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The impact of intensive treatment on non-progressive dysarthric speakers: A pilot study. Deborah Theodoros PhD Rachel Wenke PhD Candidate Petrea Cornwell PhD The University of Queensland Brisbane Australia. Introduction. Treatment for non-progressive dysarthria Most commonly behavioural

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the impact of intensive treatment on non progressive dysarthric speakers a pilot study

The impact of intensive treatment on non-progressive dysarthric speakers: A pilot study

Deborah Theodoros PhD

Rachel Wenke PhD Candidate

Petrea Cornwell PhD

The University of Queensland

Brisbane

Australia

introduction
Introduction
  • Treatment for non-progressive dysarthria
    • Most commonly behavioural
    • Multi-faceted
    • Restoring/normalizing function across motor speech subsystems
    • Maximising intelligibility & communication efficiency
    • Facilitating compensatory communication strategies
  • Limited evidence of efficacy (Sellars et al 2002)
introduction3
Introduction
  •  evidence to support intensive training/exercise for motor skill learning
    • Facilitates neuroplasticity (adaptive capacity of CNS) (Cotman & Berchtold 2002)
    • Long-term structural changes (cortical synaptogenesis & motor map reorganisation) in neural functioning occur following continued practice (Kleim et al 2004)
    •  expression neurotrophic factors  cell survival (Ying et al 2005)
introduction4
Introduction
  • Intensity achieved by:
    • Freq of treatment (e.g. days per week)
    • Repetitions within session
    • Req.  effort, resistance & accuracy during motor speech tasks
  • LSVT® – intensive treatment for PD
  • Limited investigation of intensive treatment for non-progressive dysarthria
slide5
Aim

To investigate the immediate & long-term effects of intensive dysarthria treatment on speech, voice & everyday communication in non-progressive dysarthric speakers

participants
Participants
  • 10 participants
  • M age= 54.8 yrs; Ra=22-86yrs
  • 7 males; 3 females
  • CVA = 7; TBI = 3
  • Time post-onset: Ra=0.5–21yrs
participants7
Participants
  • Non-progressive dysarthria (with resp-phonatory impairment)
    • Spastic = 7
    • Spastic-Flaccid = 2
    • Spastic-hypokinetic = 1
  • Severity
    • Mild = 2
    • Mild-mod = 2
    • Mod = 5
    • Mod-sev = 1
procedure
Procedure

Pre treatment Ax 1

Pre treatment Ax 2

Pre treatment Assmt 1

Dysarthria Treatment

Post treatment Ax 1

Post treatment Ax 2

6 month Follow up Ax 1

6 month Follow up Ax 2

assessment
Assessment
  • Speech sample – “Rainbow Passage”
    • Perceptual evaluations – direct magnitude estimation (DME)
    • 2 independent SLPs - randomised speech samples scored against standard (moderate dysarthric speaker) – Standard = 100
    • Loudness, roughness, breathiness, articulatory precision, rate, stress, breath support, intelligibility
assessment10
Assessment
  • Assessment of Intelligibility of Dysarthric Speech (AssIDS)
    • % Word intell, % Sentence intell, CER
  • Acoustic
    • SPL sustained /ah/ (dB)
    • Duration phonation (secs)
    • SPL conversation (dB)
    • SPL reading (dB)
assessment outcome measures
Assessment – Outcome Measures

AusTOMS (Speech)

    • 5-point scale (1=complete difficulty; 5=no difficulty)
    • 4 domains - Impairment, Activity Limitation, Participation, Wellbeing/Distress
  • Participant Ques
    • 5-point scale (1=normal; 5=Severe)
      • Slurred speech
      • Hoarse voice
      • How well understood
      • Participate in conversations with unfamiliar people
      • Initiate conversation
assessment outcome measures12
Assessment – Outcome Measures
  • Communication Partner Ques
    • 7-point VAS
    • 1=very difficult; 4=sometimes difficult; 7=very easy
    • How easy to understand speaker
    • How often request repeat
    • How often initiate conversation with you
    • How often initiate conversation with stranger
    • Overall, how rate speaker’s speech and voice
treatment
Treatment
  • 1hr per day, 4 days per week for 4 weeks
  • Individualised intervention – multi-faceted
  • Common behavioural treatments(Literature & SLP focus group)
  • One SLP administered all treatments
  • Homework each day
  • Maintenance program
results statistical analyses
ResultsStatistical analyses
  • Repeated measures ANOVA & contrasts
    • DME
    • Acoustic data
  • Paired t-tests (pre/post data only)
    • AssIDS
  • Friedman & Wilcoxin signed ranks
    • AusTOMS
    • Participant & Communication partner Ques
results perceptual analysis geometric means
Results - Perceptual AnalysisGeometric means

Significant Pre/Post p<.05 Significant Pre/FU p<.05

results assids
Results - AssIDS

12.5% 

9.4% 

Significant Pre/Post p<.05

results acoustic
Results - Acoustic

Duration phonation = NS





Mean SPL (dB)

Significant Pre/Post p<.05Significant Pre/FU p<.05

results austoms
Results - AusTOMS



Improvement 

 Significant Pre/Post p<.05Significant Pre/FU p<.05

results participant ques
Results – Participant Ques







Improvement 

Significant Pre/Post p<.05 Significant Pre/FU p<.05

results communication partner ques
Results – Communication Partner Ques

Improvement 

Significant Pre/Post p<.05

discussion
Discussion
  • Positive short & long-term effects of intensive dysarthria treatment
    • Articulatory precision
    • Speech intelligibility
    • Loudness during reading
    • Activity limitation (AusTOMS)
    • Slurring (Part. Ques)
    • How well understood (Part. Ques)
    • Initiate conversation (Part. Ques)
  • Intensive treatment led to greater acquisition & learning of motor speech behaviours
discussion22
Discussion
  • Short-term effects only for some parameters
  • Maintenance remains important issue
  • Effects achieved in participants several years post-impairment
    • 60% > than 1yr post-BI
    • Ongoing potential for rehab
conclusion future directions
Conclusion & Future Directions

Intensive treatment has positive impact on non-progressive dysarthria

  • Treatment parameters:
    • Frequency & duration
    • Intensity within session – no. of reps
    • Saliency of tasks – relevance to P
  • Maintenance of effects
    • Alt. treatment protocol / service delivery
      • Computer-based self-directed activities
      • Telerehabilitation