Localization of stuttering based on causal brain lesions.

Stuttering affects approximately 1 in 100 adults and can result in significant communication problems and social anxiety. It most often occurs as a developmental disorder but can also be caused by focal brain damage. These latter cases may lend unique insight into the brain regions causing stuttering. Here, we investigated the neuroanatomical substrate of stuttering using three independent datasets: (i) case reports from the published literature of acquired neurogenic stuttering following stroke (n = 20, 14 males/six females, 16-77 years); (ii) a clinical single study cohort with acquired neurogenic stuttering following stroke (n = 20, 13 males/seven females, 45-87 years); and (iii) adults with persistent developmental stuttering (n = 20, 14 males/six females, 18-43 years). We used the first two datasets and lesion network mapping to test whether lesions causing acquired stuttering map to a common brain network. We then used the third dataset to test whether this lesion-based network was relevant to developmental stuttering. In our literature dataset, we found that lesions causing stuttering occurred in multiple heterogeneous brain regions, but these lesion locations were all functionally connected to a common network centred around the left putamen, including the claustrum, amygdalostriatal transition area and other adjacent areas. This finding was shown to be specific for stuttering (PFWE < 0.05) and reproducible in our independent clinical cohort of patients with stroke-induced stuttering (PFWE < 0.05), resulting in a common acquired stuttering network across both stroke datasets. Within the common acquired stuttering network, we found a significant association between grey matter volume and stuttering impact for adults with persistent developmental stuttering in the left posteroventral putamen, extending into the adjacent claustrum and amygdalostriatal transition area (PFWE < 0.05). We conclude that lesions causing acquired neurogenic stuttering map to a common brain network, centred to the left putamen, claustrum and amygdalostriatal transition area. The association of this lesion-based network with symptom severity in developmental stuttering suggests a shared neuroanatomy across aetiologies.

Brain activation during non-habitual speech production: Revisiting the effects of simulated disfluencies in fluent speakers.

Over the past decades, brain imaging studies in fluently speaking participants have greatly advanced our knowledge of the brain areas involved in speech production. In addition, complementary information has been provided by investigations of brain activation patterns associated with disordered speech. In the present study we specifically aimed to revisit and expand an earlier study by De Nil and colleagues, by investigating the effects of simulating disfluencies on the brain activation patterns of fluent speakers during overt and covert speech production. In contrast to the De Nil et al. study, the current findings show that the production of voluntary, self-generated disfluencies by fluent speakers resulted in increased recruitment and activation of brain areas involved in speech production. These areas show substantial overlap with the neural networks involved in motor sequence learning in general, and learning of speech production, in particular. The implications of these findings for the interpretation of brain imaging studies on disordered and non-habitual speech production are discussed.

Exogenously triggered response inhibition in developmental stuttering.

PURPOSE: The purpose of the present study was to examine relations between children's exogenously triggered response inhibition and stuttering. METHOD: Participants were 18 children who stutter (CWS; mean age = 9;01 years) and 18 children who not stutter (CWNS; mean age = 9;01 years). Participants were matched on age (±3 months) and gender. Response inhibition was assessed by a stop signal task (Verbruggen, Logan, & Stevens, 2008). RESULTS: Results suggest that CWS, compared to CWNS, perform comparable to CWNS in a task where response control is externally triggered. CONCLUSIONS: Our findings seem to indicate that previous questionnaire-based findings (Eggers, De Nil, & Van den Bergh, 2010) of a decreased efficiency of response inhibition cannot be generalized to all types of response inhibition.

White matter tractography of the neural network for speech-motor control in children who stutter.

Stuttering is a neurodevelopmental speech disorder with a phenotype characterized by speech sound repetitions, prolongations and silent blocks during speech production. Developmental stuttering affects 1% of the population and 5% of children. Neuroanatomical abnormalities in the major white matter tracts, including the arcuate fasciculus, corpus callosum, corticospinal, and frontal aslant tracts (FAT), are associated with the disorder in adults who stutter but are less well studied in children who stutter (CWS). We used deterministic tractography to assess the structural connectivity of the neural network for speech production in CWS and controls. CWS had higher fractional anisotropy and axial diffusivity in the right FAT than controls. Our findings support the involvement of the corticostriatal network early in persistent developmental stuttering.

Effects of Age, Sex and Syllable Number on Voice Onset Time: Evidence from Children's Voiceless Aspirated Stops.

Voice onset time (VOT) is a temporal acoustic parameter that reflects motor speech coordination skills. This study investigated the patterns of age and sex differences across development of voice onset time in a group of 70 English-speaking children, ranging in age from 4.1 to 18.4 years, and 12 young adults. The effect of the number of syllables on VOT patterns was also examined. Speech samples were elicited by producing syllables /pa/ and /pataka/. Results supported previous findings showing that younger children produce longer VOT values with higher levels of variability. Markedly higher VOT values and increased variability were found for boys at ages between 8 and 11 years, confirming sex differences in VOT patterns and patterns of variability. In addition, all participants consistently produced shorter VOT with higher variability for multisyllables than monosyllables, indicating an effect of syllable number. Possible explanations for these findings and clinical implications are discussed.

The trajectory of gray matter development in Broca's area is abnormal in people who stutter.

The acquisition and mastery of speech-motor control requires years of practice spanning the course of development. People who stutter often perform poorly on speech-motor tasks thereby calling into question their ability to establish the stable neural motor programs required for masterful speech-motor control. There is evidence to support the assertion that these neural motor programs are represented in the posterior part of Broca's area, specifically the left pars opercularis. Consequently, various theories of stuttering causation posit that the disorder is related to a breakdown in the formation of the neural motor programs for speech early in development and that this breakdown is maintained throughout life. To date, no study has examined the potential neurodevelopmental signatures of the disorder across pediatric and adult populations. The current study aimed to fill this gap in our knowledge. We hypothesized that the developmental trajectory of cortical thickness in people who stutter would differ across the lifespan in the left pars opercularis relative to a group of control participants. We collected structural magnetic resonance images from 116 males (55 people who stutter) ranging in age from 6 to 48 years old. Differences in cortical thickness across ages and between patients and controls were investigated in 30 brain regions previously implicated in speech-motor control. An interaction between age and group was found for the left pars opercularis only. In people who stutter, the pars opercularis did not demonstrate the typical maturational pattern of gradual gray matter thinning with age across the lifespan that we observed in control participants. In contrast, the developmental trajectory of gray matter thickness in other regions of interest within the neural network for speech-motor control was similar for both groups. Our findings indicate that the developmental trajectory of gray matter in left pars opercularis is abnormal in people who stutter.

Age-related sex differences in language lateralization: A magnetoencephalography study in children.

It is well supported by behavioral and neuroimaging studies that typical language function is lateralized to the left hemisphere in the adult brain and this laterality is less well defined in children. The behavioral literature suggests there maybe be sex differences in language development, but this has not been examined systematically with neuroimaging. In this study, magnetoencephalography was used to investigate the spatiotemporal patterns of language lateralization as a function of age and sex. Eighty typically developing children (46 female, 34 male; 4-18 years) participated in an overt visual verb generation task. An analysis method called differential beamforming was used to analyze language-related changes in oscillatory activity referred to as low-gamma event-related desynchrony (ERD). The proportion of ERD over language areas relative to total ERD was calculated. We found different patterns of laterality between boys and girls. Boys showed left-hemisphere lateralization in the frontal and temporal language-related areas across age groups, whereas girls showed a more bilateral pattern, particularly in frontal language-related areas. Differences in patterns of ERD were most striking between boys and girls in the younger age groups, and these patterns became more similar with increasing age, specifically in the preteen years. Our findings show sex differences in language lateralization during childhood; however, these differences do not seem to persist into adulthood. We present possible explanations for these differences. We also discuss the implications of these findings for presurgical language mapping in children and highlight the importance of examining the question of sex-related language differences across development.

Changes in voice onset time and motor speech skills in children following motor speech therapy: Evidence from /pa/ productions.

This study evaluated changes in motor speech control and inter-gestural coordination for children with speech sound disorders (SSD) subsequent to Prompts for Restructuring Oral and Muscular Phonetic Targets (PROMPT) intervention. We measured the distribution patterns of voice onset time (VOT) for a voiceless stop (/p/) to examine the changes in inter-gestural coordination. Two standardized tests were used (Verbal Motor Production Assessment for Children (VMPAC), GFTA-2) to assess the changes in motor speech skills and articulation. Data showed positive changes in patterns of VOT with a lower pattern of variability. All children showed significantly higher scores for VMPAC, but only some children showed higher scores for GFTA-2. Results suggest that the proprioceptive feedback provided through PROMPT had a positive influence on speech motor control and inter-gestural coordination in voicing behavior. This set of VOT data for children with SSD adds to our understanding of the speech characteristics underlying speech motor control. Directions for future studies are discussed.

Cortical thickness in children receiving intensive therapy for idiopathic apraxia of speech.

Children with idiopathic apraxia experience difficulties planning the movements necessary for intelligible speech. There is increasing evidence that targeted early interventions, such as Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT), can be effective in treating these disorders. In this study, we investigate possible cortical thickness correlates of idiopathic apraxia of speech in childhood, and changes associated with participation in an 8-week block of PROMPT therapy. We found that children with idiopathic apraxia (n = 11), aged 3-6 years, had significantly thicker left supramarginal gyri than a group of typically-developing age-matched controls (n = 11), t(20) = 2.84, p ≤ 0.05. Over the course of therapy, the children with apraxia (n = 9) experienced significant thinning of the left posterior superior temporal gyrus (canonical Wernicke's area), t(8) = 2.42, p ≤ 0.05. This is the first study to demonstrate experience-dependent structural plasticity in children receiving therapy for speech sound disorders.

Relationship between speech motor control and speech intelligibility in children with speech sound disorders.

UNLABELLED: The current study was undertaken to investigate the impact of speech motor issues on the speech intelligibility of children with moderate to severe speech sound disorders (SSD) within the context of the PROMPT intervention approach. The word-level Children's Speech Intelligibility Measure (CSIM), the sentence-level Beginner's Intelligibility Test (BIT) and tests of speech motor control and articulation proficiency were administered to 12 children (3:11 to 6:7 years) before and after PROMPT therapy. PROMPT treatment was provided for 45 min twice a week for 8 weeks. Twenty-four naïve adult listeners aged 22-46 years judged the intelligibility of the words and sentences. For CSIM, each time a recorded word was played to the listeners they were asked to look at a list of 12 words (multiple-choice format) and circle the word while for BIT sentences, the listeners were asked to write down everything they heard. Words correctly circled (CSIM) or transcribed (BIT) were averaged across three naïve judges to calculate percentage speech intelligibility. Speech intelligibility at both the word and sentence level was significantly correlated with speech motor control, but not articulatory proficiency. Further, the severity of speech motor planning and sequencing issues may potentially be a limiting factor in connected speech intelligibility and highlights the need to target these issues early and directly in treatment. LEARNING OUTCOMES: The reader will be able to: (1) outline the advantages and disadvantages of using word- and sentence-level speech intelligibility tests; (2) describe the impact of speech motor control and articulatory proficiency on speech intelligibility; and (3) describe how speech motor control and speech intelligibility data may provide critical information to aid treatment planning.

Inhibitory control in childhood stuttering.

PURPOSE: The purpose of this study was to investigate whether previously reported parental questionnaire-based differences in inhibitory control (IC; Eggers, De Nil, & Van den Bergh, 2010) would be supported by direct measurement of IC using a computer task. METHOD: Participants were 30 children who stutter (CWS; mean age=7;05 years) and 30 children who not stutter (CWNS; mean age=7;05 years). Participants were matched on age and gender (±3 months). IC was assessed by the Go/NoGo task of the Amsterdam Neuropsychological Tasks (De Sonneville, 2009). RESULTS: Results indicated that CWS, compared to CWNS, (a) exhibited more false alarms and premature responses, (b) showed lower reaction times for false alarms, and (c) were less able to adapt their response style after experiencing response errors. CONCLUSIONS: Our findings provide further support for the hypothesis that CWS and CWNS differ on IC. CWS, as a group, were lower in IC pointing toward a lowered ability to inhibit prepotent response tendencies. The findings were linked to previous IC-related studies and to emerging theoretical frameworks of stuttering development. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the concept of inhibitory control, and its functional significance; (2) describe the findings on self-regulatory processes, attentional processes, and inhibitory control in CWS; (3) identify which Go/NoGo task variables differentiated between CWS and CWNS; and (4) summarize the theoretical implications for the development of stuttering and the possible clinical implications.

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

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

Early-stage chunking of finger tapping sequences by persons who stutter and fluent speakers.

This research note explored the hypothesis that chunking differences underlie the slow finger-tap sequencing performance reported in the literature for persons who stutter (PWS) relative to fluent speakers (PNS). Early-stage chunking was defined as an immediate and spontaneous tendency to organize a long sequence into pauses, for motor planning, and chunks of fluent motor performance. A previously published study in which 12 PWS and 12 matched PNS practised a 10-item finger tapping sequence 30 times was examined. Both groups significantly decreased the duration of between-chunk intervals (BCIs) and within-chunk intervals (WCIs) over practice. PNS had significantly shorter WCIs relative to PWS, but minimal differences between groups were found for the number of, or duration of, BCI. Results imply that sequencing differences found between PNS and PWS may be due to differences in automatizing movements within chunks or retrieving chunks from memory rather than chunking per se.

Cortical activity during speech and non-speech oromotor tasks: a magnetoencephalography (MEG) study.

We used whole-head magnetoencephalography to investigate cortical activity during two oromotor activities foundational to speech production. 13 adults performed mouth opening and phoneme (/pa/) production tasks to a visual cue. Jaw movements were tracked with an ultrasound-emitting device. Trials were time-locked to both stimulus onset and peak of jaw displacement. An event-related beamformer source reconstruction algorithm was used to detect areas of cortical activity for each condition. Beamformer output was submitted to iterative K-means clustering analyses. The time course of neural activity at each cluster centroid was computed for each individual and condition. Peaks were identified and latencies submitted for statistical analysis to reveal the relative timing of activity in each brain region. Stimulus locked activations for the mouth open task included a progression from left cuneus to left frontal and then right pre-central gyrus. Phoneme generation revealed the same sequence but with bilateral frontal activation. When time locked to jaw displacement, the mouth open condition showed left frontal followed by right frontal-temporal areas. Phoneme generation showed a complicated sequence of bilateral temporal and frontal areas. This study used three unique approaches (beamforming, clustering and jaw tracking) to demonstrate the temporal progression of neural activations that underlie the motor control of two simple oromotor tasks. These findings have implications for understanding clinical conditions with deficits in articulatory control or motor speech planning.

Oral sensorimotor integration in adults who stutter.

OBJECTIVE: To investigate the relationship between tendon vibration sensitivity and oral motor control in adults who stutter (AWS). PATIENTS AND METHODS: Ten controls and 10 AWS first made jaw-opening movements from a closed-mouth position to an 18-mm target. Then, masseter tendon vibration was applied during jaw opening in a separate condition to test whether accuracy and/or variability is related to movement undershoot. RESULTS: AWS made less accurate and more variable jaw movements than controls without visual feedback. Among the normally fluent adult participants, higher accuracy and lower variability were significantly related to masseter vibration undershoot, but significant correlations were not observed for AWS. CONCLUSION: These results suggest that increased tendon vibration sensitivity may be related to more refined oral motor control. Subtle sensorimotor limitations could be present in stuttering that render speech more susceptible to breakdowns.

The efficiency of attentional networks in children who stutter.

PURPOSE: The purpose of this study was to evaluate whether previously reported questionnaire-based differences in self-regulatory behaviors (Eggers, De Nil, & Van den Bergh, 2009, 2010) between children who stutter (CWS) and children who do not stutter (CWNS) would also be reflected in their underlying attentional networks. METHOD: Participants consisted of 41 CWS (mean age = 6;09; years;months) and 41 CWNS (mean age = 6;09) ranging in age from 4;00 to 9;00. Participants were matched on age and gender. The efficiency of the attentional networks was assessed by using the computerized Attention Network Test (Fan, McCandliss, Sommer, Raz, & Posner, 2002). RESULTS: Primary results indicated that CWS had a significantly lower efficiency of the orienting network compared with CWNS, whereas no differences were found on the alerting or executive control network. CONCLUSION: Current findings corroborate previously found differences in self-regulatory behavior and were taken to suggest a possible role for attentional processes in developmental stuttering.

Speech sequence skill learning in adults who stutter.

UNLABELLED: The present study compared the ability of 12 people who stutter (PWS) and 12 people who do not stutter (PNS) to consolidate a novel sequential speech task. Participants practiced 100 repetitions of a single, monosyllabic, nonsense word sequence during an initial practice session and returned 24-h later to perform an additional 50 repetitions. Results showed significantly slower sequence durations in the PWS compared to PNS following extensive practice and consolidation. However, the hypothesis that poor performance gains in PWS compared to PNS during practice would be maintained following a 24-h consolidation period was not supported. Further descriptive analysis revealed large within group differences in PWS which to some extent were attributed to a subgroup of PWS who failed to show any improvements in performance following practice or consolidation. The results and the possible presence of subgroups of PWS are discussed with regard to their limitations in motor learning abilities. EDUCATIONAL OBJECTIVES: The reader will be able to (1) explain the difference between practice and learning, (2) define consolidation and explain the importance of measuring performance following a consolidation period, (3) understand past research on PWS' performance during both speech and nonspeech motor tasks, and (4) explain why individual differences in practice effects and learning may have important implications for client variability in treatment outcome.

Speech-induced suppression of evoked auditory fields in children who stutter.

Auditory responses to speech sounds that are self-initiated are suppressed compared to responses to the same speech sounds during passive listening. This phenomenon is referred to as speech-induced suppression, a potentially important feedback-mediated speech-motor control process. In an earlier study, we found that both adults who do and do not stutter demonstrated a reduced amplitude of the auditory M50 and M100 responses to speech during active production relative to passive listening. It is unknown if auditory responses to self-initiated speech-motor acts are suppressed in children or if the phenomenon differs between children who do and do not stutter. As stuttering is a developmental speech disorder, examining speech-induced suppression in children may identify possible neural differences underlying stuttering close to its time of onset. We used magnetoencephalography to determine the presence of speech-induced suppression in children and to characterize the properties of speech-induced suppression in children who stutter. We examined the auditory M50 as this was the earliest robust response reproducible across our child participants and the most likely to reflect a motor-to-auditory relation. Both children who do and do not stutter demonstrated speech-induced suppression of the auditory M50. However, children who stutter had a delayed auditory M50 peak latency to vowel sounds compared to children who do not stutter indicating a possible deficiency in their ability to efficiently integrate auditory speech information for the purpose of establishing neural representations of speech sounds.

Temperament dimensions in stuttering and typically developing children.

PURPOSE: The purpose of this study was to determine whether children who stutter (CWS) and typically developing children (TDC) differ from each other on composite temperament factors or on individual temperament scales. METHODS: Participants consisted of 116 age and gender-matched CWS and TDC (3.04-8.11). Temperament was assessed with a Dutch version of the Children's Behavior Questionnaire (CBQ-D; Van den Bergh and Ackx, 2003), a caregiver rating scale. RESULTS: Results indicated significant differences between participant groups on the composite temperament factors of Negative Affectivity, and Effortful Control. Analysis of the individual temperament scales showed that CWS, compared to the TDC, scored significantly lower on the scales of 'Inhibitory Control' and 'Attentional Shifting' and higher on the scales of 'Anger/Frustration', 'Approach' and 'Motor Activation'. Stuttering severity and months of therapy were not associated with either of the temperament dimensions. CONCLUSIONS: The present study provides data that support the hypothesis that CWS and TDC differ on both composite temperament factors and temperament scales. The findings were interpreted within existing frameworks of temperament development, as well as with regard to previous studies of temperament in CWS. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) describe the concept of temperament, including Rothbart's temperamental model, and its functional significance; (2) explain the CBQ-based (Children's Behavior Questionnaire) temperamental differences between CWS and CWNS; and (3) explain possible pathways for interaction between temperament and the development of stuttering.

Coordinating voicing onset with articulation: a potential role for sensory cues in shaping phonological distinctions.

In the typical speech of any language, voicing onset and offset are effortlessly coordinated with articulation as part of the intrinsic coordination of sound production. In this paper, we argue that voicing-articulatory coordination patterns could be shaped by sensory feedback during early speech learning and these patterns persist in mature syllable productions. Our experimental results show that voicing onset is closely associated with the peak velocity and peak amplitude of jaw and upper lip movements for VC syllables in adults. This robust coordination in the onset position may function to increase the salience of VC syllables and provide a phonetically natural explanation for vowels to undergo phonological lengthening and to avoid phonological reduction in word-initial onset position.