Intensive sound production treatment for severe, chronic apraxia of speech

Abstract

ABSTRACT Background Massed practice has become a widely used method of treatment administration in the study of aphasia. It is often shown to be as or more effective than treatment provided in a distributed fashion. Some studies report changes beyond the targeted treatment materials, and durability of effects tends to be positive. Feasibility of this specific dosage for Sound Production Training (SPT) for apraxia of speech has yet to be tested. Aims This case study investigates the effects of a massed practice administration of SPT for a patient with severe and chronic apraxia of speech. Responsiveness was monitored for target treatment items at the level of the word and the manner of articulation. In addition, we assessed for changes in general aphasia severity, patient perception of communicative effectiveness, and ability to self-correct errors. Methods & Procedures SPT was administered for 3 h per weekday over 2 weeks. All sessions were audiotaped and analyzed independently by two raters. Initial responses were coded as correct or incorrect and then re-analyzed for each manner of articulation within each word. The total number of correct and incorrect self-corrections were also recorded. Multiple baselines across behaviors was used to track progress on trained materials. Outcomes & Results Improvements were observed on the accuracy of trained repeated productions, untrained equivalent exemplars, increased self-corrections, and also in reduced aphasia severity. There was no observed benefit to increased repetitions of a specific manner of articulation. Conclusions Massed practice is a viable way to administer SPT and may also positively impact non-targeted treatment items and objectives. Self-correction attempts precede or coincide with production accuracy and may be worth training in patients who do not spontaneously self-correct. Since increased repetitions did not improve a specific manner of speech, we speculate that the use of functional words versus those targeting specific phonemes may be as effective at eliciting desired speech outcomes.