Intensive Speech Research Articles

Effects of Speech Practice on Fast Mapping in Monolingual and Bilingual Speakers

This study examines the effects of the levels of speech practice on fast mapping in monolingual and bilingual speakers. Participants were 30 English-speaking monolingual and 30 Spanish-English bilingual young adults. Each participant was randomly assigned to 1 of 3 practice conditions prior to the fast-mapping task: (a) intensive speech practice, (b) moderate speech practice, or (c) no practice. In a fast-mapping experiment, each participant was briefly exposed to novel objects and their corresponding novel words. Participants' knowledge of the target novel words was assessed immediately after the exposures. There were significant effects of speech practice on fast mapping for both monolingual and bilingual adults. It is important to note that participants' language experience also played a role in their fast-mapping performance. The findings suggest that speech practice, interacting with language experience, facilitates the processes for fast mapping.

35. Surface polyelectromyography – Principle of the method and possible use in dysphagia

Surface polyelectromyography (PEMG) represents a specific application of electromyography (EMG) in the functional analysis of movement (”kinesiological EMG”) with the aid of simultaneous recordings of electrical activity from multiple muscles using specialised equipment (typically 16 channels). Swallowing is a very complex function that involves 26 muscles in head and neck. The authors present their experience with PEMG in 12 patients with dysphagia, particularly after a cerebrovascular accident. They used subsurface layer muscle groups (orbicularis oris, masseter muscle, submental and laryngeal muscles) and simple standardised tests (dry swallowing, swallowing 20 ml of water and drinking 100 ml of water without interruption) for a PEMG examination at the beginning and end of an intensive physiotherapy and speech therapy. PEMG findings are presented in practical illustrations of specific cases including software processed EMG signals. PEMG (unlike ”classic EMG”) does not provide information to identify the clinical diagnostic units that cause a disorder. However, it facilitates, in terms of muscle activity, the characterisation of a functional disturbance (acknowledging limitations of the elusive definition for a normal movement pattern) and to monitor the evolution of functional parameters over time including its reaction to various influences (e.g. therapy). Supported by the project Ministry of Health, Czech Republic NT13725–4/2012.

Telerehabilitation in poststroke anomia.

Anomia, a word-finding difficulty, is a frequent consequence of poststroke linguistic disturbance, associated with fluent and nonfluent aphasia that needs long-term specific and intensive speech rehabilitation. The present study explored the feasibility of telerehabilitation as compared to a conventional face-to-face treatment of naming, in patients with poststroke anomia. Five aphasic chronic patients participated in this study characterized by: strictly controlled crossover design; well-balanced lists of words in picture-naming tasks where progressive phonological cues were provided; same kind of the treatment in the two ways of administration. ANOVA was used to compare naming accuracy in the two types of treatment, at three time points: baseline, after treatment, and followup. The results revealed no main effect of treatment type (P = 0.844) indicating that face-to-face and tele-treatment yielded comparable results. Moreover, there was a significant main effect of time (P = 0.0004) due to a better performance immediately after treatment and in the followup when comparing them to baseline. These preliminary results show the feasibility of teletreatment applied to lexical deficits in chronic stroke patients, extending previous work on telerehabilitation and opening new vistas for future studies on teletreatment of language functions.

Treatment-induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Four Cases of Chronic Aphasia

Treatment-induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Four Cases of Chronic Aphasia

The Assessment of Velopharyngeal Function Using Nasal Ram Pressure Testing following Palatoplasty

Objective : To compare nasal ram pressure (NRP) data with perceptual speech assessments in young children following palatoplasty. Design and Setting : NRP monitoring, a noninvasive technique using a two-pronged nasal cannula that detects nasal airflow during speech, was performed on patients 12 months following palatoplasty in our Craniofacial Center. Patients : Eighteen English-speaking nonsyndromic patients, aged 21 to 28 months, without hearing or language deficits, underwent NRP testing. Main Outcome Measured : During NRP measurement, the number of oral stop consonants produced spontaneously or following prompts was recorded. Stops were considered produced with velopharyngeal closure if NRP demonstrated no nasal airflow. The percentage of closed stops as measured by NRP was compared to the clinical assessment by craniofacial team speech-language pathologists. Results : Eight patients achieved 100% stop closure. Four patients obtained 90% to 96% stop closure. Three patients had stop closure of 85%, 78%, and 50%. Three patients had 0% stop closure; two of these patients subsequently underwent secondary palatal surgery. No significant clinical speech deficits were noted in patients with >90% closure. No association with defect size or cleft type was identified. Conclusions : NRP monitoring is well-tolerated in young children following palatoplasty. Achieving velopharyngeal (VP) closure for >90% of stops is associated with a clinical assessment of adequate speech and VP function. Postoperative NRP testing may serve as a useful adjunct to clinical speech evaluation for early identification of children who require more intensive speech therapy or secondary palatal surgery.

Terapia fonoaudiológica intensiva e fissura de palato: relato de caso

A terapia intensiva tem sido relatada na literatura como uma opção de módulo inicial da terapia convencional, pois a medida que o paciente vai percebendo melhoras em sua fala, passa a ter maior envolvimento e comprometimento com a terapia. Este artigo relata a experiência com um caso de atendimento fonoaudiológico intensivo, comparando o desempenho na produção da fala de uma paciente de 25 anos, operada de fissura palatina, antes e após a terapia fonoaudiológica intensiva. O atendimento foi realizado no período de julho a agosto de 2009, com duração de 30 minutos cada sessão, sendo 18 sessões de terapia intensiva, com encontros diários de segunda a sexta pela manhã, totalizando 9 horas de intervenção terapêutica. No primeiro atendimento foi realizada anamnese e avaliação fonoaudiológica e no último apenas a reavaliação, totalizando 20 sessões. Foi gravada em vídeo uma amostra de fala espontânea, repetição de uma lista de palavras e frases e, por fim, realizadas as provas terapêuticas com o objetivo de verificar com quais fonemas a paciente apresentava maior facilidade na produção, contribuindo para elaboração do planejamento terapêutico. Foi possível a automatização de um fonema e fixação de outro dos seis trabalhados durante as 18 sessões de terapia intensiva. Isto motivou a paciente para dar continuidade ao processo por meio de terapia convencional.

A randomized, rater‐blinded, parallel trial of intensive speech therapy in sub‐acute post‐stroke aphasia: the SP‐I‐R‐IT study

There is conflicting evidence regarding the benefits of intensive speech and language therapy (SLT), particularly because intensity is often confounded with total SLT provided. A two-centre, randomized, rater-blinded, parallel study was conducted to compare the efficacy of 100 h of SLT in a regular (RT) versus intensive (IT) treatment in sub-acute post-stroke aphasia. Consecutive patients with aphasia, within 3 months of a left hemisphere ischemic stroke, were randomized to IT (2 h per day × 5 days per week, 10 weeks) or RT (2 h per week × 50 weeks). Evaluations took place at 10, 50 and 62 weeks. Primary outcome was the frequency of responders, defined by 15% increase of Aphasia Quotient (AQ) from the baseline to 50 weeks. Secondary outcomes were changes from the baseline in AQ and functional communication profile (FCP) at 50 and 62 weeks and improvement stability between 50 and 62 weeks. Thirty patients were randomized and 18 completed the study. No significant differences were found between groups in primary or secondary outcomes, although IT patients (N = 9) obtained higher scores in language measures between 10 and 62 weeks in per protocol analysis. The number of non-completions was identical between groups. This study suggests that, in the sub-acute period following stroke and controlling for the number of hours of SLT provided, there is a trend for a greater improvement in language and functional communication measures with IT compared with RT. The lack of statistical significance in results was probably due to the small sample size.

Rotterdam Aphasia Therapy Study (RATS) – 3: “The efficacy of intensive cognitive-linguistic therapy in the acute stage of aphasia”; design of a randomised controlled trial

BackgroundAphasia is a severely disabling condition occurring in 20 to 25% of stroke patients. Most patients with aphasia due to stroke receive speech and language therapy. Methodologically sound randomised controlled trials investigating the effect of specific interventions for patients with aphasia following stroke are scarce. The currently available evidence suggests that intensive speech and language therapy is beneficial for restoration of communication, but the optimal timing of treatment is as yet unclear.In the Rotterdam Aphasia Therapy Study-3 we aim to test the hypothesis that patients with aphasia due to stroke benefit more from early intensive cognitive-linguistic therapy than from deferred regular language therapy.Methods/designIn a single blinded, multicentre, randomised controlled trial, 150 patients with first ever aphasia due to stroke will be randomised within two weeks after stroke to either early intensive cognitive-linguistic therapy (Group A) or deferred regular therapy (Group B). Group A will start as soon as possible, at the latest two weeks after stroke, with a four week period of one hour a day treatment with cognitive-linguistic therapy. In Group B professional speech and language therapy is deferred for four weeks. After this period, patients will follow the conventional procedure of speech and language therapy. Participants will be tested with an extensive linguistic test battery at four weeks, three months and six months after inclusion. Primary outcome measure is the difference in score between the two treatment groups on the Amsterdam-Nijmegen Everyday Language Test, a measure of everyday verbal communication, four weeks after randomisation.Trial registrationThis trial is registered in the Dutch Trial Register (http://www.trialregister.nl), NTR3271.

TMS and tDCS in post-stroke aphasia: Integrating novel treatment approaches with mechanisms of plasticity

Aphasia is a common result of stroke, affecting over one million Americans. Currently, intensive speech therapy is the mainstay of treatment, although its efficacy has been variable at best. Recent years have seen the emergence of non-invasive brain stimulation, specifically Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), as potential treatments for post-stroke aphasia. A growing body of investigations has shown the efficacy of both modalities in facilitating recovery from chronic aphasia, while data regarding subacute aphasia are much more limited and evidence in the acute post-stroke phase are still lacking. Much remains unknown about how these techniques cause clinical improvement or about their long-term efficacy, side-effects, and safety. In this article, we examine the data demonstrating the safety and efficacy of TMS and tDCS, discuss the major differences between them, and consider how those differences may inform the use of each modality. We also consider the different models of neuroplasticity in the setting of post-stroke aphasia and how these models may influence when and in which patients each modality would impart the most benefit.

慢性期失語症患者に対する短期集中的リハビリテーションの効果

慢性期失語症患者に対する短期集中的リハビリテーションの効果

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.

Effectiveness of Low-Frequency rTMS and Intensive Speech Therapy in Poststroke Patients with Aphasia: A Pilot Study Based on Evaluation by fMRI in Relation to Type of Aphasia

Aim: To assess the safety and clinical efficacy of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with intensive speech therapy (ST) in poststroke patients with aphasia. Subjects and Methods: Twenty-four patients with left-hemispheric stroke and aphasia were subjected. During 11-day hospitalization, each patient received 10 treatment sessions consisting of 40-min 1-Hz LF-rTMS and 60-min intensive ST, excluding Sundays. The scalp area for stimulation was selected based on the findings of fMRI with language tasks and the type of aphasia. LF-rTMS was applied to the inferior frontal gyrus (IGF) for patients with nonfluent aphasia and to the superior temporal gyrus (STG) for patients with fluent aphasia. Results: On pretreatment fMRI, the most activated areas were in the left hemisphere (n = 16) and right hemisphere (n = 8). The types of aphasia were nonfluent (n = 14) and fluent (n = 10). The LF-rTMS was applied to the right STG (n = 5), left STG (n = 5), right IFG (n = 11) and left IFG (n = 3). Nonfluent aphasic patients showed significant improvement of auditory comprehension, reading comprehension and repetition. Fluent aphasic patients showed significant improvement in spontaneous speech only. Conclusion: The fMRI with aphasic type-based therapeutic LF-rTMS/intensive ST for chronic aphasia seems feasible and a potentially useful neurorehabilitative protocol.

Obstacles to Communication in Children With Cri du Chat Syndrome

Cri du chat syndrome (CCS) is a genetic disorder resulting from the deletion of the short arm of chromosome 5. Perhaps the most distinctive characteristic of this syndrome is the congenital high-pitched cry, which frequently brings these patients to the attention of an otolaryngologist. Speech and language development in children with CCS is notable for a reduced receptive vocabulary and a profound deficit in expressive language. Currently, no clear guidelines have been established for the treatment of the speech and language difficulties exhibited by these patients. In this article, we present a case report and discuss the current literature regarding the challenges to effective communication in CCS. Case report. We present a 7-year-old girl with CCS who sought help to improve her ability to communicate. The patient presented with a persistent high-pitched voice unchanged since birth and a breathy dysphonia. Findings on examination were significant for an abnormally oriented larynx with atrophic vocal folds. She continues to undertake intensive speech therapy to assist in her language development. CCS is a genetic disorder that universally results in profound deficits in expressive speech. Although patients with CCS commonly present with a high-pitched voice and marked laryngeal abnormalities, they are unlikely to benefit from surgical intervention. Speech and language therapy, including augmentative communication devices, may enhance effective communication and improve the quality of life of these patients.

Intensive treatment of dysarthria secondary to stroke

This study investigated the impact of a well-defined behavioral dysarthria treatment on acoustic and perceptual measures of speech in four adults with dysarthria secondary to stroke. A single-subject A–B–A experimental design was used to measure the effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on the speech of individual participants. Dependent measures included vocal sound pressure level, phonatory stability, vowel space area, and listener ratings of speech, voice and intelligibility. Statistically significant improvements (p < 0.05) in vocal dB SPL and phonatory stability as well as larger vowel space area were present for all participants. Listener ratings suggested improved voice quality and more natural speech post-treatment. Speech intelligibility scores improved for one of four participants. These data suggest that people with dysarthria secondary to stroke can respond positively to intensive speech treatments such as LSVT. Further studies are needed to investigate speech treatments specific to stroke.

You Can’t Just Wear Socks

You Can’t Just Wear Socks

Intensive treatment of dysarthria in two adults with Down syndrome

Objective: This study investigated the impact of an established behavioural dysarthria treatment on acoustic and perceptual measures of speech in two adults with Down syndrome (DS) and dysarthria to obtain preliminary measures of treatment effect, effect size and treatment feasibility.Methods: A single-subject A-B-A experimental design was used to measure the effects of the Lee Silverman Voice treatment (LSVT®) on speech in two adults with DS and dysarthria. Dependent measures included vocal sound pressure level (dB SPL), phonatory stability and listener intelligibility scores.Results: Statistically significant improvements (p < 0.05) in vocal dB SPL and phonatory stability were present following treatment in both participants. Speech intelligibility scores improved in one of the two participants.Conclusions: These data suggest that people with DS and dysarthria can respond positively to intensive speech treatment such as LSVT. Further investigations are needed to develop speech treatments specific to DS.

Speech therapy for compensatory articulations and velopharyngeal function: a case report

The objective of this study was to describe the process of intensive speech therapy for a 6-year-old child using compensatory articulations while presenting with velopharyngeal insufficiency (VPI) and a history of cleft lip and palate. The correction of VPI was temporarily done with a pharyngeal obturator since the child presented with very little movement of the pharyngeal walls during speech, compromising the outcome of a possible pharyngeal flap procedure (pharyngoplasty). The program of intensive speech therapy involved 3 phases, each for duration of 2 weeks incorporating 2 daily sessions of 50 minutes of therapy. A total of 60 sessions of intervention were done with the initial goal of eliminating the use of compensatory articulations. Evaluation before the program indicated the use of co-productions (coarticulations) of voiceless plosive and fricative sounds with glottal stops (simultaneous production of 2 places of productions), along with weak intraoral pressure and hypernasality, all compromising speech intelligibility. To address place of articulation, strategies to increase intraoral air pressure were used along with visual, auditory and tactile feedback, emphasizing the therapy target and the air pressure and airflow during plosive and fricative sound productions. After the first two phases of the program, oral place of articulation of the targets were achieved consistently. During the third phase, velopharyngeal closure during speech was systematically addressed using a bulb reduction program with the objective of achieving velopharyngeal closure during speech consistently. After the intensive speech therapy program involving the use of a pharyngeal obturator, we observed absence of hypernasality and compensatory articulation with improved speech intelligibility.

Treatment of dysarthria following subthalamic nucleus deep brain stimulation for Parkinson's disease

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established treatment for patients with Parkinson's disease (PD). Speech impairment is a frequent side effect of the surgery. This study examined the efficacy of an intensive speech treatment, the Lee Silverman Voice Treatment (LSVT) on dysarthria after STN-DBS. The LSVT was administered to 10 patients with STN-DBS (surgical group) and 10 patients without (medical group). Patients were assessed before, immediately after, and 6 months following the speech treatment using sustained phonation, a speech intelligibility scale, and monologue. Vocal loudness, speech intelligibility, and perceptual ratings were the primary outcome measures. Vocal loudness and perceptual scores improved significantly across tasks for the medical group only. Speech intelligibility did not significantly change for either group. Results in the surgical group were variable, with some patients deteriorating. Treatment of dysarthria following STN-DBS needs further investigation because of the variable response to LSVT.

Therapeutic application of 6-Hz-primed low-frequency rTMS combined with intensive speech therapy for post-stroke aphasia

Objective: To clarify the safety, feasibility and efficacy of 6-Hz-primed low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive speech therapy (ST) for post-stroke aphasic patients.Methods: Four adult patients with history of left hemispheric stroke and with motor-dominant aphasia were studied. During 11-day hospitalization, each patient received 18 treatment sessions consisting of 10-min 6-Hz priming stimulation followed by 20-min 1-Hz low-frequency rTMS and intensive ST for 60 min daily. Both the priming stimulation and low-frequency rTMS were applied to the right frontal lobe. The intensive ST was provided on one-to-one basis. Language function was assessed by Standard Language Test of Aphasia (SLTA), Supplementary Test of SLTA (SLTA-ST), and the Japanese version of Western Aphasia Battery (WAB) within 2 weeks prior to the admission and on the day of discharge.Results: The in-patient protocol was successfully completed by all patients without any adverse effects. Each patient showed an increase in the correct answer rate after the intervention. Improvement was found in both expressive and recessive language modalities in all patients.Conclusions: The protocol of 6-Hz-primed low-frequency rTMS and intensive ST for post-stroke aphasia was safe and feasible, suggesting its potential usefulness in the treatment of this population.

Apraxia of Speech in Children and Adolescents: Applications of Neuroscience to Differential Diagnosis and Intervention

This paper presents an overview of clinical and neuroscience research that is relevant to distinguishing characteristics of childhood apraxia of speech (CAS) from perceptual/phonological disorders (PPD) in children with speech sound disorders. An initial attempt at developing a clinical checklist of as few as seven speech production characteristics, based on a literature review, may be useful for distinguishing CAS from PPD. Data on 11 children seen for intensive speech language intervention in 2008 are presented. The paper also provides longitudinal data on four children seen over two decades that presented with CAS vs. PPD. Clinical implications of a treatment outcome study, the CAS checklist, and longitudinal case studies are discussed.