Massed sentence repetition training can augment and speed up recovery of speech production deficits in patients with chronic conduction aphasia receiving donepezil treatment

Abstract

Background: In the past two decades, single-case studies evaluated the effect of massed repetition training to improve speech production and short-term memory deficits in conduction aphasia (CA). Improvements were reported in treated language and memory domains with modest generalisation of gains to spontaneous speech or auditory comprehension. Although these results are encouraging, sentence repetition training has not been compared with distributed speech-language therapy, and no studies have examined the role of pharmacological interventions to enhance gains promoted by these behavioural interventions in CA.Aims: The effects of massed sentence repetition therapy (MSRT) were compared to those of distributed speech-language therapy (DSLT) in measures of verbal output, short-term memory and repetition in patients with chronic post-stroke CA receiving treatment with the cholinesterase inhibitor donepezil (DP).Methods and Procedures: Three patients with chronic CA aphasia associated to large left perisylvian infarctions participated in a 28-week open-label study combining DP with DSLT or MSRT. A within-patient design, with baselines across behaviours and a washout period was used. Patients were treated with DP (10 mg/day) combined first with DSLT (16 weeks, 40 hours) and after a washout period (4 weeks) with MSRT (8 weeks, 40 hours). Language functions were assessed with the Western Aphasia Battery and experimental repetition tasks prior to and after DSLT and MSRT.Outcomes and Results: Both interventions improved performance in speech production tasks, but better improvements were found with DP-MSRT than with DP-DSLT. Larger treatment effects were found for DP-MSRT in comparison with baselines and DP-DSLT in repetition of word pairs and triplets, and novel and experimental sentences with generalisation of gains to aphasia severity, connected speech and non-treated control sentences.Conclusions: Combined interventions with DP and two different aphasia therapies (DSLT and MSRT) significantly improved speech production deficits in CA, but DP-MSRT augmented and speeded up most benefits provided by DP-DSLT.