The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

On the lateralization of emotional prosody: an event-related functional MR investigation

In order to investigate the lateralization of emotional speech we recorded the brain responses to three emotional intonations in two conditions, i.e., "normal" speech and "prosodic" speech (i.e., speech with no linguistic meaning, but retaining the 'slow prosodic modulations' of speech). Participants listened to semantically neutral sentences spoken with a positive, neutral, or negative intonation in both conditions and judged how positive, negative, or neutral the intonation was on a five-point scale. Core peri-sylvian language areas, as well as some frontal and subcortical areas were activated bilaterally in the normal speech condition. In contrast, a bilateral fronto-opercular region was active when participants listened to prosodic speech. Positive and negative intonations elicited a bilateral fronto-temporal and subcortical pattern in the normal speech condition, and more frontal activation in the prosodic speech condition. The current results call into question an exclusive right hemisphere lateralization of emotional prosody and expand patient data on the functional role of the basal ganglia during the perception of emotional prosody.     

Terminal decline and cognitive performance in very old age: does cause of death matter?

Cross-sectional differences and longitudinal changes in cognitive functioning in relation to mortality across a 7-year follow-up period, with 3 times of measurement, were examined in a population-based sample of very old adults. The authors also sought to determine whether cause of death (cerebro/cardiovascular disease [CVD]; non-CVD) modified the magnitude of mortality-related cognitive deficits. Cognitive performance was indexed by tests of general cognitive ability, episodic memory, primary memory, verbal fluency, and visuospatial ability. Results indicated cross-sectional differences on all domains of functioning, with persons who would die within 3 years after baseline testing performing more poorly. Longitudinally, greater decrements were observed on all domains for persons who would die after the first follow-up period, as compared with survivors. Cause of death failed to modify the magnitude of the cross-sectional and longitudinal deficits. The pattern of results point to the general nature of this phenomenon.     

Sit-and-wait strategies in dynamic visual search

The role of memory in visual search has lately become a controversial issue. Horowitz and Wolfe (1998) observed that performance in a visual search task was little affected by whether the stimuli were static or randomly relocated every 111 ms. Because a memory-based mechanism, such as inhibition of return, would be of no use in the dynamic condition, Horowitz and Wolfe concluded that memory is likewise not involved in the static condition. However, Horowitz and Wolfe could not effectively rule out the possibility that observers adopted a different strategy in the dynamic condition than in the static condition. That is, in the dynamic condition observers may have attended to a subregion of the display and waited for the target to appear there (sit-and-wait strategy). This hypothesis is supported by experimental data showing that performance in their dynamic condition does not differ from performance in another dynamic condition in which observers are forced to adopt a sit-and-wait strategy by being presented with a limited region of the display only.     

Color filling-in under steady fixation: behavioral demonstration in monkeys and humans

Color filling-in is a phenomenon in which the color of an object appears to be filled-in by the color of the surrounding field. We have studied the question of whether monkeys perceive color filling-in with near-foveal stimuli under steady fixation. Two monkeys were trained to fixate steadily and to attend to a disk, surrounded by an annulus of the complementary color, in parafoveal vision. Using displays in which the color of the disk was gradually changed to that of the annulus, we trained the animals to signal when they perceived a uniform color field. During the experiment, we introduced a small percentage of trials in which the disk color remained constant, and looked for 'filling-in' responses in these trials. Three human subjects were also tested for comparison. All subjects produced 'filling-in' responses with frequencies that were significantly higher for static disks with blurred borders than for moving disks or disks with sharp borders. This indicates that the monkeys' responses reflected perceptual filling-in, rather than random behavior. The time course of filling-in was similar in monkeys and humans. For the blurred static disks, responses occurred first after 3-4 s of fixation, reaching a probability of 0.2-0.8 by the end of 6 s, depending on the subject.     

Comparison of the distortion of probability information in decision under risk and an equivalent visual task

Decision makers typically overweight small probabilities and underweight large probabilities. However, there are recent reports that when probability is presented in the form of relative frequencies, this typical pattern reverses. We tested this hypothesis by comparing decision making in two tasks: In one task, probability was stated numerically, and in the other task, it was conveyed through a visual representation. In the visual task, participants chose whether a "stochastic bullet" should be fired at either a large target for a small reward or a small target for a large reward. Participants' knowledge of probability in the visual task was the result of extensive practice firing bullets at targets. In the classical numerical task, participants chose between pairs of lotteries with probabilities and rewards matched to the probabilities and rewards in the visual task. We found that participants' probability-weighting functions were significantly different in the two tasks, but the pattern for the visual task was the typical, not the reversed, pattern.     

Interkulturelle Trainings für die psychosoziale Versorgung

The psychosocial care of patients with a migration background is often related to higher access barriers. Also for professionals in mental health care service the treatment of patients with a migration background often represents a challenge. One way to overcome such barriers is to train care givers in order to enhance cross-cultural competence. In addition to knowledge transfer such training focuses on the process of self-reflection and examination of ones own, as well as the unknown cultural orientation system. Sufficient effectiveness of cross-cultural training has been proven on an international level. However, evaluation studies are lacking in the German speaking region. Additionally, guidelines or quality criteria for providers of training for psychosocial care professionals are lacking. Validated psychometric instruments which assess cross-cultural competence in individuals hardly exist. The present article gives an overview of concepts of cross-cultural competence and the effectiveness of such training. Also an outlook is given on the future prospects of development in the field.