Eliana Maria Nigro Rocha


Abstract - Agosto a Dezembro de 2021





A preliminary study on the quantification of soft palate movement using ultrasonography - FALA

Congenit Anom (Kyoto). 2021 Oct 7.  Online ahead of print.


Kumiko Fujiwara, Satoru Saitou, Ryo Nagaoka, Naomi Nakamichi, Kei Tomihara, Hideyuki Hasegawa, Makoto Noguchi

University of Toyama, Toyama, Japan; Pigeon Central Research Institute, Pigeon Co., Ltd., Ibaragi, Japan.


Velopharyngeal incompetence (VPI) is a motor impairment of the soft palate that can result in functional disorders, such as stuttering. Therefore, therapeutic interventions for VPI should begin at an early stage. We examined the possibility of early detection of motor impairments of the soft palate with ultrasonographic observations. The study was conducted on five individuals without suckling disorders (two males, three females) at 6-9 postnatal weeks of age (stage 1) and 13-23 postnatal weeks of age (stage 2). The extent and speed of soft palate movement during suckling was measured with ultrasonography. The extent of movement of the soft palate was 5.67 ± 0.68 mm at stage 1 and 6.42 ± 1.55 mm at stage 2 (t = 0.929, p = 0.190). The speed of soft palate movements at stage 1 was 44.00 ± 9.93 mm/s during elevation and 27.37 ± 8.07 mm/s during depression (t = 5.182, p = 0.007), whereas that at stage 2 was 42.89 ± 14.37 mm/s during elevation and 26.43 ± 9.06 mm/s during depression (t = 3.195, p = 0.033). We observed regular soft palate elevations and depressions during suckling. There were no differences in the extent or speed of movements between stages 1 and 2. Future studies are needed to compare differences in motor impairments of the soft palate between healthy children and those suspected of having a submucous cleft palate or VPI.

PMID: 34622489 DOI: 10.1111/cga.12446




Adults who stutter do not stutter during private speech - SOCIAL

J Fluency Disord. 2021 Sep 9;70:105878. Online ahead of print.


Eric S Jackson, Lindsay R Miller, Haley J Warner, J Scott Yaruss

New York University, New York, NY, United States; Michigan State University, MI, United States.


Purpose: Adults who stutter tend not to stutter when they are alone. This phenomenon is difficult to study because it is difficult to know whether participants perceive that they are truly alone and not being heard or observed. This may explain the presence of stuttering during previous studies in which stutterers spoke while they were alone. We addressed this issue by developing a paradigm that elicited private speech, or overt speech meant only for the speaker. We tested the hypothesis that adults do not stutter during private speech.

Method: Twenty-four participants were audio-/video-recorded while speaking in several conditions: 1) conversational speech; 2) reading; 3) private speech, in which deception was used to increase the probability that participants produced speech intended for only themselves; 4) private speech+, for which real-time transcription was used so that participants produced the same words as in the private speech condition but while addressing two listeners; and 5) a second conversational speech condition.

Results: Stuttering was not observed in more than 10,000 syllables produced during the private speech condition, except for seven possible, mild stuttering events exhibited by 3 of 24 participants. Stuttering frequency was similar for the remaining conditions.

Conclusions: Adults appear not to stutter during private speech, indicating that speakers' perceptions of listeners, whether real or imagined, play a critical and likely necessary role in the manifestation of stuttering events. Future work should disentangle whether this is due to the removal of concerns about social evaluation or judgment, self-monitoring, or other communicative processes.

PMID: 34534899 DOI: 10.1016/j.jfludis.2021.105878




An unexpected iron in the fire of speech production - CONCEITO

Brain. 2021 Nov 29;144(10):2904-2905.


Martin Sommer, Shahriar SheikhBahaei, Gerald A Maguire

University Medical Center Goettingen, Germany; National Institutes of Health (NIH), Bethesda, MD 20892, USA; University of California, California, CA, USA.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634066/pdf/awab348.pdf


This scientific commentary refers to ‘Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering’, by Cler et al. (doi:10.1093/brain/awab283).

PMID: 34849599 PMCID: PMC8634066 DOI: 10.1093/brain/awab348




Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part I. Scale Development - TERAPIA

Am J Speech Lang Pathol. 2021 Sep 15;1-18. Online ahead of print.


Patricia M Zebrowski, Naomi H Rodgers, Hope Gerlach, Andrea L Paiva, Mark L Robbins

University of Iowa, Iowa City; University of Nebraska-Lincoln; Western Michigan University, Kalamazoo; University of Rhode Island, Kingston.


Purpose This article is the first in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. In this article, we describe the process of developing measures to assess stage of change (SOC) by defining behaviors of stuttering management, as well as the two primary cognitive constructs that underlie one's readiness to make behavioral change: decisional balance (DB) and situational self-efficacy (SSE). This work hinges on the ability to develop an operational definition of what it means to successfully manage or do something positive about one's stuttering.

Method We used an iterative process to develop the three scales. Through qualitative analysis of key informant interview and focus group transcripts with 24 adolescents who stutter and 26 clinicians specializing in stuttering, we developed stuttering-specific SOC, DB, and SSE scales. The drafted scales were cognitively tested with nine adolescents who stutter.

Results Thematic analysis yielded a three-part definition of successful stuttering management that formed the basis for the SOC scale: (a) learning and using strategies to modify speech or stuttering, (b) changing negative thoughts and attitudes regarding stuttering, and (c) talking without avoiding sounds, words, or situations. Results from this analysis support a broader view of successful stuttering management; that is, it is likely that doing so requires more than just behavior change, which has long been considered the main objective of stuttering treatment. Additional analyses yielded pros and cons of managing stuttering (62 items for the DB scale) and situations in which it is difficult to manage stuttering (39 items for the SSE scale). Conclusions Qualitative analyses provided a three-part definition of "stuttering management" and a comprehensive pool of items that would allow measurement of DB and SSE that underlie readiness to manage stuttering among adolescents. In the companion article in this two-part series, we describe the next step in scale development: exploratory scale validation of the drafted SOC, DB, and SSE scales.

PMID: 34525312 DOI: 10.1044/2021_AJSLP-20-00186




Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part II. Exploratory Scale Validation - TERAPIA

Am J Speech Lang Pathol. 2021 Oct 12;1-18. Online ahead of print.


Naomi H Rodgers, Hope Gerlach, Andrea L Paiva, Mark L Robbins, Patricia M Zebrowski

University of Nebraska-Lincoln; Western Michigan University, Kalamazoo; University of Rhode Island, Kingston; The University of Iowa, Iowa City.


Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter.

Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales.

Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways.

Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

PMID: 34637348 DOI: 10.1044/2021_AJSLP-21-00108




Assessing the psychosocial impact of stammering on work - SOCIAL

Occup Med (Lond). 2021 Dec 2;kqab169. Online ahead of print.


V Parsons, G Ntani, R Muiry, I Madan, G Bricker-Katz

Guy's and St Thomas NHS Foundation Trust, London, UK; King's College London, London, UK; University of Southampton, Southampton, UK; University of Sydney, Sydney , Australia.


Background: Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life.

Aims: To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention.

Methods: A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention.

Results: Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work.

Conclusions: Stammering can have a negative impact of workers' job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention.

PMID: 34865150 DOI: 10.1093/occmed/kqab169




Attentional biases in adults who stutter before and following social threat induction

Folia Phoniatr Logop. 2021 Oct 6. Online ahead of print.


Kim R Bauerly


No abstract available
PMID: 34614498 DOI: 10.1159/000519865




Atypical development of Broca's area in a large family with inherited stuttering - NEUROCIÊNCIAS

Brain. 2021 Nov 23;awab364. Online ahead of print.


Daisy G Y Thompson-Lake et al

UK;  Australia; USA


Developmental stuttering is a condition of speech dysfluency, characterized by pauses, blocks, prolongations and sound or syllable repetitions. It affects around 1% of the population, with potential detrimental effects on mental health and long-term employment. Accumulating evidence points to a genetic aetiology, yet gene-brain associations remain poorly understood due to a lack of MRI studies in affected families. Here we report the first neuroimaging study of developmental stuttering in a family with autosomal dominant inheritance of persistent stuttering. We studied a four-generation family, 16 family members were included in genotyping analysis. T1-weighted and diffusion-weighted MRI scans were conducted on seven family members (six male; aged 9-63 years) with two age and sex matched controls without stuttering (n = 14). Using Freesurfer, we analysed cortical morphology (cortical thickness, surface area and local gyrification index) and basal ganglia volumes. White matter integrity in key speech and language tracts (i.e. frontal aslant tract and arcuate fasciculus) was also analysed using MRtrix and probabilistic tractography. We identified a significant age by group interaction effect for cortical thickness in the left hemisphere pars opercularis (Broca's area). In affected family members this region failed to follow the typical trajectory of age-related thinning observed in controls. Surface area analysis revealed the middle frontal gyrus region was reduced bilaterally in the family (all cortical morphometry significance levels set at a vertex-wise threshold of P < 0.01, corrected for multiple comparisons). Both the left and right globus pallidus were larger in the family than in the control group (left P = 0.017; right P = 0.037), and a larger right globus pallidus was associated with more severe stuttering (rho = 0.86, P = 0.01). No white matter differences were identified. Genotyping identified novel loci on chromosomes 1 and 4 that map with the stuttering phenotype. Our findings denote disruption within the cortico-basal ganglia-thalamo-cortical network. The lack of typical development of these structures reflects the anatomical basis of the abnormal inhibitory control network between Broca's area and the striatum underpinning stuttering in these individuals. This is the first evidence of a neural phenotype in a family with an autosomal dominantly inherited stuttering.

PMID: 35296891 DOI: 10.1093/brain/awab364




Bidirectional Associations of Childhood Stuttering With Behavior and Temperament -  EMOCIONAL

J Speech Lang Hear Res. 2021 Nov 4;1-17. Online ahead of print.


Simone P C Koenraads, Pauline W Jansen, Robert Jan Baatenburg de Jong , Marc P van der Schroeff, Marie-Christine Franken

Erasmus University Medical Center, Rotterdam, the Netherlands.


Purpose Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood.

Method This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed.

Results Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (β = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (β = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (β = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years.

Conclusions Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

PMID: 34735297 DOI: 10.1044/2021_JSLHR-20-00252




Biomarkers Obtained by Transcranial Magnetic Stimulation in Neurodevelopmental Disorders - NEUROCIÊNCIAS

J Clin Neurophysiol. 2021 Aug 3. Online ahead of print.


Ali Jannati, Mary A Ryan, Harper L Kaye, Melissa Tsuboyama, Alexander Rotenberg

Harvard Medical School, Boston, Massachusetts, U.S.A.; Boston University School of Medicine, Boston, U.S.A.


Transcranial magnetic stimulation (TMS) is a method for focal brain stimulation that is based on the principle of electromagnetic induction where small intracranial electric currents are generated by a powerful fluctuating magnetic field. Over the past three decades, TMS has shown promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disorders in adults. However, the use of TMS in children has been more limited. We provide a brief introduction to the TMS technique; common TMS protocols including single-pulse TMS, paired-pulse TMS, paired associative stimulation, and repetitive TMS; and relevant TMS-derived neurophysiological measurements including resting and active motor threshold, cortical silent period, paired-pulse TMS measures of intracortical inhibition and facilitation, and plasticity metrics after repetitive TMS. We then discuss the biomarker applications of TMS in a few representative neurodevelopmental disorders including autism spectrum disorder, fragile X syndrome, attention-deficit hyperactivity disorder, Tourette syndrome, and developmental stuttering.

PMID: 34366399 DOI: 10.1097/WNP.0000000000000784




Case Report: Deutetrabenazine as an Adjunctive Treatment for Stuttering - FARMACOLOGIA

Case Reports Front Psychiatry. 2021 Oct 25;12:683368. eCollection 2021.


Catherine A Ha , Gerald A Maguire

University of California, Riverside, CA, United States.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8574968/pdf/fpsyt-12-683368.pdf


Childhood-Onset Fluency Disorder (Stuttering) is a neurodevelopmental disorder in which disturbances occur in the normal fluency and time patterning of speech. While the dopamine system has been well-described in its neurophysiology, there currently is no FDA-approved treatment for stuttering. Second-generation antipsychotics, which have been effective in the treatment of schizophrenia and bipolar disorder, act as dopamine D-2 receptor antagonists at the postsynaptic neuron and have been shown to reduce the symptoms of stuttering. However, the D-2 receptor antagonist and partial agonist agents carry the potential for metabolic side effects and can potentially lead to movement disorders. Deutetrabenazine, a VMAT-2 inhibitor indicated to treat hyperkinetic movement disorders, is a potential candidate in the treatment of stuttering, based on its mechanism of action in decreasing dopamine activity while not carrying the risk of metabolic adverse events.

PMID: 34759847 PMCID: PMC8574968 DOI: 10.3389/fpsyt.2021.683368




Communication attitude of Kannada-speaking adults who do and do not stutter - EMOCIONAL

J Fluency Disord. 2021 Aug 28;70:105866. Online ahead of print.


Rakesh Chowkalli Veerabhadrappa, Jyotsna Krishnakumar, Martine Vanryckeghem, Santosh Maruthy

All India Institute of Speech and Hearing, Mysore, India; University of Central Florida, Orlando, USA.


The Communication Attitude Test for Adults who stutter (BigCAT) is an established measure of cognitive traits in adults who stutter (AWS). The primary purpose of the present study was to adapt and validate the BigCAT to the Kannada language. The secondary purpose was to compare AWS' and adults who do not stutter (AWNS) BigCAT-K scores and compare AWS' score in sub-populations in terms of severity and age. The study included a purposive sample of 100 AWS and 317 AWNS. There was high test-retest reliability and solid construct validity, as made evident by the results of the discriminant analysis and cross-validation. Further, as in other investigations with the BigCAT (Vanryckeghem & Brutten, 2019), this self-report test revealed a statistically significant group mean difference between AWS and AWNS, suggesting the presence of a negative attitude towards communication in Kannada-speaking AWS. Further, individuals with severe stuttering had a significantly higher level of speech-associated negative attitude compared to those with mild stuttering. Age does not seem to influence the AWS' speech-associated belief system. Both of these findings augment the existing scant literature on exploring the association between stuttering severity and age on the cognitive dimension of stuttering. The outcomes establish the BigCAT-K as an effective tool in the assessment and subsequent management of stuttering.

PMID: 34481196 DOI: 10.1016/j.jfludis.2021.105866




Comparing evaluations of social situations for adults who do and do not stutter - EMOCIONAL

J Commun Disord. 2021 Nov 2;95:106161. Online ahead of print.


Shelley B Brundage, Katherine L Winters, Karla Armendariz, Ruchi Sabat, Janet M Beilby

George Washington University, Washington DC, United States; The University of Texas at Austin, Austin, TX, United States; KIPP NorCal Public Schools, 1000 Broadway, Oakland, CA, United States; Curtin School of Allied Health, Curtin University, Kent Street, Bentley, Perth, Western Australia.


Purpose: Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or-if like individuals with SAD-adults who stutter exhibit negative interpretation biases.

Method: Forty-eight adults who stutter and 42 age-and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios.

Results: Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme "stuttering" was mentioned infrequently by the adults who stutter.

Conclusions: Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.

PMID: 34872018 DOI: 10.1016/j.jcomdis.2021.106161




Complex nonverbal response inhibition and stopping impulsivity in childhood stuttering - PSICOMOTOR

J Fluency Disord. 2021 Sep 6;70:105877. Online ahead of print.


Levi C Ofoe, Julie D Anderson

Indiana University, Bloomington, United States


Purpose: The primary purpose of this study was to examine complex nonverbal response inhibition and stopping impulsivity in children who do (CWS) and do not stutter (CWNS).

Method: A total of 30 CWS and 30 CWNS between the ages of 3;1 and 6;0 (years; months) performed the Peg-Tapping Task (PTT; Diamond & Taylor, 1996; Luria, 1966), in which children were required to tap a dowel once when an examiner taps twice and vice versa. The main dependent variables were the number of practice trials, response accuracy, response latency for accurate responses, and the number of extra taps (i.e., tapping more than two times).

Results: The CWS were less accurate and slower on the PTT than the CWNS, with no differences in the number of practice trials. Furthermore, the CWS, especially boys, produced more extra taps than the CWNS.

Conclusions: Findings revealed that preschool CWS have weaknesses in complex response inhibition and stopping impulsivity in the nonverbal domain compared to CWNS. Taken together, these findings along with those of previous studies indicate that CWS may have weaknesses in inhibition and impulsivity in the nonverbal domain as well as the verbal domain, suggesting a domain-general weakness.

PMID: 34534900 DOI: 10.1016/j.jfludis.2021.105877




Consensus Guidelines for the Assessments of Individuals who Stutter Across the Lifespan - AVALIAÇÃO

Am J Speech Lang Pathol. 2021 Sep 13;1-15. Online ahead of print.


Shelley B Brundage, Nan Bernstein Ratner, Michael P Boyle, Kurt Eggers, Rachel Everard, Marie-Christine Franken, Elaina Kefalianos, Anne K Marcotte, Sharon Millard, Ann Packman, Martine Vanryckeghem, J Scott Yaruss

George Washington University, Washington, DC; University of Maryland, College Park; Montclair State University, Bloomfield, NJ; Thomas More University, Antwerp, Belgium; University of Turku, Finland; City Lit, London, United Kingdom; Erasmus University Medical Center, Rotterdam, the Netherlands; The University of Melbourne, Parkville, Victoria, Australia;  Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Georgia, Athens; The Michael Palin Centre for Stammering Children, London, United Kingdom; University of Technology Sydney, New South Wales, Australia; University of Central Florida, Orlando; Michigan State University, East Lansing.


Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan.

Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups.

Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering.

Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

PMID: 34516299 DOI: 10.1044/2021_AJSLP-21-00107




Convergence in voice fundamental frequency during synchronous speech - FALA

PLoS One. 2021 Oct 21;16(10):e0258747. eCollection 2021.


Abigail R Bradshaw, Carolyn McGettigan

University College London, London, United Kingdom.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530294/pdf/pone.0258747.pdf


Joint speech behaviours where speakers produce speech in unison are found in a variety of everyday settings, and have clinical relevance as a temporary fluency-enhancing technique for people who stutter. It is currently unknown whether such synchronisation of speech timing among two speakers is also accompanied by alignment in their vocal characteristics, for example in acoustic measures such as pitch. The current study investigated this by testing whether convergence in voice fundamental frequency (F0) between speakers could be demonstrated during synchronous speech. Sixty participants across two online experiments were audio recorded whilst reading a series of sentences, first on their own, and then in synchrony with another speaker (the accompanist) in a number of between-subject conditions. Experiment 1 demonstrated significant convergence in participants' F0 to a pre-recorded accompanist voice, in the form of both upward (high F0 accompanist condition) and downward (low and extra-low F0 accompanist conditions) changes in F0. Experiment 2 demonstrated that such convergence was not seen during a visual synchronous speech condition, in which participants spoke in synchrony with silent video recordings of the accompanist. An audiovisual condition in which participants were able to both see and hear the accompanist in pre-recorded videos did not result in greater convergence in F0 compared to synchronisation with the pre-recorded voice alone. These findings suggest the need for models of speech motor control to incorporate interactions between self- and other-speech feedback during speech production, and suggest a novel hypothesis for the mechanisms underlying the fluency-enhancing effects of synchronous speech in people who stutter.

PMID: 34673811 PMCID: PMC8530294




Determining the effect of tele-rehabilitation on patients with stutter using the goal attainment scaling (GAS) - TERAPIA

BMC Med Inform Decis Mak. 2021 Oct 12;21(1):280.


Maryam Eslami Jahromi, Leila Ahmadian

Iran University of Medical Sciences, Tehran, Iran; Kerman University of Medical Sciences, Kerman, Iran.

Free article: https://bmcmedinformdecismak.biomedcentral.com/track/pdf/10.1186/s12911-021-01642-3.pdf


Background: Lack of proper and timely patients' access to speech pathologists can affect the treatment and follow-up process; therefore, patients do not achieve the expected therapeutic goals. The aim of this study was to determine the effect of tele-rehabilitation on the stuttering patients using the goal attainment scaling (GAS).

Methods: This interventional study was carried out on patients who visited the rehabilitation centers affiliated to the Jahrom Welfare Office. They underwent remote speech therapy using Skype. To evaluate the treatment outcomes of the stuttering patients, GAS was used.

Results: The participants' speech and lingual skills improved using videoconferencing. The mean score of total GAS for patients was 53.08. Of 112 health goals, patients reached the expected or higher than expected levels in 78 goals.

Conclusions: Rehabilitation through video conferencing was effective for patients with stuttering, improved their speech, and decreased their stuttering. Since, application of remote rehabilitation services can provide regular access to healthcare services, it can lead to improving patient treatment provide more frequent and faster treatment follow-up.

PMID: 34641856 DOI: 10.1186/s12911-021-01642-3




[Development of speech disorders in children]- CONCEITO [Article in Russian]

Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(11):106-110.


V P Zykov, I B Komarova

Russian Medical Academy Continuing Professional Education, Moscow, Russia.


The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).

PMID: 34932295 DOI: 10.17116/jnevro2021121111106




Developmental Factors That Predict Head Movement During Resting-State Functional Magnetic Resonance Imaging in 3-7-Year-Old Stuttering and Non-stuttering Children - AVALIAÇÃO

Front Neurosci. 2021 Nov 3;15:753010.


Chelsea A Johnson, Emily O Garnett, Ho Ming Chow, Gregory J Spray, David C Zhu, Soo-Eun Chang

Michigan State University, East Lansing, MI, United States; University of Michigan, Ann Arbor, MI, United States; University of Delaware, Newark, DE, United States; Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States.


Early childhood marks a period of dynamic neurocognitive development. Preschool-age coincides with the onset of many childhood disorders and is a developmental period that is frequently studied to determine markers of neurodevelopmental disorders. Magnetic resonance imaging (MRI) is often used to explore typical brain development and the neural bases of neurodevelopmental disorders. However, acquiring high-quality MRI data in young children is challenging. The enclosed space and loud sounds can trigger unease and cause excessive head movement. A better understanding of potential factors that predict successful MRI acquisition would increase chances of collecting useable data in children with and without neurodevelopmental disorders. We investigated whether age, sex, stuttering status, and childhood temperament as measured using the Child Behavioral Questionnaire, could predict movement extent during resting-state functional MRI (rs-fMRI) in 76 children aged 3-7 years, including 42 children who stutter (CWS). We found that age, sex, and temperament factors could predict motion during rs-fMRI scans. The CWS were not found to differ significantly from controls in temperament or head movement during scanning. Sex and age were significant predictors of movement. However, age was no longer a significant predictor when temperament, specifically effortful control, was considered. Controlling for age, boys with higher effortful control scores moved less during rs-fMRI procedures. Additionally, boys who showed higher negative affectivity showed a trend for greater movement. Considering temperament factors in addition to age and sex may help predict the success of acquiring useable rs-fMRI (and likely general brain MRI) data in young children in MR neuroimaging.

PMID: 34803590 PMCID: PMC8595248 DOI: 10.3389/fnins.2021.753010




Does a simulation-based learning programme assist with the development of speech-language pathology students' clinical skills in stuttering management? - TERAPIA

Review Int J Lang Commun Disord. 2021 Sep 14. Online ahead of print.


Adriana Penman, Anne E Hill, Sally Hewat, Nerina Scarinci

The University of Queensland, St Lucia, QLD, Australia; The University of Newcastle, Callaghan, NSW, Australia.


Background: Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter.

Aims: (1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance.

Methods & procedures: Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored.

Outcomes & results: Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency.

Conclusions & implications: This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required.

PMID: 34519389 DOI: 10.1111/1460-6984.12670




Does stammering act as a barrier to exercise and sport in Irish adults who stammer? - SOCIAL

J Fluency Disord. 2021 Sep 15;70:105880. Online ahead of print.


Siobhán O'Connor, Kieran A Moran, Enda F Whyte, Aisling C Lacey

Dublin City University, Dublin, Ireland.


Purpose: Exercise and sport participation lead to many physical and psychosocial benefits. However, barriers to exercise and sporting participation exist. This study aims to examine if stammering acts as a barrier to exercise and sporting participation in adults.

Methods: One hundred and six adults who stammer (male n = 74, female n = 32; 33.83 ± 14.5 years) completed an anonymous questionnaire which evaluated their stammering history, exercise and sporting participation, views on why they exercise, whether stammering prevented or negatively influenced their participation in exercise or sport. Descriptive statistics were then calculated.

Results: The majority (90.6 %) of participants take part in some form of exercise/sport. However, their stammer prevented them from taking part in a specific exercise/sport at least once (49.1 %), due to being too nervous to introduce themselves, nervous or fear of stammering or being judged. Their stammer also negatively impacted their involvement when participating at least once (42.4 %), with not feeling part of the team and fear of speaking reported. Self-disclosure of their stammer and improving awareness of stammering were identified as common facilitators for taking part in exercise/sport.

Conclusion: Stammering was not found to impact general participation in exercise and sport but was identified as a barrier to partaking in specific exercise and sport and their enjoyment thereof. Encouraging those who stammer to inform those involved in sport and exercise (e.g. fellow players, coaches) about their stammer and improving stammer awareness across the general and sporting population may encourage further participation in exercise and sport in those who stammer.

PMID: 34543807 DOI: 10.1016/j.jfludis.2021.105880




Drug-Induced Stuttering: Occurrence and Possible Pathways - GAGUEIRA ADQUIRIDA

Front Psychiatry. 2021 Aug 25;12:692568.

Free Article: https://www.frontiersin.org/article/10.3389/fpsyt.2021.692568


Corine Ekhart, Florence van Hunsel, Peter van Harten, Jeanette van Baarsen, Tan Yingying, Bert Bast


Background: Stuttering is a well-known condition that affects mainly children. Often, they recover as they get older. However, a drug-induced form of stuttering may occur at any age. The aim of the present study was to detect drugs that have been associated with stuttering and discuss the mechanisms involved.

Method: A descriptive study based on reports submitted to the global pharmacovigilance database VigiBase of the WHO was conducted.

Results: A total of 3,385 reports of dysphemia were retrieved from VigiBase. These reports were contributed by 51 countries. Antiepileptics, antidepressants, immunosuppressants, antipsychotics, and centrally acting sympathomimetics were among the most frequently implicated drugs.

Conclusion: A wide variety of drugs has been linked to the occurrence or recurrence of stuttering. Several mechanisms, such as increased dopamine levels, reduction of GABA, anticholinergic properties of drugs, or changes in serotonin levels, have been associated with the development of drug-induced stuttering. Paradoxically, agents known to reduce stuttering in some people may induce it in others.

PMID: 34512414 PMCID: PMC8423914 DOI: 10.3389/fpsyt.2021.692568




Effect of linguistic factors on the occurrence of stuttering-like disfluency among Japanese-speaking preschool children who stutter - FALA

Clin Linguist Phon. 2021 Nov 29;1-16. Online ahead of print.


Daichi Iimura, Saburo Takahashi, Natsuki Fukazawa, Natsumi Morita, Takuya Oe, Shoko Miyamoto

Kawasaki University of Medical Welfare, Okayama, Japan; University of Tsukuba, Ibaraki, Japan; Sumiyoshi Elementar School, Tokyo, Japan; Tochigi Special Needs Education School, Tochigi, Japan.


This study aimed to investigate the linguistic factors involved in stuttering among Japanese-speaking preschool children. The participants included 10 Japanese children who stutter, with a mean age of 5 years and 9 months. Speech samples comprised spontaneous conversations of the participants with their parents for about 20 minutes. We compared the percentages of the occurrence of stuttering-like disfluencies (SLDs) at the word and sentence levels, using the Wilcoxon signed-rank test. The results showed no significant differences in SLDs based on syllable structure when comparing light and heavy syllables and comparing consonants and vowels in the initial position of each content word. SLDs occurred more frequently in the initial than non-initial position of words and in longer rather than shorter words. Additionally, SLDs occurred more frequently in sentences that contained more 'bunsetsu' (a kind of linguistic unit in Japanese). Our study is the first to show that both word and sentence-level factors could contribute to SLDs in preschool children who stutter in agglutinating languages, such as Japanese. This aspect is rarely reported in psycholinguistic studies based on stuttering occurrence in inflecting languages, such as English.

PMID: 34844496 DOI: 10.1080/02699206.2021.2001048




Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering - CONCEITO

Brain. 2021 Nov 9;awab283. Online ahead of print.


Gabriel J Cler, Saloni Krishnan, Daniel Papp, Charlotte E E Wiltshire, Jennifer Chesters, Kate E Watkins

University of Oxford, Oxford, UK; University of London, Egham Hill, UK; North Bristol NHS Trust, Bristol BS10 5NB, UK.


Theoretical accounts of developmental stuttering implicate dysfunctional cortico-striatal-thalamo-cortical motor loops through the putamen. However, the analysis of conventional MRI brain scans in individuals who stutter has failed to yield strong support for this theory in terms of reliable differences in the structure or function of the basal ganglia. Here, we performed quantitative mapping of brain tissue, which can be used to measure iron content alongside markers sensitive to myelin and thereby offers particular sensitivity to the measurement of iron-rich structures such as the basal ganglia. Analysis of these quantitative maps in 41 men and women who stutter and 32 individuals who are typically fluent revealed significant group differences in maps of R2*, indicative of higher iron content in individuals who stutter in the left putamen and in left hemisphere cortical regions important for speech motor control. Higher iron levels in brain tissue in individuals who stutter could reflect elevated dopamine levels or lysosomal dysfunction, both of which are implicated in stuttering. This study represents the first use of these quantitative measures in developmental stuttering and provides new evidence of microstructural differences in the basal ganglia and connected frontal cortical regions.

PMID: 34750604 DOI: 10.1093/brain/awab283




Ensaio clínico de tratamento – em três modalidades – para crianças com distúrbios da fluência e gagueira - INFANTIL / TERAPIA

Codas. 2021 Oct 22;34(2):e20200264. eCollection 2021.

 [Article in Portuguese, English]


Nathalia Dos Santos Fernandes de Ávila, Fabiola Juste, Julia Biancalana Costa, Claudia Regina Furquim de Andrade

Universidade de São Paulo - USP - São Paulo (SP), Brasil.

Free article: Abstract in English: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=en 

Portuguese: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=pt


Objetivo: Delinear um ensaio clínico de tratamento – em três modalidades – que verificasse se os tramentos testados para a gagueira crônica do desenvolvimento (GCD) apresentam indicadores que permitam reunir informações para a continuidade da sua aplicação, estabelecendo uma relação benefício-risco eficaz e segura.

Método: Para a realização do estudo foram analisadas 252 crianças, com idades entre 2 e 12 anos, que realizaram avaliação e tratamento para a GCD. Dentre as crianças atendidas, 93 cumpriram todos os critérios de elegibilidade. Após a obtenção dos escores de risco para GCD (Protocolo de Risco para a Gagueira do Desenvolvimento) todas as crianças foram avaliadas segundo seu perfil da fluência e grau de gravidade da gagueira. Foram aplicados os tratamentos para GCD: Programa Verde; Programa Amarelo e Programa Vermelho. A determinação do tratamento mais indicado para cada criança foi baseada na análise do grau de risco para a GCD.

Resultados: Todos os programas terapeuticos apresentaram resultados de melhora pós-tratamento consistentes nos segmentos analisados com exceção de: repetição de palavras; prolongamentos no final das palavras e intrusão de sons/segmentos.

Conclusão: Os programas terapêuticos testados – verde, amarelo e vermelho – foram eficientes para a ampla maioria dos participantes. A intervenção direta, aplicada no Programa Vermelho, foi altamente eficiente para a promoção da fala fluente, indicando que para os casos com maior índice de cronicidade a aplicação de técnicas específicas é indicada.




Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents - EMOCIONAL

J Commun Disord. 2021 Dec 8;95:106179.. Online ahead of print.


Naomi H Rodgers, Jennifer Y F Lau, Patricia M Zebrowski

University of Nebraska-Lincoln United States; Queen Mary University of London England; University of Iowa United States.


Purpose: The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

Methods: A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

Results: There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

Discussion: This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

PMID: 34902801 DOI: 10.1016/j.jcomdis.2021.106179




Fluency shaping increases integration of the command-to-execution and the auditory-to-motor pathways in persistent developmental stuttering - TERAPIA

Neuroimage. 2021 Nov 16;118736. Online ahead of print.


Alexandra Korzeczek, Annika Primaßin, Alexander Wolff von Gudenberg, Peter Dechent, Walter Paulus, Martin Sommer, Nicole E Neef

University Medical Center Göttingen, Göttingen, Germany; FH Münster University of Applied Sciences, Münster School of Health (MSH), Münster, Germany; Institut der Kasseler Stottertherapie, Bad Emstal, Germany.


Fluency-shaping enhances the speech fluency of persons who stutter, yet underlying conditions and neuroplasticity-related mechanisms are largely unknown. While speech production-related brain activity in stuttering is well studied, it is unclear whether therapy repairs networks of altered sensorimotor integration, imprecise neural timing and sequencing, faulty error monitoring, or insufficient speech planning. Here, we tested the impact of one-year fluency-shaping therapy on resting-state fMRI connectivity within sets of brain regions subserving these speech functions. We analyzed resting-state data of 22 patients who participated in a fluency-shaping program, 18 patients not participating in therapy, and 28 fluent control participants, measured one year apart. Improved fluency was accompanied by an increased synchronization within the sensorimotor integration network. Specifically, two connections were strengthened; the left inferior frontal gyrus showed increased connectivity with the precentral gyrus at the representation of the left laryngeal motor cortex, and the left inferior frontal gyrus showed increased connectivity with the right superior temporal gyrus. Thus, therapy-associated neural remediation was based on a strengthened integration of the command-to-execution pathway together with an increased auditory-to-motor coupling. Since we investigated task-free brain activity, we assume that our findings are not biased to network activity involved in compensation but represent long-term focal neuroplasticity effects.

PMID: 34798230 DOI: 10.1016/j.neuroimage.2021.118736




Granville Coggs (1925-2019) - WWII pilot, pioneering radiologist, and inspiration to minorities in medicine - HISTÓRIA

J Med Biogr. 2021 Nov 22;9677720211058314. Online ahead of print.


Anish Karlapudi, Richard B Gunderman

Indiana University School of Medicine, Indianapolis, Indiana, USA.


Role models play an important role in firing the imagination of medical students and residents, and when it comes to attracting and sustaining under-represented minorities in fields such as medicine, the inspiring stories of minority physicians can make an especially important contribution. One such physician was Granville Coggs, an Arkansas native who overcame a stutter, served among the Tuskegee Airmen during World War II, graduated from Harvard Medical School, became the first black physician at Kaiser Hospital, established the San Antonio Breast Evaluation Center, and won gold medals as a senior track star.
PMID: 34806466 DOI: 10.1177/09677720211058314




IFNAR1 gene mutation may contribute to developmental stuttering in the Chinese population - GENÉTICA

Hereditas. 2021 Nov 18;158(1):46.


Yimin Sun, Yong Gao , Yuxi Zhou, Yulong Zhou, Ying Zhang, Dong Wang, Li-Hai Tan

Tsinghua University, Beijing, 100084, China; Beijing CapitalBio Technology Co., Ltd., Beijing, China; Jinan University, Guangzhou, China; Shenzhen Institute of Neuroscience, Shenzhen, China; Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600687/pdf/41065_2021_Article_211.pdf


Background: Developmental stuttering is the most common form of stuttering without apparent neurogenic or psychogenic impairment. Recently, whole-exome sequencing (WES) has been suggested to be a promising approach to study Mendelian disorders.

Methods: Here, we describe an application of WES to identify a gene potentially responsible for persistent developmental stuttering (PDS) by sequencing DNA samples from 10 independent PDS families and 11 sporadic cases. Sanger sequencing was performed for verification with samples obtained from 73 additional patients with sporadic cases.

Results: We first searched for cosegregating variants/candidate genes in a Chinese family (Family 0) by sequencing DNA obtained from 3 affected members and 3 controls. Next, we sequenced DNA samples obtained from 9 additional Chinese families (Families 1-9) with stuttering to verify the identified candidate genes. Intriguingly, we found that two missense variants (Leu552Pro and Lys428Gln) of interferon-alpha/beta receptor 1 (IFNAR1) cosegregated with stuttering in three independent families (Families 0, 5 and 9). Moreover, we found two additional mutations (Gly301Glu and Pro335del) in the IFNAR1 gene in 4 patients with sporadic cases by using WES or Sanger sequencing. Further receptor mutagenesis and cell signaling studies revealed that these IFNAR1 variants may impair the activity of type I IFN signaling.

Conclusion: Our data indicate that IFNAR1 might be a potential pathogenic gene of PDS in the Chinese population.

PMID: 34794508 PMCID: PMC8600687 DOI: 10.1186/s41065-021-00211-y




Implementation fidelity in parent-implemented interventions for stuttering - TERAPIA

Clin Linguist Phon. 2021 Sep 23;1-24. Online ahead of print.


Íris Ö Bergþórsdóttir, Kathryn Crowe, Jóhanna T Einarsdóttir

University of Iceland, Reykjavik, Iceland; Charles Sturt University, Bathurst, Australia.


Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.

PMID: 34553655 DOI: 10.1080/02699206.2021.1965659




Influence of gestures on the intelligibility and comprehensibility of utterances with stuttering events in individuals with Down syndrome - OUTRAS ÁREAS

J Commun Disord. 2021 Dec 5;95:106178 Online ahead of print.


Babette Maessen, Ellen Rombouts, Bea Maes, Inge Zink

Experimental Otorhinolaryngology, KU Leuven, Leuven, Belgium; Parenting and Special Education Research Group, KU, Leuven, Belgium.


Introduction: Individuals with Down syndrome (DS) often stutter, which can affect their speech intelligibility. Previous research has shown that manual signs can enhance speech intelligibility and comprehensibility. It remains unclear to what extent spontaneous hand gestures, such as iconic and beat gestures, may enhance intelligibility and/or comprehensibility during utterances with stuttering events.

Methods: Eleven individuals with DS who stutter provided video-recorded speech samples. From these samples, 60 utterances containing a stuttering event were selected. In half of them, the stuttering events were accompanied by gestures; in the other half, the stuttering events were not accompanied by gestures. The samples were shown to 250 assessors who were blind to the study's goals. Each sample was shown in three visibility conditions: 1) video-with-audio, 2) video-with-audio but with the speaker's mouth covered and 3) audio-only. The assessors rated speech intelligibility on a 7-point Likert scale and transcribed the speech sample. The effect of gesture production, gesture type and the visibility conditions on comprehensibility and intelligibility was examined with a hierarchical multiple linear regression.

Results: When a speaker had used a gesture during a stuttering event, the Likert scale score increased with 0.47 and the accuracy of transcription with 9.07%. There was no difference in effect between the different gesture types. Despite the effect from gesture use, there was no effect of the visibility conditions on the Likert scale or transcription score.

Conclusions: Gestures positively affect intelligibility and comprehensibility of utterances with stuttering events in individuals with DS by altering the speech production. The possibility of beat gestures as a therapy method should be examined, with caution for the development of maladaptive behaviours.

PMID: 34896743 DOI: 10.1016/j.jcomdis.2021.106178




Intensive Stuttering Therapy with Telepractice Follow-up: Longitudinal Outcomes

Folia Phoniatr Logop. 2021 Sep 28. Online ahead of print.


Farzan Irani, Raúl Rojas


No abstract available
PMID: 34583350 DOI: 10.1159/000519866




Invoking the influence of emotion in central auditory processing to improve the treatment of speech impairments - TERAPIA

Saudi Med J. 2021 Dec;42(12):1325-1332.


Safa Alqudah, Maha Zaitoun, Sara Alqudah

Faculty of Applied Medical Sciences, Jordan University of Science and Technology; King Abdullah University Hospital, Irbid, Jordan.

Free article: https://smj.org.sa/content/smj/42/12/1325.full.pdf


Objectives: To explore the benefits of invoking unconscious sentiment to improve the treatment of stuttering and misarticulation.

Methods: This cross-sectional study of 80 participants with speech issues (44 patients with misarticulation and 36 with stuttering) who underwent comprehensive speech and hearing evaluations to confirm and diagnose speech difficulties. Speech and language pathologists then calculated either the percentage of correctly pronounce sounds in misarticulation cases or stuttering severity index-4 scores in cases of stuttering following the use of therapeutic stimuli recorded with familiar and non-familiar voices of similar linguistic and phonetic complexity. Descriptive and inferential statistics were used to compare the data collected following the use of familiar and unfamiliar stimuli.

Results: The analysis showed that the number of dysfluencies in cases of stuttering were significantly fewer when employing familiar voices than unfamiliar voices (3% errors vs 12% errors; Z= -5.16 p<0.001). Additionally, the percentages of correct pronouncing of target sounds in cases of articulation disorders were prominently higher when using familiar voices compared with unfamiliar voices (88% PCC vs 66% PCC; Z= -5.65, p<0.001)

CONCLUSION: This study confirms the utility of invoking emotion in improving speech therapy and maximizing therapeutic outcomes. This study also recommends engaging families and friends in providing speech services to the speech-impaired population to improve patient progress.
PMID: 34853138 DOI: 10.15537/smj.2021.42.12.20200724




Lamotrigine-Associated Movement Disorder: A Literature Review - FARMACOLOGIA

Review Neurol India. Nov-Dec 2021;69(6):1524-1538


Jamir Pitton Rissardo, Ana L Fornari Caprara

Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil.


Background: Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug.

Objective: This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders.

Methods: Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included.

Results: In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal.

Conclusions: In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done

PMID: 34979637 DOI: 10.4103/0028-3886.333440




[Malignant Central Nervous System Lymphoma after Radical Total Cystectomy : A Diagnostic Challenge] [Article in Japanese] - GAGUEIRA ADQUIRIDA

Case Reports Hinyokika Kiyo. 2021 Dec;67(12):539-542.


Yuji Fujizuka, Koichi Suzuki, Tatsuhiro Sawada, Yuta Suto, Yusuke Tsuji, Takafumi Sasaki, Yasushige Matsuo, Munenori Ide

Maebashi Red Cross Hospital; Gunma University Hospital.


We report a case of primary central nervous system lymphoma (PCNSL) in an 81-year-old man who had undergone radical cystectomy with an ileal conduit urostomy due to a diagnosis of muscle-invasive bladder cancer. The postoperative diagnosis was invasive urothelial carcinoma (pT2bN1M0, stage IV). Gemcitabine-cisplatin therapy was provided as adjuvant chemotherapy, and there was no recurrence during follow-up. Four years after surgery, he visited the emergency department because of weakness of the lower extremities and stuttering. He was found to have a parietal lobe mass on magnetic resonance imaging (MRI) and hospitalized with suspicion of brain metastasis. Despite examination by a neurosurgeon, it was not possible to make a clinical diagnosis, and the patient gradually deteriorated and died 21 days later. The pathology results were diagnostic of PCNSL.

PMID: 34991295 DOI: 10.14989/ActaUrolJap_67_12_539




Microaggression and the adult stuttering experience - SOCIAL

J Commun Disord. 2021 Dec 14;95:106180. Online ahead of print.


Geoffrey A Coalson, Alexus Crawford, Shanley B Treleaven, Courtney T Byrd, Lauren Davis, Lillian Dang, Jillian Edgerly, Alison Turk

Louisiana State University, LA, USA; The University of Texas at Austin, Austin, TX , USA.


Background: Microaggressions are subtle insults, invalidations, or slights that target people due to their association with a marginalized group. Microaggressive experiences have been shown to degrade quality of life and corroborate negative stereotypes towards persons with disabilities. To date, minimal research has been dedicated to exploring microaggressions within adults who stutter.

Methods: Seven adults who stutter participated in semi-structured focus group interviews similar to Keller and Galgay's (2010) qualitative investigation of microaggressions experienced by adults with a disability. Group interviews were transcribed and analyzed using QSR NVivo software to develop themes and subthemes.

Results: Eight major themes were identified within two supraordinate themes: Microaggressive Behavior (patronization, second-class status, perceived helplessness, workplace microaggression, clinical microaggression, denial of privacy) and Perception of Microaggressive Behavior (exoneration of listener, no or minimal microaggressive experience). Although patronization, second-class status, and helplessness were mentioned frequently by multiple participants, exoneration of the listener was the most frequently recurring theme.

Discussion: Based on these preliminary focus group interviews, stuttering-based microaggressions broadly resemble ableist microaggressions reported by Keller and Galgay (2010). Interviewees also expressed a reluctance to identify slights related to stuttering as microaggression and often characterized these incidents as unavoidable.

PMID: 34954647 DOI: 10.1016/j.jcomdis.2021.106180




Neuroanatomical anomalies associated with rare AP4E1 mutations in people who stutter - GENÉTICA

Brain Commun. 2021 Nov 13;3(4):fcab266


Ho Ming Chow, Hua Li, Siyuan Liu, Carlos Frigerio-Domingues, Dennis Drayna

University of Delaware, Newark, DE, USA; Alfred duPont Hospital for Children, Wilmington, DE, USA; University of Michigan, Ann Arbor, MI, USA; NIDCD/NIH, Bethesda, MD 20892, USA.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633735/pdf/fcab266.pdf


Developmental stuttering is a common speech disorder with strong genetic underpinnings. Recently, stuttering has been associated with mutations in genes involved in lysosomal enzyme trafficking. However, how these mutations affect the brains of people who stutter remains largely unknown. In this study, we compared grey matter volume and white matter fractional anisotropy between a unique group of seven subjects who stutter and carry the same rare heterozygous AP4E1 coding mutations and seven unrelated controls without such variants. The carriers of the AP4E1 mutations are members of a large Cameroonian family in which the association between AP4E1 and persistent stuttering was previously identified. Compared to controls, mutation carriers showed reduced grey matter volume in the thalamus, visual areas and the posterior cingulate cortex. Moreover, reduced fractional anisotropy was observed in the corpus callosum, consistent with the results of previous neuroimaging studies of people who stutter with unknown genetic backgrounds. Analysis of gene expression data showed that these structural differences appeared at the locations in which expression of AP4E1 is relatively high. Moreover, the pattern of grey matter volume differences was significantly associated with AP4E1 expression across the left supratentorial regions. This spatial congruency further supports the connection between AP4E1 mutations and the observed structural differences.

PMID: 34859215 PMCID: PMC8633735




Non-pharmacological interventions for stuttering in children six years and younger - INFANTIL / TERAPIA

Review Cochrane Database Syst Rev. 2021 Sep 9;9(9):CD013489.


Åse Sjøstrand, Elaina Kefalianos, Hilde Hofslundsengen, Linn S Guttormsen, Melanie Kirmess, Arne Lervåg, Charles Hulme, Kari-Anne Bottegaard Næss

University of Oslo, Oslo, Norway; University of Melbourne, Parkville, Australia; Western Norway University of Applied Sciences, Sogndal, Norway; University of Oxford, Oxford, UK.


Background: Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning.

Objectives: Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest.

Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences.

Selection criteria: We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual.

Data collection and analysis: We used standard methodological procedures expected by Cochrane.

Main results: We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial. All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects. The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence). However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.

AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

PMID: 34499348 PMCID: PMC8428330




No other choice: Speech-Language Pathologists' attitudes toward using telepractice to administer the Lidcombe Program during a pandemic - TERAPIA

J Fluency Disord. 2021 Sep 15;70:105879. Online ahead of print.


Gissella Santayana, Brenda Carey, Rosalee C Shenker

Montreal Fluency Centre, Montreal, Quebec, Canada; Brenda Carey Speech Pathology, Melbourne, VIC, Australia.


Purpose: Telepractice has been shown to be a viable modality for the delivery of stuttering treatment. Since the advent of COVID-19, speech-language pathologists must adapt in-clinic treatments for online presentation. This research aimed to gather information from speech-language pathologists on their experiences of telepractice to deliver the Lidcombe Program to treat stuttering in young children.

Methods: This paper presents the findings of an online survey that polled the clinical experiences of 106 speech-language pathologists who were delivering the Lidcombe Program via telepractice during COVID-19.

Results: The majority of respondents were experienced clinicians from the United States and Canada who had attended a Lidcombe Program workshop. Prior to COVID-19, 80 % had provided some clinical services online (up to 10 % of the time), and at the start of COVID-19 public lockdown orders, 77 % viewed telepractice as both a necessity and an opportunity. Three months after the public lockdown orders, the large majority, 94 %, said that they would continue to use both telepractice and in-clinic treatment in the future. Technology issues, concerns about establishing the clinical relationship, and identification of mild stuttering featured as challenges of telepractice service delivery, while benefits included time efficiency, flexibility of scheduling, and improved clinical processes.

Conclusion: Respondents reported that the Lidcombe Program was easily translatable to telepractice and the majority intend to continue telepractice in the future.

PMID: 34624789 DOI: 10.1016/j.jfludis.2021.105879




Obtaining consensus on core components of stuttering intervention for adults: An e-Delphi Survey with key stakeholders - TERAPIA

Int J Lang Commun Disord. 2021 Nov 24. Online ahead of print.


Amy Connery, J Scott Yaruss, Holly Lomheim, Torrey M Loucks, Rose Galvin, Arlene McCurtin

University of Limerick, Limerick, Ireland; HSE Dublin South West, Tallaght, Dublin, Ireland; Michigan State University, East Lansing, MI, USA; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.


Background: Evidence-based practice involves the synthesis of multiple forms of evidence to inform clinical decision-making and treatment evaluation. Practice- and patient-based evidence are two forms of evidence that are under-represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults.

Aims: To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter.

Methods & procedures: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three-round e-Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering.

Outcomes & results: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors.

Conclusions & implications: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence-based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter.

What this paper adds: What is already known on the subject Evidence-based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision-making and treatment evaluation. The stuttering literature is characterized by an over-representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge This study adds valuable practice- and patient-based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work? This research presents a stakeholder-informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence-based interventions. The framework supports the adoption of a person-centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy.

PMID: 34818457 DOI: 10.1111/1460-6984.12680




Outcomes Following Participation in a Support-Based Summer Camp for Children Who Stutter - TERAPIA EM GRUPO

Lang Speech Hear Serv Sch. 2021 Oct 18;1-13. Online ahead of print.


Caryn Herring, Ryan A Millager, J Scott Yaruss

Michigan State University, East Lansing; Vanderbilt University, Nashville, TN.


Purpose Self-help and support activities are often recommended for people who stutter, and there is growing interest in understanding whether and how such experiences might be beneficial for children who stutter. The purpose of this study was to explore the potential impact of participation in Camp SAY, an overnight support-based summer camp experience for children who stutter, by measuring changes in scores on the Overall Assessment of the Speaker's Experience of Stuttering (OASES).

Method Participants were 107 children who stutter (age range: 8-18 years) who attended Camp SAY during the summers of 2013, 2015, and/or 2016. We examined changes in OASES scores (a) pre- to postcamp, (b) the durability of changes 6 months after the conclusion of the camp, and group differences (c) between school-age campers and teenage campers and (d) between first-time campers and those who had previously attended the camp.

Results Comparison of precamp to postcamp scores revealed significant improvements related to reactions to stuttering, quality of life, and overall adverse impact of stuttering. Scores on each subsection of the OASES were maintained (and further improved) 6 months after camp. There were no significant differences between school-age campers and teenage campers. Both first-time and returning campers showed significant improvements related to reactions to stuttering, though first-time campers had a significantly larger improvement in attitudes toward communication related to stuttering than returning campers.
Conclusion These outcomes suggest that participation in support activities, like Camp SAY, is associated with significant reductions in the overall adverse impact of stuttering and can therefore be beneficial for children who stutter.

PMID: 34662219 DOI: 10.1044/2021_LSHSS-21-00034




Parental perceptions towards childhood stuttering in Sri Lanka - AMBIENTAL

J Commun Disord. 2021 Nov 4;95:106162. Online ahead of print.


Dinusha Nonis, Rachael Unicomb, Sally Hewat

University of Kelaniya, Sri Lanka;The University of Newcastle, Australia.


Introduction: Parental perceptions towards stuttering is an important consideration as parents play a crucial role in the initial identification and management of stuttering in young children. Although several studies have been conducted on parental perceptions towards childhood stuttering in other countries, little is known about how stuttering is perceived and managed by parents in Sri Lanka.

Aims: This study explored Sri Lankan parents' perceptions towards childhood stuttering and their experiences regarding attending speech and language therapy for stuttering.

Methodology: Using a qualitative approach, 15 parents of children who stutter were recruited from a stuttering clinic at a state university in Sri Lanka. Parents participated in semi-structured interviews with the first author. The interviews were conducted via telephone in Sinhala language, recorded, transcribed verbatim in Sinhala and then translated into English. The data were analysed using thematic analysis.

Results: Five themes emerged from the data: (1) limited knowledge about stuttering and management (2) influence of religion and culture on stuttering (3) variable responses to stuttering (4) impact of stuttering on the parent and child (5) impact and engagement in speech therapy.

Conclusion: The findings highlighted the need to educate the Sri Lankan public about stuttering as a communication disorder and raise awareness about the profession of speech language therapy in the country. Specifically, it is important for other health professionals and teaching professionals to learn more about stuttering, so that appropriate early referrals can be made for speech and language therapy, lessening the impact on children and their families.

PMID: 34784567 DOI: 10.1016/j.jcomdis.2021.106162




Parents' Perceptions of the Overall Impact of Stuttering on Young Children - AMBIENTAL

Am J Speech Lang Pathol. 2021 Aug 25;1-13. Online ahead of print.


Linn Stokke Guttormsen, J Scott Yaruss, Kari-Anne Bottegård Næss

University of Oslo, Norway; Michigan State University, East Lansing.


Introduction Research has revealed the presence of emotional, behavioral, and cognitive reactions in young children who stutter; however, prior studies have not examined the overall impact of stuttering on young children's lives. Such information is necessary for improving understanding of how stuttering affects young children and for ensuring appropriate early intervention.

Method This study employed an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children that was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter (2-5 years of age) provided their perceptions of the impact of stuttering on their children. Parents rated how certain they were in their judgments using a 5-point scale to provide an indication of their confidence in proxy ratings of impact. Results Results indicated that, on average, parents perceived that stuttering affected their children negatively. Qualitatively, parents provided descriptions of the impact of stuttering on their children's quality of life, communication difficulties across people and situations, and reactions to stuttering; they also commented on their own feelings and strategies for handling impact. On average, parents perceived themselves to be certain in rating the impact of stuttering on their children.

Conclusions Results indicated that parents identified adverse impact in their children's lives. Even though parents considered themselves to be certain in their impact ratings, clinicians and researchers should also assess the perspective of the children if appropriate. This is because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering. Still, parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs.

PMID: 34433002 DOI: 10.1044/2021_AJSLP-20-00113




Performance of Bimanual Finger Coordination Tasks in Speakers Who Stutter - PSICOMOTOR

Front Psychol. 2021 Sep 23;12:679607.


Akira Toyomura, Tetsunoshin Fujii, Paul F Sowman

Gunma University, Maebashi, Japan; Tokyo Denki University, Inzai, Japan; Hokkaido University, Sapporo, Japan; Macquarie University, Sydney, NSW, Australia.

Free text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495154/pdf/fpsyg-12-679607.pdf


Stuttering is a neurodevelopmental speech disorder characterized by the symptoms of speech repetition, prolongation, and blocking. Stuttering-related dysfluency can be transiently alleviated by providing an external timing signal such as a metronome or the voice of another person. Therefore, the existence of a core motor timing deficit in stuttering has been speculated. If this is the case, then motoric behaviors other than speech should be disrupted in stuttering. This study examined motoric performance on four complex bimanual tasks in 37 adults who stutter and 31 fluent controls. Two tasks utilized bimanual rotation to examine motor dexterity, and two tasks used the bimanual mirror and parallel tapping movements to examine timing control ability. Video-based analyses were conducted to determine performance accuracy and speed. The results showed that individuals who stutter performed worse than fluent speakers on tapping tasks but not on bimanual rotation tasks. These results suggest stuttering is associated with timing control for general motor behavior.

PMID: 34630201 PMCID: PMC8495154 DOI: 10.3389/fpsyg.2021.679607




Phenome risk classification enables phenotypic imputation and gene discovery in developmental stuttering - GENÉTICA

Am J Hum Genet. 2021 Dec 2;108(12):2271-2283.


Douglas M Shaw, Hannah P Polikowsky, Dillon G Pruett, Hung-Hsin Chen, Lauren E Petty, Kathryn Z Viljoen, Janet M Beilby, Robin M Jones, Shelly Jo Kraft, Jennifer E Below

Vanderbilt University Medical Center, Nashville, TN, USA; Curtin University, Perth, Australia; Wayne State University, Detroit, MI, USA.

Free article: https://www.cell.com/ajhg/pdfExtended/S0002-9297(21)00416-X


Developmental stuttering is a speech disorder characterized by disruption in the forward movement of speech. This disruption includes part-word and single-syllable repetitions, prolongations, and involuntary tension that blocks syllables and words, and the disorder has a life-time prevalence of 6-12%. Within Vanderbilt's electronic health record (EHR)-linked biorepository (BioVU), only 142 individuals out of 92,762 participants (0.15%) are identified with diagnostic ICD9/10 codes, suggesting a large portion of people who stutter do not have a record of diagnosis within the EHR. To identify individuals affected by stuttering within our EHR, we built a PheCode-driven Gini impurity-based classification and regression tree model, PheML, by using comorbidities enriched in individuals affected by stuttering as predicting features and imputing stuttering status as the outcome variable. Applying PheML in BioVU identified 9,239 genotyped affected individuals (a clinical prevalence of ∼10%) for downstream genetic analysis. Ancestry-stratified GWAS of PheML-imputed affected individuals and matched control individuals identified rs12613255, a variant near CYRIA on chromosome 2 (B = 0.323; p value = 1.31 × 10-8) in European-ancestry analysis and rs7837758 (B = 0.518; p value = 5.07 × 10-8), an intronic variant found within the ZMAT4 gene on chromosome 8, in African-ancestry analysis. Polygenic-risk prediction and concordance analysis in an independent clinically ascertained sample of developmental stuttering cases validate our GWAS findings in PheML-imputed affected and control individuals and demonstrate the clinical relevance of our population-based analysis for stuttering risk.

PMID: 34861174 DOI: 10.1016/j.ajhg.2021.11.004




Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach - AVALIAÇÃO

J Speech Lang Hear Res. 2021 Dec 14;1-26. Online ahead of print.


Cara M Singer, Sango Otieno, Soo-Eun Chang, Robin M Jones

Grand Valley State University, Allendale, MI, University of Michigan, Ann Arbor; Michigan State University, East Lansing; Vanderbilt University Medical Center, Nashville, TN.


Purpose: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering.

Method: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated.

Results: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased.

Conclusions: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

PMID: 34902288 DOI: 10.1044/2021_JSLHR-21-00162




Psychogenic Stuttering - Case Report

Psychiatr Danub. Spring-Summer 2021;33(Suppl 4):684-685.

Free article: http://www.psychiatriadanubina.com/UserDocsImages/pdf/dnb_vol33_noSuppl%204/dnb_vol33_noSuppl%204_684.pdf


Ana Došen, Tanja Grahovac Juretić, Diana Palaić, Klementina Ružić, Elizabeta Dadić-Hero

Faculty of Medicine Rijeka, Rijeka, Croatia


No abstract available

PMID: 34718302




Race and genetics versus 'race' in genetics: A systematic review of the use of African ancestry in genetic studies - GENÉTICA

Review Evol Med Public Health. 2021 Jun 15;9(1):232-245.


Theresa M Duello, Shawna Rivedal, Colton Wickland, Annika Weller

University of Wisconsin - Madison, USA.

Free PMC article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604262/pdf/eoab018.pdf


Social scientists have long understood race to be a social category invented to justify slavery and evolutionary biologists know the socially constructed racial categories do not align with our biological understanding of genetic variation. The completion of the Human Genome Project in 2003 confirmed humans are 99.9% identical at the DNA level and there is no genetic basis for race. A systematic review of the PubMed medical literature published since 2003 was conducted to assess the use of African ancestry to denote study populations in genetic studies categorized as clinical trials, to examine the stated rationale for its use and to assess the use of evolutionary principles to explain human genetic diversity. We searched for papers that included the terms 'African', 'African American' or 'Black' in studies of behavior (20 papers), physiological responses, the pharmacokinetics of drugs and/or disease associations (62 papers), and as a genetic category in studies, including the examination of genotypes associated with life stress, pain, stuttering and drug clearance (126 papers). Of these, we identified 74 studies in which self-reported race alone or in combination with admixture mapping was used to define the study population. However, none of these studies provided a genetic explanation for the use of the self-identified race as a genetic category and only seven proffered evolutionary explanations of their data. The concept of continuous genetic variation was not clearly articulated in any of these papers, presumably due to the paucity of evolutionary science in the college and medical school curricula.

PMID: 34815885 PMCID: PMC8604262 DOI: 10.1093/emph/eoab018




Reading Fluency in Children and Adolescents Who Stutter - FALA

Brain Sci. 2021 Nov 30;11(12):1595.


Mona Franke, Philip Hoole, Ramona Schreier, Simone Falk

Institute of Phonetics and Speech Processing, LMU, Munich, Germany; Department of Linguistics and Translation, UdeM, Montréal, Canada; International Laboratory for Brain, Music and Sound Research (BRAMS), Montréal, Canada.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8699115/pdf/brainsci-11-01595.pdf


Speech fluency is a major challenge for young persons who stutter. Reading aloud, in particular, puts high demands on fluency, not only regarding online text decoding and articulation, but also in terms of prosodic performance. A written text has to be segmented into a number of prosodic phrases with appropriate breaks. The present study examines to what extent reading fluency (decoding ability, articulation rate, and prosodic phrasing) may be altered in children (9-12 years) and adolescents (13-17 years) who stutter compared to matched control participants. Read speech of 52 children and adolescents who do and do not stutter was analyzed. Children and adolescents who stutter did not differ from their matched control groups regarding reading accuracy and articulation rate. However, children who stutter produced shorter pauses than their matched peers. Results on prosodic phrasing showed that children who stutter produced more major phrases than the control group and more intermediate phrases than adolescents who stutter. Participants who stutter also displayed a higher number of breath pauses. Generally, the number of disfluencies during reading was related to slower articulation rates and more prosodic boundaries. Furthermore, we found age-related changes in general measures of reading fluency (decoding ability and articulation rate), as well as the overall strength of prosodic boundaries and number of breath pauses. This study provides evidence for developmental stages in prosodic phrasing as well as for alterations in reading fluency in children who stutter.

PMID: 34942897 PMCID: PMC8699115 DOI: 10.3390/brainsci11121595




Regarding 'Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering' - TERAPIA

Int J Lang Commun Disord. 2021 Dec 9. Online ahead of print.


Nili Shah, Fred Parker, Rachel Carter, Nasir Kharma

Faculty of Life Sciences and Medicine, London, UK.


As final year medical students, we have had first-hand experience of the significant addition that simulation-based learning can provide for healthcare education. After reading the 2021 paper 'Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering' by Penman et al., we were shown once again the benefits of simulation-based learning. Having said that, we felt there were many crucial aspects omitted in the simulation-based learning program created by Penman et al. for this research article. Therefore, we attempt to highlight these issues with the hope that as students also studying towards a career in healthcare, we can build on the well-developed program created by Penman et al. and make educators aware of the possible areas of improvement in healthcare education.

PMID: 34882913 DOI: 10.1111/1460-6984.12687




Relationship between social anxiety and coping profile in adults who stutter - EMOCIONAL

J Commun Disord. 2021 Nov 16;95:106167. Online ahead of print.


Shuta Tomisato, Yasuto Yada, Koichiro Wasano

Keio University School of Medicine, Shinjuku, Tokyo, Japan; Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan; Tokyo Metropolitan University, Hachioji, Tokyo, Japan; Tokyo Medical Center, Meguro, Tokyo, Japan.


Introduction: Stuttering is a condition that can be severely disabling in the workplace and socially. Although many stuttering cases resolve, some adults who stutter (AWS) continue to be affected not only by dysfluent speech, but also by other social and psychological conditions that may develop as a result of stuttering. The aim of the present study was to determine the relationship between severity of stuttering, severity of social anxiety, and coping profile.

Methods: We objectively assessed adults who stutter (n = 44; mean age = 27.5 years) and age-matched non-stuttering control subjects on four variables: stuttering frequency, communication attitude, social anxiety, and coping profile. Stuttering frequency was calculated as the percentage stuttered morae in the Kitsuon-kensa-ho test. All subjects were assessed on the Japanese versions of the Modified Erickson's Communication Attitude Scale (S-24-J), Liebowitz Social Anxiety Scale (LSAS-J), and the Brief Scale for Coping Profile (BSCP).

Results: Compared to the non-stuttering group, the stuttering group had a higher average score on the S-24-J and LSAS-J, and tended to "avoid and suppress" instead of "seek help for resolution" on the BSCP. Comparison of individual stutterers' S-24-J scores whose LSAS-J scores were above or below the LSAS-J cutoff score revealed that their the S-24-J scores tended to be higher. Also, BSCP participants tended to engage in "proactive resolution" and "emotional venting involving others," not "seeking help for resolution." The stuttering group (vs. the non-stuttering group) and the high social-anxiety group (vs. the low social-anxiety group) adopted non-adaptive coping strategies.

Conclusions: This suggests that the coping profile of AWS may contribute to the cycle of social anxiety and stuttering to a greater or lesser extent. Thus, therapy that reduces anxiety and helps AWS to adopt more adaptive coping strategies may improve stuttering.

PMID: 34798452 DOI: 10.1016/j.jcomdis.2021.106167




Resting autonomic activity in adults who stutter and its association with self-reports of social anxiety - EMOCIONAL

J Fluency Disord. 2021 Oct 22;70:105881. Online ahead of print.


Kim R Bauerly, Cameron Bilardello

University of Vermont, VT, United States


Purpose: The purpose of this study was to investigate resting autonomic activity in adults who stutter (AWS) compared to adults who do not stutter (ANS) and the relationship this has on self-reports of social anxiety.

Methods: Thirteen AWS and 15 ANS completed the Social Interaction Anxiety Scale (SIAS; Mattick & Clark, 1998) and Brief Fear of Negative Evaluation (BFNE; Leary, 1983). Following this, measures of skin conductance levels (i.e. index of sympathetic activity) and respiratory sinus arrhythmia (i.e. index of parasympathetic activity) were taken during a 5-minute resting, baseline period. Independent sample t tests were used to assess differences between groups on self-reports of anxiety (SIAS, BFNE) and resting autonomic levels (SCL, RSA). Separate multiple regression analyses were performed in order to assess the relationship between self-reports of anxiety and autonomic measures.

Results: Results showed significantly higher mean SCL and lower mean RSA levels in the AWS compared to the ANS at resting, baseline. Regression analysis showed that self-reports from the SIAS had a significant effect on RSA levels for the AWS but not the ANS. No significant effects were found for BFNE on RSA. Nor was there a significant effect from SIAS or BFNE on SCL levels for either group.

Conclusion: Findings suggest that resting RSA levels may be a physiological marker for social anxiety levels in adults who stutter.

PMID: 34763119 DOI: 10.1016/j.jfludis.2021.105881




rsfMRI based evidence for functional connectivity alterations in adults with developmental stuttering - NEUROCIÊNCIAS

Heliyon. 2021 Aug 21;7(9):e07855.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414185/pdf/main.pdf



Seyedehsamaneh Shojaeilangari, Narges Radman, Mohammad Ehsan Taghizadeh, Hamid Soltanian-Zadeh

Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Tehran University of Medical Sciences, Tehran, Iran; Payame Noor University, Tehran, Iran; Tehran University, Tehran, Iran; Henry Ford Health System, Detroit, Michigan, USA.


Persistent developmental stuttering (PDS) is defined as a speech disorder mainly characterized by intermittent involuntary disruption in normal fluency, time patterning, and rhythm of speech. Although extensive functional neuroimaging studies have explored brain activation alterations in stuttering, the main affected brain regions/networks in PDS still remain unclear. Here, using functional magnetic resonance imaging (fMRI), we investigated resting-state whole-brain functional connectivity of 15 adults who stutter (PDS group) and 15 age-matched control individuals to reveal the connectivity abnormalities associated with stuttering. We were also interested in exploring how the severity of stuttering varies across individuals to understand the compensatory mechanism of connectivity pattern in patients showing less symptoms. Our results revealed decreased connectivity of left frontal pole and left middle frontal gyrus (MidFG) with right precentral/postcentral gyrus in stuttering individuals compared with control participants, while less symptomatic PDS individuals showed greater functional connectivity between left MidFG and left caudate. Additionally, our finding indicated reduced connectivity in the PDS group between the left superior temporal gyrus (STG) and several brain regions including the right limbic lobe, right fusiform, and right cerebellum, as well as the left middle temporal gyrus (MTG). We also observed that PDS individuals with less severe symptoms had stronger connectivity between right MTG and several left hemispheric regions including inferior frontal gyrus (IFG) and STG. The connectivity between right fronto-orbital and right MTG was also negatively correlated with stuttering severity. These findings may suggest the involvement of right MTG and left MidFG in successful compensatory mechanisms in more fluent stutterers.

PMID: 34504967 PMCID: PMC8414185




Situational Embarrassment and Its Relationship to Social Anxiety in Adults Who Stutter - EMOCIONAL

J Speech Lang Hear Res. 2021 Sep 13;1-10. Online ahead of print.


Yvonne Tran, Elaine Blumgart, Ashley Craig

Macquarie University, Sydney, New South Wales, Australia; The University of Sydney, New South Wales, Australia.


Purpose Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS.

Method AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated.

Results Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety.

PMID: 34516233 DOI: 10.1044/2021_JSLHR-21-00158




Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence - NEUROCIÊNCIAS / TERAPIA

Front Hum Neurosci. 2021 Aug 11;15:662016.


Pierpaolo Busan, Beatrice Moret, Fabio Masina, Giovanni Del Ben, Gianluca Campana

IRCCS Ospedale San Camillo, Venice, Italy; University of Trieste, Trieste, Italy; University of Padua, Padua, Italy.


Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.

PMID: 34456692 PMCID: PMC8386014 DOI: 10.3389/fnhum.2021.662016




Speech-Language Pathologist Perspectives of the Implementation of Telepractice-Delivered Stuttering Treatment for School-Age Children - TERAPIA

Lang Speech Hear Serv Sch. 2021 Nov 9;1-14. Online ahead of print.


Shane Erickson, Kate Bridgman, Lisa Furlong, Hannah Stark

La Trobe University, Bundoora, Victoria, Australia; Catholic Education Melbourne, East Melbourne, Victoria, Australia.


Purpose: The impact of stuttering can be significant, and effective treatment is critical. Despite evidence supporting direct treatment approaches for school-age children who stutter, a complex set of barriers can prevent access at school. One potential solution is telepractice. To date, however, there is no published evidence regarding the use of telepractice to deliver the Lidcombe Program within a school setting.

Method: In this pilot study, a telepractice service was established and the perspectives of the five treating speech-language pathologists (SLPs) were evaluated before, during, and after the trial through focus groups and recorded telesupervision sessions.

Results: An inductive and reflexive thematic analysis identified four main themes: (a) Understanding and managing technology is critical; (b) logistical considerations can be time-consuming and challenging; (c) preparation and support are essential; and (d) family engagement, acceptance, and independence with telepractice services can be facilitated by external support and coaching. Initially, the SLPs shared feelings of uncertainty, fear, and apprehension. Yet, despite this concern, the SLPs ultimately reported that telepractice can play an important role in their service.

Conclusions: In order to maximize the potential value of telepractice, SLPs require training and support to (a) manage the technology and troubleshoot problems that invariably arise, (b) have the opportunity to watch demonstrations of the technology, and (c) clearly explain the roles, responsibilities, and expectations of the parent engaging in treatment. These findings have particular relevance now, as schools and support services navigate a COVID-safe delivery model for the indefinite future.

PMID: 34752153 DOI: 10.1044/2021_LSHSS-20-00167




Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering

Int J Lang Commun Disord. 2021 Dec 9. Online ahead of print.


Adriana Penman, Anne E Hill, Sally Hewat, Nerina Scarinci

The University of Queensland, St Lucia, QLD, Australia; The University of Newcastle, Newcastle, NSW, Australia.


No abstract available

PMID: 34882916 DOI: 10.1111/1460-6984.12688




Speech planning and execution in children who stutter: Preliminary findings from a fNIRS investigation - INFANTIL / NEUROCIÊNCIAS

J Clin Neurosci. 2021 Sep;91:32-42. Epub 2021 Jun 28.


Eric S Jackson, Sobanawartiny Wijeakumar, Deryk S Beal, Bryan Brown, Patricia M Zebrowski, John P Spencer

York University, New York, NY, USA; University of Nottingham, University Park, UK; Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; University of Wisconsin-Eau Claire, Eau Claire, WI, USA; Wendell Johnson Speech and Hearing Center, Iowa City, IA, USA; University of East Anglia,  Norwich, UK.


Few studies have investigated the neural mechanisms underlying speech production in children who stutter (CWS), despite the critical importance of understanding these mechanisms closer to the time of stuttering onset. The relative contributions of speech planning and execution in CWS therefore are also unknown. Using functional near-infrared spectroscopy, the current study investigated neural mechanisms of planning and execution in a small sample of 9-12 year-old CWS and controls (N = 12) by implementing two tasks that manipulated speech planning and execution loads. Planning was associated with atypical activation in bilateral inferior frontal gyrus and right supramarginal gyrus. Execution was associated with atypical activation in bilateral precentral gyrus and inferior frontal gyrus, as well as right supramarginal gyrus and superior temporal gyrus. The CWS exhibited some activation patterns that were similar to the adults who stutter (AWS) as reported in our previous study: atypical planning in frontal areas including left inferior frontal gyrus and atypical execution in fronto-temporo-parietal regions including left precentral gyrus, and right inferior frontal, superior temporal, and supramarginal gyri. However, differences also emerged. Whereas CWS and AWS both appear to exhibit atypical activation in right inferior and supramarginal gyri during execution, only CWS appear to exhibit this same pattern during planning. In addition, the CWS appear to exhibit atypical activation in left inferior frontal and right precentral gyri related to execution, whereas AWS do not. These preliminary results are discussed in the context of possible impairments in sensorimotor integration and inhibitory control for CWS.

PMID: 34373047 DOI: 10.1016/j.jocn.2021.06.018




Stuttering: A Disorder of Energy Supply to Neurons? - CONCEITO

Front Hum Neurosci. 2021 Aug 26;15:662204. eCollection 2021.


Per A Alm

Uppsala University, Uppsala, Sweden.

Free Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496059/pdf/fnhum-15-662204.pdf


Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography (EEG), brain imaging, genetics, and biochemistry are reviewed: (1) Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. (2) Studies of the absolute level of regional cerebral blood flow (rCBF) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. (3) The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index (GI; Vaishnavi et al., 2010). High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. (4) Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. (5) It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. (6) Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory.

PMID: 34630054 PMCID: PMC8496059 DOI: 10.3389/fnhum.2021.662204




Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents - TERAPIA

Review J Fluency Disord. 2021 Nov 10;71:105884. Online ahead of print


Hilde Hofslundsengen, Melanie Kirmess, Linn Stokke Guttormsen, Kari-Anne Bottegaard Næss, Elaina Kefalianos

Western Norway University of Applied Sciences, Sogndal, Norway; University of Oslo, Oslo, Norway; Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway; University of Melbourne, Australia.

Full text: https://www.sciencedirect.com/science/article/pii/S0094730X21000632?via%3Dihub


Purpose: This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years).

Methods: We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms 'stutt*' or 'stamm*'and 'intervention', 'trial' or 'treatment'. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes.

Results: 3,017 references published between 1974-2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant's parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings.

Conclusion: Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering interventions is proposed.

PMID: 34798495 DOI: 10.1016/j.jfludis.2021.105884




The Effects of Written Stuttering Disclosure on the Perceptions of a Child Who Stutters - INFANTIL / TERAPIA

Lang Speech Hear Serv Sch. 2021 Aug 26;1-18. Online ahead of print.


Greg Snyder, Ashlee Manahan, Peyton McKnight, Myriam Kornisch

The University of Mississippi, Oxford.


Purpose This study measured between-groups differences in perceived speech skills and personality characteristics of a 12-year-old male child who stutters (CWS) as a function of a written factual stuttering disclosure statement, delivered by the CWS, his "mother," or his "teacher."

Method Four hundred twenty-four college-age adults were assigned to one of four groups, including three experimental groups (i.e., written self-disclosure, mother-written disclosure, and teacher-written disclosure) and a control group (no written disclosure). Participants in the control conditions viewed a brief video of the CWS. In the experimental conditions, participants read a brief written disclosure statement for 30 s, followed by the same video used in the control condition. After viewing the video, all participants completed surveys relative to their perceptions of the CWS speech skills and personality characteristics.

Results Results reveal that a written stuttering disclosure statement provided by the mother correlated with select significant desirable perceptual differences of the CWS, while a written disclosure statement provided by the CWS yielded insignificant or even undesirable perceptual differences of the CWS. Written stuttering disclosures provided by a "teacher" did not yield any significant between-groups differences in the perception of a CWS. Gender affiliation was found to be a source of covariance in a number of perceived speech skills and personality characteristics.

Conclusions Written stuttering disclosure statements provided by the "mother" correlated with select favorable perceptual differences of speech skills and personal characteristics of a CWS. Clinically, the application of novel methods (written and oral disclosure statements) and sources (i.e., CWS advocates such as "mother" and "teacher") of stuttering disclosure statement can be integrated into a systematic therapeutic program, creating an innovative approach of scaffolding self-advocacy via stuttering disclosure in CWS. Supplemental Material https://doi.org/10.23641/asha.15505857.

PMID: 34436943 DOI: 10.1044/2021_LSHSS-20-00119




Therapists' Issues in Understanding Stuttering

J Patient Exp. 2021 Nov 26;8:23743735211062397.


Upasana Bagchi, K Jayasankara Reddy

Christ University, Bangalore, Karnataka, India.

Free PMC article:



No abstract available

PMID: 34869850 PMCID: PMC8640334 DOI: 10.1177/23743735211062397




The Dopamine System and Automatization of Movement Sequences: A Review With Relevance for Speech and Stuttering - CONCEITO

Review Front Hum Neurosci. 2021 Dec 2;15:661880. eCollection 2021.


Per A Alm

Uppsala University, Uppsala, Sweden.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675130/pdf/fnhum-15-661880.pdf


The last decades of research have gradually elucidated the complex functions of the dopamine system in the vertebrate brain. The multiple roles of dopamine in motor function, learning, attention, motivation, and the emotions have been difficult to reconcile. A broad and detailed understanding of the physiology of cerebral dopamine is of importance in understanding a range of human disorders. One of the core functions of dopamine involves the basal ganglia and the learning and execution of automatized sequences of movements. Speech is one of the most complex and highly automatized sequential motor behaviors, though the exact roles that the basal ganglia and dopamine play in speech have been difficult to determine. Stuttering is a speech disorder that has been hypothesized to be related to the functions of the basal ganglia and dopamine. The aim of this review was to provide an overview of the current understanding of the cerebral dopamine system, in particular the mechanisms related to motor learning and the execution of movement sequences. The primary aim was not to review research on speech and stuttering, but to provide a platform of neurophysiological mechanisms, which may be utilized for further research and theoretical development on speech, speech disorders, and other behavioral disorders. Stuttering and speech are discussed here only briefly. The review indicates that a primary mechanism for the automatization of movement sequences is the merging of isolated movements into chunks that can be executed as units. In turn, chunks can be utilized hierarchically, as building blocks of longer chunks. It is likely that these mechanisms apply also to speech, so that frequent syllables and words are produced as motor chunks. It is further indicated that the main learning principle for sequence learning is reinforcement learning, with the phasic release of dopamine as the primary teaching signal indicating successful sequences. It is proposed that the dynamics of the dopamine system constitute the main neural basis underlying the situational variability of stuttering.

PMID: 34924974 PMCID: PMC8675130 DOI: 10.3389/fnhum.2021.661880




Tools for standardized data collection: Speech, Language, and Hearing measurement protocols in the PhenX Toolkit - CONCEITO

Ann Hum Genet. 2021 Sep 28. Online ahead of print.


Cynthia C Morton, Mary L Marazita, Beate Peter, Mabel L Rice, Shelly Jo Kraft, Julie Barkmeier-Kraemer, Carey Balaban, Michael Phillips, Jennifer Schoden, Deborah Maiese, Tabitha Hendershot, Carol M Hamilton

University of Manchester, Manchester, UK; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Arizona State University, Phoenix, Arizona, USA; University of Kansas, Lawrence, Kansas, USA; Wayne State University, Detroit, Michigan, USA; University of Utah, Salt Lake City, Utah, USA; International, Research Triangle Park, North Carolina, USA.


The PhenX Toolkit (https://www.phenxtoolkit.org/) is an online catalog of recommended measurement protocols to facilitate cross-study analyses for biomedical research. An expert review panel (ERP) reviewed and updated the PhenX Toolkit Speech and Hearing domain to improve the precision and consistency of speech, language, and hearing disorder phenotypes. A three-member ERP convened in August 2018 to review the measurement protocols in the PhenX Speech and Hearing domain. Aided by three additional experts in voice assessment, vertigo, and stuttering, the ERP updated the 28 protocols to reflect the latest science and technology. ERP recommendations include six new protocols, five updated protocols (from the same source), and one retired protocol. New additions include two voice-related, three hearing-related, and two speech-related protocols. Additions reflect new phone/tablet applications for hearing and language, and clinical evaluations of voice. "Language" was added to the domain name, which is now "Speech, Language, and Hearing," to represent language-related protocols. These protocols can facilitate the assessment of speech, language, and hearing in clinical and population research. Common data elements (i.e., use of the same variables across studies) used by geneticists, otolaryngologists, audiologists, speech-language pathologists, and in other disciplines can lead to cross-study data integration and increased statistical power when studies are combined.

PMID: 34582045 DOI: 10.1111/ahg.12447




Treatment clinical trial - three types - for children with fluency disorders and stuttering - INFANTIL / TERAPIA

Codas. 2021 Oct 22;34(2):e20200264. eCollection 2021.

 [Article in Portuguese, English]


Nathalia Dos Santos Fernandes de Ávila, Fabiola Juste, Julia Biancalana Costa, Claudia Regina Furquim de Andrade

Universidade de São Paulo - USP - São Paulo (SP), Brasil.

Free article: Abstract in English: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=en 

Portuguese: https://www.scielo.br/j/codas/a/gn9nCCrnmq9vD7553XhgCTn/?format=pdf&lang=pt


Purpose: To present a treatment clinical trial, involving three types of treatment for chronic developmental stuttering (CDS), to verify whether they present indicators and sufficient information to establish an effective and safe benefit-risk relationship.

Methods: The study included 252 children between 2 and 12 years old, who underwent assessment and treatment for CDS. Among the selected children, 93 met the established inclusion criteria. After obtaining the scores for the risk of CDS (Protocol for the Risk of Developmental Stuttering), all children were assessed according to their fluency profile and the severity level of stuttering. The children underwent treatment for CDS Green, Yellow and Red Programs. The treatment chosen for each child was based on the analysis of the risk for CDS.

Results: All therapeutic programs presented positive results in the post-treatment assessment considering the analyzed parameters, with the exception of word repetition, sound prolongation at the end of words, and intrusion of sounds/word segments.

Conclusion: The tested therapeutic programs - green, yellow, and red - were efficient for most of the participants. The direct intervention used in the Red Program was highly efficient in promoting fluent speech. This result suggests that for most of the patients with a higher risk of developing the chronic form of stuttering, the use of specific fluency promotion techniques is indicated.

PMID: 34705998 DOI: 10.1590/2317-1782/20212020264




Uncertainty and Perceived Control as Predictors of Communicative Participation and Mental Health in Adults Who Stutter - TERAPIA

Am J Speech Lang Pathol. 2022 Jan 10;1-13. Online ahead of print.


Michael P Boyle, Nicole J Chagachbanian

Montclair State University, Bloomfield, NJ.


Purpose: This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter.

Method: Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest.

Results: Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty.

Conclusions: The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.

PMID: 35007427 DOI: 10.1044/2021_AJSLP-21-00230



Valproate-associated Movement Disorder: A Literature Review - FARMACOLOGIA

Review Prague Med Rep. 2021;122(3):140-180.


Jamir Pitton RissardO, Ana Letícia Fornari Caprara, Ícaro Durante

Federal University of Santa Maria, Santa Maria, Brazil; Federal University of Fronteira Sul, Passo Fundo, Brazil.


Valproate (VPA) was first synthesized in 1882, but it was only in the early 1960s that its anticonvulsant properties were discovered. The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of VPA-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 138 reports containing 362 cases of subjects who developed a MD secondary to VPA were reported. The MD identified were parkinsonism (PKN) (252), myoclonus (MCL) (54), dystonia (DTN) (17), dyskinesia (DKN) (16), stutters (4), tics (3), akathisia (AKT) (1). In the not clearly defined group, 15 extrapyramidal symptoms, 3 AKT, 2 DTN, 1 rigidity, 1 unstable gait were assessed. The mean and median age was 55.8 (SD: 16.58) and 61 years (range: 4-87 years). The most common VPA-indication was epilepsy, and 51.36% were males. The mean and median time from the VPA start to the MD onset was 32.75 (SD: 30.05) and 21.15 months (range: 1 day - 20 years). The mean and median time from the VPA withdrawal until the MD recovery was 2.89 (SD: 2.79) and 3 months (1 day - 12 months). The most common management was drug withdrawal. A complete recovery was obtained in 80.61%. VPA-associated MD was extensively reported in the literature. PKN was the most well-described. Future studies need to clearly report the clinical history of the patient, considering the full investigation of other adverse events during their entire life.

PMID: 34606429 DOI: 10.14712/23362936.2021.14




Verbal Response Inhibition in Adults Who Stutter - PSICOMOTOR

J Speech Lang Hear Res. 2021 Aug 17;1-16. Online ahead of print.


Shanley B Treleaven, Geoffrey A Coalson

Louisiana State University, Baton Rouge.


Purpose Adults who stutter (AWS) often attempt, with varying degrees of success, to suppress their stuttered speech. The ability to effectively suppress motoric behavior after initiation relies on executive functions such as nonselective inhibition. Although previous studies found that AWS were slower to inhibit manual, button-press response than adults who do not stutter (AWNS), research has yet to confirm a consistent relationship between manual and verbal inhibition. No study has examined verbal inhibition ability in AWS. The purpose of this study, therefore, is to compare verbal response inhibition between AWS and AWNS, and compare verbal response inhibition to both the overt stuttering and the lived experience of stuttering.

Method Thirty-four adults (17 AWNS, 17 AWS) completed one manual and three verbal stop-signal tasks. AWS were assessed for stuttering severity (Stuttering Severity Instrument-Fourth Edition: SSI-4) and experience with stuttering (Overall Assessment of the Speaker's Experience With Stuttering [OASES]).

Results Results indicate no correlation between manual and verbal inhibition for either group. Generalized linear mixed-model analyses suggested no significant group differences in manual or verbal inhibition. Manual and verbal inhibition did not predict SSI-4 in AWS. However, verbal inhibition was uniquely associated with OASES scores.

Conclusion Although underlying manual and verbal inhibition was comparable between AWS and AWNS, verbal inhibition may be linked to the adverse experience of stuttering rather than the overt symptoms of stuttering severity. Supplemental Material https://doi.org/10.23641/asha.15145185.

PMID: 34403265 DOI: 10.1044/2021_JSLHR-20-00739




Weak Vestibular Response in Persistent Developmental Stuttering

Front Integr Neurosci. 2021 Sep 1;15:662127. eCollection 2021.


Max Gattie, Elena V M Lieven, Karolina Kluk

The University of Manchester, Manchester, United Kingdom.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477904/pdf/fnint-15-662127.pdf


Vibrational energy created at the larynx during speech will deflect vestibular mechanoreceptors in humans (Todd et al., 2008; Curthoys, 2017; Curthoys et al., 2019). Vestibular-evoked myogenic potential (VEMP), an indirect measure of vestibular function, was assessed in 15 participants who stutter, with a non-stutter control group of 15 participants paired on age and sex. VEMP amplitude was 8.5 dB smaller in the stutter group than the non-stutter group (p = 0.035, 95% CI [-0.9, -16.1], t = -2.1, d = -0.8, conditional R 2 = 0.88). The finding is subclinical as regards gravitoinertial function, and is interpreted with regard to speech-motor function in stuttering. There is overlap between brain areas receiving vestibular innervation, and brain areas identified as important in studies of persistent developmental stuttering. These include the auditory brainstem, cerebellar vermis, and the temporo-parietal junction. The finding supports the disruptive rhythm hypothesis (Howell et al., 1983; Howell, 2004) in which sensory inputs additional to own speech audition are fluency-enhancing when they coordinate with ongoing speech.

PMID: 34594189 PMCID: PMC8477904 DOI: 10.3389/fnint.2021.662127




White matter correlates of sensorimotor synchronization in persistent developmental stuttering - NEUROCIÊNCIAS

J Commun Disord. 2021 Nov 16;95:106169. Online ahead of print.


Sivan Jossinger, Anastasia Sares, Avital Zislis, Dana Sury, Vincent Gracco, Michal Ben-Shachar

Bar-Ilan University, Ramat-Gan, Israel; Concordia University, Montréal, Canada; McGill University, Montréal, Canada; Haskins Laboratories, New Haven, CT, United States.


Introduction: Individuals with persistent developmental stuttering display deficits in aligning motor actions to external cues (i.e., sensorimotor synchronization). Diffusion imaging studies point to stuttering-associated differences in dorsal, not ventral, white matter pathways, and in the cerebellar peduncles. Here, we studied microstructural white matter differences between adults who stutter (AWS) and fluent speakers using two complementary approaches to: (a) assess previously reported group differences in white matter diffusivity, and (b) evaluate the relationship between white matter diffusivity and sensorimotor synchronization in each group.

Methods: Participants completed a sensorimotor synchronization task and a diffusion MRI scan. We identified the cerebellar peduncles and major dorsal- and ventral-stream language pathways in each individual and assessed correlations between sensorimotor synchronization and diffusion measures along the tracts.

Results: The results demonstrated group differences in dorsal, not ventral, language tracts, in alignment with prior reports. Specifically, AWS had significantly lower fractional anisotropy (FA) in the left arcuate fasciculus, and significantly higher mean diffusivity (MD) in the bilateral frontal aslant tract compared to fluent speakers, while no significant group difference was detected in the inferior fronto-occipital fasciculus. We also found significant group differences in both FA and MD of the left middle cerebellar peduncle. Comparing patterns of association with sensorimotor synchronization revealed a novel double dissociation: MD within the left inferior cerebellar peduncle was significantly correlated with mean asynchrony in AWS but not in fluent speakers, while FA within the left arcuate fasciculus was significantly correlated with mean asynchrony in fluent speakers, but not in AWS.

Conclusions: Our results support the view that stuttering involves altered connectivity in dorsal tracts and that AWS may rely more heavily on cerebellar tracts to process timing information. Evaluating microstructural associations with sensitive behavioral measures provides a powerful tool for discovering additional functional differences in the underlying connectivity in AWS.

PMID: 34856426 DOI: 10.1016/j.jcomdis.2021.106169




Word-Final Disfluencies in a School-Age Child: Beneath the Tip of the Iceberg - AVALIAÇÃO

Lang Speech Hear Serv Sch. 2021 Oct 7;1-11. Online ahead of print.


Naomi Eichorn, Sidney Donnan

The University of Memphis, TN.


Purpose Disfluencies associated with stuttering generally occur in the initial position of words. This study reviews data from a school-age child with an atypical stuttering profile consisting predominantly of word-final disfluencies (WFDs). Our primary goals were to identify patterns in overt features of WFDs and to extend our understanding of this clinical profile by focusing on aspects of stuttering that lie beneath the surface.

Method Analyses explored the patterns and distributions of the child's observable stuttering behaviors, in addition to his awareness, perceptions, and subjective experience of stuttering.

Results Findings indicated that the WFD profile consists of relatively consistent and distinct overt features. We also found that, in many ways, the child perceived the impact of his disfluencies much like other children who stutter, even though his disfluencies manifested in a less common form.

Conclusion Findings suggest the need for increased awareness of the varied forms stuttering may take in order to ensure accurate diagnosis, clear communication to clients and parents, and timely access to appropriate intervention.

PMID: 34618549 DOI: 10.1044/2021_LSHSS-21-00005





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