Sensory Feedback Intervention for Speech Motor Learning

Recruiting at 2 trial locations

Overseen By David Ostry

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Yale University

Must not be taking: Antipsychotics, Antidepressants, Antianxiety

Disqualifiers: Epilepsy, Concussion, Pregnancy, others

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

Compensation: Varies

Number of Visits: 2

160 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how the brain helps maintain speech memory by testing the involvement of specific brain areas. It uses transcranial magnetic stimulation, a non-invasive technique, to determine if altering brain activity affects speech learning retention. Participants will try various sensory feedback methods, including Adaptation and Continuous Theta-Burst Stimulation (cTBS), to identify which impacts speech memory the most. The study seeks right-handed adults without known physical or neurological issues. As an unphased trial, it offers a unique opportunity to contribute to groundbreaking research on speech memory.

Will I have to stop taking my current medications?

If you are currently taking antipsychotic, antidepressant, or antianxiety drugs, you would not be eligible to participate in this trial.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that continuous theta burst stimulation (cTBS), combined with changes in sensory feedback, is generally well-tolerated. Studies on similar techniques indicate that cTBS can safely alter how the brain processes sensory information, such as touch or sound. When applied to brain areas involved in speech, most people experience it without significant problems.

One study found that cTBS can influence how the tongue senses things, but reported no major safety concerns. Another source on transcranial magnetic stimulation (TMS), related to cTBS, suggests it is safe for healthy individuals when guidelines are followed, indicating overall low risks.

These findings come from previous studies, and while they provide a good sense of safety, individual experiences can vary. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the sensory feedback intervention for speech motor learning because it introduces a novel approach to enhancing speech skills. Traditional treatments for speech disorders often rely on repetitive practice and therapy. However, this method uses altered sensory feedback combined with continuous theta burst stimulation (cTBS) to different brain areas (S1, A1, and M1), potentially accelerating the learning process. By directly targeting brain regions responsible for processing sensory information and motor control, this technique aims to optimize the brain’s ability to adapt and improve speech function more effectively and rapidly than conventional methods.

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

Research has shown that transcranial magnetic stimulation (TMS), specifically using continuous theta burst stimulation (cTBS), can affect brain regions involved in learning to speak. In this trial, participants will receive Adaptation to Altered Sensory Feedback combined with cTBS targeting different brain areas, such as S1, A1, or M1, or a sham cTBS. One study found that cTBS temporarily changed how the brain processes speech sounds. By focusing on certain brain areas, cTBS might improve speech learning by adjusting how the brain remembers new speech patterns. Another study found that cTBS could alter how the brain senses touch in areas important for speaking, like the tongue. These findings suggest that cTBS might enhance speech learning by changing brain activity related to speaking and sensory feedback. ^{6 7 8 9 10}

Who Is on the Research Team?

David Ostry

Principal Investigator

Haskins Laboratories

Are You a Good Fit for This Trial?

This trial is for right-handed adults with no known physical or neurological abnormalities. It's not suitable for those with epilepsy, a family history of it, on antidepressants/antipsychotics/antianxiety drugs, with heart devices/metal in the body, who are pregnant, or have had concussions.

Inclusion Criteria

I do not have any known physical or neurological abnormalities.

I am right-handed.

Exclusion Criteria

I have surgical clips or valves in my heart.

You have implants in your body.

You have a past concussion.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Adaptation and Stimulation

Subjects train using altered sensory feedback followed by cTBS to test motor memory consolidation

1 day

1 visit (in-person)

Retention Assessment

Subjects return to assess retention of learning 24 hours after initial adaptation and stimulation

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Adaptation
• cTBS

Trial Overview The study tests if brain sensory areas help solidify speech motor memory. Participants undergo transcranial magnetic stimulation (cTBS) to suppress somatosensory and auditory cortex activity after speech adaptation exercises to see if this affects learning retention.

How Is the Trial Designed?

Group I: Adaptation to Altered Sensory Feedback + cTBS to S1 Experimental Treatment 2 Interventions

Adaptation to Altered Sensory Feedback + cTBS to S1

Group II: Adaptation to Altered Sensory Feedback + cTBS to M1 Experimental Treatment 2 Interventions

Adaptation to Altered Sensory Feedback + cTBS to M1

Group III: Adaptation to Altered Sensory Feedback + cTBS to A1 Experimental Treatment 2 Interventions

Adaptation to Altered Sensory Feedback + cTBS to A1

Group IV: Adaptation to Altered Sensory Feedback + Sham cTBS Experimental Treatment 2 Interventions

Adaptation to Altered Sensory Feedback + Sham cTBS

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

McGill University

Collaborator

Trials

421

Recruited

1,017,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Published Research Related to This Trial

The study suggests that somatosensory feedback, related to the movements of the jaw during speech, plays a crucial role in how we monitor and adjust our speech, potentially more so than auditory feedback.

When both auditory and somatosensory feedback were altered during speech, participants showed varying preferences for relying on one type of feedback over the other, indicating that individuals may have different strategies for speech motor learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sensory preference in speech production revealed by simultaneous alteration of auditory and somatosensory feedback. Lametti, DR., Nasir, SM., Ostry, DJ.[2021]

Speech motor learning involves significant changes in how the brain processes both auditory and somatosensory information, as shown through experiments with altered auditory feedback.

As participants adapted their speech to correct for changes in auditory feedback, there were measurable changes in their speech outputs and corresponding neural responses, indicating a close relationship between sensory processing and motor adaptation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech motor learning changes the neural response to both auditory and somatosensory signals. Ito, T., Coppola, JH., Ostry, DJ.[2018]

In a pilot study with 24 college-aged adults learning Hindi phrases, those receiving knowledge of performance (KP) feedback performed better in intelligibility, precision, and naturalness compared to those receiving only knowledge of results (KR) feedback, both 2 days and 1 week post-training.

The findings suggest that providing augmented feedback, especially KP, can significantly enhance learning of new speech tasks, which may be beneficial for clinical applications in treating motor speech disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the Impact of Two Feedback Types on Speech Intelligibility, Precision, and Naturalness. Bislick, L., Thakar, A., Madden, EB.[2023]

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 examining the effects of sensory feedback delays on motor learning, it was found that while limb motor learning can adapt even with significant delays (up to 5000ms), speech motor learning is highly sensitive to such delays, with auditory feedback being crucial for adaptation.

Delays of just 100ms in auditory feedback completely eliminate the ability to adapt speech articulation, highlighting the importance of real-time feedback in speech motor control and suggesting implications for rehabilitation strategies for individuals with speech disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feedback delays eliminate auditory-motor learning in speech production. Max, L., Maffett, DG.[2021]

Disruption of the articulatory representation in the left primary motor cortex (M1) using repetitive transcranial magnetic stimulation (rTMS) impairs the ability to adapt speech in response to altered auditory feedback, indicating a causal role of M1 in speech sensorimotor adaptation.

Participants who received rTMS over the tongue representation did not show the expected compensatory changes in their speech production, while those who received rTMS over the hand representation successfully adapted, highlighting the specific contribution of the tongue area in M1 to speech learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disruption of speech motor adaptation with repetitive transcranial magnetic stimulation of the articulatory representation in primary motor cortex. Tang, DL., McDaniel, A., Watkins, KE.[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]

The study shows that when speakers experience altered auditory feedback while producing /s/-initial words, they not only adjust their motor plans but also modify their perceptual representation of the /s-/ sound.

This dual adaptation—changing both how they produce the sound and how they perceive it—helps to lessen the effects of the auditory feedback manipulation, indicating that speech production involves complex interactions between motor output and sensory perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceptual recalibration of speech sounds following speech motor learning. Shiller, DM., Sato, M., Gracco, VL., et al.[2009]

Research indicates that effective speech motor control relies on multi-dimensional regions in both auditory and somatosensory spaces, suggesting that how we hear and feel sounds influences our ability to produce them accurately.

Speakers with better sensory discrimination can create clearer auditory goals, leading to more distinct speech sounds, while feedback mechanisms help correct any discrepancies between what is expected and what is actually produced.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Movement goals and feedback and feedforward control mechanisms in speech production. Perkell, JS.[2023]

In a study with 32 native English speakers, all participants improved their accuracy in producing nonwords over time, regardless of the amount of feedback they received during practice, indicating effective speech motor learning.

The group that received 50% feedback showed the most significant improvement in reducing the duration of their nonword productions, suggesting that a moderate feedback schedule may optimize learning in speech motor tasks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Feedback Frequency on Performance in a Novel Speech Motor Learning Task. Lowe, MS., Buchwald, A.[2019]

In a study involving eight subjects, it was found that when auditory feedback of speech was altered, participants consistently adjusted their speech production to compensate, indicating a strong reliance on auditory feedback for speech control.

The research also revealed that while both auditory and somatosensory feedback contribute to speech production, auditory feedback plays a more dominant role in planning and adapting vowel-related articulatory movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Integration of auditory and somatosensory error signals in the neural control of speech movements. Feng, Y., Gracco, VL., Max, L.[2021]

Citations

1. withpower.com withpower.com/trial/sensory-feedback-intervention-for-speech-motor-learning-7f0f8

Sensory Feedback Intervention for Speech Motor Learning Participants undergo transcranial magnetic stimulation (cTBS) to suppress somatosensory and auditory cortex activity after speech adaptation exercises to see if ...

2. withpower.com withpower.com/trial/brain-stimulation-for-speech-learning-9f125

Brain Stimulation for Speech Learning Continuous theta burst stimulation (cTBS) can effectively induce temporary impairments in semantic processing, similar to traditional 1 Hz repetitive ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12130073/

Continuous theta burst stimulation to the medial posterior ... A total of 111 healthy right-handed adult volunteers received continuous theta burst stimulation (cTBS) to either the medial posterior cerebellum (n = 37), ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7417340/

Assessing the Effects of Continuous Theta Burst ... We conclude that continuous theta burst stimulation over the dorsolateral prefrontal cortex mainly inhibits cognitive performance.

5. researchgate.net researchgate.net/publication/390218025_Theta-burst_stimulation_over_primary_somatosensory_cortex_modulates_the_tactile_acuity_of_the_tongue

Theta-burst stimulation over primary somatosensory cortex ... The current study establishes the validity of using TBS to modulate somatosensory perception of the orofacial system. Directly modifying somatosensation in the ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT04818268

NCT04818268 | Sensory Memory in Speech Motor Learning A second set of tests will focus on the effects of cTBS on speech motor adaptation to altered auditory feedback. Both working memory and adaptation are assessed ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12265933/

Theta-burst stimulation over primary somatosensory cortex ... Results show that the spatial acuity of the tongue can be impaired or improved by cTBS or iTBS respectively. Directly modifying somatosensation ...

8. trial.medpath.com trial.medpath.com/clinical-trial/f9674df10a9ed144/nct04818268-role-sensory-working-memory-speech-motor-learning

Sensory Memory in Speech Motor Learning | MedPath A second set of tests will focus on the effects of cTBS on speech motor adaptation to altered auditory feedback. Both working memory and adaptation are assessed ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S1388245720305149

Safety and recommendations for TMS use in healthy ... This is the third article on safety of use of repetitive Transcranial Magnetic Stimulation (rTMS) in clinical practice and research following by eleven years ...

10. link.springer.com link.springer.com/article/10.3758/s13415-025-01273-5

Continuous theta burst stimulation to the medial posterior ... This study examined the direct contribution of the cerebellum to reward- and punishment-based reversal learning.