Self-Administered Computer Therapy for Apraxia of Speech

Abstract

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...

Artificial grammar learning in vascular and progressive non-fluent aphasias

“…The results imply that there is potential for improvement from an intensive paradigm based on repeated exposure-test cycles. This could in principle be made home-deliverable and patient-led, an approach that has demonstrable efficacy for improving speech production in similar patient groups ( Varley et al, 2016 ); the tasks employed in this study were automated and computer based. The finding that learning did not generalise across modalities implies that such a therapy would need to use linguistic material, as it would be unlikely to be so well learnt with non-linguistic material or to transfer across domains.…”

Motor learning guided treatment for acquired apraxia of speech

“…Behavior changes in self-controlled practice are believed to be attributed to motivation (Lewthwaite & Wulf, 2012). There is great interest to facilitate selfcontrolled practice (i.e., home practice) (Johnson et al, 2014;Lasker et al, 2008Lasker et al, , 2010 and/or self-controlled therapy using computer-based programs for acquired AOS (Varley et al, 2016). While home practice has been incorporated in multiple MLG treatment studies, the influence of the practice beyond treatment session with clinician is unknown (Ballard et al, 2015).…”

“…However, it is reported that how much and what was practiced influenced treatment outcomes more than session dose and was identified as potentially one of the missing ingredients (Cherney, 2012;Togher, 2012). Having a better understanding of specific motivating factors of our clients, could guide our decision to use self-controlled practice and identify the best structure to meet our patient's needs (Varley et al, 2016). Investigations measuring motivating factors would be a welcome area of future research (Raymer & Rothi, in press) and may be one of the missing ingredients to maximize behavioral change for speech motor learning in our clients with acquired AOS.…”

Abstracts 20th International Science of Aphasia Conference, Rome, September 2019

“…All intervention stimuli were relevant to everyday talk about experiences, opinions and exchanging information. Participants practiced flexible use of constructions via errorless learning strategies, following the steps used in the SWORD program (Varley et al, 2016;Whiteside et al, 2012).…”