Severe stuttering associated with right hemisphere lesion

Following a right hemisphere stroke, a right-handed, 50-year-old male experienced a permanent dysfluency characterized by phoneme and syllable reiterations and, to a lesser extent, word and phrase reiterations. The reiterations occurred in initial, medial, and final positions and for all sentence elements (e.g., subject nouns, object nouns, verbs, modifiers). There was a notable loss of verbal automatisms (poems, songs, etc.). The patient's symptoms conform to the acquired stuttering syndrome described by A. Helm, R. Butler, and D.F. Benson (1978, Neurology, 28, 1159-1165).     

Development of speech and language following bilateral frontal lesions

Language and speech were studied in a young child with perinatally acquired bifrontal lesions. Bilateral frontal pathology seriously interfered with the development of intelligible speech and resulted in a persistent expressive aphasia. Analysis of the neuropsychological profile indicated impairments in intelligence and language comprehension. These deficits, however, were considered secondary to the profound speech programming disorder. The findings indicate that, despite the plasticity of the immature central nervous system, bilateral frontal injury sustained at an early age precludes the development of intelligible speech. Furthermore, structurally intact cortical regions outside the territories of the speech zones fail to mediate normal speech and language development.     

A case of persistent neurogenic stuttering following a missile wound

Observational criteria that have been proposed to distinguish developmental from neurogenic stuttering are critically reviewed. It is concluded that both conditions may closely resemble each other. As an example, a case of neurogenic stuttering following a missile would is reported.     

Acquired stuttering as a forerunner of motor-neuron disease

A case of acquired stuttering that included repetitions, blocks, prolongations, fillers, and, later on, also synkinesias is reported. This stutter turned out to be the forerunner of a motor-neuron disease.     

Opposed left and right brain hemisphere contributions to sexual drive: a multiple lesion case analysis

Brain topographical studies of normal men have have shown that sexual excitation is asymmetric in the brain hemispheres. Group studies of patients with unilateral epileptic foci and other studies of patients with unilateral brain lesions have come to the same conclusion. The present study reviewed previously published single case reports of patients with frank hypo or hypersexuality subsequent to a unilateral brain lesion. Hyposexual patients tended to have left hemisphere lesions (primarily of the temporal lobe), and hypersexual patients tended to have right hemisphere lesions (primarily of the temporal lobe) (p < 0.05). We interpret this double dissociation as part of a more general phenomenon of psychic tone similarly dissociated with regard to hemispheric control, including mood, psychomotor baseline, speech rate, and even immunity. The behavioral significance of this psychic tone is to modulate approach versus avoidance behavior.     

fMRI of developmental stuttering: a pilot study

The purpose of this investigation was to explore the feasibility of fMRI in the study of developmental stuttering. Speech contrasts (loud versus silent reading) and language contrasts (reading of semantically meaningful text versus nonsense words) of six developmental stutterers and six nonstutterers were compared using a commercial 1 Tesla MR-Scanner (Siemens Expert). Results indicate that mapping cortical function in persons who stutter is indeed feasible, even with a 1TMR-system. Compared to normals the stutterers seemed to employ different and particularly less differentiated auditory and motor feedback strategies in speech. They apparently rely on auditory processing and on cerebellar contribution as much during silent reading as during reading aloud. Moreover, they showed a greater involvement of the right hemisphere in language processing, activating not only the typical language areas on the left but also and with equal magnitude the right side homologues of these areas. In spite of the promising results, at present several practical problems such as possible movement artifacts and possible masking through scanner noise still hamper a more straightforward use of fMRI in the study of developmental stuttering.     

Bilateral opercular syndrome and crossed aphemia due to a right insular lesion: A clinicopathological study

A right-handed male patient suddenly noted lower bilateral facial and lingual palsy, and inability to masticate and swallow, but with preserved automatic functions. He was mute, communicating only through writing, but verbal comprehension was normal (aphemia). On anatomopathological examination, an ischemic infarction of the entire right insula, with mild extension to the fronto-temporoparietal operculum was observed. The left hemisphere was normal. The clinical findings suggest a bilateral opercular syndrome due to a right hemisphere lesion and a crossed aphemia.     

Experimental treatment of early stuttering: a preliminary study

This pilot study compared two treatments for stuttering in preschool-age children. Thirty children were randomly assigned to either a Lidcombe Program (LP) treatment or a Demands and Capacities Model (DCM) treatment. Stuttering frequencies and severity ratings were obtained immediately before and after treatment (12 weeks). The stuttering frequencies and severity ratings significantly decreased for both treatment groups. No differences between groups were found. Parents of children in both groups were cooperative in many respects, and there were no differences between them on scales that measured their satisfaction with the two treatments. The findings suggest that randomized controlled trials of LP versus DCM treatments are feasible, and they underline the need for experimental analyses of the two treatments. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the principles and methods of Lidcombe treatment for early stuttering; (2) delineate principles and methods of Demands and Capacities Model treatment; and (3) summarize results of an investigation that compared these programs' relative effects in a pilot study.     

An instrumented method for assessment and remediation of stuttering: A single-subject case study

A single-subject experimental design was used to investigate the feasibility of applying non-invasive laboratory instrumentation for examining speech physiology to assessment and biofeedback-based remediation of stuttering. Physiologic assessment facilitated the development of behavioral goals directed at changing respiratory and phonatory behaviors for this subject. Visual biofeedback therapy produced reduction in respiratory discontinuities and increased phonatory continuity, concomitant with reduced perceivable molar dysfluency. Methods used in this case illustrate a variety of options and problems related to clinical use of instrumentation. Results suggest that signals which represent respiratory, phonatory, and articulatory physiologic events may be clinically practical for evaluating and altering perceivable dysfluency.     

His mother-tongue: from stuttering to separation, a case history

This paper delineates the transference and countertransference experiences in the analysis of a patient whose presenting symptom and main concern was his stutter. I suggest that oral-sadistic rather than anal-sadistic hostile elements may be identified in this patient's particular stutter. I focus on its significance in terms of object relationship: my patient's struggle to 'get born', to emerge as a separate other. I argue that early symbiotic fusion needs in conflict with the need to separate produce his stutter. Speech and language are seen as the vehicle for separation and the stutter as a flight from separateness back to an illusion of fusion with mother.     

Acquired aphasia with convulsive disorders in children: a case study with a seven-year follow-up.

In a 7-year follow-up a case of the “syndrome of acquired aphasia with convulsive disorder” is described. In particular, attention is paid to EEG patterns and linguistic analysis. Although seizures have been controlled medically and EEG abnormalities have tended to improve, no close parallel improvement has been observed in the patient's language disorders.     

Acquired surface alexia in Spanish: a case report

This paper reports a case study of acquired surface alexia in Spanish and discusses the most suitable tests to detect this syndrome in a writing system that is very regular for reading at the segmental and supra-segmental levels. Patient MM has surface alexia characterized by quantitatively good performance in reading words and pseudowords; accurate but slow and syllabic reading of words, nonwords and sentences; good performance in lexical decision tasks including words and nonwords; errors in lexical decision with pseudohomophones; and homophone confusions. This pattern of reading can be interpreted as a disorder in the lexical reading route and overdependence on the non-lexical route. We discuss nonlexical impairments and the interpretation of alexia and suggest tasks to identify surface alexia in a shallow orthography.     

Inhibition and the right inferior frontal cortex

It is controversial whether different cognitive functions can be mapped to discrete regions of the prefrontal cortex (PFC). The localisationist tradition has associated one cognitive function - inhibition - by turns with dorsolateral prefrontal cortex (DLPFC), inferior frontal cortex (IFC), or orbital frontal cortex (OFC). Inhibition is postulated to be a mechanism by which PFC exerts its effects on subcortical and posterior-cortical regions to implement executive control. We review evidence concerning inhibition of responses and task-sets. Whereas neuroimaging implicates diverse PFC foci, advances in human lesion-mapping support the functional localization of such inhibition to right IFC alone. Future research should investigate the generality of this proposed inhibitory function to other task domains, and its interaction within a wider network.     

Genetic and environmental effects on stuttering: a twin study from Finland

The present study explored the prevalence of self-reported stuttering in a Finnish twin population and examined the extent to which the variance in liability to stuttering was attributable to genetic and environmental effects. We analyzed data of 1728 Finnish twins, born between 1961 and 1989. The participants were asked to complete a questionnaire on speech, language, and voice. In two of the questions they were asked to report the occurrence of childhood and present stuttering of their own and that of their sibling. According to the results, 2.3% (52) of the participants were reported to have stuttered as children and 28.8% of them (15) were reported to continue to stutter in adulthood. There was no significant gender difference in the prevalence of stuttering in either childhood or adulthood. For childhood stuttering, the tetrachoric correlation was higher for monozygotic pairs (r=.74) than for dizygotic pairs (r=.27). By means of structural equation modeling it was found that 82% of the variance in liability to childhood stuttering was attributable to additive genetic effects, with the remaining 18% due to non-shared environmental effects. In conclusion, the results of the present study confirm findings from prior studies and support a strong genetic and only a moderate non-shared environmental effect on stuttering. Potential small differences in the prevalence of stuttering in different populations are suggested by our data. EDUCATIONAL OBJECTIVES: The reader will be able to recognize the contribution of genetic and environmental effects on stuttering.