Aphasia, Apraxia of Speech, Stroke
Conditions
Keywords
speech, speech therapy, apraxia of speech
Brief summary
This study was designed to examine the effects of speech therapy on ability to produce speech sounds in persons with acquired apraxia of speech.
Detailed description
This study was designed to investigate the effects of Sound Production Treatment (SPT; a treatment for acquired apraxia of speech) on sound production accuracy in persons with chronic apraxia of speech (AOS). Organization of practice (blocked practice or randomized practice) will be manipulated in an effort to determine the most efficacious application of SPT. A combination of group and single-subject experimental designs wasl be completed with 20 speakers with AOS (2 groups of 10 participants).
Interventions
BEHAVIORALSound Production Treatment - Blocked
Sound Production Treatment is a treatment for acquired apraxia of speech. Combines therapist modeling, simultaneous production, articulatory instruction, feedback and repeated practice. SPT-Blocked entailed practicing all treatment targets blocked by target. SPT-Random entailed practicing all treatment targets in a non predictable, random order.
BEHAVIORALSound Production Treatment - Random
A treatment for acquired apraxia of speech. Combines therapist modeling, simultaneous production, articulatory instruction, feedback and repeated practice. SPT-Random entailed practicing treatment targets in a non predictable order. SPT-Blocked entailed practicing treatment targets blocked by target.
Sponsors
VA Office of Research and Development
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Each participant received each arm of treatment
Eligibility
Sex/Gender
ALL
Age
21 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Must have acquired apraxia of speech that occurred following a stroke or other brain injury. * Must be at least 6 months post-onset of brain injury. * May have aphasia.
Exclusion criteria
* History of drug or alcohol abuse. * History of mental illness. * Neurological condition other than that which resulted in apraxia of speech.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Speech Production: Effect Size for Treated Items | Pre treatment (2-3 week period preceding the start of treatment) vs. 10 weeks post all treatment | Change in accuracy of articulation of trained items as measured from baseline to 10 weeks post treatment using effect size calculations as the indicator of magnitude of change; production of words designated for treatment was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (maximum = 100%, minimum = 0% correct). Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment. Positive effect sizes = increases in accuracy & negative effect sizes = decreases in accuracy. |
| Speech Production: Percent Change in Treated Items | baseline to 10 weeks post treatment | Change in accuracy of articulation of treated items as measured by percent increase in accuracy above the highest baseline measurement; production of words designated for treatment was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in pre-treatment probes was subtracted from the percentage accuracy achieved at 10 weeks post-treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline (pre-treatment). e.g., if in baseline probes, performance ranged from 10% to 30% accuracy and at post treatment performance was 90% accuracy, the change value would be 60% (90% minus 30%). A greater change value indicates greater change in articulation/production of words. Change could be positive (improved articulation) or negative (poorer articulation). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Speech Production: Percent Change in Untrained Items | baseline to 10 weeks post treatment | Percent change in articulatory accuracy of untrained items measured by change in percent accuracy over highest baseline value; production of words designated to NOT receive treatment (untrained items) was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (maximum = 100%, minimum = 0% correct). Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment. Positive effect sizes = increases in accuracy & negative effect sizes = decreases in accuracy. |
| Speech Production of Untrained Items: Effect Sizes for Untrained Items | Baseline vs. 10 weeks post all treatment | Change in accuracy of articulation of untrained items as measured by effect sizes reflecting magnitude of change. Production of words designated to not receive treatment (i.e., generalization items) was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (0% to 100% correct). Change in accuracy of articulation of untrained items was measured from baseline to 10 weeks post treatment using effect size calculations as the indicator of magnitude of change. Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment. |
Countries
United States
Participant flow
Pre-assignment details
Each participant received each treatment arm in this cross-over design. Order of treatment assignment was random.
Participants by arm
| Arm | Count |
|---|---|
| All Participants All participants received Sound Production Treatment (SPT). Half the participants received SPT applied in a blocked fashion (SPT-B) first for 20 sessions. Following a 2 week washout period, those participants then received SPT applied in random fashion (SPT-R) for 20 sessions. The other half of the participants received the treatments in the opposite order. | 20 |
| Total | 20 |
Baseline characteristics
| Characteristic | All Participants |
|---|---|
| Accuracy of Articulation | 20 Participants |
| Age, Continuous | 55.5 years |
| Race/Ethnicity, Customized Caucasian/non hispanic | 20 Participants |
| Region of Enrollment United States | 20 Participants |
| Sex: Female, Male Female | 7 Participants |
| Sex: Female, Male Male | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 20 |
| other Total, other adverse events | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 |
Outcome results
Primary
Speech Production: Effect Size for Treated Items
Change in accuracy of articulation of trained items as measured from baseline to 10 weeks post treatment using effect size calculations as the indicator of magnitude of change; production of words designated for treatment was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (maximum = 100%, minimum = 0% correct). Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment. Positive effect sizes = increases in accuracy & negative effect sizes = decreases in accuracy.
Time frame: Pre treatment (2-3 week period preceding the start of treatment) vs. 10 weeks post all treatment
Population: 20 speakers with chronic apraxia of speech and aphasia; effect sizes were calculated for each speaker for each treatment condition.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| SPT-R: All Participants | Speech Production: Effect Size for Treated Items | 6.84 effect size |
| SPT-B: All Participants | Speech Production: Effect Size for Treated Items | 6.14 effect size |
Comparison: Comparison of performance (change in articulation accuracy) with SPT-R versus SPT-B items. Based on the existing literature, it was predicted that the mean effect size associated with SPT-R would be greater than that for SPT-B.p-value: 0.254t-test, 1 sided
Primary
Speech Production: Percent Change in Treated Items
Change in accuracy of articulation of treated items as measured by percent increase in accuracy above the highest baseline measurement; production of words designated for treatment was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in pre-treatment probes was subtracted from the percentage accuracy achieved at 10 weeks post-treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline (pre-treatment). e.g., if in baseline probes, performance ranged from 10% to 30% accuracy and at post treatment performance was 90% accuracy, the change value would be 60% (90% minus 30%). A greater change value indicates greater change in articulation/production of words. Change could be positive (improved articulation) or negative (poorer articulation).
Time frame: baseline to 10 weeks post treatment
Population: 20 speakers with chronic apraxia of speech and aphasia received both arms of treatment.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| SPT-R: All Participants | Speech Production: Percent Change in Treated Items | 46 % change |
| SPT-B: All Participants | Speech Production: Percent Change in Treated Items | 38 % change |
Comparison: On the basis of existing literature. SPT-R was predicted to be associated with greater increase in articulatory accuracy over baseline levels than SPT-B.p-value: 0.043t-test, 1 sided
Secondary
Speech Production of Untrained Items: Effect Sizes for Untrained Items
Change in accuracy of articulation of untrained items as measured by effect sizes reflecting magnitude of change. Production of words designated to not receive treatment (i.e., generalization items) was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (0% to 100% correct). Change in accuracy of articulation of untrained items was measured from baseline to 10 weeks post treatment using effect size calculations as the indicator of magnitude of change. Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment.
Time frame: Baseline vs. 10 weeks post all treatment
Population: 20 speakers with chronic apraxia of speech and aphasia
| Arm | Measure | Value (MEAN) |
|---|---|---|
| SPT-R: All Participants | Speech Production of Untrained Items: Effect Sizes for Untrained Items | 2.56 effect size |
| SPT-B: All Participants | Speech Production of Untrained Items: Effect Sizes for Untrained Items | 2.11 effect size |
Comparison: Comparison of effect sizes obtained for untreated SPT-R versus untreated SPT-B items. It was predicted that effect sizes would be greater for SPT-R untreated items.p-value: 0.212t-test, 1 sided
Secondary
Speech Production: Percent Change in Untrained Items
Percent change in articulatory accuracy of untrained items measured by change in percent accuracy over highest baseline value; production of words designated to NOT receive treatment (untrained items) was measured repeatedly in non treatment probes prior to treatment, throughout all study phases, and at 10 weeks post treatment with percent accuracy calculated for each probe (maximum = 100%, minimum = 0% correct). Effect size calculations involved calculating the difference between post- and pre-treatment probe accuracy percentages with corrections made for variability (standard deviations in performance). The larger the effect size, the greater the change in performance from pre-treatment. Positive effect sizes = increases in accuracy & negative effect sizes = decreases in accuracy.
Time frame: baseline to 10 weeks post treatment
Population: 20 participants with chronic apraxia of speech and aphasia
| Arm | Measure | Value (MEAN) |
|---|---|---|
| SPT-R: All Participants | Speech Production: Percent Change in Untrained Items | 14 % change |
| SPT-B: All Participants | Speech Production: Percent Change in Untrained Items | 13 % change |
Comparison: Comparison of change in accuracy of articulation of untreated items: SPT-R versus SPT-B items. It was predicted that there would be a greater increase in accuracy for SPT-R items.p-value: 0.396t-test, 1 sided