Language therapy for word-finding difficulties in aphasia usually involves picture naming of single words with the support of cues. Most studies have addressed nouns in isolation, even though in connected speech nouns are more frequently produced with determiners. We hypothesized that improved word finding in connected speech would be most likely if intervention treated nouns in usual syntactic contexts. Six speakers with aphasia underwent language therapy using a software program developed for the purpose*, which provided lexical and syntactic (determiner) cues. Exposure to determiners with nouns would potentially lead to improved picture naming of both treated and untreated nouns, and increased production of determiner plus noun combinations in connected speech. After intervention picture naming of treated words improved for five of the six speakers, but naming of untreated words was unchanged. The number of determiner plus noun combinations in connected speech increased for four speakers. These findings attest to the close relationship between frequently co-occurring content and function words, and indicate that intervention for word-finding deficits can profitably proceed beyond single word naming, to retrieval in appropriate syntactic contexts. We also examined the relationship between effects of therapy, and amount and intensity of therapy. We found no relationship between immediate effects and amount or intensity of therapy. However, those participants whose naming maintained at follow-up completed the therapy regime in fewer sessions, of relatively longer duration. We explore the relationship between therapy regime and outcomes, and propose future considerations for research.

Acquired apraxia of speech (AOS) is a motor speech disorder that affects the implementation of articulatory gestures and the fluency and intelligibility of speech. Oral apraxia (OA) is an impairment of nonspeech volitional movement. Although many speakers with AOS also display difficulties with volitional nonspeech oral movements, the relationship between the 2 conditions is unclear. This study explored the relationship between speech and volitional nonspeech oral movement impairment in a sample of 50 participants with AOS. We examined levels of association and dissociation between speech and OA using a battery of nonspeech oromotor, speech, and auditory/aphasia tasks. There was evidence of a moderate positive association between the 2 impairments across participants. However, individual profiles revealed patterns of dissociation between the 2 in a few cases, with evidence of double dissociation of speech and oral apraxic impairment. We discuss the implications of these relationships for models of oral motor and speech control.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Keywords: Acquired apraxia of speech; Error reduction principles; computer-based speech therapy; two-phase cross-over treatment design. Permanent repository link 2 ABSTRACTWe report an intervention study focused on the speech production difficulties present in acquired apraxia of speech (AOS). The intervention was a self-administered computer therapy that targeted whole word production and incorporated error reduction strategies.The effectiveness of the therapy was contrasted to that of a visuo-spatial sham computer program and performance across treated words, and two sets of matched words was assessed. Two groups of participants completed the study which employed a two-phase cross-over treatment design. Participants were randomly assigned to a speech first or sham first condition. Treatments were administered for 6 weeks, with a 4 week rest between interventions. Participants were assessed five times in total; twice at baseline, once following each of the intervention phases, and once following a lapse of 8 weeks after the end of the second phase of intervention. The occurrence of accurate word production and speech characterised by struggle and groping behaviours was recorded on a repetition task. Participants showed significant gains in speech accuracy and fluency, and reductions in articulatory groping and struggle behaviours following the use of the speech program. These gains were largely maintained once the therapy was withdrawn.3

Speech/language impairments after stroke are subcategorized into aphasia, dysarthria, and apraxia of speech (AOS). AOS is a disorder at the interface of language and speech production, involving breakdown in mapping from abstract linguistic representations to motor plans.1 Typical behaviors include speech errors, loss of automaticity and fluency, and altered timing parameters. 2 In severe cases, patients may be nonverbal. Lesions causing AOS usually occur within the left cortical motor or somatosensory areas. 3 Because of the proximity of speech control regions to left perisylvian cortex, AOS often co-occurs with aphasia.Behavioral interventions for AOS involve 2 broad classes of therapies: bottom-up articulatory-kinematic therapies focus on individual speech sounds 4 and top-down interventions aim to reestablish fluent production of larger linguistic units. 5 Comparisons of outcomes for the 2 approaches are not conclusive. 6 Intervention research has largely used quasi-experimental designs with nonrandom assignment. A meta-analysis and systematic review conclude that there is no randomized controlled trial evidence in support of intervention for AOS. 4,7 We report outcomes of an intervention for AOS combining these 2 therapeutic traditions. The intervention aimed to improve word production, with target forms ultimately placed in sentence frames. This approach acknowledges the common comorbidity of AOS with aphasia, allowing both linguistic and phonetic processes to be targeted. Trials of aphasia therapies indicate that lower intensity interventions have limited outcomes. 8 Attempts to increase face-to-face therapy dose can result in high attrition rates because attending multiple appointments can challenge participants. 9 The use of software programs, allowing participants to self-administer intervention, may circumvent this difficulty. A feasibility study reported that computer therapy is cost-effective and acceptable to patients with poststroke anomia. 10 We used a software therapy for AOS. It involved a perceptual stage (spoken word-picture matching, auditory-written Background and Purpose-There is currently little evidence on effective interventions for poststroke apraxia of speech. We report outcomes of a trial of self-administered computer therapy for apraxia of speech. Methods-Effects of speech intervention on naming and repetition of treated and untreated words were compared with those of a visuospatial sham program. The study used a parallel-group, 2-period, crossover design, with participants receiving 2 interventions. Fifty participants with chronic and stable apraxia of speech were randomly allocated to 1 of 2 order conditions: speech-first condition versus sham-first condition. Period 1 design was equivalent to a randomized controlled trial. We report results for this period and profile the effect of the period 2 crossover. Results-Period 1 results revealed significant improvement in naming and repetition only in the speech-first group.The sham-first group displayed improvement in speech production...