Neuroanatomical attributes in stuttering - discussion and clinical intervention

Neuroanatomical attributes in stuttering - discussion and clinical intervention Can basal ganglia cause stuttering? **Answer**: Stuttering may be caused by dysfunction in the basal ganglia, the left IFG (Inferior Frontal Cortex in Broca's area), and the Corticostriatal-thalamo-Cortical (CSTC) loops. This disruption may also affect language sequencing in a domain-specific manner ([Qiao et al](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525748/#:~:text=Stuttering%20may%20be%20caused%20by,in%20a%20domain%2Dspecific%20manner)). Inside the striatum-basal ganglia lies the [Nucleus Accumbens](https://www.google.com/search?q=nucleus+accumbens) (**NAc**). Its functions are: * **Reward**: dopamine mediated reward processing and reinforcement learning; processing gains or losses, and anticipating the immediate outcomes of actions * Motivation * Emotions **Conclusion**: * In fluent speakers the reward system reinforces error repair when learning a new habit * NAc serves as a motivation-to-movement interface: translating motivational signals into actions. Dopamine release in the NAc is triggered by rewarding stimuli, such as food, drugs, or social interactions * Emerging and expected disfluencies affect reward expectations as well as the final evaluation of the actual behavioral outcome **Question**: (to everyone who reads this) In your own thoughts, what clinical interventions could we develop with the goal of targeting the dysfunction in the Nucleus Accumbens? *"What clinical interventions could we develop with the goal of targeting the dysfunction in the Nucleus Accumbens?"* In my opinion: * Building tolerance for gains and losses * Changing one’s perception of how to cope with rewarding-punishing stimuli e.g.: * intentionally activating a reward signal when learning from the attributions to stuttering-like disfluencies * don’t consider “*getting triggered by negative perception/anticipation or negative evaluation*” as a punishment anymore * even if you consider “*negative perceptions/anticipation/evaluation*” as punishing stimuli, in spite of this, learn to not send a punishment signal if this triggers you * Unlearning unhelpful stutter behaviors and learning fluency behaviors * The dopaminergic reward system may be disrupted, if PWS (1) completely lose faith in the feedforward system, (2) habitually give up on restoring this faith, or (3) justify the stutter program. **Clinical intervention**: So, I suggest to address this issue