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PubMed1986

Acoustic analysis and perception of vowels in stuttered speech.

In stuttered repetitions of a syllable, the vowel that occurs often sounds like schwa even when schwa is not intended. In this article, acoustic analyses are reported which show that the spectral properties of stuttered vowels are similar to the following fluent vowel, so it would appear that the stutterers are articulating the vowel appropriately. Though spectral properties of the stuttered vowels are normal, others are unusual: The stuttered vowels are low in amplitude and short in duration. In two experiments, the effects of amplitude and duration on perception of these vowels are examined. It is shown that, if the amplitude of stuttered vowels is made normal and their duration is lengthened, they sound more like the intended vowels. These experiments lead to the conclusion that low amplitude and short duration are the factors that cause stuttered vowels to sound like schwa. This differs from the view of certain clinicians and theorists who contend that stutterers actually articulate /schwa/'s when these are heard in stuttered speech. Implications for stuttering therapy are considered.

Acoustic Stimulation↗
PubMed1993

Lung volume changes during relatively fluent speech in stutterers.

We investigated breathing patterns in stutterers during relatively fluent speech and compared these with normal subjects for similar speech tasks. Rib cage and abdominal displacements and esophageal, gastric, and transdiaphragmatic pressures provided indexes of diaphragmatic, rib cage, and abdominal muscle contraction. We found that stutterers spoke either at substantially higher or lower lung volumes than normal subjects, confining their speech to the inspiratory capacity or expiratory reserve volume. During spontaneous speech, stutterers did not cross functional residual capacity (FRC) for most breaths. In addition, stutterers used several different motion pathways from breath to breath. At high lung volumes stutterers used the diaphragm to provide inspiratory braking. At lung volumes below FRC stutterers recruited their abdominals. This contrasted with normal subjects who spoke in the middle part of the vital capacity and who recruited inspiratory and expiratory rib cage muscles above and below FRC, respectively. Breath sizes were log-normally distributed in stutterers compared with a gaussian distribution in normal subjects (P < 0.001). During reading, stutterers tended to cross FRC (P < 0.01), used very similar initiation lung volumes from breath to breath (P < 0.001), and used similar motion pathways to achieve deflation. We conclude that stutterers sustain fluency by speaking at abnormally high or low lung volumes and that this may account for the different muscle patterns observed in stutterers compared with normal subjects.

Diaphragm↗
PubMedDate not supplied

Copper in developmental stuttering.

It has previously been reported that men with developmental stuttering showed reduced concentration of copper in the blood, and a negative correlation between the copper level and the severity of stuttering. Disorders of copper metabolism may result in dysfunction of the basal ganglia system and dystonia, a motor disorder sharing some traits of stuttering. It has been shown that copper ions affect the dopamine and the GABA systems. With this background we investigated the plasma level of copper, the copper binding protein ceruloplasmin, and the estimated level of free copper in stuttering adults. Sixteen men with developmental stuttering were compared with 16 men without speech problems. The samples were assayed in one batch in a pseudorandom and counterbalanced order. No significant differences were found between stuttering men and the control group in any of the biological variables, and no negative correlation between copper and the general severity of stuttering was shown. On the contrary, an explorative analysis resulted in a positive correlation between high plasma copper and superfluous muscular activity during stuttering (r=0.51, p=0.04). This result indicates that there is no relation between developmental stuttering and low plasma copper in the main population of stuttering adults.

Adult↗
PubMed2003

Atypical cerebral laterality in adults with persistent developmental stuttering.

BACKGROUND: Two of the most consistent anatomic asymmetries found in the human brain are a larger right than left prefrontal and left than right occipital lobe. Reduced or reversed asymmetries of these regions are considered markers of atypical cerebral laterality, and atypical cerebral laterality has been proposed to increase neural risk for developmental stuttering. OBJECTIVE: S: To learn if atypical prefrontal and occipital lobe asymmetries are more common in adults who stutter vs fluent control subjects and to determine whether lobar size or asymmetry patterns are associated with stuttering severity or language abilities. METHODS: Adults with persistent developmental stuttering (n = 16) and matched control subjects (n = 16) had language and stuttering assessments. Subjects were also studied with volumetric MRI scans. Total hemisphere, prefrontal, and occipital lobe regions were measured, and volumes were calculated proportionally to hemisphere volume. RESULTS: Hemisphere and total brain volumes did not differ between the groups. Control subjects had the expected larger right than left prefrontal and larger left than right occipital lobe volume. In contrast, the adults who stutter did not have these asymmetries. Stuttering severity was not associated with specific anatomic configurations, whereas language-processing deficits in adults who stutter were associated with prefrontal and occipital volume reduction. CONCLUSIONS: Developmental stuttering is associated with atypical prefrontal and occipital lobe asymmetries. In addition, deficits in language processing were associated with some anatomic measures in the adults who stutter.

Adult↗
PubMed1994

Laryngeal botulinum toxin injections for disabling stuttering in adults.

Stuttering is an action-induced speech disorder with involuntary, audible, or silent repetitions or prolongations in the utterance of short speech elements (sounds, syllables) and words. Symptomatic treatment programs frequently have initial success; persistent benefit is variable and many patients remain disabled. Stuttering has many characteristics similar to spasmodic dysphonia (laryngeal dystonia), often including the presence of adductor laryngeal spasms that obstruct airflow (glottal block). We hypothesized that relief of the spasmodic dysphonic glottal blocks in stutterers would modify the stuttering phenomenon and increase fluency. We therefore studied the effects of bilateral vocal fold injections of botulinum toxin type A (BTX) on dysfluency and speech characteristics in stuttering. We treated 14 adult patients (12 men, 2 women) with persistent stuttering and glottal block who previously failed standard speech therapy with 1.25 U BTX into each thyroarytenoid (vocalis) muscle. Fluency evaluations included the Stuttering Severity Instrument, the Perceptions of Stuttering Inventory, and a global rating scale (percent of normal function). Patients were evaluated at baseline and at 2-, 6-, and 12-week follow-up visits. Improvement in fluency documented by each rating instrument occurred at 2 and 6 weeks, with functional relapse by 12 weeks in most patients. We conclude that therapeutic laryngeal injections of botulinum toxin are useful in the management of stuttering with glottal block and result in a moderate improvement in fluency. When an adult patient with developmental stuttering with glottal blocks has failed speech interventional therapy and presents for treatment, a trial of BTX can be considered early.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Is stuttering due to a deficient comprehension of linguistic structures?

The results of two studies with 19 stutterers of two educational levels show that stutterers with more education stutter less but judge boundary depths in sentences better than stutterers with less education. This finding suggests that, among stutterers, the amount of stuttering and the comprehension of linguistic structures correlate negatively. These results gave rise to the loaded assumption that stuttering may be based on a deficiency in central linguistic processes. However, a third study with 20 nonstutterers leads to the conclusion that this does not hold for the imaginable continuum from nonstuttering to stuttering: for both educational levels nonstutterers do not differ from stutterers in judging constituent boundaries. This outcome does not support that stuttering may be based on a shortcoming in central linguistic processes but rather on a shortcoming in speech production at the level of articulation.

Educational Status↗
PubMed1993

[Social conditions of stuttering].

Sixty-seven stuttering and 50 non-stuttering children, all of them aged between three and five years, were investigated regarding their social conditions in an interdisciplinary study. Numerous studies so far conducted into family circumstances of stuttering children and adolescents have supported diverse conclusions regarding the parent-child relationship, personality traits of parents as well as their style of child raising and social status. Most of the resulting publications have concentrated on children from whom stuttering symptoms had been recordable for several years, so that it was not safely verifiable whether the parental behaviour described had been one of the causal factors for stuttering of children or a belated response to that stuttering. The author's own investigations showed significant differences with regard to presence in a day nursery in the child's first year, space conditions at home, attention given to the child, physical exercise, occupational satisfaction of mothers and self-appraising qualities of fathers. These differences, on balance, are interpreted to the effect that in the individual case stuttering may be affected by psychosocial conditions and would then call for therapeutic action, although it appears to be obvious that there are no stutter-specific social factors. These results are likely to confirm experience obtained from work with stuttering individuals by numerous medical doctors, teachers in lalopathology and psychologists who found that in general manifestations of stuttering may be caused and affected by a number of factors, both endogenic and exogenic.

Child, Preschool↗
PubMed1996

Stuttering Reperfusion of Ischemic Myocardium Does Not Exacerbate Myocardial Infarction: Evidence Against Lethal Cell Reperfusion Injury in the Rabbit.

In the clinical setting of acute myocardial infarction, coronary reperfusion may occur intermittently. Whether this intermittent or stuttering reperfusion exacerbates reperfusion cell injury is not known. To investigate whether stuttering reperfusion affects the development of necrosis, anesthetized male rabbits were randomized to either control or stuttering-reperfusion groups. The control rabbits underwent 40 minutes of continuous left anterior descending (LAD) occlusion followed by 3 hours of continuous reperfusion. The stuttering-reperfusion rabbits were occluded for the same 40 minutes but were reperfused for 1 minute at 37, 39, and 41 minutes into the occlusion period. Each of these brief reperfusion periods was followed by 1 minute of occlusion. After 40 minutes of occlusion (43 minutes after initial occlusion), the stuttering-reperfusion group was continuously reperfused for 3 hours. Regional myocardial blood flow was measured during occlusion and 30 minutes after final repe rfusion in both groups. Area at risk (AR, %LV) was delineated by in vivo blue dye injection and the area of necrosis (AN) by in vitro tetrazolium staining. Results: There was no difference in AR blood flow between groups, Ischemic blood flow (ml/min/g) was 0.05 +/- 0.02 in the control group and 0.09 +/- 0.04 in stuttering-reperfusion group. After reperfusion, blood flow in the ischemic area was 1.36 +/- 0.13 in control and 1.87 +/- 0.40 in stuttering-reperfusion rabbits. The AN expressed as a percentage of the AR was 43 +/- 8 in the control rabbits and 36 +/- 6 in the stuttering-reperfusion rabbits. Stuttering-reperfusion did not augment the development of necrosis compared with the control group. Conclusion: Reperfusing the myocardium in a stuttering fashion had no effect on the amount of necrosis and did not contribute to lethal cell reperfusion injury in this model.

Journal Article↗
PubMed2005

Stuttered and fluent speech production: an ALE meta-analysis of functional neuroimaging studies.

This study reports an activation likelihood estimation (ALE) meta-analysis of imaging studies of chronic developmental stuttering in adults. Two parallel meta-analyses were carried out: (1) stuttered production in the stutterers; (2) fluent production in the control subjects. The control subjects' data replicated previous analyses of single-word reading, identifying activation in primary motor cortex, premotor cortex, supplementary motor area, Rolandic operculum, lateral cerebellum, and auditory areas, among others. The stuttering subjects' analysis showed that similar brain areas are involved in stuttered speech as in fluent speech, but with some important differences. Motor areas were over-activated in stuttering, including primary motor cortex, supplementary motor area, cingulate motor area, and cerebellar vermis. Frontal operculum, Rolandic operculum, and anterior insula showed anomalous right-laterality in stutterers. Auditory activations, due to hearing one's own speech, were essentially undetectable in stutterers. The phenomenon of efference copy is proposed as a unifying account of the pattern activation revealed within this ALE meta-analysis. This provides the basis for a stuttering system model that is testable and should help to advance the understanding and treatment of this disorder.

Brain↗
PubMed1996

Stuttering may be a type of action dystonia.

We observed abnormal involuntary movements, involving principally the facial and neck muscles, in 23 patients with stuttering. These movements were similar to involuntary movements seen in distinct dystonic syndromes. There was a history of stuttering in the first degree relatives of six patients. The association of stuttering with degenerative neurologic disorders and focal brain lesions, cerebral blood flow changes in patients with developmental stuttering, its occurrence as a side effect of centrally acting drugs, induction and alleviation of stuttering by mechanical perturbation, or by electrical stimulation of the thalamus, a strong genetic predisposition with male preponderance, and the statistically significant occurrence of stuttering in the family history of patients with idiopathic torsion dystonia suggest an organic basis for developmental stuttering. These findings and the reported similarities between the involuntary movements associated with stuttering and dystonic involuntary movements support the hypothesis that stuttering is a form of segmental or focal action dystonia.

Adolescent↗
PubMed1975

Variables affecting stutterer's initial reactions to delayed auditory feedback.

Twenty male stutterers (7-18 years) described pictures under delayed auditory feedback (DAF). Delay was varied from 0 to 300 msec in 50 msec steps. There was a significant interaction between delay time, age and initial disfluency in terms of disfluent words but not speech rate. Young stutterers (7-12 years) were generally more affected by DAF than older stutterers (13-18 years). Under DAF high disfluent stutterers showed reduced disfluency, whereas low disfluent stutterers either showed little or no change or became more disfluent. Delays of 50-150 msec tended to have an ameliorative effect on stuttering. Conflicting results were obtained when the same subjects repeated short sentences under DAF. The majority of stutterers were fluent when repeating the sentences under no delay, but stuttering increased under DAF. Current explanations of the DAF effect and feedback theories of stuttering do not readily account for these results.

Adolescent↗
PubMedDate not supplied

Stuttering and the basal ganglia circuits: a critical review of possible relations.

UNLABELLED: The possible relation between stuttering and the basal ganglia is discussed. Important clues to the pathophysiology of stuttering are given by conditions known to alleviate dysfluency, like the rhythm effect, chorus speech, and singing. Information regarding pharmacologic trials, lesion studies, brain imaging, genetics, and developmental changes of the nervous system is reviewed. The symptoms of stuttering are compared with basal ganglia motor disorders like Parkinson's disease and dystonia. It is proposed that the basal ganglia-thalamocortical motor circuits through the putamen are likely to play a key role in stuttering. The core dysfunction in stuttering is suggested to be impaired ability of the basal ganglia to produce timing cues for the initiation of the next motor segment in speech. Similarities between stuttering and dystonia are indicated, and possible relations to the dopamine system are discussed, as well as the interaction between the cerebral cortex and the basal ganglia. Behavioral and pharmacologic information suggests the existence of subtypes of stuttering. LEARNING OUTCOMES: As a result of this activity, the reader will (1) become familiar with the research regarding the basal ganglia system relating to speech motor control; (2) become familiar with the research on stuttering with indications of basal ganglia involvement; and (3) be able to discuss basal ganglia mechanisms with relevance for theory of stuttering.

Basal Ganglia↗
PubMed2003

Towards a functional neural systems model of developmental stuttering.

UNLABELLED: This paper overviews recent developments in an ongoing program of brain imaging research on developmental stuttering that is being conducted at the University of Texas Health Science Center, San Antonio. This program has primarily used H(2)15O PET imaging of different speaking tasks by right-handed adult male and female persistent stutterers, recovered stutterers and controls in order to isolate the neural regions that are functionally associated with stuttered speech. The principal findings have emerged from studies using condition contrasts and performance correlation techniques. The emerging findings from these studies are reviewed and referenced to a neural model of normal speech production recently proposed by Jürgens [Neurosci. Biobehav. Rev. 26 (2002) 235]. This paper will report (1) the reconfiguration of previous findings within the Jürgens Model; (2) preliminary findings of an investigation with late recovered stutterers; (3) an investigation of neural activations during a treatment procedure designed to produce a sustained improvement in fluency; and (4) an across-studies comparison that seeks to isolate neural regions within the Jürgens Model that are consistently associated with stuttering. Two regions appear to meet this criterion: right anterior insula (activated) and anterior middle and superior temporal gyri (deactivated) mainly in right hemisphere. The implications of these findings and the direction of future imaging investigations are discussed. EDUCATIONAL OBJECTIVES: The reader will learn about (1) recent uses of H(2)15O PET imaging in stuttering research; (2) the use of a new neurological model of speech production in imaging research on stuttering; and (3) initial findings from PET imaging investigations of treated and recovered stutterers.

Adolescent↗
PubMed2003

Preliminary results of a functional MRI study of brain activation patterns in stuttering and nonstuttering speakers during a lexical access task.

UNLABELLED: An fMRI study examining lexical access and lexical generation in nine non-stuttering and seven stuttering speakers is presented. Lexical access was examined during a word description task that was presented auditorily while subjects "silently" thought of the target words. Participants alternated between four 30-s rest blocks and four 30-s "active" blocks. Activation patterns were assessed utilizing a standard subtraction paradigm, where the activation during the rest blocks was subtracted from the activation during the active blocks. High levels of variability characterized activation patterns within both speaker groups. Group comparisons using random effects statistical analyses did not identify significant differences between the groups when corrected for multiple comparisons. Analyses were subsequently conducted by comparing the trends in the group activation patterns between the speaker groups using fixed (corrected) and random effects (uncorrected) analyses. Non-stuttering control speakers activated primarily left hemisphere cortical speech and language areas while the stuttering speakers appeared to produce more bilateral activation. Discussion of these results focuses on the specific within- and between-hemispheric activation patterns and possible interpretations of these patterns. EDUCATIONAL OBJECTIVES: The reader will learn about: (1) issues related to interpreting brain activation findings in stuttering speakers; (2) the role and neurological substrates of lexical access during speech production in non-stuttering and stuttering speakers; (3) the basics of functional MRI; and (4) the brain activation areas involved during a silent lexical retrieval task in non-stuttering and stuttering speakers.

Adult↗
PubMed2005

Assessment of stuttering in a familiar versus an unfamiliar language.

UNLABELLED: The present study investigated how well individuals knowledgeable about stuttering are able to make disfluency judgments in clients who speak another language than their own. Fourteen native speakers of Brazilian Portuguese identified and judged stuttering in Dutch speakers and in Portuguese speakers. Fourteen native speakers of Dutch identified and judged stuttering in Brazilian Portuguese speakers and in Dutch speakers. It was found that judges can make similar level of judgment in a native and a foreign language, and that native and foreign judges can make similar level of judgment irrespective of native/foreign differences. It was also found, however, that the Dutch judges performed significantly better in identifying native stutterers than foreign stutterers. And for the identification of nonstutterers, both panels performed better in their native language than in the foreign language, and in their native language they both performed better than the other panel. Both the Brazilian Portuguese and the Dutch speaking panel were generally also less confident, and found identification of stuttering more difficult in the foreign language than in the native language. In addition, when asked for the characteristics that helped them identify stutterers, they provided more detail in the native language than in the foreign language. Also a number of differences were found between the two panels which may be due to differences in training or cultural background. The implications of the findings for clinical practice and for future research in this area are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how language influences the identification of a speech disorder such as stuttering, and (2) list, and (3) define behaviors that help to identify stuttering in a foreign language.

Adolescent↗
PubMed2005

The effects of temporal modification of second speech signals on stuttering inhibition at two speech rates in adults.

The recovery of 'gestural' speech information via the engagement of mirror neurons has been suggested to be the key agent in stuttering inhibition during the presentation of exogenous second speech signals. Based on this hypothesis, we expect the amount of stuttering inhibition to depend on the ease of recovery of exogenous speech gestures. To examine this possibility, linguistically non-congruent second speech signals were temporally compressed and expanded in two experiments. In Experiment 1, 12 participants who stutter read passages aloud at normal and fast speech rates while listening to second speech signals that were 0, 40, 80% compressed, and 40 and 80% expanded. Except for the 80% compressed speech signal, all other stimuli induced significant stuttering inhibition relative to the control condition. The 80% compressed speech signal was the first exogenously presented speech signal that failed to significantly reduce stuttering frequency by 60--70% that has been the case in our research over the years. It was hypothesized that at a compression ratio of 80%, exogenous speech signals generated too many gestures per unit time to allow for adequate gestural recovery via mirror neurons. However, considering that 80% compressed signal was also highly unintelligible, a second experiment was conducted to further examine whether the effects of temporal compression on stuttering inhibition are mediated by speech intelligibility. In Experiment 2, 10 participants who stutter read passages at a normal rate while listening to linguistically non-congruent second speech signals that were compressed by 0, 20, 40, 60, and 80%. Results revealed that 0 and 20% compressed speech signals induced approximately 52% stuttering inhibition. In contrast, compression ratios of 40% and beyond induced only 27% stuttering inhibition although 40 and 60% compressed signals were perceptually intelligible. Our findings suggest that recovery of gestural information is affected by temporal compression before intelligibility starts to decrease.

Adult↗
PubMed1997

Hemispheric asymmetries in stutterers: disorder severity and neuroticism?

This study tests the hypothesis that there is atypical brain asymmetry in stuttering children. In particular the association of both severity of stuttering and neuroticism with cerebral laterality in perception of visuospatial material is tested. Subjects were asked to recognize faces presented laterally in the left or right visual field and point to the exposed stimuli on response cards containing three different faces. Recognition errors committed in the left and right field presentations were analyzed. In fluent speakers and in moderately neurotic stutterers, fewer errors were found for the right hemisphere independently of their neuroticism score; in contrast, stutterers with a high neuroticism score showed fewer errors for the left hemisphere. The latter was true regardless of severity of stuttering. The study suggests a close link between atypical hemispheric dominance in the face recognition test and the emotional state in stutterers as defined by their neuroticism score. This characteristic may be related to the negative emotional reactions demonstrated relatively often by stuttering individuals. In highly neurotic stutterers, the negative affective states might be associated with disturbances of right hemisphere functioning and related to an atypical asymmetry pattern in the processing of right-hemispheric stimuli. These results illustrate the importance of controlling for subject-related factors while conducting and interpreting investigations on stutterers.

Adolescent↗
PubMedDate not supplied

Evaluating treatment outcomes for adults who stutter.

The evaluation of stuttering treatment outcomes has traditionally focused primarily on changes in the production of speech disfluencies, even though many treatment approaches also address other aspects of the stuttering disorder, such as the speaker's reactions to stuttering and the overall effect of stuttering on the speaker's ability to communicate. One reason for the relative lack of outcomes data for many commonly recommended treatment programs is the fact that clinicians and researchers have not previously had access to a reliable means of assessing changes in the broader consequences of stuttering on a speaker's life. This paper describes an ongoing effort to develop a series of measurement instruments that can be used to evaluate the outcomes of a wide variety of stuttering treatment approaches by measuring changes in speakers' affective, behavioral, and cognitive reactions to stuttering; the effect of stuttering on speakers' functional communication abilities; and the impact of stuttering on speakers' overall quality of life.

Communication↗