None listed
Conditions
Brief summary
Dysarthria occurs in up to 40% of people following stroke and brain injury leading to difficulties participating in daily communication activities, social and work roles and wellbeing. Traditionally, people with dysarthria are treated one on one by a speech pathologist which is relatively costly. This pilot study aims to explore the feasibility of implementing a group therapy model compared to individual therapy in inpatients with nonprogressive dysarthria, to inform the implementation of a larger trial. We aim to recruit 24 inpatients with dysarthria who will randomly receive either group therapy or individual therapy in hospital and be assessed before and after their treatment. The results of this pilot study will give us important information about patient, carer and clinician satisfaction, and costs and practicalities of implementing group therapy which would help develop a larger research trial to run across Australia.
Interventions
The pre-assessment will include outcome measures listed (i.e., Frenchay Dysarthria Assessment, Assessment of Intelligibility in Dysarthric speech (ASSIDS), self-report questionnaires) and be conducted face to face, one on one, by a speech pathologist not involved in the participant's treatment in a quiet room, with consistent audio recording procedures including using a mp3 audio recorder and condenser headset microphone positioned at a 5cm mouth-to-microphone distance.
Following this, the tre
The pre-assessment will include outcome measures listed (i.e., Frenchay Dysarthria Assessment, Assessment of Intelligibility in Dysarthric speech (ASSIDS), self-report questionnaires) and be conducted face to face, one on one, by a speech pathologist not involved in the participant's treatment in a quiet room, with consistent audio recording procedures including using a mp3 audio recorder and condenser headset microphone positioned at a 5cm mouth-to-microphone distance. Following this, the treating Speech Pathologist (SP) will use pre-assessment results to inform identification of an externally focussed, tailored clear speech strategy for each participant targeting speech intelligibility. Each participant will then undergo two one-on-one sessions scheduled with their treating SP involving instatement of the clear speech strategies, using principles of motor learning as per Park et al’s ‘Be clear’ treatment. These will aim to be on two separate days (across two consecutive days) for approximately 50min in duration and take place approximately 1-2 days prior to commencing either individual or group therapy participants. Group therapy: Participants allocated to receive group therapy will receive 12 sessions of group therapy delivered for 50 min, 4 days/week for 3 weeks by an SP based on the “Be clear” dysarthria treatment protocol, consistent with principles of motor learning and neuroplasticity principles of intensity, repetition, specificity and saliency. Group therapy will consist of a maximum of four participants with dysarthria and may also include other patients not part of the research study (i.e., outpatients). Sessions will take place in a group room face to face in the Speech Pathology department of the Gold Coast University Hospital. Tasks each group session will include: - reminder of clear speech strategies (i.e., written on white board) - practicing clear speech strategies in spoken functional phrases (developed collaboratively for each individual), service requests and functional speech tasks (alternating between reading, picture description and conversational speech tasks with self-ratings). Tasks are practiced in a combination of alternating turns, group speaking and in pairs with feedback provided by other pair members and SP in accordance with principles of motor learning. -Homework tasks to transfer practice outside the therapy environment will also be provided (e.g., making phone calls). - Treatment adherence: Up to 10% of sessions (of both group and individual therapy) will be randomly video-recorded and reviewed according to a prescribed data coding tool to measure adherence to key elements of the programme. -Participant attendance & recruitment: The treating SP will record attendance across both models. As active participation is required for treatment, participant and SP blinding to treatment allocation is not possible. SPs undertaking everyday communication and speech intelligibility measures however will be blinded to treatment allocation and the assessment time-point.
Sponsors
Gold Coast University Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
There are three participant groups: 1)Dysarthria participants: Adult inpatients with dysarthria from stroke or acquired brain injury (as diagnosed by a speech pathologist [SP]). 2)Caregiver participants: Caregivers of participants who have consented to receive treatment in the study and who are proficient in English will be invited to complete two questionnaires. 3) Speech Pathologists: Approximately 6-8 SPs employed by GCH providing or assessment in the study at the time of the research will be invited to participate.
Exclusion criteria
1) Dysarthria participants: Significant aphasia or apraxia of speech that would preclude participation in dysarthria therapy, as judged by the treating SP based on completion of routine language screening. As a guide, participants who have greater than a mild aphasia (i.e., <76 on the Western Aphasia Battery bedside screener) will be excluded. Diagnosis of dementia, currently in post-traumatic amnesia as documented in the patient’s medical record. Cognitive impairment impacting on their ability to participate in dysarthria therapy as judged by the treating multi-disciplinary team. As a guide, scores <22 on the Montreal Cognitive Assessment (MOCA) indicating impairments greater than a mild cognitive impairment will be excluded. Significant hearing loss (i.e., profound deafness) or perceptual impairment as documented in the medical record that would preclude the participant from interacting in dysarthria therapy. Very severe dysarthria or anarthria (total loss of speech) which would preclude ability to participate in group-based therapy based on clinical judgement of a SP. As per definition of severe dysarthria from the AUsTOMs, this may include extremely restricted range of phoneme production (e.g., only one sound class such as vowels or extremely limited strength, range and/or rate of oral movements or control. Not proficient in English prior to onset of dysarthria. 2)Caregiver participants: Caregivers <18 years or who self-report any health issue which would prevent them from completing a questionnaire will be excluded.
Outcome results
None listed