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

Trial Summary

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 data supports the effectiveness of the treatment Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) for apraxia of speech?

Research on similar treatments for apraxia of speech, like the Phonomotor Treatment (PMT) and augmented feedback methods, shows that repeated practice and feedback can improve speech accuracy and maintain treatment effects over time. These findings suggest that using motor imagery, which involves mentally practicing movements, might also help enhance speech therapy outcomes by reinforcing motor planning and execution. ^{1 2 3 4 5}

Is motor imagery safe for humans?

The research on motor imagery, mainly focused on stroke rehabilitation, suggests it is generally safe for humans, as it involves mentally practicing movements without physical execution. ^{6 7 8 9 10}

How does the Motor Imagery treatment for Apraxia of Speech differ from other treatments?

Motor Imagery for Apraxia of Speech is unique because it likely involves using mental visualization techniques to improve speech motor planning, which is different from traditional treatments that focus on physical speech practice or error reduction strategies. This approach may offer a novel way to engage the brain's motor pathways without direct speech production, potentially benefiting those who struggle with conventional methods. ^{1 3 5 11 12}

What is the purpose of this trial?

Treatment of post-stroke apraxia of speech (AOS) requires frequent and ongoing practice with a speech-language pathologist to facilitate lasting behavioral change, which is costly and, therefore, inaccessible to many patients. Thus, there is a critical need to identify novel, cost-effective ways to supplement speech therapy to increase opportunities for practice and optimize treatment outcomes. Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) which will serve as an adjunct to routine speech therapy to optimize treatment response in persons with AOS. The overall objectives of this application are to (i) evaluate the acceptability and feasibility of MI-TEE as a home practice program and (ii) determine the efficacy of MI-TEE with speech therapy, compared to speech therapy alone, in improving speech production in people with AOS. Our central hypothesis is that MI-TEE will be an accessible, feasible, and efficacious adjunct to speech therapy. To attain our objectives, the following specific aims will be pursued using two single-subject experimental designs with multiple baselines across participants (n=18): 1) Evaluate the acceptability and feasibility of MI-TEE as an adjunct to speech therapy for the rehabilitation of AOS; and 2) Compare the efficacy of adjunctive MI-TEE plus standard speech therapy to standard speech therapy alone. Under the first aim, observational data, surveys, and semi-structured interviews will be employed to assess the acceptability (perceived satisfaction, appropriateness, and intent to continue use) and feasibility (recruitment, retention, and intervention adherence rates) of MI-TEE. For the second aim, accuracy of articulation for trained words and untrained words (generalization) will be measured pre-treatment, repeatedly during the treatment phase, and post-treatment. Improvements in speech accuracy will be documented using a binary scoring system (correct/incorrect). Multilevel analyses will be used to address rate of acquisition, overall change, and response variation across participants.

Research Team

Lauren Bislick Wilson, Ph.D.

Principal Investigator

University of Central Florida

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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) 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]

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]

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 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 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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Treatment for acquired apraxia of speech: examination of treatment intensity and practice schedule. [2016]

2. United States pubmed.ncbi.nlm.nih.gov

Sound production treatment: effects of blocked and random practice. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

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

4. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

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

6. Netherlands pubmed.ncbi.nlm.nih.gov

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

7. England pubmed.ncbi.nlm.nih.gov

Effects of a single mental chronometry training session in subacute stroke patients - a randomized controlled trial. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Motor imagery in stroke patients: a descriptive review on a multidimensional ability. [2020]

9. England pubmed.ncbi.nlm.nih.gov

Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial. [2021]

10. Netherlands pubmed.ncbi.nlm.nih.gov

The functional anatomy of motor imagery after sub-acute stroke. [2019]

11. England pubmed.ncbi.nlm.nih.gov

Error reduction therapy in reducing struggle and grope behaviours in apraxia of speech. [2016]

12. United States pubmed.ncbi.nlm.nih.gov

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