Protocol summary

Study aim
Investigation of the impact of Transcranial Direct Current Stimulation over Left Inferior Frontal Cortex on Speech Fluency in People Who Stutter: A Randomized Controlled Double-blind Study
Design
Type of study: Randomized controlled clinical trial design: Parallel-group design with aim of superiority
Settings and conduct
This study is a randomized controlled clinical trial research in order to investigate the fluency of speech in people with stuttering referred to the speech therapy department of Razmjo Moghadam Comprehensive Rehabilitation Clinic. After the approval of the proposal in the Research Vice-Chancellor, the researcher/researchers of the other side, the desired groups are selected based on the study entry criteria. In this trial, two groups will participate with a ratio of 1:1, and the following steps will be taken to randomly assign the samples. First step, Random Sequence Generation Second step, Allocation concealment The third step is to implement the random allocation process
Participants/Inclusion and exclusion criteria
Subjects are available and among the patients with stuttering referred to the speech therapy clinic located in the comprehensive rehabilitation clinic of Razmjomoghadam, Zahedan, who meet the criteria for entering the study. (according to the age level of the study participants 8-12 years old) will be explained and after obtaining written informed consent, people will enter the research. If any of the study subjects do not want to continue cooperating in the research project in any of the stages of the project implementation, they will be removed from the project and replaced by a new person.
Intervention groups
Intervention group (tDCS) and control group
Main outcome variables
Index of the percentage of stuttered syllables and the level of naturalness of speech

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20231115060068N1
Registration date: 2024-04-06, 1403/01/18
Registration timing: registered_while_recruiting

Last update: 2024-04-06, 1403/01/18
Update count: 0
Registration date
2024-04-06, 1403/01/18
Registrant information
Name
Nasrin Shahouzaei
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 54 3322 8174
Email address
shahouzaei.n@zaums.ac.ir
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2024-02-20, 1402/12/01
Expected recruitment end date
2025-02-19, 1403/12/01
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The impact of Transcranial Direct Current Stimulation over Left Inferior Frontal Cortex on Speech Fluency in People Who Stutter: A Randomized Controlled Double-blind Study
Public title
The impact of Transcranial Direct Current Stimulation over Left Inferior Frontal Cortex on Speech Fluency in People Who Stutter:
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
Children with stuttering aged 8-12 years Persian monolingual or mastering the Persian language according to the examiner's opinion Confirming the presence of at least 12% dysfluency for the stuttering group using the SSI-4 instrument (moderate impairment level)
Exclusion criteria:
Previous history of receiving combined treatment of speech therapy and tDCS and speech therapy alone in one month before entering the study Presence of significant psychiatric symptoms such as mood and emotional disorders, sleep disorder, depression, etc. according to the family report Presence of disorder in the person's state of consciousness according to the therapist's diagnosis Presence of other speech and language disorders History of acute medical problems according to the medical records of the references and the family report History of any previous neurological disorder, including seizures and taking psychiatric drugs according to the family
Age
From 8 years old to 12 years old
Gender
Both
Phase
N/A
Groups that have been masked
  • Participant
  • Investigator
  • Outcome assessor
Sample size
Target sample size: 50
Randomization (investigator's opinion)
Randomized
Randomization description
Two groups will participate in this trial with a ratio of 1:1, and the following steps will be taken to randomly assign the samples. The first step is to create a random sequence (Random Sequence Generation): For this purpose, among the restricted randomization methods, the unequal permuted block balance randomization method will be used, and the size of the blocks will be considered from 2 to 8 variables. Based on the Winpepi software, the list of blocks and their random distribution will be obtained. A researcher who is not involved in any aspect of the intervention will randomly assign subjects to the intervention (tDCS) and control groups using the above method. The second step, Allocation concealment: To hide random allocation, the method of sealed envelopes with random sequence (Sequentially numbered, opaque, sealed envelope (SNOSE)) will be used. In this method, after the random sequence is created using the above method, then based on the research sample size (50 people), an opaque envelope is prepared and each of the random sequences created is recorded on a card and the cards are inside the envelope. Letters are placed in order on the outer surface of the envelopes. Finally, the lids of the envelopes are glued and placed inside a box in the same way. At the time of sampling, based on the order of entry of eligible participants into the study, one of the envelopes will be opened and the assigned group of that participant will be revealed. The third step is to implement the allocation process: In this study, the researcher (F-A) created a random sequence and the researcher (N-Sh) examined the participants in terms of the study entry and exit criteria and enrolled them in the study and the expert present at the clinic Assigned to groups. therefore, the person who creates the random sequence (F-A) is not involved in other steps such as registration or allocation of participants, and in the process of randomization, the researcher involved in creating a random program is separate from other researchers to reduce possible bias.
Blinding (investigator's opinion)
Double blinded
Blinding description
It should be noted that the researcher who checks the entry and exit criteria of the study (N-Sh), also performs the desired intervention, but to blind the study, the desired evaluations and study outcomes by another researcher (A-H) will be done and finally, the researcher (F-A) will analyze the data obtained from the study. For the participants who are in the control group (Sham), the same electrode assembly method will be used to prevent the participants from knowing and blinding. For this purpose, the device settings will be set in study mode and then a very weak current pulse (110 mA in 15 ms, with a maximum current of 3 ms) will be sent every 55 seconds for 20 minutes. In fact, these parameters provide artificial current stimulation with an ineffective dose.
Placebo
Used
Assignment
Parallel
Other design features

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Ethics Committee of Zahedan University of Medical Sciences
Street address
University of Medical Sciences Campus, Central Headquarters Building, 2nd Floor, Dr. Hasabi Square, Gulf of Fars Blvd, Zahedan, Iran
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9819635681
Approval date
2024-01-14, 1402/10/24
Ethics committee reference number
IR.ZAUMS.REC.1402.445

Health conditions studied

1

Description of health condition studied
stuttering disorder
ICD-10 code
F98.5
ICD-10 code description
Adult onset fluency disorder

Primary outcomes

1

Description
percentage of Dysfluent syllables
Timepoint
The baseline session, immediately before and after the intervention, in all intervention sessions (5 sessions), at the end of the first and sixth weeks after the intervention
Method of measurement
For this purpose, sample reading and conversation of the cases at each of the results evaluation points (baseline session, immediately before and after the intervention, in all the intervention sessions (5 sessions) before and after the therapy assignments and at the end of the first and sixth weeks after the intervention) is recorded. The first 2 minutes of each of the recorded samples are used to check the percentage of non-syllabic syllables (DS). (In these 2 minutes, the reference must have produced at least 200 floods). Also, the topic of conversations and reading text will be new in all assessment and treatment sessions, and no repeated samples will be recorded (standard Persian language texts will be used, including the Rainbow text).

Secondary outcomes

1

Description
The overall score of the Stuttering Severity Instrument-4 (SSI-4) questionnaire
Timepoint
Before the intervention (baseline session), after the last intervention session
Method of measurement
After checking the percentage of dyslexic syllables and recording a speech sample of at least 5 minutes, reading assignments and continuous speech samples will be used to evaluate the severity of stuttering and to calculate the SSI-4 score. In this questionnaire, the severity of stuttering is measured based on the scores of three subscales. These subscales include: frequency (the number of times stuttering occurs), latency (time from the beginning to the end of speech) and associated physical behaviors (behaviors that a person with stuttering commits during speech such as patting the ground, lowering the head, moving giving head and...) The total score is calculated from 0 to 56, which is obtained from the sum of the scores of frequency, latency and associated physical behaviors. The higher the score, the more severe the stuttering

2

Description
Communication attitude test score
Timepoint
Before the intervention (baseline session), after the last intervention session
Method of measurement
After checking the severity of stuttering, the communication attitude test will be used to check the attitude of the study participants towards stuttering disorder. This test has 35 sentences that measure a person's attitude towards his speech and can be answered correctly or incorrectly. Some questions show a positive attitude, for which a correct answer gets a score of one and a wrong answer gets a score of zero. Some questions show a negative attitude, for which a correct answer gets a score of zero and a wrong answer gets a score of one. The set of scores of this questionnaire is 35, a score of less than 11 indicates a completely negative attitude, a score of 11 to 19 indicates a negative attitude, a score of 20 to 24 indicates an average attitude, a score of 25 to 31 indicates a positive attitude, and a score above 31 indicates a completely positive attitude (31). In order to complete this questionnaire, the examiner will read all the test items orally and in case of any ambiguity, he will explain the relevant question. The time required to complete this questionnaire is 20 minutes, and after that, the participants will be given a 10-minute break to avoid fatigue.

3

Description
Score of Multidimensional Anxiety Scale for Children questionnaire
Timepoint
Before the intervention (baseline session), after the last intervention session
Method of measurement
After that, the children's anxiety questionnaire will be completed. For this purpose, the multidimensional children's anxiety questionnaire MASC, which was created by March and colleagues in 1997, is used. This questionnaire is a self-report tool that has 39 items and is used to evaluate anxiety symptoms in the age groups of 8 to 19 years. Each item is scored on a four-point Likert scale from zero to three (never, rarely, sometimes, and always). In order to use the multidimensional children's anxiety questionnaire in the present study, the student version (MASC-2) will be used, which was confirmed by Ashrafi Far et al. in 1400 for its validity and reliability in Persian language. Based on the findings of the mentioned research, the multidimensional scale of children's anxiety in Iranian students has good validity and reliability, and it can be used as a suitable tool in clinical and research situations to diagnose anxiety in people aged 9 to 18 years.

4

Description
Speech naturalness
Timepoint
The baseline session, immediately before and after the intervention, in all intervention sessions (5 sessions), at the end of the first and sixth weeks after the intervention
Method of measurement
The scale of abnormality of speech is assessed by a single examiner (A-H) in the baseline, treatment and follow-up sessions using a 9-point Likert scale with 1 indicating a very natural speech sound and 9 indicating a very abnormal speech sound.

5

Description
The score of components of executive functions including: inhibition, active memory and task switching using the Wisconsin test
Timepoint
Before the intervention (baseline session), after the last intervention session
Method of measurement
The Wisconsin executive skills test will be implemented to check the components of inhibition, working memory and task switching.

6

Description
Average amplitude and frequency of alpha and theta waves
Timepoint
Before the intervention (baseline session), after the last intervention session
Method of measurement
Physiological test using neurofeedback device

Intervention groups

1

Description
Intervention group: Fifty study participants were randomly divided into one of the groups (intervention and control or tDCS and sham) as described in the previous sections. In the intervention group, participants will receive traditional speech therapy methods (choral speech practice and metronome-timed speech) along with anal tDCS, while the control group will be exposed to sham tDCS in addition to receiving traditional speech therapy methods. . Each subject will participate in 5 treatment sessions with an interval of at least 48 hours (three sessions per week). The number of intervention sessions is considered based on previous findings and studies that have shown that 5 days of stimulation is effective for tDCS intervention. In the tDCS delivery section, participants receive 20 minutes of 1 mA stimulation using 5-7 cm electrodes during fluent speech from the speech therapy intervention. This proposed tDCS protocol was chosen given that it has already been shown to be effective in tDCS interventional studies. According to this protocol, the anode electrode will be placed on the left side of the inferior frontal cortex (on the FC5 center according to the EEG 10-10 electrode placement system) and the cathode on the right supraorbital ridge. It should be noted that this way of assembling the electrodes has been investigated in previous studies and is approved. In the part of the session where traditional speech therapy is provided, we will use behavioral techniques that cause temporary psychosis. We chose these techniques to induce maximum and immediate speech fluency because we wanted to be sure that the use of tDCS would only promote fluent and not dysfluent speech. The behavioral techniques used are Choral speech practice and Metronome-timed speech. Choral speech will consist of reading texts at a normal speed, first with the live voice of the participant and the therapist, and then using pre-recorded audio samples. Spontaneous videos of silent cartoons followed by conversations with the researcher on randomly selected topics (e.g., recent vacations). The metronome speed will increase from 140 to 190 beats per minute during 5 treatment sessions.
Category
Treatment - Devices

2

Description
Control group: In the intervention group, participants will receive traditional speech therapy methods (choral speech practice and metronome-timed speech) along with anal tDCS, while the control group will be exposed to sham tDCS in addition to receiving traditional speech therapy methods. .
Category
Rehabilitation

Recruitment centers

1

Recruitment center
Name of recruitment center
Comprehensive Rehabilitation Clinic of Razmjomoghadam
Full name of responsible person
Nasrin Shahouzaei
Street address
12, Sohrvardi, Zebashahr, Zahedan
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9817987658
Phone
+98 54 3322 8174
Email
shahouzaei.n@gmail.com

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
Zahedan University of Medical Sciences
Full name of responsible person
Dr. Ibrahim Kord
Street address
University of Medical Sciences Campus, Central Headquarters Building, 2nd Floor, Dr. Hasabi Square, Gulf of Fars Blvd, Zahedan, Iran
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9817987658
Phone
+98 54 3337 2116
Email
zaums.research@zaums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Zahedan University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Zahedan University of Medical Sciences
Full name of responsible person
Nasrin Shahouzaei
Position
Faculty member of speech therapy department, instructor
Latest degree
Master
Other areas of specialty/work
Speech therapy
Street address
12, Sohrvardi, Zebashahr, Zahedan
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9817987658
Phone
+98 54 3322 8174
Email
shahouzaei.n@gmail.com

Person responsible for scientific inquiries

Contact
Name of organization / entity
Zahedan University of Medical Sciences
Full name of responsible person
Nasrin Shahouzaei
Position
Faculty member of speech therapy department
Latest degree
Master
Other areas of specialty/work
Speech therapy
Street address
12, Sohrvardi, Zebashahr, Zahedan
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9817987658
Phone
0098 53 33228174
Email
shahouzaei.n@gmail.com

Person responsible for updating data

Contact
Name of organization / entity
Zahedan University of Medical Sciences
Full name of responsible person
Nasrin Shahouzaei
Position
Faculty member of speech therapy department, instructor
Latest degree
Master
Other areas of specialty/work
Speech therapy
Street address
12, Sohrvardi, Zebashahr, Zahedan
City
Zahedan
Province
Sistan-va-Balouchestan
Postal code
9817987658
Phone
+98 54 3322 8174
Email
shahouzaei.n@gmail.com

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Yes - There is a plan to make this available
Study Protocol
Yes - There is a plan to make this available
Statistical Analysis Plan
Yes - There is a plan to make this available
Informed Consent Form
Yes - There is a plan to make this available
Clinical Study Report
Yes - There is a plan to make this available
Analytic Code
Yes - There is a plan to make this available
Data Dictionary
Yes - There is a plan to make this available
Title and more details about the data/document
Information on primary and secondary outcomes will be shared
When the data will become available and for how long
The access period starts 3 months after the results are published
To whom data/document is available
Our data will only be available to researchers working in academic and scientific institutions
Under which criteria data/document could be used
The data of this study will be available if it helps other research projects in the relevant field.
From where data/document is obtainable
Host of the project, Ms. Nasrin Shahuzai Email: shahouzaei.n@gmail.com
What processes are involved for a request to access data/document
It will be possible to access the data by sending an email to the project manager and explaining why and how to use the current project documentation and the scientific documentation attachment of the applicant.
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