Enhancing speech fluency in people who stutter

提高口吃者言语的流畅度

• 批准号: MR/N025539/1
• 负责人: Kate Watkins
• 金额: $ 95.58万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN025539%2F1
• 关键词: Enhancing; speech; fluency; people; who

Developmental stuttering (also known as stammering in the UK) affects one in twenty children and persists to adulthood in one in a hundred. People who stutter experience disruption to the normal flow of speech. They produce frequent repetitions or prolongations of sounds, syllables and words and frequent hesitations or pauses when speech can appear blocked. Children and adults who stutter can experience restrictions in their academic and career choices and some suffer from anxiety as a result of their speech difficulties. Fluency can be achieved temporarily by people who stutter by changing the way speech is produced, for example by singing, speaking with a different accent or in time with an external stimulus, such as a metronome or another speaker. Altering the auditory feedback associated with speech production can also be effective; for example, feedback that is noisy, or altered in pitch or time (delayed) can result in almost complete fluency in some people (as portrayed in the film The King's Speech). The effectiveness of altering auditory feedback in enhancing fluency suggests that stuttering may be caused by a problem in combining motor and auditory information. In this research study, we will use speech therapy techniques that change the way speech is produced by people who stutter and improves their speech fluency. While people undergo this therapy, we will stimulate their brain with a weak electric current. This form of stimulation is painless and can improve the amount and rate at which new skills are learned. The therapy will take place over five days. Half of the people in the study will have therapy and stimulation, while the other half will have therapy and no stimulation. The participants and the researchers will not know who is having real stimulation and who is not. We will measure the effects of this therapy and stimulation by measuring rates of stuttering, speech naturalness and attitudes to stuttering before and after the five days of treatment. We are also interested in understanding the brain abnormalities that cause stuttering. We will use MRI brain scans to measure how brain areas involved in producing speech (motor areas) and in monitoring speech (auditory areas) communicate with each other. We expect that the communication between the motor and auditory areas will improve as speech fluency improves. MRI scans give us very detailed pictures of the brain's anatomy and its function. It can also be used to see what is happening inside our mouths when we are speaking. We will develop new ways of using MRI to scan the mouth and vocal tract during fluent speech and during stuttering. This will provide us with new information about how people who stutter control their tongue and lips and other muscles involved in speech production. As speech fluency improves, we expect that we will see differences in the brain and vocal tract images, which will provide us with another way of measuring the outcome of the speech fluency and brain stimulation training.MRI scans are very noisy and are not ideal for looking at the sensitivity of the brain areas involved in listening to speech. Also, speech is produced and understood extremely rapidly (10-12 speech sounds per second are typical in fluent speech). MRI cannot capture these rapid changes so it is necessary to use another brain imaging method called magnetoencephalography (MEG). MEG measures brain waves with very precise timing. In people who stutter, researchers have shown using MEG that speech production can alter auditory signals in the brain and that the timing of these signals is abnormal in people who stutter. We will also use MEG while people listen to and produce speech. We hope that this work will help us to understand how altering speech feedback can improve speech fluency. Such an understanding is critical for further development of effective therapies for stuttering.

发展性口吃（在英国也称为口吃）影响二十分之一的儿童，并持续到成年的比例为一百分之一。口吃的人的正常语言表达会受到干扰。他们会频繁地重复或重复声音、音节和单词，当说话出现障碍时，他们会频繁地犹豫或停顿。口吃的儿童和成年人在学业和职业选择上会受到限制，有些人会因言语困难而感到焦虑。口吃的人可以通过改变说话的方式来暂时达到流利，例如通过唱歌，用不同的口音说话或与外部刺激（如节拍器或另一个扬声器）同步。改变与言语产生相关的听觉反馈也可能是有效的;例如，嘈杂的反馈，或者音调或时间（延迟）的改变可以导致一些人几乎完全流利（如电影《国王的演讲》中所描绘的）。改变听觉反馈在提高流畅性方面的有效性表明，口吃可能是由运动和听觉信息结合问题引起的。在这项研究中，我们将使用言语治疗技术，改变口吃者的言语产生方式，提高他们的言语流利度。当人们接受这种治疗时，我们会用微弱的电流刺激他们的大脑。这种形式的刺激是无痛的，可以提高学习新技能的数量和速度。治疗将持续五天。研究中一半的人将接受治疗和刺激，而另一半将接受治疗而不接受刺激。参与者和研究人员将不知道谁有真实的刺激，谁没有。我们将通过测量口吃率、言语自然度和治疗前后对口吃的态度来衡量这种治疗和刺激的效果。我们也有兴趣了解导致口吃的大脑异常。我们将使用MRI脑部扫描来测量参与产生语音（运动区）和监控语音（听觉区）的大脑区域如何相互交流。我们预计，随着语言流畅性的提高，运动区和听觉区之间的交流也会得到改善。核磁共振成像扫描给我们提供了大脑解剖结构及其功能的非常详细的图片。它也可以用来观察我们说话时嘴里发生的事情。我们将开发新的方法，使用MRI扫描流利讲话和口吃期间的口腔和声道。这将为我们提供有关口吃者如何控制舌头和嘴唇以及其他参与言语产生的肌肉的新信息。随着语言流利程度的提高，我们希望我们能看到大脑和声道图像的差异，这将为我们提供另一种测量语言流利程度和大脑刺激训练结果的方法。MRI扫描噪音很大，不适合观察与听语音有关的大脑区域的敏感性。此外，语音产生和理解非常迅速（每秒10-12个语音声音是流利语音的典型）。MRI无法捕捉这些快速变化，因此有必要使用另一种称为脑磁图（MEG）的大脑成像方法。脑磁图测量脑电波的时间非常精确。对于口吃的人，研究人员使用脑磁图表明，言语产生可以改变大脑中的听觉信号，并且口吃的人这些信号的时间异常。我们还将使用MEG，而人们听和生产的讲话。我们希望这项工作将有助于我们了解如何改变语音反馈可以提高语音流畅性。这种理解对于进一步开发有效的口吃治疗方法至关重要。

项目成果

Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering.

• DOI: 10.1093/brain/awab283
• 发表时间: 2021-11-29
• 期刊: Brain : a journal of neurology
• 作者: Cler GJ;Krishnan S;Papp D;Wiltshire CEE;Chesters J;Watkins KE
• 通讯作者: Watkins KE

Failure of tDCS to modulate motor excitability and speech motor learning.

• DOI: 10.1016/j.neuropsychologia.2020.107568
• 发表时间: 2020-09
• 期刊: Neuropsychologia
• 影响因子: 2.6
• 作者: Wiltshire CEE;Watkins KE
• 通讯作者: Watkins KE

Transcranial direct current stimulation over left inferior frontal cortex improves speech fluency in adults who stutter.

• DOI: 10.1093/brain/awy011
• 发表时间: 2018-04-01
• 期刊: Brain : a journal of neurology
• 作者: Chesters J;Möttönen R;Watkins KE
• 通讯作者: Watkins KE

Neural changes after training with transcranial direct current stimulation to increase speech fluency in adults who stutter

经颅直流电刺激训练后口吃成人提高言语流畅度后的神经变化

• DOI: 10.31219/osf.io/8st3j
• 发表时间: 2021
• 作者: Chesters J

Speech Movement Variability in People Who Stutter: A Vocal Tract Magnetic Resonance Imaging Study.

• DOI: 10.1044/2021_jslhr-20-00507
• 发表时间: 2021-07-16
• 期刊: Journal of speech, language, and hearing research : JSLHR
• 作者: Wiltshire CEE;Chiew M;Chesters J;Healy MP;Watkins KE
• 通讯作者: Watkins KE