Motor Imagery for Apraxia of Speech

(MI-TEE Trial)

Overseen By Lauren Bislick Wilson, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Central Florida

Disqualifiers: Aphasia, Dysarthria, Untreated depression, others

Stay on Your Current Meds You can continue your current medications while participating

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 6

Duration: 8.3 weeks

18 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial seeks a cost-effective method to help individuals with apraxia of speech (AOS) after a stroke improve their speech. It tests whether a home-based program called MI-TEE (Motor Imagery for Treatment Enhancement and Efficacy), used alongside speech therapy, enhances speech recovery more than therapy alone. Participants will receive either no treatment, speech therapy alone, or speech therapy with the MI-TEE program. The trial is ideal for English speakers who experienced a stroke on the left side of the brain at least six months ago and continue to have speech difficulties. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could enhance speech recovery methods for future patients.

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 is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that the MI-TEE protocol is safe for use in speech therapy?

Research has shown that Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) might be a safe option for people with apraxia of speech. One study involved four individuals with long-term apraxia of speech and aphasia. They experienced better speech accuracy, indicating that the treatment was well-received and effective.

Although detailed information on side effects isn't available, the lack of reported negative effects in these small studies is encouraging. Since MI-TEE involves mental exercises instead of medication, it may pose fewer risks than traditional therapies. This makes it a potentially safe and accessible way to improve speech when used alongside standard speech therapy. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) because it offers a novel approach to enhancing speech therapy for apraxia of speech. Unlike traditional speech therapy, which primarily involves direct practice of speech movements, MI-TEE incorporates mental visualization of these movements, potentially strengthening neural pathways in the brain. This technique could make therapy more effective and accessible, as it includes a home practice program, allowing patients to engage in therapy outside clinical settings. The combination of speech therapy with motor imagery may accelerate progress and improve outcomes compared to conventional methods alone.

What evidence suggests that the MI-TEE protocol is effective for treating apraxia of speech?

Studies have shown that motor imagery, which involves imagining oneself performing movements, can enhance speech therapy outcomes for individuals with apraxia of speech (AOS). This trial will examine two conditions: one where participants receive only speech therapy and another where they receive speech therapy combined with motor imagery for treatment enhancement and efficacy (MI-TEE). Research suggests that integrating motor imagery with standard speech therapy can improve speech clarity and accuracy. Early findings indicate that this approach might offer a cost-effective addition to traditional therapy, increasing accessibility for many patients. By amplifying the effects of speech therapy, motor imagery could lead to better and longer-lasting speech improvements for those with AOS. ^{1 6 7 8 9}

Who Is on the Research Team?

Lauren Bislick Wilson, Ph.D.

Principal Investigator

University of Central Florida

Are You a Good Fit for This Trial?

This trial is for individuals with speech difficulties due to conditions like dyspraxia or apraxia, specifically those who have had a stroke. It's designed to help improve their speech production through regular practice and therapy.

Inclusion Criteria

Pass a hearing screening at 35 dB HL at 500, 1K, and 2K Hz for at least one ear

My vision is normal or corrected to normal with glasses or contacts.

It has been over 6 months since my stroke in the left side of my brain.

Exclusion Criteria

I am not currently receiving any other speech therapy.

I have a condition that slowly worsens my brain or nerves.

Scoring less than 3 on the Motor Imagery Questionnaire-Revised Short Form (MIQ-RS77)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline

Pre-treatment baseline testing to collect data points before treatment initiation

2 weeks

Treatment

Participants receive speech therapy 3 days a week for 8.3 weeks, with additional MI-TEE home practice sessions

8.3 weeks

3 visits per week (in-person or virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment with follow-up probes at 2, 6, and 10 weeks

10 weeks

3 follow-up visits

What Are the Treatments Tested in This Trial?

Interventions

• Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE)

Trial Overview The study tests a computer-based program called MI-TEE, used at home alongside standard speech therapy. The goal is to see if adding MI-TEE helps people get better at speaking more than just therapy alone.

How Is the Trial Designed?

Group I: Condition 2 Experimental Treatment 2 Interventions

Condition 2 will include two phases: (A) no treatment; (C) speech therapy plus MI-TEE (the home practice program).

Group II: Condition 1 Experimental Treatment 2 Interventions

Condition 1 will have three phases: (A) no treatment; (B) speech therapy alone; (C) speech therapy plus MI-TEE (the home practice program).

Who Is Running the Clinical Trial?

University of Central Florida

Lead Sponsor

Trials

101

Recruited

1,191,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Published Research Related to This Trial

In a study involving 4 speakers with chronic apraxia of speech and aphasia, all participants showed improved accuracy in speech production across different treatment intensities and schedules using sound production treatment (SPT).

No significant differences in treatment outcomes were found between the various SPT applications, suggesting that different intensities and practice schedules can be equally effective for improving speech accuracy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment for acquired apraxia of speech: examination of treatment intensity and practice schedule. Wambaugh, JL., Nessler, C., Cameron, R., et al.[2016]

Motor imagery (MI) abilities are significantly impaired after a stroke, affecting both implicit and explicit mental representations of movement, as evidenced by 15 studies reviewed from a total of 885.

Neuroimaging studies indicate that after a stroke, there is brain reorganization, with increased reliance on the contralesional hemisphere to compensate for motor deficits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor imagery in stroke patients: a descriptive review on a multidimensional ability. Santoro, S., Lo Buono, V., Corallo, F., et al.[2020]

The review highlights that response generalization in apraxia of speech (AOS) treatments has been limited, primarily focusing on untrained examples of trained behaviors rather than novel behaviors, which may restrict the effectiveness of treatment outcomes.

The paper emphasizes the importance of understanding speech motor control theories to improve treatment efficacy research, suggesting that better hypothesis development and behavior selection could enhance response generalization in AOS therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Response generalization in apraxia of speech treatments: taking another look. Ballard, KJ.[2019]

The article outlines a three-step decision process for treating apraxia of speech, focusing on whether to target articulation or prosody, defining specific targets, and practicing them in larger speech units.

It emphasizes the importance of phonetic and linguistic parameters in selecting treatment targets, and reviews recent treatment reports to enhance the understanding of effective target selection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Considerations in target selection in apraxia of speech treatment. Odell, KH.[2004]

Sound Production Treatment (SPT) was effective in improving the accuracy of speech sounds in 6 participants with acquired apraxia of speech (AOS) and aphasia, regardless of whether the treatment was presented in a blocked or random order.

The random presentation of treatment words (SPT-random) showed potential advantages in maintaining improvements for some participants, suggesting that different practice methods may influence treatment outcomes in AOS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sound production treatment: effects of blocked and random practice. Wambaugh, JL., Nessler, C., Wright, S., et al.[2016]

Motor imagery (MI) shows some potential benefits for improving walking speed in stroke rehabilitation, based on a Cochrane review of 21 studies involving 762 participants.

However, the evidence is of very low certainty, and more high-quality research is needed to better understand MI's effects on motor function and overall mobility compared to other therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is motor imagery effective for gait rehabilitation after stroke? A Cochrane Review summary with commentary. Sen, EI.[2022]

In a study of 17 patients recovering from ischemic stroke and 12 healthy individuals, motor imagery (MI) showed a more balanced activation of the cortical motor network in both groups, suggesting preserved brain function during MI.

The findings indicate that this balanced cortical activity in stroke patients could serve as a promising foundation for using MI as a rehabilitative therapy to enhance recovery in the sub-acute stage after a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The functional anatomy of motor imagery after sub-acute stroke. Kraft, E., Schaal, MC., Lule, D., et al.[2019]

A single session of motor imagery training significantly improved mental chronometry and motor execution in subacute stroke patients, indicating its potential as a beneficial rehabilitation tool.

Patients with severe sensory deficits showed poorer performance in motor tasks, but their ability to improve through motor imagery training was not negatively affected, suggesting that this training could be effective regardless of sensory challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a single mental chronometry training session in subacute stroke patients - a randomized controlled trial. Liepert, J., Stürner, J., Büsching, I., et al.[2022]

Motor imagery (MI) combined with physiotherapy significantly improved the ability of stroke patients to perform a complex motor task, with all groups showing reduced time to complete the task and decreased need for assistance after the intervention.

While both added and embedded MI strategies were beneficial, only the embedded MI group showed significant changes in MI ability over time, suggesting that this approach may enhance the learning of motor tasks more effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial. Schuster, C., Butler, J., Andrews, B., et al.[2021]

A self-administered computer therapy targeting whole word production significantly improved speech accuracy and fluency in individuals with acquired apraxia of speech over a six-week intervention period.

Participants not only showed immediate improvements in their speech but also maintained these gains after the therapy was withdrawn, indicating the long-term effectiveness of the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Error reduction therapy in reducing struggle and grope behaviours in apraxia of speech. Whiteside, SP., Inglis, AL., Dyson, L., et al.[2016]

The modified Phonomotor Treatment (PMT) program showed improved speech repetition accuracy in individuals with apraxia of speech (AOS) and aphasia, with one participant maintaining treatment effects 10 weeks posttreatment.

The study suggests that a multimodal approach, which includes participant-specific modifications to traditional PMT, may be more effective in addressing both motor planning and linguistic deficits in patients with AOS and aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phonomotor Approach to Apraxia of Speech Treatment. Bislick, L.[2021]

The study found that augmented visual kinematic feedback (AVKF) significantly improved speech accuracy in two adults with acquired apraxia of speech (AOS), suggesting that this type of feedback can enhance motor learning for speech production.

Positive effects were observed in both the acquisition of speech motor targets and their generalization to untreated contexts, indicating that AVKF may help individuals with AOS produce more accurate speech over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech. McNeil, MR., Katz, WF., Fossett, TR., et al.[2021]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06467136?cond=Apraxia&viewType=Table&rank=4

Motor Imagery for Treatment Enhancement and Efficacy in ... Treatment of post-stroke apraxia of speech (AOS) requires frequent and ongoing practice with a speech-language pathologist to facilitate lasting behavioral ...

2. reporter.nih.gov reporter.nih.gov/search/b_J15wGrcUW09Cs4fN2oxg/project-details/10887649

RePORT RePORTER - National Institutes of Health (NIH) | Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol [Motor Imagery for Treatment Enhancement and Efficacy (MI- ...

3. withpower.com withpower.com/trial/phase-apraxia-oral-11-2023-2033d

Motor Imagery for Apraxia of Speech (MI-TEE Trial) These findings suggest that using motor imagery, which involves mentally practicing movements, might also help enhance speech therapy outcomes by reinforcing ...

4. msesiom.demo.elsevierpure.com msesiom.demo.elsevierpure.com/en/projects/motor-imagery-for-treatment-enhancement-and-efficacy-mi-tee-in-pe/fingerprints/

Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) ... Nursing and Health Professions · Speech Therapy 100% · Apraxia of Speech 50% · Logopedics 18% · Treatment Response 12% · Treatment Outcome 6% · Scoring System 6%.

5. highergov.com highergov.com/grant/R21DC020548/

Grant R21DC020548 The University Of Central Florida Board ... Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol [Motor Imagery for Treatment Enhancement and Efficacy (MI- ...

6. ctv.veeva.com ctv.veeva.com/study/motor-imagery-for-treatment-enhancement-and-efficacy-in-persons-with-apraxia-of-speech

Motor Imagery for Treatment Enhancement and Efficacy in ... Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol Motor Imagery for Treatment Enhancement and ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11563796/

Exploring motor imagery as a therapeutic intervention for ... The experimental group found an 85.2% improvement on the Timed Up and Go (TUG) with a cognitive task (p < 0.02), 5.8% improvement on the TUG (p < 0.05), and 5.1 ...

8. ucf.edu ucf.edu/news/ucf-researcher-receives-nih-grant-to-develop-new-speech-therapies-for-stroke-survivors/

UCF Researcher Receives NIH Grant to Develop New ... The treatment, individually curated for each patient, will present sounds and images of target words, prompting the patient to imagine speaking ...

9. reporter.nih.gov reporter.nih.gov/project-details/10887649

Motor Imagery for Treatment Enhancement and Efficacy (MI ... We're sorry but RePORTER doesn't work properly without JavaScript enabled. Please enable it to continue.