Visual Feedback Training for Aphasia
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: The University of Texas at Dallas
Disqualifiers: Hearing, Memory, Cognitive, Laryngeal, others
No Placebo Group
Approved in 3 Jurisdictions
Trial Summary
What is the purpose of this trial?
Aphasia is the most common type of post-stroke communication disorder characterized by deficits in speech comprehension, production and control. While recovery can be promoted with speech therapy, improvement remains modest and typically requires a large number of sessions contributing to rising health care costs. Traditional aphasia therapy focus on enhancing speech motor output; however, recent evidence suggests that the auditory feedback also plays a critical role in fluent speech. Therefore, a key step toward refining treatment strategies is to develop objective biomarkers that can probe the integrity of sensorimotor mechanisms of speech auditory feedback and identify their impaired function in patients with post-stroke aphasia. This study aims to examine the behavioral, neurophysiological (EEG), and neuroimaging (fMRI) biomarkers of speech impairment following stroke with focus on understanding the role of auditory feedback for speech production and control. We plan to test individuals with post-stroke aphasia and a matched neuroptypical control group during different speech production tasks under the altered auditory feedback paradigm. In addition, we aim to examine the effect of audio-visual feedback training on enhancing communication ability during speech. These biomarkers will be combined with existing lesion-symptom-mapping data in the aphasic group in order to identify the patterns of brain damage and diminished structural connectivity within the auditory-motor areas of the left hemisphere that predict impaired sensorimotor processing of speech in aphasia. The long-term goal of this research is to develop a model for identifying the source of sensorimotor deficit and improve diagnosis and targeted treatment of speech disorders in aphasia.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Visual Feedback Training for aphasia?
Research shows that therapies involving visual and action-based feedback, like Visual Action Therapy and action observation therapy, can significantly improve communication skills in people with aphasia. These approaches help patients use gestures and observe actions, which enhances their language recovery.12345
Is Visual Feedback Training generally safe for humans?
How is Visual Feedback Training for Aphasia different from other treatments?
Research Team
Eligibility Criteria
This trial is for English-speaking adults aged 21-75 who have aphasia after a stroke, can perform the study tasks, and have no severe hearing or cognitive issues. Healthy controls with normal speech and no neurological disorders are also needed. Both groups must be right-handed.Inclusion Criteria
I have speech difficulties but can still do the required tasks.
I am between 21 and 75 years old.
I have never had a neurological or psychiatric disorder.
See 5 more
Exclusion Criteria
You have conditions that make it unsafe for you to have an EEG or MRI scan.
I have had issues with my voice box, like weakness or paralysis.
I have moderate to severe issues with hearing, memory, or thinking.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants undergo speech production tasks under altered auditory feedback and audio-visual feedback training
2 weeks
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Treatment Details
Interventions
- Visual Feedback Training (Behavioural Intervention)
Trial OverviewThe study tests how visual feedback training affects speech in people with aphasia by using EEG and fMRI to track brain activity during speech tasks under altered auditory conditions. It aims to improve communication abilities and develop targeted treatments.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: Control GroupExperimental Treatment1 Intervention
Group II: Aphasia GroupExperimental Treatment1 Intervention
Visual Feedback Training is already approved in European Union, United States, Canada for the following indications:
🇪🇺 Approved in European Union as Visual Feedback Training for:
- Post-stroke aphasia
- Speech comprehension deficits
- Speech production impairments
🇺🇸 Approved in United States as Audio-Visual Feedback Training for:
- Aphasia
- Speech disorders
- Communication impairments
🇨🇦 Approved in Canada as Speech Therapy with Visual Feedback for:
- Post-stroke communication disorders
- Speech production deficits
- Auditory feedback impairments
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of South CarolinaColumbia, SC
University of California IrvineIrvine, CA
The University of Texas at DallasRichardson, TX
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Who Is Running the Clinical Trial?
The University of Texas at Dallas
Lead Sponsor
Trials
71
Patients Recruited
108,000+
University of South Carolina
Lead Sponsor
Trials
233
Patients Recruited
122,000+
References
Visual action therapy for global aphasia. [2019]Eight globally aphasic patients who had not responded to traditional treatment received Visual Action Therapy (VAT), a nonvocal approach which ultimately trains patients to produce symbolic gestures for visually absent stimuli. Statistical analyses of pre and post VAT scores earned on the Porch Index of Communicative Ability (PICA) showed highly significant improvement on those subtests which measure pantomimic and auditory comprehension skills. The theoretical and practical implications of these findings are discussed.
Where are we now with aphasia after Stroke? [2022]To provide a brief review of research literature relating to the current state of knowledge regarding speech and language therapy for people with aphasia and place these research findings within the context of outcome data of non-selected patients receiving usual therapy in the UK.
Augmented Dyadic Therapy Boosts Recovery of Language Function in Patients With Nonfluent Aphasia. [2020]Background and Purpose- Evidence suggests that therapy can be effective in recovering from aphasia, provided that it consists of socially embedded, intensive training of behaviorally relevant tasks. However, the resources of healthcare systems are often too limited to provide such treatment at sufficient dosage. Hence, there is a need for evidence-based, cost-effective rehabilitation methods. Here, we asked whether virtual reality-based treatment grounded in the principles of use-dependent learning, behavioral relevance, and intensity positively impacts recovery from nonfluent aphasia. Methods- Seventeen patients with chronic nonfluent aphasia underwent intensive therapy in a randomized, controlled, parallel-group trial. Participants were assigned to the control group (N=8) receiving standard treatment or to the experimental group (N=9) receiving augmented embodied therapy with the Rehabilitation Gaming System for aphasia. All Rehabilitation Gaming System for aphasia sessions were supervised by an assistant who monitored the patients but did not offer any elements of standard therapy. Both interventions were matched for intensity and materials. Results- Our results revealed that at the end of the treatment both groups significantly improved on the primary outcome measure (Boston Diagnostic Aphasia Examination: control group, P=0.04; experimental group, P=0.01), and the secondary outcome measure (lexical access-vocabulary test: control group, P=0.01; experimental group, P=0.007). However, only the Rehabilitation Gaming System for aphasia group improved on the Communicative Aphasia Log ( P=0.01). The follow-up assessment (week 16) demonstrated that while both groups retained vocabulary-related changes (control group, P=0.01; experimental group, P=0.007), only the Rehabilitation Gaming System for aphasia group showed therapy-induced improvements in language ( P=0.01) and communication ( P=0.05). Conclusions- Our results demonstrate the effectiveness of Rehabilitation Gaming System for aphasia for improving language and communication in patients with chronic aphasia suggesting that current challenges faced by the healthcare system in the treatment of stroke might be effectively addressed by augmenting traditional therapy with computer-based methods. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02928822.
Follow-Up in Aphasia Caused by Acute Stroke in a Prospective, Randomized, Clinical, and Experimental Controlled Noninvasive Study With an iPad-Based App (Neolexon®): Study Protocol of the Lexi Study. [2020]Rationale: Treatment of aphasia is still challenging for clinicians and patients. So far, there is proven evidence for "face-to-face" speech therapy. However, the digital age potentially offers new and complementary strategies that may add to treatment outcome in a cost-effective way. Neolexon® is a commercial tablet-based software for treatment of aphasia, which can be applied with the help of a therapist or as self-training by the patient. Aims and hypothesis: In the Lexi study, we aim to determine whether treatment with Neolexon® is superior to standard therapy in acute post-stroke aphasia. Sample size estimates: A sample size of 180 patients, 90 for each group, will be included with an assumed dropout rate of ~20%. Methods and design: Prospective, randomized, parallel group, open-label, blinded-endpoint clinical, and experimental controlled non-invasive trial (PROBE). Adult German native speakers with acute aphasia after stroke are included. Computer-generated, blocked, and stratified randomization by aphasia severity will assign patients to one of two groups: 4 weeks of either standard logopedic speech therapy or logopedic speech therapy with the app version of Neolexon®. Both groups will be instructed in self-training: the frequency and duration of self-training will be documented. Screening for aphasia will be performed using the Language Screening Test (LAST). The severity of aphasia in general and in subitems will be assessed using the Bielefelder Aphasie Screening (BIAS) and the Aphasia Check List (ACL). Follow-up will be assessed after 3 months. Study outcomes: Based on the consensus in our study team, we considered a 10% mean difference in the change of percentile rank (PR) of BIAS to be a minimal and clinically important difference. The primary endpoint is defined as a significant difference in BIAS comparing the two groups. Differences in quality of life, Beck Depression Inventory (BDI), and modified Ranking Scale (mRS) will be evaluated as secondary outcome parameters. Discussion: This trial will determine whether speech therapy with the use of Neolexon® is superior to standard logopedic therapy. Subgroups with the greatest response to Neolexon® will be described. The trial was prospectively registered on the "EU Clinical Trials Register" (NCT04080817).
Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy. [2014]Aphasia is a highly disabling language disorder usually caused by a left-lateralized brain damage. Even if traditional linguistic-based therapies have been proved to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Therefore, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of non-invasive neurostimulation techniques to language rehabilitation has already provided promising results particularly for the recovery of word-retrieval deficits in chronic stroke aphasic patients. Positive outcomes also come from action observation therapy. Indeed, some very recent studies have shown that the observation and/or execution of gestures positively influences language recovery especially for words related to human actions. This article gives an overview of the most important results achieved using these two approaches and discusses how the application of these treatments might potentiate aphasia recovery.
Game-Based Augmented Visual Feedback for Enlarging Speech Movements in Parkinson's Disease. [2019]The purpose of this pilot study was to demonstrate the effect of augmented visual feedback on acquisition and short-term retention of a relatively simple instruction to increase movement amplitude during speaking tasks in patients with dysarthria due to Parkinson's disease (PD).
Do Participants Report Any Undesired Effects in Ultrasound Speech Therapy? [2023]Ultrasound visual feedback of the tongue is increasingly used as a component of speech therapy in clinical research and practice. The purpose is to offer a preliminary summary of the nature of participant-reported undesired effects related to ultrasound visual feedback.
The effects of three feedback modes on the ability of normal geriatric individuals to match speaking rate. [2019]The present study investigated the effects of three feedback modes (visual-verbal, verbal-quantitative, and verbal-qualitative) on the ability of 30 normal geriatric individuals to match three different speaking rates (slow, average, and fast). Ten subjects were randomly assigned to each feedback condition. Each subject was instructed to produce the stimulus phrase, Buy Bobby a doughnut, at each of the three speaking rates. Subjects in the visual-verbal mode received both visual feedback of the utterance duration via a PM Trainer and verbal feedback from the experimenter indicating the subject's accuracy in matching the specified speaking rate. Feedback during the verbal-quantitative condition consisted of verbal information indicating the subject's accuracy in matching each speaking rate. The verbal-qualitative condition consisted of verbal feedback relative to the subject's ability to match speaking rate, although the feedback was less precise than in the other conditions. Results suggest that visual-verbal and verbal-quantitative feedback lead to significantly better performance than verbal-qualitative feedback in matching speaking rate, particularly when the task becomes more difficult. These results have implications for the training of a similar task in speech-disordered populations.
Effects of feedback frequency and timing on acquisition, retention, and transfer of speech skills in acquired apraxia of speech. [2022]Two studies examined speech skill learning in persons with apraxia of speech (AOS). Motor-learning research shows that delaying or reducing the frequency of feedback promotes retention and transfer of skills. By contrast, immediate or frequent feedback promotes temporary performance enhancement but interferes with retention and transfer. These principles were tested in the context of a common treatment for AOS.
Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback. [2018]To study the effects of masked auditory feedback (MAF) on speech fluency in adults with aphasia and/or apraxia of speech (APH/AOS). We hypothesized that adults with AOS would increase speech fluency when speaking with noise. Altered auditory feedback (AAF; i.e., delayed/frequency-shifted feedback) was included as a control condition not expected to improve speech fluency.
Electromagnetic articulography treatment for an adult with Broca's aphasia and apraxia of speech. [2019]Electromagnetic articulography (EMA) was explored as a means of remediating [s]/[symbol in text] articulation deficits in the speech of an adult with Broca's aphasia and apraxia of speech. Over a 1-month period, the subject was provided with 2 different treatments in a counterbalanced procedure: (1) visually guided biofeedback concerning tongue-tip position and (2) a foil treatment in which a computer program delivered voicing-contrast stimuli for simple repetition. Kinematic and perceptual data suggest improvement resulting from visually guided biofeedback, both for nonspeech oral and, to a lesser extent, speech motor tasks. In contrast, the phonetic contrast treated in the foil condition showed only marginal improvement during the therapy session, with performance dropping back to baseline 10 weeks post-treatment. Although preliminary, the findings suggest that visual biofeedback concerning tongue-tip position can be used to treat nonspeech oral and (to a lesser extent) speech motor behavior in adults with Broca's aphasia and apraxia of speech.
Role of visual feedback treatment for defective /s/ sounds in patients with cleft palate. [2019]The role of visual feedback in the treatment of defective /s/ sounds in patients with cleft palate is described. Six patients with cleft palate who were similar in age, velopharyngeal function, and type of misarticulation were selected for this study. Treatment was provided using either visual feedback or no visual feedback. Visual feedback for tongue placement was provided by the Rion Electropalatograph (EPG). Visual feedback for frication was provided by a multi-function speech training aid (MFSTA). Improvement in /s/ sound production was assessed objectively using a method described previously (Michi et al., 1986). The results indicated that visual feedback for tongue placement and frication was especially useful in the treatment of defective /s/ sounds in patients with cleft palate who exhibited abnormal posterior tongue posturing during the production of dental or alveolar sounds.