Laryngeal Adaptation for Speech and Swallowing

Study Overview
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Brief Summary
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This study will test laryngeal adaptation in speech and swallowing function in healthy adults, in patients with cerebral stroke, and in patients with spinocerebellar ataxia type 6. The findings from this proposal will be the first step toward implementing rehabilitation techniques that help patients to prevent speech and swallowing errors before they occur.

Official Title
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Laryngeal Adaptation for Speech and Swallowing

Conditions
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Stroke, Spinocerebellar Ataxia, Cerebral Stroke, Dysphagia, Dysarthria

Intervention / Treatment
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* Device: Intermittent Perturbation to Continuous Perturbation
* Device: Continuous Perturbation to Intermittent Perturbation


Participation Criteria
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Eligibility Criteria
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Patient Inclusion Criteria: All stroke and ataxia Ataxia DNA diagnosis of SCA6 and phenotype consistent with the DNA diagnosis No recessive, X-linked or mitochondrial Stroke Bilateral or unilateral middle cerebral artery (MCA) stroke No structural abnormalities (i.e. nodules) Dysphagia involving laryngeal dysfunction Stroke and ataxia with speech and swallowing disorders no structural abnormalities dysphagia involving laryngeal dysfunction Patient Exclusion Criteria: Montreal Cognitive Assess. <24 Moderate to severe hearing loss Barium allergy Other confounding speech disorder (i.e. stuttering) Chemo-radiation, surgical head and neck treatment Smoking Hx in the past 5 yrs or >5 years at any one time Twenty one years of age or older Breathing disorders or diseases

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 100 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: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: A cross-sectional study design will be used to examine laryngeal adaptation across all study groups.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stroke without Dysarthria<br>Examine laryngeal adaptation across all study groups: (1) baseline measures of speech or swallowing , (2) a clinical examination of disease/condition severity and (3) the experimental paradigm. | Device: Intermittent Perturbation to Continuous Perturbation<br>* Manipulate the Movement Planning Period (MPP), by interrupting sensory predictions by removing e-stim during the inter-trial interval (Intermittent Perturbation), followed by a washout/de-adaptation period.<br>* Other names: I to C Paradigm;Device: Continuous Perturbation to Intermittent Perturbation<br>* Manipulate the Movement Planning Period (MPP), by keep sensory input about the perturbation constant by maintaining e-stim during the inter-trial interval.<br>* Other names: C to I Paradigm;|
| Experimental: Stroke with Dysarthria<br>Examine laryngeal adaptation across all study groups: (1) baseline measures of speech or swallowing , (2) a clinical examination of disease/condition severity and (3) the experimental paradigm. | Device: Intermittent Perturbation to Continuous Perturbation<br>* Manipulate the Movement Planning Period (MPP), by interrupting sensory predictions by removing e-stim during the inter-trial interval (Intermittent Perturbation), followed by a washout/de-adaptation period.<br>* Other names: I to C Paradigm;Device: Continuous Perturbation to Intermittent Perturbation<br>* Manipulate the Movement Planning Period (MPP), by keep sensory input about the perturbation constant by maintaining e-stim during the inter-trial interval.<br>* Other names: C to I Paradigm;|
| Experimental: SCA6 without Dysarthria<br>Examine laryngeal adaptation across all study groups: (1) baseline measures of speech or swallowing , (2) a clinical examination of disease/condition severity and (3) the experimental paradigm. | Device: Intermittent Perturbation to Continuous Perturbation<br>* Manipulate the Movement Planning Period (MPP), by interrupting sensory predictions by removing e-stim during the inter-trial interval (Intermittent Perturbation), followed by a washout/de-adaptation period.<br>* Other names: I to C Paradigm;Device: Continuous Perturbation to Intermittent Perturbation<br>* Manipulate the Movement Planning Period (MPP), by keep sensory input about the perturbation constant by maintaining e-stim during the inter-trial interval.<br>* Other names: C to I Paradigm;|
| Experimental: SCA6 with Dysarthria<br>Examine laryngeal adaptation across all study groups: (1) baseline measures of speech or swallowing , (2) a clinical examination of disease/condition severity and (3) the experimental paradigm. | Device: Intermittent Perturbation to Continuous Perturbation<br>* Manipulate the Movement Planning Period (MPP), by interrupting sensory predictions by removing e-stim during the inter-trial interval (Intermittent Perturbation), followed by a washout/de-adaptation period.<br>* Other names: I to C Paradigm;Device: Continuous Perturbation to Intermittent Perturbation<br>* Manipulate the Movement Planning Period (MPP), by keep sensory input about the perturbation constant by maintaining e-stim during the inter-trial interval.<br>* Other names: C to I Paradigm;|
| Active Comparator: Age-Matched Controls<br>Examine laryngeal adaptation across all study groups: (1) baseline measures of speech or swallowing , (2) a clinical examination of disease/condition severity and (3) the experimental paradigm. | Device: Intermittent Perturbation to Continuous Perturbation<br>* Manipulate the Movement Planning Period (MPP), by interrupting sensory predictions by removing e-stim during the inter-trial interval (Intermittent Perturbation), followed by a washout/de-adaptation period.<br>* Other names: I to C Paradigm;Device: Continuous Perturbation to Intermittent Perturbation<br>* Manipulate the Movement Planning Period (MPP), by keep sensory input about the perturbation constant by maintaining e-stim during the inter-trial interval.<br>* Other names: C to I Paradigm;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Laryngeal Adaptation in Speech | To differentiate laryngeal adaptation during speech among cerebral stroke, SCA6, and healthy controls when vocal loudness is perturbed with expiratory loading. | Day 1 | 
| Laryngeal Adaptation in Swallowing | To differentiate laryngeal adaptation among cerebral stroke, SCA6, and healthy controls when swallowing is perturbed with neck surface electrical stimulation to restrict laryngeal elevation. | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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speech, swallowing, rehabilitation, stroke, deglutition, dysphagia, dysarthria, laryngeal, ataxia