Eliana Maria Nigro Rocha



Abstract - Janeiro a Julho de 2019

A fNIRS Investigation of Speech Planning and Execution in Adults Who Stutter - NEUROCIÊNCIAS

Neuroscience. 2019 Mar 6. [Epub ahead of print]


Jackson ES, Wijeakumar S, Beal DS, Brown B, Zebrowski P, Spencer JP.

New York University, New York, NY, University of Stirling, Stirling, Scotland, UK; Holland Bloorview Kids Rehabilitation Hospital, Ontario; University of Toronto, Toronto, ON; University of Wisconsin-Eau Claire,  WI; Wendell Johnson Speech and Hearing Center, Iowa City, Iowa;  University of East Anglia, Norwich, UK.


Our study aimed to determine the neural correlates of speech planning and execution in adults who stutter (AWS). Fifteen AWS and 15 controls (CON) completed two tasks that either manipulated speech planning or execution processing loads. Functional near-infrared spectroscopy (fNIRS) was used to measure changes in blood flow concentrations during each task, thus providing an indirect measure of neural activity. An image-based reconstruction technique was used to analyze the results and facilitate their interpretation in the context of previous functional neuroimaging studies of AWS that used positron emission tomography (PET) or functional magnetic resonance imaging (fMRI). For planning, we compared neural activity associated with high versus low planning load in AWS and CON. For execution, we compared the neural activity associated with overt versus covert naming in AWS and CON. Broadly, group level effects corroborate previous PET/fMRI findings including under-activation in left-hemisphere perisylvian speech-language networks and over-activation in right-hemisphere homologues. Increased planning load revealed atypical left-hemisphere activation in AWS, whereas increased execution load yielded atypical right fronto-temporo-parietal and bilateral motor activation in AWS. Our results add to the limited literature differentiating speech planning versus execution processes in AWS.

PMID: 30851356 DOI: 10.1016/j.neuroscience.2019.02.032




A single case report of a patient with stuttering who improved after open label TMS. - NEUROCIÊNCIAS

Brain Stimul. 2019 Jan 19. [Epub ahead of print]


Mejías G, Prieto J.

Hospital General Universitario Gregorio Marañón, Madrid, Spain.


No abstract available.

PMID: 30704893 DOI: 10.1016/j.brs.2019.01.011




A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions - TERAPIA

J Fluency Disord. 2019 May 8;61:105708.. [Epub ahead of print]


Trajkovski N, O'Brian S, Onslow M, Packman A, Lowe R, Menzies R, Jones M, Reilly S.

The University of Sydney, NSW, Australia; The University of Queensland, QLD, Australia; Griffith University, QLD, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.


PURPOSE: To compare two experimental Westmead Program treatments with a control Lidcombe Program treatment for early stuttering.

METHOD: The design was a three-arm randomized controlled trial with blinded outcome assessments 9 months post-randomization. Participants were 91 pre-school children.

RESULTS: There was no evidence of difference in percentage syllables stuttered at 9 months among groups. Dropout rates were substantive and may have been connected with novel aspects of the trial design: the use of community clinicians, no exclusion criteria, and randomization of children younger than 3 years of age.

CONCLUSION: The substantive dropout rate for all three arms in this trial means that any conclusions about the 9-month stuttering outcomes must be regarded as tentative. However, continued development of the Westmead Program is warranted, and we are currently constructing an internet version.

PMID: 31121476 DOI: 10.1016/j.jfludis.2019.105708




An exploratory factor analysis of action responses to stuttering anticipation - TERAPIA

J Fluency Disord. 2019 Mar 7;60:1-10. [Epub ahead of print]


Jackson ES, Rodgers NH, Rodgers DB.

New York University, New York, NY, United States; University of Iowa, Iowa City, IA, United States.


PURPOSE: We previously introduced theStuttering Anticipation Scale (SAS; Jackson, E. S., Gerlach, H., Rodgers, N. H., & Zebrowski, P. M. (2018). My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter? Seminars in Speech and Language, 39, 356-370) - a non-standardized self-report measure for children, teens, and adults who stutter (CWS, TWS, AWS) that quantifies how often they engage in 25 commonly reported action responses to anticipation. The purpose of this study was to leverage the SAS to explore the factor structure of action responses to stuttering anticipation.

METHODS: A total of 121 people who stutter completed the SAS online (27 CWS, 40 TWS, 54 AWS). We used exploratory factor analysis (EFA) to determine the underlying latent variables within the 25 SAS items that characterize how people who stutter respond to anticipation.

RESULTS: A three-factor model was most appropriate for the data with regard to factor loadings and other model fit indices. The three factors were named: avoidance (17 items), physical change (4 items), and approach (4 items).

CONCLUSION: Understanding these three types of action responses to anticipation can help guide clinical decision-making by providing a novel framework for clinicians and their clients who stutter to discuss how the client tends to respond to anticipation, and explore ways to facilitate productive responses to anticipation.

PMID: 30875585 DOI: 10.1016/j.jfludis.2019.03.001




Abnormal neural response to phonological working memory demands in persistent developmental stuttering - NEUROCIÊNCIAS

Hum Brain Mapp. 2019 Jan;40(1):214-225. Epub 2018 Aug 26.


Yang Y, Jia F, Fox PT, Siok WT, Tan LH.

Shenzhen University, Shenzhen, China; Shenzhen Institute of Neuroscience, Shenzhen, China; University of Texas Health Science Center at San Antonio, San Antonio, Texas;  University of Hong Kong, Pokfulam Road, Hong Kong.


Persistent developmental stuttering is a neurological disorder that commonly manifests as a motor problem. Cognitive theories, however, hold that poorly developed cognitive skills are the origins of stuttering. Working memory (WM), a multicomponent cognitive system that mediates information maintenance and manipulation, is known to play an important role in speech production, leading us to postulate that the neurophysiological mechanisms underlying stuttering may be associated with a WM deficit. Using functional magnetic resonance imaging, we aimed to elucidate brain mechanisms in a phonological WM task in adults who stutter and controls. A right-lateralized compensatory mechanism for a deficit in the rehearsal process and neural disconnections associated with the central executive dysfunction were found. Furthermore, the neural abnormalities underlying the phonological WM were independent of memory load. This study demonstrates for the first time the atypical neural responses to phonological WM in PWS, shedding new light on the underlying cause of stuttering.

PMID: 30145850 DOI: 10.1002/hbm.24366




After the RESTART trial: six guidelines for clinical trials of early stuttering intervention. - OUTRAS ÁREAS

Int J Lang Commun Disord. 2019 Feb 17. [Epub ahead of print]


Onslow M, Lowe R.

The University of Sydney, Sydney, NSW, Australia.


BACKGROUND: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter.

AIMS: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention.

METHOD: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning.

MAIN CONTRIBUTION: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development.

CONCLUSION: In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.

PMID: 30773736 DOI: 10.1111/1460-6984.12463




An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders - EMOCIONAL

J Commun Disord. 2019 Feb 15;78:69-83. [Epub ahead of print]


Druker KC, Mazzucchelli TG, Beilby JM.

Curtin University, Western Australia, Australia.


PURPOSE: The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes.

METHODS: This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment.

RESULTS: Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only.

CONCLUSION: Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

PMID: 30798143 DOI: 10.1016/j.jcomdis.2019.02.002




Adults who stutter and metronome synchronization: evidence for a nonspeech timing deficit - PSICOMOTOR

Ann N Y Acad Sci. 2019 May 29. [Epub ahead of print]


Sares AG, Deroche MLD, Shiller DM, Gracco VL

Integrated Program in Neuroscience, Montréal, Quebec, Canada; McGill University, Montréal, Quebec, Canada; School of Communication Sciences and Disorders, Montréal, Quebec, Canada; Université de Montréal, Montréal, Quebec, Canada; Haskins Laboratories, New Haven, Connecticut.


Speech timing deficits have been proposed as a causal factor in the disorder of stuttering. The question of whether individuals who stutter have deficits in nonspeech timing is one that has been revisited often, with conflicting results. Here, we uncover subtle differences in a manual metronome synchronization task that included tempo changes with adults who stutter and fluent speakers. We used sensitive circular statistics to examine both asynchrony and consistency in motor production. While both groups displayed a classic negative mean asynchrony (tapping before the beat), individuals who stutter anticipated the beat even more than their fluent peers, and their consistency was particularly affected at slow tempi. Surprisingly, individuals who stutter did not have problems with interval correction at tempo changes. We also examined the influence of music experience on synchronization behavior in both groups. While music perception and training were related to synchronization behavior in fluent participants, these correlations were not present for the stuttering group; however, one measure of stuttering severity (self-rated severity) was negatively correlated with music training. Overall, we found subtle differences in paced auditory-motor synchronization in individuals who stutter, consistent with a timing problem extending to nonspeech.

PMID: 31144336 DOI: 10.1111/nyas.14117




Are variants in sex hormone metabolizing genes associated with stuttering? - GENÉTICA

Brain Lang. 2019 Feb 21;191:28-30. [Epub ahead of print]


Frigerio Domingues CE, Grainger K, Cheng H, Moretti-Ferreira D, Riazuddin S, Drayna D.

NIDCD/National Institutes of Health, Bethesda, MD 20892, USA; Sao Paulo State University, Botucatu, Brazil; Alama Iqbal Medical Research Center, Pakistan.


No abstract available.

PMID: 30798091 DOI: 10.1016/j.bandl.2019.02.003




Backward-Looking Sentence Processing in Typically Disfluent versus Stuttered Speech: ERP Evidence - SOCIAL

Lang Cogn Neurosci. 2019;34(5):561-579 Epub 2018 Oct 9.


Maxfield ND, Ferreira F.

University of South Florida; University of California – Davis.


The aim was to determine how backward-looking sentence processing is affected by typically-disfluent versus stuttered speech. Two listener groups heard Garden Path (GP) and control sentences. GP sentences contained no disfluency, a silent pause, or a filled pause before the disambiguating verb. For one group, the sentence preambles additionally contained stuttering-like disfluencies. Comprehension accuracy, event-related potentials (ERPs) time-locked to disambiguating verbs, and perceptual speaker ratings, were compared between groups. The With Stuttering group perceived the speaker as less competent but had better comprehension accuracy for GP sentences. ERPs to disambiguating verbs in GP sentences included a P600 component, indexing backward-looking sentence processing, but only for the No Stuttering group. Other ERP components, elicited to GP sentences with silent/filled pauses, did not differ between groups. Results suggest that listeners abandon prior expectations when processing sentences containing stuttering-like disfluencies, possibly because they lack a speaker model defined by the presence of stuttering.

PMID: 31032374 PMCID: PMC6483388 [Available on 2020-01-01] DOI: 10.1080/23273798.2018.1533140




Bimanual task performance: Adults who do and do not stutter - PSICOMOTOR

J Commun Disord. 2019 May 24;81:105911 [Epub ahead of print]


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




Cerebral laterality as assessed by hand preference measures and developmental stuttering - PSICOMOTOR

Laterality. 2019 May 30:1-23. [Epub ahead of print]


Mohammadi H, Papadatou-Pastou M.

Kermanshah University of Medical Sciences , Kermanshah , Iran; National and Kapodistrian University of Athens , Athens , Greece.


The causes of developmental stuttering, a neurodevelopmental communicative disorder, have not been elucidated to date. Neuroimaging studies suggest that atypical cerebral laterality could be one of such causal factors. Moreover, handedness, a behavioural index for cerebral laterality, has been linked to stuttering and recovery from it. However, findings are conflicting, possibly due to sample selection procedures, which typically rely on self-reported stuttering, and to the fact that handedness is typically assessed with regards to its direction rather than degree. We investigated the possible relationship between handedness and stuttering. This is the first study where children who stutter (CWS) were selected using clinical criteria as well as speech samples and where a non-Western population was studied. Findings from 83 CWS aged 3-9 years (mean = 6.43, SD = 1.84) and 90 age- and sex-matched children who do not stutter (mean = 6.45, SD = 1.71) revealed no differences in their hand preference scores as evaluated by parent-completed Edinburgh Handedness Inventory, for both direction and degree. The severity of stuttering was not found to correlate with the degree of handedness. We suggest that parents and professionals not treat left- or mixed-hand preference as a reason for concern with regards to stuttering.

PMID: 31144576 DOI: 10.1080/1357650X.2019.1621329




Clinical correlates of repetitive speech disorders in Parkinson's disease - GAGUEIRA ADQUIRIDA

J Neurol Sci. 2019 Apr 11;401:67-71 [Epub ahead of print]


Tsuboi T, Watanabe H, Tanaka Y, Ohdake R, Sato M, Hattori M, Kawabata K, Hara K, Nakatsubo D, Maesawa S, Kajita Y, Katsuno M, Sobue G.

Nagoya University Graduate School of Medicine, Nagoya, Japan; Nagoya University, Nagoya, Japan; National Hospital Organization Nagoya Medical Center, Nagoya, Japan.


OBJECTIVES: This study aimed to explore clinical correlates of repetitive speech disorders in patients with Parkinson's disease (PD).

METHODS: This study investigated speech function (Assessment of Motor Speech for Dysarthria and Stuttering Severity Instrument-3), motor function (Unified Parkinson's Disease Rating Scale III [UPDRS-III] and UPDRS-IV), cognitive function (Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA], Stroop color-word test, verbal fluency, digit span tests, and line orientation), and activities of daily living of 113 PD patients. Comparison between groups (independent t-tests, Mann-Whitney U tests, or χ2 test) and linear regression analyses were performed to determine clinical correlates of repetitive speech disorders.

RESULTS: Totally, 65 patients (57.5%) had repetitive speech disorders. Patients with repetitive speech disorders had significantly worse UPDRS-III (P = .049), MoCA (P = .030), and speech function and higher levodopa equivalent daily dose (LEDD; P = .031) than those without repetitive speech disorders. Males were significantly predominant in patients with repetitive speech disorders (64.6%) compared to those without repetitive speech disorders (18.7%; P < .001). The univariate and subsequent multiple linear regression analyses revealed that the severity of repetitive speech disorders significantly correlated with gender (P < .001), MoCA (P = .006), and speech variables (abnormal rate, P = .007; imprecise consonants, P = .043), independent from disease duration, UPDRS III, and LEDD.

CONCLUSIONS: PD patients with repetitive speech disorders had worse motor, cognitive, and speech functions than those without repetitive speech disorders. The most influential factor for repetitive speech disorders might be male gender.

PMID: 31029883 DOI: 10.1016/j.jns.2019.04.012




Clozapine-Associated Myoclonus and Stuttering Secondary to Smoking Cessation and Drug Interaction: A Case Report. - FARMACOLOGIA

J Clin Psychopharmacol. 2019 Mar 28. [Epub ahead of print]


Chochol MD, Kataria L, OʼRourke MC, Lamotte G.

Medstar Georgetown University Hospital Washington, DC; George Washington University Hospital Washington, DC


PMID: 30925500 DOI: 10.1097/JCP.0000000000001032

No abstract available




Cognitive behaviour language therapy for speech anxiety among stuttering school adolescents - EMOCIONAL

J Int Med Res. 2019 Jun 3:30. [Epub ahead of print]


Nnamani A, Akabogu J, Otu MS, Ukoha E, Uloh-Bethels AC, Omile JC, Obiezu MN, Dike AE, Ike CV, Iyekekpolor OM.

University of Nigeria, Nsukka, Nigeria; Federal College of Education (Technical), Umunze, Nigeria.


OBJECTIVE: To determine the effectiveness of a cognitive behaviour language therapy (CBLT) programme to reduce speech anxiety among stuttering school adolescents.

METHODS: This was a group randomized clinical trial that enrolled stuttering school adolescents who had severe speech anxiety. The participants were randomized to either the treatment group or the control group. The Speech Anxiety Thoughts Inventory (SATI) score was recorded before and after a 12-week CBLT programme was delivered in 24 group sessions to the treatment group. The control group did not receive any therapy.

RESULTS: A total of 92 stuttering school adolescents who met the inclusion criteria were randomized to the treatment group ( n = 46; 22 males, 24 females; mean ± SD age, 16.36 ± 2.20 years) or the control group ( n = 46; 28 males, 18 females; mean ± SD age, 15.45 ± 2.10 years). Results showed that the CBLT intervention significantly reduced speech anxiety among stuttering school adolescents compared with the control group (post-test SATI assessment, mean ± SD 26.52 ± 1.67 versus 89.92 ± 3.17, respectively).

CONCLUSION: These findings suggest that speech educators and therapists in educational institutions and hospitals should follow the principles of CBLT when treating speech anxiety.

PMID: 31154887 DOI: 10.1177/0300060519853387




Detection of Gap and Modulations: Auditory Temporal Resolution Deficits in Adults Who Stutter - AUDITIVO

Folia Phoniatr Logop. 2019 May 27:1-9. [Epub ahead of print]


Devaraju DS, Maruthy S, Kumar AU.

All India Institute of Speech and Hearing, Manasagangothri, Mysuru, India,


BACKGROUND: Recent models of speech production suggest a link between speech production and perception. Persons with stuttering are known to have deficits in sensorimotor timing and exhibit auditory processing problems. Most of the earlier studies have focused on assessing temporal ordering in adults who stutter (AWS), but limited attempts have been made to document temporal resolution abilities in AWS.

METHODS: A group of 16 AWS and 16 age- and gender-matched adults who do not stutter (AWNS) were recruited for the study. Temporal resolution abilities were assessed using the Gap Detection Test and temporal modulation transfer function (TMTF).

RESULTS: The results revealed significant differences in TMTF between AWS and AWNS, but no differences were found in the gap detection thresholds.

CONCLUSIONS: Results suggest that the sensory representations of the temporal modulations are compromised in AWS, which may contribute to the programming of rhythmic movements during speech planning.

PMID: 31132766 DOI: 10.1159/000499565




Differences in the relation between temperament and vocabulary based on children's stuttering trajectories - EMOCIONAL

J Commun Disord. 2019 Jan 25;78:57-68. [Epub ahead of print]


Singer CM, Walden TA, Jones RM.

Vanderbilt University, Nashville, TN, United States


PURPOSE: The purpose of this study was to assess the relation between temperament and vocabulary development for children who stutter and persist, children who stutter and recover and children who do not stutter.

METHODS: Participants, aged 3;0-4;11 at the start of the study, were followed for two years. They were classified as persisting (n = 10), recovered (n = 26), and non-stuttering (n = 24) based on multiple assessments of stuttering spaced across study participation. Groups were balanced for age and gender ratios. At each visit, participants completed the Peabody Picture Vocabulary Test, 4th edition, and the Expressive Vocabulary Test, 2nd edition; caregivers completed the Children's Behavior Questionnaire.

RESULTS: For both persisting and recovered groups, higher negative emotionality was associated with lower receptive vocabulary. These associations were both significantly more negative than the non-stuttering group's association.

CONCLUSION: These findings suggest that receptive vocabulary development is differentially linked to temperament based on a child's stuttering status. As others have speculated (Conture & Walden, 2012), it appears as though there are salient associations between temperament, speech-language development, and childhood stuttering.

PMID: 30771599 DOI: 10.1016/j.jcomdis.2019.01.004




Disfluency clusters in speakers with and without neurogenic stuttering following traumatic brain injury - GAGUEIRA ADQUIRIDA

J Fluency Disord. 2019 Jan 11;59:33-51. [Epub ahead of print]


Penttilä N, Korpijaakko-Huuhka AM, Kent RD.

University of Tampere, Tampere, Finland; University of Wisconsin-Madison, Madison WI, United States.


PURPOSE: Analyze the characteristics and rate of disfluency clusters in adults with and without neurogenic stuttering after traumatic brain injury (TBI).

METHOD: Twenty adults with TBI participated in this study, including 10 with neurogenic stuttering (Group B) and 10 without -stuttering (Group A). Disfluency clusters in speech samples were classified into three types: Stuttering-like (SLD), other (OD), and mixed (MIX).

RESULTS: Speakers with and without neurogenic stuttering produced the same mean number of disfluency clusters. In addition, the mean length of clusters did not differ between these speaker groups although the longest clusters did. The most frequently occurring cluster type for people with neurogenic stuttering was MIX and OD for people without stuttering. Although the speakers in Group A produced stuttering-like disfluencies, these never occurred together to form a SLD type cluster. For Group B, the starter units of the clusters were usually stuttering-like disfluencies, while for Group A, the starter units were mostly interruptions.

CONCLUSIONS: Compared to non-stuttering speakers, stuttering after TBI did not increase the number of clusters, but rather lengthened them. In speakers with neurogenic stuttering, the number and length of clusters were related to the manifestation of other communication deficits, not to the frequency of stuttering-like disfluencies. Still, SLD clusters occurred only in those people with neurogenic stuttering. These findings raise questions about the nature of both neurogenic stuttering and the dynamics of disfluency clustering.

PMID: 30641458 DOI: 10.1016/j.jfludis.2019.01.001




Dissociating motor-speech from lexico-semantic systems in the left frontal lobe: insight from a series of 17 awake intraoperative mappings in glioma patients - NEUROCIÊNCIAS

Brain Struct Funct. 2019 Jan 14.. [Epub ahead of print]


Corrivetti F, de Schotten MT, Poisson I, Froelich S, Descoteaux M, Rheault F, Mandonnet E.

Lariboisière Hospital, APHP, Paris, France; Université Paris, Paris, France; Université de Sherbrooke, Sherbrooke, Canada.


Functional brain mapping during awake surgery procedures is the gold standard technique in the management of left frontal lobe tumors. Nevertheless, a unified picture of the language subsystems encountered during left frontal lobe mapping is still lacking. We retrospectively analyzed the 49 cortical and the 33 axonal sites of functional language mapping performed in 17 patients operated for a left frontal lobe glioma under awake conditions. Sites were tagged on the postoperative MRI, based on anatomical landmarks and intraoperative photography. All MRIs and tags were then registered in the MNI template. Speech disturbances related to motor functions (speech arrest-with or without superior limb arrest-, stuttering, and vocalization) were grouped together as "motor-speech" responses. Anomias, semantic paraphasia, perseverations, and PPTT errors were classified as "lexico-semantic" responses. MNI-registered axonal sites were used as seed for computing disconnectome maps from a tractogram atlas of ten healthy individuals, as implemented in the BCB toolkit. The cortical distribution of lexico-semantic responses appeared to be located anteriorly (pars triangularis of the inferior frontal gyrus and posterior end of the middle and superior frontal gyrus) compared to motor-speech responses (lower end of the precentral gyrus and pars opercularis). Within the white matter, motor-speech responses and lexico-semantic responses overlapped on the trajectory of the aslant and fronto-striatal tracts, but the lexico-semantic sites were located more anteriorly (mean Y coordinate on the MNI system was 21.2 mm for lexico-semantic sites and 14.3 mm for the motor-speech sites; Wilcoxon test: W = 60.5, p = 0.03). Moreover, disconnectome maps evidenced a clear distinction between the two subsystems: posterior fronto-striatal and frontal aslant tracts, corpus callosum and cortico-spinal tract were related to the motor-speech sites, whereas anterior frontal aslant tract, inferior-fronto-occipital fasciculus (IFOF) and anterior thalamic radiations were related to the lexico-semantic sites. Hence, we evidenced distinct anatomical substrates for the motor-speech and lexico-semantic systems. Regarding the aslant/fronto-striatal system, an anterior to posterior gradient was found, with a lexico-semantic role for the anterior part and a motor-speech involvement for the posterior part. For tumors abutting the precentral sulcus, posterior boundaries of the resection are made of motor-speech sites, meaning that the anteriorly located lexico-semantic system is no more functional, as a result of network reorganization by plasticity.

PMID: 30637492 DOI: 10.1007/s00429-019-01827-7




Effect of phonological and morphological factors on speech disfluencies of Kannada speaking preschool children who stutter - FALA

J Fluency Disord. 2019 May 3;61:105707. [Epub ahead of print]


Seth D, Maruthy S.

All India Institute of Speech and Hearing, Mysore, India.


PURPOSE: Empirical investigations have revealed a strong association between linguistic factors and stuttering, specifically phonological and morphological factors. However, the effect of these factors is suggested to vary across languages owing to the differences in their linguistic structure. Further, the trend is found to vary between AWS and CWS. Literature in this regard is scarce in the Kannada language, particularly in children. Hence, the study was driven by the need to understand the effect of phonological and morphological factors on stuttering in Kannada speaking CWS.

METHOD: Spontaneous speech samples were obtained from twenty Kannada speaking preschool CWS with a confirmed diagnosis of stuttering by an experienced speech-language pathologist. The recorded samples were transcribed, and disfluencies were marked. Further, the stuttered words were analysed for phonological and morphological features. The phonological factors included were phoneme position in a word, phoneme type and word length. Morphological factors consisted of word class and word end inflectional morphology. The percentage of stuttering was calculated with respect to each of the factors mentioned above.

RESULTS: Phoneme in the initial position of a word and words beginning with consonants had a higher rate of stuttering. Word length, word class and word end inflections were found to have no significant effect on the rate of stuttering in CWS.

CONCLUSION: Overall, current findings revealed that stuttering might manifest differently across languages varying in their linguistic structures.

PMID: 31103753 DOI: 10.1016/j.jfludis.2019.105707




Genetic factors and therapy outcomes in persistent developmental stuttering - GENÉTICA

J Commun Disord. 2019 Apr 5;80:11-17. [Epub ahead of print]


Frigerio-Domingues CE, Gkalitsiou Z, Zezinka A, Sainz E, Gutierrez J, Byrd C, Webster R, Drayna D.

National Institutes of Health, Bethesda, USA; University of Texas, Austin, TX, USA; Hollins Communications Research Institute, Roanoke, VA, USA.


PURPOSE: We investigated whether outcomes of therapy for persistent developmental stuttering differ in individuals who carry a mutation in one of the known genes associated with stuttering compared to individuals without such mutations.

METHOD: We studied outcomes of an intensive fluency shaping-based therapy program in individuals with persistent developmental stuttering. We evaluated a cohort of 51 stuttering individuals with who carried a mutation in either the GNPTAB, GNPTG, NAGPA, or AP4E1 gene. We compared therapy outcomes in these individuals with outcomes in 51 individuals matched for age, gender, and ethnicity, who stutter and underwent the same therapy program, and did not carry a mutation in any of these genes. Fluency pre- and post-therapy was evaluated using blinded observer-based quantitative stuttering dysfluency measures (Dysfluent Words Score, DWS), and by subjects' self-reported measures of struggle, avoidance and expectancy behavior associated with speaking (Perceptions of Stuttering Inventory, PSI). The difference between pre- and post-therapy fluency scores was taken as the measure of near-term therapy efficacy.

RESULTS: Comparison of fluency measures showed a strong effect of therapy overall. Mutation carriers achieved significantly less resolution in PSI following therapy, with PSI scores showing significantly less improvement in individuals who carry a mutation (p = 0.0157, RR = 1.75, OR = 2.92) while the group difference in DWS between carriers and non-carriers was statistically not significant in the present study, the trend observed in the results warrants further research focused on this important issue.

CONCLUSIONS: These results suggest stuttering is more resistant to therapy in individuals who carry a mutation in one of the genes known to be associated with stuttering.

PMID: 31003007 DOI: 10.1016/j.jcomdis.2019.03.007




Impaired processing speed in categorical perception: Speech perception of children who stutter - INFANTIL

PLoS One. 2019 Apr 26;14(4):e0216124. eCollection 2019.

Free full text: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0216124&type=printable


Bakhtiar M, Zhang C, Sze Ki S.

The Hong Kong Polytechnic University, Hong Kong SAR, China.


There have been controversial debates across multiple disciplines regarding the underlying mechanism of developmental stuttering. Stuttering is often related to issues in the speech production system; however, the presence and extent of a speech perception deficit is less clear. This study aimed to investigate the speech perception of children who stutter (CWS) using the categorical perception paradigm to examine their ability to categorize different acoustic variations of speech sounds into the same or different phonemic categories. In this study, 15 CWS and 16 children who do not stutter (CWNS) completed identification and discrimination tasks involving acoustic variations of Cantonese speech sounds in three stimulus contexts: consonants (voice onset times, VOTs), lexical tones, and vowels. The results showed similar categorical perception performance in boundary position and width in the identification task and similar d' scores in the discrimination task between the CWS and CWNS groups. However, the reaction times (RTs) were slower in the CWS group compared with the CWNS group in both tasks. Moreover, the CWS group had slower RTs in identifying stimuli located across categorical boundaries compared with stimuli located away from categorical boundaries. Overall, the data implied that the phoneme representation evaluated in speech perception might be intact in CWS as revealed by similar patterns in categorical perception as those in CWNS. However, the CWS group had slower processing speeds during categorical perception, which may indicate an insufficiency in accessing the phonemic representations in a timely manner, especially when the acoustic stimuli were ambiguous.

PMID: 31026270 DOI: 10.1371/journal.pone.0216124




In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe - EMOCIONAL

J Speech Lang Hear Res. 2019 May 20:1-11 [Epub ahead of print]


Menzies RG, Packman A, Onslow M, O'Brian S, Jones M, Helgadóttir FD.

The University of Sydney, New South Wales; The University of Queensland, Brisbane, Australia.


Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.

PMID: 31112442 DOI: 10.1044/2019_JSLHR-S-18-0340



Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement - OUTRAS ÁREAS

Int J Lang Commun Disord. 2019 Apr 2. [Epub ahead of print]


Namasivayam AK, Pukonen M, Goshulak D, Granata F, Le DJ, Kroll R, van Lieshout P.

University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; The Speech and Stuttering Institute, Toronto, ON, Canada; University of Toronto Mississauga, Mississauga, ON, Canada.


BACKGROUND: Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population.

AIMS: To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI.

METHODS & PROCEDURES: A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention.

OUTCOMES & RESULTS: Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions.

CONCLUSIONS & IMPLICATIONS: Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.

PMID: 30941860 DOI: 10.1111/1460-6984.12472




"I Stopped Hearing Voices, Started to Stutter" - A Case of Clozapine-Induced Stuttering. - FARMACOLOGIA

Indian J Psychol Med. 2019 Jan-Feb;41(1):97-98.

Free Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337922/#__ffn_sectitle


Nagendrappa S, Sreeraj VS, Venkatasubramanian G.

National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.


No abstract available.

PMID: 30783319 PMCID: PMC6337922 DOI: 10.4103/IJPSYM.IJPSYM_157_18




Language Growth Predicts Stuttering Persistence Over and Above Family History and Treatment Experience: Response to Marcotte - LINGUAGEM

J Speech Lang Hear Res. 2019 May 6:1-2. [Epub ahead of print]


Leech KA, Bernstein Ratner N, Brown B, Weber CM.

Harvard University , Cambridge, MA; University of Maryland, College Park; Purdue University, West Lafayette, IN.


Purpose This response addresses comments made by Marcotte (2019) regarding our recent publication, "Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery" ( Leech, Bernstein Ratner, Brown, & Weber, 2017 ). Marcotte calls into question our finding that language growth is a valid predictor of recovery from stuttering because we did not account for treatment and family history. Conclusions In response to her comments, we provide additional empirical analyses couched in a larger discussion of the difficulty of calibrating treatment and family history of stuttering. In short, we show that once treatment history and family history of stuttering are accounted for, the effect of language growth remains a significant predictor of stuttering persistence.

PMID: 31058570 DOI: 10.1044/2019_JSLHR-S-18-0318




Novel PANK2 mutation in a Chinese boy with PANK2-associated neurodegeneration: A case report and review of Chinese cases.- GENÉTICA

Medicine (Baltimore). 2019 Jan;98(4):e14122.


Zhang Y, Zhou D, Yang T.

West China Hospital, Sichuan University, Chengdu, China


RATIONALE: Pantothenate kinase-associated neurodegeneration (PKAN), also called Hallervorden-Spatz Syndrome (HSS), is a rare neurodegeneration with brain iron accumulation from pantothenate kinase 2 gene (PANK2) mutation characterized as extrapyramidal symptoms. However, few studies involving PKAN patients were reported in China. This study was conducted to identify the genetic mutations in a Chinese boy with PKAN, and to review all PANK2 mutations reported in Chinese cases with PKAN.

PATIENT CONCERN: We reported a 23-year-old Chinese boy with PKAN, exhibiting difficulty in writing and manipulation using right hand with slow progression for 12 years. He spoke with a severe stutter when he was 15 years old.

DIAGNOSIS: Considering results of magnetic resonance images, brain computed tomography and medical history, the case was suspected to be related to genetic factors.

INTERVENTIONS: Whole exome sequencing was arranged, and the mutations were identified in his parents' genome.

OUTCOMES: In the present study, whole exome sequencing revealed 2 novel mutations (c.1696C > G in exon 7 and c.1160_c.1161insG in exon3) of the PANK2 gene in the proband. c.1696C > G and c.1160_c.1161insG, respectively, were confirmed in his father and mother. We also reviewed 14 different PANK2 mutations, most of which were missense type in Chinese cases. Those mutations did not show apparent hotspots, but exon 3 and 4 were frequently involved.

LESSONS: Two novel compound heterozygous mutations were identified and considered to be pathogenic in PKAN patients. This review of the reports indicated that atypical PKAN is the more common phenotype in China and no apparent genotype-phenotype correlation was found.

PMID: 30681573 DOI: 10.1097/MD.0000000000014122




Phonological and Semantic Contributions to Verbal Short-Term Memory in Young Children With Developmental Stuttering. - INFANTIL

J Speech Lang Hear Res. 2019 Mar 25;62(3):644-667


Anderson JD, Wagovich SA, Brown BT.

Indiana University, Bloomington; University of Missouri, Columbia.


Purpose The purpose of this study was to examine the verbal short-term memory skills of children who stutter (CWS) and children who do not stutter (CWNS) in 2 experiments, focusing on the influence of phonological and semantic similarity. Method Participants were 42 CWS and 42 CWNS between the ages of 3;0 and 5;11 (years;months). In Experiment 1, children completed the phonological similarity task, in which they listened to lists of phonologically similar and dissimilar words and then repeated them when signaled to do so. In Experiment 2, children completed another forward span task, the semantic category task, which is similar to the phonological similarity task, except that it consisted of lists of semantically homogeneous and heterogeneous words. Main dependent variables were cumulative memory span, proportion of errors by type, and speech reaction time (SRT) for correct responses. Results The CWS exhibited significantly shorter memory spans for phonologically dissimilar words and were less affected by the phonological qualities of the words than the CWNS in Experiment 1, based on the findings of both between-groups and within-group analyses. In Experiment 2, although the groups did not differ in their performance in either condition, within-group analyses revealed that the CWNS benefitted from semantic similarity, whereas the CWS did not. The between-groups difference in absolute difference scores, however, did not reach significance. The CWS produced more omissions and false alarms than the CWNS in both experiments, but the 2 groups of children were otherwise comparable in SRT, although the CWS exhibited overall faster SRT than the CWNS in Experiment 2. Conclusions Verbal short-term memory is one domain-general cognitive process in which CWS display weakness relative to typically fluent peers. These weaknesses are likely due, in part, to differences in phonological and, perhaps, semantic processing of words to aid memory.

PMID: 30950742 DOI: 10.1044/2018_JSLHR-S-18-0039




Reliability and validity of the UTBAS-TR (The Unhelpful Thoughts and Beliefs Scale-the Turkish version) in the Turkish population - AVALIAÇÃO

Int J Speech Lang Pathol. 2019 Mar 11:1-6. [Epub ahead of print]


Aydın Uysal A, Ege P.

Kocaeli University , Kocaeli , Turkey and Ankara Speech and Language Therapy Center , Ankara , Turkey.


PURPOSE: This paper decribes the development of the Turkish adaptation of UTBAS (UTBAS-TR) and reports the results concerning its applicability and psychometric structure.

METHOD: The sample consisted of 81 males and 19 females diagnosed with developmental stuttering in two centres. Test-retest reliability score was obtained by correlating results of repeated aplications of the scale within a one-week interval and a paired t-test was calculated to see the differences in the total and UTBAS I, II and III scores. The internal consistency was assessed using the Cronbach's alpha. Construct validity was also assessed by examining inter-scale correlations and with the correlations of the UTBAS-TR with two other scales (State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI)).

RESULT: The internal consistency of the UTBAS-TR and the test and retest reliability score was statiıstically significant. The correlation between UTBAS-TR total score and the UTBAS-TR I, II and III correlations were high. A significant correlation was observed between UTBAS-TR total score with State Anxiety Inventory. However, the correlations between UTBAS-TR-Total Score and Trait Anxiety Inventory and Beck Anxiety Inventory were low.

CONCLUSION: The UTBAS-TR proved to be suitable for use with the Turkish population.

PMID: 30856006 DOI: 10.1080/17549507.2019.1568572




Response to the Letter to the Editor From Marcotte (2019) Regarding "The History of Stuttering by 7 Years: Follow-Up of a Prospective Community Cohort" by Kefalianos et al. (2017) - TERAPIA

J Speech Lang Hear Res. 2019 May 6:1-2. [Epub ahead of print]


Kefalianos E, Onslow M4, Packman A, Vogel A, Pezic A, Mensah F, Conway L, Bavin E, Block S, Reilly S.

University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; University of Technology Sydney, Australia; University of Tübingen, Germany; Royal Children's Hospital, Australia; La Trobe University, Australia; Menzies Health Institute Queensland, Griffith University, Australia.


Purpose The purpose of this letter is to respond to Marcotte's (2019) letter to the editor, "The Influence of Treatment on Children's Recovery from Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017)," published by the Journal of Speech, Language, and Hearing Research.

PMID: 31058567 DOI: 10.1044/2019_JSLHR-S-17-0476




Self-acceptance, resilience, coping and satisfaction of life in people who stutter. - TERAPIA

J Fluency Disord. 2019 Mar;59:52-63. Epub 2018 Nov 1.


Plexico LW, Erath S2, Shores H, Burrus E.

Auburn University, United States.


PURPOSE: The purpose of the present study was to evaluate self-acceptance and satisfaction with life with people who stutter and the influence of coping and resilience on the two factors.

METHOD: Forty-seven people who stutter (PWS) and 47 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 main areas: (a) background information, (b) satisfaction with life, (c) coping, (d) avoidance, (e) self-acceptance, and resilience.

RESULTS: Avoidant coping and maladaptive coping moderated the association between stuttering and self- acceptance but not satisfaction with life. Resilience was found to moderate the association between stuttering and self-acceptance as well as satisfaction with life.

CONCLUSION: Stuttering was associated with lower self-acceptance at higher levels of avoidant coping and maladaptive coping. PWS who have lower levels of resilience were more likely to have a lower satisfaction with life indicating that higher levels of resilience could serve as a protective factor for having a greater satisfaction with life. Further, stuttering was associated with lower self-acceptance at lower levels of resilient attitude. Resilience and coping appear to protect against having diminished self-acceptance and satisfaction with life for PWS.

PMID: 30446168 DOI: 10.1016/j.jfludis.2018.10.004




Self-efficacy beliefs: Experiences of adults who stutter - TERAPIA

J Fluency Disord. 2019 Mar 29;60:11-25. [Epub ahead of print]


Carter AK, Breen LJ, Beilby JM.

Curtin University, Western Australia, Australia.


PURPOSE: Childhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual's self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals.

METHOD: Semi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs.

RESULTS: Thematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme.

CONCLUSION: These preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence.

PMID: 30953951 DOI: 10.1016/j.jfludis.2019.03.002




Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial - EMOCIONAL

J Commun Disord. 2019 May 2;80:81-91. [Epub ahead of print]


Menzies R, O'Brian S, Packman A, Jones M, Helgadóttir FD, Onslow M.

The University of Sydney, Australia; The University of Queensland, Australia.


PURPOSE: It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment.

METHOD: Participants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe.

RESULTS: There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes.

CONCLUSIONS: The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.

PMID: 31100535 DOI: 10.1016/j.jcomdis.2019.04.003




Stuttering and gray matter morphometry: A population-based neuroimaging study in young children - NEUROCIÊNCIAS

Brain Lang. 2019 May 10. [Epub ahead of print]


Koenraads SPC, El Marroun H, Muetzel RL, Chang SE, Vernooij MW, Baatenburg de Jong RJ, White T, Franken MC, van der Schroeff MP.

Erasmus University Medical Center, Rotterdam, the Netherlands; University of Michigan, Ann Arbor, MI, United States.


Stuttering is a developmental speech disorder originating in early childhood. We aimed to replicate the association of stuttering and structural morphometry using a large, population-based prospective cohort, the Generation R Study, and explore the neurobiological mechanism of stuttering in children. Twenty-six children with a history of stuttering and 489 fluent speaking peers (ages 6-9) were included in the MRI sub-study. Cortical and subcortical regions of interest were analyzed using linear regression models. Compared to fluent speakers, children with a history of stuttering had less gray matter volume in the left inferior frontal gyrus and supplementary motor area. Exploratory surface-based brain analysis showed thinner cortex in the left inferior frontal gyrus, and in bilateral frontal and parietal areas. These findings corroborate previous studies that reported aberrant brain morphometry in speech motor and auditory regions in children who stutter. Future research is needed to explore the causal nature of this association.

PMID: 31085031 DOI: 10.1016/j.bandl.2019.04.008




The Efficacy of Phonological Processing Treatment on Stuttering Severity in Persian Pre-School Children - FALA

Iran J Child Neurol. 2019 Spring;13(2):89-102.


Tahmasebi N, Rasti Borujeni M, Soltani M, Latifi M, Moradi N.

University of Medical Sciences, Ahvaz, Iran.


OBJECTIVES: Correct phonological encoding is crucial to fluent speech production. Phonological working memory and phonological awareness are important phonological processes that affect phonological encoding. The purpose of this study was to investigate the effect of phonological processing on stuttering severity of Persian pre-school children.

MATERIALS & METHODS: Six children were targeted in this study in Ahvaz City, southern Iran in 2018, with Quasi-experimental design (Before and after clinical trial). These children participated in a treatment protocol, scheduled in 13-sessions. The treatment protocol of the phonological processing included nonword repetition in the phonological working memory and phonological awareness therapy. Overall, 30 nonwords were taken to examine the phonological working memory. The Persian test of language development was taken to examine phonological awareness. Stuttering severity measurements were performed with pre- and post-treatment. The severity rating was instructed to the parents based on Guitar protocol. They were asked to keep score every day until the end of the treatment sessions, and they reported the score to the therapist.

RESULTS: The stuttering severity score in pre and post-treatment was significant (P=0.027), and in the follow-up, phase was not significant (P=0.236); stuttering severity was reduced in children who stutter. Moreover, the severity rating score reported by parents during treatment was significant (P= 0.0001). This showed a reduction in stuttering severity.

CONCLUSION: The poor performance of phonological awareness and phonological working memory in phonological processing affect stuttering severity. Treatment of sub-systems of phonological processing can have an important role in reducing stuttering severity and increasing speech fluency.

PMID: 31037082 PMCID: PMC6451850 [Available on 2019-06-01]




The Influence of Treatment on Children's Recovery from Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017). - LINGUAGEM

J Speech Lang Hear Res. 2019 May 6:1-5 [Epub ahead of print]


Marcotte AK.

University of Georgia, Athens.


Purpose Two studies published recently in this journal sought to expand on previous attempts to explain and predict young children's recovery from stuttering. This letter addresses the influence of treatment on such research. Conclusions Recent publications from Kefalianos et al. (2017) and Leech, Bernstein Ratner, Brown, and Weber (2017) added to previous information that gender and language ability (or language growth) may be related to children's recovery from stuttering. The conclusions from both studies are difficult to interpret, however, because neither incorporated two factors known to influence children's recovery: a family history of recovery and, especially, the type and timing of treatment. Consideration of these two articles therefore raises multiple empirical, theoretical, and clinical issues that deserve to be fully addressed if our discipline is seeking to understand and to maximize recovery for young children who stutter.

PMID: 31058572 DOI: 10.1044/2019_JSLHR-S-17-0437




The lived experience of stuttering: a synthesis of qualitative studies with implications for rehabilitation - TERAPIA

Disabil Rehabil. 2019 Jan 29:1-11. [Epub ahead of print]


Connery A, McCurtin A, Robinson K.

University of Limerick , Limerick , Ireland; HSE Dublin South West , Dublin , Ireland.


PURPOSE: Stuttering is a chronic communication disorder resulting in challenging life experiences for many individuals. This review aimed to integrate qualitative findings on the lived experiences of people who stutter and identify implications for rehabilitation.

MATERIALS AND METHODS: A systematic literature search of electronic databases for studies published since 2000 was completed to identify research papers that used qualitative methods to explore the lived experiences of adults who stutter. Forty-five papers were read in full and a final seventeen papers were synthesised using a meta-ethnographic approach.

RESULTS: Five themes are described: (i) Avoidance is used to manage stuttering; (ii) Stuttering unfavourably impacts employment experiences; (iii) Stuttering shapes self-identity; (iv) Stuttering leads to negative reactions; and (v) Stuttering impacts relationships adversely.

CONCLUSIONS: This review identifies the profound and predominantly negative impact that stuttering has on individuals' experiences. Avoidance is a commonly used strategy to manage stuttering with further negative consequences for the individual. To promote person-centred care and enhance treatment outcomes, clinicians should be cognizant of the profound impact of stuttering on the individual's life experience and incorporate targeted goals to reflect this when intervening.

IMPLICATIONS FOR REHABILITATION Clinicians should be aware of and understand the extent of the impact of stuttering on an individual's life which is typified by various forms of avoidance and challenges in a number of domains including employment, identity formation, relationship development and others' perceptions of the person who stutters. An impairment-based approach to stuttering treatment with adults focusing on the overt aspects of stuttering (i.e., speech behaviours) is not holistic and does not do justice to the spectrum of covert features such as avoidance, and internalised thoughts and feelings that are associated with the condition. Therefore, the adoption of a holistic approach to stuttering intervention is recommended. An understanding of adults' lived experience of stuttering has the potential to inform programme developments for children and adolescents with the same condition and thus employ preventative strategies to reduce the development of negative life experiences at an earlier age. Clinicians should engage with the field of disability studies to strengthen their practice and consider their role in addressing socially-imposed barriers such as negative attitudes impacting on people who stutter.

PMID: 30696288 DOI: 10.1080/09638288.2018.1555623




The working alliance in stuttering treatment: a neglected variable? - TERAPIA

Int J Lang Commun Disord. 2019 Mar 13. [Epub ahead of print]


Sønsterud H, Kirmess M, Howells K, Ward D, Feragen KB, Halvorsen MS.

University of Oslo, Oslo, Norway; Department of Speech and Language Disorders, Oslo, Norway; Sunnaas Rehabilitation Hospital, Norway; Independent scholar, Wilmslow, UK; University of Reading, Speech Research Laboratory, Reading, UK; Oslo University Hospital, Centre for Rare Disorders, Oslo, Norway.


BACKGROUND: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular.

AIMS: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post-therapy.

METHODS & PROCEDURES: Eighteen adults (21-61 years) participated in this multiple single-case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory-Short Version Revised (WAI-SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST-E), the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A), the Wright & Ayre Stuttering Self-Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS).

OUTCOMES & RESULTS: Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post-treatment. The association between client-led goals and therapy tasks appeared particularly important.

CONCLUSIONS & IMPLICATIONS: The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client-clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.

PMID: 30866151 DOI: 10.1111/1460-6984.12465