Foreign accent syndrome

Foreign accent syndrome is a medical condition in which patients develop speech patterns that are perceived as a foreign accent[1] that is different from their native accent, without having acquired it in the perceived accent's place of origin.

Foreign accent syndrome
SpecialtyPsychiatry, Neurology

Foreign accent syndrome usually results from a stroke,[1] but can also develop from head trauma,[1] migraines[2] or developmental problems.[3] The condition might occur due to lesions in the speech production network of the brain, or may also be considered a neuropsychiatric condition.[4] The condition was first reported in 1907,[5] and between 1941 and 2009 there were 62 recorded cases.[3]

Its symptoms result from distorted articulatory planning and coordination processes and although popular news articles commonly attempt to identify the closest regional accent, speakers suffering from foreign accent syndrome acquire neither a specific foreign accent nor any additional fluency in a foreign language. Despite an unconfirmed news report in 2010 that a Croatian speaker had gained the ability to speak fluent German after emergence from a coma,[6] there has been no verified case where a patient's foreign language skills have improved after a brain injury.

Signs and symptoms

To the untrained ear, those with the syndrome sound as though they speak their native languages with a foreign accent; for example, an American native speaker of English might sound as though he spoke with a south-eastern English accent, or a native English speaker from Britain might speak with a New York American accent. However, researchers at Oxford University have found that certain specific parts of the brain were injured in some foreign accent syndrome cases, indicating that particular parts of the brain control various linguistic functions, and damage could result in altered pitch and/or mispronounced syllables, causing speech patterns to be distorted in a non-specific manner. Contrary to popular belief that individuals with FAS exhibit their accent without any effort, these individuals feel as if they are suffering from a speech disorder.[7] More recently, there is mounting evidence that the cerebellum, which controls motor function, may be crucially involved in some cases of foreign accent syndrome, reinforcing the notion that speech pattern alteration is mechanical, and thus non-specific.[8][9]

Generally, FAS is not a persisting disorder; it is a temporary stage in recovery from stroke or trauma, or potentially a stage of deterioration. FAS mainly affects speech at a segmental or prosodic level. Vowels are more likely to be affected than consonants. Vowel errors include an increase in vowel tensing, monophthongization of diphthongs, and vowel fronting and raising. There is evidence of both vowel shortening and lengthening. Consonantal anomalies include cases of changes in articulation, manner, and voicing.[10] On a suprasegmental level, there are changes in intonation and pitch, such as monotonous intonation or exaggerations in pitch height and range. There are also difficulties in using stress accents to indicate pragmatics and meaning.[11] There is a tendency for FAS patients to switch to syllable-timed prosody when their native language is stress-timed. This perception could be due to changes in syllable durations, and the addition of epenthetic vowels.[10]

FAS has many similarities to apraxia of speech (AoS), which is another motor speech disorder. Some researchers think that FAS is a mild form of AoS because they are both caused by similar lesions in the brain. However, FAS differs from AoS in that FAS patients have more control over their speech deficits and their “foreign accent” is a form of compensation for their speech problems. Because there are relatively few differences in the symptoms of FAS and AoS, a listeners’ perception of the affected speech plays a large role in diagnosis of FAS rather than AoS. The listener has to be familiar with a foreign accent in order to attribute it to the affected speech of someone with FAS.[10]

The perception of a foreign accent is likely to be a case of pareidolia on the part of the listener. Nick Miller, Professor of Motor Speech Disorders at Newcastle University has explained: "The notion that sufferers speak in a foreign language is something that is in the ear of the listener, rather than the mouth of the speaker. It is simply that the rhythm and pronunciation of speech has changed."[12]

Causes and diagnosis

In a meta-analysis of 112 patients with FAS, 97% were adults, and 67% were female. Foreign accent syndrome is more commonly pronounced in females than it is in males. The typical age range for this disease is around 25–49 years of age.[13] FAS is about twice as common in women than in men. In cases where handedness was recorded, the majority of patients were right-handed. Only in 12.5% of the cases did the patients have previous exposure to the accent that they later seemed to developed due to FAS.[14]

The majority of FAS patients develop FAS due to a stroke, but some are due to developmental or psychological disorders, or due to trauma or tumors. Of the patients with neurological damage, the majority had a lesion in the supratentorial left hemisphere. Lesions primarily affected the premotor cortex, motor cortex, basal ganglia or Broca’s area. Lesions are also seen in the cerebellum, which projects to the previous areas. Right hemisphere damage rarely causes FAS. The majority of patients with FAS usually present other speech disorders as well, such as mutism, aphasia, dysarthria, agrammatism, and apraxia of speech.[14]

H. Whitaker first coined the term Foreign Accent Syndrome in 1982. He originally proposed some criteria that must be present in order to diagnose someone with FAS; they must be monolingual, they must have damage to their central nervous system that affects their speech, and their speech must be perceived as subjectively sounding foreign by themselves or clinicians. One problem with Whitaker’s criteria is that they are based primarily on subjectivity, and therefore acoustic phonetic measurements are rarely used to diagnose FAS.[14]

Since this syndrome is very rare, it takes a multidisciplinary team to evaluate the syndrome and diagnose it, including speech-language pathologists, neurolinguists, neurologists, neuropsychologists, and psychologists.[15] In 2010, Verhoeven and Mariën [16][17] identified several subtypes of Foreign Accent Syndrome. They described a neurogenic, developmental, psychogenic and mixed variant. Neurogenic FAS is the term used when FAS occurs after central nervous system damage.[17] Developmental FAS is used when the accent is perceptible as of an early age, e.g. children who have always spoken with an accent.[18] Psychogenic FAS is used when FAS is psychologically induced, associated with psychiatric disorder or clear psychiatric traits.[19][20][21] The term mixed FAS is used when patients develop the disorder after neurological damage, but the accent change has such a profound impact on the self-perception and identity that they will modify or enhance the accent to make it fit with the new persona. Hence, there is a psychological component.[22] Diagnosis, up until today, is generally purely perceptually based. However, in order to find out what subtype the patient is suffering from, complementary investigations are necessary. This differentiation is necessary for the clinician to allow for correct therapeutic guidance. Psychological evaluations may be performed in order to rule out any psychiatric condition that may be causing the change in speech, as well as tests to assess reading, writing, and language comprehension in order to identify comorbid disorders often co-occurring with the disorder.[15] One of the symptoms of this syndrome is that the patient moves their tongue or jaw differently while speaking, which creates a different sound, so a recording is done of the speech pattern in order to analyze it. Often images of the brain are taken with either MRI, CT, SPECT[18] or PET scans.[15] This is done in order to see if there is structural and or functional damage in the areas of the brain that control speech and/or rhythm and melody of speech. EEG is sometimes performed to investigate whether there are disturbances at the electrophysiological level.[15]

Treatment involves intense speech therapy. Methods such as oromotor exercises, using mirrors, targeting phonetic awareness, reading lists and texts, and using electropalatography are all methods that have been used in the past. Treatment should be developed on a patient by patient basis. About a quarter of FAS patients go through remission after treatment.[14]

Additional research on psychogenic FAS has been done, which can help outline some symptoms or commonalities among FAS patients. The findings include the following: 1) it is more common in women than men. The typical age range FAS is found in also renders the patient more prone to depression or mental issues (25–49 years). 2) it affects prosody such that intonation (pitch) becomes abnormal and speech is slowed 3) In terms of phones, vowels are more affected than consonants 4) Remission seemed to be related to the relieving of a patient’s positive psychiatric symptoms that are comorbid with FAS.[23]

History

The condition was first described in 1907 by the French neurologist Pierre Marie,[5] and another early case was reported in a Czech study in 1919, conducted by German internist Alois Pick (1859–1945).[24] Other well-known cases of the syndrome have included one that occurred in Norway in 1941 after a young woman, Astrid L., suffered a head injury from shrapnel during an air-raid. After apparently recovering from the injury, she was left with what sounded like a strong German accent and was shunned by her fellow Norwegians.[25][26]

Society and culture

Cases of foreign accent syndrome often receive significant media coverage, and cases have been reported in the popular media as resulting from various causes including stroke,[27][28][29][30][31][32] allergic reaction,[33] physical injury,[32][31][34][35] and migraine.[36][37][38][39][40][41][42][43] A woman with foreign accent syndrome was featured on both Inside Edition and Discovery Health Channel's Mystery ER[44] in October 2008, and in September 2013 the BBC published an hour-long documentary about Sarah Colwill, a woman from Devon, whose "Chinese" foreign accent syndrome resulted from a severe migraine.[45][46][47] In 2016, a Texas woman, Lisa Alamia, was diagnosed with Foreign Accent Syndrome when, following a jaw surgery, she developed what sounded like a British accent.[48][49] Ellen Spencer, a woman from Indiana who has foreign accent syndrome, was interviewed on the American public radio show Snap Judgment.[50]

In season 2 episode 12 of the American television series Hart of Dixie, one storyline revolves around character Annabeth Nass and a man she's attracted to named Oliver who has foreign accent syndrome.

The British singer George Michael said that, after waking from a three-week long coma in 2012, he temporarily had a West Country accent.[51]

Potential treatments

FAS is a very rare disorder. Likewise, there are not very many proposed treatments. Two that may provide relief to patients with FAS in the future include mastery of musical skills and “tongue reading”.[4]

In terms of mastery of music skills, research by Christiner and Reiterer suggests that musicians, both instrumental and vocal, are better at imitating foreign accents that non-musicians. Vocalists are further better than instrumentalists at this task. In this way, individuals with FAS might be able to reimitate their original, lost native accents more easily if they master a music - especially vocal – skill.[4]

Pursuing this further, another set of researchers, Banks et al. investigated the role of hearing a foreign accent versus hearing and seeing someone use a foreign accent and which of these may be better for helping an individual replicate a foreign accent. Contrary to the researcher’s predictions, “no differences were found in perceptual gains between the two modalities.” By contrast, a method that did seem to improve learning of non-native speech sounds was “real-time visual feedback of tongue movements with an interactive 3D visualization system based on electromagnetic articulography.” Hopefully, this visual representation of a patient’s motor movements while producing speech can help patients with FAS become salient of the movement patterns required of their original accent.[4]

Cases

Table #1: Cases from developmental FAS (DFAS), Psychogenic FAS (PFAS) and a New Variant of Neurologic FAS[4]

Subtype Case Descriptions
DFAS An adolescent male without family history of developmental disorders or personal psychiatric issues. No cognitive issue except for some executive function issues. Through a functional neuroimaging study, researchers found significantly decreased blood flow to the “medial prefrontal and lateral temporal regions bilaterally.” They also found hypoperfusion in the cerebellum.
Two males with mild DFAS had psychiatric disorders, which suggested a potential psychogenic diagnosis. But upon further examination, they were determined to have structural issue in their brains – “venous malformation and expanded perivascular spaces”.
PFAS Patient with head trauma received the diagnosis of PFAS. The reason for the given diagnosis instead of one of the others was due to lack of structural brain damage and the existence of neuropsychiatric disorders.
New Variant Three adult males dealing with Broca’s aphasia lose their regional accents. Studies on these patients imply that lesion of the “middle part of the left motor cortex and adjoining regions” may contribute to loss of regional accent.

See also

References
  1. Kurowski, K. M.; Blumstein, S. E.; Alexander, M. (1996). "The foreign accent syndrome: a reconsideration" (PDF). Brain and Language. 54 (1): 1–25. doi:10.1006/brln.1996.0059. PMID 8811940.
  2. "Severe migraines give Devon woman a bizarre Chinese accent at". Asylum.co.uk. Retrieved 16 June 2011.
  3. Mariën, P.; Verhoeven, J.; Wackenier, P.; Engelborghs, S.; De Deyn, P. P. (2009). "Foreign accent syndrome as a developmental motor speech disorder" (PDF). Cortex. 45 (7): 870–878. doi:10.1016/j.cortex.2008.10.010. PMID 19121521.
  4. Moreno-Torres, Ignacio; Mariën, Peter; Dávila, Guadalupe; Berthier, Marcelo L. (20 December 2016). "Editorial: Language beyond Words: The Neuroscience of Accent". Frontiers in Human Neuroscience. 10: 639. doi:10.3389/fnhum.2016.00639. ISSN 1662-5161. PMC 5169099. PMID 28066210.
  5. Marie P. (1907). Presentation de malades atteints d'anarthrie par lesion de l'hemisphere gauche du cerveau. Bulletins et Memoires Societe Medicale des Hopitaux de Paris, 1: 158–160.
  6. "Croatian teenager wakes from coma speaking fluent German". The Daily Telegraph. London: Telegraph Media Group. 12 April 2010. Retrieved 17 April 2010.
  7. Miller, Nick; Jill Taylor; Chloe Howe; Jennifer Read (September 2011). "Living with foreign accent syndrome: Insider perspectives". Aphasiology. 25 (9): 1053–1068. doi:10.1080/02687038.2011.573857. Retrieved 9 December 2012.
  8. Mariën P., Verhoeven J., Engelborghs, S., Rooker, S., Pickut, B. A., De Deyn, P. P. (2006). A role for the cerebellum in motor speech planning: evidence from foreign accent syndrome. Clinical Neurology and Neurosurgery, 108, 518–522.
  9. Mariën P., Verhoeven J. (2007). Cerebellar involvement in motor speech planning: some further evidence from foreign accent syndrome. Folia Phoniatrica et Logopaedica, 59:4, 210–217.
  10. van der Scheer, Fennetta; Jonkers, Roel; Gilbers, Dicky (18 December 2013). "Foreign accent syndrome and force of articulation". Aphasiology. 28 (4): 471–489. doi:10.1080/02687038.2013.866210. hdl:11370/abd6e99a-586d-4f6f-acad-3392c800d119. ISSN 0268-7038.
  11. Kuschmann, Anja; Lowit, Anja (27 September 2012). "Phonological and phonetic marking of information status in Foreign Accent Syndrome" (PDF). International Journal of Language & Communication Disorders. 47 (6): 738–749. doi:10.1111/j.1460-6984.2012.00184.x. ISSN 1368-2822. PMID 23121531.
  12. "Unusual illnesses: Curiouser and curiouser". The Independent. 21 September 2010. Retrieved 2 June 2015.
  13. Maria Cohut, P. D. (n.d.). Top 5 strangest medical conditions. Retrieved from https://www.medicalnewstoday.com/articles/323395#Foreign-accent-syndrome
  14. Mariën, Peter; Keulen, Stefanie; Verhoeven, Jo (January 2019). "Neurological Aspects of Foreign Accent Syndrome in Stroke Patients". Journal of Communication Disorders. 77: 94–113. doi:10.1016/j.jcomdis.2018.12.002. ISSN 0021-9924. PMID 30606457.
  15. Lukas, Rimas (March 2014). "Foreign Accent Syndrome". EBSCO Publishing. Retrieved 15 July 2014.
  16. Verhoeven, Jo; Mariën, Peter (2010). "Suprasegmental aspects of Foreign Accent Syndrome". In Stojanovik, V.; Setter, J. (eds.). Speech Prosody in Atypical Populations. Assessment and Remediation. Guilford: J and R Press. pp. 103–128.
  17. Verhoeven, Jo; Mariën, Peter (2010). "Neurogenic foreign accent syndrome: Articulatory setting, segments and prosody in a Dutch speaker" (PDF). Journal of Neurolinguistics. 23 (6): 599–614. doi:10.1016/j.jneuroling.2010.05.004.
  18. Keulen, Stefanie; Mariën, Peter; Wackenier, Peggy; Jonkers, Roel; Bastiaanse, Roelien; Verhoeven, Jo (10 March 2016). "Developmental Foreign Accent Syndrome: Report of a New Case". Frontiers in Human Neuroscience. 10 (65): 65. doi:10.3389/fnhum.2016.00065. PMC 4785140. PMID 27014011.
  19. Keulen, Stefanie; Verhoeven, Jo; De Witte, Elke; De Page, Louis; Bastiaanse, Roelien; Mariën, Peter (27 April 2016). "Foreign Accent Syndrome As a Psychogenic Disorder: A Review". Frontiers in Human Neuroscience. 10 (168): 168. doi:10.3389/fnhum.2016.00168. PMC 4846654. PMID 27199699.
  20. Keulen, Stefanie; Verhoeven, Jo; Bastiaanse, Roelien; Mariën, Peter; Mavroudakis, Nicolas; Paquier, Philippe (2 March 2016). "Perceptual Accent Rating and Attribution in Psychogenic FAS: Some Further Evidence Challenging Whitaker's Operational Definition". Frontiers in Human Neuroscience. 10 (62): 62. doi:10.3389/fnhum.2016.00062. PMC 4773440. PMID 26973488.
  21. Keulen, Stefanie; Verhoeven, Jo; De Page, Louis; Jonkers, Roel; Bastiaanse, Roelien; Mariën, Peter (19 April 2016). "Psychogenic Foreign Accent Syndrome: A New Case". Frontiers in Human Neuroscience. 10 (143): 143. doi:10.3389/fnhum.2016.00143. PMC 4835482. PMID 27148003.
  22. Ryalls, Jack; Whiteside, Janet (2006). "An atypical case of foreign accent syndrome". Clinical Linguistics and Phonetics. 20 (2–3): 157–162. doi:10.1080/02699200400026900. PMID 16428232.
  23. Keulen, Stefanie; Verhoeven, Jo; De Witte, Elke; De Page, Louis; Bastiaanse, Roelien; Mariën, Peter (27 April 2016). "Foreign Accent Syndrome As a Psychogenic Disorder: A Review". Frontiers in Human Neuroscience. 10. doi:10.3389/fnhum.2016.00168. ISSN 1662-5161. PMC 4846654. PMID 27199699.
  24. Pick, A. 1919. Über Änderungen des Sprachcharakters als Begleiterscheinung aphasicher Störungen. Zeitschrift für gesamte Neurologie und Psychiatrie, 45, 230–241.
  25. Monrad-Krohn G. H. (1947). "Dysprosody or Altered 'Melody of Language'". Brain. 70 (4): 405–15. doi:10.1093/brain/70.4.405. PMID 18903253.
  26. "Foreign Accent Syndrome Support". Retrieved 24 October 2013.
  27. Naidoo, Raveeni (1 July 2008). "A Case of Foreign Accent Syndrome Resulting in Regional Dialect". the Canadian Journal of Neurological Science. Retrieved 3 July 2008.
  28. "Ontario woman gains East Coast accent following stroke". CBC News. 3 July 2008. Retrieved 3 July 2008.
  29. Bunyan, Nigel (4 July 2006). "Geordie wakes after stroke with new accent". The Daily Telegraph. London: Telegraph Media Group Limited. Retrieved 20 December 2007.
  30. Lewis, Angie; Guin, Karen. "Communicative Disorders Clinic Diagnoses Rare Foreign Accent Syndrome in Sarasota Woman". University of Central Florida-College of Health and Public Affairs. Archived from the original on 11 November 2007. Retrieved 29 December 2007.
  31. "Experience: I woke up with a Russian accent". The Guardian. London.
  32. Miebach, Elisa (29 August 2019). "Stroke: When you lose your mother tongue". DW.COM. Retrieved 2 September 2019.
  33. "Foreign Accent Syndrome (FAS) Support". Utdallas.edu. Retrieved 24 October 2013.
  34. Schocker, Laura (5 June 2011). "Woman Gets Oral Surgery, Wakes Up With Irish Accent". The Huffington Post. Retrieved 16 June 2011.
  35. "Woman Gets New Accent After Dentist Visit". Wmtw.com. 6 May 2011. Archived from the original on 11 June 2011. Retrieved 16 June 2011.
  36. Spencer, Ellen (5 June 2015). "What Accent?". Snap Judgment. NPR. Retrieved 23 June 2016.
  37. "Health Sentinel: Connecting symptoms finally leads to disorder diagnosis". The News-Sentinel. 6 December 2010. Archived from the original on 11 March 2012. Retrieved 8 April 2014.
  38. "Migraine left woman with Chinese accent". The Sunday Times. 20 April 2010. Archived from the original on 25 April 2010. Retrieved 20 April 2010.
  39. "Severe Migraine Leaves English Woman with Chinese Accent". Fox News. 19 April 2010. Archived from the original on 2 November 2012. Retrieved 20 April 2010.
  40. "Plymouth woman 'woke up sounding Chinese'". BBC News. 3 September 2013. Retrieved 3 September 2013.
  41. Morris, Steven (14 September 2010). "Woman's migraine gave her French accent". The Guardian. London.
  42. "Migraine gives woman French accent". The Independent. London. 14 September 2010.
  43. "Coping with Foreign Accent Syndrome". BBC News. 13 September 2010. Retrieved 3 September 2013.
  44. "Woman's Accent Foreign Even to Her". The Seattle Times. 27 October 2008. Retrieved 27 October 2008.
  45. "BBC One – The Woman Who Woke Up Chinese". bbc.co.uk. 3 September 2013. Retrieved 24 October 2013.
  46. "Sarah Colwill, British Woman, 'Woke Up Chinese' After Suffering Severe Migraine In Hospital [VIDEO]". Medicaldaily.com. 7 March 2010. Retrieved 24 October 2013.
  47. Thomas, Emily (4 September 2013). "Sarah Colwill Speaks Out About Foreign Accent Syndrome In BBC Documentary 'The Woman Who Woke Up Chinese'". The Huffington Post. Retrieved 24 October 2013.
  48. "Texas mom has jaw surgery, ends up with British accent". .ajc.com. 23 June 2016. Retrieved 27 June 2016.
  49. Doug Criss (23 June 2016). "Texas woman sports British accent after surgery". CNN. Retrieved 25 June 2016.
  50. "Godsend - Snap #614 | Snap Judgment". snapjudgment.org. Retrieved 6 December 2016.
  51. "George Michael: I woke up from coma with a West Country accent". The Daily Telegraph. London. 18 July 2012. Retrieved 17 December 2012.

Further reading
  • Dankovičová J, Gurd JM, Marshall JC, MacMahon MKC, Stuart-Smith J, Coleman JS, Slater A. Aspects of non-native pronunciation in a case of altered accent following stroke (foreign accent syndrome). Clinical Linguistics and Phonetics 2001;15:195-218.
  • Gurd, J. M.; Bessell, N. J.; Bladon, R. A.; Bamford, J. M. (1988). "A case of foreign accent syndrome, with follow-up clinical, neuropsychological and phonetic descriptions". Neuropsychologia. 26 (2): 237–251. doi:10.1016/0028-3932(88)90077-2. PMID 3399041.
  • Gurd, J. M.; Coleman, J. S.; Costello, A.; Marshall, J. C. (2001). "Organic or functional? A new case of foreign accent syndrome". Cortex. 37 (5): 715–718. doi:10.1016/s0010-9452(08)70622-1. PMID 11804223.
  • Ryalls, Jack; Miller, Nick (2015). Foreign accent syndromes. London: Psychology Press. ISBN 978-1-84872-153-1.
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