Jason A. Tourville

This study investigated the clinical and neural correlates of speech motor sequence learning in primary progressive aphasia (PPA) to test specific predictions regarding the roles of the left posterior inferior frontal sulcus (pIFS) and left ventral premotor cortex (vPMC). A cohort of 26 participants with PPA completed a 2-day non-native consonant cluster learning paradigm. Participants also completed a battery of clinical speech-language assessments, including tests of phonological and motor programming ability, and T1-weighted structural MRI scans were obtained for a subcohort (n = 19) of participants. Mean cortical thickness measures were extracted using FreeSurfer software for each cortical region of interest. Separate statistical analyses were conducted to test for correlations between learning outcomes on the consonant cluster paradigm (both error rate and duration) with (1) clinical measures and (2) cortical thickness. Both analyses indicated a dissociation between correlates of error rate and duration: Duration was more strongly associated with sensorimotor cortex (including the left vPMC) and clinical motor speech measures, while error rate was primarily associated with phonological working memory correlates (including the left pIFS) and clinical repetition measures.

Purpose: Stuttering is characterized by intermittent speech disfluencies, which are dramatically reduced when speakers synchronize their speech with a steady beat. The goal of this study was to characterize the neural underpinnings of this phenomenon using functional magnetic resonance imaging.Method: Data were collected from 16 adults who stutter and 17 adults who do not stutter while they read sentences aloud either in a normal, self-paced fashion or paced by the beat of a series of isochronous tones (“rhythmic”). Task activation and task-based functional connectivity analyses were carried out to compare neural responses between speaking conditions and groups after controlling for speaking rate.Results: Adults who stutter produced fewer disfluent trials in the rhythmic condition than in the normal condition. Adults who stutter did not have any significant changes in activation between the rhythmic condition and the normal condition, but when groups were collapsed, participants had greater activation in the rhythmic condition in regions associated with speech sequencing, sensory feedback control, and timing perception. Adults who stutter also demonstrated increased functional connectivity among cerebellar regions during rhythmic speech as compared to normal speech and decreased connectivity between the left inferior cerebellum and the left prefrontal cortex.Conclusions: Modulation of connectivity in the cerebellum and prefrontal cortex during rhythmic speech suggests that this fluency-inducing technique activates a compensatory timing system in the cerebellum and potentially modulates top-down motor control and attentional systems. These findings corroborate previous work associating the cerebellum with fluency in adults who stutter and indicate that the cerebellum may be targeted to enhance future therapeutic interventions.Supplemental Material: https://doi.org/10.23641/asha.14417681

Stuttering is a neurodevelopmental disorder characterized by impaired production of coordinated articulatory movements needed for fluent speech. It is currently unknown whether these abnormal production characteristics reflect disruptions to brain mechanisms underlying the acquisition and/or execution of speech motor sequences. To dissociate learning and control processes, we used a motor sequence learning paradigm to examine the behavioral and neural correlates of learning to produce novel phoneme sequences in adults who stutter (AWS) and neurotypical controls. Participants intensively practiced producing pseudowords containing non-native consonant clusters (e.g., “GVAZF”) over two days. The behavioral results indicated that although the two experimental groups showed comparable learning trajectories, AWS performed significantly worse on the task prior to and after speech motor practice. Using functional magnetic resonance imaging (fMRI), the authors compared brain activity during articulation of the practiced words and a set of novel pseudowords (matched in phonetic complexity). FMRI analyses revealed no differences between AWS and controls in cortical or subcortical regions; both groups showed comparable increases in activation in left-lateralized brain areas implicated in phonological working memory and speech motor planning during production of the novel sequences compared to the practiced sequences. Moreover, activation in left-lateralized basal ganglia sites was negatively correlated with in-scanner mean disfluency in AWS. Collectively, these findings demonstrate that AWS exhibit no deficit in constructing new speech motor sequences but do show impaired execution of these sequences before and after they have been acquired and consolidated.

In this cross-sectional study, we examined the relationship between cortical thickness and performance on several verbal repetition tasks in a cohort of patients with primary progressive aphasia (PPA) in order to test predictions generated by theoretical accounts of phonological working memory (PWM) that predict phonological content buffers in left posterior inferior frontal sulcus (pIFS) and supramarginal gyrus (SMG). Cortical surfaces were reconstructed from magnetic resonance imaging scans from 42 participants diagnosed with PPA. Cortical thickness was measured in a set of anatomical regions spanning the entire cerebral cortex. Correlation analyses were performed between cortical thickness and average score across three PWM related tasks: the Repetition subtest from the Western Aphasia Battery, a forward digit span task, and a backward digit span task. Significant correlations were found between average PWM score across tasks and cortical thickness in left SMG and left pIFS, in support of prior theoretical accounts of PWM. Exploratory whole-brain correlation analyses performed for each of the three behavioral tasks individually revealed a distinct set of positively-correlated regions for each task. Comparison of cortical thickness measures from different PPA subtypes to cortical thickness in age-matched controls further revealed unique patterns of atrophy in the different PPA subtypes.

Stuttering affects nearly 1% of the population worldwide and often has life-altering negative consequences, including poorer mental health and emotional well-being, and reduced educational and employment achievements. Over two decades of neuroimaging research reveals clear anatomical and physiological differences in the speech neural networks of adults who stutter. However, there have been few neurophysiological investigations of speech production in children who stutter. Using functional near-infrared spectroscopy (fNIRS), we examined hemodynamic responses over neural regions integral to fluent speech production including inferior frontal gyrus, premotor cortex, and superior temporal gyrus during a picture description task. Thirty-two children (16 stuttering and 16 controls) aged 7–11 years participated in the study. We found distinctly different speech-related hemodynamic responses in the group of children who stutter compared to the control group. Whereas controls showed significant activation over left dorsal inferior frontal gyrus and left premotor cortex, children who stutter exhibited deactivation over these left hemisphere regions. This investigation of neural activation during natural, connected speech production in children who stutter demonstrates that in childhood stuttering, atypical functional organization for speech production is present and suggests promise for the use of fNIRS during natural speech production in future research with typical and atypical child populations.

Speech is perhaps the most sophisticated example of a species-wide movement capability in the animal kingdom, requiring split-second sequencing of approximately 100 muscles in the respiratory, laryngeal, and oral movement systems. Despite the unique role speech plays in human interaction and the debilitating impact of its disruption, little is known about the neural mechanisms underlying speech motor learning. Here, we studied the behavioral and neural correlates of learning new speech motor sequences. Participants repeatedly produced novel, meaningless syllables comprising illegal consonant clusters (e.g., GVAZF) over 2 days of practice. Following practice, participants produced the sequences with fewer errors and shorter durations, indicative of motor learning. Using fMRI, we compared brain activity during production of the learned illegal sequences and novel illegal sequences. Greater activity was noted during production of novel sequences in brain regions linked to non-speech motor sequence learning, including the BG and pre-SMA. Activity during novel sequence production was also greater in brain regions associated with learning and maintaining speech motor programs, including lateral premotor cortex, frontal operculum, and posterior superior temporal cortex. Measures of learning success correlated positively with activity in left frontal operculum and white matter integrity under left posterior superior temporal sulcus. These findings indicate speech motor sequence learning relies not only on brain areas involved generally in motor sequencing learning but also those associated with feedback-based speech motor learning. Furthermore, learning success is modulated by the integrity of structural connectivity between these motor and sensory brain regions.

A critical examination of speech motor control depends on an in-depth understanding of network connectivity associated with Brodmann areas 44 and 45 and surrounding cortices. Damage to these areas has been associated with two conditions - the speech motor programming disorder apraxia of speech (AOS) and the linguistic / grammatical disorder of Broca’s aphasia. Here we focus on AOS, which is most commonly associated with damage to posterior Broca's area and adjacent cortex. We provide an overview of our own studies into the nature of AOS, including behavioral and neuroimaging methods, to explore components of the speech motor network that are associated with normal and disordered speech motor programming in AOS. Behavioral, neuroimaging, and computational modeling studies are indicating that AOS is associated with impairment in learning feedforward models and/or implementing feedback mechanisms and with the functional contribution of BA6. While functional connectivity methods are not yet routinely applied to the study of AOS, we highlight the need for focusing on the functional impact of localised lesions throughout the speech network, as well as larger scale comparative studies to distinguish the unique behavioral and neurological signature of AOS. By coupling these methods with neural network models, we have a powerful set of tools to improve our understanding of the neural mechanisms that underlie AOS, and speech production generally.

Deficits in brain white matter have been a main focus of recent neuroimaging studies on stuttering. However, no prior study has examined brain connectivity on the global level of the cerebral cortex in persons who stutter (PWS). In the current study, we analyzed the results from probabilistic tractography between regions comprising the cortical speech network. An anatomical parcellation scheme was used to define 28 speech production-related ROIs in each hemisphere. We used network-based statistic (NBS) and graph theory to analyze the connectivity patterns obtained from tractography. At the network level, the probabilistic corticocortical connectivity from the PWS group were significantly weaker that from persons with fluent speech (PFS). NBS analysis revealed significant components in the bilateral speech networks with negative correlations with stuttering severity. To facilitate comparison with previous studies, we also performed tract-based spatial statistics (TBSS) and regional fractional anisotropy (FA) averaging. Results from tractography, TBSS and regional FA averaging jointly highlight the importance of several regions in the left peri-Rolandic sensorimotor and premotor areas, most notably the left ventral premotor cortex and middle primary motor cortex, in the neuroanatomical basis of stuttering.