Sequencing and Initiation in Speech Production

Boston UniversityCollege of Arts and Sciences 677 Beacon Street Boston, Massachusetts 02215 Department of Cognitive and Neural Systems Center for Adaptive Systems 617 353-7857 phone 617

Boston University

College of Arts and Sciences

677 Beacon Street

Boston, Massachusetts 02215

Department of Cognitive and Neural Systems

Center for Adaptive Systems

(617) 353-7857 (phone)

(617) 353-7755 (fax)

Consent Form for Functional Magnetic Resonance Imaging Sessions

Project title: Sequencing and Initiation in Speech Production

Principal Investigator: Prof Frank H Guenther

Telephone number: (617) 353-5765

We would like your permission to include you in a research project involving functional magnetic resonance imaging (fMRI), which is a technique for measuring brain activations The research, which will provide us with information concerning the brain processes involved in speech production, will be conducted at the Charlestown location of Massachusetts General Hospital (Building 149, 13th Street, Charlestown, MA) You will be paid $100 for your participation You are free to discontinue your participation in the project at any time Refusal to participate will not affect your status at Boston University or Massachusetts General Hospital in any way If you discontinue your participation for any reason, you will be paid $25 for each half-hour of participation

The procedure consists of lying on a table and having your body slid into a large horizontal cylinder which is inside a large magnet You will be asked to remain still during the imaging time In order to help immobilize your head, foam head holders will be placed around your head Conventional MRI images will be obtained during the first fifteen minutes of scanning These scans provide a 3D image of the structure of your brain After these images are obtained, additional images will be obtained using the high-speed function of the MRI system to measure brain activations During this time, you will be asked to attend to sounds, produce speech, and/or attend to visual stimuli Visual stimulation will be provided by projection onto a screen that you will view through a small mirror Audio stimulation will be provided by a stereo headset at a sound level that you deem to be comfortable You may be asked to respond by speaking or by pressing a button At the end of the imaging session, additional conventional images may be collected to help us accurately localize your brain activations The entire scanning session will last approximately 2 hours

There are no known or foreseeable risks or side effects associated with conventional MRI proce-dures except for those individuals who have electrically, magnetically, or mechanically activated implants (such as cardiac pacemakers or cochlear implants) or those who have intracerebral vas-cular clips There are no known additional risks associated with high-speed MRI Both the

con-ventional and high-speed MRI systems have been approved by the FDA and will be operated within the operating parameters reviewed and accepted by the FDA

Some individuals may experience claustrophobia (fear of enclosed spaces) while in the scanner

If you feel claustrophobic at any time during the session and wish to be immediately removed from the scanner at any point, you can signal the experimenter by waving your foot back and forth If you suffer from severe claustrophobia, you should indicate this to the experimenter, who will remove you from the study for this reason

You can expect to hear knocking sounds during imaging Headphones or ear plugs will be pro-vided so the sound should not be bothersome The flashing pattern displayed by the video projec-tor (if used) does not present any health hazards to normal volunteers However, if you have a history of epilepsy or other seizure disorder, you should indicate this to the experimenter, who will exclude you from participation if the experiment involves visual presentation of stimuli Research such as this will give us insight into the brain processes involved in speech production

We will be happy to answer any questions concerning our procedures or any aspect of the project

at any time Although this research will not be of any direct benefit to you, it will be published in scientific journals and will be presented at scientific conferences Publications that arise from this research will not contain your name or initials; you will instead be identified by randomly assigned numbers or letters Only members of this research team will have access to your data unless required by law or regulation, and the data will be stored in password-protected computer files or on CDROMs kept in a locked room

I have read and understood the description of the procedures I hereby agree to participate in your study My questions have been answered to my satisfaction, and I understand that Professor Guenther or his associates will answer any questions I may have in the future I understand that I may withdraw from the project without any effect on my academic status at Boston University and that my collected data will be destroyed upon request I understand that I will be provided a copy of the consent form

I am also aware that if I have any questions regarding my rights as a subject, I may contact David Berndt of the Boston University Institutional Review Board at 353-4365

Date:

Subject’s signature:

Person obtaining consent:

Principal Investigator: Frank H Guenther, Ph.D

Associate Professor, Department of Cognitive and Neural Systems, Boston University

677 Beacon Street, Boston, MA 02215

(617) 353-5765