, Kerman 7616911319, Iran
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46
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Singer CM, Otieno S, Chang SE, Jones RM. Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:70-95. [PMID: 34902288 PMCID: PMC9150747 DOI: 10.1044/2021_jslhr-21-00162] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/02/2021] [Accepted: 09/12/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. METHOD We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. RESULTS Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. CONCLUSIONS Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.
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Affiliation(s)
- Cara M. Singer
- Department of Communication Sciences and Disorders, Grand Valley State University, Allendale, MI
| | - Sango Otieno
- Department of Statistics, Grand Valley State University, Allendale, MI
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Robin M. Jones
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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47
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Lescht E, Venker C, McHaney JR, Bohland JW, Wray AH. Novel word recognition in childhood stuttering. TOPICS IN LANGUAGE DISORDERS 2022; 42:41-56. [PMID: 35295185 PMCID: PMC8920118 DOI: 10.1097/tld.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Erica Lescht
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Courtney Venker
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Jacie R. McHaney
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason W. Bohland
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amanda Hampton Wray
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
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48
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Abstract
The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).
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Affiliation(s)
- V P Zykov
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
| | - I B Komarova
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
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49
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Alm PA. The Dopamine System and Automatization of Movement Sequences: A Review With Relevance for Speech and Stuttering. Front Hum Neurosci 2021; 15:661880. [PMID: 34924974 PMCID: PMC8675130 DOI: 10.3389/fnhum.2021.661880] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022] Open
Abstract
The last decades of research have gradually elucidated the complex functions of the dopamine system in the vertebrate brain. The multiple roles of dopamine in motor function, learning, attention, motivation, and the emotions have been difficult to reconcile. A broad and detailed understanding of the physiology of cerebral dopamine is of importance in understanding a range of human disorders. One of the core functions of dopamine involves the basal ganglia and the learning and execution of automatized sequences of movements. Speech is one of the most complex and highly automatized sequential motor behaviors, though the exact roles that the basal ganglia and dopamine play in speech have been difficult to determine. Stuttering is a speech disorder that has been hypothesized to be related to the functions of the basal ganglia and dopamine. The aim of this review was to provide an overview of the current understanding of the cerebral dopamine system, in particular the mechanisms related to motor learning and the execution of movement sequences. The primary aim was not to review research on speech and stuttering, but to provide a platform of neurophysiological mechanisms, which may be utilized for further research and theoretical development on speech, speech disorders, and other behavioral disorders. Stuttering and speech are discussed here only briefly. The review indicates that a primary mechanism for the automatization of movement sequences is the merging of isolated movements into chunks that can be executed as units. In turn, chunks can be utilized hierarchically, as building blocks of longer chunks. It is likely that these mechanisms apply also to speech, so that frequent syllables and words are produced as motor chunks. It is further indicated that the main learning principle for sequence learning is reinforcement learning, with the phasic release of dopamine as the primary teaching signal indicating successful sequences. It is proposed that the dynamics of the dopamine system constitute the main neural basis underlying the situational variability of stuttering.
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Affiliation(s)
- Per A Alm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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50
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Altered resting-state functional connectivity of the frontal-striatal circuit in elderly with apathy. PLoS One 2021; 16:e0261334. [PMID: 34898646 PMCID: PMC8668136 DOI: 10.1371/journal.pone.0261334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Apathy is defined as reduction of goal-directed behaviors and a common nuisance syndrome of neurodegenerative and psychiatric disease. The underlying mechanism of apathy implicates changes of the front-striatal circuit, but its precise alteration is unclear for apathy in healthy aged people. The aim of our study is to investigate how the frontal-striatal circuit is changed in elderly with apathy using resting-state functional MRI. Eighteen subjects with apathy (7 female, 63.7 ± 3.0 years) and eighteen subjects without apathy (10 female, 64.8 ± 3.0 years) who underwent neuropsychological assessment and MRI measurement were recruited. We compared functional connectivity with/within the striatum between the apathy and non-apathy groups. The seed-to-voxel group analysis for functional connectivity between the striatum and other brain regions showed that the connectivity was decreased between the ventral rostral putamen and the right dorsal anterior cingulate cortex/supplementary motor area in the apathy group compared to the non-apathy group while the connectivity was increased between the dorsal caudate and the left sensorimotor area. Moreover, the ROI-to-ROI analysis within the striatum indicated reduction of functional connectivity between the ventral regions and dorsal regions of the striatum in the apathy group. Our findings suggest that the changes in functional connectivity balance among different frontal-striatum circuits contribute to apathy in elderly.
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