Speech Sequencing Therapies for Stuttering

Recruiting at 2 trial locations

Overseen By Barbara Holland

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Boston University Charles River Campus

Must not be taking: Speech medications

Disqualifiers: Seizures, Claustrophobia, Implants, others

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

Compensation: Varies

Number of Visits: 7

2 Participants Needed

Trial Summary

What is the purpose of this trial?

Persistent developmental stuttering affects more than three million people in the United States, and it can have profound adverse effects on quality of life. Despite its prevalence and negative impact, stuttering has resisted explanation and effective treatment, due in large part to a poor understanding of the neural processing impairments underlying the disorder. The overall goal of this study is to improve understanding of the brain mechanisms involved in speech motor planning and how these are disrupted in neurogenic speech disorders, like stuttering. The investigators will do this through an integrated combination of experiments that involve speech production, functional MRI, and non-invasive brain stimulation. The study is designed to test hypotheses regarding the brain processes involved in learning and initiating new speech sound sequences and how those processes compare in persons with persistent developmental stuttering and those with typical speech development. These processes will be studied in both adults and children. Additionally, these processes will be investigated in patients with neurodegenerative speech disorders (primary progressive aphasia) to further inform the investigators understanding of the neural mechanisms that support speech motor sequence learning. Together these experiments will result in an improved account of the brain mechanisms underlying speech production in fluent speakers and individuals who stutter, thereby paving the way for the development of new therapies and technologies for addressing this disorder.

Do I need to stop my current medications to join the trial?

If you have primary progressive aphasia (PPA), you cannot participate if you are taking medications that affect speech or language. For others, the protocol does not specify if you need to stop taking your current medications.

What data supports the effectiveness of the treatment Speech Sequencing Therapies for Stuttering?

Research shows that fluency training, which is part of speech therapy for stuttering, significantly reduces stuttering frequency and improves speaking rate and communication attitudes. Additionally, modified stuttering therapy programs focusing on self-therapy and specific target responses have led to greater improvements in speech fluency. ^{1 2 3 4 5}

How is the Speech Sequencing Therapy for Stuttering different from other treatments?

This treatment is unique because it focuses on practicing non-native phoneme combinations and multisyllabic nonwords, which helps improve speech fluency by enhancing the brain's ability to store and recall speech sequences as cohesive chunks, reducing memory load and improving motor performance. ^{2 6 7 8 9}

Research Team

Frank H Guenther, PhD

Principal Investigator

Boston University

Soo-Eun Chang, PhD

Principal Investigator

University of Michigan

Eligibility Criteria

This trial is for native American English speakers with limited second language exposure. It includes children who pass a hearing test, adults without neurological issues (except stuttering), and those diagnosed with primary progressive aphasia by MGH-FTD. Excluded are individuals with contraindications to MRI or tDCS, certain medication use in PPA patients, severe cognitive impairment, and outside the age range for child participants.

Inclusion Criteria

My hearing is good at specific test frequencies.

I am healthy with no history of brain, speech, or hearing problems, except for stuttering.

Only native speakers of American English with limited exposure to a second language will be recruited

Exclusion Criteria

I am not on medications that could affect my speech or language.

You cannot participate in MRI studies if you have had seizures, severe claustrophobia, metal implants in your body, or if you are pregnant.

You cannot participate if you have metal implants in your head, certain medical devices in your body, a history of seizures, significant scalp injuries, or if you are pregnant.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants undergo training sessions to learn novel speech sequences using various methods such as tDCS and fMRI

2-3 days

6-8 training sessions

Intervention

Functional MRI and other assessments are conducted to measure brain activity and speech performance

1 day

1 fMRI session

Follow-up

Participants are monitored for changes in speech performance and brain activity post-intervention

4 weeks

Treatment Details

Interventions

• Anodal tDCS
• Learning of non-native phoneme combinations: 1 training session
• Learning of non-native phoneme combinations: 6 training sessions
• Learning of non-native phoneme combinations: 8 training sessions
• Learning of novel multisyllabic nonwords
• Sham tDCS

Trial Overview The study investigates brain mechanisms in speech motor planning through experiments involving speech production tasks, functional MRI scans, and non-invasive brain stimulation like sham and anodal tDCS. Participants will learn new phoneme combinations or multisyllabic nonwords across multiple sessions to help understand these processes in people with stuttering or neurodegenerative speech disorders.

Participant Groups

Group I: Sub-syllabic learning in PPA Experimental Treatment 1 Intervention

30 adults with primary progressive aphasia (PPA) will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations during 8 training sessions over 2 days. Following training, subjects will complete a behavioral test to compare their performance on the words learned during training with a set of unfamiliar words also formed by non-native phoneme combinations.

Group II: Sub-syllabic learning and fMRI Experimental Treatment 1 Intervention

60 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations during 6 training sessions over 2 days. Following training, subjects will participate in a functional magnetic resonance imaging (fMRI) session on a third day to measure brain activity associated with producing the words learned during training and with a set of unfamiliar words also formed by non-native phoneme combinations.

Group III: Sub-syllabic learning and anodal tDCS of inferior frontal sulcus Experimental Treatment 2 Interventions

35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations. During the training, anodal transcranial direct current stimulation (tDCS) will be applied to the the subject's left inferior frontal sulcus.

Group IV: Sub-syllabic learning and anodal tDCS of cerebellum Experimental Treatment 2 Interventions

35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable words formed by non-native phoneme combinations. During the training, continuous anodal transcranial direct current stimulation (tDCS) will be applied to the the subject's right cerebellum.

Group V: Multisyllabic learning in children Experimental Treatment 1 Intervention

45 children with persistent developmental stuttering (CWS) and 45 children with neurotypical speech development (CNS) will participate in this arm. Subjects will learn nonsense words formed by novel combinations of 2 syllables that are legal in American English during 6 training sessions over 2 days. Behavioral measures extracted from the data will be used to compare performance before and after training and across the CWS and CNS participants.

Group VI: Multisyllabic learning and fMRI in adults Experimental Treatment 1 Intervention

30 adults persistent developmental stuttering (AWS) and 30 adults with neurotypical speech development (ANS) will participate in this arm. Subjects will learn nonsense words formed by novel combinations of 3 syllables that are legal in American English during 6 training sessions over 2 days. Following training, subjects will participate in a functional magnetic resonance imaging (fMRI) session on a third day to measure brain activity associated with producing the words formed by pairing 2 learned 3-syllable strings learned during training and those formed by pairing 2 unfamiliar 3-syllable strings. Behavioral measures extracted from the data will be used to compare performance before and after training and across the AWS and ANS participants.

Group VII: Sub-syllabic learning and sham tDCS Placebo Group 2 Interventions

35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable words formed by non-native phoneme combinations. During training, Sham transcranial direct current stimulation stimulation (tDCS) will be delivered to the subject's brain.

Who Is Running the Clinical Trial?

Boston University Charles River Campus

Lead Sponsor

Trials

125

Recruited

14,100+

University of Michigan

Collaborator

Trials

1,891

Recruited

6,458,000+

Massachusetts General Hospital

Collaborator

Trials

3,066

Recruited

13,430,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Findings from Research

Both intensive (16 sessions over 4 days) and spaced (2 sessions per week for 8 weeks) fluency training formats significantly reduced stuttering frequency and improved speaking rate and communication attitudes in 20 adult and adolescent participants.

Both treatment formats were equally effective, but the maintenance of improvements varied across different speaking situations, indicating that tailored training may be necessary for specific contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relative efficacy of intensive and spaced behavioral treatment of stuttering. James, JE., Ricciardelli, LA., Hunter, CE., et al.[2017]

Fluency shaping (FS) and stuttering management (SM) are both evidence-based treatments for developmental stuttering in adults, with FS focusing on treatment outcomes and SM on understanding the nature of stuttering events.

While neither treatment guarantees uniform success, strategies like self-management and modeling are effective in both approaches and should be further studied for their efficacy, potentially using cognitive behavior theory as a framework.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence-based treatment and stuttering--historical perspective. Prins, D., Ingham, RJ.[2022]

Nonspeech oral motor treatments (NSOMTs) are methods aimed at improving oral muscle function in children with developmental speech sound disorders, but their effectiveness is highly questionable.

Current research does not provide substantial evidence to support the use of NSOMTs as effective interventions for these speech disorders, raising concerns about their theoretical basis and clinical application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonspeech oral motor treatment issues related to children with developmental speech sound disorders. Ruscello, DM.[2008]

The Therapeutic Stuttering Summer-camp, involving participants aged 9 to 19, successfully reduced stuttering frequency from 22.2% to 9.5%, demonstrating a significant effect size of 1.29, indicating effective therapy.

Follow-up assessments and various measurement tools, including questionnaires and Goal Attainment Scaling, showed clear improvements in participants' handling of stuttering and fluency, confirming the therapy's efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Treatment outcome study of the stuttering therapy summer camp 2000 for children and adolescents]. Baumeister, H., Caspar, F., Herziger, F.[2006]

A modified stuttering therapy program for school-age children, which emphasized self-therapy and clearly defined targets, led to significantly greater perceived improvements in speech fluency compared to an earlier program.

Follow-up videotape samples supported the participants' perceptions of improvement, indicating that the changes in the therapy approach were effective in reducing stuttering severity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stutterers' perceptions of therapy improvement and of posttherapy regression: effects of certain program modifications. Prins, D.[2019]

In two studies involving nine people who stutter (PWS) and nine fluent speakers (PNS), significant differences were found in the speed of sequence skill learning, indicating that PWS may struggle more in the early stages of learning sequencing tasks compared to PNS.

The studies measured performance through finger tapping and reading nonsense syllables, revealing that PWS had slower reaction times and differences in retention and transfer of skills, which could inform future interventions for improving speech fluency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech and nonspeech sequence skill learning in adults who stutter. Smits-Bandstra, S., De Nil, LF., Saint-Cyr, JA.[2015]

The study demonstrated that practicing phoneme sequences with non-native consonant clusters improved utterance duration for new syllables containing those clusters, suggesting that our brains efficiently store these clusters as 'chunks' to enhance speech production.

However, practicing whole syllables led to greater reductions in error rates, indicating that while consonant clusters are important for phonological memory, syllables play a crucial role in the motor programming of speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chunking of phonological units in speech sequencing. Segawa, J., Masapollo, M., Tong, M., et al.[2020]

The study found that trained speech patterns in stuttering can be reliably identified by experts, with over 80% agreement in their assessments, similar to how fluent and stuttered speech is evaluated.

Using modified time interval analysis, the research suggests that measuring trained speech patterns could enhance outcome studies in stuttering therapy, providing a more comprehensive understanding of fluency improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measurement of trained speech patterns in stuttering: interjudge and intrajudge agreement of experts by means of modified time-interval analysis. Alpermann, A., Huber, W., Natke, U., et al.[2013]

Adults who stutter (AWS) demonstrated significantly lower accuracy in repeating nonwords as their length and complexity increased, indicating potential challenges in phonemic encoding and speech motor processes compared to control participants.

While both groups showed some practice effects, AWS did not retain improvements in speech kinematics across sessions, suggesting difficulties in skill acquisition and retention that may require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice and retention of nonwords in adults who stutter. Sasisekaran, J., Weisberg, S.[2021]

References

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

Relative efficacy of intensive and spaced behavioral treatment of stuttering. [2017]

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

Evidence-based treatment and stuttering--historical perspective. [2022]

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

Nonspeech oral motor treatment issues related to children with developmental speech sound disorders. [2008]

4. Germany pubmed.ncbi.nlm.nih.gov

[Treatment outcome study of the stuttering therapy summer camp 2000 for children and adolescents]. [2006]

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

Stutterers' perceptions of therapy improvement and of posttherapy regression: effects of certain program modifications. [2019]

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

Speech and nonspeech sequence skill learning in adults who stutter. [2015]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Chunking of phonological units in speech sequencing. [2020]

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

Measurement of trained speech patterns in stuttering: interjudge and intrajudge agreement of experts by means of modified time-interval analysis. [2013]

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

Practice and retention of nonwords in adults who stutter. [2021]