Treatment For Apraxia Of Speech Research Articles

Parent experiences of variations in service delivery of Rapid Syllable Transition (ReST) treatment for childhood apraxia of speech

ABSTRACTPurpose: To understand parents’ perceptions of Rapid Syllable Transition (ReST) treatment and their experience of either telehealth or combined parent-clinician delivery of speech–language pathology. Method: Thematic analyses of semi-structured interviews were conducted with 10 parents (5 telehealth, 5 parent-clinician) after their child completed 12 sessions of ReST treatment. Results: Three themes were unique to telehealth: “telehealth was a million times easier,” “technical problems weren’t deal breakers,” and “telehealth therapy has different boundaries.” Three themes were unique to parent-clinician delivery: “therapy is something to get over and done with,” “I wasn’t very good at doing therapy,” and “my child doesn’t like me as his therapist.” Both groups had themes related to the significance of childhood apraxia of speech, the importance of specialist treatment, and ReST being a “different way forward.” Conclusions: Speech–language pathologists should carefully consider the suitability of caregiver-provided ReST treatment, and increase telehealth delivery of ReST treatment.

Combined clinician-parent delivery of rapid syllable transition (ReST) treatment for childhood apraxia of speech

Purpose: Although speech-language pathologists use parent-delivered home-practice, little is known about the quality of this practice and its relation to treatment efficacy. This study reports both treatment outcomes and fidelity following combined clinician-parent delivery of Rapid Syllable Transition (ReST) treatment.Method: Five children aged 5:1–11:7 with childhood apraxia of speech received 12 treatment sessions; six clinic-based and six at home, using multiple baselines across participants design. We investigated the children’s acquisition of treated pseudo words, generalisation to untreated pseudo and real words, and maintenance of gains. We also assessed parent and clinician treatment fidelity and reliability of perceptual judgements.Result: Two children improved on all treated behaviours; two showed treatment effect on one of their two treated behaviours, and one child had no treatment effect. Only two children generalised to the majority of untreated items. Variable treatment fidelity was found across parents and aspects of treatment. Child outcome was likely influenced by multiple factors, including treatment fidelity, reliability of perceptual judgements and child factors.Conclusion: Combined clinician-parent delivery of ReST was less efficacious than previously reported clinician-only delivered ReST. Further investigation of the factors affecting outcome is recommended prior to clinical application of the combined model of service delivery.

Principles of motor learning in treatment for apraxia of speech

Principles of motor learning in treatment for apraxia of speech

Application of Learning Theory to Aphasia Intervention

Event Abstract Back to Event Application of Learning Theory to Aphasia Intervention Erica L. Middleton1* 1 Moss Rehabilitation Research Institute, United States Whereas a vast literature indicates interventions for aphasia can bring about positive clinical outcomes, research is limited on how to prioritize, schedule, and combine different kinds of treatment experiences for maximal benefit. By elaborating fundamental principles that govern change in the intact and damaged language system, learning theory can play a research-directing role towards explication of how and why language interventions work, how to alter the interventions to increase their efficiency and potency, and to provide prescriptions for use with specific populations. The symposium includes five speakers whose work collectively spans the translational pipeline, from recent developments in the science of learning and language use, to the application of learning theory in different domains of aphasia treatment. 1. Implicit learning as a mechanism of change in language production Gary S. Dell, Nathaniel D. Anderson, & Amanda C. Kelley—University of Illinois, Urbana-Champaign The presentation explores whether learning in various domains of language production is inherently associative or cognitive, the former characterized by automatic, gradual change with experience, the latter by fast change, suggestive of rule-governed behavior. The implications for the treatment of aphasia are discussed. 2. Principles of motor learning in treatment for apraxia of speech Edwin Maas--Temple University A large literature has explored the differential potency of certain practice conditions (e.g., random versus blocked practice) to inform general principles of motor learning. However, such studies have almost exclusively focused on nonspeech tasks. This presentation discusses recent evidence regarding the applicability of principles of motor learning to treatment for apraxia of speech. 3. Retrieval practice principles: A theory of learning for naming rehabilitation Erica L. Middleton—Moss Rehabilitation Research Institute The presentation reviews progress towards a theory of learning for oral naming rehabilitation in aphasia based on the principles that (1) practice retrieving names for pictures from long-term memory (i.e., retrieval practice) benefits future naming, particularly when effortful; (2) spacing repeated training trials for to-be-treated vocabulary over time confers superior learning compared to massing trials close in time. Individual differences in response to these principles is discussed. 4. Examining the relationship between language and learning: Insights from the serial reaction time task Sofia Vallila Rohter—MGH Institute of Health Professions Limitations in our understanding of how learning is affected in aphasia is a barrier to developing efficacious patient-centered treatments. This research examines learning ability in aphasia within frameworks of implicit and explicit learning to provide a foundation for understanding how to conform treatment in light of possible learning deficits. 5. Spacing and timing: Maximizing learning and retention in aphasia treatment Brenda Rapp & Robert Wiley—Johns Hopkins University While research has shown that the spacing and timing of training trials have important consequences for learning and retention, their role in aphasia treatment has received scant attention. This work examines the spacing and timing of training trials in individuals who underwent dysgraphia treatment, finding greater accuracy for distributed compared to clustered trial spacing, and that longer retention intervals require longer intervals between training trials. Future research directions will be discussed. Keywords: Language production, apraxia of speech, retrieval practice, implicit learning, Lexical impairment Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: symposium Topic: Aphasia Citation: Middleton EL (2019). Application of Learning Theory to Aphasia Intervention. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00079 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 18 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: PhD. Erica L Middleton, Moss Rehabilitation Research Institute, Elkins Park, United States, middleer@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Erica L Middleton Google Erica L Middleton Google Scholar Erica L Middleton PubMed Erica L Middleton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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Treating apraxia of speech with an implicit protocol that activates speech motor areas via inner speech

Background: Treatments of apraxia of speech (AOS) have traditionally relied on overt practice. One alternative to this method is implicit phoneme manipulation which was derived from early models on inner speech. Implicit phoneme manipulation requires the participant to covertly move and combine phonemes to form a new word. This process engages a system of self-monitoring which is referred to as fully conscious inner speech.Aims: The present study aims to advance the understanding and validity of a new treatment for AOS, implicit phoneme manipulation. Tasks were designed to answer the following questions. (1) Would the practice of implicit phoneme manipulation improve the overt production of complex consonant blends in words? (2) Would this improvement generalise to untrained complex and simpler consonant blends in words? (3) Would these treatment tasks activate regions known to support motor planning and programming as verified by functional magnetic resonance imaging (fMRI)?Method & Procedures: The participant was asked to covertly manipulate phonemes to create a new word and to associate this newly formed word to a target picture among four phonologically related choices. To avoid overt practice, probes were collected only after each block of training was completed. Probe sessions assessed the effects of implicit practice on the overt production of simple and complex consonant blends in words. An imaging protocol compared semantic baseline tasks to treatment tasks to verify that implicit phoneme manipulation activated brain regions of interest.Outcomes & Results: Behavioural: Response to implicit training of complex consonant blends resulted in improvements which were maintained 6 weeks after treatment. Further, this treatment generalised to simpler consonant blends in words. Imaging: Functional imaging during implicit phoneme manipulation showed significant activation in brain regions responsible for phonological processing when compared to the baseline semantic task.Conclusions: Implicit phoneme manipulation offers an alternative to traditional methods that require overt production for treatment of AOS. Additionally, this implicit treatment method was shown to activate neural areas known to be involved in phonological processing, motor planning, and programming.

Treatment for apraxia of speech in nonfluent variant primary progressive aphasia.

There is a growing body of literature examining the utility of behavioral treatment in primary progressive aphasia (PPA). There are, however, no studies exploring treatment approaches to improve speech production in individuals with apraxia of speech (AOS) associated with the nonfluent variant of PPA. The purpose of this study was to examine a novel approach to treatment of AOS in nonfluent PPA. We implemented a treatment method using structured oral reading as a tool for improving production of multisyllabic words in an individual with mild AOS and nonfluent variant PPA. Our participant showed a reduction in speech errors during reading of novel text that was maintained at one year post-treatment. Generalization of improved speech production was observed on repetition of words and sentences and the participant showed stability of speech production over time in connected speech. Results suggest that oral reading treatment may offer an efficient and effective means of addressing multisyllabic word production in AOS associated with nonfluent PPA, with lasting and generalized treatment effects.

Treatment for Apraxia of Speech in Nonfluent Variant Primary Progressive Aphasia

There is a growing body of literature examining the utility of behavioral treatment in primary progressive aphasia (PPA). There are, however, no studies exploring treatment approaches to improve speech production in individuals with apraxia of speech (AOS) associated with the nonfluent variant of PPA. The purpose of this study was to examine a novel approach to treatment of AOS in nonfluent PPA. We implemented a treatment method using structured oral reading as a tool for improving production of multisyllabic words in an individual with mild AOS and nonfluent variant PPA. Our participant showed a reduction in speech errors during reading of novel text that was maintained at one year post-treatment. Generalization of improved speech production was observed on repetition of words and sentences and the participant showed stability of speech production over time in connected speech. Results suggest that oral reading treatment may offer an efficient and effective means of addressing multisyllabic word production in AOS associated with nonfluent PPA, with lasting and generalized treatment effects.

Speech Planning Happens Before Speech Execution: Online Reaction Time Methods in the Study of Apraxia of Speech

The purpose of this article is to present an argument for the use of online reaction time (RT) methods to the study of apraxia of speech (AOS) and to review the existing small literature in this area and the contributions it has made to our fundamental understanding of speech planning (deficits) in AOS. Following a brief description of limitations of offline perceptual methods, we provide a narrative review of various types of RT paradigms from the (speech) motor programming and psycholinguistic literatures and their (thus far limited) application with AOS. On the basis of the review of the literature, we conclude that with careful consideration of potential challenges and caveats, RT approaches hold great promise to advance our understanding of AOS, in particular with respect to the speech planning processes that generate the speech signal before initiation. A deeper understanding of the nature and time course of speech planning and its disruptions in AOS may enhance diagnosis and treatment for AOS. Only a handful of published studies on apraxia of speech have used reaction time methods. However, these studies have provided deeper insight into speech planning impairments in AOS based on a variety of experimental paradigms.

Assessing the treatment effects in apraxia of speech: introduction and evaluation of the Modified Diadochokinesis Test

The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech.

Conditions of Practice and Feedback in Treatment for Apraxia of Speech

Purpose: The purpose of this article is to review a number of conditions of practice and feedback (sometimes referred to as principles of motor learning) in relation to treatment for apraxia of speech (AOS). Methods: A narrative review of pertinent literature is provided. Conclusions: Although there has been little systematic study of these conditions in treatment for AOS, the emerging evidence is consistent with the idea that conditions of practice and feedback have similar effects in treatment for AOS as those seen in the motor learning literature.

Studies of Articulatory Feedback Treatment for Apraxia of Speech Based on Electromagnetic Articulography

Electromagnetic articulography (EMA) is a method originally designed for the laboratory measurement of speech articulatory motion (Schönle et al., 1987). We describe a novel use of this technology applied to the remediation of apraxia of speech (AOS). In this experimental technique, individuals with AOS are provided with real-time, visual information concerning the movement of the tongue during speech. From information sent via EMA sensors mounted on the tongue, patients are guided into hitting “targets” displayed on a computer monitor, designed to guide correct articulatory placement. The results of several studies suggest that augmented feedback-based treatment is efficacious and that this treatment follows principles of motor learning described in the limb motor literature. Potential challenges facing this type of approach, as well as some new directions, are discussed.

Plasticity, Permanence, and Patient Performance: Study Design and Data Analysis in the Cognitive Rehabilitation of Acquired Communication Impairments

Communication impairments such as aphasia and apraxia can follow brain injury and result in limitation of an individual's participation in social interactions, and capacity to convey needs and desires. Our research group developed a computerized treatment program which is based on neuroscientific principles of speech production (Whiteside and Varley, 1998; Varley and Whiteside, 2001; Varley, 2010) and has been shown to improve communication in people with apraxia and aphasia (Dyson et al., 2009; Varley et al., 2009). Investigations of treatment efficacy have presented challenges in study design, effect measurement, and statistical analysis which are likely to be shared by other researchers in the wider field of cognitive neurorehabilitation evaluation. Several key factors define neurocognitively based therapies, and differentiate them and their evaluation from other forms of medical intervention. These include: (1) inability to “blind” patients to the content of the treatment and control procedures; (2) neurocognitive changes that are more permanent than pharmacological treatments on which many medical study designs are based; and (3) the semi-permanence of therapeutic effects means that new baselines are set throughout the course of a given treatment study, against which comparative interventions or long term retention effects must be measured. This article examines key issues in study design, effect measurement, and data analysis in relation to the rehabilitation of patients undergoing treatment for apraxia of speech. Results from our research support a case for the use of multiperiod, multiphase cross-over design with specific computational adjustments and statistical considerations. The paper provides researchers in the field with a methodologically feasible and statistically viable alternative to other designs used in rehabilitation sciences.

Effects of Feedback Frequency and Timing on Acquisition, Retention, and Transfer of Speech Skills in Acquired Apraxia of Speech

Two studies examined speech skill learning in persons with apraxia of speech (AOS). Motor-learning research shows that delaying or reducing the frequency of feedback promotes retention and transfer of skills. By contrast, immediate or frequent feedback promotes temporary performance enhancement but interferes with retention and transfer. These principles were tested in the context of a common treatment for AOS. Two studies (N = 4, N = 2) employed single-subject treatment designs to examine acquisition and retention of speech skills in adults with AOS under different feedback conditions. Reduced-frequency or delayed feedback enhanced learning in 3 participants with AOS. Feedback manipulation was not an influential variable in 3 other cases in which stimulus-complexity effects may have masked treatment effects. These findings demonstrate that individuals with AOS can benefit from structured intervention. They provide qualified support for reduction and delay of feedback, although interaction with other factors such as stimulus complexity or task difficulty needs further exploration. This study adds to the growing body of literature investigating the use of principles of motor learning in treating AOS and provides impetus for consideration of pre-treatment variables that affect outcome in treatment studies.

Treatment for Childhood Apraxia of Speech: A Description of Integral Stimulation and Motor Learning

Treatment for Childhood Apraxia of Speech: A Description of Integral Stimulation and Motor Learning

Current Directions in Treatment for Apraxia of Speech: Principles of Motor Learning

Current Directions in Treatment for Apraxia of Speech: Principles of Motor Learning

Effects of on-line kinematic feedback treatment for apraxia of speech

Effects of on-line kinematic feedback treatment for apraxia of speech

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.

Oral Motor Training and Treatment for Apraxia of Speech

Oral Motor Training and Treatment for Apraxia of Speech

Sound Production Treatment for Apraxia of Speech

Sound Production Treatment for Apraxia of Speech

Influence of order of stimulus presentation on speech motor learning: A principled approach to treatment for apraxia of speech

The present study was designed to examine whether applying principles of motor learning to a commonly used treatment approach for acquired apraxia of speech (AOS) would enhance relearning of speech production skills. In particular, we examined one main principle, random practice, and compared it to blocked practice. Of importance is the fact that many speech treatments utilize blocked practice, but the literature on motor learning clearly shows that blocked practice facilitates acquisition of target behaviours, but not retention and transfer. The latter two are considered true indices of learning. In two subjects with severe AOS, results showed that random practice facilitated retention whereas blocked practice did not. The present study provides preliminary evidence that these principles may have a similar effect on learning of skilled speech motor acts as they do on learning of limb movements. The results reported here are encouraging and provide justification and focus for further investigation.