Disfluency as... er... delay: An investigation into the immediate and lasting consequences of disfluency and temporal delay using EEG and mixed-effects modelling

Difficulties in speech production are often marked by disfluency; fillers, hesitations, prolongations, repetitions and repairs. In recent years a body of work has emerged that demonstrates that listeners are sensitive to disfluency, and that this affects their expectations for upcoming speech, as well as their attention to the speech stream. This thesis investigates the extent to which delay may be responsible for triggering these effects. The experiments reported in this thesis build on an Event Related Potential (ERP) paradigm developed by Corley et al., (2007), in which participants listened to sentences manipulated by both fluency and predictability. Corley et al. reported an attenuated N400 effect for words following disfluent ers, and interpreted this as indicating that the extent to which listeners made predictions was reduced following an er. In the current set of experiments, various noisy interruptions were added to Corley et al.,'s paradigm, time matched to the disfluent fillers. These manipulations allowed investigation of whether the same effects could be triggered by delay alone, in the absence of a cue indicating that the speaker was experiencing difficulty. The first experiment, which contrasted disfluent ers with artificial beeps, revealed a small but significant reduction in N400 effect amplitude for words affected by ers but not by beeps. The second experiment, in which ers were contrasted with speaker generated coughs, revealed no fluency effects on the N400 effect. A third experiment combined the designs of Experiments 1 and 2 to verify whether the difference between them could be characterised as a context effect; one potential explanation for the difference between the outcomes of Experiments 1 and 2 is that the interpretation of an er is affected by the surrounding stimuli. However, in Experiment 3, once again no effect of fluency on the magnitude of the N400 effect was found. Taken together, the results of these three studies lead to the question of whether er's attenuation effect on the N400 is robust. In a second part to each study, listeners took part in a surprise recognition memory test, comprising words which had been the critical words in the previous task intermixed with new words which had not appeared anywhere in the sentences previously heard. Participants were significantly more successful at recognising words which had been unpredictable in their contexts, and, importantly, for Experiments 1 and 2, were significantly more successful at recognising words which had featured in disfluent or interrupted sentences. There was no difference between the recognition rates of words which had been disfluent and those which were affected by a noisy interruption. Collard et al., (2008) demonstrated that disfluency could raise attention to the speech stream, and the finding that interrupted words are equally well remembered leads to the suggestion that any noisy interruption can raise attention. Overall, the finding of memory benefits in response to disfluency, in the absence of attenuated N400 effects leads to the suggestion that different elements of disfluencies may be responsible for triggering these effects. The studies in this thesis also extend previous work by being designed to yield enough trials in the memory test portion of each experiment to permit ERP analysis of the memory data. Whilst clear ERP memory effects remained elusive, important progress was made in that memory ERPs were generated from a disfluency paradigm, and this provided a testing ground on which to demonstrate the use of linear mixed-effects modelling as an alternative to ANOVA analysis for ERPs. Mixed-effects models allow the analysis of unbalanced datasets, such as those generated in many memory experiments. Additionally, we demonstrate the ability to include crossed random effects for subjects and items, and when this is applied to the ERPs from the listening section of Experiment 1, the effect of fluency on N400 amplitude is no longer significant. Taken together, the results from the studies reported in this thesis suggest that temporal delay or disruption in speech can trigger raised attention, but do not necessarily trigger changes in listeners' expectations

Learning to handle a myoelectric upper-limb prosthesis:The development of an evidence-based guideline for training

Wanneer iemand een arm mist door een amputatie of een aangeboren afwijking wordt vaak een armprothese aangemeten. Veel armprothesen worden echter niet of nauwelijks gebruikt in het dagelijks leven omdat het moeilijk is om de prothese op een vaardige manier te leren gebruiken. Hoewel training het gebruik en de functionaliteit van armprotheses verhoogt, is tot op heden niet bekend wat de meest efficiënte manier van trainen is. In dit proefschrift heb ik onderzocht hoe mensen leren omgaan met een prothese om vervolgens richting aan het revalidatieproces te kunnen geven. Als eerste zijn de bewegingen van ervaren prothesegebruikers gemeten. Ook is bekeken welke factoren bepalend zijn voor het vaardigheidsniveau van prothesegebruikers. Nadat in kaart is gebracht hoe men omgaat met een armprothese, is bekeken hoe het leerproces verloopt tijdens het revalidatieproces. Er zijn maar weinig prothesegebruikers, daarom zijn de studies naar het leerproces uitgevoerd met een prothesesimulator. Deze simulator is speciaal ontwikkeld voor niet-geamputeerde personen, zodat er meer metingen mogelijk waren. Zo was het mogelijk verschillende typen trainingen met elkaar te vergelijken. Ook werden verschillende activiteiten zoals reiken, grijpen en fixeren, en het doseren van de grijpkracht tijdens meerdere trainingssessies geoefend met de simulator waarbij veranderingen in de prestaties werden gemeten. Daarnaast is de structuur van de training bestudeerd om te bepalen hoe taken het best kunnen worden gepresenteerd. De resultaten uit de diverse studies zijn in een trainingsrichtlijn samengevat. Deze richtlijn kan worden gebruikt tijdens de revalidatie van prothesegebruikers zodat ze een zo hoog mogelijk vaardigheidsniveau kunnen bereiken

Changes in performance over time while learning to use a myoelectric prosthesis

BACKGROUND: Training increases the functional use of an upper limb prosthesis, but little is known about how people learn to use their prosthesis. The aim of this study was to describe the changes in performance with an upper limb myoelectric prosthesis during practice. The results provide a basis to develop an evidence-based training program. METHODS: Thirty-one able-bodied participants took part in an experiment as well as thirty-one age- and gender-matched controls. Participants in the experimental condition, randomly assigned to one of four groups, practiced with a myoelectric simulator for five sessions in a two-weeks period. Group 1 practiced direct grasping, Group 2 practiced indirect grasping, Group 3 practiced fixating, and Group 4 practiced a combination of all three tasks. The Southampton Hand Assessment Procedure (SHAP) was assessed in a pretest, posttest, and two retention tests. Participants in the control condition performed SHAP two times, two weeks apart with no practice in between. Compressible objects were used in the grasping tasks. Changes in end-point kinematics, joint angles, and grip force control, the latter measured by magnitude of object compression, were examined. RESULTS: The experimental groups improved more on SHAP than the control group. Interestingly, the fixation group improved comparable to the other training groups on the SHAP. Improvement in global position of the prosthesis leveled off after three practice sessions, whereas learning to control grip force required more time. The indirect grasping group had the smallest object compression in the beginning and this did not change over time, whereas the direct grasping and the combination group had a decrease in compression over time. Moreover, the indirect grasping group had the smallest grasping time that did not vary over object rigidity, while for the other two groups the grasping time decreased with an increase in object rigidity. CONCLUSIONS: A training program should spend more time on learning fine control aspects of the prosthetic hand during rehabilitation. Moreover, training should start with the indirect grasping task that has the best performance, which is probably due to the higher amount of useful information available from the sound hand

Upper limb activity in myoelectric prosthesis users is biased towards the intact limb and appears unrelated to goal-directed task performance

Studies of the effectiveness of prosthetic hands involve assessing user performance on functional tasks in the lab/clinic, sometimes combined with self-report of real-world use. In this paper we compare real-world upper limb activity between a group of 20 myoelectric prosthesis users and 20 anatomically intact adults. Activity was measured from wrist-worn accelerometers over a 7-day period. The temporal patterns in upper limb activity are presented and the balance of activity between the two limbs quantified. We also evaluated the prosthesis users’ performance on a goal-directed task, characterised using measures including task success rate, completion time, gaze behaviour patterns, and kinematics (e.g. variability and patterns in hand aperture). Prosthesis users were heavily reliant on their intact limb during everyday life, in contrast to anatomically intact adults who demonstrated similar reliance on both upper limbs. There was no significant correlation between the amount of time a prosthesis was worn and reliance on the intact limb, and there was no significant correlation between either of these measures and any of the assessed kinematic and gaze-related measures of performance. We found participants who had been prescribed a prosthesis for longer to demonstrate more symmetry in their overall upper limb activity, although this was not reflected in the symmetry of unilateral limb use. With the exception of previously published case studies, this is the first report of real world upper limb activity in myoelectric prosthesis users and confirms the widely held belief that users are heavily reliant on their intact limb