Cortical networks for speech motor control in unilateral vocal fold paralysis

Naunheim, Molly; Yung, Katherine C.; Schneider, Sarah; Henderson‐Sabes, Jennifer; Kothare, Hardik; Hinkley, Leighton B.; Mizuiri, Danielle; Klein, David J.; Houde, John F.; Nagarajan, Srikantan S.; Cheung, Steven W.

doi:10.1002/lary.27730

Cited by 9 publications

(12 citation statements)

References 38 publications

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“…Changes in vocal pitch relative to pre‐shift baseline were calculated as Cents = 1200 × log 2 (pitch/mean baseline). Reponses to upward pitch‐shifts were flipped such that any compensatory response opposite the shift was positive (and any imitation downward) 21, 30 . Calculations were complicated by the presence of vocal tremor in a number of subjects (Table I), which lead to significant variability in pitch compensation measurements due to perturbations beginning at random phases of the 4 Hz to 5 Hz tremor 31 .…”

Section: Methodsmentioning

confidence: 99%

“…Due to the presence of SD‐related vocal breaks, there were significant outlying pitch measurements on most trials. While such trials are often excluded in these sort of experiments, 30 doing so here would have eliminated most trials. We, therefore, chose to use median rather than mean pitch contours for these analyses, and selected the peak from this by visual inspection of the averaged waveform.…”

Section: Methodsmentioning

confidence: 99%

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Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

2020

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Objectives/Hypothesis Hearing plays an important role in the maintenance of vocal control in normal individuals. In patients with spasmodic dysphonia (SD), however, the ability to maintain sustained control of phonation is impaired. The origins of SD are unknown, and it is unclear whether auditory feedback‐dependent vocal control is compromised in these patients. Study Design Prospective case‐control study. Methods We tested 15 SD patients and 11 age‐matched controls. Voice recordings were performed while subjects repeated the vowel /e/ and auditory feedback of their vocal sounds was altered in real‐time to introduce a pitch‐shift (±2 semitones), presented back to subjects using headphones. Recordings were analyzed to determine voice changes following the pitch‐shifted feedback. Results were further compared with patient demographics and subjective measures of dysphonia, including the Voice Handicap Index (VHI). Results Despite considerable pitch variability and vocal breaks, SD patients exhibited significantly higher average vocal pitch compensation than control subjects. SD patients also exhibited greater variability than controls. However, there were no significant correlations between vocal compensation and patient demographics, although there was a significant inverse correlation with VHI. Conclusions In this pilot study, patients with SD exhibited increased sensitivity to altered auditory feedback during sustained phonation. These results are consistent with recent theories of SD as a disorder of sensory‐motor feedback processing, and suggest possible avenues for future investigation. Level of Evidence 3 Laryngoscope, 131:2070–2075, 2021

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

2020

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“…The DSP was implemented on a PC as a real-time vocoder program called Feedback Utility for Speech Processing (FUSP) 38,[40][41][42] .…”

Section: Meg Imaging and Experimental Designmentioning

confidence: 99%

“…To correct for multiple comparisons across time and space, corrected p-value thresholds were calculated for = 0.05 and a False Discovery Rate (FDR) of 5%. Furthermore, cluster correction was performed to exclude clusters with less than 18 congruent voxels as done in previous studies 40 .…”

Section: Meg Data Processingmentioning

confidence: 99%

Temporal specificity of abnormal neural oscillations during phonatory events in Laryngeal Dystonia

Kothare

Schneider²,

Mizuiri

et al. 2021

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Laryngeal Dystonia is a debilitating disorder of voicing in which the laryngeal muscles are intermittently in spasm resulting in involuntary interruptions during speech. The central pathophysiology of laryngeal dystonia, underlying computational impairments in vocal motor control, remains poorly understood. Although prior imaging studies have found aberrant activity in the central nervous system during phonation in patients with laryngeal dystonia, it is not known at what timepoints during phonation these abnormalities emerge and what function may be impaired. To investigate this question, we recruited 22 adductor laryngeal dystonia patients (15 female, age range = 28.83-72.46 years) and 18 controls (8 female, age range = 27.40-71.34 years). We leveraged the fine temporal resolution of magnetoencephalography to monitor neural activity around glottal movement onset, subsequent voice onset and after the onset of pitch feedback perturbations. We examined event-related beta-band (12-30 Hz) and high-gamma band (65-150 Hz) neural oscillations. Prior to glottal movement onset, we observed abnormal frontoparietal motor preparatory activity. After glottal movement onset, we observed abnormal activity in somatosensory cortex persisting through voice onset. Prior to voice onset and continuing after, we also observed abnormal activity in the auditory cortex and the cerebellum. After pitch feedback perturbation onset, we observed no differences between controls and patients in their behavioural responses to the perturbation. But in patients, we did find abnormal activity in brain regions thought to be involved in the auditory feedback control of vocal pitch (premotor, motor, somatosensory and auditory cortices). Our study results confirm the abnormal processing of somatosensory feedback that has been seen in other studies. However, there were several remarkable findings in our study. First, patients have impaired vocal motor activity even before glottal movement onset, suggesting abnormal movement preparation. These results are significant because: (i) they occur before movement onset, abnormalities in patients cannot be ascribed to deficits in vocal performance, and (ii) they show that neural abnormalities in laryngeal dystonia are more than just abnormal responses to sensory feedback during phonation as has been hypothesised in some previous studies. Second, abnormal auditory cortical activity in patients begins even before voice onset, suggesting abnormalities in setting up auditory predictions before the arrival of auditory feedback at voice onset. Generally, activation abnormalities identified in key brain regions within the speech motor network around various phonation events not only provide temporal specificity to neuroimaging phenotypes in laryngeal dystonia but also may serve as potential therapeutic targets for neuromodulation.

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“…Long‐term expectation mismatch in voice production may drive observable change to networks in the brain that are involved in judgment of voice‐as‐self or self‐referential behavior. A recent magnetoencephalography imaging (MEGI) pilot study in UVFP patients expertly treated by type I thyroplasty revealed enhanced β‐band oscillatory activity in the medial frontal brain region . This particular region is a constitutive component of the default mode network (DMN), a large‐scale interconnected network of brain regions that is broadly active during self‐referential behavior and can be examined using resting‐state functional magnetic resonance imaging (RS‐fMRI) .…”

Section: Introductionmentioning

confidence: 99%

Cortical‐Basal Ganglia‐Cerebellar Networks in Unilateral Vocal Fold Paralysis: A Pilot Study

et al. 2019

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Objectives/Hypothesis To evaluate differences in cortical‐basal ganglia‐cerebellar functional connectivity between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts using resting‐state functional magnetic resonance imaging (RS‐fMRI). Study Design Cross‐sectional. Methods Ten UVFP study patients treated by type I thyroplasty and 12 control subjects underwent RS‐fMRI on a 3‐Tesla scanner to evaluate differences in functional connectivity of whole‐brain networks. Spontaneous RS‐fMRI data were collected using a gradient echo planar pulse sequence, preprocessed, and analyzed to compare seed‐to‐voxel maps between the two cohorts. Seeds were placed in the caudate, putamen, and globus pallidus divisions of the basal ganglia in both hemispheres. Group contrasts were tested for statistical significance using two‐tailed unpaired t tests corrected for multiple comparisons with a cluster false discovery rate threshold of P < .05. Results UVFP patients demonstrated increased connectivity between both caudate nuclei and the precuneus, a node of the default mode network, compared to healthy controls. Both caudate nuclei also showed decreased connectivity with the left cerebellar hemisphere. The putamen and globus pallidus divisions of the basal ganglia were not abnormally connected to other brain structures. Conclusions UVFP patients treated by type I thyroplasty exhibited long‐term alterations of cortical‐basal ganglia‐cerebellar networks thought to be important for self‐referential voice quality awareness and learning processes that compensate for changes to the paralyzed hemilarynx. This pilot study on relatively small cohorts adds to growing evidence for persistent central nervous system changes in treated UVFP. Replication studies with larger numbers of subjects will be essential to validate and extend findings. Level of Evidence 3b Laryngoscope, 130:460–464, 2020

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Cortical networks for speech motor control in unilateral vocal fold paralysis

Cited by 9 publications

References 38 publications

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

Temporal specificity of abnormal neural oscillations during phonatory events in Laryngeal Dystonia

Cortical‐Basal Ganglia‐Cerebellar Networks in Unilateral Vocal Fold Paralysis: A Pilot Study

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