Perceptual Training to Improve Listeners' Ability to Understand Speech Produced by Individuals With Dysarthria

Perceptual Training for Improved Intelligibility of Dysarthric Speech

There exist very few effective treatments that ease the intelligibility burden of dysarthria. Perceptual training offers a promising avenue for improving intelligibility of dysarthric speech by offsetting the communicative burden from the speaker with dysarthria on to their primary communication partners-family, friends, and caregivers. This project, utilizing advanced explanatory models, will permit identification of speaker and listener parameters, and their interactions, that allow perceptual training paradigms to be optimized for intelligibility outcomes in dysarthria rehabilitation. This work addresses this critical gap in clinical practice and sets the stage for extension of dysarthria management to listener-targeted remediation-advancing clinical practice and enhanced communication and quality of life outcomes for this population.

Study Overview

• Status: Completed
• Conditions: Intelligibility, Speech; Dysarthria
• Intervention / Treatment: Behavioral: Perceptual Training

Detailed Description

There exist very few effective treatments that ease the intelligibility burden of dysarthria, and all of these require cognitive and physical effort on the part of the speaker to achieve and maintain gains. Therefore, individuals with intelligibility deficits whose cognitive and physical impairments limit their ability to modify their speech are currently not viable treatment candidates. This constitutes a significant health disparity that disproportionately affects those clinical populations with developmental, cognitive, and/or significant neuromuscular impairment.

To address this critical gap in current dysarthria management, the weight of behavioral change is shifted from the speaker to the listener. While a novel concept for dysarthria management, the idea is firmly rooted in the field of psycholinguistics and supported by a programmatic body of research showing that listener-targeted perceptual training paradigms (wherein listeners are familiarized with the degraded speech signal and provided with an orthographic transcription of what the speaker is saying) result in statistically and clinically significant intelligibility gains in dysarthria. Further, preliminary evidence suggests that these intelligibility outcomes may be influenced by hypothesis-driven speaker parameters, such as acoustic predictability of speech rhythm cues, and listener parameters, such as expertise in rhythm perception.

A requisite next step to bringing listener-targeted perceptual training closer to clinical implementation, and the overarching goal of this clinical trial, is the systematic and rigorous analysis of the speaker and listener parameters, and their interactions, that modulate, and in some cases optimize, perceptual training benefits of intelligibility improvement. To achieve this aim, an existing database of dysarthric speech (20 speakers with dysarthria) and a large cohort of listeners (n = 400) across two well-established testing sites, Utah State University and Florida State University are utilized. Thus, the key deliverable resulting from this work will be explanatory models that account for the unique and joint contributions of speaker and listener parameters on the magnitude of intelligibility improvement following perceptual training with dysarthric speech.

• Study Type: Interventional
• Enrollment (Actual): 373
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Florida
    • Tallahassee, Florida, United States, 32301
      • Florida State University
  • Utah
    • Logan, Utah, United States, 84322
      • Utah State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

*Native speakers of American English

Exclusion Criteria:

• No self-reported history of speech impairment
• No self-reported history of language impairment
• No self-reported history of cognitive impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Perceptual training with a speaker with dysarthria; To examine the effect of perceptual training with speakers with dysarthria, we use a standard three-phase perceptual training protocol involving pretest, training, and posttest phases, in which speech samples from a single speaker with dysarthria are utilized for all three phases.	Behavioral: Perceptual Training; Each listener is familiarized/trained with a single speaker with dysarthria. Pretest/posttest transcription data will be used to build explanatory models of intelligibility improvement.; Other Names: Familiarization

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Transcription accuracy	A percentage words correct (PWC) score is tabulated for each listener at pretest	Transcription accuracy is assessed at pretest, immediately before perceptual training.
Transcription accuracy	A percentage words correct (PWC) score is tabulated for each listener at posttest	Transcription accuracy is assessed at posttest, immediately after perceptual training.

Collaborators and Investigators

• Sponsor: Utah State University
• Collaborators: National Institute on Deafness and Other Communication Disorders (NIDCD)
• Investigators: Principal Investigator: Stephanie A Borrie, PhD, Utah State University; Principal Investigator: Kaitlin L Lansford, PhD, Florida State University

Publications and helpful links

General Publications

• Borrie SA, Lansford KL, Barrett TS. Understanding dysrhythmic speech: When rhythm does not matter and learning does not happen. J Acoust Soc Am. 2018 May;143(5):EL379. doi: 10.1121/1.5037620.
• Lansford KL, Borrie SA, Barrett TS. Regularity Matters: Unpredictable Speech Degradation Inhibits Adaptation to Dysarthric Speech. J Speech Lang Hear Res. 2019 Nov 20;62(12):4282-4290. doi: 10.1044/2019_JSLHR-19-00055. Print 2019 Dec 18.
• Borrie SA, Lansford KL, Barrett TS. Rhythm Perception and Its Role in Perception and Learning of Dysrhythmic Speech. J Speech Lang Hear Res. 2017 Mar 1;60(3):561-570. doi: 10.1044/2016_JSLHR-S-16-0094.
• Lansford KL, Borrie SA, Bystricky L. Use of Crowdsourcing to Assess the Ecological Validity of Perceptual-Training Paradigms in Dysarthria. Am J Speech Lang Pathol. 2016 May 1;25(2):233-9. doi: 10.1044/2015_AJSLP-15-0059.
• Borrie SA, McAuliffe MJ, Liss JM, Kirk C, O'Beirne GA, Anderson T. Familiarisation conditions and the mechanisms that underlie improved recognition of dysarthric speech. Lang Cogn Process. 2012 Sep 1;27(7-8):1039-1055. doi: 10.1080/01690965.2011.610596.
• Borrie SA, Lansford KL, Barrett TS. Generalized Adaptation to Dysarthric Speech. J Speech Lang Hear Res. 2017 Nov 9;60(11):3110-3117. doi: 10.1044/2017_JSLHR-S-17-0127.
• Lansford KL, Luhrsen S, Ingvalson EM, Borrie SA. Effects of Familiarization on Intelligibility of Dysarthric Speech in Older Adults With and Without Hearing Loss. Am J Speech Lang Pathol. 2018 Feb 6;27(1):91-98. doi: 10.1044/2017_AJSLP-17-0090.
• Hirsch ME, Lansford KL, Barrett TS, Borrie SA. Generalized Learning of Dysarthric Speech Between Male and Female Talkers. J Speech Lang Hear Res. 2021 Feb 17;64(2):444-451. doi: 10.1044/2020_JSLHR-20-00313. Epub 2021 Jan 28.
• Lansford KL, Borrie SA, Barrett TS, Flechaus C. When Additional Training Isn't Enough: Further Evidence That Unpredictable Speech Inhibits Adaptation. J Speech Lang Hear Res. 2020 Jun 22;63(6):1700-1711. doi: 10.1044/2020_JSLHR-19-00380. Epub 2020 May 20.
• Borrie SA, Lansford KL, Barrett TS. A Clinical Advantage: Experience Informs Recognition and Adaptation to a Novel Talker With Dysarthria. J Speech Lang Hear Res. 2021 May 11;64(5):1503-1514. doi: 10.1044/2021_JSLHR-20-00663. Epub 2021 Apr 8.
• Borrie SA, Barrett TS, Yoho SE. Autoscore: An open-source automated tool for scoring listener perception of speech. J Acoust Soc Am. 2019 Jan;145(1):392. doi: 10.1121/1.5087276.

Study record dates

Study Major Dates

• Study Start (Actual): April 26, 2021
• Primary Completion (Actual): July 1, 2023
• Study Completion (Actual): July 1, 2023

Study Registration Dates

• First Submitted: May 10, 2021
• First Submitted That Met QC Criteria: May 14, 2021
• First Posted (Actual): May 21, 2021

Study Record Updates

• Last Update Posted (Actual): August 14, 2023
• Last Update Submitted That Met QC Criteria: August 10, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: intelligibility; dysarthria; motor speech disorders; perceptual training
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Language Disorders; Communication Disorders; Speech Disorders; Articulation Disorders; Dysarthria
• Other Study ID Numbers: 11110 (DAIDS ES Registry Number); R21DC018867 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Results of the proposed research will be disseminated through conference presentations and manuscripts submitted to academic journals. In addition, the de-identified data will be available for public access via a data repository at the University of Michigan (ICPSR). The study will be registered in ClinicalTrials.gov within 21 days of enrollment of the first participant. Results will be submitted within 1 year of completion of the study. Informed consent documents will contain a statement concerning posting of information to ClinicalTrials.gov. Utah State University's Investigator Handbook (Chapter 9) outlines a policy for reporting all ClinicalTrials.gov information, specifically stating that it is the PI's responsibility to do so according to NIH policy.
• IPD Sharing Time Frame: Within one year of completion
• IPD Sharing Access Criteria: Information related to the protocol and statistical analysis plan will be shared in future publications. The analytic code will be shared via the Open Science website, with the link included in associated publications.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No