Researchers from the Division of Speech and Hearing Sciences at the University of North Carolina have published a feasibility study reporting therapeutic effects in a person with aphasia (PWA) and accompanying apraxia of speech (AOS), who received treatment for AOS through a customized therapy app that permitted home practice of self-modeled video stimuli. The goals of the study were to: (a) demonstrate feasibility of the use of such tools, materials, and methods for AOS therapy delivery; and (b) to demonstrate the clinical efficacy of AOS therapy delivered this way, while establishing treatment effect sizes.
The subject was a single woman with moderate AOS and Broca’s aphasia (WAB AQ = 52.6). During the study she met with clinical staff twice weekly to develop self-modeled video cues for presentation on her home practice app, to review app use strategies, to work on improving her speech, and to monitor progress. Home practice was afforded via a custom app on a tablet computer, the subject selecting the specific materials from options presented by the treating clinician. A multiple baseline design was used to study the relationship between oral reading performance of 30 conversational phrases of importance to the subject, and the start of practice for those phrases. The study ran for approximately 5 months altogether. Three principles that the investigators wished to exploit in particular during this research were: expectation of performance competence, user autonomy, and external attentional focus.
The results show this approach to be both workable and effective. The PWA actively engaged in the activities throughout the study, during both clinical meetings and home practice. Analysis of multiple baseline data reveal presence of experimental control, with a relatively stable baseline maintained for phrases prior to initiating their practice, and discernible rates of improvement once practice was initiated. Daily levels of engagement with the app were reported: On average, the subject practiced 43 minutes on days with clinical sessions, and 27 minutes on days without clinical sessions. Overall, percentage accuracy of reading the sentences – the dependent variable – registered at approximately 30% prior to treatment, then rose as a rule into the 60% range during treatment and was maintained at that level during probes administered several weeks following treatment.
Investigators demonstrated the feasibility of using their custom app combined with biweekly clinical sessions to deliver AOS therapy, and they showed intervention efficacy for improving the reading of sentences selected by the subject. Further research is indicated to identify most promising candidates for such a regimen, to determine whether benefits extend to include ability to produce practiced sentences without written support, and whether they further extend to successful production of unpracticed utterances via generalization.
For further reading: K. L. Haley, K. T. Cunningham, I. Kim, J. S. Shafer. 2019, Autonomy-supportive treatment for acquired apraxia of speech: feasibility and therapeutic effect. Aphasiology, 1-22. Published online: 24 Dec 2019, https://doi.org/10.1080/02687038.2019.170566