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The Role of Cerebellum in Speech

Primary Purpose

Cerebellar Ataxia, Dysarthria, Healthy

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
MRI
TMS
Speech-motor behavioral testing
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Cerebellar Ataxia focused on measuring dysarthria, ataxia, cerebellum, cerebellar, adult, speaking, language, TMS, MRI, speech

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion criteria:

  • Diagnosis of cerebellar ataxia (CA) resulting from degeneration of the cerebellum AND normal hearing abilities OR
  • Healthy volunteers with no known history of physical or neurological abnormalities AND normal speech, hearing, and reading abilities
  • For some studies, primary language of American English may be required

Exclusion criteria for healthy volunteers:

  • Neurological impairment or psychiatric illness

Exclusion criteria for participants with cerebellar ataxia (CA):

  • Neurological impairment or psychiatric illness apart from those arising from cerebellar damage

Exclusion criteria for participants with CA or for healthy volunteers participating in MRI (may still be eligible for other study procedures):

  • Any contraindication to participating in an MRI study including the following: implanted metallic parts or implanted electronic devices, including pacemakers, defibrillators, stimulators, or implant medication pump, or nonremovable piercings; aneurysm clip or other metal in the head (except mouth); claustrophobia precluding MRI

Exclusion criteria for healthy volunteers participating in TMS (may still be eligible for other study procedures):

  • Any contraindications to participating in a TMS study including the following: epilepsy, use of certain medications, heart disease, and pregnancy; scalp wounds or infections; any other contraindication discovered during screening procedures
  • Any contraindication to participating in an MRI study including the following: implanted metallic parts or implanted electronic devices, including pacemakers, defibrillators, or implant medication pump, or nonremovable piercings; claustrophobia precluding MRI

Exclusion criteria for all potential participants:

  • Pregnant or trying to become pregnant (may still be eligible for behavioral studies only)
  • History of alcohol abuse, illicit drug use or drug abuse or significant mental illness
  • Hypertensive or hypotensive condition
  • Any condition that would prevent the subject from giving voluntary informed consent
  • Enrolled or plans to enroll in an interventional trial during this study
  • Ongoing seizures that are not well controlled despite medication
  • Use of hearing aid or other device to improve hearing

Sites / Locations

  • University of California, BerkeleyRecruiting
  • University of California, San Francisco
  • University of Wisconsin--MadisonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Experimental

Arm Label

Patients with cerebellar ataxia (CA)

Matched controls

Additional healthy volunteers

Arm Description

Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI)

Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI)

Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI) Transcranial magnetic stimulation (TMS)

Outcomes

Primary Outcome Measures

Speech-motor response percent compensation
Percent compensation is calculated as the following ratio: -100*(change in acoustic feature produced by the subject)/(change in acoustic feature caused by auditory feedback alteration). The negative sign ensures that changes produced by the subject that oppose the auditory feedback alteration changes are counted as positive compensation. Acoustic features used to compute percent compensation depend on the experiment performed and will include pitch or formant frequencies of subjects' output speech (measured by frequency in Hz), voice onset time (measured in milliseconds), fricative consonant duration (measured in milliseconds), and formant transition time (measured in milliseconds). We will look for short-term (within-trial) and long-term (across-trial) changes in percent compensation produced by subjects in response to alterations in subjects' auditory feedback they hear while speaking.
Dysarthria symptoms
Ataxic dysarthria (AD) symptoms will be quantified in patients with cerebellar ataxia (CA) by licensed speech-language pathologists using the Bogenhausen Dysarthria Scales (BoDyS), a dysarthria assessment tool that has been shown to be objective, reliable, and sensitive to dysarthria subtypes 31, 60, and 61. The BoDyS test entails 33 separate component ratings, including symptoms that may be related to feedforward and feedback components of speech motor control systems.
Voxel-based morphometry (VBM)
VBM will be applied to explore the functional organization of the cerebellum for speech production, focusing on psychophysical measures of speech motor control as well as clinical measures of dysarthric speech symptoms.

Secondary Outcome Measures

Full Information

First Posted
May 24, 2019
Last Updated
February 9, 2023
Sponsor
University of California, San Francisco
Collaborators
University of California, Berkeley, University of Wisconsin, Madison, National Institute on Deafness and Other Communication Disorders (NIDCD)
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1. Study Identification

Unique Protocol Identification Number
NCT03972202
Brief Title
The Role of Cerebellum in Speech
Official Title
The Role of Cerebellum in Speech
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 15, 2019 (Actual)
Primary Completion Date
August 15, 2023 (Anticipated)
Study Completion Date
September 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
University of California, Berkeley, University of Wisconsin, Madison, National Institute on Deafness and Other Communication Disorders (NIDCD)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will investigate the how the cerebellum is involved in speech motor learning over time and short-term corrections in patients with cerebellar ataxia and healthy controls. This will be accomplished through three approaches: behavioral studies, magnetic resonance imaging (MRI), and transcranial magnetic stimulation (TMS). During behavioral studies, participants will be asked to speak into a microphone while their voice is played back over earphones, and to do other speaking tasks. MRI will be acquired to perform a detailed analysis on brain function and anatomy related to speech and the cerebellum. In healthy controls, TMS will also be performed to temporarily disrupt the cerebellum before, during, or after the participant performs speaking tasks. Patients with cerebellar ataxia and healthy volunteers will be asked to complete behavioral studies and/or MRI; healthy volunteers may be asked to additionally participate in TMS.
Detailed Description
This study will investigate the role of the cerebellum in speech, building upon prior work in understanding cerebellar function in reaching and walking. Neuroimaging and lesion studies have provided strong evidence that the cerebellum is an integral part of the speech production network, though its precise role in the control of speech remains unclear. Furthermore, damage to the cerebellum (either degenerative or focal) can lead to ataxic dysarthria, a motor speech disorder characterized, in part, by impaired articulation and severe temporal deficits. This project seeks to bridge the gap between theoretical models of cerebellar function and the speech symptoms associated with ataxic dysarthria. Two mechanisms underlie speech motor control - feedback and feedforward control. In feedback control, speakers use sensory feedback (e.g., of their own voice) to control their speech. In feedforward control, speakers use knowledge gained from their past speech productions, rather than on-line feedback, to control their speech. This study entails a systematic plan to elucidate the role of the cerebellum in feedforward and feedback control of speech. A central hypothesis is that the cerebellum is especially critical in the feedforward control of speech, but has little involvement in feedback control. To explore this hypothesis, we will obtain converging evidence from three innovative methodologies: 1) Neuropsychological studies of speech-motor responses to real-time altered auditory feedback in patients with cerebellar atrophy (CA) and matched healthy controls, 2) Parallel studies in healthy controls undergoing theta-burst transcranial magnetic stimulation to create "virtual lesions" of the cerebellum, and 3) Structural and functional studies in CA patients to examine the relationship between cerebellar lesion location, dysarthria symptoms, and feedforward and feedback control ability. Speech provides an important opportunity to examine how well current theories of cerebellar function generalize to a novel effector (vocal tract) and sensory (auditory) domain. Its purpose for communication imposes exacting spectro-temporal constraints not seen in other motor domains. Furthermore, the distinctive balance of feedback and feedforward control in speech allows us to examine changes in both control types subsequent to cerebellar damage. Critically, this is the first work examining the link between theoretically motivated control deficits in CA patients and the speech symptoms associated with ataxic dysarthria, as well as their neural correlates.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cerebellar Ataxia, Dysarthria, Healthy
Keywords
dysarthria, ataxia, cerebellum, cerebellar, adult, speaking, language, TMS, MRI, speech

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
264 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Patients with cerebellar ataxia (CA)
Arm Type
Experimental
Arm Description
Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI)
Arm Title
Matched controls
Arm Type
Active Comparator
Arm Description
Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI)
Arm Title
Additional healthy volunteers
Arm Type
Experimental
Arm Description
Behavioral testing including various speaking tasks Magnetic resonance imaging (MRI) Transcranial magnetic stimulation (TMS)
Intervention Type
Diagnostic Test
Intervention Name(s)
MRI
Other Intervention Name(s)
Magnetic Resonance Imaging
Intervention Description
Brain MRI will be performed (no contrast) to correlate brain anatomy/function with behavioral testing.
Intervention Type
Device
Intervention Name(s)
TMS
Other Intervention Name(s)
Transcranial Magnetic Stimulation, Repetitive TMS, rTMS
Intervention Description
Repetitive TMS will be applied to transiently disrupt cerebellar speech pathways.
Intervention Type
Behavioral
Intervention Name(s)
Speech-motor behavioral testing
Intervention Description
Language/speaking tasks will be performed during which participants are asked to speak in response to audio/video cues; participants' responses will be recorded. For patients with cerebellar ataxia, additional diagnostic surveys may be completed.
Primary Outcome Measure Information:
Title
Speech-motor response percent compensation
Description
Percent compensation is calculated as the following ratio: -100*(change in acoustic feature produced by the subject)/(change in acoustic feature caused by auditory feedback alteration). The negative sign ensures that changes produced by the subject that oppose the auditory feedback alteration changes are counted as positive compensation. Acoustic features used to compute percent compensation depend on the experiment performed and will include pitch or formant frequencies of subjects' output speech (measured by frequency in Hz), voice onset time (measured in milliseconds), fricative consonant duration (measured in milliseconds), and formant transition time (measured in milliseconds). We will look for short-term (within-trial) and long-term (across-trial) changes in percent compensation produced by subjects in response to alterations in subjects' auditory feedback they hear while speaking.
Time Frame
Baseline
Title
Dysarthria symptoms
Description
Ataxic dysarthria (AD) symptoms will be quantified in patients with cerebellar ataxia (CA) by licensed speech-language pathologists using the Bogenhausen Dysarthria Scales (BoDyS), a dysarthria assessment tool that has been shown to be objective, reliable, and sensitive to dysarthria subtypes 31, 60, and 61. The BoDyS test entails 33 separate component ratings, including symptoms that may be related to feedforward and feedback components of speech motor control systems.
Time Frame
Baseline
Title
Voxel-based morphometry (VBM)
Description
VBM will be applied to explore the functional organization of the cerebellum for speech production, focusing on psychophysical measures of speech motor control as well as clinical measures of dysarthric speech symptoms.
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion criteria: Diagnosis of cerebellar ataxia (CA) resulting from degeneration of the cerebellum AND normal hearing abilities OR Healthy volunteers with no known history of physical or neurological abnormalities AND normal speech, hearing, and reading abilities For some studies, primary language of American English may be required Exclusion criteria for healthy volunteers: Neurological impairment or psychiatric illness Exclusion criteria for participants with cerebellar ataxia (CA): Neurological impairment or psychiatric illness apart from those arising from cerebellar damage Exclusion criteria for participants with CA or for healthy volunteers participating in MRI (may still be eligible for other study procedures): Any contraindication to participating in an MRI study including the following: implanted metallic parts or implanted electronic devices, including pacemakers, defibrillators, stimulators, or implant medication pump, or nonremovable piercings; aneurysm clip or other metal in the head (except mouth); claustrophobia precluding MRI Exclusion criteria for healthy volunteers participating in TMS (may still be eligible for other study procedures): Any contraindications to participating in a TMS study including the following: epilepsy, use of certain medications, heart disease, and pregnancy; scalp wounds or infections; any other contraindication discovered during screening procedures Any contraindication to participating in an MRI study including the following: implanted metallic parts or implanted electronic devices, including pacemakers, defibrillators, or implant medication pump, or nonremovable piercings; claustrophobia precluding MRI Exclusion criteria for all potential participants: Pregnant or trying to become pregnant (may still be eligible for behavioral studies only) History of alcohol abuse, illicit drug use or drug abuse or significant mental illness Hypertensive or hypotensive condition Any condition that would prevent the subject from giving voluntary informed consent Enrolled or plans to enroll in an interventional trial during this study Ongoing seizures that are not well controlled despite medication Use of hearing aid or other device to improve hearing
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Coordinator for Cerebellum Speech Study
Phone
415-476-6888
Email
cerebellumspeech@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Anne Findlay
Phone
415-476-6888
Email
anne.findlay@ucsf.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John F. Houde, Ph.D.
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Srikantan S. Nagarajan, Ph.D.
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Richard Ivry, Ph.D.
Organizational Affiliation
University of California, Berkeley
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ben Parrell, Ph.D.
Organizational Affiliation
University of Wisconsin, Madison
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California, Berkeley
City
Berkeley
State/Province
California
ZIP/Postal Code
94720
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richard Ivry, Ph.D.
Phone
510-642-5292
Email
ivry@berkeley.edu
First Name & Middle Initial & Last Name & Degree
Richard Ivry, Ph.D.
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Anne Findlay
Phone
415-476-6888
Email
anne.findlay@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Danielle Mizuiri
Phone
415-476-6888
Email
danielle.mizuiri@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Srikantan Nagarajan, Ph.D.
First Name & Middle Initial & Last Name & Degree
John Houde, Ph.D.
Facility Name
University of Wisconsin--Madison
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53705
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chris Naber
Email
cwnaber@wisc.edu
First Name & Middle Initial & Last Name & Degree
Ben Parrell, Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
23345447
Citation
Chang EF, Niziolek CA, Knight RT, Nagarajan SS, Houde JF. Human cortical sensorimotor network underlying feedback control of vocal pitch. Proc Natl Acad Sci U S A. 2013 Feb 12;110(7):2653-8. doi: 10.1073/pnas.1216827110. Epub 2013 Jan 23.
Results Reference
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27098695
Citation
Hinkley LB, Marco EJ, Brown EG, Bukshpun P, Gold J, Hill S, Findlay AM, Jeremy RJ, Wakahiro ML, Barkovich AJ, Mukherjee P, Sherr EH, Nagarajan SS. The Contribution of the Corpus Callosum to Language Lateralization. J Neurosci. 2016 Apr 20;36(16):4522-33. doi: 10.1523/JNEUROSCI.3850-14.2016.
Results Reference
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PubMed Identifier
26917046
Citation
Kort NS, Cuesta P, Houde JF, Nagarajan SS. Bihemispheric network dynamics coordinating vocal feedback control. Hum Brain Mapp. 2016 Apr;37(4):1474-85. doi: 10.1002/hbm.23114. Epub 2016 Feb 25.
Results Reference
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28131013
Citation
Ranasinghe KG, Gill JS, Kothare H, Beagle AJ, Mizuiri D, Honma SM, Gorno-Tempini ML, Miller BL, Vossel KA, Nagarajan SS, Houde JF. Abnormal vocal behavior predicts executive and memory deficits in Alzheimer's disease. Neurobiol Aging. 2017 Apr;52:71-80. doi: 10.1016/j.neurobiolaging.2016.12.020. Epub 2017 Jan 3.
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Citation
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Citation
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Parrell, B., Agnew, Z., Houde, J., Nagarajan, S., & Ivry, R. (2016) Individuals with cerebellar degeneration correct for within-category variation of vowels even in the absence of auditory feedback. Talk presented at Society for Neuroscience 2016, San Diego, CA, November 2016.
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The Role of Cerebellum in Speech

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