Effect of external auditory pacing on the neural activity of stuttering speakers.

External auditory pacing, such as metronome sound and speaking in unison with others, has a fluency-enhancing effect in stuttering speakers. The present study investigated the neural mechanism of the fluency-enhancing effect by using functional magnetic resonance imaging (fMRI). 12 stuttering speakers and 12 nonstuttering controls were scanned while performing metronome-timed speech, choral speech, and normal speech. Compared to nonstuttering controls, stuttering speakers showed a significantly greater increase in activation in the superior temporal gyrus under both metronome-timed and choral speech conditions relative to a normal speech condition. The caudate, globus pallidus, and putamen of the basal ganglia showed clearly different patterns of signal change from rest among the different conditions and between stuttering and nonstuttering speakers. The signal change of stuttering speakers was significantly lower than that of nonstuttering controls under the normal speech condition but was raised to the level of the controls, with no intergroup difference, in metronome-timed speech. In contrast, under the chorus condition the signal change of stuttering speakers remained lower than that of the controls. Correlation analysis further showed that the signal change of the basal ganglia and motor areas was negatively correlated with stuttering severity, but it was not significantly correlated with the stuttering rate during MRI scanning. These findings shed light on the specific neural processing of stuttering speakers when they time their speech to auditory stimuli, and provide additional evidence of the efficacy of external auditory pacing.