Intensive Speech-language Therapy Research Articles

Behavioral, Functional Imaging, and Neurophysiological Outcomes of Transcranial Direct Current Stimulation and Speech-Language Therapy in an Individual with Aphasia.

Speech-language therapy (SLT) is the most effective technique to improve language performance in persons with aphasia. However, residual language impairments remain even after intensive SLT. Recent studies suggest that combining transcranial direct current stimulation (tDCS) with SLT may improve language performance in persons with aphasia. However, our understanding of how tDCS and SLT impact brain and behavioral relation in aphasia is poorly understood. We investigated the impact of tDCS and SLT on a behavioral measure of scripted conversation and on functional connectivity assessed with multiple methods, both resting-state functional magnetic resonance imaging (rs-fMRI) and resting-state electroencephalography (rs-EEG). An individual with aphasia received 15 sessions of 20-min cathodal tDCS to the right angular gyrus concurrent with 40 min of SLT. Performance during scripted conversation was measured three times at baseline, twice immediately post-treatment, and at 4- and 8-weeks post-treatment. rs-fMRI was measured pre-and post-3-weeks of treatment. rs-EEG was measured on treatment days 1, 5, 10, and 15. Results show that both communication performance and left hemisphere functional connectivity may improve after concurrent tDCS and SLT. Results are in line with aphasia models of language recovery that posit a beneficial role of left hemisphere perilesional areas in language recovery.

A pilot study of AID-COMp: An innovative speech-language intervention for patients with early-stage major neurocognitive disorder.

Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties. This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp). We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively. For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs. We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences. What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.

Long-Term Stability of Short-Term Intensive Language–Action Therapy in Chronic Aphasia: A 1–2 year Follow-Up Study

Background. Intensive aphasia therapy can improve language functions in chronic aphasia over a short therapy interval of 2–4 weeks. For one intensive method, intensive language–action therapy, beneficial effects are well documented by a range of randomized controlled trials. However, it is unclear to date whether therapy-related improvements are maintained over years. Objective. The current study aimed at investigating long-term stability of ILAT treatment effects over circa 1–2 years (8–30 months). Methods. 38 patients with chronic aphasia participated in ILAT and were re-assessed at a follow-up assessment 8–30 months after treatment, which had been delivered 6–12.5 hours per week for 2–4 weeks. Results. A standardized clinical aphasia battery, the Aachen Aphasia Test, revealed significant improvements with ILAT that were maintained for up to 2.5 years. Improvements were relatively better preserved in comparatively young patients (<60 years). Measures of communicative efficacy confirmed improvements during intensive therapy but showed inconsistent long-term stability effects. Conclusions. The present data indicate that gains resulting from intensive speech–language therapy with ILAT are maintained up to 2.5 years after the end of treatment. We discuss this novel finding in light of a possible move from sparse to intensive therapy regimes in clinical practice.

Transcranial Direct Current Stimulation to Enhance Training Effectiveness in Chronic Post-Stroke Aphasia: A Randomized Controlled Trial Protocol.

Background: Intensive speech-language therapy (SLT) can promote recovery from chronic post-stroke aphasia, a major consequence of stroke. However, effect sizes of intensive SLT are moderate, potentially reflecting a physiological limit of training-induced progress. Transcranial direct current stimulation (tDCS) is an easy-to-use, well-tolerated and low-cost approach that may enhance effectiveness of intensive SLT. In a recent phase-II randomized controlled trial, 26 individuals with chronic post-stroke aphasia received intensive SLT combined with anodal-tDCS of the left primary motor cortex (M1), resulting in improved naming and proxy-rated communication ability, with medium-to-large effect sizes.Aims: The proposed protocol seeks to establish the incremental benefit from anodal-tDCS of M1 in a phase-III randomized controlled trial with adequate power, ecologically valid outcomes, and evidence-based SLT.Methods: The planned study is a prospective randomized placebo-controlled (using sham-tDCS), parallel-group, double-blind, multi-center, phase-III superiority trial. A sample of 130 individuals with aphasia at least 6 months post-stroke will be recruited in more than 18 in- and outpatient rehabilitation centers.Outcomes: The primary outcome focuses on communication ability in chronic post-stroke aphasia, as revealed by changes on the Amsterdam-Nijmegen Everyday Language Test (A-scale; primary endpoint: 6-month follow-up; secondary endpoints: immediately after treatment, and 12-month follow-up). Secondary outcomes include measures assessing linguistic-executive skills, attention, memory, emotional well-being, quality of life, health economic costs, and adverse events (endpoints: 6-month follow-up, immediately after treatment, and 12-month follow-up).Discussion: Positive results will increase the quality of life for persons with aphasia and their families while reducing societal costs. After trial completion, a workshop with relevant stakeholders will ensure transfer into best-practice guidelines and successful integration within clinical routine.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03930121.

PB2. Beneficial Effects of intensive speech-language therapy or virtual dance training on mobility deficits in patients with Parkinsons disease (PD)

Literature Parkinson’s disease comprises postural instability, problems with gait, balance and mobility. Such deficits may lead to falls, which may further decrease quality of life, morbidity of PD and mortality in PD patients ( Muslimovic et al., 2008 ). PD patients suffer from 3 times the risk of falls and 5 times the injuries when compared to age-matched healthy controls (Horak, 2005). Although DBS improves motor skills, a trend towards more falls has been reported after STN-DBS (Weaver, 2009; Lai, 2013). Dancing therapies have been reported to improve balance ( Earhart, 2009 ). However, whether a virtual dance training (VDT) may reduce problems with balance and mobility compared to an intensive speech-language therapy (SLT) and compared to no therapy (NT) remains uninvestigated so far. Method This study is laid out as a cross-over design with 26 PD Patients ( N = 13 DBS; N = 13 non-DBS; Education Mdn 16 yrs. [12–20 yrs.]; gender: 16 m/10f; PD-Onset Mdn 7 yrs. [3–10 yrs.]; L-Dopa Mdn 350 mg. [80–450 mg]), who – so far – participated in SLT ( N = 19), or a VDT ( N = 9) or NT ( N = 17). Their neurophysiological abilities were tested using POMA (Tinetti, 1990), TUG (Podsiadlo and Richardson, 1991) and the Tandem-Test (Murphay, 2003). Participants were tested at baseline, directly after the intensive training (4 weeks) and again after 6 months. These preliminary results are based on raw data. Independent t - tests were performed and if results reached p > . 05 or below, results were seen as significant. Result Both SLT and VDT groups showed a significant improvement on the TUG ( p . 05 ), the Tandem ( p . 01 ), and the POMA test ( p . 05 ) comparing their performance at baseline and after 4 weeks of intensive training. Improvements were more pronounced in the VDT compared to the SLT ( p . 05 ). Whilst the NT group had highest performance levels at baseline compared to VDT ( p . 001 ) and SLT ( p . 01 ), the NT group showed a non significant decrease in performance over time. At 6 months, results were similar to baseline ( p > . 92 ) for each group and across groups ( p > .42). Conclusions VDT may reduce problems with balance and mobility on a short-term basis. SLT may have beneficial ‘transfer-effects’ due to empathy and due to the fact that (self-)perception is a main focus in therapy. After 6 months, therapeutic effects are erased and require a refresher intervention.

P 67 Electrophysiological correlates of language improvements after intensive language therapy in patients with chronic post-stroke aphasia

Background Aphasia affects approximately one third of all stroke patients and may lead to chronic disability. Effective neurorehabilitation programs focusing on improving speech and language in patients with post-stroke aphasia are essential. A better understanding of the neurobiological processes accompanying language deficits and rehabilitation may bear fruit in the advancement of neurorehabilitation programs. Methods Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post-stroke > 1 year) post-stroke aphasia. The mismatch negativity (MMN), a language-related event-related potential (ERP) known to reflect automatic lexico-semantic and grammar processing, was recorded in a distracted oddball paradigm to short spoken sentences. Critical “deviant” sentence stimuli where either well-formed and meaningful, or grammatically incorrect, or meaningless. Results The Aachen Aphasia Test (AAT) demonstrated significant clinical language improvements, which were accompanied by enhancement of the MMN responses, after 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week). In particular, MMN amplitudes to grammatically correct and meaningful sentences and to sentences containing a meaningless pseudoword significantly increased after therapy. However, no therapy-related changes in MMN were found for grammatically incorrect sentences that violated pronoun-verb agreement. Discussion/conclusions MMN increases to well-formed meaningful and to meaningless strings and the absence thereof for ungrammatical sentences suggest neuroplastic changes consistent with recent cognitive linguistic theories. The results confirm previous reports that intensive SLT leads to improvements of language and communication skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of language processing above single-word level. Furthermore, the data suggest that the language-elicited MMN may be a useful tool to map functional language recovery in post-stroke aphasia patients.

Therapy-Induced Neuroplasticity of Language in Chronic Post Stroke Aphasia: A Mismatch Negativity Study of (A)Grammatical and Meaningful/less Mini-Constructions.

Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post stroke >1 year) post stroke aphasia (PSA). As event-related potential (ERP) measure, the mismatch negativity (MMN) was recorded in a distracted oddball paradigm to short spoken sentences. Critical ‘deviant’ sentence stimuli where either well-formed and meaningful, or syntactically, or lexico-semantically incorrect. After 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week), clinical language assessment with the Aachen Aphasia Test battery demonstrated significant linguistic improvements, which were accompanied by enhanced MMN responses. More specifically, MMN amplitudes to grammatically correct and meaningful mini-constructions and to ‘jabberwocky’ sentences containing a pseudoword significantly increased after therapy. However, no therapy-related changes in MMN responses to syntactically incorrect strings including agreement violations were observed. While MMN increases to well-formed meaningful strings can be explained both at the word and construction levels, the neuroplastic change seen for ‘jabberwocky’ sentences suggests an explanation in terms of constructions. The results confirm previous reports that intensive SLT leads to improvements of linguistic skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of construction processing, although no comparable change is present for ungrammatical strings. Furthermore, the data confirm that the language-induced MMN is a useful tool to map functional language recovery in PSA.

Crossing Borders Without Leaving the University: MISTIC—An International Collaboration

International collaborations usually involve individuals from one country traveling to another country (Kuehn &amp; Henne, 2003). However, for various reasons, students and faculty from the United States do not always have the option to travel to another country. This was the case when the Department of Communication Disorders Speech-Language Hearing Clinic at Texas State University was contacted by personnel from a clinic in Monterrey, México. Together, we developed an international collaboration that would be mutually beneficial to all parties involved. We developed goals for the clinical component of the speech-language pathology graduate program, the participating clients and their families, professionals employed at the private clinic in Monterrey, México, and research goals to document the effectiveness of the international collaboration we called the Multicultural Intensive Speech-Language Therapy Intervention Clinic (MISTIC). In this case, families and professionals from México traveled to the United States to participate in this international collaboration.

Changes in N400 topography following intensive speech language therapy for individuals with aphasia

Our goal was to characterize the effects of intensive aphasia therapy on the N400, an electrophysiological index of lexical-semantic processing. Immediately before and after 4weeks of intensive speech-language therapy, people with aphasia performed a task in which they had to determine whether spoken words were a ‘match’ or a ‘mismatch’ to pictures of objects. Pre-therapy, people with aphasia exhibited an N400 mismatch effect that started over right hemisphere electrodes. Post-therapy, gains were seen in clinical measures of language ability, and the onset of the N400 was left-lateralized. No changes in the scalp distribution of the N400 were observed in healthy controls tested twice over the same 4week interval. Since the distribution of the N400 after aphasia therapy differed from that of healthy controls, we conclude that it reflects the engagement of compensatory neural mechanisms for language processing rather than a return to a “normal” pattern of brain activation.

Epidural cortical stimulation as adjunctive treatment for non-fluent aphasia: preliminary findings

Background and purposeThis study evaluated the safety and feasibility of targeted epidural cortical stimulation delivered concurrently with intensive speech–language therapy for treatment of chronic non-fluent aphasia.MethodsEight stroke survivors with non-fluent...

Response to Letter by Marshall

Response: We thank Dr Marshall for his interest in our article and welcome this opportunity to respond to his 2 concerns. In our 2003 review article,1 we concluded that intensive speech language therapy was more effective than less intense therapy. Dr Marshall states that there were inaccuracies in the reporting of one of his studies included in our review.2 It was brought to our attention that the results from 37 patients had been counted twice in our analyses. Dr Marshall is correct. We had not realized that his article reported on a …