Effects of massed practice and cue-controlled relaxation on tic frequency in Gilles de la Tourette's syndrome

The effects of massed practice (MP) and cue-controlled relaxation on tic frequency were assessed in three single-case studies. Measures of tic frequency, subjective tension and fatigue, and physiological arousal were obtained throughout treatment.MP failed to produce any reduction in tic frequency in the three Gilles de la Tourette's syndrome patients studied. Cue-controlled relaxation resulted in a moderate decrease in tic frequency in only one patient.Tic frequency was related to physiological arousal, as assessed by skin conductance response frequency. No evidence was obtained in support of the suggestion that ticquers demonstrate a deficit in their habituation to sensory stimulation.     

Decreased volume of the cerebral ventricles on CT images in Gilles de la Tourette's syndrome

The aim of the present study was to estimate the volume of the ventricular system comprising lateral plus third ventricles in patients with Gilles de la Tourette's syndrome on computed tomographic (CT) scannings using unbiased stereological principles and to compare that volume with a control group. We found a significantly reduced ventricular volume in 24 patients with Gilles de la Tourette's syndrome (GTS) compared with 28 controls.     

Decreased volume of the cerebral ventricles on CT images in Gilles de la Tourette's syndrome

The aim of the present study was to estimate the volume of the ventricular system comprising lateral plus third ventricles in patients with Gilles de la Tourette's syndrome on computed tomographic (CT) scannings using unbiased stereological principles and to compare that volume with a control group. We found a significantly reduced ventricular volume in 24 patients with Gilles de la Tourette's syndrome (GTS) compared with 28 controls.     

Creating tic suppression: comparing the effects of verbal instruction to differential reinforcement

The purpose of this study was to compare two methods designed to produce tic reduction in 4 children with Tourette's syndrome. Specifically, a verbal instruction not to engage in tics was compared to a verbal instruction plus differential reinforcement of zero-rate behavior (DRO). Results showed that the DRO-enhanced procedure yielded greater reductions in tic frequency.     

Ambulatory accelerometry to quantify involuntary movements and tics in the syndrome of Gilles de la Tourette

Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder characterizedby recurrent and involuntary tics, in addition to complex behavioral symptoms. Objective quantification of the nonspecific movements in Tourette patients can contribute much to understanding the pathophysiology of this disease. We used three accelerometersto characterizehead movement patterns and to objectively quantify head motility in the lateral, sagittal, and transversal planes in 9 Tourette patients and 14 controls during periods of rest, conversation, and watching a videotape with an entertaining program. Characteristic head movement patterns can be documented by means of accelerometry. Head motility levels in the lateral, sagittal, and transversal planes were significantly higher in the patients than in the controls during all the procedures. The patients and the controls showed a similar significant increase in head motility during conversation, but not during video watching. This first study shows that for both standardized and ambulatory research, accelerometry may provide an objective tool by which to quantify the severity and temporal dynamics of tics or nonspecific movements.     

ANALYZING THE INFLUENCE OF TIC‐RELATED TALK ON VOCAL AND MOTOR TICS IN CHILDREN WITH TOURETTE'S SYNDROME

This study examined the effect of tic‐related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.     

Gilles de la Tourette syndrome in India: two cases.

Two cases of Gilles de la Tourette syndrome from India are presented. The symptomatology of Tourette syndrome is the same as that documented in western populations which suggests biological factors in the aetiology of the syndrome.     

EEG phase synchronization during semantic unification relates to individual differences in children’s vocabulary skill

As we listen to speech, our ability to understand what was said requires us to retrieve and bind together individual word meanings into a coherent discourse representation. This so‐called semantic unification is a fundamental cognitive skill, and its development relies on the integration of neural activity throughout widely distributed functional brain networks. In this proof‐of‐concept study, we examine, for the first time, how these functional brain networks develop in children. Twenty‐six children (ages 4–17) listened to well‐formed sentences and sentences containing a semantic violation, while EEG was recorded. Children with stronger vocabulary showed N400 effects that were more concentrated to centroparietal electrodes and greater EEG phase synchrony (phase lag index; PLI) between right centroparietal and bilateral frontocentral electrodes in the delta frequency band (1–3 Hz) 1.27–1.53 s after listening to well‐formed sentences compared to sentences containing a semantic violation. These effects related specifically to individual differences in receptive vocabulary, perhaps pointing to greater recruitment of functional brain networks important for top‐down semantic unification with development. Less skilled children showed greater delta phase synchrony for violation sentences 3.41–3.64 s after critical word onset. This later effect was partly driven by individual differences in nonverbal reasoning, perhaps pointing to non‐verbal compensatory processing to extract meaning from speech in children with less developed vocabulary. We suggest that functional brain network communication, as measured by momentary changes in the phase synchrony of EEG oscillations, develops throughout the school years to support language comprehension in different ways depending on children's verbal and nonverbal skill levels.     

Short therapy of a child with Gilles de la Tourette's Syndrome*

This paper describes a three-hour intervention with a family whose younger son, aged four, was brought for consultation for Gilles de la Tourette's syndrome. The theoretical elaboration of the intervention is discussed so as to elucidate the therapeutic effect of the session leading to the lasting eradication of the symptoms.     

The linguistic interpretation of aphasic syndromes: Agrammatism in Broca's aphasia,an example

One of the most striking characteristics typical of the speech of Broca's aphasics is its agrammatism — the omission of ‘function’ words and inflectional morphemes. Agrammatism is generally viewed as being symptomatic of a syntactic deficit. We argue here that such an account lacks grammatical systematicity, and that the only uniform and systematic interpretation of this deficit is in terms of phonological structure. A natural class consisting of ‘function’ words and some bound morphemes can be defined with reference to the junctural properties of sentences which characterize phonological words. It is this class of elements which tend to be omitted in agrammatic speech. The goal of this paper is not only to provide an hypothesis for the interpretation of one aphasic syndrome, but also to test and illustrate the efficacy of paying close attention to substantive universals of grammatical structure in proposing accounts of linguistic deficits.     

Behavioral and pharmacological treatments for tourette syndrome: A review

This article reviews the published treatment outcome research on pharmacological and behavioral treatments for Gilles de la Tourette syndrome (TS). Controlled group outcome studies of pharmacological treatments show about a 50–60% reduction in tics with haloperidol and pimozide and about a 20% reduction with clonidine. A controlled group outcome study and several within-subject design studies of behavioral treatments show about a 90% reduction in tics with habit reversal training. A large number of case studies generally confirm these results and also show benefits from other behavioral treatments such as relaxation training, self-monitoring, and contingency management. Clinical limitations of TS drugs are that they produce side effects in 50–85% of the patients and require continuous use, and long-term compliance with the medications is limited. The primary limitation of behavioral treatments is that they require a large initial time commitment. The methodological strengths of the controlled drug studies are the use of double-blind and group designs. For the behavioral studies, the strengths are rigorous recording and controlled within-subject designs.     

Visual content of words delays negation

Many studies have shown the advantage of processing visualizable words over non-visualizables due to the associated image code. The present paper reports the case of negation in which imagery could slow down processing. Negation reverses the truth value of a proposition from false to true or vice versa. Consequently, negation works only on propositions (reversing their truth value) and cannot apply directly to other forms of knowledge representation such as images (although they can be veridical or not). This leads to a paradoxical hypothesis: despite the advantage of visualizable words for general processing, the negation of clauses containing words related to the representation of an image would be more difficult than negation containing non-visualizable words. Two experiments support this hypothesis by showing that sentences with a previously negated visualizable word took longer to be read than sentences with previously negated non-visualizable words. The results suggest that a verbal code is used to process negation.     

Significance of pauses for speech perception

Pauses can be used to facilitate certain operations involved in the production and in the perception of speech. In the case of speech perception, pauses have been found to improve the accuracy of detection and the recall of lists of digits and letters. The aim of the present experiments was to examine the effects of pause time on the perception of sentences. In experiment I, a semantic categorization task was used and in experiment II a sentence recall task. The results indicated that in sentences containing pauses between clauses, words were categorized more rapidly (experiment I) and propositions were recalled more accurately (experiment II) than in sentences containing pauses, within the clause. The results are interpreted in the context of existing models of speech processing, and the significane of pause time for cognitive activity is discussed.     

Behavioral and fMRI evidence that cognitive ability modulates the effect of semantic context on speech intelligibility

Text cues facilitate the perception of spoken sentences to which they are semantically related (Zekveld, Rudner, et al., 2011). In this study, semantically related and unrelated cues preceding sentences evoked more activation in middle temporal gyrus (MTG) and inferior frontal gyrus (IFG) than nonword cues, regardless of acoustic quality (speech in noise or speech in quiet). Larger verbal working memory (WM) capacity (reading span) was associated with greater intelligibility benefit obtained from related cues, with less speech-related activation in the left superior temporal gyrus and left anterior IFG, and with more activation in right medial frontal cortex for related versus unrelated cues. Better ability to comprehend masked text was associated with greater ability to disregard unrelated cues, and with more activation in left angular gyrus (AG). We conclude that individual differences in cognitive abilities are related to activation in a speech-sensitive network including left MTG, IFG and AG during cued speech perception.     

Analyzing spoken language into words,syllables, and phonomes: A developmental study

Fifty children aged 3–7 years were asked to repeat spoken sentences and then to divide up these sentences into words, the words into syllables, and the syllables into speech sounds. There was a clear developmental progression in the ability to analyze spoken language in this way. The skills of analyzing sentences into words and words into syllables were highly related. Items requiring analysis of syllables into phonemes were highly correlated with each other and somewhat independent of sentence and word analysis items. The results are related to Gibson's model of reading, in which the acquisition of grapheme-phoneme correspondences is a crucial process.     

Planning sentences while doing other things at the same time: effects of concurrent verbal and visuospatial working memory load

This study investigated to what extent advance planning during sentence production is affected by a concurrent cognitive load. In two picture–word interference experiments in which participants produced subject–verb–object sentences while ignoring auditory distractor words, we assessed advance planning at a phonological (lexeme) and at an abstract–lexical (lemma) level under visuospatial or verbal working memory (WM) load. At the phonological level, subject and object nouns were found to be activated before speech onset with concurrent visuospatial WM load, but only subject nouns were found to be activated with concurrent verbal WM load, indicating a reduced planning scope as a function of type of WM load (Experiment 1). By contrast, at the abstract–lexical level, subject and object nouns were found to be activated regardless of type of concurrent load (Experiment 2). In both experiments, sentence planning had a more detrimental effect on concurrent verbal WM task performance than on concurrent visuospatial WM task performance. Overall, our results suggest that advance planning at the phonological level is more affected by a concurrently performed verbal WM task than advance planning at the abstract–lexical level. Also, they indicate an overlap of resources allocated to phonological planning in speech production and verbal WM.     

Talker-specific learning in speech perception

The effects of perceptual learning of talker identity on the recognition of spoken words and sentences were investigated in three experiments. In each experiment, listeners were trained to learn a set of 10 talkers’ voices and were then given an intelligibility test to assess the influence of learning the voices on the processing of the linguistic content of speech. In the first experiment, listeners learned voices from isolated words and were then tested with novel isolated words mixed in noise. The results showed that listeners who were given words produced by familiar talkers at test showed better identification performance than did listeners who were given words produced by unfamiliar talkers. In the second experiment, listeners learned novel voices from sentence-length utterances and were then presented with isolated words. The results showed that learning a talker’s voice from sentences did not generalize well to identification of novel isolated words. In the third experiment, listeners learned voices from sentence-length utterances and were then given sentence-length utterances produced by familiar and unfamiliar talkers at test. We found that perceptual learning of novel voices from sentence-length utterances improved speech intelligibility for words in sentences. Generalization and transfer from voice learning to linguistic processing was found to be sensitive to the talker-specific information available during learning and test. These findings demonstrate that increased sensitivity to talker-specific information affects the perception of the linguistic properties of speech in isolated words and sentences.     

The ability to orient attention in Gilles de la Tourette syndrome

Gilles de la Tourette syndrome is characterised by tics, although patients also commonly present with attentional problems. This experiment aimed to ascertain whether TS patients have problems in orienting attention, via the use of a vibrotactile choice reaction time task. Participants were required to push a button in response to a faint vibration delivered to the index finger. Prior to each stimulus vibration, a pre-cue (valid, neutral or invalid) was administered to the finger. The performance benefits and costs participants gained from valid and invalid precues were calculated. Contrary to our prediction TS patients did not show significantly different costs or benefits. Furthermore, both patients and controls showed an equal and increased benefit in the crossed arm posture, compared to the uncrossed. These results suggest TS patients do not generally have problems in orienting attention. In addition, in the tactile modality, both patients and controls may benefit from directed attention when difficulty levels are maximal.     

Production of Stress Retraction by Left- and Right-Hemisphere-Damaged Patients

An acoustic-perceptual investigation of a phonological phenomenon in which stress is retracted in double-stressed words (e.g., thirTEEN vs THIRteen MEN) was undertaken to identify the locus of functional impairments in speech prosody. Subjects included left-hemisphere-damaged (LHD) and right-hemisphere-damaged (RHD) patients and nonneurological controls. They were instructed to read sentences containing double-stressed target words in the presence of a clause boundary or its absence. Whereas all three groups of subjects were capable of manipulating the acoustic parameters that signal a shift in stress, there were some differences between the performance of the patient groups and that of the normal controls. Further, stress production deficits were more severe in LHD aphasic patients than in RHD patients. LHD speakers exhibited deficits in the control of both temporal and F0 cues. Their F0 disturbance appears to be secondary to a primary deficit in temporal control at the phase or sentence level, as an increased number of continuation rises found for the LHD patients seemed to arise from lengthy pauses within sentences. Findings are highlighted to address the nature of breakdown in speech prosody and the competing views of prosodic lateralization.