Sensory-Motor Integration for Speech Rehabilitation in Patients with Post-stroke Aphasia
- Conditions
- Aphasia Non FluentStroke
- Interventions
- Device: Enriched rehabilitationDevice: Simple rehabilitation
- Registration Number
- NCT04433351
- Lead Sponsor
- University Hospital, Grenoble
- Brief Summary
SEMO is a multidisciplinary project (language sciences, cognitive psychology and neuropsychology, physical medicine and rehabilitation, neurology, speech-language pathology, functional neuroimaging and engineering sciences) that aims first, to test and develop a novel speech rehabilitation program designed for patients with non-fluent aphasia and, second, to better describe neural reorganization after successful recovery. To this end, the investigators will conduct a prospective monocentric cross-over study, including two cohorts of post-stroke aphasic patients and two control groups.
- Detailed Description
In this project, the investigators propose to evaluate the effectiveness of a new rehabilitation program, based on illustration of speech articulators, to improve speech in patients with non-fluent aphasia. The instigators' method is based on the reinforcement of the interaction between perceptual and motor representations, thanks to the innovative Ultraspeech device. The investigators will exploit a fundamental psycholinguistic principle, which postulates that speech is based both on the activation of the system controlling the motricity of effectors related to word articulation (action) and on the auditory or visual representation of words (perception). The sensory-motor interaction method that the investigators propose allows the patient to perceive phonemes and visualize on a computer screen the movements of the tongue and lips previously recorded by a healthy speaker, typically a speech therapist. Through repeated exercises, the patient is trained to produce sounds correctly, using the correct pronunciation and articulatory movements of the reference speaker as a model. The investigators will compare patients who will follow a classical speech and language therapy rehabilitation program followed by an 'enriched' rehabilitation program including rehabilitation based on sensory-motor interaction associated with speech and language therapy, and vice versa. In order to judge the favorable effect of the rehabilitation program including sensory-motor integration, the following measures will be considered: (a) language skills, (b) phonemic quality, (c) inner speech abilities and (d) cognitive function. Brain language networks will be evaluated with neuroimaging.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 36
- patients with non-fluent aphasia after lesion in the dominant hemisphere for language
- native speakers of French
- normal or corrected to normal vision
- satisfying all criteria for the MRI examination
- patients with comprehension deficits, hemi-spatial neglect or upper limb apraxia
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description SE cohort Simple rehabilitation Patients in the SE cohort will carry out first the simple rehabilitation protocol (S, 4 weeks) followed by enriched rehabilitation (E, 4 weeks). ES cohort Simple rehabilitation Patients in the ES cohort will carry out first the enriched rehabilitation protocol (E, 4 weeks) followed by simple rehabilitation (S, 4 weeks). SE cohort Enriched rehabilitation Patients in the SE cohort will carry out first the simple rehabilitation protocol (S, 4 weeks) followed by enriched rehabilitation (E, 4 weeks). ES cohort Enriched rehabilitation Patients in the ES cohort will carry out first the enriched rehabilitation protocol (E, 4 weeks) followed by simple rehabilitation (S, 4 weeks).
- Primary Outcome Measures
Name Time Method Evaluation of acoustic changes in the speech signal before and after each rehabilitation protocol Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of acoustic properties (formants, voice onset time and spectral moments) with a phoneme repetition task. Repeated phonemes are isolated vowels, semi-consonants in vowel context and consonants in /a/ context with the consonants (C) placed in initial (/Ca/) or medial (/aCa/) positions.
- Secondary Outcome Measures
Name Time Method Evaluation of changes in inner speech abilities before and after each rehabilitation protocol - Inner speech testing 1 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Evaluate inner speech abilities with an introspective questionnaire
Evaluation of changes in inner speech abilities before and after each rehabilitation protocol - Inner speech testing 2 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Evaluate inner speech abilities with a behavioral task (homophone detection task)
Clinical language assessment 1a Baseline pre-intervention Assessment of oral and written expression with BDAE (Boston Diagnostic Aphasia Examination).
Evaluation of changes in language abilities before and after rehabilitation - Clinical language assessment 1b Immediately after the first intervention; immediately after the second intervention Assessment of oral expression (picture naming) with BDAE (Boston Diagnostic Aphasia Examination).
Clinical language assessment 2a Baseline pre-intervention Assessment of transcoding (word/sentence repetition and syllable/word reading) with BDAE (Boston Diagnostic Aphasia Examination).
Evaluation of changes in language abilities before and after rehabilitation - Clinical language assessment 2b Immediately after the first intervention; immediately after the second intervention Assessment of transcoding (word repetition and word reading) with BDAE (Boston Diagnostic Aphasia Examination).
Evaluation of changes in language abilities before and after each rehabilitation protocol - Clinical language assessment 3 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of verbal fluency with phonemic and semantic fluency tasks. The patient must generate words that satisfy certain criteria: beginning with a particular letter (phonemic fluency) or belonging to a particular semantic category (semantic fluency).
Clinical language assessment 4 Baseline pre-intervention Assessment of bucco-facial praxia with MT-86 (Montreal-Toulouse aphasia language examination protocol).
Evaluation of changes in language abilities before and after each rehabilitation protocol - Clinical language assessment 5 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of phonemic discrimination with BALE (Batterie Analytique du Langage Ecrit).
Evaluation of changes in language abilities before and after each rehabilitation protocol - Clinical language assessment 6 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of phonological awareness with a rhyme detection task. The patient must decide whether two heard words rhyme or not.
Evaluation of changes in cognitive level before and after each rehabilitation protocol - Neuropsychological assessment 1 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of general cognitive level with CASP (Cognitive Assessment Scale for Stroke Patients). CASP evaluates several abilities (naming, comprehension, inhibition, flexibility etc.) and the global score is out of 36.
Evaluation of changes in specific executive functions before and after each rehabilitation protocol - Neuropsychological assessment 2 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of visuo-spatial span with the Corsi blocks task.
Evaluation of changes in specific executive functions before and after each rehabilitation protocol - Neuropsychological assessment 3 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of non-verbal fluency with the Ruff figural fluency test.
Evaluation of changes in specific executive functions before and after each rehabilitation protocol - Neuropsychological assessment 4 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of executive functions with the TMT A-B (Trail Making Test A-B).
Evaluation of changes in non-verbal episodic memory before and after each rehabilitation protocol - Neuropsychological assessment 5 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of non-verbal episodic memory with BEM84 (Batterie d'Efficience Mnésique de Signoret). This test contains an immediate recall task (score out of 12) and a delayed recall task (score out of 12).
Evaluation of changes in mental rotation abilities before and after each rehabilitation protocol - Neuropsychological assessment 6 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of mental rotation abilities.
Evaluation of mood changes before and after each rehabilitation protocol - Neuropsychological assessment 7 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of depression with Aphasic Depression Rating Scale (ADRS; score out of 32; a score lower than 7 is for "no depression").
Evaluation of mood changes before and after each rehabilitation protocol - Neuropsychological assessment 8 Baseline pre-intervention; immediately after the first intervention; immediately after the second intervention Assessment of anxiety with Hamilton scale (score out of 56; a score lower or equal to 12 is for "normal anxiety"; a score between 12 and 20 is for "mild anxiety"; a score between 20 and 25 is for "moderate anxiety"; a score higher than 25 is for "severe anxiety").
Neuropsychological assessment 9 Baseline pre-intervention Assessment of familiarity degree with digital tools with an in-house test developed by the neuropsychologists from our clinical setting. This task allows to evaluate the use of the computer tools, its frequency of use and the type of activities carried out.
Evaluation of brain network activation (with measurement of BOLD, Blood Oxygen Level Dependent) before and after rehabilitation - Evaluation-brain 1 Baseline pre-intervention; immediately after the first intervention Assessment of brain networks modulation with fMRI (functional MRI) tasks : syllable repetition (repeating a heard syllable), picture-prompted rhyme detection (judging if verbal labels of pictures presented in pairs rhyme or not), and picture naming (naming pictures).
Evaluation of brain functional connectivity before and after rehabilitation - Evaluation-brain 2 Baseline pre-intervention; immediately after the first intervention Assessment of functional connectivity with rs-fMRI (resting state-functional MRI).
Evaluation of brain anatomical connectivity before and after rehabilitation - Evaluation-brain 3 Baseline pre-intervention; immediately after the first intervention Assessment of diffuse white-matter changes in multiple bundles with MRI-DTI (Diffusion Tension Imaging).
Trial Locations
- Locations (1)
Chu Grenoble Alpes
🇫🇷Grenoble, France