An interventional study of Unison speech (vs. solo) and Metrical timing (vs. conversational) in Aphasia and Apraxia of Speech, sponsored by MGH Institute of Health Professions. Completed at 1 site in United States. Open to participants aged 18 Years to 80 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-05-18.
Sponsored by MGH Institute of Health Professions · Not applicable, Interventional, and Basic science
Speaking in unison with another person is included as a part of many treatment approaches for aphasia. It is not well understood why and how this technique works. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech are most helpful. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? A possible mechanism for this benefit is examined, by testing whether the degree of alignment of a person's speech with that of another speaker can account for unison benefit.
Aphasia is an acquired language disorder, most commonly due to stroke. It can affect an individual's ability to speak, understand spoken language, read, and write. Many treatments designed to improve spoken language in persons with aphasia (PWAs) use unison speech, having the person with aphasia speak along with the clinician or with a recording. One goal of this study is to determine who benefits from speaking in unison, and what characteristics of speech help them the most. Another goal is to investigate a possible mechanism for this benefit: why does speaking in unison help? This knowledge is important because understanding who benefits from this commonly used and potentially powerful therapy component, under which conditions they benefit, and why they do, is critical for customizing therapy so it can be as effective and efficient as possible. Unison speech is conducted using one of two different timing patterns: (1) a natural conversational pattern, which is used in everyday conversations, or (2) a metrical pattern, which follows a beat-based timing framework, as in songs or some poems. In either case, precisely aligning one's speech with that of another person (i.e., entraining one's speech) requires prediction: each speaker must plan their own speech motor commands before having heard the other speaker say the words they are planning. Natural conversational timing requires the speaker to make use of knowledge about language, particularly grammar, to align with the other person. In contrast, a metrical pattern allows a speaker to predict speech timing without relying heavily on language-based knowledge. Given that many PWAs have impaired grammar, we hypothesize that most PWAs will benefit more from speaking in unison to sentences with metrical vs. conversational timing patterns. However, there is great variation in linguistic, motor speech, and timing skills across PWAs, so metrical and conversational timing patterns are likely to have different degrees of effectiveness for different individuals. Results from this study will demonstrate how individual characteristics and speech timing affect whether or not a person with aphasia benefits from speaking in unison. Results will also indicate whether a speaker's ability to predict speech timing is necessary for a benefit of unison speech. Prediction ability will be measured by how closely the speaker aligns their speech with a spoken model.
338 studies on the registry are indexed under Aphasia; 95 are open to participants now.
This study's enrollment of 75 is above the median of 30 across 298 interventional studies indexed under Aphasia.
Browse Aphasia studies →MGH Institute of Health Professions is the lead sponsor of 19 studies on the registry; 12 are open to participants now.
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Exclusion Criteria:
Adults with stroke-based aphasia. Designating this group as experimental reflects the focus on studying responses in people with aphasia. All participants will complete the same 4 study conditions in a 2x2 design (Unison vs. Solo and Metrical vs. Conversational).
Behavioral: Unison speech (vs. solo) · Behavioral: Metrical timing (vs. conversational)
Adults without a history of speech, language, or neurological disorder, or stroke. This group is intended to serve as a context-providing reference group rather than a true comparator. All participants will complete the same 4 study conditions in a 2x2 design (Unison vs. Solo and Metrical vs. Conversational).
Behavioral: Unison speech (vs. solo) · Behavioral: Metrical timing (vs. conversational)
Participants will repeat sentences in four conditions, in a 2x2 design with the factors unison vs. solo repetition, and metrical vs. conversational speech timing. Measures of speech accuracy and timing will be collected.
This is the secondary contrast in the 2x2 design described above.
Percent Syllables Correct
The percentage of syllables correctly repeated from the target sentences will be computed for each contrast, Unison vs. Solo and Metrical vs. Conversational, capturing all 4 conditions in the 2x2 design (Unison Metrical, Unison Conversational, Solo Metrical, Solo Conversational). A protocol will be used to score syllables for correctness.
Time frame: 1 day study visit
Mean Syllable Offset From Model
Of the syllables attempted by the participant, the mean offset from the corresponding target syllable in the model is computed for each syllable for each participant using the formula (p - d) - s, where p is the timing of voicing onset in the participant response, d is the timing of voicing onset in the model, and s is the line delay in the audio equipment. Means are computed for each participant and each condition. Note this measure can only be computed in the Unison conditions (Unison Metrical and Unison Conversational), since the Solo conditions do not have a simultaneous spoken model to which the participant is trying to align their speech.
Time frame: 1 day study visit
| Milestone | People With Aphasia | Controls |
|---|---|---|
| Started | 23 | 52 |
| Completed | 18 | 49 |
| Not completed | 5 | 3 |
| Withdrew: Found ineligible | 4 | 1 |
| Withdrew: Withdrawal by subject | 0 | 1 |
| Withdrew: Data loss: audio recording error | 1 | 1 |
The percentage of syllables correctly repeated from the target sentences will be computed for each contrast, Unison vs. Solo and Metrical vs. Conversational, capturing all 4 conditions in the 2x2 design (Unison Metrical, Unison Conversational, Solo Metrical, Solo Conversational). A protocol will be used to score syllables for correctness.
| percentage | Controls | People With Aphasia |
|---|---|---|
| Unison | 99.22 ± 1.08 | 64.26 ± 23.13 |
| Solo | 99.46 ± 1.18 | 52.71 ± 33.57 |
| Metrical | 99.65 ± 0.67 | 60.47 ± 29.68 |
| Conversational | 99.03 ± 1.39 | 56.50 ± 28.98 |
Of the syllables attempted by the participant, the mean offset from the corresponding target syllable in the model is computed for each syllable for each participant using the formula (p - d) - s, where p is the timing of voicing onset in the participant response, d is the timing of voicing onset in the model, and s is the line delay in the audio equipment. Means are computed for each participant and each condition. Note this measure can only be computed in the Unison conditions (Unison Metrical and Unison Conversational), since the Solo conditions do not have a simultaneous spoken model to which the participant is trying to align their speech.
| seconds | Controls | People With Aphasia |
|---|---|---|
| Metrical | -.016 ± .028 | 0.030 ± 0.052 |
| Conversational | 0.006 ± 0.040 | 0.154 ± 0.188 |
Collected over One study visit for controls and two study visits for people with aphasia, typically 1 day to 2 weeks apart. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Intervention | 0/75 (0%) | 0/75 (0%) | 0/75 (0%) |
| Age, Continuous(years) | People With Aphasia | Controls | Total |
|---|---|---|---|
| Mean | 59.0 ± 7.6 | 42.4 ± 18.4 | 47.5 ± 17.7 |
| Sex: Female, Male(Participants) | People With Aphasia | Controls | Total |
|---|---|---|---|
| Female | 9 | 31 | 40 |
| Male | 14 | 21 | 35 |
| Race/Ethnicity, Customized(Participants) | People With Aphasia | Controls | Total |
|---|---|---|---|
| White, not Hispanic | 20 | 36 | 56 |
| White, Hispanic | 0 | 1 | 1 |
| White, unknown ethnicity | 0 | 2 | 2 |
| Black, not Hispanic | 3 | 5 | 8 |
| Black, Hispanic | 0 | 0 | 0 |
| Black, unknown ethnicity | 0 | 0 | 0 |
| Asian, not Hispanic | 0 | 6 | 6 |
| Asian, Hispanic | 0 | 1 | 1 |
| Asian, ethnicity unknown | 0 | 0 | 0 |
| race not specified, ethnicity unknown | 0 | 1 | 1 |
| Hearing Screen(Participants) | People With Aphasia | Controls | Total |
|---|---|---|---|
| Count of participants | 22 | 52 | 74 |
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