Abstract  - Janeiro a Julho de 2023

 

 

A Comprehensive Analysis of Speech Disfluencies in Autistic Young Adults and Control Young Adults: Group Differences in Typical, Stuttering-Like, and Atypical Disfluencies - OUTRAS ÁREAS

J Speech Lang Hear Res. 2023 Feb 10;1-17 Online ahead of print.

 

Veera Pirinen, Soile Loukusa, Katja Dindar, Leena Mäkinen, Tuula Hurtig, Katja Jussila, Marja-Leena Mattila, Kurt Eggers

University of Oulu, Finland; Oulu University Hospital, Finland;  Ghent University, Belgium; Thomas More University College, Antwerp, Belgium; University of Turku, Finland.

 

Purpose: The purpose of this study was to examine the nature of speech disfluencies in autistic young adults and controls by using a wide-range disfluency classification of typical disfluencies (TD; i.e., filled pauses, revisions, abandoned utterances, and multisyllable word and phrase repetitions), stuttering-like disfluencies (SLD; i.e., sound and syllable repetitions, monosyllable word repetitions, prolongations, blocks, and broken words), and atypical disfluencies (AD; i.e., word-final prolongations and repetitions and atypical insertions).

Method: Thirty-two autistic young adults and 35 controls completed a narrative telling task based on socially complex events. Frequencies of total disfluencies, TD, SLD, AD and stuttering severity were compared between groups.

Results: The overall frequency of disfluencies was significantly higher in the autistic group and significant between-group differences were found for all disfluency categories. The autistic group produced significantly more revisions, filled pauses, and abandoned utterances, and each subtype of SLD and AD than the control group. In total, approximately every fourth autistic participants scored at least a very mild severity of stuttering, and every fifth produced more than three SLD per 100 syllables.

Conclusions: Disfluent speech can be challenging for effective communication. This study revealed that the speech of autistic young adults was highly more disfluent than that of the controls. The findings provide information on speech disfluency characteristics in autistic young adults and highlight the importance of evaluating speech disfluency with a wide-range disfluency classification in autistic persons in order to understand their role in overall communication. The results of this study offer tools for SLPs to evaluate and understand the nature of disfluencies in autistic persons.

PMID: 36763844 DOI: 10.1044/2022_JSLHR-22-00265

 

 

 

A cross-sectional investigation of disfluencies in typically developing Spanish-English bilingual children - INFANTIL / LINGUAGEM

J Fluency Disord. 2023 Jun 15;77:105988. Online ahead of print.

 

Raúl Rojas, Farzan Irani, Svenja Gusewski, Natalia Camacho

University of Kansas, Lawrence, KS, United States; Texas State University, TX, United States; Southern Connecticut State University, New Haven, CT, United States; University of Texas at Dallas, Dallas, TX, United States.

 

Purpose: This study examined the language skills and the type and frequency of disfluencies in the spoken narrative production of typically developing Spanish-English bilingual children.

Method: A cross-sectional sample of 106 bilingual children (50 boys; 56 girls) enrolled in kindergarten through Grade 4, produced a total of 212 narrative retell language samples in English and Spanish. A specialized fluency coding system was implemented to index the percentage of total (%TD) and stuttering-like disfluencies (%SLD) in each language. Large-scale reference databases were used to classify children's dual language proficiency profiles (balanced, English dominant, Spanish dominant) based on language sample analysis measures of morphosyntax and lexical diversity.

Results: The bilingual Spanish-English children in this study did not demonstrate significant cross-linguistic differences for mean %TD or %SLD. However, the mean %TD and %SLD in both languages exceeded the risk threshold based on monolingual English-speaking norms. English dominant bilingual children demonstrated significantly lower %TD in English than Spanish. Spanish dominant children demonstrated significantly lower %SLD in Spanish than English.

Conclusions: This study included the largest sample size of bilingual Spanish-English children investigated to date from a fluency perspective. The frequency of disfluencies was found to be variable across participants and change dynamically as a function of grade and dual language proficiency profiles, indicating the need for studies that employ larger sample sizes and longitudinal designs.

PMID: 37331088 DOI: 10.1016/j.jfludis.2023.105988

 

 

 

A link between seizure and stuttering disorders? A case report
Ann Clin Psychiatry. 2023 Feb;35(1):61-62.

 

Ariana Z Turk, Mutahir Farhan, Lama Al-Khoury, Gerald A Maguire, Shahriar SheikhBahaei

National Institutes of Health, Bethesda, Maryland, USA; University of California, Riverside School of Medicine, Riverside, California, USA; American University of Health Sciences, School of Medicine, Signal Hill, California, USA; CenExel CIT Research, Riverside, California, USA.

 

No abstract available

PMID: 36716463 DOI: 10.12788/acp.0100

 

 

 

A novel non-word speech preparation task to increase stuttering frequency in experimental settings for longitudinal research - AVALIAÇÃO

J Commun Disord. 2023 Jun 10;105:106353. Online ahead of print.

 

Farzan Irani, Jeffrey R Mock, John C Myers, Jennifer Johnson, Edward J Golob

Texas State University; University of Texas, San Antonio; Baylor College of Medicine, Houston TX.

 

Purpose: The variable and intermittent nature of stuttering makes it difficult to consistently elicit a sufficient number of stuttered trials for longitudinal experimental research. This study tests the efficacy of using non-word pairs that phonetically mimic English words with no associated meaning, to reliably elicit balanced numbers of stuttering and fluent trials over multiple sessions. The study also evaluated the effect of non-word length on stuttering frequency, the consistency of stuttering frequency across sessions, and potential carry-over effects of increased stuttering frequency in the experimental task to conversational and reading speech after the task.

Methods: Twelve adults who stutter completed multiple sessions (mean of 4.8 sessions) where they were video-recorded during pre-task reading and conversation, followed by an experimental task where they read 400 non-word pairs randomized for each session, and then a post-task reading and conversation sample.

Results: On average, across sessions and participants, non-word pairs consistently yielded a balanced distribution of fluent (60.7%) and stuttered (39.3%) trials over five sessions. Non-word length had a positive effect on stuttering frequency. No carryover effects from experimental to post-task conversation and reading were found.

Conclusions: Non-word pairs effectively and consistently elicited balanced proportions of stuttered and fluent trials. This approach can be used to gather longitudinal data to better understand the neurophysiological and behavioral correlates of stuttering.

PMID: 37331327 DOI: 10.1016/j.jcomdis.2023.106353

 

 

 

A preliminary investigation of the mental health of parents of young children who stutter - INFANTIL / AMBIENTE

J Commun Disord. 2023 Apr 8;103:106329. Online ahead of print.

 

Brenda Carey, Shane Erickson, Susan Block

La Trobe University, Bundoora, Australia.

 

Introduction: While research has shown that parents of preschool-aged children who stutter (CWS) may be negatively affected by their child's stuttering, few studies have investigated their mental health. If parents of CWS have poor mental health, this may impact stuttering treatment choices, the conduct of treatment, stuttering treatment outcomes, and the development of stuttering treatments.

Methods: 82 parents (74 mothers and 8 fathers) of preschool-aged children who stutter (aged 1-5) were recruited upon application for an assessment for their child. A survey battery extracting quantitative and qualitative information about symptoms of potential depression, anxiety, stress, and psychological distress, as well as the emotional effect of stuttering on parents was administered and the results summarized.

Results: Data from standardised measures revealed similar incidence as normative data for the presence of stress, anxiety or depression (1 in 6 parents) and distress (almost 1 in 5 parents). However, more than half of the participants reported experiencing a negative emotional effect due to their child's stuttering and a large proportion also reported that stuttering influenced their communication with their child.

Conclusions: Speech-language pathologists (SLPs) should broaden the scope of their duty of care to include the parents of CWS more fully. Parents should be provided with informational counselling or other support services that will help reduce worry and anxiety related to negative emotions.

PMID: 37054521 DOI: 10.1016/j.jcomdis.2023.106329

 

 

 

A Preliminary Study of Speech Rhythm Differences as Markers of Stuttering Persistence in Preschool-Age Children - AVALIAÇÃO

J Speech Lang Hear Res. 2023 Feb 24;1-20. Online ahead of print.

 

Aysu Erdemir, Tedra A Walden, Sam Tilsen, Antje S Mefferd, Robin M Jones

Vanderbilt University Medical Center, Nashville, TN; Cornell University, Ithaca, NY.

 

Purpose: The purpose of this study was twofold: (a) to determine whether there are speech rhythm differences between preschool-age children who stutter that were eventually diagnosed as persisting (CWS-Per) or recovered (CWS-Rec) and children who do not stutter (CWNS), using empirical spectral analysis and empirical mode decomposition of the speech amplitude envelope, and (b) to determine whether speech rhythm characteristics close to onset are predictive of later persistence.

Method: Fifty children (3-4 years of age) participated in the study. Approximately 2-2.5 years after the experimental testing took place, children were assigned to the following groups: CWS-Per (nine boys, one girl), CWS-Rec (18 boys, two girls), and CWNS (18 boys, two girls). All children produced a narrative based on a text-free storybook. From the audio recordings of these narratives, fluent utterances were selected for each child from which seven envelope-based measures were extracted. Group-based differences on each measure as well as predictive analyses were conducted to identify measures that discriminate CWS-Per versus CWS-Rec.

Results: CWS-Per were found to have a relatively higher degree of power in suprasyllabic oscillations and greater variability in the timing of syllabic rhythms especially for longer utterances. A logistic regression model using two speech rhythm measures was able to discriminate the eventual outcome of recovery versus persistence, with 80% sensitivity and 75% specificity.

Conclusion: Findings suggest that envelope-based speech rhythm measures are a promising approach to assess speech rhythm differences in developmental stuttering, and its potential for identification of children at risk of developing persistent stuttering should be investigated further.

PMID: 36827517 DOI: 10.1044/2022_JSLHR-22-00126

 

 

 

A study of respiratory sinus arrhythmia and stuttering persistence - EMOCIONAL

J Commun Disord. 2023 Feb 2;102:106304. Online ahead of print.

 

Dillon G Pruett, Stephen W Porges, Tedra A Walden, Robin M Jones

Vanderbilt University, Nashville, TN, USA; Indiana University, Bloomington, IN, USA; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

 

Introduction: The present study investigated potential differences in respiratory sinus arrhythmia between preschool-age children with persisting stuttering, children who recovered from stuttering, and children who do not stutter.

Methods: Participants were 10 children with persisting stuttering (persisting group), 20 children who recovered from stuttering (recovered group), and 36 children who do not stutter (non-stuttering group). Participants viewed a neutral video clip to establish a pre-arousal baseline and then viewed two emotionally-arousing video clips (positive and negative, counterbalanced). Age-appropriate speaking tasks followed each of the video clips (post-baseline, post-positive, and post-negative). Respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system activity, was measured during the video clips and subsequent speaking tasks.

Results: First, the persisting group, recovered group, and non-stuttering group did not significantly differ in baseline RSA. Second, during the emotionally-arousing video clips, there was a significant group x condition interaction, with the recovered group exhibiting significantly lower RSA in the positive than negative condition, and the non-stuttering group exhibiting significantly higher RSA in the positive than negative condition. Third, in the narrative tasks, there was a significant group x condition interaction, with a greater difference in RSA between the post-baseline speaking task and the post-positive and post-negative speaking tasks for the persisting compared to the non-stuttering group. Lastly, a follow-up analysis indicated that the recovered and nonstuttering groups, compared to the persisting group, exhibited significantly greater RSA during the baseline (neutral) condition compared to the post-neutral narrative task.

Conclusions: Findings provide a physiological perspective of emotion within children who stutter and persist and children who stutter and recover. Future investigations with larger sample sizes and diverse methodologies are necessary to provide novel insights on the specific emotion-related processes that are potentially involved with persistence of stuttering in young children.
PMID: 36738522 DOI: 10.1016/j.jcomdis.2023.106304

 

 

 

Ableism to Empowerment: Navigating School Structures When Working With Students Who Stutter - TERAPIA

Lang Speech Hear Serv Sch. 2023 Jan 6;1-19. Online ahead of print.

 

Nina A Reeves, Timothy W Flynn, Reuben Z Schuff

Frisco Independent School District, TX; Arlington Public Schools, VA; American Board of Fluency and Fluency Disorders, Kimberly, WI.

 

Purpose: School-based speech-language pathologists (SLPs) face uniquely complex webs of guidelines and criteria that can undermine their ability to move toward disability-affirming practices. The purpose of this clinical focus article is to present a contrast between ableist and disability-affirming practices in school-based stuttering therapy while highlighting the critical perspectives of students who stutter. Practical examples of disability-affirming stuttering therapy in public school settings are provided.

Conclusions: This clinical focus article outlines practical guidelines and specific examples of affirming collaboration, eligibility decisions, goal choice, and accommodations for students who stutter. These discussions demonstrate how SLPs can adopt updated assessment therapy planning and institutional practices to affirm students who stutter while informing school cultures and society about the dignity and value of stuttered voices.

PMID: 36608333 DOI: 10.1044/2022_LSHSS-22-00026

 

 

 

Accepting Things as They Are: Dispositional Mindfulness, Decentering, Self-Compassion, and the Impact of Stuttering on Adults Who Stutter - TERAPIA

Am J Speech Lang Pathol. 2023 May 31;1-17. Online ahead of print.

 

Shiran Israel, Omer Reuveni, Ittai Glick, Nava Levit-Binnun

Reichman University, Herzliya, Israel; University of Haifa, Israel; Private Practice, Tel Aviv, Israel.

 

Purpose: Mindfulness is defined as intentional, present-moment, nonjudgmental awareness. Previous studies have proposed that mindfulness practice may benefit people who stutter. This study aimed to test the relationship between levels of dispositional mindfulness in people who stutter and the impact of stuttering and whether self-compassion and the metacognitive ability of shifting to an objective perspective (decentering) mediate this relationship. It is hypothesized that greater dispositional mindfulness is associated with attenuated negative impact of stuttering on a person's life through a higher capability to shift into an objective and compassionate perspective.

Method: A total of 150 Israeli adults who stutter completed a full online survey in Hebrew to assess their levels of dispositional mindfulness, self-compassion, decentering capability, and impact of stuttering on their lives. The relationships between constructs were assessed using Pearson's correlation and mediation analysis.

Results: The adverse impact of stuttering was negatively and moderately associated with dispositional mindfulness, such that individuals with greater self-reported dispositional mindfulness reported fewer reactions to stuttering, difficulty in communication, and higher quality of life. This relationship was fully and sequentially mediated via decentering and self-compassion, which were also negatively and moderately associated with the impact of stuttering.

Conclusions: People who stutter with greater dispositional mindfulness have an increased ability to view their experiences in a more objective and compassionate manner, which is associated with an attenuated impact of stuttering on their lives. As these capabilities can be cultivated through practice, this study proposes mindfulness practice as an additional beneficial tool for people who stutter.

PMID: 37256701 DOI: 10.1044/2023_AJSLP-22-00388

 

 

 

Acoustic analysis in stuttering: a machine-learning study - AVALIAÇÃO

Front Neurol. 2023 Jun 30;14:1169707.

Free Full Text: https://www.frontiersin.org/articles/10.3389/fneur.2023.1169707/full

 

Francesco Asci et al

Sapienza University of Rome, Rome, Italy; IRCCS Neuromed Institute, Pozzilli, Italy; University of Cincinnati, Cincinnati, OH, United States; CRC - Centro Ricerca e Cura, Rome, Italy; IRCCS San Raffaele Pisana, Rome, Italy.

 

Background: Stuttering is a childhood-onset neurodevelopmental disorder affecting speech fluency. The diagnosis and clinical management of stuttering is currently based on perceptual examination and clinical scales. Standardized techniques for acoustic analysis have prompted promising results for the objective assessment of dysfluency in people with stuttering (PWS).

Objective: We assessed objectively and automatically voice in stuttering, through artificial intelligence (i.e., the support vector machine - SVM classifier). We also investigated the age-related changes affecting voice in stutterers, and verified the relevance of specific speech tasks for the objective and automatic assessment of stuttering.

Methods: Fifty-three PWS (20 children, 33 younger adults) and 71 age-/gender-matched controls (31 children, 40 younger adults) were recruited. Clinical data were assessed through clinical scales. The voluntary and sustained emission of a vowel and two sentences were recorded through smartphones. Audio samples were analyzed using a dedicated machine-learning algorithm, the SVM to compare PWS and controls, both children and younger adults. The receiver operating characteristic (ROC) curves were calculated for a description of the accuracy, for all comparisons. The likelihood ratio (LR), was calculated for each PWS during all speech tasks, for clinical-instrumental correlations, by using an artificial neural network (ANN).

Results: Acoustic analysis based on machine-learning algorithm objectively and automatically discriminated between the overall cohort of PWS and controls with high accuracy (88%). Also, physiologic ageing crucially influenced stuttering as demonstrated by the high accuracy (92%) of machine-learning analysis when classifying children and younger adults PWS. The diagnostic accuracies achieved by machine-learning analysis were comparable for each speech task. The significant clinical-instrumental correlations between LRs and clinical scales supported the biological plausibility of our findings.

Conclusion: Acoustic analysis based on artificial intelligence (SVM) represents a reliable tool for the objective and automatic recognition of stuttering and its relationship with physiologic ageing. The accuracy of the automatic classification is high and independent of the speech task. Machine-learning analysis would help clinicians in the objective diagnosis and clinical management of stuttering. The digital collection of audio samples here achieved through smartphones would promote the future application of the technique in a telemedicine context (home environment).

PMID: 37456655 PMCID: PMC10347393 DOI: 10.3389/fneur.2023.1169707

 

 

 

Acquired Stuttering in Parkinson's Disease - GAGUEIRA ADQUIRIDA

Mov Disord Clin Pract. 2023 May 8;10(6):956-966.

Free Full Text: https://movementdisorders.onlinelibrary.wiley.com/doi/epdf/10.1002/mdc3.13758

 

Eloïse A Gooch et al

University of Canterbury Christchurch New Zealand; New Zealand Brain Research Institute Christchurch New Zealand; University of Otago Christchurch New Zealand; Te Whatu Ora Health New Zealand Christchurch New Zealand.

 

Background: Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new-onset stuttering is limited.

Objectives: To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease.

Method: Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function.

Results: Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P < 0.01). 21% of people with Parkinson's disease (n = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading (P < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset (P < 0.01), higher levodopa equivalent dosage (P < 0.01), and lower cognitive (P < 0.01) and motor scores (P < 0.01).

Conclusion: One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis.

PMID: 37332649 PMCID: PMC10272914 DOI: 10.1002/mdc3.13758

 

 

 

Adaptation and Validation of Overall Assessment of the Speaker's Experience of Stuttering for Adults in Kannada (OASES-A-K) - AVALIAÇÃO

Folia Phoniatr Logop. 2023 May 13;1. Online ahead of print.

 

Sangeetha Mahesh, Mariswamy Pushpavathi, Divya Seth, Sivaranjani Saravanan, J Scott Yaruss

 

Introduction: Psychosocial aspects of stuttering may affect the quality of life of a person who stutters (PWS). Further, the social stigma and experiences of PWS may vary globally. The WHO-ICF guidelines recommends quality of life as an essential component in the assessment of individuals who stutter. However, the availability of linguistically and culturally appropriate tools is often a challenge. Thus, the current study adapted and validated the OASES-A for Kannada-speaking adults who stutter.

Method: The original English version of OASES-A was adapted to Kannada using a standard reverse translation process. The adapted version was administered on 51 Kannada-speaking adults with very mild to very severe stuttering. The data were analyzed for item characteristics, reliability, and validity assessment.

Results: The results revealed floor and ceiling effects for six and two items respectively. The mean overall impact score indicated a moderate impact of stuttering. Further, the impact score for section II was relatively higher when compared to the data from other countries. The reliability and validity analyses showed good internal consistency and test-retest reliability for OASES-A-K.

Conclusion: The findings of the current research suggest that OASES-A-K is a sensitive and reliable tool to assess the impact of stuttering in Kannada-speaking PWS. The findings also highlight cross-cultural differences and the need for research in this direction.

PMID: 37231963 DOI: 10.1159/000531048

 

 

 

Adult-Onset Stuttering in Schizophrenia With Catatonia That Responded to Electroconvulsive Therapy - EMOCIONAL

J Acad Consult Liaison Psychiatry. 2023 Jul-Aug;64(4):407-408.

 

Carol Lim, Smita Patel, Oliver Freudenreich

Harvard Medical School, Massachusetts General Hospital, Boston, MA; Tufts University School of Medicine, Burlington, MA.

 

No abstract available
Introduction

Stuttering is a disorder of speech fluency characterized by the repetition of sounds, syllables, or monosyllabic whole-words. It can also present with the prolongation of sounds as well as interruptions in speech. Stuttering is usually a developmental disorder that arises in childhood but can emerge later in life. Adult-onset stuttering is most commonly associated with organic brain conditions, such as traumatic brain injuries, Parkinson's disease, stroke, or seizures, but can also be drug-induced. Psychotropic medications in particular can induce stuttering, including the antipsychotic clozapine.

Adult-onset stuttering affects 2% of patients with severe chronic schizophrenia, and cases of stuttering appearing during catatonia have been reported. We describe a case of adult-onset stuttering in a patient with schizophrenia and catatonia whose stuttering worsened during clozapine treatment but improved significantly after a course of electroconvulsive therapy (ECT). Stuttering, although not included in the Bush Francis Rating Scale (BFCRS), could be a symptom of catatonia that shares similar pathology to other speech dysfluencies included in the BFCRS.

PMID: 37474245 DOI: 10.1016/j.jaclp.2023.03.004

 

 

 

Adult recasts as fluency-facilitators in preschoolers who stutter: Evidence from FluencyBank - INFANTIL / AMBIENTE

J Fluency Disord. 2023 Mar 24;76:105971. Online ahead of print.

 

Lisa LaSalle, Lesley Wolk

California State University-Monterey Bay, USA; University of Redlands, USA.

 

Adult conversational recasts are based on child platform utterances that contain errors (e.g., Child: "Me going." Adult: "Yes, you are going"), and recasts are effective in the child language literature. For many years, adult recasts of preschoolers' stuttered utterances were surmised as fluency-facilitating, but to date, no evidence has been reported to support their efficacy. The purpose was to investigate the natural occurrence of, and the fluency-facilitating potential of, recasts produced by caregivers and clinicians/examiners in free-play interactions transcribed from audio or video recordings on FluencyBank. Forty-three participants with a median age of 38 mo (3;2) (Range=28-73 mo), including 32 boys and 11 girls were selected from five databases, and recasts which were near-imitations and simple recasts as per Weiss (2002) were identified. One database chosen was the Illinois project, to include a subgroup of persistent (n = 9) and recovered children (n = 9). In the 43 participants, significantly (p < 0.0001) fewer stutters and lower percent syllables stuttered (%SS) were observed in post-recast utterances (4%SS) as compared to post-nonrecast utterances (12.5%SS). The CWS-persistent subgroup (n = 9) did not fit the group trend of the 34 others who significantly differed in stuttering frequency post-nonrecast versus postrecast. Findings are taken to mean that adult conversational recasts of preschoolers' stuttered utterances are fluency-facilitating, and interpretations are addressed.

PMID: 37001466 DOI: 10.1016/j.jfludis.2023.105971

 

 

 

Advancing Stuttering Detection via Data Augmentation, Class-Balanced Loss and Multi-Contextual Deep Learning - AVALIAÇÃO

IEEE J Biomed Health Inform. 2023 Feb 23;PP. Online ahead of print.

 

Shakeel A Sheikh, Md Sahidullah, Fabrice Hirsch, Slim Ouni

 

Stuttering is a neuro-developmental speech impairment characterized by uncontrolled utterances (interjections) and core behaviors (blocks, repetitions, and prolongations), and is caused by the failure of speech sensorimotors. Due to its complex nature, stuttering detection (SD) is a difficult task. If detected at an early stage, it could facilitate speech therapists to observe and rectify the speech patterns of persons who stutter (PWS). The stuttered speech of PWS is usually available in limited amounts and is highly imbalanced. To this end, we address the class imbalance problem in the SD domain via a multibranching (MB) scheme and by weighting the contribution of classes in the overall loss function, resulting in a huge improvement in stuttering classes on the SEP-28k dataset over the baseline (StutterNet). To tackle data scarcity, we investigate the effectiveness of data augmentation on top of a multi-branched training scheme. The augmented training outperforms the MB StutterNet (clean) by a relative margin of 4.18% in macro F1-score (F1). In addition, we propose a multi-contextual (MC) StutterNet, which exploits different contexts of the stuttered speech, resulting in an overall improvement of 4.48% in (F1) over the single context based MB StutterNet. Finally, we have shown that applying data augmentation in the cross-corpora scenario can improve the overall SD performance by a relative margin of 13.23% in F1 over the clean training.

PMID: 37027629 DOI: 10.1109/JBHI.2023.3248281

 

 

 

Associations between glutamic acid decarboxylase antibodies, oxidative stress markers, and cognitive capacity in adolescents who stutter - CONCEITO

Saudi J Biol Sci. 2023 Mar;30(3):103580. Epub 2023 Feb 1.

 

Abdulaziz Almudhi, Sami A Gabr

King Khalid University, Abha, Saudi Arabia; Faculty of Medicine, Mansoura University, Mansoura, Egypt.

 

In this study, we amid to evaluate the correlation between the change in the expressed levels of anti-GAD antibodies titers, oxidative stress markers, cytokines markers, and cognitive capacity in adolescents with mild stuttering. Eighty participants (60 male/20 female) with the age range of 10-18 years with moderate stuttering participated in this study. To assess the stuttering and cognitive function, stuttering severity instrument (SSI-4; 4th edit.) and the LOTCA-7 scores assessment were applied respectively in all subjects. In addition, serum GAD antibodies, cytokines like TNF-α, CRP,and IL-6 withtotal antioxidant capacity and nitric oxide as oxidative stress markers were estimated using calorimetry and immunoassay techniques.The results showed that good cognitive capacity was reported in about 56.25 % of the study population (n = 45) with a 117.52 ± 6.3 mean LOTCA-7 score. However, abnormal cognitive function was identified in 43.75 % of the study population (n = 35); they were categorized into moderate (score 62-92, n = 35), and poor (score 31-62; n = 10). There were significant associations between cognitive capacity reported and all biomarkers. The expression of GAD antibodies is significantly associated with the degree of cognitive capacity among students with stuttering. Significant association with the reduction (P = 0.01) in LOTCA-7 score domains, particularly orientation, thinking operations, attention, and concentration among students with variable cognitive capacity compared to controls. In addition, the expressed higher GAD antibodies in students with moderate and poor cognitive capacity showed to be significantly correlated with both elevated concentrations of cytokines; TNF-α, CRP, and IL-6, and the reduction of TAC and nitric oxide (NO) respectively. This study concludes that abnormality of cognitive capacity showed to be associated with higher expression of GAD antibodies, cytokines, and oxidative stress in school students with moderate stuttering.

PMID: 36844638 PMCID: PMC9943924 DOI: 10.1016/j.sjbs.2023.103580

 

 

 

Behavioral and cognitive-affective features of stuttering in preschool-age children: Regression and exploratory cluster analyses - CONCEITO

J Fluency Disord. 2023 Mar 29;76:105972. Online ahead of print

 

Ryan A Millager, Mary S Dietrich, Robin M Jones

Vanderbilt University, Nashville, TN, United States.

 

Purpose: The purpose of this study was to investigate associations among behavioral and cognitive-affective features of stuttering in preschool-age children who stutter, and the extent to which participants may or may not cluster together based on multiple indices of stuttering.

Methods: Participants were 296 preschool-age children who stutter (mean age 47.9 months). Correlation and regression analyses, as well as k-means cluster analyses were conducted between and among several indices of stuttering: frequency of stuttering- and non-stuttering-like disfluencies (SLDs and NSLDs), ratios of repetitions and prolongations/blocks out of total number of SLDs, associated nonspeech behaviors, duration of stuttering events, KiddyCAT scores (Vanryckeghem & Grutten, 2007), and a TOCS parent-rated scale (Gillam et al., 2009).

Results: For preschool-age children who stutter, most indices of overt stuttering behaviors were intercorrelated (e.g., more SLDs were associated with higher ratio of repetitions). Self-reported KiddyCAT scores (Vanryckeghem & Grutten, 2007) were largely not significantly associated with stuttering. Cluster analyses yielded two participant groupings: a larger group with less prominent stuttering features and a smaller group with more prominent features.

Conclusions: This study contributes to an increasingly comprehensive and nuanced understanding of the heterogeneous features of stuttering and their development in preschool-age children. Findings show strong intercorrelations between measures of stuttering behaviors, but more tenuous relationships between behaviors and cognitive-affective reactions to stuttering. Exploration of clusters of characteristics within this population revealed potential opportunities for future research.

PMID: 37031644 DOI: 10.1016/j.jfludis.2023.105972

 

 

 

Behavioral assessment of auditory processing in adulthood: population of interest and tests - a systematic review - AUDITIVO

Codas. 2023 May 1;35(2):e20220044.

 [Article in Portuguese, English]

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162648/pdf/codas-35-2-e20220044.pdf - texto em português após o texto em inglês 

 

Pamela Papile Lunardelo, Marisa Tomoe Hebihara Fukuda, Ana Cecília Grilli Fernandes Stefanelli, Sthella Zanchetta

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

 

Purpose: To identify the behavioral tests used to assess auditory processing throughout adulthood, focusing on the characteristics of the target population as an interest group.

Research strategies: PubMed, CINAHL, Web of Science, and Scielo, databases were searched with descriptors: "auditory perception" or "auditory perception disorders" or "auditory processing" or "central auditory processing" or "auditory processing disorders" or "central auditory processing disorders" with adults OR aging.

Selection criteria: Studies with humans included, the adult population from 18 to 64 years old, who performed at least one behavioral test to assess auditory processing in the absence of hearing loss.

Data analysis: Data extraction was performed independently, using a protocol developed by the authors that included different topics, mainly the behavioral auditory tests performed and the results found.

Results: Of the 867 records identified, 24 contained the information needed to answer the survey questions.

Conclusion: Almost all studies were conducted verify performance in one or two auditory processing tests. The target target population was heterogeneous, with the most frequent persons with diabetes, stuttering, auditory processing disorder, and noise exposure. There is little information regarding benchmarks for testing in the respective age groups.

PMID: 37132698 PMCID: PMC10162648

 

 

 

Bibliometric mapping of non-invasive brain stimulation techniques (NIBS) for fluent speech production - NEUROCIÊNCIAS

Front Hum Neurosci. 2023 Jun 22;17:1164890.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10323431/pdf/fnhum-17-1164890.pdf

 

Wesley Medeiros, Tayná Barros, Fabio V Caixeta

University of Brasilia, Brasília, Brazil.

 

Introduction: Language production is a finely regulated process, with many aspects which still elude comprehension. From a motor perspective, speech involves over a hundred different muscles functioning in coordination. As science and technology evolve, new approaches are used to study speech production and treat its disorders, and there is growing interest in the use of non-invasive modulation by means of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).

Methods: Here we analyzed data obtained from Scopus (Elsevier) using VOSViewer to provide an overview of bibliographic mapping of citation, co-occurrence of keywords, co-citation and bibliographic coupling of non-invasive brain stimulation (NIBS) use in speech research.

Results: In total, 253 documents were found, being 55% from only three countries (USA, Germany and Italy), with emerging economies such as Brazil and China becoming relevant in this topic recently. Most documents were published in this last decade, with 2022 being the most productive yet, showing brain stimulation has untapped potential for the speech research field.

Discussion: Keyword analysis indicates a move away from basic research on the motor control in healthy speech, toward clinical applications such as stuttering and aphasia treatment. We also observe a recent trend in cerebellar modulation for clinical treatment. Finally, we discuss how NIBS have established over the years and gained prominence as tools in speech therapy and research, and highlight potential methodological possibilities for future research.

PMID: 37425291 PMCID: PMC10323431

 

 

 

Bilingualism as a risk factor for false reports of stuttering in the Early Childhood Longitudinal Study (ECLS-K:2011) - AVALIAÇÃO

Front Psychol. 2023 Jul 20;14:1155895

 

Susanne Gahl
University of California at Berkeley, Berkeley, CA, United States.

 

Introduction: Bilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim.

Methods: We analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011.

Results and discussion: The prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word "stuttering" on the part of teachers and parents to describe typical disfluencies.

PMID: 37546483 PMCID: PMC10399746

 

 

 

Brain activity during the preparation and production of spontaneous speech in children with persistent stuttering - INFANTIL / NEUROCIÊNCIAS

Neuroimage Clin. 2023 Apr 20;38:103413. Online ahead of print.

 

Ho Ming Chow, Emily O Garnett, Nan Bernstein Ratner, Soo-Eun Chang

University of Delaware, United States; University of Michigan, United States; University of Maryland, United States.

 

Speech production forms the basis for human verbal communication. Though fluent speech production is effortless and automatic for most people, it is disrupted in speakers who stutter, who experience difficulties especially during spontaneous speech and at utterance onsets. Brain areas comprising the basal ganglia thalamocortical (BGTC) motor loop have been a focus of interest in the context of stuttering, given this circuit's critical role in initiating and sequencing connected speech. Despite the importance of better understanding the role of the BGTC motor loop in supporting overt, spontaneous speech production, capturing brain activity during speech has been challenging to date, due to fMRI artifacts associated with severe head motions during speech production. Here, using an advanced technique that removes speech-related artifacts from fMRI signals, we examined brain activity occurring immediately before, and during, overt spontaneous speech production in 22 children with persistent stuttering (CWS) and 18 children who do not stutter (controls) in the 5-to-12-year age range. Brain activity during speech production was compared in two conditions: spontaneous speech (i.e., requiring language formulation) and automatic speech (i.e., overlearned word sequences). Compared to controls, CWS exhibited significantly reduced left premotor activation during spontaneous speech production but not during automatic speech. Moreover, CWS showed an age-related reduction in left putamen and thalamus activation during speech preparation. These results provide further evidence that stuttering is associated with functional deficits in the BGTC motor loop, which are exacerbated during spontaneous speech production.

PMID: 37099876 DOI: 10.1016/j.nicl.2023.103413

 

 

 

Brain developmental trajectories associated with childhood stuttering persistence and recovery - INFANTIL / NEUROCIÊNCIAS

Dev Cogn Neurosci. 2023 Feb 26;60:101224. Online ahead of print.

Free PMC article: https://www.sciencedirect.com/science/article/pii/S1878929323000294?via%3Dihub

 

Ho Ming Chow, Emily O Garnett, Simone P C Koenraads, Soo-Eun Chang

University of Delaware, Newark, DE, USA; University of Michigan, Ann Arbor, MI, USA; Erasmus University Medical Center, GD Rotterdam, the Netherlands.

 

Stuttering is a neurodevelopmental disorder affecting 5-8 % of preschool-age children, continuing into adulthood in 1 % of the population. The neural mechanisms underlying persistence and recovery from stuttering remain unclear and little information exists on neurodevelopmental anomalies in children who stutter (CWS) during preschool age, when stuttering symptoms typically first emerge. Here we present findings from the largest longitudinal study of childhood stuttering to date, comparing children with persistent stuttering (pCWS) and those who later recovered from stuttering (rCWS) with age-matched fluent peers, to examine the developmental trajectories of both gray matter volume (GMV) and white matter volume (WMV) using voxel-based morphometry. A total of 470 MRI scans were analyzed from 95 CWS (72 pCWS and 23 rCWS) and 95 fluent peers between 3 and 12 years of age. We examined overall group and group by age interactions in GMV and WMV in preschool age (3-5 years old) and school age (6-12 years old) CWS and controls, controlling for sex, IQ, intracranial volume, and socioeconomic status. The results provide broad support for a possible basal ganglia-thalamocortical (BGTC) network deficit starting in the earliest phases of the disorder and point to normalization or compensation of earlier occurring structural changes associated with stuttering recovery.

PMID: 36863188 PMCID: PMC9986501 DOI: 10.1016/j.dcn.2023.101224

 

 

 

Combined otolaryngology and respiratory airway endoscopy for complex paediatric airway patients: A prospective qualitative review of 20 patients

Clin Otolaryngol. 2023 Mar 13.. Online ahead of print.

 

Adam Stammer, Liam Sutton, Reshma Ghedia, Surendran Thavagnanam 3, Nara Orban

Queen Mary University of London, London, UK; Royal London Hospital, London, UK.

 

No abstract available

PMID: 36914381 DOI: 10.1111/coa.14044

 

 

 

Communicative participation with public authorities: Experiences of people with aphasia, people who stutter, and employees of public authorities - SOCIAL

J Commun Disord . 2023 Feb 15;102:106314. Online ahead of print.

 

Anja Wunderlich, Georg Newesely, Johanna Reheis

University of Applied Sciences Tyrol, Innsbruck, Austria.

 

Introduction: Several studies have examined the communicative participation of people with communication disorders (PWCD). Hindering and facilitating factors were analyzed in different population groups considering various private and public communication contexts. However, knowledge about (a) the experiences of persons with different communication disorders, (b) communication with public authorities, and (c) the perspective of communication partners in this area remains limited. Therefore, this study aimed to explore the communicative participation of PWCD with public authorities. We analyzed communicative experiences (hindering and facilitating factors) and suggestions for improving communicative access described by persons with aphasia (PWA) and persons who stutter (PWS) as well as by employees of public authorities (EPA).

Methods: In semi-structured interviews, PWA (n = 8), PWS (n = 9), and EPA (n = 11) reported specific communicative encounters with public authorities. The interviews were analyzed using qualitative content analysis, focusing on hindering/facilitating experiences and suggestions for improvement.

Results: The personal experiences of the participants during authority encounters were represented by the interwoven themes of familiarity and awareness, attitudes and behavior, and support and autonomy. The perspectives of the three groups overlap in several areas; however, the results also indicate specific differences between PWA and PWS as well as between PWCD and EPA.

Conclusion: The results indicate a need to improve awareness/knowledge about communication disorders and communicative behavior in EPA. Moreover, PWCD should actively engage in encounters with authorities. In both groups, awareness must be raised about how each communication partner can contribute to successful communication, and avenues to achieve this goal must be demonstrated.

PMID: 36801532 DOI: 10.1016/j.jcomdis.2023.10631

 

 

 

Comparing the Effectiveness of Cognitive Behavioral Group Therapy and Mindfulness and Acceptance Group Therapy for Adults who Stutter: A Randomized Clinical Trial - TERAPIA

Adv Biomed Res. 2023 Feb 25;12:26.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086645/pdf/ABR-12-26.pdf

 

Soroush Khoshnam, Banafsheh Gharraee, Ahmad Ashouri

Iran University of Medical Sciences, Tehran, Iran.

 

Background: Considering the importance of psychological interventions for adults who stutter (AWS), the present study compared the effectiveness of Cognitive Behavioral Group Therapy (CBGT) and Mindfulness and Acceptance Group Therapy (MAGT), in combination with Speech Therapy (ST) in AWS.

Materials and methods: A randomized clinical trial was conducted with 36 AWS in Tehran and Alborz provinces in Iran from September-2019 to September-2020. Participants were assigned to CBGT + ST and MAGT + ST groups. Outcomes variables, the fear of negative evaluation scale (FNE) and the social avoidance and distress scale (SAD), were measured at four stages: (1) pretest, (2) after MAGT/CBGT, (3) after ST, and (4) at 6-month follow-up.

Results: The results of repetitive measure-analysis on variance showed that CBGT + ST and MAGT + ST were significantly effective (P = 0.001 and P = 0.003) on SAD. The same analysis showed that CBGT + ST was significantly effective (P = 0.001) on FNE. The results of Analysis of Covariance showed that there was no significant difference between CBGT + ST and MAGT + ST on SAD but CBGT + ST was more effective than MAGT + ST at stage 3 (P < 0.05) on FNE.

Conclusion: Data indicated that CBGT + ST and MAGT + ST were both effective for SAD of AWS. Regarding FNE, unlike MAGT + ST, CBGT was effective either alone or in combination with ST for AWS. Further studies are needed to confirm the results of this study.

PMID: 37057245 PMCID: PMC10086645 DOI: 10.4103/abr.abr_322_21

 

 

 

Complex working memory in adults with and without stuttering disorders: Performance patterns and predictive relationships - PROCEDURAL

J Fluency Disord. 2023 Jun 26;77:105993. Online ahead of print.

 

Naomi Eichorn, Jessica Hall, Klara Marton

The University of Memphis, Memphis, TN, USA; City University of New York, New York, NY, USA; Eötvös Loránd University, Budapest , Hungary.

 

Purpose: Available studies of working memory (WM) in speakers who stutter tend to rely on parent report, focus on phonological WM, or measure WM in combination with other processes. The present research aimed to: (1) compare complex WM in adults who stutter (AWS) and adults who do not stutter (AWNS); (2) characterize group performance patterns; and (2) determine whether WM predicts stuttering severity.

Methods: Eighteen AWS and 20 AWNS completed parallel verbal and spatial span tasks in which to-be-remembered items were interleaved with a distracting task across varying set sizes. Dependent variables included the number of correctly recalled items, accuracy on distraction tasks, and detailed analyses of item-level responses. We further examined whether span scores predicted subjective and objective measures of stuttering severity.

Results: Relative to AWNS, AWS showed poorer recall, specifically on short set sizes in the spatial task. Groups performed similarly on distraction tasks and showed comparable error patterns. Predictive relationships differed by span task and severity measure. Lower verbal span scores predicted greater stuttering impact and more overt stuttering behaviors; lower spatial span scores predicted lower impact and was unrelated to overt behaviors.

Conclusions: Findings suggest that AWS differ subtly from AWNS in WM performance. Group differences became more apparent under certain task conditions but could not be attributed to specific underlying processes. Data further indicated a complex relationship between WM and stuttering severity. Overall, results corroborate previous studies linking stuttering to domain-general weaknesses, but highlight the need for additional research to clarify the nature of this relationship.

PMID: 37406551 DOI: 10.1016/j.jfludis.2023.105993

 

 

 

Cushing's Disease Presenting with Functional Neurological (Conversion) Disorder - GAGUEIRA ADQUIRIDA

Case Reports Case Rep Psychiatry. 2023 Mar 8;2023

Free Full Text: https://downloads.hindawi.com/journals/crips/2023/1662271.pdf

 

Sahar Ashrafzadeh, Maria Theresa Mariano, Saba Syed

University of California, Los Angeles, CA, USA; Olive View-UCLA Medical Center, Sylmar, CA, USA.

 

While psychiatric manifestations are common in patients with Cushing's syndrome (CS), to our knowledge, there are no reported cases of CS presenting with functional neurological disorder (FND), a neuropsychiatric condition in which patients experience neurological symptoms, such as motor dysfunctions, sensory symptoms, speech disorders, or nonepileptic seizures, in the absence of neurological disease. Here, we report a case of a complex patient with Cushing's disease who presented with multiple FND symptoms including nonepileptic seizures, bilateral lower extremity paralysis, decreased finger flexion resulting in limited hand function, and stuttering. This case illustrates a rare psychiatric manifestation of CS presenting as multiple neurological complaints. Furthermore, we elucidate how a multidisciplinary treatment approach improved our patient's FND symptoms.

PMID: 36938346 PMCID: PMC10017209 DOI: 10.1155/2023/1662271

 

 

 

Decontextualized Utterances Contain More Typical and Stuttering-Like Disfluencies in Preschoolers Who Do and Do Not Stutter - LINGUAGEM

J Speech Lang Hear Res. 2023 Jul 24;1-14. Online ahead of print.

 

Kathleen E Oppenheimer, Jessica Lee, Yi Ting Huang, Nan Bernstein Ratner

University of Maryland at College Park.

 

Purpose: Stuttering-like disfluencies (SLDs) and typical disfluencies (TDs) are both more likely to occur as utterance length increases. However, longer and shorter utterances differ by more than the number of morphemes: They may also serve different communicative functions or describe different ideas. Decontextualized language, or language that describes events and concepts outside of the "here and now," is associated with longer utterances. Prior work has shown that language samples taken in decontextualized contexts contain more disfluencies, but averaging across an entire language sample creates a confound between utterance length and decontextualization as contributors to stuttering. We coded individual utterances from naturalistic play samples to test the hypothesis that decontextualized language leads to increased disfluencies above and beyond the effects of utterance length.

Method: We used archival transcripts of language samples from 15 preschool children who stutter (CWS) and 15 age- and sex-matched children who do not stutter (CWNS). Utterances were coded as either contextualized or decontextualized, and we used mixed-effects logistic regression to investigate the impact of utterance length and decontextualization on SLDs and TDs.

Results: CWS were more likely to stutter when producing decontextualized utterances, even when controlling for utterance length. An interaction between decontextualization and utterance length indicated that the effect of decontextualization was greatest for shorter utterances. TDs increased in decontextualized utterances when controlling for utterance length for both CWS and CWNS. The effect of decontextualization on TDs did not differ statistically between the two groups.

Conclusions: The increased working memory demands associated with decontextualized language contribute to increased language planning effort. This leads to increased TD in CWS and CWNS. Under a multifactorial dynamic model of stuttering, the increased language demands may also contribute to increased stuttering in CWS due to instabilities in their speech motor systems.

PMID: 37486762 DOI: 10.1044/2023_JSLHR-23-00173

 

 

 

Development of a probability discounting task of communication for adults who stutter - SOCIAL

J Exp Psychol Gen. 2023 Mar 30. Online ahead of print.

 

Luis R Rodriguez, Erin B Rasmussen, Daniel Hudock

Department of Psychology [?]; Department of Communication Sciences and Disorders[?]

 

Previous research indicates speaking may be emotionally and socially risky for adults who stutter (AWS) due to psychological distress induced by others following a dysfluency. This may impact communication-related decision-making; however, no measure had been developed to objectively quantify this variable. The present study aimed to develop and validate the Probability Discounting for Communication (PDC) task, a behavioral measure of risk taking that characterizes decreasing subjective value of hypothetical communication engagement as the probability of stuttering and listener reaction change. AWS (n = 67) and adults who do not stutter (AWNS; n = 93) were recruited from an online listserv and MTurk. Across a series of trials, participants completed the PDC by using a visual analog scale to indicate their subjective value of communication as probabilities of stuttering (1%-99%) and magnitudes of negative listener reaction risk (10%, 50%, 90%) were manipulated. They also completed measures of stuttering, communication, and demographics. Results revealed communication was discounted hyperbolically across increasing dysfluency odds. AWS showed more systematic discounting patterns compared to AWNS suggesting AWS may be more sensitive to communication due to experiences with stuttering. A magnitude effect was found with both AWS and AWNS discounting communication more steeply with increasing negative listener reaction risk. Significant associations were observed between discounting, stuttering, and communication measures among AWS, which indicates that sensitivity to risk in the context of stuttering and social reaction may influence communication engagement. Overall, the PDC functions as a measure to assess underlying decision-making patterns related to communication among AWS, which may inform treatment.

PMID: 36996158 DOI: 10.1037/xge0001379

 

 

 

 

Developmental stuttering, physical concomitants associated with stuttering, and Tourette syndrome: A scoping review - AVALIAÇÃO

Review J Fluency Disord. 2023 Jun 23;77:105992. Online ahead of print.

 

Christelle Nilles, Lindsay Berg, Cassidy Fleming, Davide Martino, Tamara Pringsheim

University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.

 

Background and purpose: Developmental stuttering and Tourette syndrome (TS) are common neurodevelopmental disorders. Although disfluencies may co-occur in TS, their type and frequency do not always represent pure stuttering. Conversely, core symptoms of stuttering may be accompanied by physical concomitants (PCs) that can be confused for tics. This scoping review aimed to explore the similarities and differences between stuttering and tics in terms of epidemiology, comorbidities, phenomenology, evolution, physiopathology, and treatment. We also described the nature of PCs in stuttering and disfluencies in TS.

Methods: A literature search on Medline, Embase and PsycInfo was executed in March 2022. From 426 studies screened, 122 were included in the review (a majority being narrative reviews and case reports).

Results: TS and stuttering have several epidemiological, phenomenological, comorbidity, and management similarities suggesting shared risk factors and physiopathology (involving the basal ganglia and their connections with speech and motor control cortical regions). PCs in stuttering commonly involve the face (eyelids, jaw/mouth/lip movements) and sometimes the head, trunk and limbs. PCs can be present from early stages of stuttering and vary over time and within individuals. The function of PCs is unknown. Some individuals with TS have a distinct disfluency pattern, composed of a majority of typical disfluencies (mostly between-word disfluencies), and a mix of cluttering-like behaviors, complex phonic tics (e.g. speech-blocking tics, echolalia, palilalia), and rarely, atypical disfluencies.

Conclusion: Future investigations are warranted to better understand the complex relationships between tics and stuttering and address the management of disfluencies in TS and PCs in stuttering.

PMID: 37393778 DOI: 10.1016/j.jfludis.2023.105992

 

 

 

Differences in auditory verbal working memory between adults who do and do not stutter on an N-back task - PSICOMOTOR

J Fluency Disord. 2023 Jul 29;77:105998. Online ahead of print.

 

Zoi Gkalitsiou, Courtney Byrd

The University of Texas at Austin, USA.

 

Purpose: The purpose of this study was to investigate auditory verbal working memory in adults who do (AWS) and do not (AWNS) stutter using a highly demanding linguistic N-back task.

Methods: Fifteen AWS and 15 AWNS matched in age, gender and educational level were asked to hear series of words and respond by pressing a "yes" button if the word they just heard was the same as the word one, two, or three trials back. Words were either phonologically similar (i.e., Phonological Linguistic Condition) or phonologically dissimilar (i.e., Neutral Linguistic Condition). Accuracy and false alarms rates as well as reaction time on correct target trials, missed target trials and false alarms were collected and analyzed.

Results: Differences were not found between AWS and AWNS in accuracy. Both groups were more accurate and significantly faster in 1- followed by 2- followed by 3-back trials. However, AWS were significantly slower than AWNS in the 2-back level, regardless of linguistic condition. Furthermore, AWS demonstrated more false alarms compared to AWNS.

Conclusion: Results revealed differences in auditory verbal working memory and interference control between AWS and AWNS when processing highly linguistically demanding stimuli.

PMID: 37531866 DOI: 10.1016/j.jfludis.2023.105998

 

 

 

Digital games for rehabilitation of speech disorders: A scoping review - TERAPIA

Health Sci Rep. 2023 Jun 4;6(6):e1308

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10240099/pdf/HSR2-6-e1308.pdf

 

Sadrieh Hajesmaeel-Gohari, Saeideh Goharinejad, Elaheh Shafiei, Kambiz Bahaadinbeigy

University of Medical Sciences Kerman Iran; The Australian College of Rural and Remote Medicine Brisbane Queensland Australia.

 

Background and aims: Digital games are among the treatment methods for speech disorders that serve purposes other than mere entertainment. These games have been used for different speech disorders at any age. This study aims to review articles that have used digital games for rehabilitating speech disorders.

Methods: This study was a scoping review. PubMed, Scopus, and Web of Science were searched on February 28, 2022, to access the articles on digital games used in rehabilitation of speech disorders without any date restrictions. The search strategy was as follows: ("video game [MeSH term]" OR "computer game" OR "mobile game" OR "serious game" OR gamification [MeSH term]) AND ("speech pathology" OR "speech therapy [MeSH term]" OR "speech disorder [MeSH term]" OR stuttering [MeSH term]). Original interventional and observational studies in English were included. The data were extracted from the relevant articles, including the first author's name, year of publication, country, target group, participants, mobile device/computer-based, type of game design, language level, number of sessions, and outcome. Descriptive statistics were used to analyze the data.

Results: Of 693 retrieved articles, 10 articles were included in this study. Digital games were used for different speech disorders such as apraxia (20%), dysarthria (10%), articulatory hypokinesia in Parkinson's disease (10%), dysphonic disorder (10%), hearing disability (10%), phonological impairment (10%), and speech disorder in autism (10%). Most of the articles (60%) used a mobile device-based game. Phonemes (30%), words (30%), and sentences (20%) were the most frequently used language levels in designing digital games. All the reviewed articles reported the positive effect of digital games on speech and the patients' motivation in therapy.

Conclusion: Digital games can improve patients' speech and motivation in therapy. Although studies showed the positive impact of digital games on speech disorders, personalized speech therapy should be considered in designing these games.

PMID: 37283880 PMCID: PMC10240099 DOI: 10.1002/hsr2.1308

 

 

 

Disfluências e Gaguez: Revisão e Critérios de Referenciação - INFANTIL / AVALIAÇÃO

Acta Med Port. 2023 Jun 1;36(6):434-439. Epub 2023 Jun 1.

 [Article in Portuguese]

Free article: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/18909/15159

 

José Alarcão, Isabel Lucas, Lígia Lapa, Joana Monteiro, Teresa Mota Castelo

Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

 

A gaguez é uma perturbação da comunicação a nível da fluência em que a pessoa sabe claramente a mensagem que quer transmitir, mas o seu dis-curso é caracterizado por alterações do ritmo, repetições, prolongamentos, pausas e bloqueios, podendo ainda associar-se a quadros de ansiedade ou tensão emocional. Até uma em cada seis crianças, tipicamente entre os dois e os cinco anos, experienciam um período de disfluência transitória, com habitual recuperação espontânea até à idade escolar, verificando-se uma prevalência de gaguez em até 1% da população adulta, com maior incidência no sexo masculino (4:1). Em Portugal, é estimado que a gaguez afete cerca de 100 mil pessoas, adquirindo particular importância pela sua frequência e associação a redução da autoestima, ansiedade e isolamento social com impacto na capacidade de comunicação do indivíduo e no seu bem-estar e interações sociais. Este artigo tem como objectivo alertar para a complexidade da abordagem diagnóstica e terapêutica em idade pediátrica, com particular incidência na diferenciação entre disfluências normais da fala e perturbação da fluência com início na infância (gaguez) e critérios de referenciação, pretendendo consciencializar e facilitar a deteção e orientação precoce destes casos.

 

 

 

Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering - AUDITIVO

Iran J Child Neurol. 2023 Winter;17(1):39-53. Epub 2023 Jan 1.

 

Morteza Farazi, Zahra Hosseini Dastgerdi, Yones Lotfi, Abdollah Moossavi, Enayatollah Bakhshi

University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Iran University of Medical Sciences, Tehran, Iran.

 

Objectives: The present study aims to investigate the effect of a temporal processing-based auditory training program on alleviating stuttering severity in children diagnosed with auditory temporal processing disorders.

Materials & methods: Thirty-one children with stuttering diagnosed with auditory temporal processing disorders participated in this study (intervention group: 17 participants between seven to 12 years old; control group: 14 participants between eight to 12 years old). The auditory temporal processing test and Stuttering Severity Instrument-3 (SSI-3) were examined before/after 12 sessions (nearly 540 minutes) of training and three months following the conclusion of the intervention.

Results: According to the results, auditory temporal processing improved significantly in the intervention group after temporal processing-based auditory training. Besides, the differences between the intervention and control groups were significant (P<0.05). The improvement of auditory temporal processing skills remained stable in the post-training evaluation after three months (P>0.05). Although the SSI-3 score was somewhat improved in the intervention group, no significant difference was found between the two groups (P=0.984).

Conclusion: The findings revealed that auditory temporal processing training acted as a complementary therapy alleviating the stuttering severity of children who stutter with auditory temporal processing disorders to some extent.

PMID: 36721835 PMCID: PMC9881827

 

 

 

Effectiveness of speech therapy in treating vocal blocking tics in children with Tourette syndrome: Two case reports - INFANTIL / OUTROS

Clin Child Psychol Psychiatry. 2023 May 24; Online ahead of print.

Free article: https://journals.sagepub.com/doi/pdf/10.1177/13591045231177433

 

Sini Peltokorpi, Auli Laiho, Vappu Carlson, Hanna Raaska

University of Turku, Turku, Finland; HUS Helsinki University Hospital, Helsinki, Finland; Stuttering Resource Center Tempo, Espoo, Finland; The Social Insurance Institution of Finland, Helsinki, Finland.

 

Tourette syndrome is characterized by at least two motor tics and one vocal tic, which persist for over a year. Infrequently, tics can manifest as blocking tics in speech when they prevent a person from starting to speak or interrupt their speech flow. Vocal blocking tics (VBTs) resemble stuttering, and they can be difficult to differentiate from each other. A previous report described two patients with severe VBTs who did not benefit from stuttering-therapy-based speech therapy and were treated effectively with cannabis-based medicine. Here, we present the cases of two patients, seven- and nine-year-old boys, who benefited from speech therapy in which stuttering therapy techniques were used. Detailed descriptions of the interventions are included. Further research is needed to test the effectiveness of speech therapy in treating VBTs in a larger group of children with Tourette syndrome.

PMID: 37225162 DOI: 10.1177/13591045231177433

 

 

 

Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3-6-year-old children who stutter - EMOCIONAL

J Commun Disord. 2023 May 11;104:106332. Online ahead of print.

 

Victoria Tumanova, Dahye Choi, Qiu Wang

Syracuse University, Syracuse, NY, United States; University of South Alabama,  AL, United States.

 

Purpose: The purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI.

Method: Forty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009).

Results: We found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering.

Conclusions: This study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.

PMID: 37178639 DOI: 10.1016/j.jcomdis.2023.106332

 

 

 

Effects of Binaural Beat Stimulation in Adults with Stuttering - NEUROCIÊNCIAS

Brain Sci. 2023 Feb 11;13(2):309.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9954735/pdf/brainsci-13-00309.pdf

 

Dmytro Chernetchenko, Pramax Prasolov, Sam Aganov, Andrii Voropai, Yuliia Polishchuk, Dmytro Lituiev, Eugene Nayshtetik

Research and Development Lab, San Francisco, CA, USA; Dnipro National University, Dnipro, Ukraine; UC Berkeley, San Francisco, CA, USA; California Institute for Human Science, Encinitas, CA, USA; University of the Cumberland, Williamsburg, KY, USA

 

In recent decades, several studies have demonstrated a link between stuttering and abnormal electroencephalographic (EEG) β-power in cortex. Effects of exposure to binaural stimuli were studied in adults with stuttering (AWS, n = 6) and fluent participants (n = 6) using EEG, ECG, and speech analysis. During standard reading tasks without stimulation, in controls but not in the AWS group, EEG β-power was significantly higher in the left hemisphere than in the right hemisphere. After stimulation, the power of the β-band in AWS participants in the left hemisphere increased 1.54-fold. The average β-band power within the left frontotemporal area and temporoparietal junction of the cortex after stimulation in AWS participants shows an increase by 1.65-fold and 1.72-fold, respectively. The rate of disfluency dropped significantly immediately after stimulation (median 74.70% of the baseline). Similarly, the speech rate significantly increased immediately after stimulation (median 133.15%). We show for the first time that auditory binaural beat stimulation can improve speech fluency in AWS, and its effect is proportional to boost in EEG β-band power in left frontotemporal and temporoparietal junction of cortex. Changes in β-power were detected immediately after exposure and persisted for 10 min. Additionally, these effects were accompanied by a reduction in stress levels.

PMID: 36831852 PMCID: PMC9954735 DOI: 10.3390/brainsci13020309

 

 

 

Effects of task variations on language productivity, syntactic complexity, and stuttering in children who stutter - INFANTIL / LINIGUAGEM

Clin Linguist Phon. 2023 Jul 13;1-21. Online ahead of print.

 

Jayanthi Sasisekaran, Xiaofan Lei

University of Minnesota, Minneapolis, Minnesota, USA.

 

Purpose: The aim of this preliminary study was to compare the effects of variations in task demands on: (a) language productivity in sentences categorised into stuttered vs. non-stuttered sentences; (b) syntactic complexity in stuttered vs. non-stuttered sentence categories, and (c) stuttering and typical disfluencies in school-age children who stutter (CWS). Language Sample Analysis (LSA) was conducted on samples from three tasks - Conversation, fable retell, and critical thinking based on the fables.

Methods: Participants were 14 CWS categorised into younger (9 to 12-year-olds, n = 8) and older age groups (13 to 15-year-olds, n = 6). The Computerized Language ANalysis program was used to conduct language and disfluency analyses. Repeated measures analysis of variance and nonparametric statistical analyses were used to investigate: (a) Language productivity in total number of words and sentences by task and sentence category; (b) Syntactic complexity at the word- (use of metacognitive verbs), phrase- (use of verb phrases), and utterance (Mean Length of Utterances in words, MLUw) levels by task and sentence category; and (c) Disfluencies measured using % stuttered syllables (%SS) and % typical disfluencies (%TD).

Results and conclusions: Task effects in language productivity did not differ by sentence category and suggested limited influences of propositionality and volubility in stuttering. In contrast, higher syntactic complexity was obtained in the stuttered compared to non-stuttered sentences at the word, phrase, and utterance levels and it was the same task - conversation, that elicited the effect. Additionally, variations in task demands did not result in significant differences in %SS. The findings inform assessment planning with the selection of tasks guided by task demands and assessment requirements.

PMID: 37439119 DOI: 10.1080/02699206.2023.2232517

 

 

 

Eliciting Stuttering in School-Age and Adolescent Stutterers in Experimental Settings - INFANTIL / TERAPIA

J Speech Lang Hear Res. 2023 Apr 14;1-8 Online ahead of print.

 

Jake H Goldfarb, Joan Orpella, Eric S Jackson

New York University, NY.

 

Purpose: Most neural and physiological research on stuttering focuses on the fluent speech of speakers who stutter due to the difficulty associated with eliciting stuttering reliably in the laboratory. We previously introduced an approach to elicit stuttered speech in the laboratory in adults who stutter. The purpose of this study was to determine whether that approach reliably elicits stuttering in school-age children and teenagers who stutter (CWS/TWS).

Method: Twenty-three CWS/TWS participated. A clinical interview was used to identify participant-specific anticipated and unanticipated words in CWS and TWS. Two tasks were administered: (a) a delayed word reading task in which participants read words and produced them after a 5-s delay and (b) a delayed response question task in which participants responded to examiner questions after a 5-s delay. Two CWS and eight TWS completed the reading task; six CWS and seven TWS completed the question task. Trials were coded as unambiguously fluent, ambiguous, and unambiguously stuttered.

Results: The method yielded, at a group level, a near-equal distribution of unambiguously stuttered and fluent utterances: 42.5% and 45.1%, respectively, in the reading task and 40.5% and 51.4%, respectively, in the question task.

Conclusions: The method presented in this article elicited a comparable amount of unambiguously stuttered and fluent trials in CWS and TWS, at a group level, during two different word production tasks. The inclusion of different tasks supports the generalizability of our approach, which can be used to elicit stuttering in studies that aim to unravel the neural and physiological bases that underlie stuttered speech.

PMID: 37059075 DOI: 10.1044/2023_JSLHR-22-00626

 

 

 

Enfin, a podcast in French on stuttering! - "Je je je suis un podcast": Impacts of accessing stuttering-related information in one's mother tongue - SOCIAL

J Fluency Disord. 2023 Feb 24;76:105961. Online ahead of print.

 

Geneviève Lamoureux, Judith Labonté, Edith Coulombe, Ingrid Verduyckt

Université de Montréal, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada.

 

Purpose: English-language podcasts on stuttering are numerous. However, stuttering-related podcasts in French are far more rare. In order to create a space to explore stuttering for a French-speaking population, the Association bégaiement communication (ABC), a French-Canadian stuttering organization, produced "Je je je suis un podcast". This study seeks to understand 1) how French, as the language of the podcast, has impacted accessibility to stuttering-related information in the Francophone stuttering community, and 2) how this information impacted listeners' experience with stuttering.

Method: An anonymous online survey which included multiple choice, Likert scale and open-ended questions was conducted to better understand the impact, among listeners, of having access to a stuttering-related podcast in French. Answers were analyzed quantitatively and qualitatively.

Results: Eighty-seven people (40 people who stutter [PWS], 39 speech-language pathologists [SLP]/SLP students, eight parents/close persons to a person who stutters), who had listened to "Je je je suis un podcast" participated in the survey. All three populations reported a greater accessibility, and a sense of identification and connection facilitated because of French. SLPs reported seeing the podcast as a way to support their practice, to gain perspective from PWS, and as a lever for change in the SLP field. PWS reported that the podcast gives them a sense of belonging that encourages involvement, as well as knowledge that empowers and supports them in managing their stuttering.

Conclusion: "Je je je suis un podcast" is a podcast about stuttering produced in French that increases accessibility to stuttering-related information and empowers PWS and SLPs.

PMID: 36889119 DOI: 10.1016/j.jfludis.2023.105961

 

 

 

Episodic stuttering as the presenting manifestation of acute ischemic stroke: A case report and systematic literature review - GAGUEIRA NEUROGÊNICA

Case Reports J Stroke Cerebrovasc Dis. 2023 Jul 27;32(9). Online ahead of print.

 

Nil Saez-Calveras, Nguyen Tran, Conny Tran, Parth Upadhyaya

University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Memorial Hospital, Dallas, TX, USA

 

Background: Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature.

Case presentation: We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex.

Systematic literature review: We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution.

Conclusion: Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.

PMID: 37516023 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107271

 

 

 

ERRATUM: Treatment clinical trial - three types - for children with fluency disorders and stuttering

Published Erratum Codas. 2023 Feb 10;35(1):e20220208.
 [Article in Portuguese, English]

 

No authors listed

 

PMID: 36790244 DOI: 10.1590/2317-1782/20212022208pt

 

 

 

Explicit benefits: Motor sequence acquisition and short-term retention in adults who do and do not stutter - PSICOMOTOR

J Fluency Disord. 2023 Jan 19;75:105959. Online ahead of print.

 

Fiona Höbler, Tali Bitan, Luc Tremblay, Luc De Nil

University of Toronto, Toronto, ON, Canada; University of Haifa, Haifa, Israel; University Health Network, Toronto, ON, Canada.

 

Motor sequencing skills have been found to distinguish individuals who experience developmental stuttering from those who do not stutter, with these differences extending to non-verbal sequencing behaviour. Previous research has focused on measures of reaction time and practice under externally cued conditions to decipher the motor learning abilities of persons who stutter. Without the confounds of extraneous demands and sensorimotor processing, we investigated motor sequence learning under conditions of explicit awareness and focused practice among adults with persistent development stuttering. Across two consecutive practice sessions, 18 adults who stutter (AWS) and 18 adults who do not stutter (ANS) performed the finger-to-thumb opposition sequencing (FOS) task. Both groups demonstrated significant within-session performance improvements, as evidenced by fast on-line learning of finger sequences on day one. Additionally, neither participant group showed deterioration of their learning gains the following day, indicating a relative stabilization of finger sequencing performance during the off-line period. These findings suggest that under explicit and focused conditions, early motor learning gains and their short-term retention do not differ between AWS and ANS. Additional factors influencing motor sequencing performance, such as task complexity and saturation of learning, are also considered. Further research into explicit motor learning and its generalization following extended practice and follow-up in persons who stutter is warranted. The potential benefits of motor practice generalizability among individuals who stutter and its relevance to supporting treatment outcomes are suggested as future areas of investigation.

PMID: 36736073 DOI: 10.1016/j.jfludis.2023.105959

 

 

 

Exploratory Examination of Speech Disfluencies in Spoken Narrative Samples of School-Age Bidialectal Children - INFANTIL / AVALIAÇÃO

Am J Speech Lang Pathol. 2023 Mar 31;1-13. Online ahead of print.

 

Kia N Johnson, Monique T Mills

University of Houston, TX; The University of Texas at Austin.

 

Purpose: This study examined the relationship between school-age children's speech disfluencies and the use of and variation of Mainstream American English (MAE) and African American English (AAE). Given that bilingual children may present with notably more speech disfluencies than monolingual children, it was hypothesized that bidialectal speaking children (i.e., those that use both MAE and AAE) may exhibit higher speech disfluencies, as compared to children who speak mainly MAE and those who mainly speak AAE. It was also hypothesized that bidialectal speaking children would exhibit a greater variety of speech disfluency types when compared to the other two dialect groups (i.e., MAE and AAE).

Method: School-age children (n = 61) with typical development and fluency were classified into three dialect groups: MAE speakers (n = 21), bidialectal MAE-AAE speakers (n = 11), and AAE speakers (n = 29). Tell-retell narrative samples were elicited from each participant using a wordless picture book. Speech disfluencies exhibited during these narrative samples were examined for frequency of stuttering-like and nonstuttering-like speech disfluencies and type of speech disfluency.

Results: Findings indicated that bidialectal speaking children do not present with a higher frequency of speech disfluencies when compared to children who speak MAE and children who speak AAE. Additionally, there were no differences in the types of speech disfluencies exhibited by the different dialect groups.

Conclusions: Unexpected findings of this study nullify both hypotheses and suggest that bidialectalism, in comparison to bilingualism, has less of an impact on speech fluency. Findings provide evidence that bidialectal speaking children are not at an increased risk for a misdiagnosis of stuttering. Clinically, these preliminary findings provide some scientific validity and specification to the appropriateness of using already established diagnostic criteria commonly used for stuttering with dialect speakers.

PMID: 37000927 DOI: 10.1044/2023_AJSLP-21-00158

 

 

 

Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children - EMOCIONAL

J Speech Lang Hear Res. 2023 Jun 30;1-18. Online ahead of print.

 

Bridget M Walsh, Hannah Grobbel, Sharon L Christ, Seth E Tichenor, Katelyn L Gerwin

Michigan State University, East Lansing; Purdue University, West Lafayette, IN; Duquesne University, Pittsburgh, PA.

 

Purpose: People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore.

Method: One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement.

Results: Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings.

Conclusions: These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering.

PMID: 37390495 DOI: 10.1044/2023_JSLHR-23-00012

 

 

 

Facebook groups for people who stutter: An extension of and supplement to in-person support groups - SOCIAL

J Commun Disord. 2023 Jan 3;101:106295. Online ahead of print.

 

Erik X Raj, Derek E Daniels, Paula E Thomson

Monmouth University, NJ, USA; Wayne State University, MI, USA; Monmouth University, NJ, USA.

 

Introduction: Online support group experiences, using social networking websites like Facebook, have shown much promise in past research unrelated to stuttering. Therefore, this study aimed to determine the utility of a Facebook-based stuttering support group that was created as an extension of and supplement to an in-person stuttering support group as a means of providing psychosocial support for people who stutter (PWS).

Method: A qualitative approach that was inspired by ethnography was used to explore the experiences of seven participants (six participants who stutter and one participant who does not stutter) who digitally connect on a private Facebook-based stuttering support group that was created as an extension of and supplement to an already existing in-person stuttering support group. The main question posed to the participants related to describing their experiences being a member of the Facebook-based stuttering support group.

Results: Data analysis revealed two major themes, which included the benefits and challenges of participating in a Facebook-based stuttering support group. Each major theme contained five subthemes. Specific results are discussed with reference to past research, as well as implications for practice and recommendations for future research.

Conclusions: There are numerous benefits and challenges associated with being a member of a Facebook-based stuttering support group. However, the overall utility of a Facebook-based stuttering support group, used in tandem with an in-person stuttering support experience, seems to provide members with a useful and impactful way to gain psychosocial support from other PWS.

PMID: 36603411 DOI: 10.1016/j.jcomdis.2022.106295

 

 

 

Factors Associated With Symptoms of Anxiety and Depression in Children Who Stutter - EMOCIONAL

Lang Speech Hear Serv Sch. 2023 Feb 17;1-15. Online ahead of print.

 

Ria Frances Louisa Bernard 1, Courtenay Frazier Norbury 1 2

University College London, United Kingdom; University of Oslo, Norway.

 

Purpose: Children and adolescents who stutter may be at risk of elevated anxiety and depression symptoms, although studies have indicated variability in reported internalizing symptoms in this population. This study considers the association between anxiety and depression symptoms and stuttering, as well as child, family, and contextual factors that may affect this association.

Method: Thirty-five school-age children who stutter completed the Revised Children's Anxiety and Depression Scale-Short Version. We fitted regression models to examine the association between anxiety and depression symptoms with bullying, stuttering severity, family history of adverse mental health, and age in children who stutter.

Results: Family history of adverse mental health was found to significantly predict anxiety and depression scores. Age also predicted depression scores, with older children reporting higher scores.

Conclusions: Family history of adverse mental health is associated with higher self-reported internalizing symptoms in children who stutter. The interaction between child, family, and contextual factors may change with age, and this requires further exploration in larger, longitudinal studies. The association between bullying and anxiety scores indicates the importance of anti-bullying initiatives in promoting psychosocial development in school-age children who stutter. This study also highlights the contribution of known risk factors for mental health, such as family history, to variability in symptom reporting.

PMID: 36800488 DOI: 10.1044/2022_LSHSS-22-00086

 

 

 

High definition-transcranial random noise stimulation to improve speech fluency in persistent developmental stuttering: A case study

Clin Neurophysiol. 2023 Jun 9;152:71-74. Online ahead of print.

 

Pierpaolo Busan, Beatrice Moret, Emanuela Formaggio, Lisa Riavis, Caterina Pisciotta, Fabio Masina, Paolo Manganotti, Gianluca Campana

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

 

No abstract available

DOI: 10.1016/j.clinph.2023.06.001

PMID: 37343446

 

 

 

Identification of stuttering in bilingual Lebanese children across two presentation modes - AVALIAÇÃO

J Fluency Disord. 2023 Mar 9;76:105970. Online ahead of print.

 

Selma Saad Merouwe, Raymond Bertram, Sami Richa, Kurt Eggers

Saint-Joseph University, Lebanon, Turku University, Finland;Ghent University, Belgium; Thomas More University College, Belgium.

 

The goals of this study were to investigate whether Lebanese speech-language pathologists (SLPs) are accurate at identifying stuttering in bilingual children, to examine whether the use of video-recordings instead of audio-recordings allows for better analyses, and to explore factors that may affect the SLPs' judgments. In phase 1, 32 SLPs listened to narrative samples in Lebanese Arabic of 6 children who do not stutter (CWNS) and 2 who stutter (CWS). They were instructed to label each child as stuttering or not, and to explain what motivated their decisions. Afterwards, they were asked to provide background information by means of a questionnaire. In phase 2, they were asked to judge the same speech samples on the basis of video-recordings, and to explain for each child which speech characteristics they relied on to make their decisions. The results showed that misidentification happens frequently, is significantly more likely to happen with CWNS than with CWS, but also varies within these categories. Moreover, the use of video-recordings does not provide more reliable analyses of speech disfluencies, and speech samples' characteristics and bilingual profile rather than SLPs' characteristics seem to influence the judgments. Qualitative analyses indicate that, in the current study, misidentification may be driven by neglecting or misinterpreting physical concomitants. In general, the findings indicate that identifying and analyzing speech fluency behaviors remain a challenging perceptual task, which underlies the need for developing consistent methods for training students and clinicians in identifying stuttering, especially in a bilingual context.

PMID: 36934695 DOI: 10.1016/j.jfludis.2023.105970

 

 

 

Impact of self-disclosure and communication competence on perceived listener distraction - TERAPIA

J Commun Disord. 2023 Apr 25; Online ahead of print.

 

Danielle Werle, Courtney T Byrd, Geoffrey A Coalson

The University of Texas at Austin, Austin, TX, USA.

 

Purpose: The purpose of this study was to investigate the distraction reported by unfamiliar adults when listening to a speaker who stutters, and whether listener distraction is influenced by two factors: self-disclosure and communication competence.

Method: Two hundred seventy-five adults watched a video vignette and were asked to rate their level of distraction when observing an adult Latinx male producing stuttered speech. Each participant watched one of six randomized videos of the same speaker sharing the same content systematically manipulated by (a) presence or absence of 15% stuttering, (b) presence or absence of self-disclosure, and (c) high or low communication competence.

Results: Listener distraction was higher when rating speakers with low communication competence, regardless of whether stuttering or self-disclosure were heard. Videos wherein the speaker was fluent were rated as significantly less distracting, but only in the context of high communication competence. For videos wherein the speaker stuttered, listeners reported significantly less distraction when the speaker demonstrated high communication competence and self-disclosed.

Findings: These findings suggest that for persons who stutter, high communication competence and disclosing that they stutter will yield maximum reduction in listener distraction.

PMID: 37130470 DOI: 10.1016/j.jcomdis.2023.106333

 

 

 

Inefficient speech-motor control affects predictive speech comprehension: atypical electrophysiological correlates in stuttering - LINGUAGEM
Cereb Cortex. 2023 Jan 21;bhad004. Online ahead of print.

 

Simone Gastaldon, Pierpaolo Busan, Giorgio Arcara, Francesca Peressotti

University of Padova, Padova (PD), Italy; 3IRCCS Ospedale San Camillo, Lido (VE), Italy.

 

Listeners predict upcoming information during language comprehension. However, how this ability is implemented is still largely unknown. Here, we tested the hypothesis proposing that language production mechanisms have a role in prediction. We studied 2 electroencephalographic correlates of predictability during speech comprehension-pre-target alpha-beta (8-30 Hz) power decrease and the post-target N400 event-related potential effect-in a population with impaired speech-motor control, i.e. adults who stutter (AWS), compared to typically fluent adults (TFA). Participants listened to sentences that could either constrain towards a target word or not, modulating its predictability. As a complementary task, participants also performed context-driven word production. Compared to TFA, AWS not only displayed atypical neural responses in production, but, critically, they showed a different pattern also in comprehension. Specifically, while TFA showed the expected pre-target power decrease, AWS showed a power increase in frontal regions, associated with speech-motor control. In addition, the post-target N400 effect was reduced for AWS with respect to TFA. Finally, we found that production and comprehension power changes were positively correlated in TFA, but not in AWS. Overall, the results support the idea that processes and neural structures prominently devoted to speech planning also support prediction during speech comprehension.

PMID: 36682885 DOI: 10.1093/cercor/bhad004

 

 

 

Intensive speech-language pathology therapy with adults who stutter: preliminary study - TERAPIA

Codas. 2023 May 26;35(3)

Free article:

Article in Portuguese: https://www.scielo.br/j/codas/a/Y6d6Wj64d3vNRS8zJDnN4YF/?format=pdf&lang=pt

Article in English: https://www.scielo.br/j/codas/a/Y6d6Wj64d3vNRS8zJDnN4YF/?format=pdf&lang=en

 

Amanda Caroline Pereira da Silva Miranda, Camila Queiroz de Moraes Silveira Di Ninno, Denise Brandão de Oliveira E Britto

Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil; Fonoaudióloga Clínica, Consultório Particular - São Paulo (SP), Brasil.

 

Purpose: To compare the results of fluency and self-perception of the impact of stuttering on the lives of adults who stutter, before and after undergoing intensive speech-language pathology therapy.

Methods: This is a descriptive and longitudinal study with data collection before and after intensive therapy in four patients who stutter. The intensive care program consisted of thirty one-hour sessions held in five individual sessions a week. Speech samples collected before and after therapy were analyzed by two fluency experts. Descriptive data analysis was performed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of continuous variables. The verification of agreement between the evaluations carried out by the two judges was performed using the intraclass correlation coefficient (ICC). Correlation analysis was also performed using Spearman's rank correlation coefficient between the variables in the speech sample and the OASES-A scores.

Results: There was a reduction of the percentage of stuttering disfluencies, increasing the flow of words per minute of the participants. The descriptive analysis of the OASES-A showed a decrease in the degree of impact of stuttering on the participants' lives in all parts of the questionnaire.

Conclusion: There was an improvement in all variables analyzed after intensive care, including an improvement in speech fluency and a reduction in the impact of stuttering on the participants' lives, which suggests the relevance of the intensive speech therapy proposal for stuttering.

PMID: 37255078 DOI: 10.1590/2317-1782/20232021159pt

 

 

 

Korean listeners' identification and discrimination of lengthened /s/ as prolongations - AVALIAÇÃO

Clin Linguist Phon. 2023 Feb 13;1-17. Online ahead of print.

 

Jin Park, Inkie Chung

Catholic Kwandong University, Gangneung, South Korea; Sogang University, Seoul, South Korea.

 

This study aimed to examine Korean listeners' judgement of sound duration as prolongation and the mode of perceiving prolongation, whether discrete or continuous. A total of 75 Korean undergraduate students listened to the Korean segment /s/, each of which was lengthened by 0-380 ms (ranging from the original 205 to 585 ms) in 20-ms increments. Then, the participants were asked to complete two different primary tasks: determine whether the sound was normal (0) or abnormal (1) and rate each version of the sound based on a rating of 1 to 100 (the closer to 100, the less fluent). The minimum duration for the Korean sound to be perceived as abnormally prolonged was calculated by analysing the receiver operating characteristic (ROC) curves using Youden's index. To examine whether listeners perceived durational variations for the fricative segment discretely or continuously, a curve was estimated using the best fitting regression model for the observed data with the highest adjusted R-squared value. The minimum duration identified as abnormal prolongation for the Korean lenis fricative /s/ was 375 ms, corresponding to 182.9% of the original, unaltered sound's length. The mode of perceiving durational variations for the segment was continuous (or gradient) rather than discrete. No gender difference was found in the minimum durational threshold and the mode of perceiving prolongation. The findings of this study were further discussed in relation to the existing body of research, and some clinical implications for the assessment of stuttering were also presented.

PMID: 36779876 DOI: 10.1080/02699206.2023.2175332

 

 

 

Listener perceptions of stuttering and stuttering modification techniques - TERAPIA

J Fluency Disord. 2023 Jan 27;75:105960; Online ahead of print.

 

Thales De Nardo, John A Tetnowski, Geoffrey A Coalson

Western Carolina University, USA; Oklahoma State University, USA; University of Texas at Austin, USA.

 

Purpose: The purpose of this study was to analyse naïve listener perceptions of speech containing unmodified stuttering, use of the pull-out technique, and use of preparatory-sets.

Method: Participants (N = 62) were randomly assigned to listen to one audio sample (unmodified stuttered speech, speech with pull-outs, or speech with preparatory-sets) and completed a survey assessing perceptions of the speaker's speech and personality and the listener's comfort level and willingness to social interact with the speaker.

Results: Survey results revealed low perceptual ratings in all experimental conditions. Unmodified stuttered speech received significantly more positive ratings than the stuttering modification conditions in all measurements except for speech naturalness. Listeners reported being less willing to socially interact with those who use preparatory-sets than unmodified stuttered speech.

Conclusion: The use of stuttering modification techniques did not improve listeners' perceptions or willingness to interact with persons who stutter. Clinicians and those who stutter should be aware that the use of speech techniques will not decrease negative social interactions or stereotypes.

PMID: 36736074 DOI: 10.1016/j.jfludis.2023.105960

 

 

 

Nonword reading by adults who stutter in a transparent orthography - CONCEITO

J Fluency Disord. 2023 Jul 26;77. Online ahead of print.

 

Horabail Venkatagiri, Nuggehalli P Nataraja, Theja Kuriakose

Iowa State University, Ames, IA, USA; JSS College of Speech and Hearing, Mysuru, Karnataka, India.; JSS College of Speech and Hearing, Dharwad, Karnataka, India.

 

Purpose: Using word- and nonword-reading passages in Kannada, which has a transparent orthography, we attempted to determine (a) whether orthographic differences between English and Kannada may explain the observed differences in stutter rates on nonwords, and (b) whether longer nonwords, like words, incur higher rates of stutters.

Methods: Stutters are defined as sound or syllable repetitions, sound prolongations, broken words or nonwords (a pause within a word or nonword), abnormal pauses, and intrusive vowel-like sounds. Twenty-six persons, who stutter, read the word and nonword passages. The nonwords were created by changing the first syllable of each word; otherwise words and nonwords were equivalent in length and syllable structure. Stutters were counted from audio-recordings and statistically analyzed.

Results: PWS stuttered on words in varying amounts and in significantly larger amounts on nonwords. Stutter frequency increased roughly in proportion to the increase in the length of phonological words (previously known) and nonwords (reported for the first time here).

Conclusion: The results cannot be attributed to the difficulty of pronouncing nonwords because Kannada orthography has a one-to-one relationship between the written and spoken forms of words. Speech production is a multi-stage process consisting of ideation, lemma selection, phonological word creation, and the articulatory planning and execution. Because nonwords lack meaning and clearly identifiable part of speech, it appears that stutters arise late in the speech production process at the phonological word formation and articulatory planning stages. Meaning, lexicality, and morphosyntax may not contribute significantly to the occurrence of stutters.

PMID: 37544029 DOI: 10.1016/j.jfludis.2023.105996

 

 

 

Psychosocial features of stuttering for school-age children: A systematic review - INFANTIL / TERAPIA

Review Int J Lang Commun Disord. 2023 May 3. Online ahead of print.

 

Georgina Johnson, Mark Onslow, Sarah Horton, Elaina Kefalianos

University of Melbourne, Melbourne, VIC, Australia; University of Technology Sydney, Sydney, NSW, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.

 

Background: Contemporary clinical and empirical perspectives indicate that management of the psychosocial features of stuttering is fundamental for effective treatment. Interventions that improve psychosocial outcomes for school-age children who stutter are, therefore, needed.

Aims: This systematic review identifies what psychosocial outcomes have been explored in existing school-age clinical research, the measures used and the potential treatment effects. This will provide guidance for developing interventions that reflect contemporary perspectives of stuttering management.

Methods & procedures: A total of 14 databases and three conference proceedings were searched for clinical reports of psychosocial outcomes of children aged 6-12 years. The review did not include pharmacological interventions. Psychosocial measures and outcomes were analysed in each study based on data recorded pre-treatment, immediately post-treatment and for any follow-up assessments.

Main contributions: Of the 4051 studies identified from the databases, a total of 22 studies met criteria for inclusion in the review. From these 22 studies, the review identified four prominent psychosocial domains that have been explored in school-age clinical research to date: Impact of stuttering, communication attitude, anxiety and speech satisfaction. These domains vary in measurement and effect sizes. Two behavioural treatments were associated with anxiety reduction, even though they did not contain anxiolytic procedures. No evidence of potential treatment effects emerged for communication attitudes. Quality of life-an important psychosocial domain pertinent to health economics-did not feature in school-age clinical reports.

Conclusions & implications: The psychosocial features of stuttering need to be managed during the school years. Three psychosocial domains-impact of stuttering, anxiety and speech satisfaction-show evidence of potential treatment effects. This review provides direction for future clinical research so that speech-language pathologists can effectively and holistically manage school-age children who stutter.

PMID: 37132231 DOI: 10.1111/1460-6984.12887

 

 

 

Reactions and responses to anticipation of stuttering and how they contribute to stuttered speech that listeners perceive as fluent - An opinion paper - TERAPIA

J Fluency Disord. 2023 Jul 26;77:105997. Online ahead of print.

 

Patrick M Briley

East Carolina University, Greenville, NC, USA.

 

The experience of stuttering is wide ranging and includes a variety of perceived and unperceived behaviors and experiences. One of those experiences is anticipation of stuttering. While anticipation of stuttering is commonly discussed in terms of being a prediction of an upcoming event, it has also been equated to an internal realization of stuttering - which is the conceptualization applied here. The aim of this paper is to impress upon the reader that anticipated moments of stuttering (whether at a conscious or subconscious level) must be met with an adaptive reaction or response (which may also occur consciously or subconsciously). While these adaptive reactions and responses may differ based on whether they promote positive or negative communicative behaviors, they still represent adaptations by the speaker. Among the broad category of reactions and responses to anticipation of stuttering are motoric adaptations to speech, which include characteristic stuttering behaviors and other adaptations that may contribute to speech that is perceived by listeners as fluent. An outcome of this conceptualization is, even when adaptations result in listener perceived fluency, the speech of the person who stutters is still controlled by stuttering - meaning that some observable or unobservable adaptation is required. It is critical that speech-language pathologists recognize that the behaviors of people who stutter may reflect reactions and responses to an internal realization of stuttering and observable and unobservable reactions and responses must be considered in both assessments and interventions.

PMID: 37515980 DOI: 10.1016/j.jfludis.2023.105997

 

 

 

Reduced duration of stuttering-like disfluencies and consistent anticipatory slowing during an adaptation task - FALA

Int J Lang Commun Disord. 2023 Jul 13. Online ahead of print.

 

Amy Neel, Chloe Mizusawa, Quynh Do, Richard Arenas

University of New Mexico, Albuquerque, New Mexico, USA.

 

Purpose: The adaptation effect in stuttering, traditionally described as the reduction of stuttering moments over repeated readings, provides a context to investigate fluency facilitation as well as a relatively controlled means of comparing fluent speech in the immediate vicinity of words that were stuttered versus fluently produced. Acoustic studies have documented decreased duration of fluent speech during adaptation but rarely address changes in disfluencies or the speech preceding or following the disfluencies. This study addresses this gap in the research by documenting frequency and duration changes in both fluent and stuttered syllables.

Method: Fifteen people who stutter read passages aloud five times in succession. Frequency and duration of fluent syllables, pauses, stuttering-like disfluencies (SLDs) and other disfluencies (ODs) were compared across the five readings. In addition, durations for syllables before and after pauses and SLDs were compared to determine if there were anticipation or carryover effects of SLDs on surrounding syllables.

Results: Durations measured for more than 22 000 fluent syllables, 1531 pauses, 128 ODs and 1752 SLDs. For most of the 15 participants, significant decreases in both frequency and duration of SLDs over the five readings were observed. In addition, lengthening of fluent syllables immediately preceding the disfluent syllables was observed: this pre-SLD lengthening did not change over the five readings.

Conclusions: Decreased duration of SLDs across readings supports the motor practice hypothesis, which assumes that successive reading of the same text increases the efficiency of the speech motor plans resulting in less stuttering and decreased durations of the stuttering that persists. Pre-SLD lengthening merits further study, because it informs our knowledge of the time course of stuttered events and may be associated with conscious or unconscious anticipation of upcoming SLDs that does not decrease with motor practice.

PMID: 37439575 DOI: 10.1111/1460-6984.12930

 

 

 

Repetitive Negative Thinking in Adolescents Who Stutter - INFANTIL / TERAPIA

J Speech Lang Hear Res. 2023 Jul 26;1-17. Online ahead of print.

 

Seth E Tichenor, Katelyn L Gerwin, Bridget Walsh

Duquesne University, Pittsburgh, PA; Michigan State University, East Lansing, MI.

 

Purpose: Repetitive negative thinking (RNT) is the process of engaging in negatively valenced and habitual thought patterns. RNT is strongly associated with mental health conditions and often affects quality of life. This study explored RNT in older school-age children and adolescents who stutter to quantify the relationship between RNT and self-reported anxiety characteristics. An additional aim was to describe how individual differences in an adolescent's goal when speaking influences the frequency they engage in RNT.

Method: Ninety-nine children and adolescents who stutter aged 9-18 years completed a measurement of the frequency/severity of RNT, a screener of anxiety characteristics, and a measure of adverse impact related to stuttering. Children aged 10 years and above also answered questions about their goal when speaking.

Results: Individual differences in RNT significantly predicted Overall Assessment of the Speaker's Experience of Stuttering (OASES) Total Scores more so than a child or adolescent's age. Higher generalized or social anxiety scores were significantly correlated with more frequent RNT and higher OASES Total Scores. Individual differences in goal when speaking (i.e., whether or not to stutter openly) were found to predict RNT. Finally, 22 children and adolescents (22.2%) also screened positive for generalized anxiety disorder and 32 (32.3%) screened positive for social anxiety disorder.

Discussion: These data provide strong evidence that (a) many children and adolescents who stutter engage in RNT; (b) children and adolescents who engage more frequently in RNT or who have higher OASES Total Scores may be at increased risk for more characteristics of generalized or social anxiety; and (c) individual differences in goal when speaking can predict the degree to which an adolescent engages in RNT.

Supplemental material: https://doi.org/10.23641/asha.23713296.

PMID: 37494925 DOI: 10.1044/2023_JSLHR-23-00147

 

 

 

Rhythmic tapping difficulties in adults who stutter: A deficit in beat perception, motor execution, or sensorimotor integration? - PSICOMOTOR

PLoS One. 2023 Feb 3;18(2):e0276691. eCollection 2023.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9897587/pdf/pone.0276691.pdf

 

Anneke Slis, Christophe Savariaux, Pascal Perrier, Maëva Garnier

University Grenoble Alpes, Grenoble, France.

 

Objectives: The study aims to better understand the rhythmic abilities of people who stutter and to identify which processes potentially are impaired in this population: (1) beat perception and reproduction; (2) the execution of movements, in particular their initiation; (3) sensorimotor integration.

Material and method: Finger tapping behavior of 16 adults who stutter (PWS) was compared with that of 16 matching controls (PNS) in five rhythmic tasks of various complexity: three synchronization tasks - a simple 1:1 isochronous pattern, a complex non-isochronous pattern, and a 4 tap:1 beat isochronous pattern -, a reaction task to an aperiodic and unpredictable pattern, and a reproduction task of an isochronous pattern after passively listening.

Results: PWS were able to reproduce an isochronous pattern on their own, without external auditory stimuli, with similar accuracy as PNS, but with increased variability. This group difference in variability was observed immediately after passive listening, without prior motor engagement, and was not enhanced or reduced after several seconds of tapping. Although PWS showed increased tapping variability in the reproduction task as well as in synchronization tasks, this timing variability did not correlate significantly with the variability in reaction times or tapping force. Compared to PNS, PWS exhibited larger negative mean asynchronies, and increased synchronization variability in synchronization tasks. These group differences were not affected by beat hierarchy (i.e., "strong" vs. "weak" beats), pattern complexity (non-isochronous vs. isochronous) or presence versus absence of external auditory stimulus (1:1 vs. 1:4 isochronous pattern). Differences between PWS and PNS were not enhanced or reduced with sensorimotor learning, over the first taps of a synchronization task.

Conclusion: Our observations support the hypothesis of a deficit in neuronal oscillators coupling in production, but not in perception, of rhythmic patterns, and a larger delay in multi-modal feedback processing for PWS.

PMID: 36735662 PMCID: PMC9897587

 

 

 

Self-Stigma of Stuttering: Implications for Communicative Participation and Mental Health - TERAPIA

J Speech Lang Hear Res. 2023 Jul 31;1-18. Online ahead of print.

 

Michael P Boyle, Madeline R Cheyne, Amy L Rosen

Montclair State University, Bloomfield, NJ.

 

Purpose: The purpose of this study was to determine if self-stigma-related variables predicted communicative participation and mental health in adults who stutter. A progressive model of self-stigma was theorized and tested.

Method: Adults who stutter (N = 344) completed a survey that included measures of communicative participation, global mental health, and a variety of self-stigma-related variables including perceived enacted stigma, stigma awareness, anticipated stigma, felt stigma, stereotype agreement, and stigma application, in addition to demographic and speech-related variables. Hierarchical regression was performed to test whether self-stigma-related variables progressively explained significant variance in both communicative participation and global mental health.
Results: After controlling for demographic and speech-related variables, stigma-related variables were found to be significant predictors of both communicative participation and global mental health among adults who stutter. Most self-stigma-related variables entered later in the model predicted additional unique variance in the outcome variables than the self-stigma-related variables entered in previous steps, thus supporting the trickle-down and progressive nature of the self-stigma model theorized.

Conclusions: Accounting for self-stigma in the assessment and treatment of individuals who stutter may identify and ultimately reduce environmental and personal barriers to communicative functioning and well-being in people who stutter. The self-stigma terminology and model described in this study will help practitioners, researchers, and the public better understand the process of self-stigma and how it may be associated with adverse outcomes experienced by people who stutter.

PMID: 37524109 DOI: 10.1044/2023_JSLHR-23-00098

 

 

 

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and a phonological speech sound disorder: protocol for a systematic review with narrative synthesis - INFANTIL / TERAPIA "WILL"

BMJ Open . 2023 Jun 1;13(6):e071262

Free article: https://bmjopen.bmj.com/content/bmjopen/13/6/e071262.full.pdf

 

Lucy Rodgers, Nicola Botting, Martin Cartwright, Sam Harding, Rosalind Herman

Sussex Community NHS Foundation Trust, Brighton, UK; City University of London, London, UK; North Bristol NHS Trust, Westbury on Trym, UK.

 

Introduction: Evidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children.

Methods and analysis: This search will build on a previous systematic review by Roulstone et al (2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis.

PMID: 37263699 DOI: 10.1136/bmjopen-2022-071262

 

 

 

Source Localization and Spectrum Analyzing of EEG in Stuttering State upon Dysfluent Utterances - NEUROCIÊNCIAS

Clin EEG Neurosci. 2023 Jan 10. Online ahead of print.

 

Masoumeh Bayat et al; University of Medical Sciences, Shiraz, Iran; Shiraz University, Shiraz, Iran; Islamic Azad University, North Tehran Branch, Tehran, Iran; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Iran University of Medical Sciences, Tehran, Iran; Neuroscience Center, INDICASAT-AIP, Panama City, Republic of Panama; Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran; Academy of Health, Senses Cultural Foundation, Sacramento, CA, USA.

 

Purpose: The present study which addressed adults who stutter (AWS) attempted to investigate power spectral dynamics in the stuttering state by answering the questions using quantitative electroencephalography (qEEG).

Method: A 64-channel electroencephalography (EEG) setup was used for data acquisition at 20 AWS. Since the speech, especially stuttering, causes significant noise in the EEG, 2 conditions of speech preparation (SP) and imagined speech (IS) were considered. EEG signals were decomposed into 6 bands. The corresponding sources were localized using the standard low-resolution electromagnetic tomography (sLORETA) tool in both fluent and dysfluent states.

Results: Significant differences were noted after analyzing the time-locked EEG signals in fluent and dysfluent utterances. Consistent with previous studies, poor alpha and beta suppression in SP and IS conditions were localized in the left frontotemporal areas in a dysfluent state. This was partly true for the right frontal regions. In the theta range, disfluency was concurrence with increased activation in the left and right motor areas. Increased delta power in the left and right motor areas as well as increased beta2 power over left parietal regions was notable EEG features upon fluent speech.

Conclusion: Based on the present findings and those of earlier studies, explaining the neural circuitries involved in stuttering probably requires an examination of the entire frequency spectrum involved in speech.

PMID: 36627837 DOI: 10.1177/15500594221150638

 

 

 

Speech Motor Profiles in Primary Progressive Aphasia - AVALIAÇÃO

Am J Speech Lang Pathol. 2023 Apr 26;1-26. Online ahead of print.

 

Anja Staiger et al

Ludwig-Maximilians-Universität (LMU) München, Germany.; University Hospital Leipzig, Germany;University of Munich School of Medicine, Germany; University of Augsburg, Germany…

 

Purpose: Previous research on motor speech disorders (MSDs) in primary progressive aphasia (PPA) has largely focused on patients with the nonfluent/agrammatic variant of PPA (nfvPPA), with few systematic descriptions of MSDs in variants other than nfvPPA. There has also been an emphasis on studying apraxia of speech, whereas less is known about dysarthria or other forms of MSDs. This study aimed to examine the qualitative and quantitative characteristics of MSDs in a prospective sample of individuals with PPA independent of subtype.

Method: We included 38 participants with a root diagnosis of PPA according to current consensus criteria, including one case with primary progressive apraxia of speech. Speech tasks comprised various speech modalities and levels of complexity. Expert raters used a novel protocol for auditory speech analyses covering all major dimensions of speech.

Results: Of the participants, 47.4% presented with some form of MSD. Individual speech motor profiles varied widely with respect to the different speech dimensions. Besides apraxia of speech, we observed different dysarthria syndromes, special forms of MSDs (e.g., neurogenic stuttering), and mixed forms. Degrees of severity ranged from mild to severe. We also observed MSDs in patients whose speech and language profiles were incompatible with nfvPPA.

Conclusions: The results confirm that MSDs are common in PPA and can manifest in different syndromes. The findings emphasize that future studies of MSDs in PPA should be extended to all clinical variants and should take into account the qualitative characteristics of motor speech dysfunction across speech dimensions.

Supplemental material: https://doi.org/10.23641/asha.22555534.

PMID: 37099755 DOI: 10.1044/2023_AJSLP-22-00319

 

 

 

Stalling for Time: Stall, Revision, and Stuttering-Like Disfluencies Reflect Language Factors in the Speech of Young Children - INFANTIL / LINGUAGEM

J Speech Lang Hear Res. 2023 May 24;1-17. Online ahead of print.

 

Julianne Garbarino, Nan Bernstein Ratner

University of Maryland, College Park.

 

Purpose: Disfluencies can be classified as stuttering-like disfluencies (SLDs) or typical disfluencies (TDs). Dividing TDs further, stalls (fillers and repetitions) are thought to be prospective, occurring due to planning glitches, and revisions (word and phrase revisions, word fragments) are thought to be retrospective, occurring when a speaker corrects language produced in error. In the first study assessing stalls, revisions, and SLDs in matched groups of children who stutter (CWS) and children who do not stutter (CWNS), we hypothesized that SLDs and stalls would increase with utterance length and grammaticality but not with a child's expressive language level. We expected revisions to be associated with a child having more advanced language but not with utterance length or grammaticality. We hypothesized that SLDs and stalls (thought to be planning-related) would tend to precede grammatical errors.

Method: We analyzed 15,782 utterances from 32 preschool-age CWS and 32 matched CWNS to assess these predictions.

Results: Stalls and revisions increased in ungrammatical and longer utterances and with the child's language level. SLDs increased in ungrammatical and longer utterances, but not with overall language level. SLDs and stalls tended to occur before grammatical errors.

Conclusions: Results suggest that both stalls and revisions are more likely to occur in utterances that are harder to plan (those that are ungrammatical and/or longer) and that, as children's language develops, so do the skills they need to produce both stalls and revisions. We discuss clinical implications of the finding that ungrammatical utterances are more likely to be stuttered.

PMID: 37224005 DOI: 10.1044/2023_JSLHR-22-00595

 

 

 

Stuttering as a signal of encephalopathy associated with toripalimab in a pancreatic ductal adenocarcinoma patient: a case report - GAGUEIRA ADQUIRIDA

Case Reports BMC Neurol. 2023 Mar 4;23(1):96
Free Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985276/pdf/12883_2023_Article_3140.pdf

 

Jianping He, Xi Chen, Ke Cheng, Wanrui Lv, Dan Cao, Zhiping Li

Sichuan University, Cancer Center, Chengdu, China.

 

Background: Immune checkpoint inhibitor (ICI) combined with chemotherapy has exhibited promising results in small sample studies of pancreatic cancer patients. The efficacy of toripalimab, a programmed cell death protein 1 (PD-1) monoclonal antibody has been explored in the previous studies and it was established that immune-related adverse events (irAEs) associated with administration of this drug deserve proper attention and adequate management.

Case presentation: A 43-year-old female patient with advanced pancreatic ductal adenocarcinoma (PDAC) was treated with toripalimab in combination with gemcitabine and nab-paclitaxel (T-GA) as the first-line treatment. She developed immune-related encephalopathy with stuttering as the main clinical symptom and Magnetic resonance imaging (MRI) showed multiple cerebral white matter demyelination changes, concomitant with asymptomatic cardiac enzyme elevation and hypothyroidism. The symptoms resolved after the discontinuation of toripalimab and corticosteroid treatment.

Conclusions: Stuttering might be an early sign of neurotoxicity which can be easily neglected during the treatment. These findings provide guidance for the identification of these rare and occult neurological irAEs (n-irAEs) in the clinical practice.

PMID: 36870985 PMCID: PMC9985276 DOI: 10.1186/s12883-023-03140-7

 

 

 

Stuttering experience of people in China: A cross-cultural perspective - SOCIAL

J Fluency Disord. 2023 Jul 6;77:105994. Online ahead of print.

 

Yan Ma, Judith D Oxley, J Scott Yaruss, John A Tetnowski

Purdue University Fort Wayne, IN, United States;  University of Louisiana at Lafayette, LA, United States; Michigan State University, East Lansing, MI, United States; Oklahoma State University, OK, United States.

 

Purpose: This study uses the Simplified Chinese version of the Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A-SC) to examine the stuttering experience of people in China and determine if there are differences between the data collected in China and other countries.

Methods: A total of 139 responses to the OASES-A-SC were collected in an online self-help community of people in China who stutter. Descriptive analyses were conducted to obtain the understanding of how stuttering impacts the life experience of people in China who stutter. Comparisons were conducted regarding the groups of gender, highest education, and therapy history. Cross-cultural comparisons among the data collected from China, Australia, the Netherlands, Japan, Sweden, and the USA were also conducted.

Results: The data for the OASES-A-SC showed a skewed distribution toward the severe end of the OASES-A impacting scale. About 93.5% participants rated the overall impact of stuttering on their life at and above the "Moderate" category. The mean scores of the General Information, Reaction to Stuttering, and Qualify of Life sections fell in the moderate-to-severe category. Compared with the data in other five countries, the Chinese data were significantly higher in the impact severity level.

Conclusion: The results showed that people in China who stutter have more adverse experiences related to stuttering compared with their counterparts in western or developed countries. Higher negative attitudes toward stuttering in China, social stigma against people with disabilities, and the fewer professional supports were discussed to be associated with this more adverse experience. Cultural differences such as a greater power distance and higher collectivism in Chinese culture were considered to be associated with the elevated level of adverse impact of stuttering in China.

PMID: 37478807 DOI: 10.1016/j.jfludis.2023.105994

 

 

 

[Stuttering in Children: Review and Referral Criteria]

Acta Med Port. 2023 Jun 1;36(6):434-439. Epub 2023 Jun 1.

 [Article in Portuguese]

Free article: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/18909/15159

 

José Alarcão, Isabel Lucas, Lígia Lapa, Joana Monteiro, Teresa Mota Castelo

Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

 

Abstract in English, Portuguese

Stuttering is a speech fluency disorder, in which people know perfectly well the message they want to convey, even though their speech is characterized by changes in rhythm, repetitions, prolongations, pauses and blocks, and may also be associated with states of anxiety or emotional tension. Up to one in every six children, typically between two and five years old, experience a period of transitory speech disfluency, with usual spontaneous recovery before reaching school age, with a prevalence rate of stuttering of up to 1% of the adult population, and a higher incidence rate in males (4:1). In Portugal, it is estimated that stuttering affects around 100 thousand people, acquiring importance due to its frequency and association with lower self-esteem, anxiety and social isolation, with negative impact on people's ability to communicate and on their well-being and social interactions. The aim of this article is to highlight the complexity of the diagnostic and therapeutic approach of stuttering in pediatrics, with a particular focus on differentiating between normal speech disfluencies and childhood-onset fluency disorder (stuttering) and referral criteria, in order to raise awareness and facilitate early detection of these cases.

PMID: 37261913 DOI: 10.20344/amp.18909

 

 

 

Stuttering-Like Dysfluencies as a Consequence of Long COVID-19 - GAGUEIRA ADQUIRIDA

J Speech Lang Hear Res. 2023 Feb 13;66(2):415-430. Epub 2023 Feb 7.

 

Giovanni Furlanis, Pierpaolo Busan, Emanuela Formaggio, Alina Menichelli, Alberta Lunardelli, Milos Ajcevic, Valentina Pesavento, Paolo Manganotti

University Hospital and Health Services of Trieste, ASUGI, Italy; University of Trieste, Italy; IRCCS Ospedale San Camillo, Venice, Italy; University of Padua, Italy.

 

Purpose: We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection.

Methods and results: Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery.

Conclusions: It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.

DOI: 10.1044/2022_JSLHR-22-00381

 

 

 

Stuttering management practices in Sri Lanka: A mixed method study - TERAPIA

J Fluency Disord. 2023 Mar 31;76:105973. Online ahead of print.

 

Dinusha Nonis, Rachael Unicomb, Sally Hewat

The University of Newcastle, Australia; University of Kelaniya, Sri Lanka; OST Therapy, Shenzhen, China.

 

Purpose: Speech and language therapy is a growing profession in Sri Lanka, and little is known about how stuttering is currently managed in the country. Therefore, this study aimed to investigate the current stuttering management practices in Sri Lanka and to investigate any barriers to service provision.

Method: A convergent mixed methods design was employed across two phases. Sixty-four Sri Lankan speech and language therapists (SALTs) participated in online surveys in phase one and ten participated in semi structured interviews in phase two. Survey data in phase one was analysed using descriptive statistics and data in phase two was analysed using thematic analysis. Results from both phases were triangulated for the overall interpretation of the data.

Results: Sri Lankan SALTs conduct a comprehensive assessment, however some assessment contexts (e.g., stuttering beyond the clinic) were not routinely considered. Speech and language therapists reported using multiple and varied intervention approaches/strategies, which were often adapted and/or combined. It was noted that the delivery of treatment was more challenging. Barriers identified were including limited knowledge of some aspects of stuttering management, limited access to resources, and workplace constraints.

Conclusion: Overall, findings revealed that most Sri Lankan SALTs employ a comprehensive and holistic approach in assessment; however, some limited knowledge of the disorder and intervention was identified. Findings highlighted the need for further training for SALTs regarding the management of stuttering, the need for culturally and linguistically validated appropriate assessments as well as the need to consider logistical issues in clinical settings and service delivery.

PMID: 37028210 DOI: 10.1016/j.jfludis.2023.105973

 

 

 

Syllable- and word-based measures of stuttering in speech samples of Turkish-speaking school-aged children - INFANTIL / FALA - LINGUAGEM

Clin Linguist Phon. 2023 Mar 10;1-18. Online ahead of print.

 

Burcu Büşra Bircan, I Lkem Kara, Maviş Emel Kulak Kayıkcı

Likya Center for Speech and Language, Antalya, Turkey;  Ankara Yıldırım Beyazıt University, Ankara, Turkey; Hacettepe University, Ankara, Turkey.

 

Linguistic factors influence the likelihood of occurrence of stuttering instances on a certain word within an utterance. However, studies on the relationship between stuttering instances and linguistic factors of Turkish-speaking individuals are scarce. This study aimed to determine the syllable- and word-based measures of stuttering speech samples of Turkish-speaking school-aged children who stutter. Stuttering-like disfluencies (SLDs) and lexical categories were identified after transcription of 61 children's spontaneous speech samples (age range = 6-16). Syllable-, word- and utterance-level measures were employed. Syllable-based and word-based stuttering frequency findings were significantly different (p < .001); SLDs were more likely to occur at the utterance-initial (p < .001) and word-initial (p < .001) positions; content words were more likely to be stuttered and, there was a relation between the occurrence of SLDs and utterance length (p = .001). Since there is great variability between word-based and syllable-based measures, and SLDs tend to occur at word onsets, using word-based measures in Turkish would provide a measure of stuttering frequency that is comparable to the literature. Moreover, findings support that phrases requiring greater demands on utterance planning increase the possibility of occurrence of stuttering instances.

PMID: 36897763 DOI: 10.1080/02699206.2023.2186764

 

 

 

Temporal organization of syllables in paced and unpaced speech in children and adolescents who stutter - INFANTIL / CONCEITO

J Fluency Disord. 2023 May 11;76:105975. Online ahead of print.

 

Mona Franke, Philip Hoole, Simone Falk

University of Munich, Germany; Université de Montréal, Canada,; International Laboratory for Brain, Music and Sound Research (BRAMS), Montréal, Canada; Centre for Research on Brain, Language and Music (CRBLM), Montréal, Canada

 

Purpose: Speaking with an external rhythm has a tremendous fluency-enhancing effect in people who stutter. The aim of the present study is to examine whether syllabic timing related to articulatory timing (c-center) would differ between children and adolescents who stutter and a matched control group in an unpaced vs. a paced condition.

Methods: We recorded 48 German-speaking children and adolescents who stutter and a matched control group reading monosyllabic words with and without a metronome (unpaced and paced condition). Analyses were conducted on four minimal pairs that differed in onset complexity (simple vs. complex). The following acoustic correlates of a c-center effect were analyzed: vowel and consonant compression, acoustic intervals (time from c-center, left-edge, and right-edge to an anchor-point), and relative standard deviations of these intervals.

Results: Both groups show acoustic correlates of a c-center effect (consonant compression, vowel compression, c-center organization, and more stable c-center intervals), independently of condition. However, the group who stutters had a more pronounced consonant compression effect. The metronome did not significantly affect syllabic organization but interval stability improved in the paced condition in both groups.

Conclusion: Children and adolescents who stutter and matched controls have a similar syllable organization, related to articulatory timing, regardless of paced or unpaced speech. However, consonant onset timing differs between the group who stutters and the control group; this is a promising basis for conducting an articulatory study in which articulatory (gestural) timing can be examined in more detail.

PMID: 37247502 DOI: 10.1016/j.jfludis.2023.105975

 

 

 

Terapia fonoaudiológica intensiva com adultos que gaguejam: estudo preliminar - TERAPIA

Codas. 2023 May 26;35(3)

Free article:

Article in Portuguese: https://www.scielo.br/j/codas/a/Y6d6Wj64d3vNRS8zJDnN4YF/?format=pdf&lang=pt

Article in English: https://www.scielo.br/j/codas/a/Y6d6Wj64d3vNRS8zJDnN4YF/?format=pdf&lang=en

 

Amanda Caroline Pereira da Silva Miranda, Camila Queiroz de Moraes Silveira Di Ninno, Denise Brandão de Oliveira e Britto

Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil; Fonoaudióloga Clínica, Consultório Particular - São Paulo (SP), Brasil.

 

Objetivo: Comparar os resultados da fluência e da autopercepção do impacto da gagueira na vida de adultos que gaguejam, antes e depois de terapia fonoaudiológica intensiva.

Método: Trata-se de estudo descritivo longitudinal com coleta de dados antes e após terapia fonoaudiológica intensiva de quatro pacientes com gagueira. O programa de terapia intensiva constituiu-se em trinta encontros, de uma hora cada, realizados em cinco sessões individuais na semana. As amostras de fala coletadas antes e após a terapia foram analisadas por dois juízes especialistas em Fluência. A análise descritiva dos dados foi realizada por meio da distribuição de frequência das variáveis categóricas e análise das medidas de tendência central e de dispersão das variáveis contínuas. A verificação da concordância entre as análises realizadas pelos dois juízes foi realizada por meio do coeficiente de correlação intraclasse (CCI). Foi realizada também a análise de correlação pelo coeficiente de correlação de Spearman, entre as variáveis da amostra de fala e os escores do OASES-A.

Resultados: Houve redução do percentual de descontinuidade da fala e do percentual de disfluências gagas, aumentando o fluxo de palavras por minuto dos participantes. Na análise descritiva do OASES-A observou-se que em todas as partes do questionário, houve diminuição do grau de impacto da gagueira na vida dos participantes.

Conclusão: Verificou-se melhora de todas variáveis analisadas após terapia intensiva. Observou-se melhora na fluência da fala e redução do impacto da gagueira na vida dos participantes, sugerindo a relevância da proposta de terapia fonoaudiológica intensiva na gagueira.

 

 

 

The Association Between Atypical Speech Development and Adolescent Self-Harm - INFANTL / EMOCIONAL 

J Speech Lang Hear Res. 2023 Apr 20;1-18. Online ahead of print.

 

Jan McAllister, Jane Skinner, Rosemarie Hayhow, Jon Heron, Yvonne Wren

University of Essex, Colchester, United Kingdom; University of East Anglia, United Kingdom; Bristol Speech & Language Therapy Research Unit, United Kingdom; University of Bristol, United Kingdom; Cardiff Metropolitan University, United Kingdom.

 

Background: Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

Method: Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

Results: Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

Conclusion: Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

PMID: 37080239 DOI: 10.1044/2023_JSLHR-21-00652

 

 

 

The effect of stuttering on symptoms of depression and social anxiety in adolescents - INFANTIL / TERAPIA

Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3288-3293.

 

E Sizer 1, B Sizer

Mardin Training and Research Hospital, Mardin, Turkey.

 

Objective: This study aims at examining the relationship between the severity of stuttering, which makes it difficult to speak and communicate, and the symptoms of depressive and social anxiety disorders during adolescence.

Patients and methods: A total of 65 children between 14 and 18 years old, diagnosed with stuttering, were included in the study, regardless of gender. Stuttering Severity Instrument, Beck Depression Scale, and Social Anxiety Scale for Adolescents were administered to all participants.

Results: The mean age of the 65 patients was 15.41±0.93. Out of them, 36 (55.4%) were female and 29 (44.6%) were male. In terms of stuttering levels, 25 participants (35.8%) had mild stuttering, 20 (30.8%) showed moderate stuttering, and 20 (30.8%) had severe stuttering. Depression levels of individuals diagnosed with stuttering increased significantly in parallel with the severity of stuttering (p<0.001). The social anxiety scale total score and subscale scores of individuals diagnosed with stuttering also increased significantly in parallel with stuttering severity (p<0.01).

Conclusions: The symptoms of depression and social anxiety disorders increase with the severity of stuttering in adolescent patients who applied to the child psychiatry clinic presenting stuttering.

PMID: 37140278 DOI: 10.26355/eurrev_202304_32099

 

 

 

The effects of attentional focus on speech motor control in adults who stutter with and without social evaluative threat - TERAPIA

J Fluency Disord. 2023 Jul 22;77:105995. Online ahead of print.

 

Kim R Bauerly, Antje Mefferd

University of Vermont, Burlington, VT, USA; Vanderbilt University Medical Center, Nashville, TN, USA.

 

Purpose: We sought to investigate the effects of cued attentional shifts on speechmotor control in adults who stutter (AWS) and adults who do not stutter (ANS) when speaking under low and high social stress conditions.

Method: Thirteen AWS' and 10 ANS' lip aperture (LA) and posterior tongue (PT) movements were assessed under a Cued-Internal and Cued-External attentional focus condition with and without social stress induction (i.e. speaking to an audience). Skin conductance levels were used to measure a stress response. Speech motor control was assessed by measuring movement duration and variability of movement for LA and PT using the spatial temporal index (STI).

Results: A significant Group x Condition interaction was found for LA STI. Post-hoc comparisons indicated AWS' LA STI significantly decreased under Cued External Focus conditions during both low and high social stress. No significant Group x Condition interaction was found for PT STI. AWS showed significantly slower tongue movements (PT) across all low and high social stress conditions; however, there was no significant Group x Condition interaction for PT or LA.

Discussion: Findings yield preliminary insights into the role of attentional focus on speech motor control when speaking during high social stress. Theoretical and clinical implications are discussed.

PMID: 37494845 DOI: 10.1016/j.jfludis.2023.105995

 

 

 

The Effects of Different Sources and Modalities of Stuttering Disclosure on Listeners' Perceptions of a Child who Stutters - TERAPIA

Folia Phoniatr Logop. 2023 Feb 6. Online ahead of print.

 

Gregory Snyder, Peyton McKnight Sinak, Ashlee Manahan, Myriam Kornisch, Paul Blanchet

 

Introduction: Research reveals the clinical efficacy of both verbal and written stuttering disclosure statements provided by a child who stutters (CWS) and his advocates (i.e., mother or teacher) [1,2]. Although existing data reveals that both the source (i.e., self- vs. advocate-disclosure) and modality (i.e., verbal or written) of stuttering disclosure yields significant improvements in the perceptions of speech skills and personality characteristics of CWS, there is a paucity of research directly comparing the modality (verbal vs. written) and source (self, mother, teacher) of disclosure statements. Accordingly, this study analyzes listeners' perceptions of a 12-year-old male CWS' speech skills and personal characteristics, as a function of both the source and modality of factual stuttering disclosure statements [1,2].

Methods: A total of 641 college-aged adults participated in this analysis; study participants reported their perceptions of speech skills and personality characteristics of a 12 year-old CWS as a function of stuttering disclosure. Participants were randomly assigned to view one video containing one of two disclosure modalities (verbal or written), and one of three stuttering disclosure source conditions (self-disclosure, mother disclosure, teacher disclosure), or a no disclosure control condition. Participants in the control group viewed a brief video of a 12-year-old CWS reciting a short reading passage; participants in the experimental groups viewed their assigned disclosure statement followed by the same video used in the control condition. Immediately following the video, all participants completed a survey quantifying their perceptions of the child who stutters relative to his speech skills and personal characteristics.

Results: Results reveal optimal results via verbal self-disclosure and verbal teacher disclosure. A limited number of nominally positive perceptual differences were noted within the written mother-disclosure group, while written CWS self-disclosure yielded significantly negative perceptions of the CWS. Overall, verbal disclosures yields far more significant and desirable perceptions of CWS' speech skills and personal characteristics when compared to written stuttering disclosure.

Discussion/conclusion: Results of this analysis reveal that verbal stuttering disclosure is significantly more effective in improving listeners' perceptions of a CWS, when compared to written stuttering disclosures. Despite the widespread adoption of written communication over digital media (e.g., email and text messages), these data support the notion that face-to-face or video verbal stuttering disclosure provide the most desirable perceptual benefits for CWS. Within verbal stuttering disclosure, verbal self-disclosure appears to be the single best overall disclosure methodology relative to clinical application.

PMID: 36746128 DOI: 10.1159/000529499

 

 

 

The effect of manual movements on stuttering in individuals with down syndrome - OUTRAS ÁREAS

J Fluency Disord. 2023 Jan 4;75:105958. Online ahead of print.

 

Babette Maessen, Inge Zink, Bea Maes, Ellen Rombouts

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

 

Purpose: Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients' needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.

Method: Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.

Results: The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.

Conclusion: Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.

PMID: 36621164 DOI: 10.1016/j.jfludis.2023.105958

 

 

 

The experience of Polish individuals who stutter based on the OASES outcomes - AVALIAÇÃO

J Fluency Disord. 2023 Jun 15;77:105991. Online ahead of print.

 

Katarzyna Węsierska, J Scott Yaruss, Kalina Kosacka, Łukasz Kowalczyk, Aleksandra Boroń

University of Silesia in Katowice, Poland; Michigan State University, East Lansing, MI, USA; Maria Curie-Sklodowska University in Lublin, Poland; The Maria Grzegorzewska University in Warsaw, Poland; Private Practice, Syców, Zgorzelec, Poland.

 

Background: Prior research has shown that stuttering is a complex and individualized condition. The Overall Assessment of the Speaker's Experience of Stuttering (OASES; Yaruss & Quesal, 2016) is a well-researched tool that measures the impact of stuttering on an individual's life. This study has used the Polish version of the OASES to examine the experience of stuttering among Polish people who stutter.

Method: The original, English version of the OASES was translated into Polish. Reliability and validity for the Polish version were evaluated. Comparisons were made between samples from Poland and the United States for all of the sections and for the overall results of the OASES-S, OASES-T, and OASES-A. To explore the structure of the stuttering experience, a factor structure of the OASES was conducted.

Results: Like other versions of the OASES, the OASES-Polish (OASES-PL) demonstrated good reliability and validity. Cross-cultural comparisons have shown that Polish school-age children had significantly lower knowledge and awareness of stuttering than children in the United States (USA). Factor analysis further revealed that the structure of the experience of stuttering is similar across all age groups, but the importance of the particular aspects of stuttering varies at different stages of life.

Conclusion: The OASES-PL is a reliable and valid instrument for measuring the impact of stuttering on Polish people who stutter and can therefore be used as a clinical tool. Polish results were relatively similar to those from the USA, though there were subtle cross-cultural differences that are worthy of further exploration.

Educational objectives: After reading the article, the participant will be able: (1) to describe the diverse experiences of Polish people who stutter at different ages, (2) to explain the importance of quality of life analysis in diagnosis and speech therapy with people who stutter, and (3) to explain the breadth of the stuttering phenomenon among Polish individuals who stutter.

PMID: 37354736 DOI: 10.1016/j.jfludis.2023.105991

 

 

 

The reliability of simultaneous versus individual data collection during stuttering assessment - AVALIAÇÃO

Int J Lang Commun Disord. 2023 Mar 2. Online ahead of print.

 

Jason H Davidow, Jun Ye, Robin L Edge

Hofstra University, Hempstead, NY, USA; University of Akron, Akron, OH, USA; Jacksonville University, Jacksonville, FL, USA.

 

Abstract

Background: Speech-language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously.

Aims: The present study sought to determine reliability when collecting multiple measures simultaneously versus individually.

Methods & procedures: Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra- and inter-rater reliability values were calculated for each measure.

Outcomes & results: The following results were notable: better intra-rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra-rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter-rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups.

Conclusions & implications: These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols.

What this paper adds: What is already known on the subject The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI-4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge The present study has multiple novel findings. First, relative and absolute intra-rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter-rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra-rater and inter-rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work? Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI-4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and stronger clinical decision making.

PMID: 36861494 DOI: 10.1111/1460-6984.12860

 

 

 

The Use of an Interactive Social Simulation Tool for Adults Who Stutter: A Pilot Study - TERAPIA
Eur J Investig Health Psychol Educ. 2023 Jan 13;13(1):187-198.
Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9858588/pdf/ejihpe-13-00014.pdf

 

Grant Meredith, Leigh Achterbosch, Blake Peck, Daniel Terry, Evan Dekker, Ann Packman
Federation University, Mt. Helen, Ballarat, VIC, Australia; University of Technology Sydney, Sydney, NSW, Australia.

 

This study reports a user evaluation of a DVD-based social simulator, developed for people who stutter to potentially gain confidence in using a learned fluency technique. The aim was to examine and evaluate the pilot of the DVD-based social simulator, Scenari-Aid, to inform the development of an online version of the program. Thirty-seven adults who were stuttering were recruited to the study from non-professional groups in Australia. The DVD comprised scenarios with actors in real-life settings that were designed to elicit verbal responses. Participants worked through the scenarios at their own rate and then completed an online survey. The survey comprised 29 statements requiring responses on a 5-point Likert scale and provided information about users' perceptions of participating in the social simulations. There was high positive agreement among the participants on all statements, the most important being that they perceived the scenarios represented in everyday speaking situations and that they felt immersed in them. Participants also agreed that both their fluency and confidence increased in everyday speaking situations as a result of working through the DVD scenarios. The developers were satisfied that, despite the subjective nature of the findings, the study provided sufficient support for constructing the online version, which is now available to the public free of charge. Further research is needed to provide empirical evidence of the contribution it can make to the efficacy of speech programs for adults who stutter.
PMID: 36661764 PMCID: PMC9858588 DOI: 10.3390/ejihpe13010014

 

 

 

There is more to cluttering than meets the eye: The prevalence of cluttering and association with psychological well-being indices in an undergraduate sample - TAQUIFEMIA

Int J Lang Commun Disord. 2023 Jun 21. Online ahead of print.

 

Michal Icht, Gil Zukerman, Avi Zigdon, Liat Korn

Ariel University, Ariel, Israel.

 

Background: Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech delivery rate along with disfluencies that are frequent but are not judged to be stuttering. Data on cluttering prevalence in the general population are scarce, as well as its association with psychological well-being indices, such as anxiety, and depressive symptoms.

Aims: To estimate cluttering prevalence among undergraduates, as well as its relationship with psychological and well-being indicators.

Methods & procedures: To address these issues, a large sample (n = 1582) of undergraduates completed a questionnaire that provided a lay definition of cluttering and were asked to identify themselves as clutterers (SI-Clut), as well as to indicate the presence of several psychological and mental well-being indices.

Outcomes & results: A total of 276 respondents (23%) self-identified as clutterers (now or in the past), with 55.1% of those being male. Only 56 respondents (3.5% of the total sample; about 21% of SI-Clut) reported having received speech therapy for cluttering. Relative to students self-identifying as non-clutterers, self-identification of cluttering was associated with higher levels of psychosomatic symptoms, depressive symptoms and stress, indicating a tendency toward internalizing psychopathology, along with lower self-esteem, and lower subjective happiness.

Conclusions & implications: The current findings point to the high prevalence of students self-identifying as clutterers, along with a significant link between cluttering and mental distress. Therefore, it is important to increase public awareness of cluttering, its diagnosis and treatment. From the clinical perspective, the elevated levels of somatic complaints, anxiety and depression may represent internalizing psychopathology, associated with more covert rather than overt symptomatology. Such symptom manifestation calls for special attention from the speech-language pathologists providing cluttering therapy, using designated well-being or mental health screening tools. Although data on standard cluttering treatment are limited, it should be customized to the client's unique difficulties. Speech-language pathologists' understanding of cluttering, which includes both speech characteristics as well as psychological and social aspects of well-being, may assist them in implementing effective treatments.

PMID: 37341168

 

 

 

T-PALS framework to assess children who stutter with coexisting disorders: A tutorial - INFANTIL / AVALIAÇÃO

J Fluency Disord. 2023 Apr 26;76:105974. Online ahead of print.

 

Lesley Wolk, Lisa LaSalle

University of Redlands, USA; California State University-Monterey Bay, USA.

 

The purpose of this paper is to present a tutorial on a diagnostic framework developed to assess children who stutter and exhibit co-existing disorders. While we have guidelines for treating these children, there are no specific guidelines for assessing them. We provide a rationale for the development of T-PALS with support from the literature. The T-PALS framework assesses 5 foundational key elements for the child: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Both qualitative and quantitative measures are used within each dimension. This framework is discussed with reference to using two clinical case examples. T-PALS observation data are presented as well as treatment suggestions for each case. We conclude that T-PALS may be a useful framework for both clinicians and researchers, working with children who present with stuttering and comorbid conditions. Clinicians are encouraged to reach beyond the traditional focus on solely assessing the stuttering behavior, even when that is the main concern for referral, and to consider a broader view of the child. It is hoped that this more integrative approach to assessment may yield a more holistic diagnostic picture of a dual diagnosis child from which treatment goals can be derived.

PMID: 37150093 DOI: 10.1016/j.jfludis.2023.105974

 

 

 

Understanding the Broader Impact of Stuttering: Suicidal Ideation - AVALIAÇÃO

Am J Speech Lang Pathol. 2023 Jul 20;1-24. Online ahead of print.

 

Seth E Tichenor, Scott Palasik, J Scott Yaruss

Duquesne University, Pittsburgh, PA; University of Akron, OH; Michigan State University, East Lansing.

 

Purpose: Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

Method: One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

Results: Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

Conclusions: Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

PMID: 37473446 DOI: 10.1044/2023_AJSLP-23-00007

 

 

 

Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial - TERAPIA

Front Digit Health. 2023 Feb 9;5:1061323.

 

Ian Chard, Nejra Van Zalk, Lorenzo Picinali

Imperial College London, London, United Kingdom.

 

We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET (n = 13) or be put on a waitlist (n = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering.

PMID: 36845336 PMCID: PMC9947508 DOI: 10.3389/fdgth.2023.1061323

 

 

 

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                                    janeiro a julho de 2017

                                    agosto a dezembro de 2017

 

                                    janeiro a julho de 2016

                                    agosto a dezembro de 2016

 

                                    janeiro a julho de 2015

                                    agosto a dezembro de 2015

 

                                    janeiro a julho de 2014
                                    agosto a dezembro de 2014

 

                                     janeiro a julho de 2013

                                     agosto a dezembro de 2013

 

                                      janeiro a julho de 2012

                                      agosto a dezembro de 2012