A Simple 3-Parameter Model for Examining Adaptation in Speech and Voice Production

Modeling voice production and self-perception in noise: Understanding the Lombard effect in non-phonotraumatic vocal hyperfunctiona)

The sensorimotor adaptation process is crucial for maintaining oral communication. Recent studies have shown that individuals with non-phonotraumatic vocal hyperfunction (NPVH) experience difficulties in sensorimotor adaptation when speaking in noise (known as the Lombard effect). However, the role of auditory and somatosensory feedback in the dynamics of adaptation to speaking in noise is still unclear. In this study, the use of a simple three-parameter mathematical model, known as SimpleDIVA model, was extended to explore the adaptation dynamics of speaking in noise among a group of participants with typical voices and NPVH. All participants were asked to utter a series of syllables under three conditions: baseline (quiet environment), Lombard (speech-shaped noise at 80 dB), and recovery (quiet environment after 5 min of rest). The results indicate that participants with NPVH did not return to baseline after exposure to speaking under noise. The SimpleDIVA model analysis reveals a diminished feedforward learning rate and reduced somatosensory feedback gain in participants with NPVH in comparison to participants with typical voices. This suggests that participants with NPVH may be using less somatosensory information when speaking in noise and may require more time to update the feedforward commands during and after speaking in noise.

How to cut the pie is no piece of cake: Toward a process-oriented approach to assessment and diagnosis of speech sound disorders

BACKGROUND

'Speech sound disorder' is an umbrella term that encompasses dysarthria, articulation disorders, childhood apraxia of speech and phonological disorders. However, differential diagnosis between these disorders is a persistent challenge in speech pathology, as many diagnostic procedures use symptom clusters instead of identifying an origin of breakdown in the speech and language system.

AIMS

This article reviews typical and disordered speech through the lens of two well-developed models of production-one focused on phonological encoding and one focused on speech motor planning. We illustrate potential breakdown locations within these models that may relate to childhood apraxia of speech and phonological disorders.

MAIN CONTRIBUTION

This paper presents an overview of an approach to conceptualisation of speech sound disorders that is grounded in current models of speech production and emphasises consideration of underlying processes. The paper also sketches a research agenda for the development of valid, reliable and clinically feasible assessment protocols for children with speech sound disorders.

CONCLUSION

The process-oriented approach outlined here is in the early stages of development but holds promise for developing a more detailed and comprehensive understanding of, and assessment protocols for speech sound disorders that go beyond broad diagnostic labels based on error analysis. Directions for future research are discussed.

WHAT THIS PAPER ADDS

What is already known on the subject Speech sound disorders (SSD) are heterogeneous, and there is agreement that some children have a phonological impairment (phonological disorders, PD) whereas others have an impairment of speech motor planning (childhood apraxia of speech, CAS). There is also recognition that speech production involves multiple processes, and several approaches to the assessment and diagnosis of SSD have been proposed. What this paper adds to existing knowledge This paper provides a more detailed conceptualisation of potential impairments in children with SSD that is grounded in current models of speech production and encourages greater consideration of underlying processes. The paper illustrates this approach and provides guidance for further development. One consequence of this perspective is the notion that broad diagnostic category labels (PD, CAS) may each comprise different subtypes or profiles depending on the processes that are affected. What are the potential or actual clinical implications of this work? Although the approach is in the early stages of development and no comprehensive validated set of tasks and measures is available to assess all processes, clinicians may find the conceptualisation of different underlying processes and the notion of potential subtypes within PD and CAS informative when evaluating SSD. In addition, this perspective discourages either/or thinking (PD or CAS) and instead encourages consideration of the possibility that children may have different combinations of impairments at different processing stages.

Bayesian inference of state feedback control parameters for fo perturbation responses in cerebellar ataxia

Behavioral speech tasks have been widely used to understand the mechanisms of speech motor control in typical speakers as well as in various clinical populations. However, determining which neural functions differ between typical speakers and clinical populations based on behavioral data alone is difficult because multiple mechanisms may lead to the same behavioral differences. For example, individuals with cerebellar ataxia (CA) produce atypically large compensatory responses to pitch perturbations in their auditory feedback, compared to typical speakers, but this pattern could have many explanations. Here, computational modeling techniques were used to address this challenge. Bayesian inference was used to fit a state feedback control (SFC) model of voice fundamental frequency (fo) control to the behavioral pitch perturbation responses of speakers with CA and typical speakers. This fitting process resulted in estimates of posterior likelihood distributions for five model parameters (sensory feedback delays, absolute and relative levels of auditory and somatosensory feedback noise, and controller gain), which were compared between the two groups. Results suggest that the speakers with CA may proportionally weight auditory and somatosensory feedback differently from typical speakers. Specifically, the CA group showed a greater relative sensitivity to auditory feedback than the control group. There were also large group differences in the controller gain parameter, suggesting increased motor output responses to target errors in the CA group. These modeling results generate hypotheses about how CA may affect the speech motor system, which could help guide future empirical investigations in CA. This study also demonstrates the overall proof-of-principle of using this Bayesian inference approach to understand behavioral speech data in terms of interpretable parameters of speech motor control models.

Sensorimotor Adaptation to Formant-Shifted Auditory Feedback Is Predicted by Language-Specific Factors in L1 and L2 Speech Production

Auditory feedback plays an important role in the long-term updating and maintenance of speech motor control; thus, the current study explored the unresolved question of how sensorimotor adaptation is predicted by language-specific and domain-general factors in first-language (L1) and second-language (L2) production. Eighteen English-L1 speakers and 22 English-L2 speakers performed the same sensorimotor adaptation experiments and tasks, which measured language-specific and domain-general abilities. The experiment manipulated the language groups (English-L1 and English-L2) and experimental conditions (baseline, early adaptation, late adaptation, and end). Linear mixed-effects model analyses indicated that auditory acuity was significantly associated with sensorimotor adaptation in L1 and L2 speakers. Analysis of vocal responses showed that L1 speakers exhibited significant sensorimotor adaptation under the early adaptation, late adaptation, and end conditions, whereas L2 speakers exhibited significant sensorimotor adaptation only under the late adaptation condition. Furthermore, the domain-general factors of working memory and executive control were not associated with adaptation/aftereffects in either L1 or L2 production, except for the role of working memory in aftereffects in L2 production. Overall, the study empirically supported the hypothesis that sensorimotor adaptation is predicted by language-specific factors such as auditory acuity and language experience, whereas general cognitive abilities do not play a major role in this process.

Do Not Cut Off Your Tail: A Mega-Analysis of Responses to Auditory Perturbation Experiments

PURPOSE

The practice of removing "following" responses from speech perturbation analyses is increasingly common, despite no clear evidence as to whether these responses represent a unique response type. This study aimed to determine if the distribution of responses to auditory perturbation paradigms represents a bimodal distribution, consisting of two distinct response types, or a unimodal distribution.

METHOD

This mega-analysis pooled data from 22 previous studies to examine the distribution and magnitude of responses to auditory perturbations across four tasks: adaptive pitch, adaptive formant, reflexive pitch, and reflexive formant. Data included at least 150 unique participants for each task, with studies comprising younger adult, older adult, and Parkinson's disease populations. A Silverman's unimodality test followed by a smoothed bootstrap resampling technique was performed for each task to evaluate the number of modes in each distribution. Wilcoxon signed-ranks tests were also performed for each distribution to confirm significant compensation in response to the perturbation.

RESULTS

Modality analyses were not significant (p > .05) for any group or task, indicating unimodal distributions. Our analyses also confirmed compensatory reflexive responses to pitch and formant perturbations across all groups, as well as adaptive responses to sustained formant perturbations. However, analyses of sustained pitch perturbations only revealed evidence of adaptation in studies with younger adults.

CONCLUSION

The demonstration of a clear unimodal distribution across all tasks suggests that following responses do not represent a distinct response pattern, but rather the tail of a unimodal distribution.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24282676.

DIVA Meets EEG: Model Validation Using Formant-Shift Reflex

The neurocomputational model 'Directions into Velocities of Articulators' (DIVA) was developed to account for various aspects of normal and disordered speech production and acquisition. The neural substrates of DIVA were established through functional magnetic resonance imaging (fMRI), providing physiological validation of the model. This study introduces DIVA_EEG an extension of DIVA that utilizes electroencephalography (EEG) to leverage the high temporal resolution and broad availability of EEG over fMRI. For the development of DIVA_EEG, EEG-like signals were derived from original equations describing the activity of the different DIVA maps. Synthetic EEG associated with the utterance of syllables was generated when both unperturbed and perturbed auditory feedback (first formant perturbations) were simulated. The cortical activation maps derived from synthetic EEG closely resembled those of the original DIVA model. To validate DIVA_EEG, the EEG of individuals with typical voices (N = 30) was acquired during an altered auditory feedback paradigm. The resulting empirical brain activity maps significantly overlapped with those predicted by DIVA_EEG. In conjunction with other recent model extensions, DIVA_EEG lays the foundations for constructing a complete neurocomputational framework to tackle vocal and speech disorders, which can guide model-driven personalized interventions.

Modeling Responses to Auditory Feedback Perturbations in Adults, Children, and Children With Complex Speech Sound Disorders: Evidence for Impaired Auditory Self-Monitoring?

PURPOSE

Previous studies have found that typically developing (TD) children were able to compensate and adapt to auditory feedback perturbations to a similar or larger degree compared to young adults, while children with speech sound disorder (SSD) were found to produce predominantly following responses. However, large individual differences lie underneath the group-level results. This study investigates possible mechanisms in responses to formant shifts by modeling parameters of feedback and feedforward control of speech production based on behavioral data.

METHOD

SimpleDIVA was used to model an existing dataset of compensation/adaptation behavior to auditory feedback perturbations collected from three groups of Dutch speakers: 50 young adults, twenty-three 4- to 8-year-old children with TD speech, and seven 4- to 8-year-old children with SSD. Between-groups and individual within-group differences in model outcome measures representing auditory and somatosensory feedback control gain and feedforward learning rate were assessed.

RESULTS

Notable between-groups and within-group variation was found for all outcome measures. Data modeled for individual speakers yielded model fits with varying reliability. Auditory feedback control gain was negative in children with SSD and positive in both other groups. Somatosensory feedback control gain was negative for both groups of children and marginally negative for adults. Feedforward learning rate measures were highest in the children with TD speech followed by children with SSD, compared to adults.

CONCLUSIONS

The SimpleDIVA model was able to account for responses to the perturbation of auditory feedback other than corrective, as negative auditory feedback control gains were associated with following responses to vowel shifts. These preliminary findings are suggestive of impaired auditory self-monitoring in children with complex SSD. Possible mechanisms underlying the nature of following responses are discussed.

Auditory and Somatosensory Development for Speech in Later Childhood

PURPOSE

This study collected measures of auditory-perceptual and oral somatosensory acuity in typically developing children and adolescents aged 9-15 years. We aimed to establish reference data that can be used as a point of comparison for individuals with residual speech sound disorder (RSSD), especially for RSSD affecting American English rhotics. We examined concurrent validity between tasks and hypothesized that performance on at least some tasks would show a significant association with age, reflecting ongoing refinement of sensory function in later childhood. We also tested for an inverse relationship between performance on auditory and somatosensory tasks, which would support the hypothesis of a trade-off between sensory domains.

METHOD

Ninety-eight children completed three auditory-perceptual tasks (identification and discrimination of stimuli from a "rake"-"wake" continuum and category goodness judgment for naturally produced words containing rhotics) and three oral somatosensory tasks (bite block with auditory masking, oral stereognosis, and articulatory awareness, which involved explicit judgments of relative tongue position for different speech sounds). Pairwise associations were examined between tasks within each domain and between task performance and age. Composite measures of auditory-perceptual and somatosensory functions were used to investigate the possibility of a sensory trade-off.

RESULTS

Statistically significant associations were observed between the identification and discrimination tasks and the bite block and articulatory awareness tasks. In addition, significant associations with age were found for the category goodness and bite block tasks. There was no statistically significant evidence of a trade-off between auditory-perceptual and somatosensory domains.

CONCLUSIONS

This study provided a multidimensional characterization of speech-related sensory function in older children/adolescents. Complete materials to administer all experimental tasks have been shared, along with measures of central tendency and dispersion for scores in two subgroups of age. Ultimately, we hope to apply this information to make customized treatment recommendations for children with RSSD based on sensory profiles.

Quantitatively characterizing reflexive responses to pitch perturbations

Background

Reflexive pitch perturbation experiments are commonly used to investigate the neural mechanisms underlying vocal motor control. In these experiments, the fundamental frequency–the acoustic correlate of pitch–of a speech signal is shifted unexpectedly and played back to the speaker via headphones in near real-time. In response to the shift, speakers increase or decrease their fundamental frequency in the direction opposing the shift so that their perceived pitch is closer to what they intended. The goal of the current work is to develop a quantitative model of responses to reflexive perturbations that can be interpreted in terms of the physiological mechanisms underlying the response and that captures both group-mean data and individual subject responses.

Methods

A model framework was established that allowed the specification of several models based on Proportional-Integral-Derivative and State-Space/Directions Into Velocities of Articulators (DIVA) model classes. The performance of 19 models was compared in fitting experimental data from two published studies. The models were evaluated in terms of their ability to capture both population-level responses and individual differences in sensorimotor control processes.

Results

A three-parameter DIVA model performed best when fitting group-mean data from both studies; this model is equivalent to a single-rate state-space model and a first-order low pass filter model. The same model also provided stable estimates of parameters across samples from individual subject data and performed among the best models to differentiate between subjects. The three parameters correspond to gains in the auditory feedback controller’s response to a perceived error, the delay of this response, and the gain of the somatosensory feedback controller’s “resistance” to this correction. Excellent fits were also obtained from a four-parameter model with an additional auditory velocity error term; this model was better able to capture multi-component reflexive responses seen in some individual subjects.

Conclusion

Our results demonstrate the stereotyped nature of an individual’s responses to pitch perturbations. Further, we identified a model that captures population responses to pitch perturbations and characterizes individual differences in a stable manner with parameters that relate to underlying motor control capabilities. Future work will evaluate the model in characterizing responses from individuals with communication disorders.

LaDIVA: A neurocomputational model providing laryngeal motor control for speech acquisition and production

Many voice disorders are the result of intricate neural and/or biomechanical impairments that are poorly understood. The limited knowledge of their etiological and pathophysiological mechanisms hampers effective clinical management. Behavioral studies have been used concurrently with computational models to better understand typical and pathological laryngeal motor control. Thus far, however, a unified computational framework that quantitatively integrates physiologically relevant models of phonation with the neural control of speech has not been developed. Here, we introduce LaDIVA, a novel neurocomputational model with physiologically based laryngeal motor control. We combined the DIVA model (an established neural network model of speech motor control) with the extended body-cover model (a physics-based vocal fold model). The resulting integrated model, LaDIVA, was validated by comparing its model simulations with behavioral responses to perturbations of auditory vocal fundamental frequency (fo) feedback in adults with typical speech. LaDIVA demonstrated capability to simulate different modes of laryngeal motor control, ranging from short-term (i.e., reflexive) and long-term (i.e., adaptive) auditory feedback paradigms, to generating prosodic contours in speech. Simulations showed that LaDIVA's laryngeal motor control displays properties of motor equivalence, i.e., LaDIVA could robustly generate compensatory responses to reflexive vocal fo perturbations with varying initial laryngeal muscle activation levels leading to the same output. The model can also generate prosodic contours for studying laryngeal motor control in running speech. LaDIVA can expand the understanding of the physiology of human phonation to enable, for the first time, the investigation of causal effects of neural motor control in the fine structure of the vocal signal.

Feedback and Feedforward Auditory-Motor Processes for Voice and Articulation in Parkinson's Disease

PURPOSE

Unexpected and sustained manipulations of auditory feedback during speech production result in "reflexive" and "adaptive" responses, which can shed light on feedback and feedforward auditory-motor control processes, respectively. Persons with Parkinson's disease (PwPD) have shown aberrant reflexive and adaptive responses, but responses appear to differ for control of vocal and articulatory features. However, these responses have not been examined for both voice and articulation in the same speakers and with respect to auditory acuity and functional speech outcomes (speech intelligibility and naturalness).

METHOD

Here, 28 PwPD on their typical dopaminergic medication schedule and 28 age-, sex-, and hearing-matched controls completed tasks yielding reflexive and adaptive responses as well as auditory acuity for both vocal and articulatory features.

RESULTS

No group differences were found for any measures of auditory-motor control, conflicting with prior findings in PwPD while off medication. Auditory-motor measures were also compared with listener ratings of speech function: first formant frequency acuity was related to speech intelligibility, whereas adaptive responses to vocal fundamental frequency manipulations were related to speech naturalness.

CONCLUSIONS

These results support that auditory-motor processes for both voice and articulatory features are intact for PwPD receiving medication. This work is also the first to suggest associations between measures of auditory-motor control and speech intelligibility and naturalness.

Articulatory compensation for low-pass filtered formant-altered auditory feedback

Auditory feedback while speaking plays an important role in stably controlling speech articulation. Its importance has been verified in formant-altered auditory feedback (AAF) experiments where speakers utter while listening to speech with perturbed first (F1) and second (F2) formant frequencies. However, the contribution of the frequency components higher than F2 to the articulatory control under the perturbations of F1 and F2 has not yet been investigated. In this study, a formant-AAF experiment was conducted in which a low-pass filter was applied to speech. The experimental results showed that the deviation in the compensatory response was significantly larger when a low-pass filter with a cutoff frequency of 3 kHz was used compared to that when cutoff frequencies of 4 and 8 kHz were used. It was also found that the deviation in the 3-kHz condition correlated with the fundamental frequency and spectral tilt of the produced speech. Additional simulation results using a neurocomputational model of speech production (SimpleDIVA model) and the experimental data showed that the feedforward learning rate increased as the cutoff frequency decreased. These results suggest that high-frequency components of the auditory feedback would be involved in the determination of corrective motor commands from auditory errors.

Compensation to Altered Auditory Feedback in Children With Developmental Language Disorder and Typical Development

Purpose Developmental language disorder (DLD), an unexplained problem using and understanding spoken language, has been hypothesized to have an underlying auditory processing component. Auditory feedback plays a key role in speech motor control. The current study examined whether auditory feedback is used to regulate speech production in a similar way by children with DLD and their typically developing (TD) peers. Method Participants aged 6-11 years completed tasks measuring hearing, language, first formant (F1) discrimination thresholds, partial vowel space, and responses to altered auditory feedback with F1 perturbation. Results Children with DLD tended to compensate more than TD children for the positive F1 manipulation and compensated less than TD children in the negative shift condition. Conclusion Our findings suggest that children with DLD make atypical use of auditory feedback.

A Computational Model for Estimating the Speech Motor System's Sensitivity to Auditory Prediction Errors

Purpose The speech motor system uses feedforward and feedback control mechanisms that are both reliant on prediction errors. Here, we developed a state-space model to estimate the error sensitivity of the control systems. We examined (a) whether the model accounts for the error sensitivity of the control systems and (b) whether the two systems have similar error sensitivity. Method Participants (N = 50) completed an adaptation paradigm, in which their first and second formants were perturbed such that a participant's /ε/ would sound like her /ӕ/. We measured adaptive responses to the perturbations at early (0-80 ms) and late (220-300 ms) time points relative to the onset of the perturbations. As data-driven correlates of the error sensitivity of the feedforward and feedback systems, we used the average early responses and difference responses (i.e., late minus early responses), respectively. We fitted the state-space model to participants' adaptive responses and used the model's parameters as model-based estimates of error sensitivity. Results We found that the late responses were larger than the early responses. Additionally, the model-based estimates of error sensitivity strongly correlated with the data-driven estimates. However, the data-driven and model-based estimates of error sensitivity of the feedforward system did not correlate with those of the feedback system. Conclusions Overall, our results suggested that the dynamics of adaptive responses as well as error sensitivity of the control systems can be accurately predicted by the model. Furthermore, our results suggested that the feedforward and feedback control systems function independently. Supplemental Material https://doi.org/10.23641/asha.14669808.

Online Control of Voice Intensity in Late Bilinguals' First and Second Language Speech Production: Evidence From Unexpected and Brief Noise Masking

Purpose Speech production requires the combined efforts of feedforward control and feedback control subsystems. The primary purpose of this study is to explore whether the relative weighting of auditory feedback control is different between the first language (L1) and the second language (L2) production for late bilinguals. The authors also make an exploratory investigation into how bilinguals' speech fluency and speech perception relate to their auditory feedback control. Method Twenty Chinese-English bilinguals named Chinese or English bisyllabic words, while being exposed to 30- or 60-dB unexpected brief masking noise. Variables of language (L1 or L2) and noise condition (quiet, weak noise, or strong noise) were manipulated in the experiment. L1 and L2 speech fluency tests and an L2 perception test were also included to measure bilinguals' speech fluency and auditory acuity. Results Peak intensity analyses indicated that the intensity increases in the weak noise and strong noise conditions were larger in L2-English than L1-Chinese production. Intensity contour analysis showed that the intensity increases in both languages had an onset around 80-140 ms, a peak around 220-250 ms, and persisted till 400 ms post vocalization onset. Correlation analyses also revealed that poorer speech fluency or L2 auditory acuity was associated with larger Lombard effect. Conclusions For late bilinguals, the reliance on auditory feedback control is heavier in L2 than in L1 production. We empirically supported a relation between speech fluency and the relative weighting of auditory feedback control, and provided the first evidence for the production-perception link in L2 speech motor control.

Speech compensation responses and sensorimotor adaptation to formant feedback perturbations

Control of speech formants is important for the production of distinguishable speech sounds and is achieved with both feedback and learned feedforward control. However, it is unclear whether the learning of feedforward control involves the mechanisms of feedback control. Speakers have been shown to compensate for unpredictable transient mid-utterance perturbations of pitch and loudness feedback, demonstrating online feedback control of these speech features. To determine whether similar feedback control mechanisms exist in the production of formants, responses to unpredictable vowel formant feedback perturbations were examined. Results showed similar within-trial compensatory responses to formant perturbations that were presented at utterance onset and mid-utterance. The relationship between online feedback compensation to unpredictable formant perturbations and sensorimotor adaptation to consistent formant perturbations was further examined. Within-trial online compensation responses were not correlated with across-trial sensorimotor adaptation. A detailed analysis of within-trial time course dynamics across trials during sensorimotor adaptation revealed that across-trial sensorimotor adaptation responses did not result from an incorporation of within-trial compensation response. These findings suggest that online feedback compensation and sensorimotor adaptation are governed by distinct neural mechanisms. These findings have important implications for models of speech motor control in terms of how feedback and feedforward control mechanisms are implemented.

Adaptation to pitch-altered feedback is independent of one's own voice pitch sensitivity

Monitoring voice pitch is a fine-tuned process in daily conversations as conveying accurately the linguistic and affective cues in a given utterance depends on the precise control of phonation and intonation. This monitoring is thought to depend on whether the error is treated as self-generated or externally-generated, resulting in either a correction or inflation of errors. The present study reports on two separate paradigms of adaptation to altered feedback to explore whether participants could behave in a more cohesive manner once the error is of comparable size perceptually. The vocal behavior of normal-hearing and fluent speakers was recorded in response to a personalized size of pitch shift versus a non-specific size, one semitone. The personalized size of shift was determined based on the just-noticeable difference in fundamental frequency (F0) of each participant’s voice. Here we show that both tasks successfully demonstrated opposing responses to a constant and predictable F0 perturbation (on from the production onset) but these effects barely carried over once the feedback was back to normal, depicting a pattern that bears some resemblance to compensatory responses. Experiencing a F0 shift that is perceived as self-generated (because it was precisely just-noticeable) is not enough to force speakers to behave more consistently and more homogeneously in an opposing manner. On the contrary, our results suggest that the type of the response as well as the magnitude of the response do not depend in any trivial way on the sensitivity of participants to their own voice pitch. Based on this finding, we speculate that error correction could possibly occur even with a bionic ear, typically even when F0 cues are too subtle for cochlear implant users to detect accurately.

Noninvasive neurostimulation of left ventral motor cortex enhances sensorimotor adaptation in speech production

Sensorimotor adaptation-enduring changes to motor commands due to sensory feedback-allows speakers to match their articulations to intended speech acoustics. How the brain integrates auditory feedback to modify speech motor commands and what limits the degree of these modifications remain unknown. Here, we investigated the role of speech motor cortex in modifying stored speech motor plans. In a within-subjects design, participants underwent separate sessions of sham and anodal transcranial direct current stimulation (tDCS) over speech motor cortex while speaking and receiving altered auditory feedback of the first formant. Anodal tDCS increased the rate of sensorimotor adaptation for feedback perturbation. Computational modeling of our results using the Directions Into Velocities of Articulators (DIVA) framework of speech production suggested that tDCS primarily affected behavior by increasing the feedforward learning rate. This study demonstrates how focal noninvasive neurostimulation can enhance the integration of auditory feedback into speech motor plans.