Whole word therapy in a case of acquired apraxia of speech
A self-administered software therapy for acquired apraxia of speech
F. Windsor, R. A. Varley*, & S. P. Whiteside*
Department of Speech Pathology and Therapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Hathersage Road, Manchester, M13 0JA, UK
*Department of Human Communication Sciences, University of Sheffield, Sheffield, S10 2TA, UK.
EMAIL: f.windsor@mmu.ac.uk
PHONE: 0161-247 2355
Abstract
Recent models of speech encoding suggest that movement plans for frequently used words are stored and that not all output is encoded by a process of segment-by segment assembly (Levelt, et al., 1999; Whiteside & Varley, 1998; Varley & Whiteside, 2001). We explore the implications of this view for the management of apraxia of speech (AOS). In a treatment study, the effectiveness of a computer-administered, word-level therapy was examined.
Six people with chronic AOS participated in the study. Each participant self-administered two computer treatments: (1) a word-level speech intervention programme; (2) a visuo-spatial programme. Each treatment was administered for a 6-week period, with a 4-week rest phase between interventions. The order of administration was counterbalanced across participants. Prior to treatment, baseline assessments of treated and control behaviours were taken. The study utilized a multiple baseline design with control behaviours (word reading and spoken sentence comprehension) in order to control for the effects of spontaneous recovery and general language stimulation on performance. The study also investigated whether therapy organized around a word set with a common onset structure (e.g., kiss, kid) was more effective than that organised around words with a common rime structure (e.g., sat, hat).
With regard to words targeted in treatment, there were 30 treated items that were sub-divided into sets of shared onset structure or shared rime. There were a further 30 items that were drawn from the same onset or rime cohorts but which did not appear in treatment. These words allowed evaluation of whether treatment generalised to structurally related words. Finally, there were 30 structurally unrelated control words, that did not appear in treatment. All word sets were matched on frequency and phonetic complexity. Production of these words and the control behaviors were assessed at baseline, at the termination of each intervention, and at a follow-up assessment 8-weeks after the end of treatment. Outcomes were assessed through perceptual accuracy scores in word repetition and naming, and in acoustic measures of utterance duration before and after intervention. Inter-rater reliability measures were made on the data, with the second rater being blind to the phase at which speech tokens were recorded.
The results demonstrated that treated words showed significant improvement on both perceptual and acoustic measures. Treatment effects were not due to spontaneous recovery, the motivational effects of computer therapy, or general language stimulation. The sham visuo-spatial software programme had no effect on speech, and unrelated language behaviours did not alter as a result of treatment. In addition to improvement of treated words, there was generalisation of improvement to phonetically related untreated words, and some generalisation to untreated, phonetically unrelated words. The effects of treatment were maintained to a final follow-up assessment, which, for some participants, was 18 weeks after the termination of the speech intervention.
We discuss the implications of these results for the management of AOS, and evaluate the use of software programmes in the treatment of acquired speech and language disorders. Programmes that can be self-administered allow for controlled quality, high dosage therapy, and facilitate patient autonomy.
References:
Levelt, W.J.M., Roelofs, A., & Meyer, A.S. 1999. A theory of lexical access in speech production. Behavioural and Brain Sciences, 22, 1-71.
Varley, R. A. & Whiteside, S. P. 2001. What is the underlying impairment in acquired apraxia of speech. Aphasiology, 15, 39-49.
Whiteside, S. P. & Varley, R. A. 1998. A reconceptualisation of apraxia of speech: a synthesis of evidence. Cortex, 34, 221-231.
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