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Mauszycki SC, Bunker LD, Bailey DJ, Wambaugh JL. Speech Intelligibility Outcomes Associated With Treatment for Acquired Apraxia of Speech: Magnitude of Change and Stability of Measurement. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-15. [PMID: 39270061 DOI: 10.1044/2024_ajslp-24-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
PURPOSE 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. METHOD 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. RESULTS 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. CONCLUSIONS 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. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26972425.
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Affiliation(s)
| | - Lisa D Bunker
- Speech-Language Pathology Program, Midwestern University, Glendale, AZ
| | - Dallin J Bailey
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Julie L Wambaugh
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Bunker LD, Bailey DJ, Poss E, Mauszycki S, Wambaugh JL. Stability Over Time of Word Syllable Duration for Speakers With Acquired Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-15. [PMID: 38527280 DOI: 10.1044/2024_jslhr-23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE Neurogenic speech and language disorders-such as acquired apraxia of speech (AOS) and aphasia with phonemic paraphasia (APP)-are often misdiagnosed due to similarities in clinical presentation. Word syllable duration (WSD)-a measure of average syllable length in multisyllabic words-serves as a proxy for speech rate, which is an important and arguably more objective clinical characteristic of AOS and APP. This study reports stability of WSD over time for speakers with AOS (and aphasia). METHOD Twenty-nine participants with AOS and aphasia (11 women and 18 men, Mage = 53.5 years, SD = 13.3) repeated 30 multisyllabic words (of three-, four-, and five-syllable lengths) on three occasions across 4 weeks. WSDs were calculated for each word and then averaged across each list (i.e., word length), as well as across combined lists (i.e., all 30 words) to yield four WSDs for each participant at each time point. Stability over time was calculated using Friedman's test for the group and using Spearman's rho for the individual level. Effects of time and word length were examined using robust mixed-effects linear regression. RESULTS Friedman's tests and correlations indicated no significant difference in WSDs across sampling occasions for each word length separately or combined. WSD correlated positively with AOS severity and negatively with intelligibility but was not correlated with aphasia severity. Regression analyses confirmed WSD to be stable over time, while WSD calculated from only five tokens (i.e., WSD-5) was less stable over time. CONCLUSIONS Results indicate that WSD can be a stable measure over time, at the individual and group level, providing support for its use in diagnosis and/or as an outcome measure, both clinically and for research. In general, WSD outperformed WSD-5, suggesting that it may be better to calculate WSD from more than five tokens. Stability of WSD in other populations and suitability for differential diagnosis need to be determined. Currently, differentiating disorders by speaking rate, alone, is not recommended. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25438735.
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Affiliation(s)
| | | | - Elaine Poss
- VA Sierra Nevada Health Care System, Reno, NV
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Wong ECH, Wong MN, Wong TOK. An online survey of clinical practice and confidence in diagnosing acquired apraxia of speech in Cantonese speakers. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-15. [PMID: 37885159 DOI: 10.1080/17549507.2023.2263181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE The assessment and diagnosis of apraxia of speech (AOS) have been well studied in the English context, yet there is limited understanding of the clinical practice in speakers of other languages, like Cantonese. This study aimed to obtain information about the clinical practice of assessment methods and diagnostic criteria used, and confidence in diagnosing, AOS in Cantonese speakers. METHOD An online survey constructed with Google Forms was completed by 27 speech-language pathologists (SLPs) in Hong Kong. The questionnaire comprised 12 questions covering (a) demographic information, (b) experience working with speakers with AOS, (c) confidence in making AOS diagnosis in Cantonese speakers, (d) assessment tasks or methods used for assessing AOS in Cantonese speakers, (e) clinical features used for diagnostic purposes, and (f) assessment tasks used to determine the presence of clinical features for diagnostic purposes. RESULT All respondents (100%) made AOS diagnoses based on the observed clinical features, while no respondents made diagnoses using only standardised tests or quantitative measures. Six clinical features were commonly used by most of the respondents: articulatory groping (100%), inconsistent articulatory errors (100%), length effects (85.2%), difficulty initiating speech (81.5%), automaticity effects (81.5%), and sound distortions (77.8%). More than half of the respondents collected connected speech samples (64%), and conducted diadochokinesis (64%) and repetition tasks (64%). The average confidence level of the respondents for making AOS diagnoses was fair (3.63/5). CONCLUSION The SLPs in Hong Kong make AOS diagnoses based on the observed clinical features that have been reported in the English literature. Although some of the clinical features have been updated as non-discriminatory for AOS, they are still being used for AOS diagnosis in Cantonese speakers. Tendencies were observed with respect to the assessment tasks selected. The fair diagnostic confidence level suggests a need for future investigations of AOS in Cantonese speakers and the development of assessment tools.
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Affiliation(s)
- Eddy C H Wong
- The Department of Chinese and Bilingual Studies, Faculty of Humanities, The Hong Kong Polytechnic University, Hong Kong, China
| | - Min Ney Wong
- Research Centre for Language, Cognition, and Neuroscience, Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China, and
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Tiffany On Kiu Wong
- The Department of Chinese and Bilingual Studies, Faculty of Humanities, The Hong Kong Polytechnic University, Hong Kong, China
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Haley KL, Jacks A, Kim S, Rodriguez M, Johnson LP. Normative Values for Word Syllable Duration With Interpretation in a Large Sample of Stroke Survivors With Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2480-2492. [PMID: 37595782 PMCID: PMC10721249 DOI: 10.1044/2023_ajslp-22-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/07/2023] [Accepted: 05/16/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology. METHOD Fifty neurotypical participants produced 49 multisyllabic words during a repetition task. Audio recordings were submitted to an automated speech recognition (ASR) service (IBM Watson) to measure word duration and generate an orthographic transcription. The transcribed words were compared to a lexical database, and the number of syllables was identified. Automatic and manual measures were compared for 50% of the sample. Results were interpreted relative to WSD scores from an existing data set of 195 people with mostly chronic aphasia. RESULTS ASR correctly identified 83% of target words and 98% of target syllable counts. Automated word duration calculations were longer than manual measures due to imprecise cursor placement. Upon applying regression coefficients to the automated measures and examining the frequency distributions for both manual and estimated measures, a WSD of 303-316 ms was found to indicate longer-than-normal performance (corresponding to the 95th percentile). With this cutoff, 40%-45% of participants with aphasia in our comparison sample had an abnormally long WSD. CONCLUSIONS We recommend using a rounded WSD cutoff score between 303 and 316 ms for manual measures. Future research will focus on customizing automated WSD methods to speech samples from people with aphasia, identifying target words that maximize production and measurement reliability, and developing WSD standard scores based on a large participant sample with and without aphasia.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill
| | - Soomin Kim
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill
| | - Marcia Rodriguez
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill
| | - Lorelei P. Johnson
- Physical Medicine & Rehabilitation Program, Carolinas Rehabilitation, Atrium Health, Charlotte, NC
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Costa BM, Brescancini CR, Ortiz KZ. Assessment protocol for acquired apraxia of speech. Codas 2023; 36:e20220251. [PMID: 37851756 DOI: 10.1590/2317-1782/20232022251pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/20/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. METHODS Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. RESULTS After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. CONCLUSION The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.
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Affiliation(s)
- Beatriz Maurer Costa
- Departamento de Fonoaudiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
| | - Cláudia Regina Brescancini
- Programa de Pós-graduação em Letras, Escola de Humanidades, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
| | - Karin Zazo Ortiz
- Departamento de Fonoaudiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
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Faroqi-Shah Y. A reconceptualization of sentence production in post-stroke agrammatic aphasia: the synergistic processing bottleneck model. FRONTIERS IN LANGUAGE SCIENCES 2023; 2:1118739. [PMID: 39175803 PMCID: PMC11340809 DOI: 10.3389/flang.2023.1118739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The language production deficit in post-stroke agrammatic aphasia (PSA-G) tends to result from lesions to the left inferior frontal gyrus (LIFG) and is characterized by a triad of symptoms: fragmented sentences, errors in functional morphology, and a dearth of verbs. Despite decades of research, the mechanisms underlying production patterns in PSA-G have been difficult to characterize. Two major impediments to progress may have been the view that it is a purely morphosyntactic disorder and the (sometimes overzealous) application of linguistic theory without interceding psycholinguistic evidence. In this paper, empirical evidence is examined to present an integrated portrait of language production in PSA-G and to evaluate the assumption of a syntax-specific syndrome. In light of extant evidence, it is proposed that agrammatic language production results from a combination of morphosyntactic, phonomotor, and processing capacity limitations that cause a cumulative processing bottleneck at the point of articulatory planning. This proposed Synergistic Processing Bottleneck model of PSA-G presents a testable framework for future research. The paper ends with recommendations for future research on PSA-G.
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Affiliation(s)
- Yasmeen Faroqi-Shah
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
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Haley KL, Jacks A. Three-Dimensional Speech Profiles in Stroke Aphasia and Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1825-1834. [PMID: 36603554 PMCID: PMC10561969 DOI: 10.1044/2022_ajslp-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Behaviorally, acquired apraxia of speech (AOS) is a multidimensional syndrome that the experienced clinician recognizes based on impaired articulation and abnormal temporal prosody. We conducted this study to determine the extent to which three core features of AOS-when defined quantitatively-distinguish categorically among aphasia with no or minimal speech sound involvement, aphasia with AOS, and aphasia with phonemic paraphasia (APP). METHOD The study involved retrospective analysis of 195 participants with stroke-induced aphasia. We used three quantitative measures (phonemic error frequency, distortion error frequency, and word syllable duration [WSD]) to divide the sample into four participant groups according to the most likely speech diagnosis: aphasia with minimal speech sound errors, AOS, APP, and a borderline group with mixed profiles. We then conducted nonparametric comparisons across groups for which the measures were not defined and visualized all three measures in a three-dimensional graph. RESULTS The measures distributed as multidimensional spectra rather than discrete diagnostic entities, and there was considerable behavioral overlap among participant groups. Thirty percent of participants presented with aphasia with minimal sound production difficulties, and they were statistically indistinguishable from the APP group on distortion frequency and WSD. Distortion frequency and WSD were in a borderline region between AOS and APP for 29% of participants. Compared to all other groups, participants with AOS produced significantly more errors that affected listeners' phonemic perception. CONCLUSIONS The results suggest that the current AOS-APP dichotomy has limited validity. We conclude that a continuous multidimensional view of speech variation would be a constructive perspective from which to understand how the left cerebral hemisphere produces speech and that quantitative and normed speech measures should be used to inform differential diagnosis in clinical settings. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21807609.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Santos DHND, Lima ILB, Lopes LW. Translation into Brazilian Portuguese and transcultural adaptation of the Apraxia of Speech Rating Scale 3.5. Codas 2023; 35:e20220012. [PMID: 37403877 DOI: 10.1590/2317-1782/20232022012pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/15/2022] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To present the translation into Brazilian Portuguese and cross-cultural adaptation of the Apraxia of Speech Rating Scale (ASRS) version 3.5. METHODS Validation study restricted to translation and cross-cultural adaptation. The following steps were carried out: translation and synthesis of translations; verification of applicability of the scale synthesis by judges recruited for this purpose; analysis of the relevance and feasibility of the scale calculated by the Content Validity Index (CVI), individual (CVI-I) and total (CVI-T). Eighteen speech therapists were selected. Their answers were used for the analysis of agreement (intraclass correlation coefficients - ICC) and for the calculation of the Content Validity Index (CVI). Finally, the synthesis of the translation was matched in terms of semantic, idiomatic, experiential, conceptual, syntactic, grammatical, and operational equivalence. RESULTS The ICC ranged between 0.83 and 0.94. Six items obtained values higher than 0.9. The other items presented values between 0.8 and 0.9. The CVI-I and CVI-T had excellent values (CVI ≥ 0.78) for relevance and feasibility. CONCLUSION The Brazilian version of the ASRS 3.5 presents semantic, idiomatic, experiential, conceptual, and syntactic/grammatical equivalence to the original document. Thus, it is ready for the next validation steps.
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Affiliation(s)
| | | | - Leonardo Wanderley Lopes
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
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Munasinghe TU, Ariyasena ADK, Siriwardhana DD. Speech Therapy Interventions for Acquired Apraxia of Speech: An Updated Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1336-1359. [PMID: 36917788 DOI: 10.1044/2022_ajslp-21-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE This systematic review aims to summarize and evaluate the available literature on speech and language therapy interventions for acquired apraxia of speech since 2012. METHOD A systematic search in six electronic databases was performed from 2013 to 2020. The following primary outcomes were summarized: (a) improvement in targeted behaviors, (b) generalization, and (c) maintenance of outcomes. Moreover, studies were evaluated for the level of evidence and the clinical phase. RESULTS Of the 3,070 records identified, 27 studies were included in this review. The majority of the studies (n = 22) used articulatory kinematic approaches followed by intersystemic facilitation/reorganization treatments (n = 4) and other approaches (n = 1). According to the classes defined in Clinical Practice Guideline Process Manual (Gronseth et al., 2017), one was Class II, 10 were Class III, 10 were Class III-b (fulfill Class III criteria except for independence of assessors' criterion), and five were Class IV. In terms of clinical phase, one study classified as Phase III, 10 as Phase II, and 15 as Phase I. CONCLUSIONS Among the interventions for apraxia of speech, articulatory kinematic treatments have become prominent over the last 8 years. Focusing on self-administrated therapies, use of technology for therapy administration and development of treatments that focus on apraxia of speech and aphasia simultaneously were identified as new advancements in the apraxia of speech literature. The methodological quality, clinical phase, and level of evidence of the studies have improved within the past 8 years. Large-scale randomized controlled trials for articulatory kinematic approaches and future studies on other treatment approaches are warranted. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22223785.
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Affiliation(s)
- Thushani Umesha Munasinghe
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Akila Dinethra K Ariyasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Dhammika Deepani Siriwardhana
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka
- Research Department of Primary Care and Population Health, University College London, United Kingdom
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Duffy JR, Martin PR, Clark HM, Utianski RL, Strand EA, Whitwell JL, Josephs KA. The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:469-491. [PMID: 36630926 PMCID: PMC10171845 DOI: 10.1044/2022_ajslp-22-00148] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features. METHOD Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence. RESULTS Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence. CONCLUSIONS The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817584.
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Affiliation(s)
| | - Peter R. Martin
- Department of Quantitative Health Sciences (Biostatistics), Mayo Clinic, Rochester, MN
| | | | | | - Edythe A. Strand
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Speech & Hearing Sciences, University of Washington, Seattle
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11
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Wong ECH, Wong MN, Velleman SL. Assessment and Diagnostic Standards of Apraxia of Speech in Chinese-Speaking Adults and Children: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:316-340. [PMID: 36378894 DOI: 10.1044/2022_ajslp-21-00355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Apraxia of speech (AOS) and childhood apraxia of speech (CAS) are motor-based speech disorders that have been well studied in Indo-European languages. There is limited understanding of these disorders in speakers of Sino-Tibetan languages, such as Chinese. The purpose of this study is to review methods used in research studies for the assessment and diagnosis of AOS and CAS in Chinese speakers. METHOD This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Articles with a focus on AOS or CAS in Chinese speakers were systematically searched in seven English and six Chinese databases. Three reviewers performed independent screening, data extraction, and quality assessment after obtaining 100% agreement on the prescreening exercise. A qualitative analysis was conducted to rate the quality of diagnoses, ranging from high (Level I) to low (Level III), with Level IV assigned to studies for which the appropriate rating was unclear due to insufficient evidence. RESULTS Twenty-eight AOS articles and five CAS articles were identified. A variety of assessment and diagnostic methods were reported. No study of Chinese speakers with AOS or CAS received a rating of Level I. The highest level achieved was Level IIIa for both AOS and CAS studies. CONCLUSIONS There is no reliable and valid test or method for the diagnosis of AOS or CAS in Chinese speakers. The current gold standard of diagnosis is based upon expert perceptual judgment. Further single-language and cross-linguistic investigations of AOS and CAS and the future development of assessment and diagnostic methods are recommended.
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Affiliation(s)
- Eddy Chun Ho Wong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hung Hom
| | - Min Ney Wong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hung Hom
- Research Centre for Language, Cognition, and Neurosciences, Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hung Hom
| | - Shelley L Velleman
- Department of Communication Sciences and Disorders, The University of Vermont, Burlington
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Rowe HP, Gochyyev P, Lammert AC, Lowit A, Spencer KA, Dickerson BC, Berry JD, Green JR. The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates. J Neural Transm (Vienna) 2022; 129:1487-1511. [PMID: 36305960 PMCID: PMC9859630 DOI: 10.1007/s00702-022-02550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023]
Abstract
Despite the impacts of neurodegeneration on speech function, little is known about how to comprehensively characterize the resulting speech abnormalities using a set of objective measures. Quantitative phenotyping of speech motor impairments may have important implications for identifying clinical syndromes and their underlying etiologies, monitoring disease progression over time, and improving treatment efficacy. The goal of this research was to investigate the validity and classification accuracy of comprehensive acoustic-based articulatory phenotypes in speakers with distinct neurodegenerative diseases. Articulatory phenotypes were characterized based on acoustic features that were selected to represent five components of motor performance: Coordination, Consistency, Speed, Precision, and Rate. The phenotypes were first used to characterize the articulatory abnormalities across four progressive neurologic diseases known to have divergent speech motor deficits: amyotrophic lateral sclerosis (ALS), progressive ataxia (PA), Parkinson's disease (PD), and the nonfluent variant of primary progressive aphasia and progressive apraxia of speech (nfPPA + PAOS). We then examined the efficacy of articulatory phenotyping for disease classification. Acoustic analyses were conducted on audio recordings of 217 participants (i.e., 46 ALS, 52 PA, 60 PD, 20 nfPPA + PAOS, and 39 controls) during a sequential speech task. Results revealed evidence of distinct articulatory phenotypes for the four clinical groups and that the phenotypes demonstrated strong classification accuracy for all groups except ALS. Our results highlight the phenotypic variability present across neurodegenerative diseases, which, in turn, may inform (1) the differential diagnosis of neurological diseases and (2) the development of sensitive outcome measures for monitoring disease progression or assessing treatment efficacy.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA
| | - Perman Gochyyev
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA, USA
- Berkeley Evaluation and Assessment Research Center, University of California at Berkeley, Berkeley, CA, USA
| | - Adam C Lammert
- Department of Biomedical Engineering, Worchester Polytechnic Institute, Worcester, MA, USA
| | - Anja Lowit
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, Scotland, UK
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James D Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA.
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Hybbinette H, Östberg P, Schalling E, Deboussard C, Plantin J, Borg J, Lindberg PG. Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke. Front Neurol 2022; 13:1013652. [DOI: 10.3389/fneur.2022.1013652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
ObjectiveThe cerebral substrates of apraxia of speech (AOS) recovery remain unclear. Resting state fMRI post stroke can inform on altered functional connectivity (FC) within cortical language networks. Some initial studies report reduced FC between bilateral premotor cortices in patients with AOS, with lowest FC in patients with the most severe AOS. However, longitudinal FC studies in stroke are lacking. The aims of the present longitudinal study in early post stroke patients with AOS were (i) to compare connectivity strength in AOS patients to that in left hemisphere (LH) lesioned stroke patients without a speech-language impairment, (ii) to investigate the relation between FC and severity of AOS, aphasia and non-verbal oral apraxia (NVOA) and (iii) to investigate longitudinal changes in FC, from the subacute phase to the chronic phase to identify predictors of AOS recovery.MethodsFunctional connectivity measures and comprehensive speech-language assessments were obtained at 4 weeks and 6 months after stroke in nine patients with AOS after a LH stroke and in six LH lesioned stroke patients without speech-language impairment. Functional connectivity was investigated in a network for speech production: inferior frontal gyrus (IFG), anterior insula (aINS), and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres.ResultsInterhemispheric vPMC connectivity was significantly reduced in patients with AOS compared to LH lesioned patients without speech-language impairment. At 6 months, the AOS severity was associated with interhemispheric aINS and vPMC connectivity. Longitudinal changes in FC were found in individuals, whereas no significant longitudinal change in FC was found at the group level. Degree of longitudinal AOS recovery was strongly associated with interhemispheric IFG connectivity strength at 4 weeks.ConclusionEarly interhemispheric IFG connectivity may be a strong predictor of AOS recovery. The results support the importance of interhemispheric vPMC connection in speech motor planning and severity of AOS and suggest that also bilateral aINS connectivity may have an impact on AOS severity. These findings need to be validated in larger cohorts.
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Bouvier L, Monetta L, Martel-Sauvageau V. Speech rate increase in primary progressive apraxia of speech and its cost on articulatory accuracy. CLINICAL LINGUISTICS & PHONETICS 2022; 36:849-869. [PMID: 34355627 DOI: 10.1080/02699206.2021.1960622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Impaired articulation (e.g., articulatory accuracy) and prosody (e.g., slow speech rate) are considered primary diagnostic criterions for apraxia of speech both in neurodegenerative and post-stroke contexts. The primary aim of this study was to investigate the ability of participants with primary progressive apraxia of speech (PPAOS), a neurodegenerative disease characterised by initially isolated progressive apraxia of speech, to increase speech rate and the interaction between articulatory accuracy and speech rate. The secondary aim was to investigate the effect of syllable frequency and structure on this interaction. Four speakers with PPAOS, and four sex- and age-matched healthy speakers (HS) read eight two-syllable words embedded two times in a ten-syllable carrier phrase. Syllable frequency and structure were manipulated for the first syllable of the target words and controlled for the second syllable. All sentences were produced at three different target speech rates (conditions): habitual, regular (five syllables/second), and fast (seven syllables/second). Prosodic measures for target words and sentences were computed based on acoustic analysis of speech rate. Articulatory measures for words and sentences were rated based on a perceptual assessment of articulatory accuracy. Results show slower speech rate and reduced articulatory accuracy in speakers with PPAOS compared to HS. Results suggest that speakers with PPAOS also have limited ability to increase their speech rate. Finally, results suggest that articulatory complexity influences speech rate but that the cost of speech rate increase on articulatory accuracy varies greatly across speakers with PPAOS and is not necessarily related to the extent of the increase when measured in a highly structured sentence production task. Theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Liziane Bouvier
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
- Centre de Recherche CERVO Research Centre, Québec, Canada
| | - Laura Monetta
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
- Centre de Recherche CERVO Research Centre, Québec, Canada
| | - Vincent Martel-Sauvageau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
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15
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Bruffaerts R, Schaeverbeke J, Radwan A, Grube M, Gabel S, De Weer AS, Dries E, Van Bouwel K, Griffiths TD, Sunaert S, Vandenberghe R. Left Frontal White Matter Links to Rhythm Processing Relevant to Speech Production in Apraxia of Speech. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:515-537. [PMID: 37215340 PMCID: PMC10158569 DOI: 10.1162/nol_a_00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/03/2022] [Indexed: 05/24/2023]
Abstract
Recent mechanistic models argue for a key role of rhythm processing in both speech production and speech perception. Patients with the non-fluent variant (NFV) of primary progressive aphasia (PPA) with apraxia of speech (AOS) represent a specific study population in which this link can be examined. Previously, we observed impaired rhythm processing in NFV with AOS. We hypothesized that a shared neurocomputational mechanism structures auditory input (sound and speech) and output (speech production) in time, a "temporal scaffolding" mechanism. Since considerable white matter damage is observed in NFV, we test here whether white matter changes are related to impaired rhythm processing. Forty-seven participants performed a psychoacoustic test battery: 12 patients with NFV and AOS, 11 patients with the semantic variant of PPA, and 24 cognitively intact age- and education-matched controls. Deformation-based morphometry was used to test whether white matter volume correlated to rhythmic abilities. In 34 participants, we also obtained tract-based metrics of the left Aslant tract, which is typically damaged in patients with NFV. Nine out of 12 patients with NFV displayed impaired rhythmic processing. Left frontal white matter atrophy adjacent to the supplementary motor area (SMA) correlated with poorer rhythmic abilities. The structural integrity of the left Aslant tract also correlated with rhythmic abilities. A colocalized and perhaps shared white matter substrate adjacent to the SMA is associated with impaired rhythmic processing and motor speech impairment. Our results support the existence of a temporal scaffolding mechanism structuring perceptual input and speech output.
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Affiliation(s)
- Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
- Computational Neurology, Experimental Neurobiology Unit (ENU), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ahmed Radwan
- Translational MRI, Department of Imaging and Pathology & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Manon Grube
- Biosciences Institute, Medical School, Newcastle University, Newcastle-upon-Tyne, UK
- BIFOLD, Technische Universität Berlin, Germany; Department of Psychology, Ashoka University, India
| | - Silvy Gabel
- Laboratory for Cognitive Neurology, Department of Neurosciences & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - An-Sofie De Weer
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Timothy D. Griffiths
- Biosciences Institute, Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Stefan Sunaert
- Translational MRI, Department of Imaging and Pathology & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences & Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
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16
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Pernon M, Assal F, Kodrasi I, Laganaro M. Perceptual Classification of Motor Speech Disorders: The Role of Severity, Speech Task, and Listener's Expertise. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2727-2747. [PMID: 35878401 DOI: 10.1044/2022_jslhr-21-00519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The clinical diagnosis of motor speech disorders (MSDs) is mainly based on perceptual approaches. However, studies on perceptual classification of MSDs often indicate low classification accuracy. The aim of this study was to determine in a forced-choice dichotomous decision-making task (a) how accuracy of speech-language pathologists (SLPs) in perceptually classifying apraxia of speech (AoS) and dysarthria is impacted by speech task, severity of MSD, and listener's expertise and (b) which perceptual features they use to classify. METHOD Speech samples from 29 neurotypical speakers, 14 with hypokinetic dysarthria associated with Parkinson's disease (HD), 10 with poststroke AoS, and six with mixed dysarthria associated with amyotrophic lateral sclerosis (MD-FlSp [combining flaccid and spastic dysarthria]), were classified by 20 expert SLPs and 20 student SLPs. Speech samples were elicited in spontaneous speech, text reading, oral diadochokinetic (DDK) tasks, and a sample concatenating text reading and DDK. For each recorded speech sample, SLPs answered three dichotomic questions following a diagnostic approach, (a) neurotypical versus pathological speaker, (b) AoS versus dysarthria, and (c) MD-FlSp versus HD, and a multiple-choice question on the features their decision was based on. RESULTS Overall classification accuracy was 72% with good interrater reliability, varying with SLP expertise, speech task, and MSD severity. Correct classification of speech samples was higher for speakers with dysarthria than for AoS and higher for HD than for MD-FlSp. Samples elicited with continuous speech reached the best classification rates. An average number of three perceptual features were used for correct classifications, and their type and combination differed between the three MSDs. CONCLUSIONS The auditory-perceptual classification of MSDs in a diagnostic approach reaches substantial performance only in expert SLPs with continuous speech samples, albeit with lower accuracy for AoS. Specific training associated with objective classification tools seems necessary to improve recognition of neurotypical speech and distinction between AoS and dysarthria.
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Affiliation(s)
- Michaela Pernon
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
- Laboratoire de Phonétique et Phonologie, UMR 7018, CNRS-Université Sorbonne Nouvelle, Paris, France
- CRMR Wilson & Parkinson Unit, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Ina Kodrasi
- Signal Processing for Communication Group, Idiap Research Institute, Martigny, Switzerland
| | - Marina Laganaro
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
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17
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Md Nor A, Masso S, Ballard KJ. Identifying segmental and prosodic errors associated with the increasing word length effect in acquired apraxia of speech. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:294-306. [PMID: 35473426 DOI: 10.1080/17549507.2022.2061593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Individuals with stroke-related apraxia of speech (AOS) plus aphasia tend to produce more speech errors with increasing word length. The Words of Increasing Length task (WIL) uses a 3-point scale to score word accuracy but penalises for error types that can arise either from language or motor impairment, reducing the test's sensitivity and specificity. The purpose here was to identify error types explaining variance in the WIL score, and those associated with AOS and word length.Method: Speech errors were perceptually identified on the WIL task for 51 Australian English-speaking adults with stroke-related aphasia, 25 with concomitant AOS. Multiple regression and linear mixed effects modelling were applied.Result: Variance in WIL scores was best explained with four error types: consonant additions, incorrect number of syllables, false starts and consonant substitutions/distortions. False starts were significantly associated with AOS diagnosis. Incorrect number of syllables, consonant omissions, false starts, and lexical stress errors increased in frequency for longer words and, while the interaction with diagnosis did not reach significance, the effect appeared driven by the AOS group.Conclusion: Findings provide further support for using polysyllabic word production to assess apraxic speech. The WIL task has limitations that may bias patients' performance and clinicians' perceptual evaluation. Data provide valuable information for designing a more sensitive diagnostic protocol for AOS.
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Affiliation(s)
- Anisah Md Nor
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Masso
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Charles Sturt University, Bathurst Campus, Bathurst, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Frontotemporal Dementia Research Group, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
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18
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Van Sickle A, Dembowski J. Case study: use of sentence completion with a person with aphasia and apraxia of speech. CLINICAL LINGUISTICS & PHONETICS 2022:1-14. [PMID: 35445636 DOI: 10.1080/02699206.2022.2062577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Several interventions for acquired apraxia of speech (AOS) involve models, imitation, or repetition to elicit production of words. Early researchers wrote about anecdotal experiences, in which sentence completion facilitated speech production for individuals with AOS. The use of sentence completion to elicit production of words during intervention has not been systematically researched. The purpose of this research was to evaluate the effectiveness of sentence completion to elicit correct productions of words, as part of an intervention for one individual with aphasia and AOS. Training occurred three times a week for six weeks. In each session, the participant answered 20 simple questions, for which the answer was one of 20 target words. Ten of these 20 words were used for training, while the other set of 10 words remained untrained. During training, the participant produced words, as the final word of a sentence. The participant improved production of the trained target words. By the end of training, the participant produced more words, as the final word in a sentence and as the answer to a simple question. For this case study, an individual with severe Broca's aphasia and severe AOS increased the number of personally-relevant words produced following training using sentence completion to elicit production.
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Affiliation(s)
- Angela Van Sickle
- Department of Speech, Language and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - James Dembowski
- Department of Speech, Language and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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19
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Conterno M, Kümmerer D, Dressing A, Glauche V, Urbach H, Weiller C, Rijntjes M. Speech apraxia and oral apraxia: association or dissociation? A multivariate lesion-symptom mapping study in acute stroke patients. Exp Brain Res 2021; 240:39-51. [PMID: 34652492 PMCID: PMC8803819 DOI: 10.1007/s00221-021-06224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
The anatomical relationship between speech apraxia (SA) and oral apraxia (OA) is still unclear. To shed light on this matter we studied 137 patients with acute ischaemic left-hemisphere stroke and performed support vector regression-based, multivariate lesion–symptom mapping. Thirty-three patients presented with either SA or OA. These two symptoms mostly co-occurred (n = 28), except for few patients with isolated SA (n = 2) or OA (n = 3). All patient with either SA or OA presented with aphasia (p < 0.001) and these symptoms were highly associated with apraxia (p < 0.001). Co-occurring SA and OA were predominantly associated with insular lesions, while the insula was completely spared in the five patients with isolated SA or OA. Isolated SA occurred in case of frontal lesions (prefrontal gyrus and superior longitudinal fasciculus), while isolated OA occurred in case of either temporoparietal or striatocapsular lesions. Our study supports the notion of a predominant, but not exclusive, role of the insula in verbal and non-verbal oral praxis, and indicates that frontal regions may contribute exclusively to verbal oral praxis, while temporoparietal and striatocapsular regions contribute to non-verbal oral praxis. However, since tests for SA and OA so far intrinsically also investigate aphasia and apraxia, refined tests are warranted.
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Affiliation(s)
- Martina Conterno
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany. .,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.
| | - Dorothee Kümmerer
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Andrea Dressing
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Volkmar Glauche
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cornelius Weiller
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Michel Rijntjes
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
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20
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Miller HE, Ballard KJ, Campbell J, Smith M, Plante AS, Aytur SA, Robin DA. Improvements in Speech of Children with Apraxia: The Efficacy of Treatment for Establishing Motor Program Organization (TEMPO SM). Dev Neurorehabil 2021; 24:494-509. [PMID: 34241564 DOI: 10.1080/17518423.2021.1916113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: This study investigated the efficacy of Treatment for Establishing Motor Program Organization (TEMPOSM) in childhood apraxia of speech (CAS).Method: A mixed between- and within-participant design with multiple baselines across participants and behaviors was used to examine acquisition, generalization, and maintenance of skills. TEMPOSM was administered in four one-hour sessions a week over a four-week period for eleven participants (ages 5 to 8), allocated to either an immediate treatment group or a wait-list control group. Acoustic and perceptual variables were measured at baseline, immediate post-treatment, and one-month post-treatment.Results: Children demonstrated significant improvements in specific acoustic measures of segmentation and lexical stress, as well as perceptual measures of fluency, lexical stress, and speech-sound accuracy. Treatment and generalization effects were maintained one-month post-treatment with generalization to untreated stimuli.Conclusion: TEMPOSM was efficacious in improving segmental and suprasegmental impairments in the speech of children with CAS.
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21
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Landin-Romero R, Liang CT, Monroe PA, Higashiyama Y, Leyton CE, Hodges JR, Piguet O, Ballard KJ. Brain changes underlying progression of speech motor programming impairment. Brain Commun 2021; 3:fcab205. [PMID: 34541532 PMCID: PMC8445394 DOI: 10.1093/braincomms/fcab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Aquired apraxia of speech is a disorder that impairs speech production, despite intact peripheral neuromotor function. Its pathomechanism remains to be established. Neurodegenerative lesion models provide an unequalled opportunity to explore the neural correlates of apraxia of speech, which is present in a subset of patients diagnosed with non-semantic variants of primary progressive aphasia. The normalized pairwise variability index, an acoustic measure of speech motor programming, has shown high sensitivity and specificity for apraxia of speech in cross-sectional studies. Here, we aimed to examine the strength of the pairwise variability index and overall word duration (i.e. articulation rate) as markers of progressive motor programming deficits in primary progressive aphasia with apraxia of speech. Seventy-nine individuals diagnosed with primary progressive aphasia (39 with non-fluent variant and 40 with logopenic variant) and 40 matched healthy controls participated. Patients were followed-up annually (range 1-6 years, median number of visits = 2). All participants completed a speech assessment task and a high-resolution MRI. Our analyses investigated trajectories of speech production (e.g. pairwise variablity index and word duration) and associations with cortical atrophy in the patients. At first presentation, word duration differentiated the nonfluent and logopenic cases statistically, but the range of scores overlapped substantially across groups. Longitudinally, we observed progressive deterioration in pairwise variability index and word duration specific to the non-fluent group only. The pairwise variability index showed particularly strong associations with progressive atrophy in speech motor programming brain regions. Of novelty, our results uncovered a key role of the right frontal gyrus in underpinning speech motor programming changes in non-fluent cases, highlighting the importance of right-brain regions in responding to progressive neurological changes in the speech motor network. Taken together, our findings validate the use of a new metric, the pairwise variability index, as a robust marker of apraxia of speech in contrast to more generic measures of speaking rate. Sensitive/specific neuroimaging biomarkers of the emergence and progression of speech impairments will be useful to inform theories of the pathomechanisms underpinning impaired speech motor control. Our findings justify developing more sensitive measures of rhythmic temporal control of speech that may enable confident detection of emerging speech disturbances and more sensitive tracking of intervention-related changes for pharmacological, neuromodulatory and behavioural interventions. A more reliable detection of speech disturbances has relevance for patient care, with predominance of progressive apraxia of speech a high-risk factor for later diagnosis of progressive supranuclear palsy or corticobasal degeneration.
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Affiliation(s)
- Ramon Landin-Romero
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Cheng T Liang
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Penelope A Monroe
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yuichi Higashiyama
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Cristian E Leyton
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John R Hodges
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kirrie J Ballard
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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22
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Vitti E, Mauszycki S, Bunker L, Wambaugh J. Stability of Speech Intelligibility Measures Over Repeated Sampling Times in Speakers With Acquired Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1429-1445. [PMID: 33761278 DOI: 10.1044/2020_ajslp-20-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this investigation was to measure the test-retest stability of single-word intelligibility in a group of 28 speakers with chronic apraxia of speech and aphasia. Method The Assessment of Intelligibility of Dysarthric Speech was administered twice to each participant, with samples separated by 1 week. Scoring of recorded samples was completed independently by three expert listeners using transcription and multiple-choice scoring formats. Results Percent intelligible words was very similar for the group over the two sampling times for both scoring formats (i.e., within 1.5%), with no statistically significant differences found between times. Statistically significant, very strong, positive correlations were found between sampling times for intelligibility scores. Transcription and multiple-choice scores were strongly, positively correlated, with multiple-choice scores being statistically higher. There was a statistically significant difference between mean transcription and multiple-choice scores for the group at Time 1 and Time 2. Individual performance was similar to group performance for the majority of participants. Conclusions These findings indicate that single-word intelligibility measures are stable over repeated sampling occasions. Stability was evident for transcription and multiple-choice scoring methods. Supplemental Material https://doi.org/10.23641/asha.14226737.
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Affiliation(s)
- Emilia Vitti
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Shannon Mauszycki
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Lisa Bunker
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie Wambaugh
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
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23
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Mailend ML, Maas E, Story BH. Apraxia of speech and the study of speech production impairments: Can we avoid further confusion? Reply to Romani (2021). Cogn Neuropsychol 2021; 38:309-317. [PMID: 34881683 PMCID: PMC10011684 DOI: 10.1080/02643294.2021.2009790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We agree with Cristina Romani (CR) about reducing confusion and agree that the issues raised in her commentary are central to the study of apraxia of speech (AOS). However, CR critiques our approach from the perspective of basic cognitive neuropsychology. This is confusing and misleading because, contrary to CR's claim, we did not attempt to inform models of typical speech production. Instead, we relied on such models to study the impairment in the clinical category of AOS (translational cognitive neuropsychology). Thus, the approach along with the underlying assumptions is different. This response aims to clarify these assumptions, broaden the discussion regarding the methodological approach, and address CR's concerns. We argue that our approach is well-suited to meet the goals of our recent studies and is commensurate with the current state of the science of AOS. Ultimately, a plurality of approaches is needed to understand a phenomenon as complex as AOS.
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Affiliation(s)
- Marja-Liisa Mailend
- Moss Rehabilitation Research Institute, Einstein Healthcare Network, Elkins Park, PA, USA.,Department of Special Education, University of Tartu, Tartu, Estonia
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, USA
| | - Brad H Story
- Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
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Scholl DI, McCabe P, Nickels L, Ballard KJ. Outcomes of semantic feature analysis treatment for aphasia with and without apraxia of speech. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:485-500. [PMID: 33590683 DOI: 10.1111/1460-6984.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND To date, studies have not explored whether a dual diagnosis of aphasia plus apraxia of speech (AOS) versus aphasia alone (APH) affects the response to language-based naming treatments. AIMS To compare the effects of semantic feature analysis (SFA) treatment for individuals with APH versus aphasia plus AOS, and to test if the presence of AOS impacted the effects of treatment. METHODS AND PROCEDURES A non-randomized experimental group study was conducted to explore the treatment, generalization and maintenance effects between the AOS and APH groups. Participants included nine individuals with aphasia and 11 with concomitant aphasia and AOS. Dependent measures included lexical accuracy, number of sound-level distortions, and lexical stress and syllable segmentation errors. OUTCOMES AND RESULTS Both groups showed significantly improved naming accuracy of trained items for up to 2 months post-treatment. Improvement on naming accuracy of untrained items post-treatment, both semantically related and unrelated to trained items, was lower in magnitude. That this may have been due to effects of repeated probing (which included target repetition) or regression to the mean cannot be excluded. There was a tendency for the AOS group to respond slightly better to treatment than the APH group overall, which was not correlated with aphasia severity. Also, measures of phonetic accuracy and fluency improved for both groups, with no main effect of group. Treatment effects did not generalize to formal measures of (untrained) picture naming or expression of correct information units in discourse in a story retelling task. CONCLUSIONS AND IMPLICATIONS Findings indicate that individuals with aphasia plus AOS can gain equivalent benefits in word retrieval and production from the language-based SFA treatment as individuals with aphasia alone. This may be, in part, due to the tendency for SFA to incorporate principles of practice that are known to support motor learning in AOS, such as high intensity, random stimulus presentation and variable practice. Findings provide further support for high-intensity practice and use of self-generated features to facilitate maintenance of effects. What this paper adds What is already known on the subject SFA treatment is the most common intervention for word-finding difficulties for individuals with aphasia. AOS is a common concomitant disorder to aphasia. However, it is not clear whether the effects of language-based SFA treatment are mitigated by the presence of AOS, which tends to respond well to treatments focused on articulatory-kinematic aspects of speech movement. What this paper adds to the existing knowledge This study compares the effects of SFA in a group of individuals with aphasia alone and a group with similar severity of aphasia but with concomitant AOS, ranging from mild to moderate-severe. Overall, AOS did not have a negative effect on response to the treatment. What are the potential or actual clinical implications of this work? Individuals with aphasia plus AOS can be expected to benefit to a similar degree from SFA as people with aphasia alone. It is likely that the use of practice principles of high intensity, random stimulus presentation and varied practice are important components of the protocol.
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Affiliation(s)
- Dominique I Scholl
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Frontotemporal Dementia Research Group (FRONTIER), Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Themistocleous C, Webster K, Tsapkini K. Effects of tDCS on Sound Duration in Patients with Apraxia of Speech in Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11030335. [PMID: 33800933 PMCID: PMC8000042 DOI: 10.3390/brainsci11030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus (IFG) was found to improve oral and written naming in post-stroke and primary progressive aphasia (PPA), speech fluency in stuttering, a developmental speech-motor disorder, and apraxia of speech (AOS) symptoms in post-stroke aphasia. This paper addressed the question of whether tDCS over the left IFG coupled with speech therapy may improve sound duration in patients with apraxia of speech (AOS) symptoms in non-fluent PPA (nfvPPA/AOS) more than sham. Eight patients with non-fluent PPA/AOS received either active or sham tDCS, along with speech therapy for 15 sessions. Speech therapy involved repeating words of increasing syllable-length. Evaluations took place before, immediately after, and two months post-intervention. Words were segmented into vowels and consonants and the duration of each vowel and consonant was measured. Segmental duration was significantly shorter after tDCS compared to sham and tDCS gains generalized to untrained words. The effects of tDCS sustained over two months post-treatment in trained and untrained sounds. Taken together, these results demonstrate that tDCS over the left IFG may facilitate speech production by reducing segmental duration. The results provide preliminary evidence that tDCS may maximize efficacy of speech therapy in patients with nfvPPA/AOS.
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Affiliation(s)
| | - Kimberly Webster
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore, MD 21210, USA;
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21210, USA;
- Correspondence: ; Tel.: +1-410-7362940
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Utianski RL, Martin PR, Hanley H, Duffy JR, Botha H, Clark HM, Whitwell JL, Josephs KA. A Longitudinal Evaluation of Speech Rate in Primary Progressive Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:392-404. [PMID: 33476188 PMCID: PMC8632475 DOI: 10.1044/2020_jslhr-20-00253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/27/2020] [Accepted: 10/24/2020] [Indexed: 05/19/2023]
Abstract
Purpose Individuals with primary progressive apraxia of speech (PPAOS) have apraxia of speech (AOS) in which disruptions in articulation or prosody predominate the speech pattern, referred to, respectively, as phonetic or prosodic subtypes. Many develop aphasia and/or dysarthria. Past research has demonstrated that simple temporal acoustic measures are sensitive to the presence of AOS. The aim of this study was to describe the change in temporal acoustic measures over time and assess if specific patterns of AOS or co-occurring aphasia or dysarthria impact the rate of change over time. Method Durations for multiple productions of the words cat, catnip, catapult, and catastrophe, in an imitative speech task, were recorded for 73 patients, with two to six visits each. A linear mixed-effects model was used to assess the cross-sectional differences and longitudinal influence of AOS subtype and presence of aphasia/dysarthria on speech rate. Pearson correlations were calculated between rate measures and performance on other clinical measures. Results Cross-sectionally, patients with prosodic-predominant PPAOS produced words more slowly than those with phonetic-predominant PPAOS. Patients with either aphasia or dysarthria produced words more slowly than those without. Longitudinally, the speech rate of patients with phonetic-predominant PPAOS had a reduction of 0.5 syllables per second per year. Patients with prosodic-predominant AOS changed less quickly, as did those who developed aphasia. Dysarthria did not impact rate of change. There were strong associations between speech rate measures and other clinical indices of speech and language functioning. Conclusion Simple temporal acoustic measures may reflect the subtype of AOS (phonetic or prosodic predominant), serve as an index of progression of AOS, and inform prognostication relative to the presenting combination of speech and language features. Supplemental Material https://doi.org/10.23641/asha.13564724.
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Affiliation(s)
| | | | - Holly Hanley
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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Mailend ML, Maas E, Beeson PM, Story BH, Forster KI. Examining speech motor planning difficulties in apraxia of speech and aphasia via the sequential production of phonetically similar words. Cogn Neuropsychol 2021; 38:72-87. [PMID: 33249997 PMCID: PMC7895325 DOI: 10.1080/02643294.2020.1847059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 08/11/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
Abstract
This study investigated the underlying nature of apraxia of speech (AOS) by testing two competing hypotheses. The Reduced Buffer Capacity Hypothesis argues that people with AOS can plan speech only one syllable at a time Rogers and Storkel [1999. Planning speech one syllable at a time: The reduced buffer capacity hypothesis in apraxia of speech. Aphasiology, 13(9-11), 793-805. https://doi.org/10.1080/026870399401885]. The Program Retrieval Deficit Hypothesis states that selecting a motor programme is difficult in face of competition from other simultaneously activated programmes Mailend and Maas [2013. Speech motor programming in apraxia of speech: Evidence from a delayed picture-word interference task. American Journal of Speech-Language Pathology, 22(2), S380-S396. https://doi.org/10.1044/1058-0360(2013/12-0101)]. Speakers with AOS and aphasia, aphasia without AOS, and unimpaired controls were asked to prepare and hold a two-word utterance until a go-signal prompted a spoken response. Phonetic similarity between target words was manipulated. Speakers with AOS had longer reaction times in conditions with two similar words compared to two identical words. The Control and the Aphasia group did not show this effect. These results suggest that speakers with AOS need additional processing time to retrieve target words when multiple motor programmes are simultaneously activated.
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Affiliation(s)
- Marja-Liisa Mailend
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
- Marja-Liisa Mailend is now at Moss Rehabilitation Research Institute, Einstein Healthcare Network, Elkins Park, PA, USA
| | - Edwin Maas
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
- Edwin Maas is now at the Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, USA
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
| | - Brad H. Story
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
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Mailend ML, Maas E. To Lump or to Split? Possible Subtypes of Apraxia of Speech. APHASIOLOGY 2020; 35:592-613. [PMID: 33981126 PMCID: PMC8112072 DOI: 10.1080/02687038.2020.1836319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/17/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND The speculation that apraxia of speech (AOS) is not a unitary diagnosis, but consists of different subtypes instead, has been around for decades. However, attempts to empirically substantiate such a notion remain few and far between. AIMS The primary objective of this article is to consider the different bases for identifying subtypes of AOS, review existing evidence regarding subtypes under each classification basis, and provide discussion and implications for future research. MAIN CONTRIBUTION AOS subtypes have been proposed on the basis of clinical symptomatology, theoretical constructs, and an analogy to limb apraxia. Different possible subtypes of AOS are reviewed, along with their empirical support and limitations. Empirical evidence, particularly in the context of a progressive disease, supports the idea that AOS diagnosis may capture different underlying impairments of speech motor planning. Future research to advance our understanding of AOS should carefully consider the basis for subtype classification, and include large sample sizes to differentiate individual variability from possible subtypes. CONCLUSIONS Several proposed AOS subtypes have found some support in the literature. Further research is needed to determine the validity, coherence and utility of possible AOS subtypes for theoretical and clinical purposes.
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Ramage AE, Aytur S, Ballard KJ. Resting-State Functional Magnetic Resonance Imaging Connectivity Between Semantic and Phonological Regions of Interest May Inform Language Targets in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3051-3067. [PMID: 32755498 PMCID: PMC7890222 DOI: 10.1044/2020_jslhr-19-00117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/16/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
Purpose Brain imaging has provided puzzle pieces in the understanding of language. In neurologically healthy populations, the structure of certain brain regions is associated with particular language functions (e.g., semantics, phonology). In studies on focal brain damage, certain brain regions or connections are considered sufficient or necessary for a given language function. However, few of these account for the effects of lesioned tissue on the "functional" dynamics of the brain for language processing. Here, functional connectivity (FC) among semantic-phonological regions of interest (ROIs) is assessed to fill a gap in our understanding about the neural substrates of impaired language and whether connectivity strength can predict language performance on a clinical tool in individuals with aphasia. Method Clinical assessment of language, using the Western Aphasia Battery-Revised, and resting-state functional magnetic resonance imaging data were obtained for 30 individuals with chronic aphasia secondary to left-hemisphere stroke and 18 age-matched healthy controls. FC between bilateral ROIs was contrasted by group and used to predict Western Aphasia Battery-Revised scores. Results Network coherence was observed in healthy controls and participants with stroke. The left-right premotor cortex connection was stronger in healthy controls, as reported by New et al. (2015) in the same data set. FC of (a) connections between temporal regions, in the left hemisphere and bilaterally, predicted lexical-semantic processing for auditory comprehension and (b) ipsilateral connections between temporal and frontal regions in both hemispheres predicted access to semantic-phonological representations and processing for verbal production. Conclusions Network connectivity of brain regions associated with semantic-phonological processing is predictive of language performance in poststroke aphasia. The most predictive connections involved right-hemisphere ROIs-particularly those for which structural adaptions are known to associate with recovered word retrieval performance. Predictions may be made, based on these findings, about which connections have potential as targets for neuroplastic functional changes with intervention in aphasia. Supplemental Material https://doi.org/10.23641/asha.12735785.
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Affiliation(s)
- Amy E. Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
| | - Semra Aytur
- Department of Health Policy and Management, University of New Hampshire, Durham
| | - Kirrie J. Ballard
- Faculty of Medicine and Health and the Brain and Mind Centre, The University of Sydney, New South Wales, Australia
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Allison KM, Cordella C, Iuzzini-Seigel J, Green JR. Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2952-2994. [PMID: 32783767 PMCID: PMC7890226 DOI: 10.1044/2020_jslhr-20-00061] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Claire Cordella
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston
| | - Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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Speights Atkins M, Bailey DJ, Boyce SE. Speech exemplar and evaluation database (SEED) for clinical training in articulatory phonetics and speech science. CLINICAL LINGUISTICS & PHONETICS 2020; 34:878-886. [PMID: 32200647 DOI: 10.1080/02699206.2020.1743761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
One challenge faced by teachers of phonetics, speech science, and clinical speech disorders courses is providing meaningful instruction that closes the theory to practice gap. One barrier to providing this type of deep learning experience is the lack of publicly available examples of speech recordings that illustrate comparisons between typical and disordered speech production across a broad range of disorder populations. Data of this type exist, but are typically collected for specific research projects under narrowly written IRB protocols that do not allow for release of even de-identified speech recordings to other investigators or teachers. As a partial corrective to this problem, we have developed an approved publicly available database of speech recordings that provides illustrative examples of adult and child speech production from individuals with and without speech disorders. The recorded speech materials were designed to illustrate important clinical concepts, and the recordings were collected under controlled conditions using high-quality equipment. The ultimate goal of creating this corpus is to improve practitioners' and scientists' understanding of the scientific bases of knowledge in our profession and improve our ability to develop clinical scientists and young researchers in the field.
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Affiliation(s)
| | - Dallin J Bailey
- Communication Disorders, Auburn University , Auburn, AL, USA
| | - Suzanne E Boyce
- Communication Sciences and Disorders, University of Cincinnati , Cincinnati, OH, USA
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Tetzloff KA, Duffy JR, Clark HM, Utianski RL, Strand EA, Machulda MM, Botha H, Martin PR, Schwarz CG, Senjem ML, Reid RI, Gunter JL, Spychalla AJ, Knopman DS, Petersen RC, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Progressive agrammatic aphasia without apraxia of speech as a distinct syndrome. Brain 2020; 142:2466-2482. [PMID: 31199471 DOI: 10.1093/brain/awz157] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
Agrammatic aphasia affects grammatical language production and can result from a neurodegenerative disease. Although it typically presents with concomitant apraxia of speech, this is not always the case. Little is known about the clinical course and imaging features of patients that present with agrammatism in the absence of apraxia of speech, which we will refer to as progressive agrammatic aphasia. We aimed to make a detailed description of the longitudinal clinical, linguistic, and neuroimaging features of a cohort of 11 patients with progressive agrammatic aphasia to provide a complete picture of this syndrome. All patients underwent detailed speech and language, neurological and neuropsychological assessments, 3 T structural and diffusion tensor imaging MRI, 18F-fluorodeoxyglucose and Pittsburgh compound B PET. The 11 patients were matched by age and gender to 22 patients who had mixed apraxia of speech and agrammatism. The progressive agrammatic aphasia patients performed abnormally on tests of language, general cognition, executive function, and functional ability at baseline and declined in these measures over time. Only two patients eventually developed apraxia of speech, while parkinsonism was absent-to-mild throughout all visits for all patients. When compared to the patients with mixed apraxia of speech and agrammatism, the patients with progressive agrammatic aphasia performed better on tests of motor speech and parkinsonism but more poorly, and declined faster over time, on tests of general aphasia severity, agrammatism, and naming. The patients with progressive agrammatic aphasia also showed different neuroimaging abnormalities, with greater atrophy, hypometabolism and white matter tract degeneration in the prefrontal and anterior temporal lobes compared to patients with mixed apraxia of speech and agrammatism. These differences were more pronounced as the disease progressed. These results demonstrate that progressive agrammatic aphasia has a different clinical disease course and different underlying neuroanatomical abnormalities than patients with the more common syndrome of mixed agrammatism and apraxia of speech. This supports the distinction of progressive agrammatic aphasia and has implications for the classification of patients with agrammatic aphasia.
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Affiliation(s)
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Peter R Martin
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Duncan ES, Donovan NJ, Sajjadi SA. Clinical Assessment of Characteristics of Apraxia of Speech in Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:485-497. [PMID: 31419154 DOI: 10.1044/2019_ajslp-cac48-18-0225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose We sought to examine interrater reliability in clinical assessment of apraxia of speech (AOS) in individuals with primary progressive aphasia and to identify speech characteristics predictive of AOS diagnosis. Method Fifty-two individuals with primary progressive aphasia were recorded performing a variety of speech tasks. These recordings were viewed by 2 experienced speech-language pathologists, who independently rated them on the presence and severity of AOS as well as 14 associated speech characteristics. We calculated interrater reliability (percent agreement and Cohen's kappa) for these ratings. For each rater, we used stepwise regression to identify speech characteristics significantly predictive of AOS diagnosis. We used the overlap between raters to create a more parsimonious model, which we evaluated with multiple linear regression. Results Results yielded high agreement on the presence (90%) and severity of AOS (weighted Cohen's κ = .834) but lower agreement for specific speech characteristics (weighted Cohen's κ ranging from .036 to .582). Stepwise regression identified 2 speech characteristics predictive of AOS diagnosis for both raters (articulatory groping and increased errors with increased length/complexity). These alone accounted for ≥ 50% of the variance of AOS severity in the constrained model. Conclusions Our study adds to a growing body of research that highlights the difficulty in objective clinical characterization of AOS and perceptual characterization of speech features. It further supports the need for consensus diagnostic criteria with standardized testing tools and for the identification and validation of objective markers of AOS. Additionally, these findings underscore the need for a training protocol if diagnostic tools are to be effective when shared beyond the research teams that develop and test them and disseminated to practicing speech-language pathologists, in order to ensure consistent application.
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Affiliation(s)
- E Susan Duncan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - Neila J Donovan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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Bislick L, Hula WD. Perceptual Characteristics of Consonant Production in Apraxia of Speech and Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1411-1431. [PMID: 31454259 DOI: 10.1044/2019_ajslp-18-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690.
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Affiliation(s)
- Lauren Bislick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - William D Hula
- VA Pittsburgh Healthcare System, PA
- University of Pittsburgh, PA
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Bailey DJ, Bunker L, Mauszycki S, Wambaugh JL. Reliability and stability of the metrical stress effect on segmental production accuracy in persons with apraxia of speech. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:902-913. [PMID: 31338954 DOI: 10.1111/1460-6984.12493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acquired apraxia of speech (AOS) involves speech-production deficits on both the segmental and suprasegmental levels. Recent research has identified a non-linear interaction between the metrical structure of bisyllabic words and word-production accuracy in German speakers with AOS, with trochaic words (strong-weak stress) being resistant to errors compared with iambic words (weak-strong). AIMS To replicate previous findings in English speakers with AOS, to measure the test-retest reliability of the effect, and to examine the potential impact of different methods of word scoring. METHODS & PROCEDURES Speech samples were collected from 27 speakers with AOS and aphasia. Participants were at least 12 months post-stroke or penetrating brain injury, and represented a large range of AOS and aphasia severities. Productions were elicited via verbal model. Sampling was conducted on three separate occasions: the initial data-collection session and then repeated samplings at 1- and 4-week intervals. Bisyllabic words with a CVCVC segmental structure were selected. The list was divided into sublists representing differing lexical stress patterns: A list of 42 trochees, and one of 37 iambs. All speech samples were phonetically transcribed and then aligned with canonical transcriptions via an edit distance algorithm that followed transcription alignment principles. Phonetic-level errors (distortions) were penalized less severely than phonemic-level errors. Per cent consonants correct and whole-word accuracy were also examined. Trochee and iamb lists were analysed separately. OUTCOMES & RESULTS Paired samples t-tests indicated that the modified edit distance was significantly lower for the trochee lists than for the iamb lists. There was a lack of a significant effect of time on the absolute difference between modified edit distance for both lists. Intraclass coefficients suggested the list and procedures used are appropriate as an outcome measure for group research. CONCLUSIONS & IMPLICATIONS The results suggest that in English, as in German, the trochaic structure is more resistant to segmental errors in persons with AOS and aphasia, providing replication of the findings of Aichert et al. in 2016. Further, this effect is stable over repeated sampling occasions. Implications for clinical management of AOS include possible ways to scaffold item difficulty and potentially improve stimulus generalization.
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Affiliation(s)
- Dallin J Bailey
- Department of Communication Disorders, Auburn University, Auburn, AL, USA
| | - Lisa Bunker
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Shannon Mauszycki
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Julie L Wambaugh
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
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Molloy J, Jagoe C. Use of diverse diagnostic criteria for acquired apraxia of speech: a scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:875-893. [PMID: 31322824 DOI: 10.1111/1460-6984.12494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is a growing body of evidence that speech and language therapy (SLT) intervention is effective in improving communication ability for individuals with non-progressive acquired apraxia of speech (AOS). However, there is no universally agreed diagnostic standard for AOS, and diverging opinions on its diagnostic features. This has led to claims that diverse diagnostic criteria may be used to select participants for AOS research studies. These claims raise concerns for evidence-based practice in AOS but have yet to be systematically investigated. AIMS To determine the presence, nature and extent of diversity in the diagnostic criteria for non-progressive AOS used in both published studies and clinical practice internationally. METHODS & PROCEDURES The study used a scoping review methodology that followed the 2005 framework of Arksey and O'Malley and included a consultation exercise in the form of an online survey of international SLTs. The scoping review included 157 studies involving participants with acquired AOS, published between 1997 and 2017. There were 264 respondents to the online survey of SLTs, with a completion rate of 72%. Respondents came from 15 countries and had varying levels of clinical experience. MAIN CONTRIBUTION This study found that no common set of diagnostic criteria for AOS was used universally across research and practice. Although the diagnostic criteria used to select participants with AOS were reported explicitly in most studies, they varied from study to study. Some studies used directly conflicting criteria. Use of specific diagnostic criteria in studies was influenced by year of publication but not by location. There was a trend towards increasing consistency in diagnostic criteria in recent years. Compared with the research, the survey revealed relatively greater consistency among SLTs on the speech features considered indicative of AOS, although the SLTs who responded to the survey showed variation in how diagnostic criteria were combined into sets. Use of specific diagnostic criteria was not associated with SLTs' location or experience. There were differences between the diagnostic criteria for AOS used most commonly in research studies and those selected most commonly by SLTs in the survey. These findings have implications for the generalizability of AOS research to clinical practice, as well as implications for effective research synthesis. CONCLUSIONS & IMPLICATIONS The claim that research and practice in the field of AOS is characterized by the use of diverse diagnostic criteria is supported by this scoping review. The findings support the need to develop a universal consensus standard for AOS diagnosis to ensure consistency across research and clinical practice.
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Affiliation(s)
- Jessica Molloy
- Department of Clinical Speech & Language Studies, School of Linguistic Speech and Communication Sciences, Trinity College Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Caroline Jagoe
- Department of Clinical Speech & Language Studies, School of Linguistic Speech and Communication Sciences, Trinity College Dublin, Ireland
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Ballard KJ, Etter NM, Shen S, Monroe P, Tien Tan C. Feasibility of Automatic Speech Recognition for Providing Feedback During Tablet-Based Treatment for Apraxia of Speech Plus Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:818-834. [PMID: 31306595 DOI: 10.1044/2018_ajslp-msc18-18-0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Individuals with neurogenic speech disorders require ongoing therapeutic support to achieve functional communication goals. Alternative methods for service delivery, such as tablet-based speech therapy applications, may help bridge the gap and bring therapeutic interventions to the patient in an engaging way. The purpose of this study was to evaluate an iPad-based speech therapy app that uses automatic speech recognition (ASR) software to provide feedback on speech accuracy to determine the ASR's accuracy against human judgment and whether participants' speech improved with this ASR-based feedback. Method Five participants with apraxia of speech plus aphasia secondary to stroke completed an intensive 4-week at-home therapy program using a novel word training app with built-in ASR. Multiple baselines across participants and behaviors designs were employed, with weekly probes and follow-up at 1 month posttreatment. Four sessions a week of 100 practice trials each were prescribed, with 1 being clinician-run and the remainder done independently. Dependent variables of interest were ASR-human agreement on accuracy during practice trials and human-judged word production accuracy over time in probes. Also, user experience surveys were completed immediately posttreatment. Results ASR-human agreement on accuracy averaged ~80%, which is a common threshold applied for interrater agreement. All participants demonstrated improved word production accuracy over time with the ASR-based feedback and maintenance of gains after 1 month. All participants reported enjoying using the app with support of a speech pathologist. Conclusion For these participants with apraxia of speech plus aphasia due to stroke, satisfactory gains were made in word production accuracy with an app-based therapy program providing ASR-based feedback on accuracy. Findings support further testing of this ASR-based approach as a supplement to clinician-run sessions to assist clients with similar profiles in achieving higher amount and intensity of practice as well as empowering them to manage their own therapy program. Supplemental Material https://doi.org/10.23641/asha.8206628.
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Affiliation(s)
- Kirrie J Ballard
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Nicole M Etter
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Songjia Shen
- Games Studio, University of Technology Sydney, New South Wales, Australia
| | - Penelope Monroe
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chek Tien Tan
- InfoComm Technology Cluster, Singapore Institute of Technology, Singapore
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Wambaugh JL, Bailey DJ, Mauszycki SC, Bunker LD. Interrater Reliability and Concurrent Validity for the Apraxia of Speech Rating Scale 3.0: Application With Persons With Acquired Apraxia of Speech and Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:895-904. [PMID: 31306600 DOI: 10.1044/2018_ajslp-msc18-18-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This investigation was designed to provide interrater reliability data for the Apraxia of Speech Rating Scale 3.0 (ASRS 3.0; Strand, Duffy, Clark, & Josephs, 2014 ). Importantly, ratings were completed by investigators who were not involved with the ASRS development. Another aim was to evaluate the relationship of the ASRS 3.0 total score to word intelligibility. Method Two investigators independently completed ASRS 3.0 ratings for 28 participants with chronic apraxia of speech and aphasia. Intelligibility scores were obtained for all participants. Results Consistency of ratings for each feature and total score of the ASRS 3.0 was measured using intraclass correlation coefficients. Twelve of 13 intraclass correlation coefficients for feature ratings reached significance; clinical meaningfulness ranged from poor to excellent. Interrater reliability for the total scores was excellent. Similarly, absolute difference of ratings was minimal for the total scores, but varied across the 13 feature ratings. Correlations between the intelligibility scores and ASRS 3.0 total score were moderate to strong. Conclusion The total ASRS 3.0 score may be viewed as a reliable indicator of prevalence of apraxia of speech features. Although there was good to acceptable correspondence in ratings of the majority of the individual features, additional operationalization of rating procedures may be needed to improve interrater reliability for a few features.
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Affiliation(s)
- Julie L Wambaugh
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Dallin J Bailey
- Department of Communication Disorders, Auburn University, AL
| | - Shannon C Mauszycki
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Lisa D Bunker
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
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MacPherson MK. Cognitive Load Affects Speech Motor Performance Differently in Older and Younger Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1258-1277. [PMID: 31051090 DOI: 10.1044/2018_jslhr-s-17-0222] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to determine the impact of cognitive load imposed by a speech production task on the speech motor performance of healthy older and younger adults. Response inhibition, selective attention, and working memory were the primary cognitive processes of interest. Method Twelve healthy older and 12 healthy younger adults produced multiple repetitions of 4 sentences containing an embedded Stroop task in 2 cognitive load conditions: congruent and incongruent. The incongruent condition, which required participants to suppress orthographic information to say the font colors in which color words were written, represented an increase in cognitive load relative to the congruent condition in which word text and font color matched. Kinematic measures of articulatory coordination variability and movement duration as well as a behavioral measure of sentence production accuracy were compared between groups and conditions and across 3 sentence segments (pre-, during-, and post-Stroop). Results Increased cognitive load in the incongruent condition was associated with increased articulatory coordination variability and movement duration, compared to the congruent Stroop condition, for both age groups. Overall, the effect of increased cognitive load was greater for older adults than younger adults and was greatest in the portion of the sentence in which cognitive load was manipulated (during-Stroop), followed by the pre-Stroop segment. Sentence production accuracy was reduced for older adults in the incongruent condition. Conclusions Increased cognitive load involving response inhibition, selective attention, and working memory processes within a speech production task disrupted both the stability and timing with which speech was produced by both age groups. Older adults' speech motor performance may have been more affected due to age-related changes in cognitive and motoric functions that result in altered motor cognition.
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Affiliation(s)
- Megan K MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
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Borrie SA, Barrett TS, Willi MM, Berisha V. Syncing Up for a Good Conversation: A Clinically Meaningful Methodology for Capturing Conversational Entrainment in the Speech Domain. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:283-296. [PMID: 30950701 PMCID: PMC6436892 DOI: 10.1044/2018_jslhr-s-18-0210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose Conversational entrainment, the phenomenon whereby communication partners synchronize their behavior, is considered essential for productive and fulfilling conversation. Lack of entrainment could, therefore, negatively impact conversational success. Although studied in many disciplines, entrainment has received limited attention in the field of speech-language pathology, where its implications may have direct clinical relevance. Method A novel computational methodology, informed by expert clinical assessment of conversation, was developed to investigate conversational entrainment across multiple speech dimensions in a corpus of experimentally elicited conversations involving healthy participants. The predictive relationship between the methodology output and an objective measure of conversational success, communicative efficiency, was then examined. Results Using a real versus sham validation procedure, we find evidence of sustained entrainment in rhythmic, articulatory, and phonatory dimensions of speech. We further validate the methodology, showing that models built on speech signal entrainment measures consistently outperform models built on nonentrained speech signal measures in predicting communicative efficiency of the conversations. Conclusions A multidimensional, clinically meaningful methodology for capturing conversational entrainment, validated in healthy populations, has implications for disciplines such as speech-language pathology where conversational entrainment represents a critical knowledge gap in the field, as well as a potential target for remediation.
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Affiliation(s)
- Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Tyson S. Barrett
- Department of Kinesiology and Health Sciences, Utah State University, Logan
| | - Megan M. Willi
- Department of Communication Sciences and Disorders, California State University, Chico
| | - Visar Berisha
- Department of Speech and Hearing Science, Arizona State University, Tempe
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe
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Anderlini D, Wallis G, Marinovic W. Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation. Neurorehabil Neural Repair 2019; 33:167-178. [PMID: 30757952 DOI: 10.1177/1545968319829454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca's aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca's area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.
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Affiliation(s)
- Deanna Anderlini
- 1 The University of Queensland, St Lucia, Queensland, Australia.,2 Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Guy Wallis
- 1 The University of Queensland, St Lucia, Queensland, Australia
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Haley KL, Jacks A. Word-level prosodic measures and the differential diagnosis of apraxia of speech. CLINICAL LINGUISTICS & PHONETICS 2019; 33:479-495. [PMID: 30486684 PMCID: PMC6428596 DOI: 10.1080/02699206.2018.1550813] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Impaired production of prosody is considered a primary diagnostic criterion for apraxia of speech. In this study, we examined diagnostic relevance for five word-level prosody measures. Seven speakers with AOS, nine with aphasia and no AOS, and 19 age-matched neurotypical controls produced nine words consisting of three or four syllables. Lexical stress indices were computed based on relative values for duration, fundamental frequency, and intensity across pairs of unstressed-stressed syllables with varying intrinsic vowel duration contrast patterns. A simple average syllable duration measure was also obtained. AOS speakers differed from the other two groups on three metrics that were solely or primarily derived from duration measures. The degree of diagnostic overlap was smallest for the syllable duration metric, which also showed the strongest inter-observer reliability and most complete overlap between neurotypical speakers and speakers with aphasia and no AOS. Vowel intrinsic durational properties affected lexical stress metrics significantly, indicating a need to select word targets purposefully. Based on these results, it appears that the average syllable duration metric is a more stable and informative alternative for differential diagnostic purposes. The results will, however, need to be replicated in a larger sample.
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Affiliation(s)
- Katarina L Haley
- a Department of Allied Health Sciences , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , NC , USA
| | - Adam Jacks
- a Department of Allied Health Sciences , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , NC , USA
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Ballard KJ, Halaki M, Sowman P, Kha A, Daliri A, Robin DA, Tourville JA, Guenther FH. An Investigation of Compensation and Adaptation to Auditory Perturbations in Individuals With Acquired Apraxia of Speech. Front Hum Neurosci 2018; 12:510. [PMID: 30618687 PMCID: PMC6305734 DOI: 10.3389/fnhum.2018.00510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 12/05/2018] [Indexed: 12/29/2022] Open
Abstract
Two auditory perturbation experiments were used to investigate the integrity of neural circuits responsible for speech sensorimotor adaptation in acquired apraxia of speech (AOS). This has implications for understanding the nature of AOS as well as normal speech motor control. Two experiments were conducted. In Experiment 1, compensatory responses to unpredictable fundamental frequency (F0) perturbations during vocalization were investigated in healthy older adults and adults with acquired AOS plus aphasia. F0 perturbation involved upward and downward 100-cent shifts versus no shift, in equal proportion, during 2 s vocalizations of the vowel /a/. In Experiment 2, adaptive responses to sustained first formant (F1) perturbations during speech were investigated in healthy older adults, adults with AOS and adults with aphasia only (APH). The F1 protocol involved production of the vowel /ε/ in four consonant-vowel words of Australian English (pear, bear, care, dare), and one control word with a different vowel (paw). An unperturbed Baseline phase was followed by a gradual Ramp to a 30% upward F1 shift stimulating a compensatory response, a Hold phase where the perturbation was repeatedly presented with alternating blocks of masking trials to probe adaptation, and an End phase with masking trials only to measure persistence of any adaptation. AOS participants showed normal compensation to unexpected F0 perturbations, indicating that auditory feedback control of low-level, non-segmental parameters is intact. Furthermore, individuals with AOS displayed an adaptive response to sustained F1 perturbations, but age-matched controls and APH participants did not. These findings suggest that older healthy adults may have less plastic motor programs that resist modification based on sensory feedback, whereas individuals with AOS have less well-established and more malleable motor programs due to damage from stroke.
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Affiliation(s)
- Kirrie J. Ballard
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Mark Halaki
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Paul Sowman
- Department of Cognitive Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alise Kha
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Ayoub Daliri
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, United States
| | - Donald A. Robin
- Department of Communication Sciences and Disorders, Interdisciplinary Program in Neuroscience and Behavior, University of New Hampshire, Durham, NH, United States
| | - Jason A. Tourville
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Frank H. Guenther
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
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Utianski RL, Duffy JR, Clark HM, Strand EA, Boland SM, Machulda MM, Whitwell JL, Josephs KA. Clinical Progression in Four Cases of Primary Progressive Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1303-1318. [PMID: 30458509 PMCID: PMC6436456 DOI: 10.1044/2018_ajslp-17-0227] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/14/2018] [Indexed: 05/12/2023]
Abstract
PURPOSE This case series details the clinical progression of patients with primary progressive apraxia of speech (PPAOS) to illustrate, using several methods and supplemental material examples, the changes that occur in speech and language functioning in this patient population. METHOD Four patients who presented with PPAOS were followed between 5 and 6 years. Two patients had predominant articulatory abnormalities (termed phonetic PPAOS), 1 had predominant prosodic abnormalities (prosodic PPAOS), and 1 had relatively equal articulatory and prosodic abnormalities (mixed PPAOS). Detailed speech (including acoustics), language, neurologic, and neuropsychological data were collected. RESULTS At initial exam, the patients ranged from 60 to 77 years old, with presenting disease duration of 1.5-10 years. Although all patients presented with an isolated apraxia of speech, all developed varying degrees of aphasia and dysarthria. Patients with phonetic PPAOS developed relatively more severe aphasia than the other 2 patients. All patients eventually had severe functional communication limitations and required alternative or augmentative means of communication, although at varying times postonset of their initial speech problem. Two patients developed dysphagia, 3 showed mild-moderate Parkinsonism, and 2 developed depression. For all patients, simple temporal acoustic measurements documented slowed speech rate over time. CONCLUSIONS This case series demonstrates that patients who initially present with PPAOS may develop aphasia and dysarthria, cognitive and behavioral changes, and other neurologic signs. Whether these changes can be predicted by the perceptual characteristics of the apraxia of speech is yet to be determined. The detailed longitudinal profiles provide valuable clinical insight into the progression of disease in people with PPAOS. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.7051616.
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Affiliation(s)
| | | | | | | | | | - Mary M. Machulda
- Department of Psychiatry & Psychology Services, Mayo Clinic, Rochester, MN
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Basilakos A. Contemporary Approaches to the Management of Post-stroke Apraxia of Speech. Semin Speech Lang 2018; 39:25-36. [PMID: 29359303 DOI: 10.1055/s-0037-1608853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Apraxia of speech (AOS) is a motor speech disorder that disrupts the planning and programming of speech motor movements. In the acute stage of stroke recovery, AOS following unilateral (typically) left hemisphere stroke can occur alongside dysarthria, an impairment in speech execution and control, and/or aphasia, a higher-level impairment in language function. At this time, perceptual evaluation (the systematic, although subjective, description of speech and voice characteristics) is perhaps the only "gold standard" for differential diagnosis when it comes to motor speech disorders. This poses a challenge for speech-language pathologists charged with the evaluation of poststroke communication abilities, as distinguishing production impairments associated with AOS from those that can occur in aphasia and/or dysarthria can be difficult, especially when more than one deficit is present. Given the need for more objective, reliable methods to identify and diagnose AOS, several studies have turned to acoustic evaluation and neuroimaging to supplement clinical assessment. This article focuses on these recent advances. Studies investigating acoustic evaluation of AOS will be reviewed, as well as those that have considered the extent that neuroimaging can guide clinical decision making. Developments in the treatment of AOS will also be discussed. Although more research is needed regarding the use of these methods in everyday clinical practice, the studies reviewed here show promise as emerging tools for the management of AOS.
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Affiliation(s)
- Alexandra Basilakos
- Arnold School of Public Health, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
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L’apport critique de l’évaluation de la communication dans le diagnostic précoce de l’apraxie primaire progressive de la parole. Can J Aging 2017; 37:50-59. [DOI: 10.1017/s0714980817000502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTPrimary progressive apraxia of speech (PPAoS) is a neurodegenerative syndrome characterized by speech apraxia at its onset; as it progresses, it often evolves into total mutism. Even though this syndrome is increasingly recognized, its early differential diagnostic is still complex. The objective of this study was to illustrate why a fine evaluation of speech and language is essential for the differential diagnosis of PPAoS. This longitudinal case study presents the progression of a PPAoS patient over a period of 5 years. Periodic neurological and speech-language assessments were carried out to follow the progression of neurological, memory, language and speech symptoms. The different diagnostic labels established over time were also reported. The evolution of the patient’s communication profile was characterized by a preservation of language components and episodic memory, in parallel with a progressive deterioration of speech which gradually reduced intelligibility, and was associated with signs of spasticity, resulting in a complete anarthria. This case study sheds light upon the evolution of a patient with PPAoS. A better understanding of the clinical profile and progression of PPAoS is necessary in order to improve early diagnosis and adequate care for these patients.
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Basilakos A, Yourganov G, den Ouden DB, Fogerty D, Rorden C, Feenaughty L, Fridriksson J. A Multivariate Analytic Approach to the Differential Diagnosis of Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3378-3392. [PMID: 29181537 PMCID: PMC6111519 DOI: 10.1044/2017_jslhr-s-16-0443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/10/2017] [Accepted: 07/19/2017] [Indexed: 05/08/2023]
Abstract
Purpose Apraxia of speech (AOS) is a consequence of stroke that frequently co-occurs with aphasia. Its study is limited by difficulties with its perceptual evaluation and dissociation from co-occurring impairments. This study examined the classification accuracy of several acoustic measures for the differential diagnosis of AOS in a sample of stroke survivors. Method Fifty-seven individuals were included (mean age = 60.8 ± 10.4 years; 21 women, 36 men; mean months poststroke = 54.7 ± 46). Participants were grouped on the basis of speech/language testing as follows: AOS-Aphasia (n = 20), Aphasia Only (n = 24), and Stroke Control (n = 13). Normalized Pairwise Variability Index, proportion of distortion errors, voice onset time variability, and amplitude envelope modulation spectrum variables were obtained from connected speech samples. Measures were analyzed for group differences and entered into a linear discriminant analysis to predict diagnostic classification. Results Out-of-sample classification accuracy of all measures was over 90%. The envelope modulation spectrum variables had the greatest impact on classification when all measures were analyzed together. Conclusions This study contributes to efforts to identify objective acoustic measures that can facilitate the differential diagnosis of AOS. Results suggest that further study of these measures is warranted to determine the best predictors of AOS diagnosis. Supplemental Materials https://doi.org/10.23641/asha.5611309.
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Affiliation(s)
- Alexandra Basilakos
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
| | | | - Dirk-Bart den Ouden
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
| | - Daniel Fogerty
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
- McCausland Center for Brain Imaging, University of South Carolina, Columbia
| | - Lynda Feenaughty
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
- McCausland Center for Brain Imaging, University of South Carolina, Columbia
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Maruthy S, Venugopal S, Parakh P. Speech rhythm in Kannada speaking adults who stutter. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:529-537. [PMID: 27576027 DOI: 10.1080/17549507.2016.1221459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE A longstanding hypothesis about the underlying mechanisms of stuttering suggests that speech disfluencies may be associated with problems in timing and temporal patterning of speech events. METHOD Fifteen adults who do and do not stutter read five sentences, and from these, the vocalic and consonantal durations were measured. Using these, pairwise variability index (raw PVI for consonantal intervals and normalised PVI for vocalic intervals) and interval based rhythm metrics (PercV, DeltaC, DeltaV, VarcoC and VarcoV) were calculated for all the participants. RESULT Findings suggested higher mean values in adults who stutter when compared to adults who do not stutter for all the rhythm metrics except for VarcoV. Further, statistically significant difference between the two groups was found for all the rhythm metrics except for VarcoV. CONCLUSION Combining the present results with consistent prior findings based on rhythm deficits in children and adults who stutter, there appears to be strong empirical support for the hypothesis that individuals who stutter may have deficits in generation of rhythmic speech patterns.
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Affiliation(s)
- Santosh Maruthy
- a All India Institute of Speech and Hearing , Manasagangothri , Mysore , India
| | - Sahana Venugopal
- a All India Institute of Speech and Hearing , Manasagangothri , Mysore , India
| | - Priyanka Parakh
- a All India Institute of Speech and Hearing , Manasagangothri , Mysore , India
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Haley KL, Jacks A, Richardson JD, Wambaugh JL. Perceptually Salient Sound Distortions and Apraxia of Speech: A Performance Continuum. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:631-640. [PMID: 28654944 PMCID: PMC5576969 DOI: 10.1044/2017_ajslp-16-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/12/2016] [Indexed: 05/08/2023]
Abstract
PURPOSE We sought to characterize articulatory distortions in apraxia of speech and aphasia with phonemic paraphasia and to evaluate the diagnostic validity of error frequency of distortion and distorted substitution in differentiating between these disorders. METHOD Study participants were 66 people with speech sound production difficulties after left-hemisphere stroke or trauma. They were divided into 2 groups on the basis of word syllable duration, which served as an external criterion for speaking rate in multisyllabic words and an index of likely speech diagnosis. Narrow phonetic transcriptions were completed for audio-recorded clinical motor speech evaluations, using 29 diacritic marks. RESULTS Partial voicing and altered vowel tongue placement were common in both groups, and changes in consonant manner and place were also observed. The group with longer word syllable duration produced significantly more distortion and distorted-substitution errors than did the group with shorter word syllable duration, but variations were distributed on a performance continuum that overlapped substantially between groups. CONCLUSIONS Segment distortions in focal left-hemisphere lesions can be captured with a customized set of diacritic marks. Frequencies of distortions and distorted substitutions are valid diagnostic criteria for apraxia of speech, but further development of quantitative criteria and dynamic performance profiles is necessary for clinical utility.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | | | - Julie L. Wambaugh
- Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, UT
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Duffy JR, Hanley H, Utianski R, Clark H, Strand E, Josephs KA, Whitwell JL. Temporal acoustic measures distinguish primary progressive apraxia of speech from primary progressive aphasia. BRAIN AND LANGUAGE 2017; 168:84-94. [PMID: 28187331 PMCID: PMC5366265 DOI: 10.1016/j.bandl.2017.01.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/19/2016] [Accepted: 01/23/2017] [Indexed: 05/08/2023]
Abstract
The purpose of this study was to determine if acoustic measures of duration and syllable rate during word and sentence repetition, and a measure of within-word lexical stress, distinguish speakers with primary progressive apraxia of speech (PPAOS) from nonapraxic speakers with the agrammatic or logopenic variants of primary progressive aphasia (PPA), and control speakers. Results revealed that the PPAOS group had longer durations and reduced rate of syllable production for most words and sentences, and the measure of lexical stress. Sensitivity and specificity indices for the PPAOS versus the other groups were highest for longer multisyllabic words and sentences. For the PPAOS group, correlations between acoustic measures and perceptual ratings of AOS were moderately high to high. Several temporal measures used in this study may aid differential diagnosis and help quantify features of PPAOS that are distinct from those associated with PPA in which AOS is not present.
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Affiliation(s)
- Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA.
| | - Holly Hanley
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
| | - Rene Utianski
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Heather Clark
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Edythe Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology (Behavioral Neurology and Movement Disorders), Mayo Clinic, Rochester, MN, USA
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