Aphasia, Apraxia of Speech, CVA
Conditions
Keywords
apraxia, aphasia, rehabilitation, efficacy, intensity
Brief summary
A growing neurorehabilitation literature suggests that intense treatment may be desired to maximize the effects of therapy following neurologic injury. This investigation is designed to facilitate the development of efficacious, clinically applicable treatment for acquired apraxia of speech by examining the effects of intensity of treatment (e.g., 9 hours per week vs. 3 hours per week, while holding total number of sessions constant) with a group of speakers who have chronic apraxia of speech and aphasia.
Detailed description
This research was designed to examine the effects of treatment intensity on outcomes associated with an established treatment for acquired apraxia of speech (AOS). Intensity in the form of dose frequency and total intervention duration was evaluated with Sound Production Treatment (SPT). The investigators examined the effects of intense dose frequency (nine, one-hour sessions per week) and traditional dose frequency (three, one hour sessions per week). Total number of treatment sessions was held constant allowing for comparison of total intervention duration (27 sessions over 3 weeks versus 27 sessions over 9 weeks). A two-phase, group cross-over design was used. Thirty-six participants with chronic aphasia and AOS were recruited. Twenty-four participants completed then entire study and were quasi-randomly assigned to one of two treatment groups - intense first or traditional first (12 per group). One group received SPT applied with intense dose frequency (SPT-I) followed by SPT applied with traditional dose frequency (SPT-T). The other group received the treatments in the reverse order (SPT-T followed by SPT-I). A two week no treatment interval separated the treatment phases. The outcomes of interest addressed changes in trained and untrained speech behaviors.
Interventions
BEHAVIORALSound Production Treatment (SPT)
SPT is a behavioral treatment for acquired apraxia of speech. It involves verbal modeling of target words by the clinician, simultaneous productions, articulatory placement instructions, and repeated practice. Treatment is administered in the context of an hierarchy.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Veterans and non Veterans * Males or females * Stroke survivor who is at least 4 months post-stroke * Speaker of English since childhood * Ability to pass a pure-tone hearing screening (aided or unaided) * currently non-hospitalized * Age 21 to 90 years
Exclusion criteria
* neurological condition other than stroke * currently clinically depressed * history of speech/language problems prior to stroke * untreated psychopathology
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Accuracy of Articulation of TREATED ITEMS Measured as Effect Size - Change From Baseline to End of Treatment Phase | Pre treatment, 2 weeks following the first treatment phase, 2 weeks following the second treatment phase | Accuracy of articulation of sounds in words, phrases, sentences designated for treatment. Assessed in nontreatment probes with productions elicited through repetition. Change in accuracy of articulation of trained items was measured from baseline to 2 weeks post treatment using effect size calculations as the indicator of magnitude of change. Percent accuracy was 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. |
| Accuracy of Articulation of Untreated Items (Generalization) Measured as Effect Size - Change From Baseline to End of Treatment Phase | Pre treatment, 2 weeks following the first treatment phase, 2 weeks following the second treatment phase | 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 2 weeks post treatment with percent accuracy calculated for each probe (0% to 100% 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | Pre treatment & 2 weeks following each treatment phase | Measure of how well an unfamiliar listener can understand speech. The Assessment of Intelligibility of Dysarthric Speech will be employed. The participant will repeat words which will be audiorecorded. A trained, but unfamiliar listener will orthographically transcribe the words that are produced. The transcriptions will be compared to the list of target (intended words) to determine a percentage of words that are correctly understood. The score may range from 0% to 100% of words understood. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SPT - Intense First Participants received intense application in the first phase of treatment, followed by the non intense application of treatment.
Sound Production Treatment (SPT): SPT is a behavioral treatment for acquired apraxia of speech. It involves verbal modeling of target words by the clinician, simultaneous productions, articulatory placement instructions, and repeated practice. Treatment is administered in the context of an hierarchy.
Intense application = SPT-I: treatment administered for 3 hourly sessions per day, 3 days per week, for 3 weeks for a total of 27 hourly sessions. | 12 |
| SPT - Traditional First Participants received non intense, traditional application of treatment in the first phase of treatment, followed by the intense application of treatment.
Sound Production Treatment (SPT): SPT is a behavioral treatment for acquired apraxia of speech. It involves verbal modeling of target words by the clinician, simultaneous productions, articulatory placement instructions, and repeated practice. Treatment is administered in the context of an hierarchy.
Traditional application = SPT-T: treatment administered for 1 hourly session, 3 days per week for 9 weeks for a total of 27 hourly sessions. | 12 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | did not meet inclusion criteria | 2 | 4 |
| Overall Study | Moved out of region | 3 | 0 |
| Overall Study | Travel distance prohibitive | 0 | 1 |
| Overall Study | Unrelated illness | 1 | 1 |
Baseline characteristics
| Characteristic | SPT - Intense First | Total | SPT - Traditional First |
|---|---|---|---|
| Accuracy of Articulation of Treated Items in Baseline (Pre-treatment) | 12.03 units on a scale STANDARD_DEVIATION 6.14 | 11.28 units on a scale STANDARD_DEVIATION 7.19 | 10.5 units on a scale STANDARD_DEVIATION 8.3 |
| Accuracy of Articulation of UNtreated Items in Baseline (Pre-treatment) | 14.07 units on a scale STANDARD_DEVIATION 6.67 | 13.99 units on a scale STANDARD_DEVIATION 8.3 | 13.9 units on a scale STANDARD_DEVIATION 9.98 |
| Age, Continuous | 55.75 years STANDARD_DEVIATION 13.07 | 58.79 years STANDARD_DEVIATION 12.72 | 61.83 years STANDARD_DEVIATION 12.13 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 12 Participants | 23 Participants | 11 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 12 Participants | 23 Participants | 11 Participants |
| Sex: Female, Male Female | 2 Participants | 7 Participants | 5 Participants |
| Sex: Female, Male Male | 10 Participants | 17 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 24 | 0 / 24 |
| other Total, other adverse events | 0 / 24 | 0 / 24 |
| serious Total, serious adverse events | 0 / 24 | 0 / 24 |
Outcome results
Primary
Accuracy of Articulation of TREATED ITEMS Measured as Effect Size - Change From Baseline to End of Treatment Phase
Accuracy of articulation of sounds in words, phrases, sentences designated for treatment. Assessed in nontreatment probes with productions elicited through repetition. Change in accuracy of articulation of trained items was measured from baseline to 2 weeks post treatment using effect size calculations as the indicator of magnitude of change. Percent accuracy was 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 weeks following the first treatment phase, 2 weeks following the second treatment phase
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SPT - Intense: All Participants | Accuracy of Articulation of TREATED ITEMS Measured as Effect Size - Change From Baseline to End of Treatment Phase | 19.7 effect sizes; magnitude of change | Standard Deviation 12.6 |
| SPT - Traditional (Non-intense): All Participants | Accuracy of Articulation of TREATED ITEMS Measured as Effect Size - Change From Baseline to End of Treatment Phase | 28.9 effect sizes; magnitude of change | Standard Deviation 17.2 |
Comparison: Null hypothesis is that there is no difference in mean effect size values for 2-week follow-up values for treated items for SPT-Intense and SPT-Traditional. The test was performed with a significance level of 0.05 (two-sided).p-value: 0.0128t-test, 2 sided
Primary
Accuracy of Articulation of Untreated Items (Generalization) Measured as Effect Size - Change From Baseline to End of Treatment Phase
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 2 weeks post treatment with percent accuracy calculated for each probe (0% to 100% 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.
Time frame: Pre treatment, 2 weeks following the first treatment phase, 2 weeks following the second treatment phase
Population: 24 effect sizes from all 24 participants
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SPT - Intense: All Participants | Accuracy of Articulation of Untreated Items (Generalization) Measured as Effect Size - Change From Baseline to End of Treatment Phase | 7.9 effect sizes; magnitude of change | Standard Deviation 5.6 |
| SPT - Traditional (Non-intense): All Participants | Accuracy of Articulation of Untreated Items (Generalization) Measured as Effect Size - Change From Baseline to End of Treatment Phase | 8.1 effect sizes; magnitude of change | Standard Deviation 8.9 |
Comparison: Null hypothesis is that there is no difference in mean effect size values for 2-week follow-up values for untreated (generalization) items for SPT-Intense and SPT-Traditional. The test was performed with a significance level of 0.05 (two-sided).p-value: 0.942t-test, 2 sided
Secondary
Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases
Measure of how well an unfamiliar listener can understand speech. The Assessment of Intelligibility of Dysarthric Speech will be employed. The participant will repeat words which will be audiorecorded. A trained, but unfamiliar listener will orthographically transcribe the words that are produced. The transcriptions will be compared to the list of target (intended words) to determine a percentage of words that are correctly understood. The score may range from 0% to 100% of words understood.
Time frame: Pre treatment & 2 weeks following each treatment phase
Population: Intense SPT First Arm: one participant's data was lost due to data storage problems \& three participants moved out of the region after the first treatment phase; Non-intense SPT First Arm: one participant's data was lost due to data storage problems \& one participant moved out of the region after the first treatment phase
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SPT - Intense: All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #2: % Intelligibility | 61.3 % Intelligible words | Standard Deviation 34.9 |
| SPT - Intense: All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #1: % Intelligibility | 54.3 % Intelligible words | Standard Deviation 37.2 |
| SPT - Intense: All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | Baseline % Intelligibility | 45.15 % Intelligible words | Standard Deviation 33.9 |
| SPT - Traditional (Non-intense): All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #2: % Intelligibility | 68.7 % Intelligible words | Standard Deviation 30.5 |
| SPT - Traditional (Non-intense): All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | Baseline % Intelligibility | 46.15 % Intelligible words | Standard Deviation 29.5 |
| SPT - Traditional (Non-intense): All Participants | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #1: % Intelligibility | 61.5 % Intelligible words | Standard Deviation 30.5 |
| Both Arms Combined: Intense First + Traditional First | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #1: % Intelligibility | 60.5 % Intelligible words | Standard Deviation 33.1 |
| Both Arms Combined: Intense First + Traditional First | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | Baseline % Intelligibility | 48.96 % Intelligible words | Standard Deviation 31.92 |
| Both Arms Combined: Intense First + Traditional First | Speech Intelligibility - Percent Intelligible Words Comparing Baseline to End of Treatment Phases | 2 weeks Post Treatment #2: % Intelligibility | 65 % Intelligible words | Standard Deviation 32.2 |
Comparison: Null Hypothesis: No difference in pre-treatment and post-treatment intelligibility scoresp-value: <0.001t-test, 2 sided