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 CNS) (Cotman & Berchtold 2002) (adaptive capacity of • Long-term structural changes (Kleim et al 2004) (cortical synaptogenesis & motor map reorganisation) in neural functioning occur following continued practice •  expression neurotrophic factors  survival (Ying et al 2005) cell

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 & long term effects of intensive dysarthria treatment on speech, voice & everyday communication in non progressive 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 (with resp phonatory impairment) • Spastic = 7 • Spastic-Flaccid = 2 • Spastic-hypokinetic = 1 Severity • Mild = 2 • Mild-mod = 2 • Mod = 5 • Mod-sev = 1

Procedure

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 – multi faceted 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 Loudness Artic. Prec Rate Stress Breathiness Breath Supp Intelligibility 90.09

92.25

72.34

127.82

75.92

63.09

80.94



Significant Pre/Post p<.05

Post FU 121.59 106.95  68.62

99.47 135.52  67.90

113.63

64.95

82.20  62.59

77.98

101.11   83.98  124.51 

Significant Pre/FU p<.05

Results  AssIDS 

90 80 70 60 50 40 30 20 10 0 12.5%



9.4%



% Word



Significant Pre/Post p<.05

% Sent Pre Post

Results Acoustic

Duration phonation = NS

78 76 74 72 70 68 66 64 62

   

Pre Post FU 60 AH Reading



Significant Pre/Post p<.05

Convers



Significant Pre/FU p<.05

4 3.5

3 2.5

2 1.5

1 0.5

 Results - AusTOMS    

Pre Post FU



0 Impairment Activity Participation Significant Pre/Post p<.05



Well-being Significant Pre/FU p<.05

Results – Participant Ques

4 3.5

3 2.5

2 1.5

 

1 0.5

0 Slurring Voice How well understood



Significant Pre/Post p<.05

 

Pre Post FU Convo Initiate Convo partic



Significant Pre/FU p<.05

Results –

Communication Partner Ques

3 2 6 5 4



1 0 Ability to Freq of Rep Convo Convo with



understand Initiat Significant Pre/Post p<.05

unfam Ov Rating Pre Post FU



Discussion

Positive short & long-term effects of intensive dysarthria treatment • Articulatory precision • Speech intelligibility • Loudness during reading • Activity limitation • Slurring (AusTOMS) (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