Speech Sequencing Therapies for Stuttering
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: Any Age
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Boston University Charles River Campus
Must not be taking: Speech medications
Disqualifiers: Seizures, Claustrophobia, Implants, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
Persistent developmental stuttering affects more than three million people in the United States, and it can have profound adverse effects on quality of life. Despite its prevalence and negative impact, stuttering has resisted explanation and effective treatment, due in large part to a poor understanding of the neural processing impairments underlying the disorder. The overall goal of this study is to improve understanding of the brain mechanisms involved in speech motor planning and how these are disrupted in neurogenic speech disorders, like stuttering. The investigators will do this through an integrated combination of experiments that involve speech production, functional MRI, and non-invasive brain stimulation. The study is designed to test hypotheses regarding the brain processes involved in learning and initiating new speech sound sequences and how those processes compare in persons with persistent developmental stuttering and those with typical speech development. These processes will be studied in both adults and children. Additionally, these processes will be investigated in patients with neurodegenerative speech disorders (primary progressive aphasia) to further inform the investigators understanding of the neural mechanisms that support speech motor sequence learning. Together these experiments will result in an improved account of the brain mechanisms underlying speech production in fluent speakers and individuals who stutter, thereby paving the way for the development of new therapies and technologies for addressing this disorder.
Do I need to stop my current medications to join the trial?
If you have primary progressive aphasia (PPA), you cannot participate if you are taking medications that affect speech or language. For others, the protocol does not specify if you need to stop taking your current medications.
What data supports the effectiveness of the treatment Speech Sequencing Therapies for Stuttering?
Research shows that fluency training, which is part of speech therapy for stuttering, significantly reduces stuttering frequency and improves speaking rate and communication attitudes. Additionally, modified stuttering therapy programs focusing on self-therapy and specific target responses have led to greater improvements in speech fluency.12345
How is the Speech Sequencing Therapy for Stuttering different from other treatments?
This treatment is unique because it focuses on practicing non-native phoneme combinations and multisyllabic nonwords, which helps improve speech fluency by enhancing the brain's ability to store and recall speech sequences as cohesive chunks, reducing memory load and improving motor performance.26789
Eligibility Criteria
This trial is for native American English speakers with limited second language exposure. It includes children who pass a hearing test, adults without neurological issues (except stuttering), and those diagnosed with primary progressive aphasia by MGH-FTD. Excluded are individuals with contraindications to MRI or tDCS, certain medication use in PPA patients, severe cognitive impairment, and outside the age range for child participants.Inclusion Criteria
My hearing is good at specific test frequencies.
I am healthy with no history of brain, speech, or hearing problems, except for stuttering.
Only native speakers of American English with limited exposure to a second language will be recruited
See 8 more
Exclusion Criteria
I am not on medications that could affect my speech or language.
You cannot participate in MRI studies if you have had seizures, severe claustrophobia, metal implants in your body, or if you are pregnant.
You cannot participate if you have metal implants in your head, certain medical devices in your body, a history of seizures, significant scalp injuries, or if you are pregnant.
See 3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Training
Participants undergo training sessions to learn novel speech sequences using various methods such as tDCS and fMRI
2-3 days
6-8 training sessions
Intervention
Functional MRI and other assessments are conducted to measure brain activity and speech performance
1 day
1 fMRI session
Follow-up
Participants are monitored for changes in speech performance and brain activity post-intervention
4 weeks
Treatment Details
Interventions
- Anodal tDCS (Device)
- Learning of non-native phoneme combinations: 1 training session (Behavioral Intervention)
- Learning of non-native phoneme combinations: 6 training sessions (Behavioral Intervention)
- Learning of non-native phoneme combinations: 8 training sessions (Behavioral Intervention)
- Learning of novel multisyllabic nonwords (Behavioral Intervention)
- Sham tDCS (Device)
Trial OverviewThe study investigates brain mechanisms in speech motor planning through experiments involving speech production tasks, functional MRI scans, and non-invasive brain stimulation like sham and anodal tDCS. Participants will learn new phoneme combinations or multisyllabic nonwords across multiple sessions to help understand these processes in people with stuttering or neurodegenerative speech disorders.
Participant Groups
7Treatment groups
Experimental Treatment
Placebo Group
Group I: Sub-syllabic learning in PPAExperimental Treatment1 Intervention
30 adults with primary progressive aphasia (PPA) will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations during 8 training sessions over 2 days. Following training, subjects will complete a behavioral test to compare their performance on the words learned during training with a set of unfamiliar words also formed by non-native phoneme combinations.
Group II: Sub-syllabic learning and fMRIExperimental Treatment1 Intervention
60 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations during 6 training sessions over 2 days. Following training, subjects will participate in a functional magnetic resonance imaging (fMRI) session on a third day to measure brain activity associated with producing the words learned during training and with a set of unfamiliar words also formed by non-native phoneme combinations.
Group III: Sub-syllabic learning and anodal tDCS of inferior frontal sulcusExperimental Treatment2 Interventions
35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable nonsense words formed by non-native phoneme combinations. During the training, anodal transcranial direct current stimulation (tDCS) will be applied to the the subject's left inferior frontal sulcus.
Group IV: Sub-syllabic learning and anodal tDCS of cerebellumExperimental Treatment2 Interventions
35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable words formed by non-native phoneme combinations. During the training, continuous anodal transcranial direct current stimulation (tDCS) will be applied to the the subject's right cerebellum.
Group V: Multisyllabic learning in childrenExperimental Treatment1 Intervention
45 children with persistent developmental stuttering (CWS) and 45 children with neurotypical speech development (CNS) will participate in this arm. Subjects will learn nonsense words formed by novel combinations of 2 syllables that are legal in American English during 6 training sessions over 2 days. Behavioral measures extracted from the data will be used to compare performance before and after training and across the CWS and CNS participants.
Group VI: Multisyllabic learning and fMRI in adultsExperimental Treatment1 Intervention
30 adults persistent developmental stuttering (AWS) and 30 adults with neurotypical speech development (ANS) will participate in this arm. Subjects will learn nonsense words formed by novel combinations of 3 syllables that are legal in American English during 6 training sessions over 2 days. Following training, subjects will participate in a functional magnetic resonance imaging (fMRI) session on a third day to measure brain activity associated with producing the words formed by pairing 2 learned 3-syllable strings learned during training and those formed by pairing 2 unfamiliar 3-syllable strings. Behavioral measures extracted from the data will be used to compare performance before and after training and across the AWS and ANS participants.
Group VII: Sub-syllabic learning and sham tDCSPlacebo Group2 Interventions
35 adults with neurotypical speech development will participate in this arm. Subjects will learn novel 1-syllable words formed by non-native phoneme combinations. During training, Sham transcranial direct current stimulation stimulation (tDCS) will be delivered to the subject's brain.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Boston UniversityBoston, MA
Massachusetts General HospitalBoston, MA
University of MichiganAnn Arbor, MI
Loading ...
Who Is Running the Clinical Trial?
Boston University Charles River CampusLead Sponsor
University of MichiganCollaborator
Massachusetts General HospitalCollaborator
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
References
Relative efficacy of intensive and spaced behavioral treatment of stuttering. [2017]Twenty adult and adolescent stutterers were randomly assigned to two treatment formats consisting of either 16 two-hour sessions of fluency training administered within a concentrated period of four consecutive days (intensive treatment), or two two-hour sessions per week for eight weeks (spaced treatment). Frequency of stuttering and rate of speaking were repeatedly assessed from speech samples obtained in six different clinic and extra-clinic speech settings. The efficiency of treatment, subject compliance, and communication "attitudes" were also measured. Fluency training produced significant reductions in stuttering frequency, and significant improvements in speaking rate and communication attitudes for both treatment formats. Both formats were found equivalent on all measures. In addition, generalization of treatment effects was observed in all settings. However, maintenance of generalization effects was uneven across settings, suggesting the possible need for differential levels of training for different speaking situations.
Evidence-based treatment and stuttering--historical perspective. [2022]To illustrate the way in which both fluency shaping (FS) and stuttering management (SM) treatments for developmental stuttering in adults are evidence based.
Nonspeech oral motor treatment issues related to children with developmental speech sound disorders. [2008]This article examines nonspeech oral motor treatments (NSOMTs) in the population of clients with developmental speech sound disorders. NSOMTs are a collection of nonspeech methods and procedures that claim to influence tongue, lip, and jaw resting postures; increase strength; improve muscle tone; facilitate range of motion; and develop muscle control. In the case of developmental speech sound disorders, NSOMTs are employed before or simultaneous with actual speech production treatment.
[Treatment outcome study of the stuttering therapy summer camp 2000 for children and adolescents]. [2006]Therapists are generally confronted with the question, to what extent results of randomised clinical trials with their emphasis on internal validity are relevant for practitioners and their unselected patients. Often results from clinical trials are neglected in clinical practice and the "normal" practice remains unstudied. In this study a therapeutic approach for stuttering has been studied under practice conditions, but with a maximum of methodological validity. Beyond the concrete study it is also discussed whether the chosen procedure can be a model for practice studies. Patients from age 9 to 19 participated in a stuttering therapy summer-camp for children and adolescents by the Austria-Self-Aid-Initiative Stuttering. Participants were supposed to learn a more open handling of their stuttering and acquire basics for a fluent speech. The therapy concept includes elements of a fluency shaping and a stuttering modification therapy. The evaluation followed a panel design with two assessments before, one assessment after therapy and one follow-up and three types of measurement: 1. three videotaped speech situations, 2. four questionnaires for the participants and their parents, and 3. Goal Attainment Scalings (GAS). The stuttering frequency shows a reduction from 22.2 to 9.5 % (effect size 1.29). Follow-up results, GAS and all questionnaires also indicate clear improvements. Altogether, the Therapeutic Stuttering Summer-camp was able to reach its aims.
Stutterers' perceptions of therapy improvement and of posttherapy regression: effects of certain program modifications. [2019]In an attempt to improve its effectiveness, a traditional, symptomatic stuttering therapy program for school-age children was modified to (1) focus more upon self-therapy activities while reducing group work emphasis; (2) specify more precisely the target responses used to replace stuttering; (3) establish clearly the criteria for client progress; and (4) provide well-defined activities for the transfer of speech change. Participants used a questionnaire to evaluate their improvement and post-therapy regression in various dimensions of stuttering severity, and results were compared with questionnaire findings from an earlier treatment program. Significantly greater improvement in speech fluency was perceived by the participants following the modified program, and follow-up videotape samples confirmed their perceptions as revealed on the questionnaire.
Speech and nonspeech sequence skill learning in adults who stutter. [2015]Two studies compared the speech and nonspeech sequence skill learning of nine persons who stutter (PWS) and nine matched fluent speakers (PNS). Sequence skill learning was defined as a continuing process of stable improvement in speed and/or accuracy of sequencing performance over practice and was measured by comparing PWS's and PNS's performance curves of accuracy, reaction time, and sequence duration, as well as retention and transfer. In experiment one, participants completed a 30-trial finger tapping sequence and in experiment two, a 30-trial read-aloud sequence of nonsense syllables. Significant between-group differences were found in the speed of sequencing performance after practice, and on retention and transfer tests. These results partially supported the inference that PWS demonstrated differences in early stages of sequence skill learning compared to PNS.
Chunking of phonological units in speech sequencing. [2020]Efficient speech communication requires rapid, fluent production of phoneme sequences. To achieve this, our brains store frequently occurring subsequences as cohesive "chunks" that reduce phonological working memory load and improve motor performance. The current study used a motor-sequence learning paradigm in which the generalization of two performance gains (utterance duration and errors) from practicing novel phoneme sequences was used to infer the nature of these speech chunks. We found that performance improvements in duration from practicing syllables with non-native consonant clusters largely generalized to new syllables that contained those clusters. Practicing the whole syllable, however, resulted in larger performance gains in error rates compared to practicing just the consonant clusters. Collectively, these findings are consistent with theories of speech production that posit the consonant cluster as a fundamental unit of phonological working memory and speech sequencing as well as those positing the syllable as a fundamental unit of motor programming.
Measurement of trained speech patterns in stuttering: interjudge and intrajudge agreement of experts by means of modified time-interval analysis. [2013]Improved fluency after stuttering therapy is usually measured by the percentage of stuttered syllables. However, outcome studies rarely evaluate the use of trained speech patterns that speakers use to manage stuttering. This study investigated whether the modified time interval analysis can distinguish between trained speech patterns, fluent speech, and stuttered speech. Seventeen German experts on stuttering judged a speech sample on two occasions. Speakers of the sample were stuttering adults, who were not undergoing therapy, as well as participants in a fluency shaping and a stuttering modification therapy. Results showed satisfactory inter-judge and intra-judge agreement above 80%. Intervals with trained speech patterns were identified as consistently as stuttered and fluent intervals. We discuss limitations of the study, as well as implications of our findings for the development of training for identification of trained speech patterns and future outcome studies.
Practice and retention of nonwords in adults who stutter. [2021]We investigated short-term practice and retention of nonwords in 10 adults who stutter (Mean age=30.7 years, SD=15.1) and age and sex-matched 10 control participants (Mean age=30.8 years, SD=14.9).