Neural Markers of Persistence and Recovery from Childhood Stuttering: An fMRI Study of Continuous Speech Production

虽然儿童口吃的症状在明显的、持续的言语产生过程中完全显现出来， 了解与儿童言语产生相关的神经过程，以及这些过程是如何 中断，导致口吃的明显表现。此外，大多数儿童 口吃可以自然恢复，但我们不知道儿童的大脑如何在功能上适应这种疾病 并实现流利的演讲。缺乏这样的知识，神经缺陷的基础口吃和如何 混乱解决本身不能完全理解，一个困难，限制了我们的能力，发展进步， 临床评估和干预。我们的长期目标是开发有效的治疗干预措施， 治疗和预防儿童时期的持续性口吃。本申请的目的是提供一种用于制造半导体器件的方法。 实现这一目标的下一步是确定与连续语音相关的大脑活动模式 持续性口吃儿童（pCWS）和从口吃中恢复的儿童（rCWS）的生产。的 该申请的中心假设是，持续性口吃与大脑活动异常有关， 语言运动控制的神经回路，而从口吃中恢复与更大的 右额区受累。这项拟议研究的基本原理是， 理解与pCWS和rCWS的连续语音产生相关的大脑活动模式， 是开发未来试图改变异常活动的治疗干预措施的基础。 使用一种新的功能磁共振成像技术，我们将通过追求以下具体目标来测试我们的中心假设：1） 识别与持续性口吃特征相关的持续言语产生的大脑活动， 和2）识别与连续语音产生相关的大脑活动，其特征在于从 口吃为了实现目标#1，在pCWS和对照组之间，大脑活动与流畅的语音产生相关 将被比较。此外，在pCWS患者中，与流利和口吃言语产生相关的大脑活动 将被分开并进行比较。为了实现目标#2，与流畅的语音产生相关的大脑活动 将比较rCWS和对照之间的差异。这项应用是创新的，因为它将是第一项研究， 检查与儿童连续言语产生相关的皮质和皮质下活动， 高空间分辨率使用一种新的功能磁共振成像去噪技术。这个项目的结果将是重要的 因为它们有望从根本上推进我们对与神经系统相关的神经过程的理解， 流利和不流利的连续言语生产的儿童口吃，并提供见解， 与儿童口吃恢复有关的神经可塑性。最终，这些新知识可能会指导 未来发展更好的儿童口吃治疗策略。

Although symptoms of childhood stuttering fully manifest during overt, continuous speech production, little is known about the neural processes associated with speech production in children, and how these processes are disrupted, resulting in the overt manifestation of stuttering instances. Moreover, the majority of children who stutter recover naturally, but we do not know how children’s brains functionally adapt to cope with the disorder and achieve fluent speech. Absent such knowledge, the neurological deficits underlying stuttering and how the disorder resolves itself cannot be fully understood, a difficulty that limits our ability to develop advances in clinical assessment and intervention. Our long-term goal is to develop effective therapeutic interventions to treat and prevent persistent stuttering during childhood. The objective of the present application, which is the next step in pursuing that goal, is to determine brain activity patterns associated with continuous speech production in children with persistent (pCWS) and children who recovered from stuttering (rCWS). The central hypothesis of the application is that persistent stuttering is associated with anomalous brain activity in the neural circuits for speech-motor control, while recovery from stuttering is associated with greater involvement of right frontal areas. The rationale of this proposed research is that an empirically-based understanding of brain activity patterns associated with continuous speech production of pCWS and rCWS is foundational for the development of future therapeutic interventions attempting to modify anomalous activity. Using a novel fMRI technique, we will test our central hypothesis by pursuing the following specific aims: 1) Identify brain activity associated with continuous speech production that characterizes persistent stuttering, and 2) Identify brain activity associated with continuous speech production that characterizes recovery from stuttering. To achieve Aim #1, brain activity associated fluent speech production between pCWS and controls will be compared. Furthermore, brain activity associated with fluent and stuttered speech production in pCWS will be separated and compared. To achieve Aim #2, brain activity associated with fluent speech production between rCWS and controls will be compared. This application is innovative because it will be the first study to examine both cortical and subcortical activity associated with continuous speech production in children with high spatial resolution using a novel fMRI de-noising technique. Findings of this project will be significant because they are expected to fundamentally advance our understanding of the neural processes associated with fluent and disfluent continuous speech production in children who stutter and provide insights into neuroplasticity associated with recovery from childhood stuttering. Ultimately, this new knowledge may guide the future development of better treatment strategies for childhood stuttering.