Sound Production Treatment Research Articles

Speech Intelligibility Outcomes Associated With Treatment for Acquired Apraxia of Speech: Magnitude of Change and Stability of Measurement.

The purpose of this investigation was to examine single-word speech intelligibility outcomes following sound production treatment in a group of 22 speakers with chronic acquired apraxia of speech (AOS) and aphasia. Also, the stability of repeated posttreatment intelligibility measures was examined for two scoring methods. The Assessment of Intelligibility of Dysarthric Speech was administered twice to each participant at pretreatment and twice at 8 weeks posttreatment. The test-retest reliability of the pretreatment samples was evaluated in a prior study; repeated samples were found to be stable over sampling times. For the current study, the three expert listeners who had rated the pretreatment samples scored the posttreatment samples using transcription and multiple-choice scoring formats. An additional expert listener, blinded to sampling time, scored pre- and posttreatment samples. The posttreatment samples were found to be stable over sampling times for the group. Posttreatment intelligibility scores were statistically significantly higher than the pretreatment scores for both scoring methods (i.e., increases of 9%-10%). Scores derived from the two scoring methods were strongly, positively correlated, with multiple-choice scores being significantly higher than transcription. The scoring methods did not differ significantly in the amount of change found from pre- to posttreatment. There were no statistically significant correlations between AOS severity and changes in pre- to posttreatment intelligibility scores. Performance for most participants was similar to group performance. Stability of posttreatment intelligibility samples supports use of intelligibility scores as outcome measures. This group of speakers demonstrated statistically significant increases in single-word speech intelligibility following sound production treatment. https://doi.org/10.23641/asha.26972425.

A Comparison of Sound Production Treatment and Metrical Pacing Therapy for Apraxia of Speech: A Single-Case Experimental Design.

The purpose of this investigation was to compare the effects of two specific treatment protocols for acquired apraxia of speech (AOS): Sound Production Treatment (SPT) and Metrical Pacing Therapy (MPT), and to examine changes in communicative participation. Four speakers with chronic AOS and aphasia were each administered SPT and MPT in a replicated crossover design (ABACA/ACABA) with nonconcurrent multiple baselines across participants and behaviors. Treatment outcomes were compared with respect to whole word correctness (WWC) for treated and untreated multisyllabic word targets. Speech intelligibility was assessed using the Chapel Hill Multilingual Intelligibility Test, and communicative participation was measured using the Communicative Participation Item Bank at baseline, washout, and follow-up phases. Three of the four participants experienced statistically significant improvements in WWC with SPT, and three of the four participants with MPT. Based on a priori criteria, three participants demonstrated relatively greater benefit from SPT and one participant demonstrated relatively greater benefit from MPT. There were measurable improvements in intelligibility following SPT for three of the four participants. Only one participant in this investigation reported a significant change in communicative participation, and only following MPT. This study demonstrated that individuals in the chronic stages of AOS can benefit from both SPT and MPT, corroborating prior research on articulatory kinematic and rate and/or rhythm control treatment approaches. It contributes a comparison of two protocols for AOS with respect to whole word targets, intelligibility, and individual self-report of communicative participation changes. More participants showed a relative advantage of SPT over MPT. One individual reported communicative participation improvement after MPT. https://doi.org/10.23641/asha.23971929.

The Impact of Telehealth on the Efficacy of Sound Production Treatment.

This investigation was designed to systematically examine the acquisition, maintenance, and response generalization effects of Sound Production Treatment (SPT) delivered via telehealth in comparison to existing in-person outcomes for SPT. A multiple-baseline design across behaviors and participants was used with two individuals with chronic apraxia of speech (AOS) and aphasia. Accuracy of target speech sounds in treated and untreated words within phrases served as the dependent variable. Both participants demonstrated positive gains for treatment and generalization items. Participant 1 demonstrated gains for both sets of treatment items with the application of treatment, but production accuracy at 2 and 6 weeks posttreatment was inconsistent. Participant 2 demonstrated large gains for both sets of treatment items with good maintenance at 2 and 6 weeks posttreatment. Effect sizes for both participants were similar to the traditional (in-person) SPT effect size benchmarks. The positive outcomes from this study indicate that individuals with AOS can benefit from SPT delivered via telehealth. These findings warrant further research examining the effects of SPT through telehealth and should include individuals with AOS with varying severity. This investigation serves as the first telehealth study to systematically examine treatment outcomes for SPT.

Facing a Clinical Challenge: Limited Empirical Support for Toddler Speech Sound Production Intervention Approaches.

Speech sound production intervention in early childhood is relatively rare despite empirical and theoretical support for providing this type of targeted therapy for toddlers. Challenges perpetuate the present clinical condition including those related to treatment decision making (e.g., intervention approach). Although there are numerous speech sound production treatment approaches appropriate for the pediatric population, a much smaller proportion are proposed to be appropriate for children under the age of 3 years. Of these, five approaches (i.e., core vocabulary, cycles, naturalist recast, stimulability, and psycholinguistic intervention) were selected for review because they can be used to treat functional speech sound disorders produced by toddlers and none required additional clinician training for implementation. We found the empirical evidence supporting the use of these approaches with children under the age of 3 years scant to nonexistent. Due to the lack of empirical evidence, early intervention speech-language pathologists must primarily rely on internal factors (e.g., clinician experience and client/caregiver perspectives) to support evidence-based intervention decisions in the absence of external empirical support. Clinical action steps such as careful documentation of approaches used/discontinued and associated individual client outcomes are necessary for evidence-based decision making until more robust empirical evidence is established.

Generalization outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech: relationship to treatment dosage

ABSTRACT Background Dosage is an important aspect of treatment for acquired apraxia of speech (AOS) that has received little attention. Knowledge concerning the association of dosage to treatment outcomes is crucial for informing clinical practice and treatment research. Dosage metrics, representing the number of treatment sessions and teaching episodes (TEs) required to achieve specific performance milestones with Sound Production Treatment (SPT), have recently been provided for treated items. Aims The current investigation was designed to extend AOS dosage research to untreated items. Methods and Procedures Retrospective analyses were performed using data from a previously reported SPT study (Wambaugh et al., 2017) in which 20 speakers with AOS received two applications of SPT with different practice schedules (i.e., SPT-Random and SPT-Blocked). Probe data were used to determine achievement of the following milestones: 1) change above baseline; 2) clinically relevant improvement; and 3) mastery. Follow-up data were used to examine the relationship between the dosage metrics and maintenance of accuracy. Outcomes and Results On average, change above baseline and clinically relevant improvement was achieved for untreated items following 9–10 and 7–8 treatment sessions, respectively. Mastery of untreated items occurred for 45% of targets, following an average of 16–17 treatment sessions. TEs varied widely for all dosage metrics. No statistically significant differences were found between practice schedules for any of the dosage metrics. Better maintenance was associated with earlier achievement of performance milestones. More treatment sessions and TEs were required to meet performance milestones for untreated items in comparison to treated items. Conclusions This study provides dosage metrics for response generalization outcomes which can be used for planning and guiding treatment for AOS.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance.

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12-14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190.

Further Study of the Effects of Treatment Intensity on Outcomes of Sound Production Treatment for Acquired Apraxia of Speech: Does Dose Frequency Matter?

Purpose The aim of this study was to examine the effects of dose frequency, an aspect of treatment intensity, on articulation outcomes of sound production treatment (SPT). Method Twelve speakers with apraxia of speech and aphasia received SPT administered with an intense dose frequency and a nonintense/traditional dose frequency (SPT-T). Each participant received both treatment intensities in the context of multiple baseline designs across behaviors. SPT-Intense was provided for 3 hourly sessions per day/3 days per week; and SPT-T for 1 hour-long session per day/3 days per week. Twenty-seven treatment sessions were completed with each phase of treatment. Articulation accuracy was measured in probes of production of treated and untreated words. Results All participants achieved improved articulation of treated words with both intensities; there were no notable differences in magnitude of improvement associated with dose frequency. Positive response generalization to untrained words was found in 21 of 24 treatment applications; the cases of negligible response generalization occurred with SPT-T words. Conclusions Dose frequency (and corresponding total intervention duration) did not appear to impact treatment response for treated items. Disparate response generalization findings for 3 participants in the current study may relate to participant characteristics such as apraxia of speech severity and/or stimuli factors.

Intensive sound production treatment for severe, chronic apraxia of speech

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.

Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech.

This investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech. Five men with chronic apraxia of speech and aphasia received both intense SPT (3 hr per day/3 days per week) and nonintense/traditional SPT (SPT-T; 1 hr per day/3 days per week) in the context of single-case experimental designs. Each treatment was applied separately to a designated set of experimental words with 1 treatment applied at a time. Twenty-seven treatment sessions were conducted with each phase of treatment. Accuracy of articulation of target sounds within treated and untreated experimental words was measured during the course of the investigation. All participants demonstrated improved articulation with both treatment intensities. Better maintenance of gains for treated items was found with SPT-T for 2 participants as measured at an 8-week posttreatment retention probe. Superior maintenance of increased accuracy of production of untreated items was also observed with SPT-T for all participants. A less intense (distributed) application of SPT facilitated better maintenance of improved articulatory accuracy for untreated items, and in some cases treated items, than intense SPT. https://doi.org/10.23641/asha.5734053.

Acquired Apraxia of Speech: The Relationship Between Awareness of Errors in Word Productions and Treatment Outcomes.

Awareness of errors has been considered a clinical feature of acquired apraxia of speech (AOS). However, there is limited research examining error awareness in speakers with AOS. The purpose of this investigation was to examine awareness of errors and explore the relationship between awareness of errors and treatment outcomes in speakers with AOS. Twenty speakers with AOS and aphasia produced mono- and multisyllabic words in a repetition task. Following each production, speakers were asked to judge the accuracy of their production (i.e., correct or incorrect). Then, speakers received Sound Production Treatment. Judgment accuracy of productions for the group ranged from 20% to 96%. There was a weak relationship between judgment accuracy and probe performance at posttreatment (r = .47) and a moderate relationship between judgment accuracy and probe performance at follow-up (r = .53). Findings indicate that speakers with AOS varied in their ability to judge the accuracy of their productions. For some speakers, the ability to judge the accuracy of their productions did not coincide with their production accuracy of treatment stimuli at posttreatment and at follow-up. Further research is needed to explore the relationship between error awareness and treatment outcomes.

Sound production treatment for acquired apraxia of speech: Effects of blocked and random practice on multisyllabic word production

Purpose: This study was designed to examine the effects of practice schedule, blocked vs random, on outcomes of a behavioural treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT).Method: SPT was administered to four speakers with chronic AOS and aphasia in the context of multiple baseline designs across behaviours and participants. Treatment was applied to multiple sound errors within three-to-five syllable words. All participants received both practice schedules: SPT-Random (SPT-R) and SPT-Blocked (SPT-B).Result: Improvements in accuracy of word production for trained items were found for both treatment conditions for all participants. One participant demonstrated better maintenance effects associated with SPT-R. Response generalisation to untreated words varied across participants, but was generally modest and unstable. Stimulus generalisation to production of words in sentence completion was positive for three of the participants. Stimulus generalisation to production of phrases was positive for two of the participants.Conclusion: Findings provide additional efficacy data regarding SPT’s effects on articulation of treated items and extend knowledge of the treatment’s effects when applied to multiple targets within multisyllabic words.

Sound Production Treatment: Synthesis and Quantification of Outcomes

This investigation was designed to provide a quantification and synthesis of a series of single-case experimental design investigations into the effects of sound production treatment, an articulatory-kinematic treatment for acquired apraxia of speech (AOS). The main purpose was to perform a meta-analysis of aggregated sound production treatment data in order to provide benchmarks to serve as indicators of magnitude of change. Additional analyses explored various factors influencing effect sizes and level of performance. Effect sizes were calculated for treated and untreated items for 24 participants across 10 investigations. Benchmarks were calculated as the quartiles of the distributions of the effect sizes. Correlational analyses were performed to examine (a) end-of-treatment performance relative to follow-up performance, (b) response of trained items relative to untrained items, and (c) effect size relative to participant variables. Effect sizes were predominantly large and positive; benchmarks for treated items were larger than those for untreated items. End of treatment and follow-up performance were positively correlated, and response generalization was positively correlated with AOS severity. These benchmarks may assist in evaluating the effects of interventions for individuals with AOS utilizing similar outcome measures in both clinical and research settings.

Combined Aphasia and Apraxia of Speech Treatment (CAAST): effects of a novel therapy.

This investigation was designed to examine the effects of a newly developed treatment for aphasia and acquired apraxia of speech (AOS). Combined Aphasia and Apraxia of Speech Treatment (CAAST) targets language and speech production simultaneously, with treatment techniques derived from Response Elaboration Training (Kearns, 1985) and Sound Production Treatment (Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998). The purpose of this study was to determine whether CAAST was associated with positive changes in verbal language and speech production with speakers with aphasia and AOS. Four participants with chronic aphasia and AOS received CAAST applied sequentially to sets of pictures in the context of multiple baseline designs. CAAST entailed elaboration of participant-initiated utterances, with sound production training applied as needed to the elaborated productions. The dependent variables were (a) production of correct information units (CIUs; Nicholas & Brookshire, 1993) in response to experimental picture stimuli, (b) percentage of consonants correct in sentence repetition, and (c) speech intelligibility. CAAST was associated with increased CIU production in trained and untrained picture sets for all participants. Gains in sound production accuracy and speech intelligibility varied across participants; a modification of CAAST to provide additional speech production treatment may be desirable.

Sound Production Treatment: Effects of Blocked and Random Practice

This investigation was designed to further the development of a treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT), by examining the effects of blocked and random practice. A multiple-baseline design across participants and behaviors was used with 6 speakers with chronic AOS and aphasia. Accuracy of production of target sounds in treated and untreated words produced in probe sessions served as the primary dependent variable. Stimulus generalization was also measured to phrase production and sentence completion. Participants received SPT applied with blocked presentation of treatment words (SPT-blocked) and SPT applied with random presentation of treatment words (SPT-random). Increases in accuracy of articulation of target sounds in treated words were observed for all participants for both conditions of treatment. SPT-random appeared to be associated with better maintenance for 2 participants. Generalization to untreated words was positive for all participants for SPT-random and SPT-blocked. Stimulus generalization effects varied across participants and measurement conditions; patterns of generalization did not appear to be associated with treatment condition. There may be an advantage for SPT-random for some speakers with AOS. Findings from the nonspeech motor learning literature may not translate directly to the treatment of AOS.

Treatment for Acquired Apraxia of Speech: Examination of Treatment Intensity and Practice Schedule

The authors designed this investigation to extend the development of a treatment for acquired apraxia of speech (AOS)--sound production treatment (SPT)--by examining the effects of 2 treatment intensities and 2 schedules of practice. The authors used a multiple baseline design across participants and behaviors with 4 speakers with chronic AOS and aphasia. Accuracy of production of trained and untrained words in phrases served as the dependent measure. Participants received 4 permutations of SPT (i.e., intensive-blocked, intensive-random, traditional-blocked, and traditional-random) applied sequentially to different lists of words. Positive changes in accuracy of articulation were observed for all participants for all phases of treatment. Two participants had a slightly poorer response to the traditional-random application of treatment. However, no clinically meaningful differences were noted among treatment applications when follow-up data were considered. Findings from this preliminary Phase II investigation suggest that similar outcomes may be achieved with SPT applied with different treatment intensities and different practice schedules. Extending treatment to achieve higher levels of accuracy may have improved maintenance effects, which may have revealed possible differences among conditions. In addition, overlap in methods used for random and blocked practice may have minimized distinctions between these conditions.

Sound Production Treatment for Acquired Apraxia of Speech

Acquired apraxia of speech (AOS) has been demonstrated to be responsive to various types of treatments, even when AOS is chronic (Wambaugh, Duffy, McNeil, Robin, & Rogers, 2006a). Of the different types of AOS treatments, the Academy of Neurologic Communication Disorders and Sciences (ANCDS) AOS Treatment Guidelines report identified articulatory-kinematic treatments as having the strongest evidence supporting their use (Wambaugh et al., 2006a & b). Articulatory-kinematic treatments are those that employ techniques to improve speech production through the facilitation of movement, positioning, timing, and coordination of the articulators. Sound Production Treatment (SPT; Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998) is an articulatory-kinematic treatment that has received relatively more systematic study than other AOS treatments to date. This report describes SPT and the research supporting its application with speakers with AOS.

Sound Production Treatment: Application with severe apraxia of speech

Background: Acquired apraxia of speech (AOS) has been shown to be responsive to behavioural intervention. Although numerous treatments for AOS have been developed, most have received limited study. Specifically, the AOS treatment evidence base is compromised by a lack of replication of treatment effects. Sound Production Treatment (SPT; Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998) has undergone more systematic examination than other AOS treatments and has been documented to result in predictable improvements in consonant production. However, SPT has not been studied with persons with severe AOS and perseverative speech behaviours. Aims: The purpose of this investigation was to examine the acquisition, response generalisation, and maintenance effects of SPT with a speaker with severe AOS, significant nonfluent aphasia, and verbal perseverations. Methods & Procedures: A single-participant, multiple baseline design across behaviours was employed to examine the effects of treatment on production of six consonants in monosyllabic words. Treatment was applied sequentially to two sets of items, with three consonants targeted in each set. A third phase of treatment entailed training of all target sounds. Follow-up probing was conducted at 10 and 15 weeks post-treatment. Outcomes & Results: Improved productions were observed for all trained items and response generalisation to untrained exemplars of trained items was positive. Across-sound generalisation was not evident. Maintenance effects were strong at 10 weeks post-treatment, but diminished considerably for most of the sounds by 15 weeks. Conclusions: Results for this speaker with severe AOS and verbal perseverations were similar to those previously reported for SPT. The decrease in performance from 10 weeks to 15 weeks indicated that changes in behaviour had not been sufficiently instantiated. Furthermore, these findings suggested that maintenance probing may need to be conducted over a considerably longer period of time than has previously been reported in the literature.

Modification of sound production treatment for apraxia of speech: Acquisition and generalisation effects

Background: Sound errors are characteristic of acquired apraxia of speech (AOS) and are frequently the focus of treatment. One treatment for AOS, Sound Production Treatment (SPT), has been shown to facilitate improved sound production in trained sounds and untrained exemplars of those sounds (Wambaugh, Kalinyak‐Fliszar, West, & Doyle, 1998a). Although the effects of SPT are relatively well understood when the treatment has been applied sequentially to single sounds in words, little is known about its application to multiple sounds. Additionally, the stimulus generalisation effects of SPT have not been well specified.Aims: This investigation was designed to further investigate the acquisition and stimulus generalisation effects of SPT for AOS. Treatment application was modified from previous investigations to allow for application with multiple sounds and in a different treatment context.Methods & Procedures: A multiple baseline design across behaviours and contexts was used to assess the effects of treatment with a speaker with chronic AOS and aphasia. Treatment was initially applied within the context of words elicited through repetition. In order to assess stimulus generalisation, the nine consonants of interest were elicited in words through sentence completion. Additionally, the target sounds were elicited in a different word position (i.e., word‐final) from that utilised in treatment (i.e., word‐initial).Outcomes & Results: Treatment resulted in increased correct productions of the target sounds in trained contexts. Generalisation to the different stimulus contexts was limited and varied across sounds. Treatment was extended to the sentence completion context and additional treatment gains were observed.Conclusions: The application of SPT to multiple sounds and to an additional treatment context appears to have promise in the treatment of AOS. Additional replications are required for external validity.

Treatment of sound errors in aphasia and apraxia of speech: Effects of phonological complexity

Background: Recent research suggests that the complexity of treatment stimuli influences the effectiveness of treatment. However, no studies have examined the role of complexity on sound production treatment in adult individuals with sound production impairments. Aims: This study examines effects of syllable complexity on treatment outcome in two patients with acquired sound production problems. Complexity is defined in terms of syllable structure: clusters are more complex than singletons. Using a single-subject multiplebaseline design, we address the question: Is treatment of complex syllables more effective than treatment of simple syllables? Methods & Procedures: Two patients with aphasia and apraxia of speech were trained to produce complex or simple syllables (using modelling). Improvement was measured by percent correct on a word and nonword repetition test. Outcomes & Results: We found that both treatment on simple syllables and treatment on complex syllables led to improved production of simple syllables, while treatment of complex syllables also led to improvement on some complex syllables for one of the two patients. Conclusions: These results suggests that training complex items is more effective than training simple items, at least for some patients. Possible reasons for lack of stronger effects are discussed, as well as directions for future research.

Sound Production Treatment for Apraxia of Speech

Sound Production Treatment for Apraxia of Speech