The neural circuitry underlying the "rhythm effect" in stuttering

Purpose: Stuttering is characterized by intermittent speech disfluencies which are dramatically reduced when speakers synchronize their speech with a steady beat. The goal of this study was to characterize the neural underpinnings of this phenomenon using functional magnetic resonance imaging. Method: Data were collected from 17 adults who stutter and 17 adults who do not stutter while they read sentences aloud either in a normal, self-paced fashion or paced by the beat of a series of isochronous tones ("rhythmic"). Task activation and task-based functional connectivity analyses were carried out to compare neural responses between speaking conditions and groups. Results: Adults who stutter produced fewer disfluent trials in the rhythmic condition than in the normal condition. While adults who do not stutter had greater activation in the rhythmic condition compared to the normal condition in regions associated with speech planning, auditory feedback control, and timing perception, adults who stutter did not have any significant changes. However, adults who stutter demonstrated increased functional connectivity between bilateral inferior cerebellum and bilateral orbitofrontal cortex as well as increased connectivity among cerebellar regions during rhythmic speech as compared to normal speech. Conclusion: Modulation of connectivity in the cerebellum and prefrontal cortex during rhythmic speech suggests that this fluency-inducing technique activates a compensatory timing system in the cerebellum and potentially modulates top-down motor control and attentional systems. These findings corroborate previous work associating the cerebellum with fluency in adults who stutter and indicate that the cerebellum may be targeted to enhance future therapeutic interventions.