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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how the brain learns and retains new speech movements through Speech Motor Learning techniques. Researchers use methods like transcranial magnetic stimulation (to stimulate the brain) and functional magnetic resonance imaging (fMRI) to identify which brain areas assist in learning and remembering speech patterns. Participants will experience various types of auditory feedback to assess its impact on speech learning. This trial suits right-handed, fluent English speakers with normal hearing and no speech disorders or reading disabilities. As an unphased trial, participants can contribute to groundbreaking research in understanding speech learning processes.

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 prior data suggests that these motor learning techniques for speech are safe?

Research has shown that techniques for speech motor learning are generally safe and well-tolerated. In past studies, participants improved their speech control with few side effects. For example, methods to enhance speech clarity and understanding have proven effective without major issues.

While specific safety details for this trial are not available, similar techniques in other approved treatments suggest safety. However, as with any clinical research, participants should remain informed and report any concerns to the study team. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the speech motor learning techniques being tested because they delve into how different brain areas respond to auditory feedback during speech. Unlike traditional speech therapies that often focus on repetitive exercises, this approach records evoked potentials from specific brain regions like the auditory, somatosensory, and motor cortices. By comparing reactions to altered versus unaltered auditory feedback, the trial aims to uncover how these brain areas influence speech retention and adaptation. This could lead to more targeted and efficient therapies for speech disorders, improving how quickly and effectively patients can adapt and retain new speech patterns.

What evidence suggests that this trial's treatments could be effective for speech motor learning?

Research shows that techniques for learning motor skills can improve speech in people with various speech disorders. This trial will explore different methods of auditory feedback to enhance speech motor learning. Participants in one arm will receive unaltered auditory feedback, while others will experience altered auditory feedback. For individuals with normal brain function, sensory feedback helps adjust future speech movements, enhancing speech learning. Studies have found that focusing on auditory input can help individuals notice speech mistakes and improve control over speech movements. When sounds are altered, people with healthy brains can adjust their speech, but timing is crucial to avoid disrupting learning. Overall, both unchanged and altered auditory feedback methods seem promising in aiding speech learning by engaging sensory and motor parts of the brain. ^{3 6 7 8 9}

Who Is on the Research Team?

David Ostry

Principal Investigator

Yale University

Are You a Good Fit for This Trial?

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

Right-handed

No speech disorder or reading disability

I speak English fluently.

Exclusion Criteria

Metal implants

Metal in brain, skull, or spinal cord

Implanted neurostimulator

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. withpower.com withpower.com/trial/phase-speech-6-2024-d9ca0

Motor Learning Techniques for Speech Research shows that using principles of motor learning can improve speech outcomes in children with cleft palate and childhood apraxia of speech, suggesting ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4363140/

Feedback delays eliminate auditory-motor learning in ... We investigated adaptation to altered auditory feedback during speech articulation. Speech audio-motor adaptation is completely eliminated with delays of 100 ms ...

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. medrxiv.org medrxiv.org/content/10.1101/2022.05.25.22275332.full

Effects of Sensorimotor Voice Training on Event-Related ... The present study examined changes in event related potentials (ERPs) and voice pitch in three groups of subjects due to altered voice auditory feedback.

5. researchgate.net researchgate.net/publication/281069668_Transfer_Effect_of_Speech-sound_Learning_on_Auditory-motor_Processing_of_Perceived_Vocal_Pitch_Errors

(PDF) Transfer Effect of Speech-sound Learning on ... Speech perception and production are intimately linked. There is evidence that speech motor learning results in changes to auditory processing ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8599312/

The effects of continuous oromotor activity on speech motor ... This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8294667/

Behavioral and Neural Correlates of Speech Motor Sequence ... These findings demonstrate that AWS exhibit no deficit in constructing new speech motor sequences but do show impaired execution of these sequences.

8. nature.com nature.com/articles/s41390-020-0924-4

PROMPT intervention for children with severe speech ... PROMPT intervention was associated with notable improvements in speech motor control, speech articulation, and word-level speech intelligibility.

9. mdpi.com mdpi.com/2076-3425/13/5/768

Oromotor Nonverbal Performance and Speech Motor Control Speech motor control is defined as the goal-directed, nervous system control of speech production by which movements, and their derivatives, effect shapes and ...