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.

项目摘要和摘要 患有脑损伤或影响运动的疾病的人（例如帕金森氏病，大脑 麻痹，肌萎缩性的侧索硬化症以及许多其他人）通常很难被理解 说话。尽管存在治疗，但他们通常需要对演讲方式的认识 产生或需要增加呼吸支撑，以更大声说话。许多言语障碍的人 认知或呼吸困难使这些治疗无效。这些人将从 促进运动学习的替代策略：通过实践改变运动动作的能力。一种类型 运动学习，感觉运动适应性是替代康复的特别有希望的途径。在 这个范式是人们在讲话时收到的听觉反馈，从而使他们受到外部扰动，导致他们 迅速改变他们的讲话以反对这些扰动。因为它能够快速诱导变化 无意识控制的语音生产，感觉运动适应性具有独特的康复前景。 但是，其潜在的临床适用性受到对关键临床相关特征的不良理解的限制。 首先，现有的感觉运动适应范例不会以促进的方式影响语音 沟通。为了改善康复结果，感觉运动学习必须针对临床上的目标 语音参数，例如智能。我们通过一种新颖的听觉扰动来解决这个障碍 人为地减少元音之间的感知空间，从而导致扬声器产生更多的元音对比度。 至关重要的是，减少的元音对比是运动言语障碍的标志，并显着有助于 降低了清晰度。我们确定此范式提高清晰度并测试如何有效性 这些增加在多个培训课程中保留，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起它们，这是潜在临床应用的关键。 第二，尽管感觉运动适应是平均而言的强大影响，但并非所有个人都学会 相同的程度。这种差异限制了仅显示大量学习的人的潜在影响。这 提案使用行为干预措施和大脑刺激，以实现这一假设的原因 可变性。通过直接操纵这些因素，我们可以首次确定的机制 语音运动基础。另外，确定如何调制这些因素以增加 学习将使治疗受益于更广泛的个人。 尽管感觉运动适应可以迅速引起语音变化，但其当前的临床适用性 受到我们对其机制的理解的巨大差距的限制。通过确定能力 感觉运动适应以提高语音清晰度，表征保留和学习的转移，以及 确定个人之间可变性的机制，这项工作为 未来优化运动学习临床影响的未来治疗方法。