Establishing the clinical utility of sensorimotor adaptation for speech rehabilitation

建立感觉运动适应在言语康复中的临床应用

• 批准号: 10627846
• 负责人: Caroline Niziolek
• 金额: $ 45.37万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10627846
• 关键词: Acoustics; Address; Adult; Affect; Amyotrophic Lateral Sclerosis; Apraxias; Attention; Auditory; Awareness; Behavior; Behavior Control; Behavior Therapy; Behavioral; Brain; Brain Diseases; Brain Injuries; Categories; Cerebral Palsy; Characteristics; Clinical; Clinical Research; Cognitive; Communication; Complex; Conscious; Data; Development; Disease; Dysarthria; Effectiveness; Effectiveness of Interventions; Feedback; Foundations; Future; Impairment; Individual; Intervention; Learning; Limb structure; Link; Longevity; Mental Depression; Motor; Movement; Neurobiology; Neurologic; Parkinson Disease; Pathway interactions; Patients; Perception; Persons; Population; Production; Quality of life; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Role; Sensory; Social isolation; Speech; Speech Disorders; Speech Intelligibility; Testing; Time; Training; Transcranial magnetic stimulation; Translating; Work; auditory feedback; clinical application; clinical practice; clinically relevant; effectiveness evaluation; evidence base; experience; experimental study; improved; ineffective therapies; inter-individual variation; motor learning; neuroimaging; neuroregulation; novel; patient population; respiratory; tool; transfer learning; treatment optimization

Project Summary & Abstract Individuals with brain injuries or disorders that affect movement (such as Parkinson’s disease, cerebral palsy, amyotrophic lateral sclerosis, and many others) often have difficulties in being understood when they speak. While treatments exist, they often require substantial conscious attention to the way speech is produced, or require increased breath support to speak louder. Many individuals with speech disorders have cognitive or respiratory difficulty that renders these treatments ineffective. These individuals will benefit from alternative strategies that promote motor learning: the ability to alter motor actions through practice. One type of motor learning, sensorimotor adaptation, is a particularly promising pathway for alternative rehabilitation. In this paradigm, the auditory feedback people receive while speaking is externally perturbed, causing them to quickly change their speech to oppose these perturbations. Because of its ability to rapidly induce changes in speech production without conscious control, sensorimotor adaptation holds unique promise for rehabilitation. However, its potential clinical applicability is limited by poor understanding of key clinically-relevant features. First, existing sensorimotor adaptation paradigms do not affect speech in a way that facilitates communication. To improve rehabilitation outcomes, sensorimotor learning must target clinically-relevant speech parameters such as intelligibility. We address this barrier through a novel auditory perturbation that artificially decreases the perceived space between vowels, causing speakers to produce more vowel contrast. Critically, reduced vowel contrast is a hallmark of motor speech disorders and significantly contributes to decreased intelligibility. We determine the effectiveness of this paradigm to increase intelligibility and test how these increases are retained across multiple training sessions, how they generalize to untrained words, and how they can be elicited in complex sentences—characteristics which are key for potential clinical applications. Second, while sensorimotor adaptation is a robust effect on average, not all individuals learn to the same degree. This variability limits the potential impact to only those who show a large degree of learning. This proposal uses behavioral interventions and brain stimulation that target the hypothesized causes of this variability. By directly manipulating these factors, we can determine, for the first time, the mechanisms that underlie speech motor learning. Additionally, establishing how these factors can be modulated to increase learning would allow treatment to benefit a wider range of individuals. Although sensorimotor adaptation can quickly induce changes in speech, its current clinical applicability is limited by substantial gaps in our understanding of its mechanisms. By establishing the capacity of sensorimotor adaptation to increase speech intelligibility, characterizing retention and transfer of learning, and identifying the mechanisms underlying variability between individuals, this work lays a critical foundation for future treatments that optimize the clinical impact of motor learning.

项目总结及摘要 患有脑损伤或影响运动的疾病（如帕金森病、脑功能障碍）的人 麻痹症、肌萎缩侧索硬化症和许多其他疾病）当他们 虽然存在治疗方法，但它们通常需要大量有意识地关注言语的方式。 许多患有言语障碍的人都会产生或需要增加呼吸支持才能大声说话。 认知或呼吸困难使这些治疗无效，这些人将从中受益。 促进运动学习的替代策略：通过练习改变运动动作的能力。 运动学习、感觉运动适应是替代康复的一条特别有前途的途径。 在这种范式中，人们在说话时收到的听觉反馈受到外部干扰，导致他们 迅速改变他们的言论来对抗这些扰动，因为它能够迅速引发变化。 由于言语产生无需有意识控制，感觉运动适应为康复提供了独特的希望。 然而，由于对关键临床相关特征了解不足，其潜在的临床适用性受到限制。 首先，现有的感觉运动适应范式不会以促进言语的方式影响言语。 为了改善康复效果，感觉运动学习必须以临床相关为目标。 我们通过一种新颖的听觉扰动来解决这个障碍，例如清晰度。 人为地减少元音之间的感知空间，导致说话者产生更多的元音对比度。 重要的是，元音对比度降低是运动性言语障碍的一个标志，并且会显着导致 我们确定该范例提高可懂度的有效性并测试如何提高可懂度。 这些增加在多个训练课程中得以保留，它们如何推广到未经训练的单词，以及 如何在复杂的句子中引出它们——这些特征是潜在临床应用的关键。 其次，虽然感觉运动适应平均而言具有强大的影响，但并非所有个体都学会了 这种可变性将潜在影响仅限于那些表现出较高学习程度的人。 该提案使用行为干预和大脑刺激来针对造成这种情况的阻碍原因 通过直接操纵这些因素，我们可以第一次确定导致变化的机制。 此外，确定如何调节这些因素以提高言语运动学习的基础。 学习将使治疗惠及更广泛的个人。 虽然感觉运动适应可以快速诱发言语变化，但其目前的临床适用性 由于我们对其机制的理解存在重大差距而受到限制。 感觉运动适应以提高言语清晰度，表征学习的保留和迁移，以及 这项工作确定了个体之间差异的潜在机制，为 优化运动学习临床影响的未来治疗方法。