Cortical plasticity associated with stuttering therapy

doi:10.1016/j.jfludis.2004.12.002

Journal of Fluency Disorders

Volume 30, Issue 1, 2005, Pages 23-39

https://doi.org/10.1016/j.jfludis.2004.12.002 Get rights and content

Abstract

Neuroimaging studies have indicated that persistent developmental stuttering (PDS) may be associated both with an abnormality in white matter of left-hemispheric speech areas and a right-hemispheric hyperactivity. The latter may compensate for the deficient structural connectivity in the left hemisphere. To investigate the effects of stuttering therapy on brain activity nine male adults with PDS underwent functional magnetic resonance imaging (fMRI) before and within 12 weeks after fluency shaping therapy. Brain response differences during overt sentence reading before and after therapy were assessed by utilizing random effects analyses. After therapy, a more widespread activation was observed in frontal speech and language regions and temporal areas of both hemispheres, particularly and more pronounced on the left side. Interestingly, distinct posttreatment left-sided activation increases were located directly adjacent to a recently detected area of white matter anomaly [M. Sommer, M.A. Koch, W. Paulus, C. Weiller, C. Büchel (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. The Lancet, 360, 380–383] suggesting that fluency shaping techniques reorganize neuronal communication between left-sided speech motor planning, motor execution, and temporal areas. Hence, a therapeutic mechanism can be assumed to remodel brain circuitry close to the source of the dysfunction instead of reinforcing compensation via homologous contralateral brain networks.

Educational objectives:

The reader will learn about and be able to: (1) describe brain activation changes detected shortly after fluency-shaping therapy; (2) identify left-hemispheric regions where a (re)functionalization after fluency-shaping therapy seems to occur adjacent to a recently described abnormal white matter region in PDS subjects; and (3) discuss how an effective cerebral compensation mechanism for stuttering could work.

Keywords

Stuttering

Fluency shaping

fMRI

Therapy effects

Cited by (0)

Katrin Neumann, born 1961, studied medicine at Leipzig University. She specialized in otorhinolaryngology, phoniatrics, and pediatric audiology, and is currently Assistent Medical Director of the Clinic of Phoniatrics and Pedaudiology at the University of Frankfurt/Main, Germany. Her research fields are neuroimaging of speech, language, and hearing processes, and voice physiology.

Harald A. Euler, born 1943, studied psychology at the University of Bonn, Germany, and as a Fulbright Student at Washington State University (Ph.D. 1972). His Master's thesis he wrote on the operant control of stuttering by DAF. Since 1974 he is Professor for Psychology at the University of Kassel, Germany.

Alexander Wolff von Gudenberg, born 1957, studied medicine at Berlin and Hannover University. He specialized as a general practitioner, and in speech and language. In his dissertation he compared stuttering therapies in Germany and the US. He is the medical director of the Institute of the Kassel Stuttering Therapy.

Christine Preibisch, born 1970, studied physics at the Universities of Regensburg and Würzburg, Germany. The topics of her Ph.D. (1999) theses was the optimization of functional MR imaging methods. Since 1999 she works as a scientific assistant at the Department of Neuroradiology at the University of Frankfurt/Main, Germany.

Heinrich Lanfermann, born 1958, studied medicine at the University of Aachen, Germany, and wrote his thesis in pharmacology. He specialized in Radiology and Neuroradiology and was Assistant Medical Director at the University of Cologne. Since 1996 he is Executive Assistant Medical Director at the Institute of Neuroradiology, University of Frankfurt/Main.

Volker Gall, born 1943, studied medicine at the University of Halle, Germany. He specialized in otorhinolaryngology, phoniatrics, and pediatric audiology. Since 1993 he works as Medical Director of the Clinic of Phoniatrics and Pedaudiology at the University of Frankfurt/Main, Germany. His main research topics are voice physiology and therapy.

Anne-Lise Giraud, born 1968, studied biochemistry/neurophysiology in Lyon. She worked as a postdoctoral fellow at the Functional Imaging Laboratory in London, and later at the Cognitive Neurology Unit of the University of Frankfurt/Main. Currently she is at the Laboratoire de Neurosciences Cognitives, Département d’Études Cognitives, Ecole Normale Superienne, Paris.

¹: These authors contributed equally to this work.

²: Christine Preibisch is now at the Brain Imaging Center, University of Frankfurt, Frankfurt/Main, Germany.

³: Anne-Lise Giraud is now at Laboratoire de Neurosciences Cognitives, Département d’Études Cognitives, Ecole Normale Superienne, Paris, France.

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