Investigating the Effects of Rhythm and Entrainment on Fluency in People With Aphasia

MGH Institute of Health Professions

Status: Completed

Conditions: Apraxia of Speech; Aphasia

Treatments: Behavioral: Metrical timing (vs. conversational); Behavioral: Unison speech (vs. solo)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05248295

2018P001160

R15DC019231 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

Speaking in unison with another person is included as a part of many treatment approaches for aphasia. It is not well understood why and how this technique works. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech are most helpful. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? A possible mechanism for this benefit is examined, by testing whether the degree of alignment of a person's speech with that of another speaker can account for unison benefit.

Full description

Aphasia is an acquired language disorder, most commonly due to stroke. It can affect an individual's ability to speak, understand spoken language, read, and write. Many treatments designed to improve spoken language in persons with aphasia (PWAs) use unison speech, having the person with aphasia speak along with the clinician or with a recording. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech help them the most. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? This knowledge is important because understanding who benefits from this commonly used and potentially powerful therapy component, under which conditions they benefit, and why they do, is critical for customizing therapy so it can be as effective and efficient as possible. Unison speech is conducted using one of two different timing patterns: (1) a natural conversational pattern, which is used in everyday conversations, or (2) a metrical pattern, which follows a beat-based timing framework, as in songs or some poems. In either case, precisely aligning one's speech with that of another person (i.e., entraining one's speech) requires prediction: each speaker must plan their own speech motor commands before having heard the other speaker say the words they are planning. Natural conversational timing requires the speaker to make use of knowledge about language, particularly grammar, to align with the other person. In contrast, a metrical pattern allows a speaker to predict speech timing without relying heavily on language-based knowledge. Given that many PWAs have impaired grammar, we hypothesize that most PWAs will benefit more from speaking in unison to sentences with metrical vs. conversational timing patterns. However, there is great variation in linguistic, motor speech, and timing skills across PWAs, so metrical and conversational timing patterns are likely to have different degrees of effectiveness for different individuals. Results from this study will demonstrate how individual characteristics and speech timing affect whether or not a person with aphasia benefits from speaking in unison. Results will also indicate whether a speaker's ability to predict speech timing is necessary for a benefit of unison speech. Prediction ability will be measured by how closely the speaker aligns their speech with a spoken model.

Enrollment: 75 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Native-speaker fluency in American English (prior to stroke for people with aphasia)
• Controls must report no history of speech, language, neurological disorders, or stroke
• People with aphasia must be at least 6-months post-stroke, and aphasia must be due to stroke

Exclusion criteria

• Inadequate hearing ability to reliably complete task: fail hearing screen
• Inadequate cognitive ability to understand and remember task: fail cognition screening (different measures for controls and people with aphasia)
• Inadequate speech repetition ability to complete task, or to be considered a control: fail speech repetition screening (different thresholds for controls and people with aphasia)
• Inadequate auditory comprehension ability to understand task: fail auditory comprehension screen (people with aphasia only)

Trial design

Primary purpose: Basic Science

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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75 participants in 2 patient groups

People with aphasia

Experimental group

Description:

Adults with stroke-based aphasia. Designating this group as experimental reflects the focus on studying responses in people with aphasia. All participants will complete the same 4 study conditions in a 2x2 design (Unison vs. Solo and Metrical vs. Conversational).

Treatment:

Behavioral: Unison speech (vs. solo)

Behavioral: Metrical timing (vs. conversational)

Healthy controls

Other group

Description:

Adults without a history of speech, language, or neurological disorder, or stroke. This group is intended to serve as a context-providing reference group rather than a true comparator. All participants will complete the same 4 study conditions in a 2x2 design (Unison vs. Solo and Metrical vs. Conversational).

Treatment:

Behavioral: Unison speech (vs. solo)

Behavioral: Metrical timing (vs. conversational)