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Keshavarzi M, Mandke K, Macfarlane A, Parvez L, Gabrielczyk F, Wilson A, Goswami U. Atypical beta-band effects in children with dyslexia in response to rhythmic audio-visual speech. Clin Neurophysiol 2024; 160:47-55. [PMID: 38387402 DOI: 10.1016/j.clinph.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Previous studies have reported atypical delta phase in children with dyslexia, and that delta phase modulates the amplitude of the beta-band response via delta-beta phase-amplitude coupling (PAC). Accordingly, the atypical delta-band effects in children with dyslexia may imply related atypical beta-band effects, particularly regarding delta-beta PAC. Our primary objective was to explore beta-band oscillations in children with and without dyslexia, to explore potentially atypical effects in the beta band in dyslexic children. METHODS We collected EEG data during a rhythmic speech paradigm from 51 children (21 control; 30 dyslexia). We then assessed beta-band phase entrainment, beta-band angular velocity, beta-band power responses and delta-beta PAC. RESULTS We found significant beta-band phase entrainment for control children but not for dyslexic children. Furthermore, children with dyslexia exhibited significantly faster beta-band angular velocity and significantly greater beta-band power. Delta-beta PAC was comparable in both groups. CONCLUSION Atypical beta-band effects were observed in children with dyslexia. However, delta-beta PAC was comparable in both dyslexic and control children. SIGNIFICANCE These findings offer further insights into the neurophysiological basis of atypical rhythmic speech processing by children with dyslexia, suggesting the involvement of a wide range of frequency bands.
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Affiliation(s)
- Mahmoud Keshavarzi
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
| | - Kanad Mandke
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Annabel Macfarlane
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Lyla Parvez
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Fiona Gabrielczyk
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Angela Wilson
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Usha Goswami
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
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Keshavarzi M, Di Liberto GM, Gabrielczyk F, Wilson A, Macfarlane A, Goswami U. Atypical speech production of multisyllabic words and phrases by children with developmental dyslexia. Dev Sci 2024; 27:e13428. [PMID: 37381667 DOI: 10.1111/desc.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/20/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
The prevalent "core phonological deficit" model of dyslexia proposes that the reading and spelling difficulties characterizing affected children stem from prior developmental difficulties in processing speech sound structure, for example, perceiving and identifying syllable stress patterns, syllables, rhymes and phonemes. Yet spoken word production appears normal. This suggests an unexpected disconnect between speech input and speech output processes. Here we investigated the output side of this disconnect from a speech rhythm perspective by measuring the speech amplitude envelope (AE) of multisyllabic spoken phrases. The speech AE contains crucial information regarding stress patterns, speech rate, tonal contrasts and intonational information. We created a novel computerized speech copying task in which participants copied aloud familiar spoken targets like "Aladdin." Seventy-five children with and without dyslexia were tested, some of whom were also receiving an oral intervention designed to enhance multi-syllabic processing. Similarity of the child's productions to the target AE was computed using correlation and mutual information metrics. Similarity of pitch contour, another acoustic cue to speech rhythm, was used for control analyses. Children with dyslexia were significantly worse at producing the multi-syllabic targets as indexed by both similarity metrics for computing the AE. However, children with dyslexia were not different from control children in producing pitch contours. Accordingly, the spoken production of multisyllabic phrases by children with dyslexia is atypical regarding the AE. Children with dyslexia may not appear to listeners to exhibit speech production difficulties because their pitch contours are intact. RESEARCH HIGHLIGHTS: Speech production of syllable stress patterns is atypical in children with dyslexia. Children with dyslexia are significantly worse at producing the amplitude envelope of multi-syllabic targets compared to both age-matched and reading-level-matched control children. No group differences were found for pitch contour production between children with dyslexia and age-matched control children. It may be difficult to detect speech output problems in dyslexia as pitch contours are relatively accurate.
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Affiliation(s)
- Mahmoud Keshavarzi
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Giovanni M Di Liberto
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Fiona Gabrielczyk
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Angela Wilson
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Annabel Macfarlane
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Usha Goswami
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, UK
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Mandke K, Flanagan S, Macfarlane A, Feltham G, Gabrielczyk F, Wilson AM, Gross J, Goswami U. Neural responses to natural and enhanced speech edges in children with and without dyslexia. Front Hum Neurosci 2023; 17:1200950. [PMID: 37841072 PMCID: PMC10571917 DOI: 10.3389/fnhum.2023.1200950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
Sensory-neural studies indicate that children with developmental dyslexia show impairments in processing acoustic speech envelope information. Prior studies suggest that this arises in part from reduced sensory sensitivity to amplitude rise times (ARTs or speech "edges") in the envelope, accompanied by less accurate neural encoding of low-frequency envelope information. Accordingly, enhancing these characteristics of the speech envelope may enhance neural speech processing in children with dyslexia. Here we applied an envelope modulation enhancement (EME) algorithm to a 10-min story read in child-directed speech (CDS), enhancing ARTs and also enhancing low-frequency envelope information. We compared neural speech processing (as measured using MEG) for the EME story with the same story read in natural CDS for 9-year-old children with and without dyslexia. The EME story affected neural processing in the power domain for children with dyslexia, particularly in the delta band (0.5-4 Hz) in the superior temporal gyrus. This may suggest that prolonged experience with EME speech could ameliorate some of the impairments shown in natural speech processing by children with dyslexia.
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Affiliation(s)
- Kanad Mandke
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Sheila Flanagan
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Annabel Macfarlane
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Georgia Feltham
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Fiona Gabrielczyk
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Angela M. Wilson
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany
| | - Usha Goswami
- Department of Psychology, Centre for Neuroscience in Education, University of Cambridge, Cambridge, United Kingdom
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Li KE, Dimitrijevic A, Gordon KA, Pang EW, Greiner HM, Kadis DS. Age-related increases in right hemisphere support for prosodic processing in children. Sci Rep 2023; 13:15849. [PMID: 37740012 PMCID: PMC10516972 DOI: 10.1038/s41598-023-43027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
Language comprehension is a complex process involving an extensive brain network. Brain regions responsible for prosodic processing have been studied in adults; however, much less is known about the neural bases of prosodic processing in children. Using magnetoencephalography (MEG), we mapped regions supporting speech envelope tracking (a marker of prosodic processing) in 80 typically developing children, ages 4-18 years, completing a stories listening paradigm. Neuromagnetic signals coherent with the speech envelope were localized using dynamic imaging of coherent sources (DICS). Across the group, we observed coherence in bilateral perisylvian cortex. We observed age-related increases in coherence to the speech envelope in the right superior temporal gyrus (r = 0.31, df = 78, p = 0.0047) and primary auditory cortex (r = 0.27, df = 78, p = 0.016); age-related decreases in coherence to the speech envelope were observed in the left superior temporal gyrus (r = - 0.25, df = 78, p = 0.026). This pattern may indicate a refinement of the networks responsible for prosodic processing during development, where language areas in the right hemisphere become increasingly specialized for prosodic processing. Altogether, these results reveal a distinct neurodevelopmental trajectory for the processing of prosodic cues, highlighting the presence of supportive language functions in the right hemisphere. Findings from this dataset of typically developing children may serve as a potential reference timeline for assessing children with neurodevelopmental hearing and speech disorders.
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Affiliation(s)
- Kristen E Li
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Andrew Dimitrijevic
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Elizabeth W Pang
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Darren S Kadis
- Department of Physiology, University of Toronto, Toronto, ON, Canada.
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Ní Choisdealbha Á, Attaheri A, Rocha S, Mead N, Olawole-Scott H, Brusini P, Gibbon S, Boutris P, Grey C, Hines D, Williams I, Flanagan SA, Goswami U. Neural phase angle from two months when tracking speech and non-speech rhythm linked to language performance from 12 to 24 months. Brain Lang 2023; 243:105301. [PMID: 37399686 DOI: 10.1016/j.bandl.2023.105301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
Atypical phase alignment of low-frequency neural oscillations to speech rhythm has been implicated in phonological deficits in developmental dyslexia. Atypical phase alignment to rhythm could thus also characterize infants at risk for later language difficulties. Here, we investigate phase-language mechanisms in a neurotypical infant sample. 122 two-, six- and nine-month-old infants were played speech and non-speech rhythms while EEG was recorded in a longitudinal design. The phase of infants' neural oscillations aligned consistently to the stimuli, with group-level convergence towards a common phase. Individual low-frequency phase alignment related to subsequent measures of language acquisition up to 24 months of age. Accordingly, individual differences in language acquisition are related to the phase alignment of cortical tracking of auditory and audiovisual rhythms in infancy, an automatic neural mechanism. Automatic rhythmic phase-language mechanisms could eventually serve as biomarkers, identifying at-risk infants and enabling intervention at the earliest stages of development.
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Affiliation(s)
| | - Adam Attaheri
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Sinead Rocha
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Natasha Mead
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Helen Olawole-Scott
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Perrine Brusini
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Samuel Gibbon
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Panagiotis Boutris
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Christina Grey
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Declan Hines
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Isabel Williams
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Sheila A Flanagan
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom
| | - Usha Goswami
- Centre for Neuroscience in Education, University of Cambridge, United Kingdom.
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Van Herck S, Economou M, Vanden Bempt F, Glatz T, Ghesquière P, Vandermosten M, Wouters J. Neural synchronization and intervention in pre-readers who later on develop dyslexia. Eur J Neurosci 2023; 57:547-567. [PMID: 36518008 PMCID: PMC10108076 DOI: 10.1111/ejn.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/07/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
A growing number of studies has investigated temporal processing deficits in dyslexia. These studies largely focus on neural synchronization to speech. However, the importance of rise times for neural synchronization is often overlooked. Furthermore, targeted interventions, phonics-based and auditory, are being developed, but little is known about their impact. The current study investigated the impact of a 12-week tablet-based intervention. Children at risk for dyslexia received phonics-based training, either with (n = 31) or without (n = 31) auditory training, or engaged in active control training (n = 29). Additionally, neural synchronization and processing of rise times was longitudinally investigated in children with dyslexia (n = 26) and typical readers (n = 52) from pre-reading (5 years) to beginning reading age (7 years). The three time points in the longitudinal study correspond to intervention pre-test, post-test and consolidation, approximately 1 year after completing the intervention. At each time point neural synchronization was measured to sinusoidal stimuli and pulsatile stimuli with shortened rise times at syllable (4 Hz) and phoneme rates (20 Hz). Our results revealed no impact on neural synchronization at syllable and phoneme rate of the phonics-based and auditory training. However, we did reveal atypical hemispheric specialization at both syllable and phoneme rates in children with dyslexia. This was detected even before the onset of reading acquisition, pointing towards a possible causal rather than consequential mechanism in dyslexia. This study contributes to our understanding of the temporal processing deficits underlying the development of dyslexia, but also shows that the development of targeted interventions is still a work in progress.
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Affiliation(s)
- Shauni Van Herck
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
| | - Maria Economou
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
- Leuven Child & Youth Institute (L‐C&Y)KU LeuvenLeuvenBelgium
| | - Femke Vanden Bempt
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
- Leuven Child & Youth Institute (L‐C&Y)KU LeuvenLeuvenBelgium
| | - Toivo Glatz
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Institute of Public HealthCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
- Leuven Child & Youth Institute (L‐C&Y)KU LeuvenLeuvenBelgium
| | - Maaike Vandermosten
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
- Leuven Child & Youth Institute (L‐C&Y)KU LeuvenLeuvenBelgium
| | - Jan Wouters
- Research Group ExpORL, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
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Peter V, Goswami U, Burnham D, Kalashnikova M. Impaired neural entrainment to low frequency amplitude modulations in English-speaking children with dyslexia or dyslexia and DLD. Brain Lang 2023; 236:105217. [PMID: 36529116 DOI: 10.1016/j.bandl.2022.105217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/19/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Neural synchronization to amplitude-modulated noise at three frequencies (2 Hz, 5 Hz, 8 Hz) thought to be important for syllable perception was investigated in English-speaking school-aged children. The theoretically-important delta-band (∼2Hz, stressed syllable level) was included along with two syllable-level rates. The auditory steady state response (ASSR) was recorded using EEG in 36 7-to-12-year-old children. Half of the sample had either dyslexia or dyslexia and DLD (developmental language disorder). In comparison to typically-developing children, children with dyslexia or with dyslexia and DLD showed reduced ASSRs for 2 Hz stimulation but similar ASSRs at 5 Hz and 8 Hz. These novel data for English ASSRs converge with prior data suggesting that children with dyslexia have atypical synchrony between brain oscillations and incoming auditory stimulation at ∼ 2 Hz, the rate of stressed syllable production across languages. This atypical synchronization likely impairs speech processing, phonological processing, and possibly syntactic processing, as predicted by Temporal Sampling theory.
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Affiliation(s)
- Varghese Peter
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia; School of Health and Behavioural Sciences, University of the Sunshine Coast, Australia
| | - Usha Goswami
- Centre for Neuroscience in Education, University of Cambridge, UK
| | - Denis Burnham
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia
| | - Marina Kalashnikova
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia; BCBL. Basque Center on Cognition, Brain and Language, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain.
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Gnanateja GN, Devaraju DS, Heyne M, Quique YM, Sitek KR, Tardif MC, Tessmer R, Dial HR. On the Role of Neural Oscillations Across Timescales in Speech and Music Processing. Front Comput Neurosci 2022; 16:872093. [PMID: 35814348 PMCID: PMC9260496 DOI: 10.3389/fncom.2022.872093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
This mini review is aimed at a clinician-scientist seeking to understand the role of oscillations in neural processing and their functional relevance in speech and music perception. We present an overview of neural oscillations, methods used to study them, and their functional relevance with respect to music processing, aging, hearing loss, and disorders affecting speech and language. We first review the oscillatory frequency bands and their associations with speech and music processing. Next we describe commonly used metrics for quantifying neural oscillations, briefly touching upon the still-debated mechanisms underpinning oscillatory alignment. Following this, we highlight key findings from research on neural oscillations in speech and music perception, as well as contributions of this work to our understanding of disordered perception in clinical populations. Finally, we conclude with a look toward the future of oscillatory research in speech and music perception, including promising methods and potential avenues for future work. We note that the intention of this mini review is not to systematically review all literature on cortical tracking of speech and music. Rather, we seek to provide the clinician-scientist with foundational information that can be used to evaluate and design research studies targeting the functional role of oscillations in speech and music processing in typical and clinical populations.
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Affiliation(s)
- G Nike Gnanateja
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dhatri S Devaraju
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthias Heyne
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yina M Quique
- Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States
| | - Kevin R Sitek
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Monique C Tardif
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Tessmer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Heather R Dial
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, United States.,Department of Communication Sciences and Disorders, University of Houston, Houston, TX, United States
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