STUTTERING AND AUDITORY FUNCTIONS .PDF / KUNNAMPALLIL GEJO

STUTTERING AND AUDITORY FUNCTIONS
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP
KUNNAMPALLIL GEJO JOHN,MASLP
INTRODUCTION
What is stuttering?
Stuttering is the involuntary disruption of a continuing attempt to produce a spoken utterance. PERKINS 1990
What is Auditory processing?

is the term used to describe the recognition &interpretation of a sound by the brain . Learning to speak involves . motor process of speaking .sensory process of feeling .hearing oneself ,
Auditory processing in stutters

Researchers have suggested that, stuttering may be the result of errors of stutterers self hearing aspect , stuttering may have its origin because of malfunctioning of the hearing mechanism
Central processing in stuttering

Hemispheric properties of stuttering
Brain waves of stutterers have been examined &compared those with non stutterers. .CNS investigation suggested that stutters lack cerebral dominance for speech .
Lindshy &Freestone (1942) - stutters demonstrate right hemisphere dominance for language
o Wilkins EEG studies - final
neural dysfunction rather than hemispheric differences in stutterers

Right hemisphere activity,

Fox (1996,2000) found decreased
activity in auditory area during increased stuttering ,so reduces the left brain communication of this sensory information to frontal speech &language areas .
Research suggested that people who stutter use Right hemisphere which leads to intermittent break down Why? .Right hemisphere is not as adopt as the left for processing rapid transmission that characterizes spoken language
Right hemisphere is also associated with emotional expression . Excessive amounts of neurotransmitter dopamine in the left caudate nucleus (This is the area that translates speech in to muscle movements ).There is no conscious awareness of central auditory processing in left caudate nucleus.
Left auditory cortex activity in stuttering

Many brain imaging studies of stuttering
have shown a lack of activity in the left superior temporal lobe ,including auditory association areas & Wernickes area (FOX et al ,2000&DE NIL et al,2003).
suggest the possibility that when
individual stutter they are not using auditory feedback to monitor & control their speech
Imaging study (SALMELIN et al ,1998) stutters have a reversal of the normal pattern of activation of the left &right auditory cortices during stuttering . stutters may have difficulty performing auditory processing tasks (BARASCH et al ,2000) Fluency can be induced by changing the way stutters hear their own speech (BRAYTON &CONTURE ,1978;POWELL ,1987)
Auditory self monitoring may provide a stimulus to time or integrate the sequence of activities that run in parallel when a speaker decides what she will say ,selects the linguistic elements for it ,and execute the utterance . Thus the dyssynchrony or timing disturbance are the basis of stuttering (Perkins,Kent,&Curlee,1991;Van Riper 1982)
may be caused by a paucity of signals
that synchronize the sequence for speech output

Craver&Faber1982,Moore1986 found that stutterers have poor recognition &recall of words on auditory presentations Carpenter & Sommers1987 found stutterers&nonstutterers have equal auditory memory .
Auditory feedback
closed circuits or cycles ,which have all components completely contained with in speakers mechanism .
The return flow of information provided by these circuits helps to monitor our own speech.
Errors are normally identified & corrected automatically .

Closed loop system

CNS MOTOR ACTIVITY SENSATION
FEEDBACK
System organizes in closely connected special & temporal units . There will not be any time normal course for the speaker to pause & check the adequacy of the utterance after each word ,phrase or even after sentence uttered. Hence ,speech once learned become self regulatory with satisfactory monitoring depends up on the proper functioning & integration of the of the all feedback circuits .
Fluency disruption as a cybernetic phenomenon:

Cybernetic theory holds that in a closed loop system ,various lines of feedback are used to regulate the output of a system . The goal of such a system termed a servo system ,is to match what is intended as system output to the actual output and reduce any differences between the two (error signal) to zero .If there is distortion of the information arriving via the feedback loop , the error signal will be incorrect When this occurs the system tends to go into oscillation.
Fairbanks (1954)&Mysak (1960)described the nature of such systems & interpreted many aspects of speech production . The basic idea is that in stutterers , distorted feedback creates the misconception that an error has occurred in the flow of speech . Stuttering occurs when the speaker attempts to correct an error that has in fact ,not occurred
According to this phenomenon ,stutteres posses a defective monitoring system sequential speech The studies shown that fluency breaks similar in stutterers can be produced in normal speakers by altering the auditory feedback of their speech output . From these findings the possible existence of a perceptual disability in stuttering is assumed probably organic in nature
The influence of cybernetic theory (Weiner 1948) has led to number of hypothetical models such as by Fairbanks (1954)describe closed feedback ,loops as the essential monitoring system for speech Planum Temporale Abnormality and DAF (leftward asymmetry). A brain scan study found that stutterers have the opposite: (rightward asymmetry).
stutterers with this abnormal------ had significantly improved fluency with DAF, but stutterers with the normal leftward asymmetry didn't improve with DAF. The study also found that stutterers with this abnormal ----stuttered more severely than stutterers with the normal leftward asymmetry.
In adults with persistent developmental stuttering and atypical PT anatomy, fluency is improved with DAF.(Neurology 2004 Nov 9;63(9):1640-6.)
Altered Auditory Feedback

Changing how stutterers hear their voices improves fluency. This can be done in many ways: Speaking in chorus with another person. Hearing a voice in headphones distorted Hearing a synthesized sound in headphones mimicking phonation (masking auditory feedback, or MAF).
Hearing a voice in headphones delayed a fraction of a second (delayed auditory feedback, or DAF). Hearing voice in headphones shifted higher or lower in pitch (frequency-shifted auditory feedback, or FAF). These phenomena are called altered auditory feedback
Nonstutterers can't tolerate altered auditory feedback. Altered auditory feedback increases blood flow to nonstutterers' auditory/somatic integration area, raising activity to an abnormally high level. The effects of too much activity in this area are somewhat like stutteringrepeating words and unexpected silent pauses.
Stuttering is reduced in many subjects by delayed,masked ,frequency altered feedback. Even amplified feedback may have some of the same power(JSHR,VOL42,910,1999) The proportion of stuttering events prescribed telephone conversations were significantly reduced in the AAF conditions relative to the non-altered auditory feedback condition (JSLHR,VOL.40,1130-1134,1997)
DELAYED AUDITORY FEEDBACK

It refers to a delay in the return of the air conducted speech signal to the central auditory system. it was reported by LEE(1950) .coined the term artificial stutter and commend on its fluency disruption effects.
The most disruptive interval was found to be in the 180-200 msec (Fairbanks & Guttman 1958:Ham &Steer1967)
(DAF) apparently degrades the individuals ability to self-monitor his or her ongoing speech. In the normal speaker, the introduction of DAF via headphones breaks down the speakers fluency, often producing prolongation of vowels , slurring of articulation & a marked interruption of normal prosodic speaking patterns.
Conversely, in the stutterer, speech may become more fluent under DAF, probably related to the prolongation of vowels which results in a general slowing down of speaking rate Slowing down the stutterers rate of speech is often facilitative for improving overall speech fluency.
Recommended Procedures for Using DAF

1. The selector mode on the Facilitator is set to DAF (the letters DAF appear on the instrument window). The loudness level of amplification-DAF is determined by the relative setting of the VOLUME switch
2. The relative time-delay on the Facilitator ranges from .05 to 0.5 secs, with the clinician able to control the delay-time by increments of approximately 10 msecs . 3. Explain to the patient something like this, "I want you to wear these headphones as you read (or repeat) aloud. What you say will be fed back to you on the phones a bit delayed. You wont be able to hear yourself as you usually do when you speak. Just keep speaking. I will record on another recorder how you sound."
4. After the initial testing on the effects of DAF on speech and voice, play the recorded output back to the patient. Depending on the effects of DAF, either go forward with more DAF practice or stop using it. 5. For those patients who profit from using DAF, it is recommended that the patient wear a portable Facilitator in the provided waist-pack. The DAF mode should be used whenever it appears to facilitate better speech or better oral reading.
AUDITORY FEED BACK TOOLS AFT does not have visual displays. It is designed to focus clients on the aural characteristics of their speech.
Pacer The pacer provides metronomic pacing in the form of an audible click to help assist patients with the timing/rhythm aspects of speech production. Among these are stutterers and patients with motor speech disorders such as cerebellar ataxia and Parkinsons disease. The pacer rate is adjustable from
Delayed Auditory Feedback as a form of disruptive feedback, which has proven to be effective in fluency therapy. The DAF in AFT has a range of feedback from 150-500 milliseconds.
Five Auditory Feedback Modes Metronomic Pacing Delayed Auditory Feedback (DAF) Looping Time-Warping Masking
Looping Playback Looping records the patients (or clinicians) speech and then plays the digitally recorded speech back immediately. used to develop critical self-listening skills. Patients can hear their own speech just as an outside listener would hear it. The clinician or the patient can record the target production. The absence of a visual display helps the patient focus strictly on the auditory aspects of speech. The duration of the recorded speech is from 5 to 30 seconds, adjustable in one-second increments
Time-Warping Time-warping record a patients speech and immediately play the speech back at different rates without changing the frequency content of the speech. This is very useful for allowing patients to hear their articulation clearly by slowing, or increasing, the rate of playback
Masking a speech-band noise signal is played through headphones so that patients cannot hear their own speech production. This deliberately degraded feedback has been shown, in some cases, to improve speech. In many patients, it can enhance the proprioception of speech/voice behaviors (e.g., easy onset, eliminating hard glottal attack, etc.).
Applications The AFT program has a wide range of applications in speech-language pathology including voice, articulation, motor speech disorders, fluency, aphasia, professional voice, accent reduction, and learning disabilities.
Delayed Auditory Feedback Most Helpful for Those Who Stutter with Atypical Auditory Anatomy (American Academy of Neurology-) 2004 Researchers have identified a subset of stutterers that may benefit most from DAF. Findings of their study were DAF has been shown to induce fluency in many individuals who stutter, though not all stutterers experience enhanced fluency by this technique
The primary aim of the study was: to learn if there is a relationship between the anatomy of the auditory association cortex (planum temporale) and fluency induced with DAF in adults with persistent developmental stuttering.
A study group of 14 adults with this type of stuttering disorder and 14 control subjects read prose passages three times: at baseline, with non-altered feedback, and with DAF. Three measures of fluency were evaluated: stuttering event frequency, severity, and reading time.
" a subgroup of adults with atypical rightward planum temporale asymmetry, who were more dysfluent at baseline and had fluency induced with DAF," (Anne Foundas, MD,) deficits in auditory processing cannot account for stuttering in all people who stutter, because we identified another subgroup of adults who had typical leftward planum temporale asymmetry and who did not become more fluent with DAF."
DAF in Stuttering: A Potential Anatomical Link DAF is a technique that can induce fluency in individuals who stutter and can make fluent individuals dysfluent The auditory system, at least at the level of auditory input, is involved in these fluency inducing conditions
Thus, there may be a defect at the level of auditory processing that is at least partially reversed with these procedures. One hypothesis is that alterations in the auditory signal under conditions of DAF diminish an auditory perceptual defect in people who stutter. This auditory perceptual defect might be related to anomalous anatomy of auditory temporal cortex.
Atypical anatomy in auditory temporal brain regions (planum temporale, PT) in a group of adults with persistent developmental stuttering (PDS). (2000)
.Postulated that anatomic defect may be functionally relevant, and the results of a recent study suggest that there may be a structure-function relationship.
In this study (November 2004, Neurology) a group of adults with PDS and fluent adults. The PT was measured on volumetric MRI brain scans, and subjects were classified as having a 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.
In the adults with PDS and atypical PT anatomy, fluency was improved with DAF. In contrast, the adults with PDS and typical PT anatomy did not improve fluency with DAF. Our results suggest that anomalous PT anatomy may be a neural risk for developmental stuttering in some individuals. It may be that atypical rightward PT anatomy may alter speech feedback, and treatment with DAF might allow these people to compensate. (Anne L. Foundas, 2000&2004
Brain activity during altered auditory feedback: an fMRI study in persistent and recovered developmental stuttering Three groups of healthy adolescents were with persistent developmental stuttering (PDS); 4 with history of developmental stuttering but considered recovered on recent testing(RDS) and 9 fluently-speaking controls. Functional images were acquired after 7-s silence which followed a period where subjects read sentences aloud (96 images in total). Speech was recorded and fed back to the subjects via a real-time digitizer
. Feedback was either (i) normal (ii) delayed by 200ms or (iii) frequency-shifted by half an octave upwards. Statistical maps were generated to show the brain areas active during speaking under normal feedback across the three groups. These areas included the sensorimotor and premotor cortices bilaterally, the superior temporal cortex bilaterally, the supplementary motor cortex, the anterior cingulate cortex and the cerebellum.
The mean activity in these areas was calculated for each condition and each subject separately; Across all conditions and compared to controls,
the PDS group had 1) significantly less activity in the sensorimotor and premotor cortices bilaterally, the supplementary motor area and the anterior cingulate cortex 2) significantly more activity in the cerebellum; the RDS group were not significantly different to the controls or the PDS group.
Frequency shifted Auditory Feedback FAF downshift makes hear voice sounding like a gravel-voiced radio announcer saying his station's call letters. A quarter-octave pitch shift reduces stuttering about 35%. A half-octave pitch shift reduces stuttering about 65-70%. A full-octave pitch shift reduces stuttering about 70-75%. Combining DAF and FAF reduces stuttering about 80%.
FAF causes non-stutterers to speak at a higher or lower vocal pitch, depending on whether the device is set for an up or down frequency shift. In other words, FAF induces changes in vocal fold tension in non-stutterers. induce vocal fold relaxation in stutterers. Usually, stutterers need a greater pitch shift, between one-half and one octave down. Also, the study used older headphones which lacked the bass response of today's headphones.
FAF downshifts induce a slower speaking rate, similar to DAF. If this effect is consistent, then a FAF downshift should produce long-term carryover fluency. Conversely, (the Mickey Mouse voice) FAF up shifts induce faster speaking rates. If this effect is consistent, then a FAF up shift should result in poor long-term performance (e.g., no carryover fluency, and possibly "wearing off)
FAF may account for the reduction in stuttering (JSLHR,VOL.42,,1347-1354,1999) Feedback control theory

Feedback from sensory systems plays a direct role in controlling on going action . Delaying this feedback results in control errors such as stuttering .
For adults ,repetition errors due to DAF increase as function of delay up to 0.2 msec .Then decrease with larger delays ,but
disappears completely even with delays as long as 0.8msec (Mc Kay 1998)
When bilinguals speak under DAF, their peak delay remains the same (MC Kay 1969)_Bilinguals make more repetition errors when producing their less familiar language under DAF, (Mc Kay1970) Mechanical distortions of the returning auditory feedback reduce the disruptions resulting from DAF(HULL1952)
Masking noise ,DAF,frequency shifts and other alterations in the properties of the auditory signal can create temporary fluency in person who stutter( Van Riper1982) DAF can create an artificial stutter in normal speakers (Black&Lee 1951). Postma &Klok (1992) stutters possess a deficit in their ability to self monitor the accuracy of their speech production and also they may be experiencing prearticulatory errors which they are attempting to covertly repair .
A variety of explanations for the effect of altered feedback .. it 1)distraction ,2)causes stutterers to change how they talk &3)compensates for a defect in stutterers auditory monitoring of their speech (Bloodstein ,1995) .Stromsta(1957,1972,1986). stutterers abnormal brain rhythms impair the integration of auditory feedback and speech output .The result is interruptions of phonation & improper coarticulation of sounds .
Stager et al (2003) .. brain scans during fluency inducing conditions indicated increased activity in stutters auditory areas ,reflecting more effective coupling of auditory & motor systems so that auditory feedback could help to integrate the sequencing of speech motor outputs
The covert repair hypothesis This hypotheses makes use of a monitoring device that checks on the accuracy of speech . In this model monitoring takes place during the formulation of the phonetic plan and prior to the implementation of articulatory commands
CONCEPTUALIZER Preverbal message FORMULATOR GRAMMATICAL ENCODING STRING OF LEMMAS PHONOLOGICAL ENCODING Phonetic plan
MONITOR
ARTICULATOR
efferent proprioceptive Tactile feedback
auditory feedback
Motor movements
sound
Speakers who stutter are impaired in their ability to encode phonological sequences ,such that the activation of target phonemes is delayed & placed in competition with other phonemes The process of detection and repair in combination with a system that is not adept in selecting the correct phonological target before it is produced results in the overt manifestation of a speech dysfluency.
Postma &Klok this covert process may
be thought of in much the same way as overt self repairing .

This hypotheses nicely explains many of the dysfluencies of normal speakers and had been extended to explain the fluency breaks in stuttering speakers ,for both loci & type of intrasyllabic dysfluencies .
It supports well with a number of reports of phonological processing abilities of stutterers (Bosshardt1990; wingate1988) .
Yarrus & Conture(1996) studied nine boys who stuttered with normal phonology & nine boys who stuttered and exhibited disordered phonology .age range was 5yrs old. They found that both groups were similar in their speech dysfluencies , speech errors and self repair behaviours .Utterances containing speech errors were significantly more likely to contain within word speech dysfluencies for both group of children
Practice & effect of DAF
Practice with a sentence reduces the effect of DAF because practice strengths internal trace of the expected feedback &successive movements are driven by discrepancy between ongoing feedback &expected feedback or feedback trace .This means practice should increase rather than decrease the probability of errors for sentences produced under DAF. These observations suggest that articulation is not under the direct feedback control.(Adams1985).
Reaction time in stutterers Research has shown that stutterers as a group are slower in their reaction times . These reaction time task s assess the sensory &motor systems working together . Adams& Hayden 1976 found that
stutterers were slower in reacting with respiration &articulations (lip closing)

Stutterers are slower in tracking a tone that goes up &down in pitch .Hoyt & Rosenfield 1987
Brain et al 1999&Fox et al 1996 stated that in stutterers there could be decrease in the blood flow in primary auditory areas .
Auditory masking
Shane (1955)&Cherry and Sayer (1956) had reported reductions in stuttering as a result of masking noise during the speech of stutterers .
involved in the use of binaural earphone receiving the output of a low frequency BBN generator . the noise usually has an intensity level with in 70-100 dBSPL range . As an aversive stimulus it can occur following stuttering spasms & it has been used as a continuous signal to facilitate fluency
.Distraction effect though distraction cannot explain completely the dysfluency reductions that occur .some clinicians .. the vocal signal changes produce as altered motor planning and productions sequence which can explain stuttering reduction through alteration of habituated speech patterns. Others masking simply reduces auditory feedback and perhaps , requires the speaker to concentrate as proprioceptive signals . Masking can be used as an in clinic therapy in order to establish fluency and then be shaped toward normalized speech .
Albert Postma & Herman Kolk(1992) studied on the effects of noise masking and required accuracy on speech Errors , dysfluencies ,and self repairs(JSHR,VOL35,537-544,1992)
Subjects: 16 women & 16 men aged 1932yrs. Result: with respect to three major issues (a)The covert repair hypothesis of dysfluency. (b) the reality of internal monitoring processes, (c)differences among the various error types in how well they are monitored that is , in the probability that they will be detected and corrected
The covert repair hypothesis of disfluency (Kolk,1991;Postma et al 1990)explains dysfluencies as by products of covert self repairs applied to internal speech errors .
Speakers must pay less attention to the internal loop,or relax criteria employed in internal monitoring ,when they could no longer hear themselves.
A major alternative to this explanation of reduced dysfluency relates to the Lombard Reflex. If delayed repairs reflect the use of auditory loop for error detection ,naturally ,fewer delayed repairs occur when the auditory loop is suppressed
Noise masking reduce disfluency and self repair rates but did not affect speech error numbers.
Wingate (1970) has claimed these changes in manner of articulation and phonation to be the mechanism by which noise ameliorates fluency in stutterers .
DAF AND STUTTERING (JSHD,VOL33,260-265,1968) AIM: In an attempt to explain why stutterers improve in fluency under DAF stuttering as perceptual defect
-stutters have disturbed speech auditory feedback loop or auditory perceptual defect (Butler &stanley1966) -Stromsta(1956) stutterers tend to have larger interear discrepancy than nonstutterers for bone tissue feedback
Interpretation: -if external side tone assumed to be similar for stutterers and nonstutterers, it can be stated that condition existed with in the stutterers at 2000Hz ,comparable to a delay of their external side tone ,a phenomenon which has been demonstrated to disrupt the speech of non stutteres . -it was postulated that. In phase& Out of phase of a side tone preserved in the cortical centers and that could cause a central phenomenon conducive to out of phase of action potential at paired peripheral muscles during a stuttering block
The manner in which DAF reduces the frequency of stuttering can be explained, 1 interpretation; phase differential between bone tissue and air conducted feedback is greater near the Fo of stutterers voice . Soderberg (1959). Sts increased vocal pitch under DAF ,as in the case of nonstutterers
2 interpretation; -bone tissue feedback of sts is out of phase with that of air conducted feedback ,then DAF restores more suitable phase relation between these two pathways for stutterers . -There is an optimum delay time (Lotzman 1961) that facilitates the fluency of individual sts , it would seem that specific delay times play an important role in correcting auditory feedback .
3 interpretation ; -the slowing of speech under DAF accounts for the reduction of stuttering rather than feedback correction . It may be necessary for some sts to speak at slower than normal rate in order to achieve a degree of stability in their speech auditory feedback loops . -Johnson &Rosen(1937) reported that the frequency of stg was greater when sts read faster than normal
TESTS RESULTS OF AUDITORY PROCESSING IN STUTTERING

Auditory threshold Harms&Malone(1939) ---- 62 stutterers
examined by pure tone audiometry had a impairment of hearing , Tomatis (cited by Van Riper,1982)stated that 90 % of his stutterers had a hearing loss in one ear .
o Hugo ,Aimard,Plantier & Wittling (1966)
could find any difference in sensitivity between the left & right ears of stutterers . MacCulloch & Eaton (1971) reported a lowered auditory pain threshold for Puretones in a comparison of 44 stuttereres with a group of controls . Phase disparities Stromsta (1957) --he used 2 pure tones of equal frequency and amplitude and diametrically (180 degrees ) out of phase .
-Stutterers and normal speakers listened to an air conducted tone and to bone conducted tone of same frequency simultaneously introduced The subject then varied the phase and amplitude of air conducted tone until a critical adjustment was at which no sound was audible to them .
Stromsta found that at 2000Hz there was differenc between stutterers and nonstutterers in the average relative phase angle of air and bone conducted sounds as indicated by the amount of adjustment they made
Later by the same method ,Stromsta found an unusual phase disparity between stutterers left & right ears . His subjects adjusted amplitude and phase of two air conducted tones heard at either ear until they cancelled an identical bone conducted tone .
At the point of cancellation the air conducted tones at the two ears had a phase disparity at several frequencies about twice as wide , on the average ,for the stutterers as for the nonstutterers. Mangan (1982)replicated Stromastas earlier
study and failed to find a difference between stutterers and nonstutterers in phase and amplitude adjustments of air and bone conducted sound .
Test of Central auditory processing
that stuttering children did not perform as well as non stutterers in making mediane plane sound location response. Sound localization findings by Kamiyama (1964)and Asp (1968),although Asp observed some differences on tests of loudness balance Herndon (1967)found differences in the ability to discriminate between different durations of the tone
Rouse Y,Goetzinger & Dirks (1959)reported
the Synthetic sentence identification / Ipsi lateral competing message test (SSI-ICM) to compare stutters &non stutters . This test requires participants to identify words in a nonsense phrase (such as small boat with a picture has become ) when competing noise is presented in the same ears.
Three studies using this test found that stutters perfomed worse than normal participants (Hall &Jerger ,1978;Molt & Guilford ,1979;Toscher & Rupp,1978)
the more fluent normal speakers performed
significantly better than the less fluent normal speakers (Wynne&Boehmler 1982&Blood1987).
Stuttering &normal dysfluencies may be associated with some difficulty in central auditory processing
o Hannely &Dorman (1982)& Guitar(1987) found no differences between stutters &non stutters on the SSI-ICM, but stutters in their study had all recently completed a treatment program . o This finding intriguing in light of evidence from brain imaging studies an absence of activity before treatment in the left auditory cortex showed normal levels of activity immediately after treatment (De Neil et al &Ingham ,2003)
In Staggered spondaic word test ,The stimuli used are series of 2 bisyllabic words having equal stress on each syllable .The syllables are then overlapped in time The overlapping syllables a dichotic input to the listener .Hall & Jerger(1962)stated that stutterers
&nonstutterers significantly differed in their total correct responses to the competing portion of the test .Stutterers performed poorly on this test when compared to non stutteres
masking level difference test (MLD) ,which requires listeners to detect the onset &offset of a tone in the presence of masking noise . When masking noise is played in the same ear as the tone ,there are fewer cues for listeners to use in filtering the tone from the masking tone Listeners must use very subtle temporal cues
to detect the tone ; under these conditions ,persons who stutter perform more poorly than groups of nonstutters(Guitar 1987) .
These results may be interpreted to support the outcome of the SSI studies because both tests require the participants to use temporal information in one case (SSI), rapidly changing formant frequencies in identifying words , and in the other case (MLD),detection of the onset &offset of a tone in masking . central auditory processing tested the hypothesis that people who stutter have difficulty resolving temporal differences .Herndon (1966) found that
stutters were poorer than nonstutters at distinguishing Which of two brief tones was longer
Barasch et al (2000) administered the duration
pattern sequence (DPS) test ,which involves judging the relative lengths of three tones , and another measure in which subjects estimated durations of tones & silent intervals
These tests failed to distinguish between the stuttering &nonstuttering participants as groups ,but they showed that less fluent participants in each group scored worse on the DPS than more fluent participants . In addition ,more disfluent subjects in both groups judged temporal intervals to be longer than less disfluent subjects
It has been suggested that fear &anxiety affect temporal processing (Fraisse 1963)
that anomalies in temporal processing may be an underlying cause of both stuttering (Kent 1984 ) and high levels of normal disfluency(Wynne1982) Researchers conclude that stutterers performance is poor on all these central auditory function tests .Stutterers as a group performed poorly than nonstutters on task requiring fine discrimination of the small time difference in signals .
Researches view stuttering as disorder in the control of sequence & timing .There are 5 observations which point the connection between stuttering &processing of auditory input 1)Stuttering can be virtually eliminated in some with the flick of switch introducing white noise with in the frequency range of speech which is loud enough to mask the stutterers auditory feedback (1955)
2)Stapedial reflex of the middle ear appears to differ between stutteres & nonstutterers ..The stapedial muscle normally contracts 100-165 msec prior to phonation ,there by reducing the amplitude of the ear drum vibration & alternates the hearing of ones own speech .
Webster &Lukes(`1968)found that stapedial reflex is less stable in stutterers
Dhonovitz & Johnson et al (1978) found that under conditions of anxiety stutteres show less stapedial attenuation than nonstutters . Hall & Jerger (1978) compared the acoustic reflexes in stutterers &controls . Reflex threshold was equivalent was in 2groups ,but reflex amplitude was smaller in stuttering group Hannley and Dorman (1982) observed nodifference in the latency or amplitude of the reflex. March banks &El-Yaniv(1986) found nodifference between stutterers and normal speakers in middle ear muscle activity during vocalization .
3)Auditory processing of an about to be produced word facilitates its correct production Stutterers often release them from a block
when someone else word on which they have difficulty (Bar &Carmel 1970) 4)stutterers become very fluent when their returning auditory feedback is delayed by means of a recording &reproducing device (Hutchinson& Burk1973)
5)Reception errors like in stutterers can be obtained in normals by amplifying as well as delaying their auditory feedback Researchers have tried to link the timing deficit to stuttering by suggesting a single mechanism in brain may control both incoming and outgoing signals Faulty timing of incoming signals would give rise to stutterers poor performance on central auditory processing tests .Faulty timing of outgoing signals would result in stuttering
Dichotic listening tests In the early studies ,a procedure was developed to assess hemispheric dominance for speech &language by testing which ear was more accurate at hearing speech sounds .Kimura 1961 invented the dichotic listening test
, which simultaneously presented two different syllables dichotically .

Listeners reported which syllable they heard .auditory nerves connecting the ears to the cerebral hemisphere carry more information to the hemisphere on the opposite side than to the hemisphere on the same side . Results with normal speakers indicated that syllables presented to the R ear were most frequently reported as heard ,which was called a R ear advantage for speech .
This procedure has been used to assess laterality differences between stuttering &nonstuttering groups .A number of experiments found that many persons who stutter do not show the typical R ear advantage that nonstutters do ,which is evidence that people who stutter some dichotic studies found no difference between stutters &nonstutters (Dorman 1975&Pinksy &McAdams ,1980)
Other studies found no significant group differences but found that fewer stutteres than nonstutters showed the expected Rear advantage (Rosenfield &Goodglass 1980) .The more linguistically complex the stimulus ,the more likely that the differences between stutters &nonstutters would be found . Any auditory processing anomaly related to stuttering is likely to be on a continuum rather than simply present or absent .More severe or neurologically involved stutters may have more abnormal auditory processing
Left-handed men who stutter and righthanded women who stutter have atypical auditory processing but differ in important ways. The left-ear bias found in lefthanded men who stutter in the nondirected attention condition suggests that their right temporal lobe may be important in perceiving speech, and, therefore, they have mixed dominance (Cogn Behav Neurol2004 Dec;17(4):224-32)
Lombard sign Panconcelli-Calzia (1955) found the lombard
sign in only 27%of a group of 80 stutterers ,as compared with 78% of a group with normal voice and speech .This is a conflict with considerable amount of research showing that most stutterers do increase the loudness of their voices under masking noise.
Brain electrical potentials reflecting auditory processing Studies of electrical brain activity in response to auditory stimuli have provided further evidence that auditory processing is abnormal in individuals who stutter . Molt and Luper(1983) found that stutterers
had faster average peak latency than normal speakers

Studies by Hood(1987)&Parker (1995) reflecting both subcortical &cortical activity have found group differences between stutters &nonstutters . However the study found stutters responses to be slower than nonstutters responses .
A study of Molt(1997) brain imaging studies of whether person who stutter have a deficit in the left auditory cortex Molt found that stutters have longer latencies &lower amplitudes of brain waves in the cortex when they where asked to make decisions about semantic incongruencies in sentences they listened to
Early latency potential (ABR)
Blood &Blood (1984) recorder longer wave III and wave V latencies for stutterers and abnormal inter peak latency for five of eight stutterers . Smith,Blood and blood (1990) found no differences in latencies but greater amplitude of wave I for stutterers .
Middle latency response in stutterers Studies have shown that auditory middle latency response Wave Pb was prolonged in subjects who stutter as compared to normals .
Hood (1987)conducted an investigation of the MLR s of of males who stutter and found that the latency of the wave Pb was significantly longer for those who stuttered than controls .MLRs were recorded from 10 males who stutter &10 controls using a variety of filter bands in response to clicks presented binaurally at various rates .
The latency of Pb was found to be significantly shorter in the group of subjects who stutter. Wave Pb of the MLR is generated by the thalamic portion of the reticular activating system .The thalamus is critical to speech and language production .Other researchers suggest that the metabolism of the thalamus is lower than normal(Rapoport1991)(JSHR,Vol.38,517,1995);
Significant difference in the delay of Wave Pb latencies in adult stutters as compare to the adult non stutters in both ears .This indicate the differences in the thalamocortical pathways &reticular formation as there are hypothesized to be the possible generators for the MLR waves .The difference may lead to poor temporal processing &programming in stutterers . Msc Dissertation of Osmania University 1997)
P300 event related potentials in stutterers Stutters exhibit different patterns of interhemispheric activity than nonstutters with a tonal P300 task. Insula and auditory cortical areas of the superior temporal lobe are majorities of generation of the P300 response (Rogers et al 1991)Ferrand,Gilbert and Blood (1991) tested stutterers using P300 and found nodifferences between stutterers and nonstutterers in the latency of p300.16 young adult males aged 17 to 36 years with R handed compared with stutterers and found that stutterers exhibited relatively lower amplitude P300s in the right hemisphere
This may be interpreted as possibility that altered cerebral dominance plays an important role .(Mattingly 1970)(JSLHR,Vol40,1334-1340,1997)
Effect of auditory feedback on Non speech Oral activity Both stutterers and nonstutterers the delayed feedback conditions produced disturbances in the pattern such as errors ,prolonged lip closures , and prolongation of the pattern .However the effect of DAF was about the same for both group of subjects .
Effect of DAF in normal speakers It is possible by means of magnetic tape recording &recording device suitably designed to return a subjects vocal output via earphones with a brief delay in transmission 2explanations are given about the effects of DAF in normal subjects
normal speakers air conducted auditory feedback is by the interval of the order 0.2sec& amplified sufficiently to complete with their bone conduction feedback ,there tends to be a disintegrative effect on their verbal output .this disintegration takes the form of a slow speaking rate ,articulatory inaccuracy ,disturbances of fluency including blocks &repetitions of the syllables like in stutters . In addition there is an increase in loudness & pitch ,which Fairbanks inferred to result from the subjects struggle to resist the interference with their response
Following activation ,the nodes responsible for speech are self inhibited & then undergo a normal cycle of recovery . this recovery cycle includes a period of hyper excitability during which nodes have greater than normal sensitivity, with a peak occurring approximately 200msec following onset of activation & return to a resting level by 300msec following onset of activation .this explains why the delay of 0.2 sec produces maximum disruption of speech
.When feedback arrives 0.2sec after onset of activations ,it provides additional priming of just activated nodes , (amplification ,hyper excitability & normal bottom up priming )combine to exceed the top down priming of appropriate nodes ,these just activated nodes will be reactivated under most primed principle ,with an effect resembling the repetition errors of stutterers
Errors under DAF decrease with slower speech rates ,since lower speech rates enables temporal summation to augment top down priming of nodes for an indented output . This may explain why some subjects speak slower at the most disruptive feedback delay (0.2sec )despite instruction to speak always at a maximum rate .By speaking slower they can overcome the effects of returning auditory feedback &gain better control over the output .
Effect of DAF on stutterers
Under the theory stuttering occurs whenever the just activated nodes receive greater priming than nodes to be activated next .There are 2 hypothesis to account for this theory.
One hypothesis is that returning feedback is delayed by about 0.2 sec with in the sensory analysis nodes of stutterers & acquires greater than normal amplitude due to mal functioning of the stapedial reflex .As a result the normal auditory feedback of these stutterers will achieve the conditions ,which disrupt the speech of normal speakers receiving delayed & amplified auditory feedback .Like wise shadowing & choral rehearsal prevents stuttering by augmenting the priming of the appropriate or next to be activated nodes
The other hypothesis is that nodes of stutterers, evidence an abnormal recovery cycle . Both hypotheses predict that masking & returning auditory feedback will reduce the probability of stuttering &amplifying it will have the opposite effect .Both hypotheses predict release from auditory input guides speech production Thus stuttering is overcome when others utter the words when stutter is blocking since the input helps prime the appropriate nodes to the level required for activation . Finally both hypotheses predict that delay producing maximal interference with speech will be shorter stutters than non stutterers .
Brandt & Wilde (1977)found that like stuttering ,the dysfluencies of normal speakers under DAF was reduced when the subject read in unison with another voice & they timed their speech to the beat of a metronome . Borden et al (1977) observed both similarities &differences between normal speakers under DAF &stutterers in electromyographic recordings from laryngeal & articulatory muscles
Venkatagiri(1982) found that like stutterers the DAF dysfluencies of normal speakers showed a distinct adaptation , effect over successive recordings occurred more often in content words than on functional words , on long words than on short words . Although the consistency effect was present,it was smaller when compared to stutters .
Studies Studies have shown that DAF at short delays &frequency altered feedbak have been shown to produce immediate &extremely powerful reduction of stuttering(FoliaPhoniatrica et Logopedica2004,56,347-357) Vowel duration significantly increased under metronome,DAF, and noise ;pressure rise time increased under MET ,DAF &noise;flow rise time increased under noise;speech rate decreased under DAF & noise (JSHR,vol36,245-253,1993)
Noise masking reduced disfluency and self repair rates but did not affect speech error numberers(JSHR,VOL 35,5375444,1992) Significant decrease in number of stuttering blocks under binaural masking noise condition in case of stutterers .Normals showed no stuttering blocks under binaural masking .an increased vowel duration found in both groups (JAIISH,VOL.XIII,1982),Msc dissertation; Nadur V.U(1982).
The error detection performance of subjects who stuttered was compared to that of subject who didnt in two speech production conditions ;one with normal auditory perception &one in which the auditory perception was masked by white noise ;and in perception condition in which they are listened to speech produced by another person .In both the normal speech &noise masked conditions that the error detection rates &false alarm rates of subjects who stuttered did not differ significantly from those of subjects who did not stutter(JSHR,VOL35,1024-1032,1992)

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STUTTERING AND AUDITORY FUNCTIONS

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

What is Auditory processing?

Auditory processing in stutters

KUNNAMPALLIL GEJO JOHN,MASLP

Central processing in stuttering

KUNNAMPALLIL GEJO JOHN,MASLP

o Wilkins EEG studies - final

neural dysfunction rather than hemispheric differences in stutterers

Right hemisphere activity,

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

Left auditory cortex activity in stuttering

that synchronize the sequence for speech output

KUNNAMPALLIL GEJO JOHN,MASLP

Errors are normally identified & corrected automatically .

Closed loop system

KUNNAMPALLIL GEJO JOHN,MASLP

Fluency disruption as a cybernetic phenomenon:

Altered Auditory Feedback

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

DELAYED AUDITORY FEEDBACK

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

Recommended Procedures for Using DAF

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

efferent proprioceptive Tactile feedback

Postma &Klok this covert process may

be thought of in much the same way as overt self repairing .

Practice & effect of DAF

stutterers were slower in reacting with respiration &articulations (lip closing)

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

TESTS RESULTS OF AUDITORY PROCESSING IN STUTTERING

o Hugo ,Aimard,Plantier & Wittling (1966)

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

KUNNAMPALLIL GEJO JOHN,MASLP

Test of Central auditory processing

Rouse Y,Goetzinger & Dirks (1959)reported