Visual Feedback Training for Aphasia

Recruiting at 2 trial locations

Overseen By Roozbeh Behroozmand, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas at Dallas

Disqualifiers: Hearing, Memory, Cognitive, Laryngeal, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 2 weeks

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve speech therapy for people with aphasia, a communication disorder often caused by a stroke, by exploring the role of auditory feedback in speech. Researchers will study how sound feedback affects speech production to develop better treatment methods. Participants with post-stroke aphasia will engage in various speech tasks using visual and audio feedback, known as Visual Feedback Training, to determine if this aids communication. Individuals who experienced a stroke over six months ago and have been diagnosed with aphasia might be suitable for this study. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance future aphasia treatments.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Visual Feedback Training is safe for individuals with aphasia?

Research has shown that visual feedback training can help people with non-fluent aphasia improve their speech. This method uses visual cues to assist individuals in understanding and speaking better. Studies indicate that this training is generally well-received, with no major reports of serious side effects or negative outcomes.

Some studies have used virtual reality (VR) to provide similar treatments for aphasia, yielding positive results and good acceptance by participants. These VR platforms often offer interactive and adaptable therapy, which participants manage well.

The treatment in this trial uses visual feedback, similar to methods in other studies. These studies have not shown significant safety concerns, suggesting that visual feedback training is likely safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Visual Feedback Training for aphasia because it offers a novel approach to improving communication skills in individuals with this condition. Unlike traditional speech therapy, which often relies on auditory exercises, this training uses visual cues to enhance language processing. This technique could be particularly beneficial for those who struggle with auditory processing, providing a personalized and potentially more effective way to regain language abilities. By tapping into visual learning, this method might offer a new pathway to recovery for people with aphasia.

What evidence suggests that Visual Feedback Training is effective for aphasia?

Research has shown that visual feedback can help people with aphasia improve their speech. In this trial, participants in the Aphasia Group will receive Visual Feedback Training, which focuses on how speech looks to enhance speech production. One study found that this approach greatly improved speech production in those with non-fluent aphasia. In another study, after 14 sessions, participants pronounced vowels and consonants more clearly. These findings suggest that visual feedback can help people with aphasia regain some speech abilities. Such improvements indicate that speech therapy could become more effective and efficient. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for English-speaking adults aged 21-75 who have aphasia after a stroke, can perform the study tasks, and have no severe hearing or cognitive issues. Healthy controls with normal speech and no neurological disorders are also needed. Both groups must be right-handed.

Inclusion Criteria

I have speech difficulties but can still do the required tasks.

I am between 21 and 75 years old.

I have never had a neurological or psychiatric disorder.

Exclusion Criteria

You have conditions that make it unsafe for you to have an EEG or MRI scan.

I have had issues with my voice box, like weakness or paralysis.

I have moderate to severe issues with hearing, memory, or thinking.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo speech production tasks under altered auditory feedback and audio-visual feedback training

2 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Visual Feedback Training

Trial Overview The study tests how visual feedback training affects speech in people with aphasia by using EEG and fMRI to track brain activity during speech tasks under altered auditory conditions. It aims to improve communication abilities and develop targeted treatments.

How Is the Trial Designed?

Group I: Control Group Experimental Treatment 1 Intervention

Group II: Aphasia Group Experimental Treatment 1 Intervention

Visual Feedback Training is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Visual Feedback Training for:

• Post-stroke aphasia
• Speech comprehension deficits
• Speech production impairments

Approved in United States as Audio-Visual Feedback Training for:

• Aphasia
• Speech disorders
• Communication impairments

Approved in Canada as Speech Therapy with Visual Feedback for:

• Post-stroke communication disorders
• Speech production deficits
• Auditory feedback impairments

Who Is Running the Clinical Trial?

The University of Texas at Dallas

Lead Sponsor

Trials

71

Recruited

108,000+

University of South Carolina

Lead Sponsor

Trials

233

Recruited

122,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Published Research Related to This Trial

In a pilot study involving 9 patients with Parkinson's disease and dysarthria, augmented visual feedback significantly improved the size of articulatory movements during speaking tasks, with 8 out of 9 participants showing increased movement amplitude after training.

The majority of participants were able to retain the learned skill 48 hours after training, indicating that this method could be a feasible approach for enhancing speech in individuals with hypokinetic dysarthria.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Game-Based Augmented Visual Feedback for Enlarging Speech Movements in Parkinson's Disease. Yunusova, Y., Kearney, E., Kulkarni, M., et al.[2019]

A 1-month study using electromagnetic articulography showed that visually guided biofeedback on tongue-tip position significantly improved articulation in an adult with Broca's aphasia and apraxia of speech, particularly for nonspeech oral tasks.

In contrast, a foil treatment using voicing-contrast stimuli resulted in only marginal improvements, indicating that visual biofeedback may be a more effective intervention for addressing articulation deficits in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electromagnetic articulography treatment for an adult with Broca's aphasia and apraxia of speech. Katz, WF., Bharadwaj, SV., Carstens, B.[2019]

A study involving 17 patients with chronic nonfluent aphasia showed that virtual reality-based therapy using the Rehabilitation Gaming System significantly improved language and communication skills compared to standard treatment, particularly in the experimental group.

Both groups improved in vocabulary retention after treatment, but only the virtual reality group demonstrated lasting improvements in overall language and communication skills at the 16-week follow-up, highlighting the potential of technology-enhanced rehabilitation methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmented Dyadic Therapy Boosts Recovery of Language Function in Patients With Nonfluent Aphasia. Grechuta, K., Rubio Ballester, B., Espín Munne, R., et al.[2020]

In a study involving 62 participants aged around 12 years, the majority reported no concerns about using ultrasound visual feedback in speech therapy, indicating a generally positive reception of the treatment.

The most common undesired effects reported were related to the ultrasound gel (40%) and probe positioning (21%), but these were considered minor and should be balanced against the potential benefits of the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do Participants Report Any Undesired Effects in Ultrasound Speech Therapy? Preston, JL., Holliman-Lopez, G., Leece, MC.[2023]

The Lexi study aims to evaluate whether the Neolexon® app, used alongside standard speech therapy, is more effective in treating acute post-stroke aphasia than standard therapy alone, involving 180 patients over a 4-week treatment period.

The primary outcome will measure the difference in aphasia severity using the Bielefelder Aphasie Screening (BIAS), with a follow-up after 3 months to assess overall effectiveness and quality of life improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Follow-Up in Aphasia Caused by Acute Stroke in a Prospective, Randomized, Clinical, and Experimental Controlled Noninvasive Study With an iPad-Based App (Neolexon®): Study Protocol of the Lexi Study. Thunstedt, DC., Young, P., Küpper, C., et al.[2020]

Non-invasive neurostimulation techniques have shown promising results in improving word-retrieval deficits in chronic stroke patients with aphasia, suggesting a new avenue for rehabilitation.

Action observation therapy, which involves observing or executing gestures, has been found to positively influence language recovery, particularly for action-related words, indicating its potential as an effective treatment for aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy. Marangolo, P., Caltagirone, C.[2014]

In a study involving eight globally aphasic patients who did not respond to traditional treatments, Visual Action Therapy (VAT) led to significant improvements in their ability to produce symbolic gestures and understand auditory information.

Statistical analyses of pre and post-treatment scores on the Porch Index of Communicative Ability (PICA) showed marked enhancements in pantomimic and auditory comprehension skills, suggesting VAT is an effective nonvocal intervention for improving communication in aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visual action therapy for global aphasia. Helm-Estabrooks, N., Fitzpatrick, PM., Barresi, B.[2019]

In a study involving 20 participants (10 with aphasia/apraxia of speech and 10 neurologically healthy), 7 out of 10 individuals with speech disorders showed improved fluency when using masked auditory feedback (MAF), suggesting that this method can help some people with speech difficulties.

In contrast, the control condition of altered auditory feedback (AAF) did not lead to improvements in fluency for most participants, indicating that MAF may specifically address issues related to auditory feedback monitoring in speech disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback. Jacks, A., Haley, KL.[2018]

Visual feedback significantly improved the production of /s/ sounds in six patients with cleft palate, particularly for those with abnormal tongue positioning, as assessed by objective measures.

The study utilized the Rion Electropalatograph and a multi-function speech training aid to provide visual feedback, demonstrating the effectiveness of these tools in speech therapy for cleft palate patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Role of visual feedback treatment for defective /s/ sounds in patients with cleft palate. Michi, K., Yamashita, Y., Imai, S., et al.[2019]

In two studies involving 6 adults with apraxia of speech (AOS), reduced-frequency or delayed feedback during speech skill training improved learning outcomes for some participants, suggesting a beneficial approach to treatment.

The results indicate that while structured interventions can help individuals with AOS, the effectiveness of feedback strategies may be influenced by other factors like the complexity of the speech tasks, highlighting the need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of feedback frequency and timing on acquisition, retention, and transfer of speech skills in acquired apraxia of speech. Austermann Hula, SN., Robin, DA., Maas, E., et al.[2022]

Speech and language therapy for individuals with aphasia after a stroke has been shown to lead to significant improvements in various domains of functioning, including impairment, activity, participation, and well-being, based on a study of 1664 patients.

The results from this large group of patients align with findings from randomized control trials, reinforcing the effectiveness of speech and language therapy in rehabilitation for aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Where are we now with aphasia after Stroke? Enderby, P., Sutton, L.[2022]

In a study involving 30 older adults, visual-verbal and verbal-quantitative feedback methods significantly improved their ability to match different speaking rates compared to verbal-qualitative feedback.

The findings suggest that using more precise feedback methods can enhance performance in tasks like speech rate matching, which could be beneficial for training individuals with speech disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of three feedback modes on the ability of normal geriatric individuals to match speaking rate. Hyland, JD., Weismer, G.[2019]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S1877065716302561

Effect of visual feedback on speech recovery and language ... To assess the efficiency of Visual Feedback (VF) on language recovery and plasticity in three chronic non-fluent aphasic patients.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2679690/

Treating visual speech perception to improve speech ... The findings suggest that focusing on visual speech perception can significantly improve speech production in non-fluent aphasia.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9256784/

Complexity and feedback during script training in aphasia This study reinforces script training as a treatment option for aphasia. Results show that training improves accuracy and rate of production of ...

4. thelancet.com thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00062-2/fulltext

Efficacy of a gamified digital therapy for speech production ... A gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised ...

5. researchgate.net researchgate.net/publication/308450487_Effect_of_visual_feedback_on_speech_recovery_and_language_plasticity_in_patients_with_post-stroke_non-fluent_aphasia_Functional_MRI_assessment

Effect of visual feedback on speech recovery and language ... Results After 14 sessions of VF, acoustic analyses showed a more canonical vowel production and better repetition of consonants. Speech analysis ...

6. frontiersin.org frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1401240/full

AI-assisted assessment and treatment of aphasia: a review The majority of studies applying VR in aphasia treatment have demonstrated positive results (61). One particularly prominent VR platform is the ...

7. pubs.asha.org pubs.asha.org/doi/10.1044/2025_PERSP-25-00035

The Potential Role of Immersive Virtual Reality Interventions iVR shows potential as an innovative tool for speech-language rehabilitation, offering adaptable and interactive therapy options. While initial studies indicate ...

8. researchgate.net researchgate.net/publication/342586600_Speech_rehabilitation_in_post-stroke_aphasia_using_visual_illustration_of_speech_articulators_A_case_report_study

Speech rehabilitation in post-stroke aphasia using visual ... Speech rehabilitation in post-stroke aphasia using visual illustration of speech articulators. A case report study. June 2020. Authors: Célise Haldin at ...