A multimodal speech-gesture training intervention for patients with schizophrenia and its neural underpinnings – the study protocol of a randomized controlled pilot trial

Abstract

Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodalspeech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation.The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency – similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 minutes each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group).With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels.

Modality-specific dysfunctional neural processing of social-abstract and non-social-concrete information in schizophrenia

“…In schizophrenia research, the past decade has witnessed substantial progress in the development of social cognitive training in schizophrenia (Kurtz et al, 2016; Kurtz & Richardson, 2011), with recent innovation regarding the incorporation of social stimuli from a broader range of modalities (Nahum et al, 2014). Our findings extend these approaches, proposing potential therapeutic implications of deploying naturalistic and multimodal stimuli during social cognitive training (Riedl et al, 2020), as they might be able to normalize processing of both social and non-social information, at least at a neural level. Future research is expected to further explore whether the neural enhancements can be linked to functional outcome after social cognitive training in a multimodal setting.…”

The processing of semantic complexity and co-speech gestures in schizophrenia: a naturalistic, multimodal fMRI study

“…Thus, future studies could examine if the differences in the processing of semantic complexity are reduced by conducting existing training developed to improve verbal communication and social cognition (70,71) 6.…”

A Novel Multimodal Speech-Gesture Training and Its Impact on Quality of Life and Neural Processing in Patients With Schizophrenia Spectrum Disorder. A Pilot Randomized Controlled Trial

“…Due to a lack of comparative studies reporting effect sizes and therewith a missing basis for power calculation, the comparison of three measurements provides further evidence for possible training-specific effects through comparing intra-individual repetition and training effects. The control group received no training and was therefore measured twice (modification of the study design described in our study protocol [86] due to recruitment problems during the Covid-19 pandemic).…”

“…A total of 29 patients diagnosed with SSD were included in the final analysis (detailed information about eligibility criteria are given in our study protocol [86]). In the healthy control group, the final sample comprised n=17.…”

“…Results from first exploratory studies give reason to assume beneficial effects of speech language interventions also for speech perception in patients with schizophrenia [83,84]. Tailored to the requirements of these patients [11,68,85,86], we therefore developed a specific multimodal speech-gesture (MSG) training which considers concretism and problems in the perception of nonverbal communication.…”