Aphasia, Acquired, Apraxia of Speech, Speech Disorders
Conditions
Keywords
Apraxia of Speech, Treatment
Brief summary
The purpose of the proposed research is to examine the effects of two treatment approaches on speech production involving speakers with chronic apraxia of speech (AOS) and aphasia. The planned investigation is designed to examine the acquisition, maintenance and generalization effects of each treatment. One approach, electropalatography (EPG) uses visual biofeedback in conjunction with articulatory-kinematic treatment and the other approach, sound production treatment (SPT) is one of the most systematically studied articulatory-kinematic treatments for AOS.
Detailed description
EPG has been used to treat apraxia of speech (AOS) as well as other speech production disorders (i.e., articulation disorders & cleft palate). SPT is one of the most systematically studied treatment approaches for AOS. Both treatment approaches are considered clinical treatment approaches/standards of care for AOS. The pseudopalate used in conjunction with EPG treatment is an acceptable device for treating speech production disorders including AOS. The pseudopalate is custom-fit for each patient and is similar to a dental retainer and is considered minimally invasive. The purpose of this research is to systematically examine the effects of treatment on speech production using EPG treatment vs. an SPT approach. The planned investigation is intended to explicate the acquisition, maintenance, and generalization effects of each treatment approach. The specific experimental questions to be addressed are as follows: 1. Will treatment using an EPG approach or an SPT approach result in greater accuracy of articulation of trained speech sounds produced in words? 2. Will treatment using an EPG approach or an SPT approach result in greater accuracy of articulation of untrained exemplars of trained speech sounds produced in words (i.e., response generalization)? 3. Will treatment using an EPG approach or an SPT approach result in greater long term maintenance effects for trained speech sounds? 4. Do different treatment approaches result in distinct ratings of functional communication skills via the Aphasia Communication Outcome Measure (ACOM; Doyle et al., 2012) and an outcome measure of speech intelligibility using the Assessment of Intelligibility of Dysarthric Speech (AIDS; Yorkston & Beukelman, 1981)?
Interventions
DEVICEEPG Tx
behavioral intervention that incorporates a device that provides visual biofeedback
BEHAVIORALSPT
A treatment hierarchy involving integral stimulation
Sponsors
VA Office of Research and Development
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Single
Intervention model description
Each participant received each arm of treatment
Eligibility
Sex/Gender
ALL
Age
21 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Veterans or non Veterans with apraxia of speech who reside in the Salt Lake City region (commutable), * 6 months or more post stroke or other focal brain injury, no other neurological conditions * native English speakers, hearing adequate for experimental task (e.g., pass puretone screening at 35dB at 500, 1K, 2K Hz or adequate aided hearing) * non linguistic cognition within normal limits
Exclusion criteria
* less than 6 months post stroke * insufficient hearing, insufficient non linguistic cognitive skills * neurological conditions other than stroke * unable to attend treatment in the Salt Lake City vicinity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Speech Production: Percent Change in Treated Items Immediately Post Treatment | Baseline vs. Immediately Post Treatment (7 week treatment period) | Change in accuracy of articulation of treated items 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 immediately post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at the conclusion of treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline (baseline). 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 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 Untreated Items (Related Items) Immediately Post Treatment | Baseline vs. Immediately Post Treatment (7 week treatment period) | Change in articulatory accuracy of untreated items, but related items as measured by percent increase in accuracy above the highest baseline measurement; production of words designated for non-treatment was measured repeatedly in non-treatment probes prior to treatment, throughout all study phases and immediately post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at the conclusion of treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline. 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) |
| Speech Production: Percent Change for Treated Items After the Completion of Treatment | Baseline vs. 7 weeks post treatment [measured immediately after the completion of each treatment] | Change in articulatory accuracy 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 7 weeks immediately after each treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at 7 weeks immediately after the conclusion of each 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. |
| Functional Communication Skills: T-Score | Baseline vs. 10 weeks after the completion of all treatment [measured at pre-treatment and post-treatment; conclusion of all treatment] | Measurement of functional every day communication skills using the Aphasia Communication Outcome Measure (ACOM) with a T-score computed at each administration which was at baseline and then 10 weeks after the completion of all treatment. This outcome measure was only completed at baseline and at the completion on all treatment \[not measured after the completion of each treatment\]. The rating scale for functional communication skills was completed by the patient (or a spouse if patient's auditory comprehension was significantly impaired) (T-Scores range from 0 to 100; Higher T-scores indicate greater functional communication skills) |
| Speech Intelligibility: Percentage | Baseline vs. 10 weeks post all treatment [measured at pre-treatment and post-treatment; conclusion of all treatment] | Measurement of speech intelligibility for a set of fifty words (non-treatment words) from the Assessment of Speech Intelligibility of Dysarthric Speech as judge by an unfamiliar listener that was measured at baseline and then at 10 weeks post all treatment with a percentage of speech intelligibility (0% to 100% intelligible).This measurement was only conducted at pre-treatment and at the conclusion of all treatment \[not measured after each treatment\]. |
Countries
United States
Participant flow
Pre-assignment details
Each participant received each treatment arm in this crossover design. Order of treatment assignment was random.
Participants by arm
| Arm | Count |
|---|---|
| All Participants All participants received Electropalatography Treatment (EPG Tx) and Sound Production Treatment (SPT). Half the participants received EPG Tx first for 20 sessions. Following a 2 week washout period, those participants then received SPT for 20 sessions. The other half of the participants received the treatments in the opposite order. | 6 |
| Total | 6 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| First Treatment Phase (7 Weeks) | Withdrawal by Subject | 0 | 1 |
Baseline characteristics
| Characteristic | All Participants |
|---|---|
| Age, Continuous | 64.6 Years STANDARD_DEVIATION 15.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 5 Participants |
| Region of Enrollment United States | 6 Participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 5 | 0 / 5 |
| other Total, other adverse events | 0 / 5 | 0 / 5 |
| serious Total, serious adverse events | 0 / 5 | 0 / 5 |
Outcome results
Primary
Speech Production: Percent Change in Treated Items Immediately Post Treatment
Change in accuracy of articulation of treated items 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 immediately post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at the conclusion of treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline (baseline). 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 value indicates greater change in articulation/production of words. Change could be positive (improved articulation) or negative (poorer articulation)
Time frame: Baseline vs. Immediately Post Treatment (7 week treatment period)
| Arm | Measure | Value (MEAN) |
|---|---|---|
| EPG Treatment | Speech Production: Percent Change in Treated Items Immediately Post Treatment | 59 % change |
| Sound Production Treatment | Speech Production: Percent Change in Treated Items Immediately Post Treatment | 66 % change |
Secondary
Functional Communication Skills: T-Score
Measurement of functional every day communication skills using the Aphasia Communication Outcome Measure (ACOM) with a T-score computed at each administration which was at baseline and then 10 weeks after the completion of all treatment. This outcome measure was only completed at baseline and at the completion on all treatment \[not measured after the completion of each treatment\]. The rating scale for functional communication skills was completed by the patient (or a spouse if patient's auditory comprehension was significantly impaired) (T-Scores range from 0 to 100; Higher T-scores indicate greater functional communication skills)
Time frame: Baseline vs. 10 weeks after the completion of all treatment [measured at pre-treatment and post-treatment; conclusion of all treatment]
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| EPG Treatment | Functional Communication Skills: T-Score | Post-Treatment | 46.0 T-Score | Standard Deviation 21 |
| EPG Treatment | Functional Communication Skills: T-Score | Pre-Treatment | 43.0 T-Score | Standard Deviation 16 |
Secondary
Speech Intelligibility: Percentage
Measurement of speech intelligibility for a set of fifty words (non-treatment words) from the Assessment of Speech Intelligibility of Dysarthric Speech as judge by an unfamiliar listener that was measured at baseline and then at 10 weeks post all treatment with a percentage of speech intelligibility (0% to 100% intelligible).This measurement was only conducted at pre-treatment and at the conclusion of all treatment \[not measured after each treatment\].
Time frame: Baseline vs. 10 weeks post all treatment [measured at pre-treatment and post-treatment; conclusion of all treatment]
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| EPG Treatment | Speech Intelligibility: Percentage | Pre-Treatment | 40.0 Percentage of Words Intelligible | Standard Deviation 30 |
| EPG Treatment | Speech Intelligibility: Percentage | Post-Treatment | 50.0 Percentage of Words Intelligible | Standard Deviation 25 |
Secondary
Speech Production: Percent Change for Treated Items After the Completion of Treatment
Change in articulatory accuracy 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 7 weeks immediately after each treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at 7 weeks immediately after the conclusion of each 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.
Time frame: Baseline vs. 7 weeks post treatment [measured immediately after the completion of each treatment]
| Arm | Measure | Value (MEAN) |
|---|---|---|
| EPG Treatment | Speech Production: Percent Change for Treated Items After the Completion of Treatment | 43 % change |
| Sound Production Treatment | Speech Production: Percent Change for Treated Items After the Completion of Treatment | 61 % change |
Secondary
Speech Production: Percent Change in Untreated Items (Related Items) Immediately Post Treatment
Change in articulatory accuracy of untreated items, but related items as measured by percent increase in accuracy above the highest baseline measurement; production of words designated for non-treatment was measured repeatedly in non-treatment probes prior to treatment, throughout all study phases and immediately post treatment with percent accuracy calculated for each probe (0% to 100% correct). The highest percentage accuracy achieved in baseline probes was subtracted from the percentage accuracy achieved at the conclusion of treatment to obtain change in accuracy value - this reflects change from maximum correct performance in baseline. 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 vs. Immediately Post Treatment (7 week treatment period)
| Arm | Measure | Value (MEAN) |
|---|---|---|
| EPG Treatment | Speech Production: Percent Change in Untreated Items (Related Items) Immediately Post Treatment | 5 % change |
| Sound Production Treatment | Speech Production: Percent Change in Untreated Items (Related Items) Immediately Post Treatment | 50 % change |