Establishing the clinical utility of sensorimotor adaptation for speech rehabilitation

项目摘要(&A) 有脑部损伤或影响运动的障碍的个人(如帕金森氏症、脑部 瘫痪、肌萎缩侧索硬化症和许多其他疾病)通常很难被理解 说。虽然存在治疗方法，但它们通常需要大量有意识地注意说话的方式 产生，或需要增加呼吸支持才能说得更大声。许多言语障碍患者都有 认知或呼吸困难，使这些治疗无效。这些个人将受益于 促进运动学习的替代策略：通过练习改变运动动作的能力。一种类型 在运动学习中，感觉运动适应是替代康复的一种特别有前途的途径。在……里面 这种范式，人们在说话时收到的听觉反馈受到外部干扰，导致他们 迅速改变他们的讲话，以反对这些干扰。因为它有能力快速地在 没有意识控制的言语产生，感觉运动适应为康复提供了独特的希望。 然而，由于对关键的临床相关特征缺乏了解，其潜在的临床适用性受到限制。 首先，现有的感觉运动适应范式不会以一种促进语音的方式影响语言 沟通。为了改善康复效果，感觉运动学习必须针对临床相关。 语音参数，如清晰度。我们通过一种新颖的听觉扰动来解决这个障碍 人为地缩小元音之间的感知间距，导致说话者产生更多的元音对比。 关键的是，元音对比度降低是运动性言语障碍的一个标志，并对 清晰度降低。我们确定了这一范例提高可理解性的有效性，并测试了 这些增长在多个培训课程中保留，它们如何概括为未培训的单词，以及 如何在复杂的句子中引出它们--这些特征是潜在临床应用的关键。 其次，虽然感觉运动适应平均来说是一种强大的效果，但并不是所有的人都学会了 同样的学位。这种可变性将潜在的影响限制在那些表现出高度学习能力的人身上。这 Proposal使用行为干预和脑刺激来针对这一假想的原因 可变性。通过直接操纵这些因素，我们可以第一次确定 语言运动学习的基础。此外，确定如何调整这些因素以增加 学习将使治疗受益于更广泛的个人。 尽管感觉运动适应可以迅速引起语音变化，但它目前的临床适用性 由于我们对其机制的理解存在很大差距，这一点受到限制。通过建立...的能力 感觉运动适应，以提高语言清晰度，表征学习的保持和转移，以及 确定个体之间差异的潜在机制，这项工作奠定了关键的基础 未来的治疗，优化运动学习的临床影响。

Project Summary & Abstract Individuals with brain injuries or disorders that affect movement (such as Parkinson’s disease, cerebral palsy, amyotrophic lateral sclerosis, and many others) often have difficulties in being understood when they speak. While treatments exist, they often require substantial conscious attention to the way speech is produced, or require increased breath support to speak louder. Many individuals with speech disorders have cognitive or respiratory difficulty that renders these treatments ineffective. These individuals will benefit from alternative strategies that promote motor learning: the ability to alter motor actions through practice. One type of motor learning, sensorimotor adaptation, is a particularly promising pathway for alternative rehabilitation. In this paradigm, the auditory feedback people receive while speaking is externally perturbed, causing them to quickly change their speech to oppose these perturbations. Because of its ability to rapidly induce changes in speech production without conscious control, sensorimotor adaptation holds unique promise for rehabilitation. However, its potential clinical applicability is limited by poor understanding of key clinically-relevant features. First, existing sensorimotor adaptation paradigms do not affect speech in a way that facilitates communication. To improve rehabilitation outcomes, sensorimotor learning must target clinically-relevant speech parameters such as intelligibility. We address this barrier through a novel auditory perturbation that artificially decreases the perceived space between vowels, causing speakers to produce more vowel contrast. Critically, reduced vowel contrast is a hallmark of motor speech disorders and significantly contributes to decreased intelligibility. We determine the effectiveness of this paradigm to increase intelligibility and test how these increases are retained across multiple training sessions, how they generalize to untrained words, and how they can be elicited in complex sentences—characteristics which are key for potential clinical applications. Second, while sensorimotor adaptation is a robust effect on average, not all individuals learn to the same degree. This variability limits the potential impact to only those who show a large degree of learning. This proposal uses behavioral interventions and brain stimulation that target the hypothesized causes of this variability. By directly manipulating these factors, we can determine, for the first time, the mechanisms that underlie speech motor learning. Additionally, establishing how these factors can be modulated to increase learning would allow treatment to benefit a wider range of individuals. Although sensorimotor adaptation can quickly induce changes in speech, its current clinical applicability is limited by substantial gaps in our understanding of its mechanisms. By establishing the capacity of sensorimotor adaptation to increase speech intelligibility, characterizing retention and transfer of learning, and identifying the mechanisms underlying variability between individuals, this work lays a critical foundation for future treatments that optimize the clinical impact of motor learning.