Priming Anxiety into People who Stutter: Arousal's Influence on Fluency

Many experimental psychologists (Bargh, Chen & Burrows, 1996; Berner & Maier, 2004; Bowers, 1999; Chartrand, VanBaaren & Bargh, 2006; Chen & Haviland-Jones, 2000; Hazlett, Dawson, Schell & Filion, 1990; Macky-Sim & Laing, 1981; Sato & Aoki, 2006; Wilkowski & Robinson, 2007) have examined priming's influence over behavior, cognition, and language across modalities. This idea of priming or influencing a behavior with subtle cues has revealed great effect on state anxiety and cognition. The change in state anxiety is relevant to stuttering and is sought due to the hypothesized interaction between the pathology and anxiety. It has been suggested that people who stutter (PWS) are more anxious and less confident than typical speakers (Daniels & Gabel, 2004; Guitar, 2003; Peters & Hulstijn, 1984). Yet this interaction of anxiety's influence on the degree and severity of stuttering has yet to be fully explored but is determined to have a strong correlation (Guitar, 2003; Miller & Watson, 1992; Peters & Hulstijn, 1984). However situational anxieties have shown to either increase (Craig, 1990) or have no effect (Armson, Foote, Witt, Kalinowski & Stuart, 1997; Kalinowski, Stuart, Wamsley & Rastatter, 1999) on dysfluencies in PWS. Though this study did not examine the effects of situations on anxiety it tried to examine a more basic unit of anxiety. This compartmentalized approach examined basic emotional priming's influence on arousal. It examined the relationship between physiologic and self-reported arousals' effect on fluency in PWS. This relationship was examined via priming tasks of silent readings of emotionally embedded analogous word sets then physiologic, self-reported arousal assessments and speech samples to assess priming's influence. Priming sets included positive, negative, and neutral conditions post baseline data. Conditions were randomly chosen and administered to influence altered arousal states in PWS. Experimental trials were separated into physiologic and speech sample collection phases. Initially during the physiologic phase participants remained seated and motionless while connected to skin conductance transducers and heart rate electrodes as they silently read the priming tasks. Post priming interstimulus phases of self reported arousal assessments via the Self Assessment Manikin (SAM) arousal scale (Lang, 1980) and regression to physiologic baseline were administered. The independent variable for this experiment was the priming condition, with dependent variables of physiologic arousal (skin conductance and heart rate), self-reported arousal (Self Assessment Manikin arousal scale Lang, 1980), and stuttered syllable counts. A significant difference was noted in stuttered syllables during the positive priming condition of the speech sample phase. This positive condition differed from all other conditions (Baseline, Negative, and Neutral) by the significant reduction of stuttered syllables per passage. These results are similar to Young, (1985) which explains the true baseline of (PWS) can never be increased, but only decreased. He describes the true baseline as PWS interacting in real situations not involved with the clinic environment.M.S

Inhibition of Stuttering from Second Speech Signals: An Evaluation of Temporal and Hierarchical Aspects

Stuttering is an intermittent and involuntary speech disorder overtly characterized by syllable repetitions, phoneme prolongations and postural fixations that disrupt the natural flow of speech. Overt stuttering is reduced by 60-100% as the person who stutters produces speech while perceiving an ongoing second speech signal. The purpose of the current investigation was to further examine mechanisms of stuttering inhibition during perception of second speech signals. To do this the researcher conducted two experiments examining the level of inhibition during temporal-spatial alignment alterations and level of inhibition during hierarchically difficult scripted telephone conversations under combined altered auditory feedback signals.    The first study examined temporal-spatial alignments of speakers during choral and shadow speech. Choral speech is when two speakers talk in approximate simultaneity. This effect is believed to be the most powerful inhibitor of stuttering, reducing it 90-100%. A slightly less powerful inhibitor of stuttering is shadow speech, which is historically defined as the person who stutters lagging or shadowing behind a fluent speakers utterance. Reductions under shadow speech typically range from 80-90%. Interestingly, prior to the current investigation, empirical analysis of output from people who stutter (PWS) when maintaining the lead speaker position during shadow speech, had yet to be evaluated. This temporal-spatial alignment most mimics delayed auditory feedback with a second speaker. Experiment I included four conditions: 1) choral speech, 2) shadow speech with the person who stutters maintaining the lead speaker position, 3) shadow speech with the person who stutters maintaining the lag speaker position, and 4) baseline. Nine participants who stutter verbally read 300 syllable passages while a second fluent speaker read the same passage and maintained close temporal-spatial alignments during choral conditions and three to four word separations during shadow speech conditions. Stuttering frequency was significantly reduced 95% during choral speech and approximately 80% during both shadow speech conditions. Results challenge notions put forth by previous hypotheses regarding reductions in stuttering during perception of second signals.    Experiment II examined stuttering inhibition during scripted telephone conversations under altered auditory feedback. As with the lag shadow speech condition, altered auditory feedback and more specifically delayed auditory feedback, presents a second speech signal along with ongoing speech. Delayed auditory feedback and frequency-altered feedback generate second speech signals from the speakers' initial speech productions. Reductions in stuttering frequency under altered auditory feedback typically range from 60-80%. These reductions occur during the presentation of one signal and one combination of signals across a variety of settings; specifically, telephone conversations, which are judged to be one of the most hierarchically difficult situations for people who stutter. The second experiment examined nine people who stutter during 15 scripted telephone conversations under baseline, one combination of DAF and FAF (i.e., 50 ms delay and ½ octave shift up respectively; 1 COMBO), and two combinations of DAF and FAF (i.e., 1 COMBO plus 200 ms delay and ½ shift down respectively; 2 COMBO). Stuttering was significantly inhibited during both altered feedback conditions (i.e., 63% during 1 COMBO and 74% during 2 COMBO). Furthermore, significant reductions in stuttering frequency during the 2 COMBO conditions as compared to the 1 COMBO indicated that presentation of increased gestural information enhances the inhibitory effects.   Results from both studies challenge notions put forth by previous models of stuttering reduction during the perception of second signals. The findings that stuttering was reduced to similar extents during both lead and lag conditions in Experiment I and that more robust stuttering inhibition occurred during the COMBO II condition in Experiment II, challenge fundamental notions from previous reduction theories during the perception of second signals. Furthermore, these findings support the flexible and dynamic gestural percepts hypothesized in the Gestural Model of Stuttering Inhibition. It is likely that increased gestural information alters mirror neuron system activation patterns, which enables a more efficient and effective release of the central neural block that is stuttering, therefore increasing inhibitory effectiveness from the perception of second signals.  Ph.D

Hearing impairment and audiovisual speech integration ability: a case study report

Research in audiovisual speech perception has demonstrated that sensory factors such as auditory and visual acuity are associated with a listener’s ability to extract and combine auditory and visual speech cues. This case study report examined audiovisual integration using a newly developed measure of capacity in a sample of hearing-impaired listeners. Capacity assessments are unique because they examine the contribution of reaction-time (RT) as well as accuracy to determine the extent to which a listener efficiently combines auditory and visual speech cues relative to independent race model predictions. Multisensory speech integration ability was examined in two experiments: An open-set sentence recognition and a closed set speeded-word recognition study that measured capacity. Most germane to our approach, capacity illustrated speed-accuracy tradeoffs that may be predicted by audiometric configuration. Results revealed that some listeners benefit from increased accuracy, but fail to benefit in terms of speed on audiovisual relative to unisensory trials. Conversely, other listeners may not benefit in the accuracy domain but instead show an audiovisual processing time benefit

Inhibition of Stuttering from Second Speech Signals: An Evaluation of Temporal and Hierarchical Aspects

Stuttering is an intermittent and involuntary speech disorder overtly characterized by syllable repetitions phoneme prolongations and postural fixations that disrupt the natural flow of speech. Overt stuttering is reduced by 60-100% as the person who stutters produces speech while perceiving an ongoing second speech signal. The purpose of the current investigation was to further examine mechanisms of stuttering inhibition during perception of second speech signals. To do this the researcher conducted two experiments examining the level of inhibition during temporal-spatial alignment alterations and level of inhibition during hierarchically difficult scripted telephone conversations under combined altered auditory feedback signals. The first study examined temporal-spatial alignments of speakers during choral and shadow speech. Choral speech is when two speakers talk in approximate simultaneity. This effect is believed to be the most powerful inhibitor of stuttering reducing it 90-100%. A slightly less powerful inhibitor of stuttering is shadow speech which is historically defined as the person who stutters lagging or shadowing behind a fluent speakers utterance. Reductions under shadow speech typically range from 80-90%. Interestingly prior to the current investigation empirical analysis of output from people who stutter (PWS) when maintaining the lead speaker position during shadow speech had yet to be evaluated. This temporal-spatial alignment most mimics delayed auditory feedback with a second speaker. Experiment I included four conditions: 1) choral speech 2) shadow speech with the person who stutters maintaining the lead speaker position 3) shadow speech with the person who stutters maintaining the lag speaker position and 4) baseline. Nine participants who stutter verbally read 300 syllable passages while a second fluent speaker read the same passage and maintained close temporal-spatial alignments during choral conditions and three to four word separations during shadow speech conditions. Stuttering frequency was significantly reduced 95% during choral speech and approximately 80% during both shadow speech conditions. Results challenge notions put forth by previous hypotheses regarding reductions in stuttering during perception of second signals. Experiment II examined stuttering inhibition during scripted telephone conversations under altered auditory feedback. As with the lag shadow speech condition altered auditory feedback and more specifically delayed auditory feedback presents a second speech signal along with ongoing speech. Delayed auditory feedback and frequency-altered feedback generate second speech signals from the speakers' initial speech productions. Reductions in stuttering frequency under altered auditory feedback typically range from 60-80%. These reductions occur during the presentation of one signal and one combination of signals across a variety of settings; specifically telephone conversations which are judged to be one of the most hierarchically difficult situations for people who stutter. The second experiment examined nine people who stutter during 15 scripted telephone conversations under baseline one combination of DAF and FAF (i.e. 50 ms delay and ½ octave shift up respectively; 1 COMBO) and two combinations of DAF and FAF (i.e. 1 COMBO plus 200 ms delay and ½ shift down respectively; 2 COMBO). Stuttering was significantly inhibited during both altered feedback conditions (i.e. 63% during 1 COMBO and 74% during 2 COMBO). Furthermore significant reductions in stuttering frequency during the 2 COMBO conditions as compared to the 1 COMBO indicated that presentation of increased gestural information enhances the inhibitory effects. Results from both studies challenge notions put forth by previous models of stuttering reduction during the perception of second signals. The findings that stuttering was reduced to similar extents during both lead and lag conditions in Experiment I and that more robust stuttering inhibition occurred during the COMBO II condition in Experiment II challenge fundamental notions from previous reduction theories during the perception of second signals. Furthermore these findings support the flexible and dynamic gestural percepts hypothesized in the Gestural Model of Stuttering Inhibition. It is likely that increased gestural information alters mirror neuron system activation patterns which enables a more efficient and effective release of the central neural block that is stuttering therefore increasing inhibitory effectiveness from the perception of second signals.

Priming Anxiety into People who Stutter: Arousal's Influence on Fluency

Many experimental psychologists (Bargh, Chen & Burrows, 1996; Berner & Maier, 2004; Bowers, 1999; Chartrand, VanBaaren & Bargh, 2006; Chen & Haviland-Jones, 2000; Hazlett, Dawson, Schell & Filion, 1990; Macky-Sim & Laing, 1981; Sato & Aoki, 2006; Wilkowski & Robinson, 2007) have examined priming's influence over behavior, cognition, and language across modalities. This idea of priming or influencing a behavior with subtle cues has revealed great effect on state anxiety and cognition. The change in state anxiety is relevant to stuttering and is sought due to the hypothesized interaction between the pathology and anxiety. It has been suggested that people who stutter (PWS) are more anxious and less confident than typical speakers (Daniels & Gabel, 2004; Guitar, 2003; Peters & Hulstijn, 1984). Yet this interaction of anxiety's influence on the degree and severity of stuttering has yet to be fully explored but is determined to have a strong correlation (Guitar, 2003; Miller & Watson, 1992; Peters & Hulstijn, 1984). However situational anxieties have shown to either increase (Craig, 1990) or have no effect (Armson, Foote, Witt, Kalinowski & Stuart, 1997; Kalinowski, Stuart, Wamsley & Rastatter, 1999) on dysfluencies in PWS. Though this study did not examine the effects of situations on anxiety it tried to examine a more basic unit of anxiety. This compartmentalized approach examined basic emotional priming's influence on arousal. It examined the relationship between physiologic and self-reported arousals' effect on fluency in PWS. This relationship was examined via priming tasks of silent readings of emotionally embedded analogous word sets then physiologic, self-reported arousal assessments and speech samples to assess priming's influence. Priming sets included positive, negative, and neutral conditions post baseline data. Conditions were randomly chosen and administered to influence altered arousal states in PWS. Experimental trials were separated into physiologic and speech sample collection phases. Initially during the physiologic phase participants remained seated and motionless while connected to skin conductance transducers and heart rate electrodes as they silently read the priming tasks. Post priming interstimulus phases of self reported arousal assessments via the Self Assessment Manikin (SAM) arousal scale (Lang, 1980) and regression to physiologic baseline were administered. The independent variable for this experiment was the priming condition, with dependent variables of physiologic arousal (skin conductance and heart rate), self-reported arousal (Self Assessment Manikin arousal scale Lang, 1980), and stuttered syllable counts. A significant difference was noted in stuttered syllables during the positive priming condition of the speech sample phase. This positive condition differed from all other conditions (Baseline, Negative, and Neutral) by the significant reduction of stuttered syllables per passage. These results are similar to Young, (1985) which explains the true baseline of (PWS) can never be increased, but only decreased. He describes the true baseline as PWS interacting in real situations not involved with the clinic environment

The Application of EEG Mu Rhythm Measures to Neurophysiological Research in Stuttering

Deficits in basal ganglia-based inhibitory and timing circuits along with sensorimotor internal modeling mechanisms are thought to underlie stuttering. However, much remains to be learned regarding the precise manner how these deficits contribute to disrupting both speech and cognitive functions in those who stutter. Herein, we examine the suitability of electroencephalographic (EEG) mu rhythms for addressing these deficits. We review some previous findings of mu rhythm activity differentiating stuttering from non-stuttering individuals and present some new preliminary findings capturing stuttering-related deficits in working memory. Mu rhythms are characterized by spectral peaks in alpha (8–13 Hz) and beta (14–25 Hz) frequency bands (mu-alpha and mu-beta). They emanate from premotor/motor regions and are influenced by basal ganglia and sensorimotor function. More specifically, alpha peaks (mu-alpha) are sensitive to basal ganglia-based inhibitory signals and sensory-to-motor feedback. Beta peaks (mu-beta) are sensitive to changes in timing and capture motor-to-sensory (i.e., forward model) projections. Observing simultaneous changes in mu-alpha and mu-beta across the time-course of specific events provides a rich window for observing neurophysiological deficits associated with stuttering in both speech and cognitive tasks and can provide a better understanding of the functional relationship between these stuttering symptoms. We review how independent component analysis (ICA) can extract mu rhythms from raw EEG signals in speech production tasks, such that changes in alpha and beta power are mapped to myogenic activity from articulators. We review findings from speech production and auditory discrimination tasks demonstrating that mu-alpha and mu-beta are highly sensitive to capturing sensorimotor and basal ganglia deficits associated with stuttering with high temporal precision. Novel findings from a non-word repetition (working memory) task are also included. They show reduced mu-alpha suppression in a stuttering group compared to a typically fluent group. Finally, we review current limitations and directions for future research

Randomized phase 3 trial of ruxolitinib for COVID-19-associated acute respiratory distress syndrome

Objectives: Evaluate the safety and efficacy of the Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib in COVID-19-associated acute respiratory distress syndrome requiring mechanical ventilation. Design: Phase 3 randomized, double-blind, placebo-controlled trial Ruxolitinib in Participants With COVID-19-Associated Acute Respiratory Distress Syndrome Who Require Mechanical Ventilation (RUXCOVID-DEVENT; NCT04377620). Setting: Hospitals and community-based private or group practices in the United States (29 sites) and Russia (4 sites). Patients: Eligible patients were greater than or equal to 12 years old, hospitalized with severe acute respiratory syndrome coronavirus 2 infection, and mechanically ventilated with a Pao2/Fio2 of less than or equal to 300 mm Hg within 6 hours of randomization. Interventions: Patients were randomized 2:2:1 to receive twice-daily ruxolitinib 15 mg, ruxolitinib 5 mg, or placebo, each plus standard therapy. Measurements and main results: The primary endpoint, 28-day mortality, was tested for each ruxolitinib group versus placebo using a mixed-effects logistic regression model and one-tailed significance test (significance threshold: p \u3c 0.025); no type 1 error was allocated to secondary endpoints. Between May 24, 2020 and December 15, 2020, 211 patients (age range, 24-87 yr) were randomized (ruxolitinib 15/5 mg, n = 77/87; placebo, n = 47). Acute respiratory distress syndrome was categorized as severe in 27% of patients (58/211) at randomization; 90% (190/211) received concomitant steroids. Day-28 mortality was 51% (39/77; 95% CI, 39-62%) for ruxolitinib 15 mg, 53% (45/85; 95% CI, 42-64%) for ruxolitinib 5 mg, and 70% (33/47; 95% CI, 55-83%) for placebo. Neither ruxolitinib 15 mg (odds ratio, 0.46 [95% CI, 0.201-1.028]; one-sided p = 0.029) nor 5 mg (odds ratio, 0.42 [95% CI, 0.171-1.023]; one-sided p = 0.028) significantly reduced 28-day mortality versus placebo. Numerical improvements with ruxolitinib 15 mg versus placebo were observed in secondary outcomes including ventilator-, ICU-, and vasopressor-free days. Rates of overall and serious treatment-emergent adverse events were similar across treatments. Conclusions: The observed reduction in 28-day mortality rate between ruxolitinib and placebo in mechanically ventilated patients with COVID-19-associated acute respiratory distress syndrome was not statistically significant; however, the trial was underpowered owing to early termination