Abstract - Agosto a Dezembro de 2019
Behavioral and Neural Correlates of Auditory n-Back Task in Adults With and Without Stuttering - AUDITIVO
Am J Audiol. 2019 Aug 28;28(2S):471-482 Epub 2019 Aug 28.
Devaraju DS, Kumar UA, Maruthy S.
All India Institute of Speech and Hearing, Mysore.
Purpose Adults with stuttering (AWS) exhibit compromised phonological working memory abilities, poor central auditory processing, and impaired auditory processing especially during overt speech production tasks. However, these tasks are sensitive to language disturbances already found in them. Thus, in this study, monosyllables were used ruling out the language effects, and auditory working memory ability was evaluated in AWS using the n-back task. In specific, the auditory sensory input of the working memory mechanism was evaluated. Method Thirty-two participants, 16 each of AWS and adults with no stuttering (AWNS), performed behavioral auditory 1-back and 2-back tasks. The long latency responses were also recorded during no-back and 2-back conditions from 64 electrode sites. Results Results revealed no significant differences between the groups in any of the behavioral parameters such as reaction time, accuracy, false alarm rate, or d'. N1 amplitude modulation was noted in AWNS, which was absent in AWS. The segmentation analysis showed a left hemisphere-oriented topographical distribution in the N2 region in AWS irrespective of conditions, whereas the scalp topography was right hemisphere-oriented with the involvement of parietal channels in AWNS. The timing differences existed between AWS and AWNS in the intervals that a topographical distribution lasted in all throughout the time window of analysis. Conclusion The results suggest altered neural pathway and hemispheric differences during auditory working memory tasks in AWS.
PMID: 31461331 DOI: 10.1044/2019_AJA-IND50-18-0101
Bimanual task performance: Adults who do and do not stutter - PSICOMOTOR
J Commun Disord. 2019 Sep - Oct; 81:105911. Epub 2019 May 24.
Werle D, Byrd C, Gkalitsiou Z, Eggers K.
The University of Texas at Austin, Austin, TX, USA; Thomas More University College, Antwerp, Belgium; University of Turku, Turku, Finland.
Research has demonstrated children who stutter score significantly lower than children who do not stutter on the Purdue Pegboard Test. Past data also suggest performance on this task may be associated with stuttering frequency (Choo et al., 2016; Mohammadi et al., 2016). The purpose of this study was to explore whether these performance differences and the relationship to stuttering frequency are present in adults who stutter (AWS). Forty-eight participants (AWS = 24, and AWNS = 24) matched for age, gender, education, and handedness completed all four tasks of the Purdue Pegboard Test. There were no significant between group differences and stuttering frequency did not predict performance. These findings suggest previous differences may only be applicable to subgroups and/or that, with development, the manual tasks unique to the Purdue Pegboard Test may not be sensitive enough to reveal differences.
PMID: 31152880 DOI: 10.1016/j.jcomdis.2019.105911
Ecopipam as a pharmacologic treatment of stuttering - FARMACOLOGIA
Ann Clin Psychiatry. 2019 Aug;31(3):164-168.
Maguire GA, LaSalle L, Hoffmeyer D, Nelson M, Lochhead JD, Davis K, Burris A, Yaruss JS.
University of California, Riverside, School of Medicine, CA. USA.
BACKGROUND: Stuttering, also known as childhood-onset fluency disorder, is a chronic neurodevelopmental disorder that affects 1% of the population and can greatly impact an individual's social, occupational, and academic functioning. Prior research has shown dopamine D2 antagonists are effective in reducing the severity of stuttering symptoms, but these compounds can be associated with metabolic and movement disorder adverse effects. Ecopipam is an investigational medication that acts as a selective dopamine D1 receptor antagonist. This mechanism should reduce the likelihood of metabolic and movement disorder adverse effects of D2 antagonists.
METHOD: This open-label pilot study investigated ecopipam in the treatment of adults who stutter.
RESULTS: The results showed that a majority of participants demonstrated improvement in their stuttering. The medication was well tolerated.
CONCLUSIONS: These positive, preliminary findings suggest that a doubleblind, randomized controlled clinical trial to examine the efficacy of ecopipam in the treatment of stuttering is warranted.
Effect of Different Body Postures on the Severity of Stuttering in Young Adults with Developmental Stuttering - PSICOMOTOR
Biomed Res Int. 2019 Aug 5
Almudhi A, Zafar H, Anwer S, Alghadir A.
King Khalid University, Abha, Saudi Arabia; King Saud University, Riyadh, Saudi Arabia; Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China.
OBJECTIVE: The current study aimed to investigate the effects of body position on the level and severity of stuttering in young adults with developmental stuttering.
METHODS: A total of 24 subjects (male: 17; female: 7; mean age: 24.9 ± 6.2 years) with developmental stuttering participated. The participants were asked to perform oral reading and spontaneous monologue-speaking tasks in different body postures while their speech was recorded. During reading and speaking tasks, the Stuttering Severity Instrument was used to quantify the severity of stuttering. The effects of different body postures on stuttering severity, reading task, and speaking task scores were analyzed.
RESULTS: Significant differences in stuttering severity, reading task, and speaking task scores were found for different body postures. Post hoc analyses revealed a significant difference in stuttering severity, reading task, and speaking task scores when subjects were sitting on a chair with no arm support compared to lying down (p<0.05). Similarly, there were significant differences for two sitting positions (sitting on a chair with no arm support vs sitting on a chair with arm support (p<0.05)).
CONCLUSIONS: Body postures or body segment positions that relax and facilitate the muscles of the neck and shoulders may potentially improve speech fluency in young adults with developmental stuttering.
PMID: 31467870 PMCID: PMC6699346 DOI: 10.1155/2019/1817906
Effects of different attention tasks on concurrent speech in adults who stutter and fluent controls - TERAPIA
J Fluency Disord. 2019 Aug 21;61:105714.. [Epub ahead of print]
Eichorn N, Pirutinsky S, Marton K.
The University of Memphis, United States; Touro College School of Social Work, United States; The Graduate School and University Center of the City University of New York, United States; Brooklyn College, CUNY, United States; Bárczi Gusztáv College of Special Education of Eötvös Loránd University, Hungary.
PURPOSE: Motor theories indicate that focusing attention on well-practiced movements interferes with skilled performance; however, specific forms of attention (alerting vs. orienting vs. executive control) associated with this effect are not well understood. The present study explored this question in relation to stuttering, and examined whether dual task conditions that engaged sustained attention or working memory (WM) affected speech fluency in different ways. We also considered whether fluency changes were associated with changes in speech rate and language.
METHODS: Nineteen adults who stutter (AWS) and 20 controls produced spontaneous speech under a baseline condition and two dual task conditions: one involving a sustained attention task, the other involving WM demands.
RESULTS: Both groups produced fewer stutter-like disfluencies under dual task relative to baseline conditions and this reduction did not differ between the two dual tasks (attention vs. WM). Speech rate and language variables, which were potentially influenced by attention conditions, were not affected by dual tasks in the same way as disfluencies, and appeared to be unassociated with fluency results.
CONCLUSIONS: Findings indicate that atypical disfluencies decrease when attention is divided, even when secondary task demands are minimal, as they were in the sustained attention task. For simple secondary tasks, fluency changes do not appear to be a byproduct of slowed rate and are not accompanied by observable changes in language. These results demonstrate that simple manipulations of attention can induce measurable effects on aspects of speech production, and may be a useful tool for facilitating fluency in clinical intervention.
PMID: 31472297 DOI: 10.1016/j.jfludis.2019.105714
Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum - GENÉTICA
Proc Natl Acad Sci U S A. 2019 Aug 27;116(35):17515-17524. Epub 2019 Aug 12.
Han TU, Root J, Reyes LD, Huchinson EB, Hoffmann JD, Lee WS, Barnes TD, Drayna D.
National Institutes of Health, Bethesda, MD 20892; Washington University School of Medicine in St. Louis, St. Louis.
Stuttering is a common neurodevelopmental disorder that has been associated with mutations in genes involved in intracellular trafficking. However, the cellular mechanisms leading to stuttering remain unknown. Engineering a mutation in N-acetylglucosamine-1-phosphate transferase subunits α and β (GNPTAB) found in humans who stutter into the mouse Gnptab gene resulted in deficits in the flow of ultrasonic vocalizations similar to speech deficits of humans who stutter. Here we show that other human stuttering mutations introduced into this mouse gene, Gnptab Ser321Gly and Ala455Ser, produce the same vocalization deficit in 8-day-old pup isolation calls and do not affect other nonvocal behaviors. Immunohistochemistry showed a marked decrease in staining of astrocytes, particularly in the corpus callosum of the Gnptab Ser321Gly homozygote mice compared to wild-type littermates, while the staining of cerebellar Purkinje cells, oligodendrocytes, microglial cells, and dopaminergic neurons was not significantly different. Diffusion tensor imaging also detected deficits in the corpus callosum of the Gnptab Ser321Gly mice. Using a range of cell type-specific Cre-drivers and a Gnptab conditional knockout line, we found that only astrocyte-specific Gnptab-deficient mice displayed a similar vocalization deficit. These data suggest that vocalization defects in mice carrying human stuttering mutations in Gnptab derive from abnormalities in astrocytes, particularly in the corpus callosum, and provide support for hypotheses that focus on deficits in interhemispheric communication in stuttering.
PMID: 31405983 DOI: 10.1073/pnas.1901480116
Limited Pre-Speech Auditory Modulation in Individuals Who Stutter: Data and Hypotheses - AUDITIVO
J Speech Lang Hear Res. 2019 Aug 29;62(8S):3071-3084. Epub 2019 Aug 29.
Max L, Daliri A.
University of Washington, Seattle; Haskins Laboratories, New Haven, CT; Arizona State University, Tempe, AZ.
Purpose We review and interpret our recent series of studies investigating motor-to-auditory influences during speech movement planning in fluent speakers and speakers who stutter. In those studies, we recorded auditory evoked potentials in response to probe tones presented immediately prior to speaking or at the equivalent time in no-speaking control conditions. As a measure of pre-speech auditory modulation (PSAM), we calculated changes in auditory evoked potential amplitude in the speaking conditions relative to the no-speaking conditions. Whereas adults who do not stutter consistently showed PSAM, this phenomenon was greatly reduced or absent in adults who stutter. The same between-group difference was observed in conditions where participants expected to hear their prerecorded speech played back without actively producing it, suggesting that the speakers who stutter use inefficient forward modeling processes rather than inefficient motor command generation processes. Compared with fluent participants, adults who stutter showed both less PSAM and less auditory-motor adaptation when producing speech while exposed to formant-shifted auditory feedback. Across individual participants, however, PSAM and auditory-motor adaptation did not correlate in the typically fluent group, and they were negatively correlated in the stuttering group. Interestingly, speaking with a consistent 100-ms delay added to the auditory feedback signal-normalized PSAM in speakers who stutter, and there no longer was a between-group difference in this condition. Conclusions Combining our own data with human and animal neurophysiological evidence from other laboratories, we interpret the overall findings as suggesting that (a) speech movement planning modulates auditory processing in a manner that may optimize its tuning characteristics for monitoring feedback during speech production and, (b) in conditions with typical auditory feedback, adults who stutter do not appropriately modulate the auditory system prior to speech onset. Lack of modulation of speakers who stutter may lead to maladaptive feedback-driven movement corrections that manifest themselves as repetitive movements or postural fixations.
PMID: 31465711 DOI: 10.1044/2019_JSLHR-S-CSMC7-18-0358
Methylphenidate and stuttering - FARMACOLOGIA
Br J Clin Pharmacol. 2019 Aug 16. [Epub ahead of print]
Trenque T, Claustre G, Herlem E, Djerada Z, Trenque A, Morel A, Azzouz B
Reims University Hospitals; University of Reims Champagne-Ardenne, Faculty of Medicine, Reims, France.
Methylphenidate (MPH) is a piperidine similar to amphetamines, and is indicated for Attention Deficit Hyperactivity Disorder. Studies concerning stuttering occurring with methylphenidate are contradictory. We investigated the association between methylphenidate and stuttering. We analyzed reports in the World Health Organization global individual case safety reports database, Vigibase, up to 31 December 2018, with the MedDRA Preferred Term "dysphemia" and the Lower Level Terms "stutter" and "stuttering". The association between exposure to MPH and occurrence of the adverse drug reaction was estimated by disproportionality analysis. Reporting Odds Ratios (ROR) were calculated with 95% Confidence Intervals (CIs). In total, 2,975 cases of dysphemia were reported, of which 46 reports were associated with MPH. For the PT "dysphemia", the ROR was 7.3 (95% CI: 5.4-9.8). With the LLT "stuttering", 584 cases were registered in the database of which 17 involved MPH. The ROR was 13.9 (95% CI: 8.6-22.5). This study found a signal for stuttering with methylphenidate.
PMID: 31418914 DOI: 10.1111/bcp.14097
Neuroanatomical Correlates of Childhood Stuttering: MRI Indices of White and Gray Matter Development That Differentiate Persistence Versus Recovery - INFANTIL
J Speech Lang Hear Res. 2019 Aug 29;62(8S):2986-2998.Epub 2019 Aug 29.
Garnett EO, Chow HM, Chang SE.
University of Michigan, Ann Arbor; Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Michigan State University, East Lansing.
Purpose We review two recent neuroanatomical studies of children who stutter (CWS), one that examines white matter integrity and the other that focuses on cortical gray matter morphology. In both studies, we sought to examine differences between children whose stuttering persists ("persistent"), children who recovered from stuttering ("recovered"), and their nonstuttering peers ("controls"). Method Both of the reviewed studies use data from a large pediatric sample spanning preschool- to school-age children (3-10 years old at initial testing). Study 1 focused on surface-based measures of cortical size (thickness) and shape (gyrification) using structural magnetic resonance imaging, whereas Study 2 utilized diffusion tensor imaging to examine white matter integrity. Results In both studies, the main difference that emerged between CWS and fluent peers encompassed left hemisphere speech motor areas that are interconnected via the arcuate fasciculus. In the case of white matter integrity, the temporoparietal junction and posterior superior temporal gyrus, both connected via the left arcuate fasciculus, and regions along the corpus callosum that contain fibers connecting bilateral motor regions were significantly decreased in white matter integrity in CWS compared to controls. In the morphometric study, children who would go on to have persistent stuttering specifically had lower cortical thickness in ventral motor and premotor areas of the left hemisphere. Conclusion These results point to aberrant development of cortical areas involved in integrating sensory feedback with speech movements in CWS and differences in interhemispheric connectivity between the two motor cortices. Furthermore, developmental trajectories in these areas seem to diverge between persistent and recovered cases.
PMID: 31465710 DOI: 10.1044/2019_JSLHR-S-CSMC7-18-0356
Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter - TERAPIA
J Fluency Disord. 2019 Aug 20:105713 [Epub ahead of print]
Douglass JE, Constantino C, Alvarado J, Verrastro K, Smith K.
Sacred Heart University, Fairfield, CT, United States; Florida State University, Tallahassee, FL, United States.
PURPOSE: Individuals who covertly stutter have a unique experience of stuttering that involves concealing the core behaviors of stuttering (e.g., repetitions, prolongations, and blocks). From the listener's perspective, covert stuttering results in minimum typical, overt stuttering behaviors. However, from the speaker's perspective, covert stuttering often increases the cognitive and emotional impact of stuttering. This study explores the speech-language therapy experiences of individuals who covertly stutter in order to improve treatment recommendations and best practice.
METHODS: This investigation is a qualitative analysis of individuals' speech-language therapy experiences as persons who covertly stutter. Real-time video interviews were conducted with the use of open-ended phenomenological interview questions. Interviews were transcribed and thematic analysis of interview transcripts was conducted to investigate the speech-language therapy experiences of the participants.
RESULTS: The participants indicated that stuttering therapy was most impactful when it included explicit goals and activities, personalized selection of therapy techniques or strategies beyond fluency techniques, encouraged self-education, and educated those in the person's environment.
CONCLUSION: The evidence suggests individualized therapy based on each client's unique manifestation of covert stuttering is beneficial; while, fluency-focused stuttering therapy is often incongruent with the needs of persons who covertly stutter. Therapeutic implications and recommendations for speech-language pathologists are discussed.
PMID: 31451301 DOI: 10.1016/j.jfludis.2019.105713
Sex Differences in Functional Brain Networks for Language - NEUROCIÊNCIAS
Cereb Cortex. 2019 Sep 12. [Epub ahead of print]
Xu M, Liang X, Ou J, Li H, Luo YJ, Tan LH.
Shenzhen University, Shenzhen, China; Shenzhen Institute of Neuroscience, Shenzhen, China; Shenzhen University Health Science Center, Shenzhen, China.
Men and women process language differently, but how the brain functions to support this difference is poorly understood. A few studies reported sex influences on brain activation for language, whereas others failed to detect the difference at the functional level. Recent advances of brain network analysis have shown great promise in picking up brain connectivity differences between sexes, leading us to hypothesize that the functional connections among distinct brain regions for language may differ in males and females. To test this hypothesis, we scanned 58 participants' brain activities (28 males and 30 females) in a semantic decision task using functional magnetic resonance imaging. We found marked sex differences in dynamic interactions among language regions, as well as in functional segregation and integration of brain networks during language processing. The brain network differences were further supported by a machine learning analysis that accurately discriminated males from females using the multivariate patterns of functional connectivity. The sex-specific functional brain connectivity may constitute an essential neural basis for the long-held notion that men and women process language in different ways. Our finding also provides important implications for sex differences in the prevalence of language disorders, such as dyslexia and stuttering.
PMID: 31512720 DOI: 10.1093/cercor/bhz184
Student clinicians' and clients' perceptions of the therapeutic alliance and outcomes in stuttering treatment - TERAPIA
J Fluency Disord. 2019 Aug 14;61:105709. [Epub ahead of print]
Croft RL, Watson J.
The University of Texas at Austin, Austin, TX. United States; Texas Christian University, United States.
PURPOSE: The purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.
METHODS: Student clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.
RESULTS: Results suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.
CONCLUSION: Clinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients' perspective regarding TA status.
PMID: 31445437 DOI: 10.1016/j.jfludis.2019.105709
The Role of Executive Function in Developmental Stuttering - CONCEITO
Semin Speech Lang. 2019 Aug;40(4):305-319. Epub 2019 Jul 16.
Anderson JD, Ofoe LC.
Indiana University, Bloomington, Indiana.
Developmental stuttering is a complex disorder and children who stutter form a heterogeneous group. Most contemporary researchers would agree that multiple factors, including those associated with linguistic, motor, sensory, and emotional processes, are likely involved in its development and/or maintenance. There is growing evidence, however, that cognitive processes also play a role. In this article, we briefly review behavioral and parent-report studies of executive function in children who stutter, the findings of which have generally suggested that these skills may be challenging for at least some children who stutter. We then consider how deficits in executive function could provide an explanatory account for not only the multifactorial nature of developmental stuttering but also the considerable amount of variability that exists among individuals who stutter.
PMID: 31311055 DOI: 10.1055/s-0039-1692965