3 research outputs found
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Treatment for speech production and fluency in two individuals with non-fluent primary progressive aphasia
textPurpose: The current study examined the utility of a script-based treatment protocol for improving speech production and fluency in two individuals with the non-fluent variant of primary progressive aphasia (PPA). Method: The treatment protocol was a modified version of the "speech entrainment" technique examined in non-fluent stroke aphasia by Fridriksson and colleagues (2012). Personalized scripts were recorded as videos of a healthy speaker's mouth. Scripts were rehearsed via synchronized spoken production in daily homework. Treatment sessions with the clinician targeted memorization and conversational usage. The protocol was modified from the original study in its use of 1.) topics of interest to the participant, 2.) tailored speech rate based on the participant's habitual rate of speech in reading and spontaneous speech tasks, and 3.) tailored level of script difficulty based on the participants' motor and linguistic profile. Speech entrainment is a homework-based treatment and required participants to practice thirty minutes per day over the course of nine weeks of treatment in addition to receiving in-person treatment twice per week. Outcome measures for trained and untrained scripts were percent correct and intelligible scripted words, errors by word class, total number of grammatical errors, and total percent intelligibility. Results: Both participants showed significant improvement in intelligibility and accuracy of trained scripts and generalized improvement on untrained scripts was observed in one participant. Participants showed a significant reduction in grammatical errors after treatment. One participant showed significant changes in overall intelligibility after treatment, and maintenance of intelligibility and script accuracy at three months post treatment. Conclusion: Script training using speech entrainment resulted in improved intelligibility, grammaticality, and overall accuracy for scripted material in two participants with PPA. Speech entrainment may be a viable treatment method for individuals with non-fluent PPA, particularly with modifications to support increased intelligibility for those with concomitant motor speech deficits. Because speech entrainment is homework-based, the frequency and dosage of treatment are maximized without necessitating an increase in face-to-face treatment sessions. This has promising implications for individuals facing limited reimbursement for treatment and for individuals who have mobility issues.Communication Sciences and Disorder
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Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia.
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) presents with a gradual decline in grammar and motor speech resulting from selective degeneration of speech-language regions in the brain. There has been considerable progress in identifying treatment approaches to remediate language deficits in other primary progressive aphasia variants; however, interventions for the core deficits in nfvPPA have yet to be systematically investigated. Further, the neural mechanisms that support behavioural restitution in the context of neurodegeneration are not well understood. We examined the immediate and long-term benefits of video implemented script training for aphasia (VISTA) in 10 individuals with nfvPPA. The treatment approach involved repeated rehearsal of individualized scripts via structured treatment with a clinician as well as intensive home practice with an audiovisual model using 'speech entrainment'. We evaluated accuracy of script production as well as overall intelligibility and grammaticality for trained and untrained scripts. These measures and standardized test scores were collected at post-treatment and 3-, 6-, and 12-month follow-up visits. Treatment resulted in significant improvement in production of correct, intelligible scripted words for trained topics, a reduction in grammatical errors for trained topics, and an overall increase in intelligibility for trained as well as untrained topics at post-treatment. Follow-up testing revealed maintenance of gains for trained scripts up to 1 year post-treatment on the primary outcome measure. Performance on untrained scripts and standardized tests remained relatively stable during the follow-up period, indicating that treatment helped to stabilize speech and language despite disease progression. To identify neural predictors of responsiveness to intervention, we examined treatment effect sizes relative to grey matter volumes in regions of interest derived from a previously identified speech production network. Regions of significant atrophy within this network included bilateral inferior frontal cortices and supplementary motor area as well as left striatum. Volumes in a left middle/inferior temporal region of interest were significantly correlated with the magnitude of treatment effects. This region, which was relatively spared anatomically in nfvPPA patients, has been implicated in syntactic production as well as visuo-motor facilitation of speech. This is the first group study to document the benefits of behavioural intervention that targets both linguistic and motoric deficits in nfvPPA. Findings indicate that behavioural intervention may result in lasting and generalized improvement of communicative function in individuals with neurodegenerative disease and that the integrity of spared regions within the speech-language network may be an important predictor of treatment response
Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) presents with a gradual decline in grammar and motor speech resulting from selective degeneration of speech-language regions in the brain. There has been considerable progress in identifying treatment approaches to remediate language deficits in other primary progressive aphasia variants; however, interventions for the core deficits in nfvPPA have yet to be systematically investigated. Further, the neural mechanisms that support behavioural restitution in the context of neurodegeneration are not well understood. We examined the immediate and long-term benefits of video implemented script training for aphasia (VISTA) in 10 individuals with nfvPPA. The treatment approach involved repeated rehearsal of individualized scripts via structured treatment with a clinician as well as intensive home practice with an audiovisual model using 'speech entrainment'. We evaluated accuracy of script production as well as overall intelligibility and grammaticality for trained and untrained scripts. These measures and standardized test scores were collected at post-treatment and 3-, 6-, and 12-month follow-up visits. Treatment resulted in significant improvement in production of correct, intelligible scripted words for trained topics, a reduction in grammatical errors for trained topics, and an overall increase in intelligibility for trained as well as untrained topics at post-treatment. Follow-up testing revealed maintenance of gains for trained scripts up to 1 year post-treatment on the primary outcome measure. Performance on untrained scripts and standardized tests remained relatively stable during the follow-up period, indicating that treatment helped to stabilize speech and language despite disease progression. To identify neural predictors of responsiveness to intervention, we examined treatment effect sizes relative to grey matter volumes in regions of interest derived from a previously identified speech production network. Regions of significant atrophy within this network included bilateral inferior frontal cortices and supplementary motor area as well as left striatum. Volumes in a left middle/inferior temporal region of interest were significantly correlated with the magnitude of treatment effects. This region, which was relatively spared anatomically in nfvPPA patients, has been implicated in syntactic production as well as visuo-motor facilitation of speech. This is the first group study to document the benefits of behavioural intervention that targets both linguistic and motoric deficits in nfvPPA. Findings indicate that behavioural intervention may result in lasting and generalized improvement of communicative function in individuals with neurodegenerative disease and that the integrity of spared regions within the speech-language network may be an important predictor of treatment response