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Researchers monitor blood concentration in cerebrum to better understand communication disorders

The human brain continues to be a treasure trove of secrets. On average, it weighs about 3 pounds and is the main organ of the central nervous system that regulates voluntary and involuntary actions, such as eating and breathing. Cerebral circulation in the four lobes is supplied by two major systems, the anterior cerebral and middle cerebral arteries that supply up to 25 percent of a healthy human being’s blood to the cerebrum. The complex vessel network of arteries, veins and capillaries provide the blood, oxygen and nutrients that are essential for proper brain health and function. That network also may be the key to better understanding articulation, voice and fluency disorders, as well as aphasia, apraxia, dysarthria, dyslexia, dysphagia and much more.

Through noninvasive methods, the Department of Speech-Language Pathology (SLP) at Misericordia University has been studying changes in oxygenated and deoxygenated hemoglobin concentrations in the brains of fluent and non-fluent speakers, as well as in individuals following voice training. This groundbreaking research has been ongoing since 2011 and is being conducted in the College of Health Sciences and Education by members of the voice and fluency teams under the direction of Cari Tellis, Ph.D., C.C.C.-S.L.P. associate professor, and Glen Tellis, Ph.D., C.C.C.-S.L.P., professor. Faculty mentors selected SLP students for the teams to conduct experiments using the innovative technology – Functional Near-Infrared Spectroscopy – better known in the industry as fNIRS. The diffuse optical technique uses a light source in a safe region of the electromagnetic spectrum to measure hemoglobin concentration changes in real time at the surface of the brain. These changes alert investigators to areas of the brain with increased activation and deactivation related to a specific task.

Misericordia scientists found fNIRS to be a better fit in advancing their research of stuttering, voice and related communication disorders because it is portable and relatively inexpensive, while it also provides precise high temporal resolution imaging of the brain. WhilePET scans, fMRIs, EEGs and other technology are useful in this type of research, they do not come without their faults. MRI, for example, is sensitive to motion, while PET scans require an injection of a radioactive isotope.

The fluency team has been collecting data from fluent speakers and individuals who stutter during certain speech and non-speech tasks in an effort to better understand how the brain responds during moments of stuttering. The goal is to use the results of these studies to develop treatment strategies to help people who stutter. The voice team’s research focuses on vocal techniques that are utilized during voice therapy to better understand how the brain responds to the acquisition of a novel voice task. Their overarching goal is to create a more individualized treatment protocol to help clients regain their voice, as well as ensure generalization and maintenance of learned techniques.

The Department of Speech-Language Pathology is one of only a few communication-disorders programs in the country to utilize fNIRS in research. The dedicated laboratory in John J. Passan Hall contains the cutting-edge technology, which consists of a mesh cap that secures a number of non-invasive probes and detectors to the head of test subjects. The probes emit near-infrared light to surface regions of the subject’s brain. The reflected light received by the detectors contains information about blood concentration levels. As data collection commences, researchers observe waveforms on a computer screen which identify measures of oxygenated and deoxygenated hemoglobin in areas of the brain. The resulting hemodynamic responses – which can vary in magnitude – mark brain activation or deactivation during planned exercises.

The ongoing research has shown promise. The collaborative student-faculty research teams have had articles published in national and international publications and findings presented at state, national and international conferences, including the 8th World Congress on Fluency Disorders in Lisbon, Portugal; 10th Oxford Dysfluency Conference in Oxford, England; Society for functional Near Infrared Spectroscopy Conference in Paris, France; Estill World Voice Symposium in St. Kilda, Australia,and the Fall Voice Conference in San Antonio, Texas.

High-tech understanding

To an outsider, the fluency and voice labs are not ostentatious by any measure. The close quarters, though, have been a hub of activity for faculty and students, alike. The teams routinely schedule participants for new studies, and design and run experiments to collect important data. Student researchers then analyze and interpret their findings and review with Dr. Glen Tellis and Dr. Cari Tellis.

“Throughout that process, I have learned many things that go beyond just understanding how to use the equipment. I’ve learned how this equipment actually works; how to interpret findings and troubleshoot when things go wrong or don’t look right,’’ says Danielle Spagnuolo ’19, who has been a member of the voice team since 2014. “The interpersonal skills that I have acquired interacting with other members of our research teams and with participants have helped me during presentations at conferences and when working with clients in the therapy setting.’’

For her master’s thesis, Erin Roberts, C.F.-S.L.P., ’16 conducted a study with individuals who have voice disorders. She examined the differences in their hemodynamic responses during the production of a targeted voice task – in this case sustained phonation in twang quality. Results for her study indicated that there was a shift in both regions of activation in the brain and magnitude over the course of training. The outcome, she says, “indicates motor learning by the test subject.’’

Her findings are important, Roberts explains, because they indicate that learning has occurred. They provide researchers with more information about how these individuals acquire the novel vocal skills taught through the integrated implicit-explicit voice therapy approach used at Misericordia. “I have learned so much from all of this, from technical information to theoretical understanding of the benefits of different study designs,’’ says Roberts, who graduated with her master’s degree in speech-language pathology in the spring, but remains active in fNIRS research. “I think the studies we’ve done have the potential to show us more clearly the impact voice therapy has on our clients, as well as help clinicians make more informed decisions about voice therapy methods.’’

Global experience

It is hard to say how many miles the research teams have logged traveling to various conferences to share their latest findings with fellow colleagues, professors, researchers and clinicians. Misericordia University SLP students and faculty routinely present at the annual Pennsylvania Speech-Language-Hearing Association and American Speech-Language-Hearing Association conferences. Lately, the Estill World Voice Symposium, World Fluency Conference and Fall Voice Conference also have become customary settings to share their scholarly work. “Presenting at national and international conferences has provided all of us with the opportunity to hear new ideas that are at the forefront of the field,’’ says Roberts, a native of Perkiomenville, Pa. “It generally gets me curious about different methods of measurement or treatment techniques that I can research more when we get home.’’The experience and exposure of presenting at conferences has tangible and intangible benefits to the academic program and students as it builds recognition among peers around the world, while also introducing the future clinicians to the importance of being life-long learners in a profession that is still evolving.

Take Danielle for example. The 20-year-old was introduced to the Department of Speech-Language Pathology as a teenager through therapy sessions in the University’s Speech-Language Hearing Center. At the time, the 13-year-old had an articulation disorder and “wanted to be taken seriously’’ when she spoke. One year later, she learned how to produce the r-sound after receiving articulation therapy. Danielle was reintroduced years later when her sister, Tia Spagnuolo ’16 matriculated to the academic program. The older Spagnuolo sister was also a lead researcher on the voice team during her time at Misericordia, and was one of the first to conduct fNIRS research at the University with Roberts.

Today, Danielle sees the importance of conference presentations and the value of mentorship and related research. “It is important to continue to talk to and learn from otherindividuals in the field,’’ acknowledges Spagnuolo, a lead researcher on the voice team. “Having the incredible opportunities to travel to national and international conferences provides the chance to talk to experts in the field about ways to improve research or ask questions about what research that is happening in other labs. “The research that is happening now is the future of the field, and these conferences provide the opportunity to talk to the individuals collecting this data about what they are doing and why they are doing it.

Being able to integrate current findings into therapy is vital to providing the most up-to-date and effective treatment,’’ the daughter of John and Cyndi Spagnuolo adds. Research, such as fNIRS at Misericordia, also enables students to find their niche in specialty fields like SLP. D’manda Price ’19, a native of Paterson, N.J., has had a deep interest in “everything that involves the brain’’ since high school. At MU, that curiosity has blossomed. “I fell in love with research,’’ says Price, who wants to seek a Ph.D. in neuroscience after earning her master’s degree at MU. “I cannot see myself doing anything else besides research. I especially love being able to research the brain’s response to different speech tasks because I feel as though this research will ultimately make a difference in the lives of the clients we see and help them better understand whatever disorder they have.’’

Mentorship

A relatively new technology, fNIRS has presented new opportunities for researchers to better understand communication disorders. It also has afforded faculty researchers with another opportunity to engage their students in one-on-one settings outside of the classroom. Those experiences, the students say, open themselves up to a new world of opportunities. “The advice that they have given me has truly shaped me and showed me that I have many options for a career in speech-language pathology,’’ says the daughter of Dalton and Sherry Price. “This department and its faculty are extraordinary and they shape each and every one of their students into becoming great clinicians because of the experiences that we receive before we go out into the field.’’

“We love what we are doing,’’ Danielle adds. “I love the research. I love the people I am working with and the excitement Dr. Cari Tellis has for it. We all feed into it. Everything starts with her. Her excitement is infectious, and now it’s a lot of hard work but we love doing it.’’“The biggest thing that I have learned about research is how often, and how quickly, research can change,’’ says Roberts. “But it’s one of the things that I’ve really grown to love about research – that there is always something new to read about, consider, or look into. It’s pretty interesting how one person’s idea can apply to research that you’re doing and spark another new idea.”