Device to help people with Parkinson’s disease communicate better now available

SpeechVive Inc. announced Wednesday (Sept. 10) the commercial launch of the SpeechVive device intended to help people with a soft voice due to Parkinson’s disease speak more loudly and communicate more effectively.

The device is now available to try as a demo through the National Parkinson’s Disease Foundation’s Centers of Excellence prior to purchasing. People who suffer from a soft voice due to Parkinson’s disease can make an appointment at any of these centers: the Muhammad Ali Parkinson Center at Barrow Neurological Institute in Phoenix; the University of Florida, Gainesville, Florida; University of North Carolina, Chapel Hill, North Carolina; Struthers Parkinson’s Center, Minneapolis, Minnesota; and Baylor College of Medicine, Waco, Texas.

"We are providing demo units and training at no cost to as many of the National Parkinson’s Centers of Excellence as are interested in offering SpeechVive in conjunction with or as an alternative to speech therapy," said Steve Mogensen, president and CEO of SpeechVive. "We also are offering the SpeechVive units and training to professionals at Veterans Administration Medical Centers across the country. The first VAMC to offer SpeechVive is in Cincinnati, Ohio."

The SpeechVive device also is available to try at the M.D. Steer Speech and Hearing Clinic at Purdue University in West Lafayette, Indiana.

The technology was developed over the past decade by Jessica Huber, associate professor in Purdue’s Department of Speech, Language and Hearing Sciences and licensed through the Purdue Office of Technology Commercialization. The focus of Huber’s research is the development and testing of behavioral treatments to improve communication and quality of life in older adults and people with degenerative motor diseases.

SpeechVive reduces the speech impairments associated with Parkinson’s disease, which cause people with the disease to speak in a hushed, whispery voice and to have mumbled speech. People with Parkinson’s disease are commonly affected in their ability to communicate effectively.

"The clinical data we have collected over the past four years demonstrates that SpeechVive is effective in 90 percent of the people using the device," Huber said. "I am proud of the improvements in communication and quality of life demonstrated in our clinical studies. I look forward to seeing the device on the market so that more people with Parkinson’s disease will have access to it."

More than 1.5 million people in the United States are diagnosed with Parkinson’s disease, and it is one of the most common degenerative neurological diseases. About 89 percent of those with the disease have voice-related change affecting how loudly they speak, and at least 45 percent have speech-related change affecting how clearly they speak.

What sign language teaches us about the brain

The world’s leading humanoid robot, ASIMO, has recently learnt sign language. The news of this breakthrough came just as I completed Level 1 of British Sign Language (I dare say it took me longer to master signing than it did the robot!). As a neuroscientist, the experience of learning to sign made me think about how the brain perceives this means of communicating.

For instance, during my training, I found that mnemonics greatly simplified my learning process. To sign the colour blue you use the fingers of your right hand to rub the back of your left hand, my simple mnemonic for this sign being that the veins on the back of our hand appear blue. I was therefore forming an association between the word blue (English), the sign for blue (BSL), and the visual aid that links the two. However, the two languages differ markedly in that one relies on sounds and the other on visual signs.

Do our brains process these languages differently? It seems that for the most part, they don’t. And it turns out that brain studies of sign language users have helped bust a few myths.

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Gestures that speak

When you gesticulate you don’t just add a “note of colour” that makes your speech more pleasant: you convey information on sentence structure and make your meanings clearer. A study carried out at SISSA in Trieste demonstrates that gestures and “prosody” (the intonation and rhythm of spoken language) form  a  single “communication system” at the cognitive level, and that we speak using our “whole  body” and not only our vocal tract.

Have you ever found yourself gesticulating and felt a bit stupid for it while talking on the phone?

You’re not alone: it happens very often that people accompany their speech with hand gestures, sometimes even when no one can see them. Why can’t we keep still while speaking? “Because gestures and words very probably form a single “communication system”, which ultimately serves to enhance expression intended as the ability to make oneself understood”, explains Marina Nespor, a neuroscientist at the International School for Advanced Studies (SISSA) of Trieste. Nespor, together with Alan Langus, a SISSA research fellow, and Bahia Guellai from the Université Paris Ouest Nanterre La Défence, who conducted the investigation at SISSA, has just published a study in Frontiers in Psychology which demonstrates the role of gestures in speech “prosody”.

Linguists define prosody as the intonation and rhythm of spoken language, features that help to highlight sentence structure and therefore make the message easier to understand. For example, without prosody, nothing would distinguish the declarative statement “this is an apple” from the surprise question “this is an apple?” (in this case the difference lies in the intonation).

According to Nespor and colleagues, even hand gestures are part of prosody: “the prosody that accompanies speech is not ‘modality specific” explains Langus. “Prosodic information, for the person receiving the message, is a combination of auditory and visual cues. The ‘superior’ aspects (at the cognitive processing level) of spoken language are mapped to the motor‐programs responsible for the production of both speech sounds and accompanying hand gestures”.

Nespor, Langus and Guellai had 20 Italian speakers listen to a series of “ambiguous” utterances, which could be said with different prosodies corresponding to two different meanings. Examples of utterances were “come sicuramente hai visto la vecchia sbarra la porta” where, depending on meaning, “vecchia” can be the subject of the main verb (sbarrare, to block) or an adjective qualifying the subject (sbarra, bar) (‘As you for sure have seen the old lady blocks the door’ versus ‘As you for sure have seen the old bar carries it’). The utterances could be simply listened to (“audio only” modality) or be presented in a video, where the participants could both listen to the sentences and see the accompanying gestures. In the “video” stimuli, the condition could be “matched” (gestures corresponding to the meaning conveyed by speech prosody) or “mismatched” (gestures matching the alternative meaning).

“In the matched conditions there was no improvement ascribable to gestures: the  participants’ performance was very good both in the video and in the “audio only” sessions. It’s in the mismatched condition that the effect of hand gestures became apparent”, explains Langus. “With these stimuli the subjects were much more likely to make the wrong choice (that is, they’d choose the meaning indicated in the gestures rather than in the speech) compared to matched or audio only conditions. This means that gestures affect how meaning is interpreted, and we believe this points to the existence of a common cognitive system for gestures, intonation and rhythm of spoken language”.

“In human communication, voice is not sufficient: even the torso and in particular hand movements are involved, as are facial expressions”, concludes Nespor.

Finding thoughts in speech

For the first time, neuroscientists were able to find out how different thoughts are reflected in neuronal activity during natural conversations. Johanna Derix, Olga Iljina and the interdisciplinary team of Dr. Tonio Ball from the Cluster of Excellence BrainLinks-BrainTools at the University of Freiburg and the Epilepsy Center of the University Medical Center Freiburg (Freiburg, Germany) report on the link between speech, thoughts and brain responses in a special issue of Frontiers in Human Neuroscience.

"Thoughts are difficult to investigate, as one cannot observe in a direct manner what the person is thinking about. Language, however, reflects the underlying mental processes, so we can perform linguistic analyses of the subjects’ speech and use such information as a "bridge" between the neuronal processes and the subject’s thoughts," explains neuroscientist Johanna Derix.

The novelty of the authors’ approach is that the participants were not instructed to think and talk about a given topic in an experimental setting. Instead, the researchers analysed everyday conversations and the underlying brain activity, which was recorded directly from the cortical surface. This study was possible owing to the help of epilepsy patients in whom recordings of neural activity had to be obtained over several days for the purpose of pre-neurosurgical diagnostics.

For a start, borders between individual thoughts in continuous conversations had to be identified. Earlier psycholinguistic research indicates that a simple sentence is a suitable unit to contain a single thought, so the researchers opted for linguistic segmentation into simple sentences. The resulting “idea” units were classified into different categories. These included, for example, whether or not a sentence expressed memory- or self-related content. Then, the researchers analysed content-specific neural responses and observed clearly visible patterns of brain activity.

Thus, the neuroscientists from Freiburg have demonstrated the feasibility of their innovative approach to investigate, via speech, how the human brain processes thoughts during real-life conditions.

You Took the Words Right Out of My Brain

Our brain activity is more similar to that of speakers we are listening to when we can predict what they are going to say, a team of neuroscientists has found. The study, which appears in the Journal of Neuroscience, provides fresh evidence on the brain’s role in communication.

“Our findings show that the brains of both speakers and listeners take language predictability into account, resulting in more similar brain activity patterns between the two,” says Suzanne Dikker, the study’s lead author and a post-doctoral researcher in New York University’s Department of Psychology and Utrecht University. “Crucially, this happens even before a sentence is spoken and heard.”

“A lot of what we’ve learned about language and the brain has been from controlled laboratory tests that tend to look at language in the abstract—you get a string of words or you hear one word at a time,” adds Jason Zevin, an associate professor of psychology and linguistics at the University of Southern California and one of the study’s co-authors. “They’re not so much about communication, but about the structure of language. The current experiment is really about how we use language to express common ground or share our understanding of an event with someone else.”

The study’s other authors were Lauren Silbert, a recent PhD graduate from Princeton University, and Uri Hasson, an assistant professor in Princeton’s Department of Psychology.

Traditionally, it was thought that our brains always process the world around us from the “bottom up”—when we hear someone speak, our auditory cortex first processes the sounds, and then other areas in the brain put those sounds together into words and then sentences and larger discourse units. From here, we derive meaning and an understanding of the content of what is said to us.

However, in recent years, many neuroscientists have shifted to a “top-down” view of the brain, which they now see as a “prediction machine”: We are constantly anticipating events in the world around us so that we can respond to them quickly and accurately. For example, we can predict words and sounds based on context—and our brain takes advantage of this. For instance, when we hear “Grass is…” we can easily predict “green.”

What’s less understood is how this predictability might affect the speaker’s brain, or even the interaction between speakers and listeners.

In the Journal of Neuroscience study, the researchers collected brain responses from a speaker while she described images that she had viewed. These images varied in terms of likely predictability for a specific description. For instance, one image showed a penguin hugging a star (a relatively easy image in which to predict a speaker’s description). However, another image depicted a guitar stirring a bicycle tire submerged in a boiling pot of water—a picture that is much less likely to yield a predictable description: Is it “a guitar cooking a tire,” “a guitar boiling a wheel,” or “a guitar stirring a bike”?

Then, another group of subjects listened to those descriptions while viewing the same images. During this period, the researchers monitored the subjects’ brain activity.

When comparing the speaker’s brain responses directly to the listeners’ brain responses, they found that activity patterns in brain areas where spoken words are processed were more similar between the listeners and the speaker when the listeners could predict what the speaker was going to say.

When listeners can predict what a speaker is going to say, the authors suggest, their brains take advantage of this by sending a signal to their auditory cortex that it can expect sound patterns corresponding to predicted words (e.g., “green” while hearing “grass is…”). Interestingly, they add, the speaker’s brain is showing a similar effect as she is planning what she will say: brain activity in her auditory language areas is affected by how predictable her utterance will be for her listeners.

“In addition to facilitating rapid and accurate processing of the world around us, the predictive power of our brains might play an important role in human communication,” notes Dikker, who conducted some of the research as a post-doctoral fellow at Weill Cornell Medical College’s Sackler Institute for Developmental Psychobiology. “During conversation, we adapt our speech rate and word choices to each other—for example, when explaining science to a child as opposed to a fellow scientist—and these processes are governed by our brains, which correspondingly align to each other.”

iPads help late-speaking children with autism develop language

The iPad you use to check email, watch episodes of Mad Men and play Words with Friends may hold the key to enabling children with autism spectrum disorders to express themselves through speech. New research indicates that children with autism who are minimally verbal can learn to speak later than previously thought, and iPads are playing an increasing role in making that happen, according to Ann Kaiser, a researcher at Vanderbilt Peabody College of education and human development.

In a study funded by Autism Speaks, Kaiser found that using speech-generating devices to encourage children ages 5 to 8 to develop speaking skills resulted in the subjects developing considerably more spoken words compared to other interventions. All of the children in the study learned new spoken words and several learned to produce short sentences as they moved through the training.

“For some parents, it was the first time they’d been able to converse with their children,” said Kaiser, Susan W. Gray Professor of Education and Human Development. “With the onset of iPads, that kind of communication may become possible for greater numbers of children with autism and their families.”

Augmentative and alternative communication devices—which employ symbols, gestures, pictures and speech output—have been used for decades by people who have difficulty speaking. Now, with the availability of apps that emulate those devices, the iPad offers a more accessible, cheaper and more user-friendly way to help minimally verbal children with autism to communicate. And, the iPad is far less stigmatizing for young people with autism who rely on them for communicating with fellow students, teachers and friends.

The reason speech-generating devices like the iPad are effective in promoting language development is simple. “When we say a word it sounds a little different every time, and words blend together and take on slightly different acoustic characteristics in different contexts,” Kaiser explained. “Every time the iPad says a word, it sounds exactly the same, which is important for children with autism, who generally need things to be as consistent as possible.”

As many as a third of children with autism have mastery of only a few words by the time they are school age. Previously, researchers thought that if children with autism had not begun to speak by age 5 or 6, they were unlikely to acquire spoken language. But Kaiser is encouraged by study results and believes that her iPad studies may help change that notion.

Building on findings from this research, Kaiser has begun a new five-year long study supported by the National Institutes of Health’s Autism Centers of Excellence with colleagues at UCLA, University of Rochester, and Cornell Weill Medical School. She and a team of researchers and therapists at the four sites are using iPads in two contrasting interventions (direct-teaching and naturalistic-teaching) to evaluate the effectiveness of the two communication interventions for children who have autism and use minimal spoken language.

In the direct-teaching approach, children are taught prerequisite skills for communication (such as matching objects, motor imitation and verbal imitation) and basic communication skills (such as requesting objects) in a massed trial format. For example, an adult partner may present five to 10 consecutive opportunities for a child to use the iPad to request preferred objects. During these opportunities, the child is prompted to use the iPad to request and may receive physical assistance if he cannot use the iPad independently.

In the naturalistic-teaching approach, the adult models the use of the iPad during play and conversation. She also teaches turn-taking, use of gestures to communicate, play with objects and social attention to partners during the play. She provides a limited number of prompts to use the iPad to make choices, to comment or make new requests.

In both approaches, children touch the symbols on the screen, listen to the device repeat the words, and sometimes say the words themselves. They are encouraged to use both words and the iPad to communicate, and the adult therapist uses both modes of communication throughout the instructional sessions.

Results from the Autism Speaks study will be available in Spring 2014; the NIH study will continue through Spring 2017; and more information can be found at Kidtalk.org.