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However, lip movements are by nature ambiguous, so that lip-reading does not allow for a full understanding of speech. The resulting language access difficulties may have serious consequences on language, cognitive and social development. Cued speech (CS) was developed to eliminate this ambiguity by complementing lip-reading with hand gestures, giving access to the entire phonological content of speech through the visual modality alone. Despite its proven efficiency for improving linguistic and communicative abilities, the mechanisms of CS perception remain largely unknown. The goal of the present study is to delineate the brain regions involved in CS perception and identify their role in visual and language-related processes. Three matched groups of participants were scanned during the presentation of videos of silent CS sentences, isolated lip movements, isolated gestures, plus CS sentences with speech sounds, and meaningless CS sentences: Prelingually deaf users of CS, hearing users of CS, and na\u00efve hearing controls. We delineated a number of mostly left-hemisphere brain regions involved in CS perception. We first found that language areas were activated in all groups by both silent CS sentences and isolated lip movements, and by gestures in deaf participants only. Despite overlapping activations when perceiving CS, several findings differentiated experts from novices. The Visual Word Form Area, which supports the interface between vision and language during reading, was activated by isolated gestures in deaf CS users. In contrast, the Bayes factor indicated either weak evidence of no activation or negligible evidence of activation in hearing and control groups. Moreover, the integration of lip movements and gestures took place in a temporal language-related region in deaf users, and in movement-related regions in hearing users, reflecting their different profile of expertise in CS comprehension and production. Finally, we observed a strong involvement of the Dorsal Attentional Network in hearing users of CS, and identified the neural correlates of the variability in individual proficiency. Cued speech constitutes a novel pathway for accessing core language processes, halfway between speech perception and reading. The current study provides a delineation of the common and specific brain structures supporting those different modalities of language input, paving the way for further research.<\/jats:p>","DOI":"10.1162\/imag.a.53","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T16:02:23Z","timestamp":1749139343000},"update-policy":"https:\/\/doi.org\/10.1162\/mitpressjournals.corrections.policy","source":"Crossref","is-referenced-by-count":2,"title":["Seeing speech: Neural mechanisms of cued speech perception in prelingually deaf and hearing users"],"prefix":"10.1162","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5083-4965","authenticated-orcid":false,"given":"Annahita","family":"Sarr\u00e9","sequence":"first","affiliation":[{"name":"Inserm U 1127, CNRS UMR 7225, Sorbonne Universit\u00e9s, Institut du Cerveau, ICM, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5010-9085","authenticated-orcid":false,"given":"Laurent","family":"Cohen","sequence":"additional","affiliation":[{"name":"Inserm U 1127, CNRS UMR 7225, Sorbonne Universit\u00e9s, Institut du Cerveau, ICM, Paris, France"},{"name":"AP-HP, H\u00f4pital de La Piti\u00e9 Salp\u00eatri\u00e8re, F\u00e9d\u00e9ration de Neurologie, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"281","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"2025062417204147900_IMAG.a.53-b1","doi-asserted-by":"crossref","first-page":"3838","DOI":"10.1523\/JNEUROSCI.2948-19.2020","article-title":"Cognitive effort modulates connectivity between dorsal anterior cingulate cortex and task-relevant cortical areas","volume":"40","author":"Aben","year":"2020","journal-title":"Journal of Neuroscience"},{"key":"2025062417204147900_IMAG.a.53-b2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/095414499382255","article-title":"The role of lip-reading and cued speech in the processing of phonological information in French-educated deaf children","volume":"11","author":"Alegria","year":"1999","journal-title":"European Journal of Cognitive Psychology"},{"key":"2025062417204147900_IMAG.a.53-b3","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1093\/cercor\/12.11.1202","article-title":"Convergence of visual and tactile shape processing in the human lateral occipital complex","volume":"12","author":"Amedi","year":"2002","journal-title":"Cerebral Cortex"},{"key":"2025062417204147900_IMAG.a.53-b4","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3389\/fpsyg.2017.00426","article-title":"The neural basis of speech perception through lipreading and manual cues: Evidence from deaf native users of cued speech","volume":"8","author":"Aparicio","year":"2017","journal-title":"Frontiers in Psychology"},{"key":"2025062417204147900_IMAG.a.53-b5","first-page":"197","article-title":"A pilot study of temporal organization in Cued Speech production of French syllables: Rules for a cued speech synthesizer","volume":"44","author":"Attina","year":"2004","journal-title":"Speech Communication, Special Issue on Audio Visual Speech Processing"},{"key":"2025062417204147900_IMAG.a.53-b6","first-page":"13","article-title":"Temporal measures of hand and speech coordination during French cued speech production","volume":"3881","author":"Attina","year":"2005","journal-title":"Lecture Notes in Artificial Intelligence"},{"key":"2025062417204147900_IMAG.a.53-b7","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3389\/fpsyg.2014.00416","article-title":"How is the McGurk effect modulated by cued speech in deaf and hearing adults?","volume":"5","author":"Bayard","year":"2014","journal-title":"Frontiers in Psychology"},{"key":"2025062417204147900_IMAG.a.53-b8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1385\/NI:3:2:093","article-title":"Statistical criteria in fMRI studies of multisensory integration","volume":"3","author":"Beauchamp","year":"2005","journal-title":"Neuroinformatics"},{"key":"2025062417204147900_IMAG.a.53-b9","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s11910-017-0764-8","article-title":"Current controversies on Wernicke\u2019s area and its role in language","volume":"17","author":"Binder","year":"2017","journal-title":"Current Neurology and Neuroscience Reports"},{"key":"2025062417204147900_IMAG.a.53-b10","doi-asserted-by":"crossref","first-page":"2767","DOI":"10.1093\/cercor\/bhp055","article-title":"Where is the semantic system? 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