Deborah

Report
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
• 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)
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)
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
Aim
To investigate the immediate & longterm effects of intensive dysarthria
treatment on speech, voice &
everyday communication in nonprogressive dysarthric speakers
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
Participants

Non-progressive dysarthria
phonatory impairment)
• Spastic = 7
• Spastic-Flaccid = 2
• Spastic-hypokinetic = 1

Severity
•
•
•
•
Mild = 2
Mild-mod = 2
Mod = 5
Mod-sev = 1
(with resp-
Procedure
Pre
treatment
Assmt
Pre
treatment
Ax 1 1
Pre treatment Ax 2
Dysarthria Treatment
Post treatment Ax 1
Post treatment Ax 2
6 month Follow up Ax 1
6 month Follow up Ax 2
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
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
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 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






1hr per day, 4 days per week for 4
weeks
Individualised intervention – multifaceted
Common behavioural treatments
(Literature & SLP focus group)
One SLP administered all treatments
Homework each day
Maintenance program
Results
Statistical 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
Parameter
Pre
Post
Loudness
90.09
121.59
99.47
Artic. Prec
92.25
Rate
72.34
106.95 
68.62
135.52 
67.90
Stress
127.82
113.63
Breathiness
75.92
64.95
82.20 
62.59
Breath Supp
63.09
77.98
83.98 
Intelligibility
80.94
101.11 
124.51 

Significant Pre/Post p<.05

FU
Significant Pre/FU p<.05
Results - AssIDS


90
80
70
60
50
40
12.5% 
9.4% 
30
20
10
0
% Word
 Significant Pre/Post p<.05
% Sent
Pre
Post
Results - Acoustic
Duration phonation = NS

78
76
Mean SPL (dB)
74

72
70


68
66
Pre
Post
FU
64
62
60
AH
Reading
 Significant Pre/Post p<.05
Convers
 Significant Pre/FU p<.05
Results - AusTOMS
4
Improvement 
3.5

 


3
2.5
Pre
Post
FU
2
1.5
1
0.5
0

Impairment
Activity
Participation
Significant Pre/Post p<.05

Well-being
Significant Pre/FU p<.05
Results – Participant Ques
4
3.5
3
Improvement 






2.5
Pre
Post
FU
2
1.5
1
0.5
0
Slurring
Voice
How well
understood
Convo
partic
 Significant Pre/Post p<.05 
Initiate
Convo
Significant Pre/FU p<.05
Results – Communication Partner Ques
Improvement 
6

5
4
Pre
Post
FU
3
2
1
0
Ability to Freq of Rep
understand
Convo
Initiat
Convo with
unfam
 Significant Pre/Post p<.05
Ov Rating
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
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
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

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