Anne K. Bothe

Brain activity in adults who stutter: Similarities across speaking tasks and correlations with stuttering frequency and speaking rate

Many differences in brain activity have been reported between persons who stutter (PWS) and typically fluent controls during oral reading tasks. An earlier meta-analysis of imaging studies identified stutter-related regions, but recent studies report less agreement with those regions. A PET study on adult dextral PWS (n=18) and matched fluent controls (CONT, n=12) is reported that used both oral reading and monologue tasks. After correcting for speech rate differences between the groups the task-activation differences were surprisingly small. For both analyses only some regions previously considered stutter-related were more activated in the PWS group than in the CONT group, and these were also activated during eyes-closed rest (ECR). In the PWS group, stuttering frequency was correlated with cortico-striatal-thalamic circuit activity in both speaking tasks. The neuroimaging findings for the PWS group, relative to the CONT group, appear consistent with neuroanatomic abnormalities being increasingly reported among PWS.

Phonation interval modification and speech performance quality during fluency-inducing conditions by adults who stutter

PURPOSE To relate changes in four variables previously defined as characteristic of normally fluent speech to changes in phonatory behavior during oral reading by persons who stutter (PWS) and normally fluent controls under multiple fluency-inducing (FI) conditions. METHOD Twelve PWS and 12 controls each completed 4 ABA experiments. During A phases, participants read normally. B phases were 4 different FI conditions: auditory masking, chorus reading, whispering, and rhythmic stimulation. Dependent variables were the durations of accelerometer-recorded phonated intervals; self-judged speech effort; and observer-judged stuttering frequency, speech rate, and speech naturalness. The method enabled a systematic replication of Ingham et al. (2009). RESULTS All FI conditions resulted in decreased stuttering and decreases in the number of short phonated intervals, as compared with baseline conditions, but the only FI condition that satisfied all four characteristics of normally fluent speech was chorus reading. Increases in longer phonated intervals were associated with decreased stuttering but also with poorer naturalness and/or increased speech effort. Previous findings concerning the effects of FI conditions on speech naturalness and effort were replicated. CONCLUSIONS Measuring all relevant characteristics of normally fluent speech, in the context of treatments that aim to reduce the occurrence of short-duration PIs, may aid the search for an explanation of the nature of stuttering and may also maximize treatment outcomes for adults who stutter. LEARNING OUTCOMES The reader will be able to (1) understand the differential effects of four well established fluency-inducing conditions on the quality of fluency of adult PWS and controls, (2) learn how intervals of phonation are modified during these conditions and (3) how the duration of specific intervals of phonation may be identified for their potential application in stuttering treatment.

Regional brain activity change predicts responsiveness to treatment for stuttering in adults

Developmental stuttering is known to be associated with aberrant brain activity, but there is no evidence that this knowledge has benefited stuttering treatment. This study investigated whether brain activity could predict progress during stuttering treatment for 21 dextral adults who stutter (AWS). They received one of two treatment programs that included periodic H2(15)O PET scanning (during oral reading, monologue, and eyes-closed rest conditions). All participants successfully completed an initial treatment phase and then entered a phase designed to transfer treatment gains; 9/21 failed to complete this latter phase. The 12 pass and 9 fail participants were similar on speech and neural system variables before treatment, and similar in speech performance after the initial phase of their treatment. At the end of the initial treatment phase, however, decreased activation within a single region, L. putamen, in all 3 scanning conditions was highly predictive of successful treatment progress.

Quantitative and qualitative research paradigms: Thoughts on the quantity and the creativity of stuttering research

Analysis of publication patterns in stuttering research showed that over 90% of articles published in three major journals between 1994 and 2003 could be described as representing a quantitative, as opposed to qualitative, tradition. Many other authors have already discussed two possible implications of this imbalance: that quantitative research is overrepresented, and that qualitative research needs to be more frequently used in stuttering. This article was constructed, therefore, to address three other possible implications of publication patterns in stuttering research: under-reporting of qualitative methodologies; under-adoption of new knowledge; and under-use of creative, interdisciplinary quantitative methodologies.

A welfare economic approach to measure outcomes in stuttering: comparing willingness to pay and quality adjusted life years.

PURPOSE The purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering. METHOD Seventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data. RESULTS Mean (median) WTP bids ranged from US

Patient-reported outcomes in stuttering treatment: conceptual framework.

16,875 (8000), for an intervention resulting in improvement from severe stuttering to mild stuttering, to US

Stuttering Treatment Research 1970–2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioral, Cognitive, and Related Approaches

41,844 (10,000) for an intervention resulting in a cure of severe stuttering. These data were consistent with mean changes in QALYs for the same stuttering interventions ranging from 2.19 (using SG) to 18.42 (using TTO). CONCLUSIONS This study presents the first published WTP and QALY data for stuttering. Results were consistent with previous cost-of-illness data for stuttering. Both WTP and QALY measures were able to quantify the reduction in quality of life that occurs in stuttering, and both can be used to compare the gains that might be achieved by different interventions. It is widely believed that stuttering can cause reduced quality of life for some speakers; the introduction into this field of standardized metrics for measuring quality of life is a necessary step for transparently weighing the costs and consequences of stuttering interventions in economic analyses. EDUCATIONAL OBJECTIVES The reader will be able to (a) describe the underlying theoretical foundations for willingness to pay and quality adjusted life years, (b) describe the application of willingness to pay and quality adjusted life years for use in economic analyses, (c) compare and contrast the value of willingness to pay and quality adjusted life years in measuring the impact of stuttering treatment on quality of life, (d) interpret quality adjusted life years, and (e) interpret willingness to pay data.

Stuttering Treatment Research 1970-2005: II. Systematic Review Incorporating Trial Quality Assessment of Pharmacological Approaches.

Evaluation of: Yaruss JS, Quesal RW. Overall Assessment of the Speaker’s Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment. J. Fluency Disord. 31(2), 90–115 (2006)1. These authors presented the first complete instrument intended to measure the impact of stuttering in adults who stutter (Overall Assessment of the Speaker’s Experience of Stuttering; [OASES]). OASES is a 100-item self-report metric with four sections: general information, reactions to stuttering, communication in daily situations and quality of life. Its conceptual framework includes historic views of the influence of emotional and cognitive variables on stuttering; the WHO’s International Classification of Impairments, Disabilities and Handicaps (ICIDH); and the WHO’s International Classification of Functioning, Disability and Health (ICF). However, both this conceptual framework and the psychometric data presented to support the OASES are problematic in ways that clinicians and researchers in areas well-beyond stuttering may find informative as they consider their own applications.