Investigating the Effects of Rhythm and Entrainment on Fluency in People With Aphasia

Study Overview
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Brief Summary
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Speaking in unison with another person is included as a part of many treatment approaches for aphasia. It is not well understood why and how this technique works. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech are most helpful. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? A possible mechanism for this benefit is examined, by testing whether the degree of alignment of a person's speech with that of another speaker can account for unison benefit.

Detailed Description
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Aphasia is an acquired language disorder, most commonly due to stroke. It can affect an individual's ability to speak, understand spoken language, read, and write. Many treatments designed to improve spoken language in persons with aphasia (PWAs) use unison speech, having the person with aphasia speak along with the clinician or with a recording. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech help them the most. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? This knowledge is important because understanding who benefits from this commonly used and potentially powerful therapy component, under which conditions they benefit, and why they do, is critical for customizing therapy so it can be as effective and efficient as possible. Unison speech is conducted using one of two different timing patterns: (1) a natural conversational pattern, which is used in everyday conversations, or (2) a metrical pattern, which follows a beat-based timing framework, as in songs or some poems. In either case, precisely aligning one's speech with that of another person (i.e., entraining one's speech) requires prediction: each speaker must plan their own speech motor commands before having heard the other speaker say the words they are planning. Natural conversational timing requires the speaker to make use of knowledge about language, particularly grammar, to align with the other person. In contrast, a metrical pattern allows a speaker to predict speech timing without relying heavily on language-based knowledge. Given that many PWAs have impaired grammar, we hypothesize that most PWAs will benefit more from speaking in unison to sentences with metrical vs. conversational timing patterns. However, there is great variation in linguistic, motor speech, and timing skills across PWAs, so metrical and conversational timing patterns are likely to have different degrees of effectiveness for different individuals. Results from this study will demonstrate how individual characteristics and speech timing affect whether or not a person with aphasia benefits from speaking in unison. Results will also indicate whether a speaker's ability to predict speech timing is necessary for a benefit of unison speech. Prediction ability will be measured by how closely the speaker aligns their speech with a spoken model.

Official Title
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Investigating the Effects of Rhythm and Entrainment on Fluency in People With Aphasia

Conditions
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Aphasia, Apraxia of Speech

Intervention / Treatment
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* Behavioral: Unison speech (vs. solo)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Native-speaker fluency in American English (prior to stroke for people with aphasia) Controls must report no history of speech, language, neurological disorders, or stroke People with aphasia must be at least 6-months post-stroke, and aphasia must be due to stroke Exclusion Criteria: Inadequate hearing ability to reliably complete task: fail hearing screen Inadequate cognitive ability to understand and remember task: fail cognition screening (different measures for controls and people with aphasia) Inadequate speech repetition ability to complete task, or to be considered a control: fail speech repetition screening (different thresholds for controls and people with aphasia) Inadequate auditory comprehension ability to understand task: fail auditory comprehension screen (people with aphasia only)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>All participants will repeat sentences under four speech conditions, in a 2x2 design | Behavioral: Unison speech (vs. solo)<br>* Participants will repeat sentences in four conditions, in a 2x2 design with the factors unison vs. solo repetition, and metrical vs. conversational speech timing. Measures of speech accuracy and timing will be collected.<br>* Other names: Metrical timing (vs. conversational);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent syllables correct | The percentage of syllables correctly repeated from the target sentences will be computed for each of the 4 experimental conditions. A protocol will be used to score syllables for correctness. | 1 day study visit | 
| Percent syllables entrained | Of the syllables attempted by the participant, the percent that are classified as entrained, meaning they are aligned in time with the target syllable. Thresholds for classifying a syllable as entrained are based on control data. | 1 day study visit |