Auditory Feedback Effects on Speech

Overseen By Ludo Max

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Must not be taking: Sensorimotor affecting

Disqualifiers: Neurological problems, Hearing loss, others

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

Compensation: Varies

Number of Visits: 1

507 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how hearing one's own voice affects speech planning and movements. Researchers are studying both typical speakers and individuals with Deep Brain Stimulation (DBS) implants, used to treat conditions like Parkinson's disease. Participants will perform speech tasks while researchers record their speech, and DBS patients will complete these tasks with their stimulators both on and off. The trial is ideal for native American English speakers without communication issues and for DBS patients with specific electrode placements. As an unphased study, this trial offers a unique opportunity to contribute to groundbreaking research in speech and neurological science.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it mentions that participants should not be on medications that affect sensorimotor functioning, except for those in the DBS group.

What prior data suggests that these methods are safe for participants?

Research shows that altering how individuals hear their own voice while speaking is generally safe. This technique, often used in speech therapy, does not cause harm and helps researchers understand how people control speech.

For deep brain stimulation (DBS), the effects on speech can differ. Some studies have found that DBS might cause slurred speech or changes in voice volume. These effects vary, and not everyone experiences them; some people notice no change in their speech.

Lastly, studies using virtual reality have shown that altering visual feedback during movement tasks is also safe. This method aids researchers in understanding how people control their movements.

Prospective participants should discuss with their healthcare provider, who can offer advice tailored to individual health needs. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how auditory and visual feedback, along with deep brain stimulation (DBS), can influence speech and movement, offering insights into the brain's control mechanisms. Unlike traditional treatments that may focus on medication or therapy to manage speech or motor disorders, this approach investigates how real-time feedback and DBS can directly alter neural pathways and improve motor learning. By manipulating auditory feedback with digital processors or visual feedback through virtual reality, combined with the unique ability to toggle DBS on and off, this trial could uncover new ways to enhance speech and movement control, potentially leading to more effective, non-invasive treatment strategies in the future.

What evidence suggests that this trial's treatments could be effective?

Research has shown that hearing one's own voice is crucial for speech. When people hear their voice altered, they often adjust their speech to correct it. This suggests that self-monitoring helps identify and fix errors in speech. In this trial, one group will experience auditory feedback perturbation during speech to explore these effects.

Another group will undergo Deep Brain Stimulation (DBS), with the stimulation toggled ON/OFF. The effects of DBS on speech are mixed. Some studies have found that it can reduce fluency, while others observe little change in clarity. The effects can vary depending on the targeted brain region. ^{6 7 8 9 10}

Who Is on the Research Team?

Ludo Max, Ph.D.

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

This trial is for American English native speakers who have normal communication and neurological function, except those with DBS implants. Adults must be 18 or older with specific hearing thresholds. Children aged between 4 to nearly 7 years old or from 10 to nearly 13 are also eligible. Participants should not be on medications affecting sensorimotor skills, unless they're part of the DBS group.

Inclusion Criteria

My child is either 4 to 6 years old or 10 to 12 years old.

I am not on medication that affects my movement or senses, except if I'm in the DBS group.

I am a native American English speaker.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Data Collection

Participants read words, sentences, or series of random syllables while their speech is recorded. For some, an electrode cap records brain activity. DBS patients perform tasks with the stimulator ON and OFF.

1-2 hours

1 visit (in-person)

Follow-up

Participants are monitored for any immediate effects or changes post data collection

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Auditory feedback perturbation during speech
• DBS stimulation ON/OFF
• Visual feedback perturbation during reaching

Trial Overview The study examines how auditory feedback influences speech movements in typical individuals and patients with Deep Brain Stimulation (DBS) implants by having them read aloud while their speech and brain activity are monitored. For DBS patients, tasks will be done with stimulation turned both ON and OFF.

How Is the Trial Designed?

Group I: Visual feedback perturbation during reaching Experimental Treatment 1 Intervention

The intervention consists of manipulating real-time visual feedback during upper limb reaching movements. In our lab, such feedback perturbations can be implemented with a virtual reality display system.

Group II: Deep brain stimulation Experimental Treatment 1 Intervention

This intervention consists of toggling the deep brain stimulation (DBS) implant ON/OFF prior to participation in the speech auditory-motor learning tasks and speech sequence learning tasks. This intervention can be implemented by the subject themselves as all patients have a hand- held controlled that they use to switch stimulation ON/OFF.

Group III: Auditory feedback perturbation during speech Experimental Treatment 1 Intervention

The intervention consists of manipulating real-time auditory feedback during speech production. In our lab, such feedback perturbations can be implemented with either a stand-alone digital vocal processor (a device commonly used by singers and the music industry) or with software-based signal processing routines (see Equipment section for details). Note that the study does not investigate the efficacy of these hardware or software methods to induce behavioral change in subjects' speech. Rather, the study addresses basic experimental questions regarding the general role of auditory feedback in the central nervous system's control of articulatory speech movements.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Published Research Related to This Trial

When subjects spoke and their auditory feedback was unexpectedly altered, they compensated for the change within about 136 milliseconds, demonstrating a quick neural response to auditory feedback.

Neuroimaging showed that this compensation involved increased activity in specific brain areas, particularly the bilateral superior temporal cortex and right prefrontal cortex, suggesting that these regions work together to correct speech based on auditory feedback.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neural mechanisms underlying auditory feedback control of speech. Tourville, JA., Reilly, KJ., Guenther, FH.[2021]

The study identified specific areas in the human brain, particularly in the posterior superior temporal gyrus, that respond differently to normal and altered auditory feedback during vocalization, indicating a complex network involved in pitch control.

When subjects' pitch was perturbed, they adjusted their vocal output accordingly, and the degree of these adjustments was linked to brain responses, suggesting that this sensorimotor network plays a crucial role in how we use auditory feedback to control our speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Human cortical sensorimotor network underlying feedback control of vocal pitch. Chang, EF., Niziolek, CA., Knight, RT., et al.[2022]

This study used magnetoencephalography (MEG) to identify distinct brain networks involved in processing auditory feedback during speech, revealing that the left ventral supramarginal gyrus/posterior superior temporal sulcus (vSMG/pSTS) plays a crucial role in monitoring and correcting pitch errors.

The research found that while speaking, the brain suppresses responses to speech onset but enhances activity in specific regions during pitch perturbations, indicating a complex network that helps speakers quickly adjust their pitch in response to auditory feedback.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A bilateral cortical network responds to pitch perturbations in speech feedback. Kort, NS., Nagarajan, SS., Houde, JF.[2021]

The study used magnetoencephalography (MEG) to investigate how the brain processes altered auditory feedback during speech, revealing that auditory cortical areas are more active when participants vocalize compared to when they listen without speaking.

Findings indicate that changes in brain wave patterns, specifically increases in θ and lower β band power, are linked to the brain's ability to detect motor errors and process sensory predictions, supporting the theory of an active comparison between expected and actual speech output.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-monitoring in the cerebral cortex: Neural responses to small pitch shifts in auditory feedback during speech production. Franken, MK., Eisner, F., Acheson, DJ., et al.[2019]

The study identified three distinct brain networks involved in processing auditory feedback during speech, highlighting that one network encodes an 'error signal' when vocalizing, regardless of the type of distortion in the feedback.

Another network is sensitive to speech features during passive listening but shows reduced sensitivity when the same sounds are part of vocalization, indicating that speech motor control involves multiple, interactive neural systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multivoxel patterns reveal functionally differentiated networks underlying auditory feedback processing of speech. Zheng, ZZ., Vicente-Grabovetsky, A., MacDonald, EN., et al.[2022]

In a study involving 20 Parkinson's disease patients with subthalamic deep brain stimulation (DBS), the stimulation did not significantly change vocal responses to pitch-shifted feedback, indicating that DBS may not effectively modulate speech-related auditory-motor integration deficits.

While DBS did not enhance vocal compensations, it was associated with increased brain activity in auditory regions during listening tasks, suggesting that while DBS affects brain function, it does not translate to improved speech performance in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deep Brain Stimulation Does Not Modulate Auditory-Motor Integration of Speech in Parkinson's Disease. Bahners, BH., Florin, E., Rohrhuber, J., et al.[2020]

Deep brain stimulation (DBS) can significantly improve speech in Parkinson's disease patients, bringing their speech closer to normal levels when settings are optimized for motor performance.

However, the study found that the DBS settings aimed at relieving motor symptoms can sometimes impair speech, highlighting the need for careful adjustment of DBS parameters to avoid negatively affecting communication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acoustic Analysis of PD Speech. Chenausky, K., Macauslan, J., Goldhor, R.[2022]

High-definition transcranial direct current stimulation (HD-tDCS) of the left ventral motor cortex significantly affects voice motor control, particularly reducing vocal compensation in response to downward pitch-shift stimuli during altered auditory feedback.

The study found that both anodal and cathodal HD-tDCS reduced vocal compensation, with stronger effects from cathodal stimulation, suggesting that neurostimulation enhances feedforward motor mechanisms in speech production.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modulation of vocal pitch control through high-definition transcranial direct current stimulation of the left ventral motor cortex. Behroozmand, R., Johari, K., Bridwell, K., et al.[2021]

Anodal transcranial direct current stimulation (tDCS) over the speech motor cortex significantly increased the rate of sensorimotor adaptation in participants, suggesting a potential method to enhance speech motor control.

The study's computational modeling indicated that tDCS primarily improved the integration of auditory feedback into speech motor plans by increasing the feedforward learning rate, highlighting a mechanism for how neurostimulation can influence speech production.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Noninvasive neurostimulation of left ventral motor cortex enhances sensorimotor adaptation in speech production. Scott, TL., Haenchen, L., Daliri, A., et al.[2021]

The model of speech motor control suggests that speech production relies on a combination of feedforward control from the motor cortex and cerebellum, along with auditory and somatosensory feedback systems, highlighting the complexity of how we learn and produce speech.

This framework not only explains how new speech sounds are learned and refined through practice but also serves as a basis for understanding communication disorders linked to brain dysfunction, integrating various types of data from kinematic, acoustic, and neuroimaging studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cortical interactions underlying the production of speech sounds. Guenther, FH.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3658624/

Neural mechanisms underlying auditory feedback control of ... The current study utilizes auditory perturbation of speech, in the form of unpredictable upward and downward shifts of the first formant frequency, to identify ...

2. frontiersin.org frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2022.905365/full

Perturbing the consistency of auditory feedback in speech We used a real-time formant manipulation system to explore how reliant speech articulation is on the accuracy or predictability of auditory feedback ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0028393224001593

Effects of attentional instructions on the behavioral and ... The present study investigated how instructions for paying attention to auditory feedback may affect speech error detection and sensorimotor control.

4. colorado.edu colorado.edu/lab/motor-speech/sites/default/files/attached-files/task_dependent_loudness_shift.pdf

Task-Dependent Modulation of Auditory Feedback Control ... When loudness auditory feedback perturbations were applied to ongoing speech, the resulting vocal intensity responses were larger in sentence production than ...

5. researchgate.net researchgate.net/publication/350009326_Responses_to_Auditory_Feedback_Manipulations_in_Speech_May_Be_Affected_by_Previous_Exposure_to_Auditory_Errors

Responses to Auditory Feedback Manipulations in Speech ... PDF | Purpose Speakers use auditory feedback to guide their speech output, although individuals differ in the magnitude of their compensatory response.

6. elifesciences.org elifesciences.org/articles/94198

Speech-induced suppression and vocal feedback ... A common hypothesis is that suppression increases sensitivity to auditory feedback, enabling the detection of vocalization errors.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9453207/

Perturbing the consistency of auditory feedback in speech We used a real-time formant manipulation system to explore how reliant speech articulation is on the accuracy or predictability of auditory feedback ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S089219972400359X

Altered Auditory Feedback in Teachers: A Preliminary ... The current study was designed to explore the effects of altered auditory feedback via bone conduction on voice production measures in university professors.

9. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/33705674/

Responses to Auditory Feedback Manipulations in Speech ... We test whether manipulating the perceived reliability of auditory feedback modulates speakers' compensation to auditory perturbations.

10. pubs.asha.org pubs.asha.org/doi/10.1044/2017_JSLHR-S-17-0072

The Potential Effect of Forbrain as an Altered Auditory ... It is suggested that Forbrain® works as an altered auditory feedback device. It may hence be used as a clinical device in speech therapy clinics.