Treating apraxia of speech (AOS) with EMA-supplied visual augmented feedback

Abstract

Background: Previous studies have suggested that visual augmented feedback provided by electromagnetic articulography (EMA) helps persons with apraxia of speech (AOS) recover speech motor control following stroke (e.g., Katz et al., 2007). However, the data are few, both in terms of the variety of participants and the speech motor targets investigated. Aims: This study was designed to determine whether EMA supplied feedback improves articulatory accuracy in an adult with acquired AOS. We also examined whether reduced feedback frequency results in (1) decreased performance during acquisition and (2) enhanced maintenance and generalisation of the targeted behaviours. Methods & Procedures: A multiple-baseline across-behaviours design was used to assess the efficacy of this treatment for an individual with AOS. Over a 27-week period, the participant received visual feedback provided by an EMA system for treatment of three groups of speech motor targets (SMTs): /j/, /θ/, and /t∫ / with various following VCs. The consonant clusters /br/ and /sw/ served as untreated controls. Frequency of feedback scheduling was 100% for /j/ and /t∫ /, and 50% for /θ/. Outcomes & Results: For the first group of SMTs treated, /j/, there was acquisition for 4/5 trained words. These were maintained post-treatment and at the long-term probe. Improved performance and maintenance were also noted for 5/8 untreated stimuli, with maintenance shown for most of these words by 1 month post-treatment. The next treated SMT, /θ/, showed acquisition for all five treated items. Two of these five targets were maintained one month post-treatment. All three untreated /θ/ probes showed generalisation, with two of these showing maintenance post-treatment. The third treated group of SMTs, /t∫/, showed improved performance for all of the five treated words. However, these gains could only be attributed to /t∫/ treatment for three of the five words. Two treated items appeared well maintained at 1 month post-treatment. Generalisation and maintenance were also noted for all six untreated /t∫ / words. However, generalisation from previously treated /j/ and /t∫/ targets was involved in their improved performance. The untrained (control) word data suggested that the gains noted for treated items did not result from across-the-board improvement or unassisted recovery. There were no consistent differences corresponding with low- versus high-frequency feedback conditions. Conclusions: Augmented kinematic feedback provided by an EMA system improved production for some, but not all, treated targets. Generalisation to untreated probes was also evident. Predictions concerning the effects of feedback frequency on the acquisition, maintenance, and transfer of trained behaviours were not supported.