Motor Learning Techniques for Speech

Overseen By David Ostry

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Yale University

Must not be taking: Psychoactive medications

Disqualifiers: Epilepsy, Neurological disorders, Pregnancy, others

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

Compensation: Varies

Number of Visits: 1

120 Participants Needed

Trial Summary

What is the purpose of this trial?

The overall goal of this research is to test a new model of speech motor learning, whose central hypothesis is that learning and retention are associated with plasticity not only in motor areas of the brain but in auditory and somatosensory regions as well. The strategy for the proposed research is to identify individual brain areas that contribute causally to retention by disrupting their activity with transcranial magnetic stimulation (TMS). Investigators will also use functional magnetic resonance imaging (fMRI) which will enable identification of circuit-level activity which predicts either learning or retention of new movements, and hence test the specific contributions of candidate sensory and motor zones. In other studies, investigators will record sensory and motor evoked potentials over the course of learning to determine the temporal order in which individual sensory and cortical motor regions contribute. The goal here is to identify brain areas in which learning-related plasticity occurs first and which among these areas predict subsequent learning.

Will I have to stop taking my current medications?

The trial excludes participants who are taking psychoactive medications, so you may need to stop taking those if you wish to participate.

What data supports the effectiveness of the treatment Speech Motor Learning for improving speech?

Research shows that using principles of motor learning can improve speech outcomes in children with cleft palate and childhood apraxia of speech, suggesting that similar techniques may be effective for other speech disorders. Studies indicate that these methods help children improve their speech sounds and maintain these improvements over time. ^{1 2 3 4 5}

Is the speech motor learning technique safe for humans?

The research does not specifically address safety concerns, but speech motor learning techniques have been applied in various studies with children and adults, suggesting they are generally considered safe for use in humans. ^{2 3 4 6 7}

How does the treatment Speech Motor Learning differ from other treatments for speech conditions?

Speech Motor Learning is unique because it focuses on the integration of auditory, motor, and linguistic information to build a comprehensive speech-motor representation. It emphasizes the role of memory consolidation and sensory feedback, particularly somatic sensory memory, in adapting and improving speech production, which is different from other treatments that may not consider these aspects. ^{8 9 10 11 12}

Research Team

David Ostry

Principal Investigator

Yale University

Eligibility Criteria

This trial is for individuals who are interested in participating in research about speech. There are specific criteria to join, but they aren't listed here.

Inclusion Criteria

No speech disorder or reading disability

I speak English fluently.

Right-handed

Exclusion Criteria

Metal implants

Implanted neurostimulator

Metal in brain, skull, or spinal cord

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Speech Motor Learning

Participants undergo speech motor learning with evoked potentials recorded from auditory, somatosensory, and motor cortices using TMS, pure tone bursts, and mentalis nerve stimulation.

30 minutes per session

Multiple sessions

Retention Testing

Retention of learning is tested 24 hours after the initial learning session, with additional evoked potential recordings.

24 hours after learning

1 visit (in-person)

Follow-up

Participants are monitored for retention and relearning of speech motor adaptation.

4 weeks

Treatment Details

Interventions

• Speech Motor Learning

Trial Overview The study tests a new model of speech motor learning by using brain stimulation (TMS) and imaging (fMRI). It aims to understand how different brain areas contribute to learning and retaining new movements.

Participant Groups

Group I: SEPs (S1) / unaltered auditory feedback / SEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area S1 (somatosensory cortex) in combination with unaltered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Group II: SEPs (S1) / altered auditory feedback / SEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area S1 (somatosensory cortex) in combination with a speech motor learning procedure known as adaptation to altered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Group III: MEPs (M1) / unaltered auditory feedback / MEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area M1 (motor cortex) in combination with unaltered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Group IV: MEPs (M1) / altered auditory feedback / MEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area M1 (motor cortex) in combination with a speech motor learning procedure known as adaptation to altered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Group V: AEPs (A1) / unaltered auditory feedback / AEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area A1 (auditory cortex) in combination with unaltered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Group VI: AEPs (A1) / altered auditory feedback / AEPs + retention tests at 24h Experimental Treatment 2 Interventions

Evoked potentials will be recorded from brain area A1 (auditory cortex) in combination with a speech motor learning procedure known as adaptation to altered auditory feedback. Retention of learning will be tested 24h later along with additional evoked potential recordings.

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Findings from Research

Motor speech interventions for children with cerebral palsy show some effectiveness in improving speech intelligibility, with 21 studies involving 131 participants reporting improvements at various levels of speech, although the overall quality of evidence is low to moderate.

Adherence to principles of motor learning in these interventions was inconsistent, indicating a need for more research to better understand how these principles can enhance the effectiveness of speech therapy for children with CP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. Korkalainen, J., McCabe, P., Smidt, A., et al.[2023]

The study explored the speech motor learning approach as a treatment for childhood apraxia of speech in a 33-month-old child, showing significant improvements in whole-word accuracy for untreated nonwords and words with age-appropriate consonants after treatment.

Despite these improvements, the rising baseline scores indicated no reliable treatment effect, suggesting that further research with a larger group of children is needed to confirm the efficacy of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Model-Driven Treatment of Childhood Apraxia of Speech: Positive Effects of the Speech Motor Learning Approach. van der Merwe, A., Steyn, M.[2019]

The study found that somatosensory inputs to oro-facial structures significantly improved speech processing for low-frequency words, indicating that these sensory cues can enhance lexical access and speech production accuracy.

In contrast, stimulation applied to non-speech areas (forehead) did not produce any significant effects, reinforcing the idea that targeted somatosensory interventions can effectively influence motor speech treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cross-Modal Somatosensory Repetition Priming and Speech Processing. Namasivayam, AK., Yan, T., Bali, R., et al.[2022]

The pilot study demonstrated that an articulatory kinematic speech intervention using principles of motor learning significantly improved speech outcomes in children with cleft palate, particularly for those with inconsistent passive speech errors.

Improvements were observed not only in treated phonemes but also generalized to untreated phonemes, indicating the potential for broader benefits from this intervention approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech Intervention for Children With Cleft Palate Using Principles of Motor Learning. Hanley, L., Ballard, KJ., Dickson, A., et al.[2023]

In a study involving 11 children with severe speech sound disorders who received high-intensity therapy three times a week for 6 weeks, it was found that achieving a high number of practice trials (average of 102 per session) did not require perfect accuracy for effective learning, as the children averaged 58% correct responses.

The results suggest that allowing for errors during practice can still lead to significant improvements in speech production, with children maintaining their learning even 3 months after treatment, indicating that the focus should be on challenging practice rather than perfect performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of the Challenge Point Framework During Treatment of Speech Sound Disorders. Matthews, T., Barbeau-Morrison, A., Rvachew, S.[2021]

There is limited empirical evidence supporting the effectiveness of oral-motor exercises in improving speech acquisition in children, making it a controversial topic in speech therapy.

The review suggests that insights from motor learning literature could inform the development of more effective nonspeech activities for treating children's phonological and articulatory disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are oral-motor exercises useful in the treatment of phonological/articulatory disorders? Forrest, K.[2005]

Participants who practiced producing novel speech sequences showed significant improvements in accuracy and speed, indicating effective motor learning over 2 days.

fMRI results revealed that successful speech motor learning engages specific brain regions associated with both general motor learning and feedback-based speech processes, suggesting a complex neural network is involved in mastering speech sequences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The neural correlates of speech motor sequence learning. Segawa, JA., Tourville, JA., Beal, DS., et al.[2021]

Memory consolidation plays a crucial role in developing speech-motor skills, suggesting that learning to speak involves integrating auditory, motor, and linguistic information into a cohesive representation.

The review highlights the importance of both conscious and unconscious memory systems in speech-motor learning, emphasizing how factors like time and sleep can enhance the stabilization and generalization of learned speech patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A case for the role of memory consolidation in speech-motor learning. van Zelst, AL., Earle, FS.[2022]

In speech motor learning, somatic sensory memory, which relates to the position and movement of facial muscles, plays a crucial role in adapting to changes in auditory feedback, even more so than auditory memory for speech sounds.

The study found that while auditory memory is generally better, it is the somatic memory that actually predicts how well individuals can adapt their speech movements, highlighting the importance of bodily sensations in learning to speak.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contribution of sensory memory to speech motor learning. Ito, T., Bai, J., Ostry, DJ.[2021]

Effective low-level motor control, such as in speech, requires the brain to invert both the dynamics and kinematics of limb or vocal tract movements, which is crucial for accurate motor function.

Erroneous learning in speech-motor control can lead to abnormal feedback loops and potentially result in stuttering, highlighting the importance of proper learning mechanisms in speech development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A neural-network model enabling sensorimotor learning: application to the control of arm movements and some implications for speech-motor control and stuttering. Kalveram, KT.[2019]

Speech motor learning can significantly alter a speaker's auditory perception, as shown by a study using a robotic device that changed jaw position during speech, leading to both motor adaptation and perceptual shifts in sound classification.

The study found that only those who successfully adapted to the mechanical changes in their speech showed changes in their perception of speech sounds, indicating a strong link between motor learning and sensory processing in speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Auditory plasticity and speech motor learning. Nasir, SM., Ostry, DJ.[2021]

Principles of motor learning from nonspeech skills may enhance treatment strategies for motor speech disorders, suggesting a potential crossover in techniques used by speech-language pathologists.

While direct studies on these principles in speech motor learning are limited, existing evidence indicates they could be beneficial, highlighting the need for further research to confirm their effectiveness in impaired populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Principles of motor learning in treatment of motor speech disorders. Maas, E., Robin, DA., Austermann Hula, SN., et al.[2022]

References

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

Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. [2023]

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

Model-Driven Treatment of Childhood Apraxia of Speech: Positive Effects of the Speech Motor Learning Approach. [2019]

3. Singapore pubmed.ncbi.nlm.nih.gov

Cross-Modal Somatosensory Repetition Priming and Speech Processing. [2022]

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

Speech Intervention for Children With Cleft Palate Using Principles of Motor Learning. [2023]

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

Application of the Challenge Point Framework During Treatment of Speech Sound Disorders. [2021]

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

Are oral-motor exercises useful in the treatment of phonological/articulatory disorders? [2005]

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

The neural correlates of speech motor sequence learning. [2021]

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

A case for the role of memory consolidation in speech-motor learning. [2022]

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

Contribution of sensory memory to speech motor learning. [2021]

10. Germany pubmed.ncbi.nlm.nih.gov

A neural-network model enabling sensorimotor learning: application to the control of arm movements and some implications for speech-motor control and stuttering. [2019]

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

Auditory plasticity and speech motor learning. [2021]

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

Principles of motor learning in treatment of motor speech disorders. [2022]