Improve Speech Using an In-the-ear Device in Parkinson's Disease
Condition: Parkinson's Disease; Dysarthria
MeSH terms: Parkinson Disease; Dysarthria
Study type: Interventional
Phase: Phase 1

Summary: 
      This project will systematically examine the therapeutic effect of altered auditory feedback
      provided by the in-the-ear device on the speech impairments in patients with Parkinson's
      disease.

      Many patients with PD have difficulty starting their speech even though they know the words
      they want to say. They experience 'freezing' of the jaw, tongue and lips. When they
      eventually get their speech started, they have a hard time moving it forward. They keep on
      saying the same words or phrases over and over again while their voice gets softer and
      softer. Many words also run together. These symptoms make patients' speech very hard to
      understand and directly affect their care and quality of life. Currently, there is no
      effective medical or surgical treatment for these speech symptoms.

      We have tested an in-the-ear therapeutic device that provides altered auditory feedback in
      eight patients with PD and moderate to severe speech impairment and the results are
      encouraging. We will recruit 100 patients with PD and moderate to severe speech impairment
      for Phase A and 20 for Phase B of the study. They will use the device routinely to provide
      the altered auditory feedback as they speak to improve their speech intelligibility.
    

Detailed description: 
      Speech problems are common in patients with Parkinson's disease (PD). At an early stage,
      patients may find it hard to project their voice. As the disease progresses, patients start
      to have difficulty starting their speech even though they know the words they want to say.
      They experience 'freezing' of the jaw, tongue and lips. When they eventually get their speech
      started, they have a hard time moving it forward. They keep on saying the same words or
      phrases over and over again while their voice gets softer and softer. Many words also run
      together or are slurred. These symptoms make patients' speech very hard to understand and
      directly affect their care and quality of life. Unfortunately, these symptoms have not
      responded to medication or surgery like other non-speech motor symptoms do. In fact, some
      surgical treatment could even make speech worse while other motor function such as walking
      improves. Traditional behavior therapy for these speech symptoms has not been successful
      either because these symptoms cannot be controlled voluntarily.

      Recently, we have tested an in-the-ear therapeutic device that provides altered auditory
      feedback in eight patients with PD and moderate to severe speech impairment. The device is
      housed in a hearing aid shell, and it is programmable. Patients wore the device in one ear
      and heard their own speech through it after a short time delay and with a shift in pitch
      while they spoke. The delay ranged from 50-220 ms and their pitch shifted up or down from
      500-2,000 Hz. For each patient, a specific combination of the time-delay and pitch-shift was
      found. Our preliminary results were encouraging. Seven of the eight PD patients made
      significant improvement in their speech, and they were much easier to understand when they
      used the device.

      This project will systematically examine the therapeutic effect of altered auditory feedback
      provided by the in-the-ear device on the speech impairments in PD. We will recruit 100
      patients with PD and moderate to severe speech impairment for Phase A and 20 for Phase B of
      the study. The Phase A study will be a single visit while the Phase B study will be over a
      one-year period while the patients use the device to provide the altered auditory feedback as
      they speak. Both short-term and long-term benefits of altered auditory feedback on speech
      will be monitored. Based on the results of our preliminary study, we expect the patients'
      speech will improve. We hypothesize that the use of altered auditory feedback provides
      salient sensory information that triggers ancillary loops to allow PD patients to initiate
      their speech more easily and to maintain a constant speaking rate, thus making their speech
      more intelligible. This project has the potential to significantly impact the quality of life
      for patients with PD. When PD patients can express their wants and needs and can communicate
      effectively with their families, caretakers and physicians, their quality of life improves.
    

Intervention name(s): SpeechEasy Model ITC
Intervention type(s): Device
Intervention description(s): The delayed auditory feedback ranging from 50 to 220 ms, and the altered frequency feedback ranging from 500 to 2,000 Hz.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: speech; Parkinson's disease; treatment; speech intelligibility; speaking rate