Foundas A L, Bollich A M, Feldman J, Corey D M, Hurley M, Lemen L C, Heilman K M
Department of Psychiatry and Neurology, Tulane University Health Sciences Center, 1440 Canal Street TB52, New Orleans, LA 70112, USA.
Neurology. 2004 Nov 9;63(9):1640-6. doi: 10.1212/01.wnl.0000142993.33158.2a.
To learn if people with persistent developmental stuttering and atypical anatomy of their auditory temporal cortex have, when compared to control subjects, changes in fluency induced with delayed auditory feedback (DAF).
DAF improves fluency in many individuals who stutter, and induces dysfluency in some normal people. The planum temporale (PT), a portion of auditory temporal cortex, is anatomically atypical in some adults who stutter and atypical anatomy might induce aberrant function. Thus, the people who demonstrate the paradoxical response to DAF might be those who have atypical anatomy.
Experimental subjects were adults with developmental stuttering (n = 14) and control subjects (n = 14) matched for age, sex, education, and handedness. Volumetric MRI scans of all subjects were obtained and the PT was measured in the right and left hemispheres. Based on these scans, subjects were classified as typical (leftward PT asymmetry) or atypical (rightward PT asymmetry). Prose passages were read at baseline, with non-altered feedback (NAF), and with DAF, and fluency was measured in these three conditions.
At baseline the adults with developmental stuttering were significantly more dysfluent than controls (p < 0.0005). Controls' fluency did not significantly change with DAF, but DAF improved fluency in adults with developmental stuttering (p < 0.0005). In the stutter group enhanced fluency was associated with atypical (rightward) PT asymmetry, and the presence of typical (leftward) PT asymmetry was not associated with any significant change in fluency. The individuals with atypical PT asymmetry also had more severe stuttering at baseline compared to the experimental subjects with typical PT anatomy.
In adults with persistent developmental stuttering and atypical PT anatomy, fluency is improved with DAF. These experimental subjects who showed improvement had more severe stuttering at baseline. Anomalous PT anatomy may be a neural risk for developmental stuttering in some individuals. Although a number of explanations are tenable, it may be that atypical rightward PT asymmetry may alter speech feedback, and treatment with DAF might allow these people to compensate.
了解持续性发育性口吃且听觉颞叶皮质解剖结构异常的人与对照受试者相比，延迟听觉反馈（DAF）诱发的流畅性变化情况。
DAF可改善许多口吃者的流畅性，并在一些正常人中诱发不流畅。颞平面（PT）是听觉颞叶皮质的一部分，在一些成年口吃者中解剖结构异常，异常的解剖结构可能导致功能异常。因此，对DAF表现出矛盾反应的人可能是那些解剖结构异常的人。
实验对象为成年发育性口吃者（n = 14）和在年龄、性别、教育程度和利手方面相匹配的对照受试者（n = 14）。对所有受试者进行容积性MRI扫描，并测量左右半球的PT。根据这些扫描结果，将受试者分为典型（PT向左不对称）或非典型（PT向右不对称）。在基线、无改变反馈（NAF）和DAF条件下朗读散文段落，并在这三种条件下测量流畅性。
在基线时，成年发育性口吃者的不流畅程度显著高于对照组（p < 0.0005）。对照组的流畅性在DAF条件下无显著变化，但DAF改善了成年发育性口吃者的流畅性（p < 0.0005）。在口吃组中，流畅性增强与非典型（向右）PT不对称相关，而典型（向左）PT不对称的存在与流畅性的任何显著变化均无关联。与具有典型PT解剖结构的实验对象相比，具有非典型PT不对称的个体在基线时口吃也更严重。
在持续性发育性口吃且PT解剖结构异常的成年人中，DAF可改善流畅性。这些表现出改善的实验对象在基线时口吃更严重。异常的PT解剖结构可能是一些个体发育性口吃的神经风险因素。虽然有多种解释成立，但可能是非典型的向右PT不对称会改变言语反馈，而DAF治疗可能使这些人得以代偿。
