Joost Hurkmans

The training of verb production in Broca's aphasia: A multiple-baseline across-behaviours study

Background: Verb production is often impaired in Brocas aphasia: Action naming is more affected than object naming and in spontaneous speech the number and/or diversity of lexical verbs is low. Because verbs play a pivotal role in the sentence, these verb problems have a serious impact on the communicative contents of speech in daily life. This project has financially been supported by grants from the Beatrixoord Foundation (Stichting Beatrixoord Noord‐Nederland) and the Dutch Aphasia Foundation (Stichting Afasie Nederland). The authors would like to thank Audrey Holland, Dirk‐Bart den Ouden, and Sharon Parry for their comments on an earlier version of the paper. Aims: The purpose of this study was to increase the informational content of spontaneous speech in two individuals with Brocas aphasia by training them in verb production. Methods & Procedures: Verb production was trained at the sentence level, using the treatment programme Verb Production at the Word and Sentence Level (Bastiaanse, Jonkers, Quak, & Varela, 1997). Six baseline sessions were planned, followed by a training programme to learn infinitives, finite verbs, and sentence construction in one participant and finite verbs, infinitives, and sentences in the other. The participants were tested each week for progress on infinitives and finite verbs not in the programme and an unrelated test. Pre‐treatment and post‐treatment (directly after and 3 months after treatment stopped) the Aachen Aphasia Test (AAT) and the Amsterdam‐Nijmegen Everyday Language Test (ANELT) were administered and spontaneous speech was elicited and analysed with respect to verbs, nouns, and utterance length. Outcomes & Results: Both participants improved significantly on the production of untrained finite verbs. No improvement was made on the untrained infinitives. There was also significant improvement on related subtests of the AAT, but no improvement on unrelated subtests. Both also showed a significant improvement on verb production in spontaneous speech and in verbal communication, as measured on the ANELT. Conclusions. The treatment programme has been shown to be an effective tool for training participants in verb production. The most important criteria for relevant treatment were met: generalisation to spontaneous speech and improvement in verbal communication.

Music in the treatment of neurological language and speech disorders: A systematic review

Background: Acquired brain injury resulting from a stroke can result in impairments in, among other things, communication. Music therapy has been used in rehabilitation to stimulate brain functions involved in speech. The use of elements of music is well known and more often used in the treatment of aphasia and apraxia of speech. Aims: The aim of the study is to synthesise studies on the effect of music parameters in the treatment of neurological language and speech disorders. In addition, possible mechanisms that explain recovery are investigated. Methods & Procedures: Search terms were formulated based on the research question. A systematic search in databases was performed using these search terms. Then inclusion criteria were formulated and articles meeting the criteria were reviewed on patient characteristics, interventions, and methodological quality. Outcomes & Results: A total of 1250 articles have been selected from the databases, of which 15 were included in this study. The Melodic Intonation Therapy was the most studied programme. Melody and rhythm were the music interventions that have been applied the most. Measurable recovery has been reported in all those reviewed studies using music in the treatment of neurological language and speech disorders. In three studies research was also conducted into the mechanisms of explanation of the measured recovery. However, the methodological quality of the investigated studies was rated as “low”, using the ASHA level of evidence indicators for judging research. Conclusions: Although treatment outcomes were reported as positive in all of the 15 reviewed studies, caution should be used relative to conclusions about the effectiveness of treatments that incorporate components of music with neurologically impaired individuals. Methodological quality was rated as low and interpretations of mechanisms of recovery were contradictory. Suggestions for standardising and improving methodological quality drawn from the analysis are presented. A revised version of this article has been published in a Dutch journal (Stem Spraak- en Taalpathologie).

Training verb and sentence production in agrammatic Broca's aphasia

Background: Many aphasic speakers have problems producing verbs at both the word and the sentence level. A treatment programme called ACTION (Bastiaanse, Bunge, & Perk, 2004; Bastiaanse, Jonkers, Quak, & Varela Put, 1997) has been developed to train verb production of both fluent and non-fluent aphasic speakers. It consists of four levels: single verbs, filling in infinitives, filling in finite verbs, and sentence construction. For the present study the efficacy of the programme for agrammatic speakers with Brocas aphasia was tested. Aims: The aim of the study was to measure the effects of treatment with ACTION on non-trained infinitives and finite verbs, and to analyse the generalisation effects on spontaneous speech and verbal communication in daily life. Methods & Procedure: ACTION was used to train 11 agrammatic patients with Brocas aphasia, following the multiple baseline across behaviours design. The patients were tested weekly on untreated items. Two follow-up assessments were done, 1 and 3 months post-treatment. Generalisation to related and unrelated materials was measured with subtasks of the Aachen Aphasia Test (AAT). Spontaneous speech was analysed, and verbal communication was measured before and after treatment and 3 months post-treatment by the Amsterdam-Nijmegen Everyday Language Test (ANELT). Outcomes & Results: There was improvement on the untrained infinitives and finite verbs. The improvement on infinitives was relatively minor; finite verbs, which were more impaired than the infinitives prior to treatment, improved up to the level of the infinitives. The improvement generalised to the related tasks of the AAT, but not to the unrelated task; verbal communication improved significantly. This improvement was reflected in relevant variables of spontaneous speech (mean length of utterances, proportion of finite verbs and verb diversity), but not in an unrelated variable (diversity of nouns). Conclusions: Treatment with ACTION resulted in better production of finite verbs. The effects generalised to spontaneous speech. Most importantly, it was shown that communication in daily life improved.

Assessing the treatment effects in apraxia of speech : introduction and evaluation of the Modified Diadochokinesis Test

BACKGROUND The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. AIMS To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. METHODS The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. RESULTS The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. CONCLUSIONS & IMPLICATIONS The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech.

The effectiveness of Speech–Music Therapy for Aphasia (SMTA) in five speakers with Apraxia of Speech and aphasia

Background: Several studies using musical elements in the treatment of neurological language and speech disorders have reported improvement of speech production. One such programme, Speech–Music Therapy for Aphasia (SMTA), integrates speech therapy and music therapy (MT) to treat the individual with Apraxia of Speech (AoS) and aphasia. We have observed encouraging results in clinical practice, but there is still no empirical evidence of the effect of SMTA. Aims: The current study investigated the effectiveness of SMTA on verbal communication in daily life. Methods & Procedures: Five participants with AoS accompanied by aphasia were included in an efficacy study using a case series design with multiple measurements. All participants received 24 SMTA sessions including two 30-min sessions per week. Pretreatment and posttreatment (immediately and 3 months after treatment stopped), verbal communication (intelligibility and comprehensibility) were tested with the Amsterdam-Nijmegen Everyday Language Test. The Aachen Aphasia Test (AAT) and the Diagnostic Instrument for Apraxia of Speech (DIAS) were also administered. The participants were tested four times before the start of the treatment (baseline) with a related test for progress on articulation (Modified Diadochokinesis Test (MDT)) and once with an unrelated control test (Psycholinguistic Assessment in Language Processing of Aphasia 12; repetition of number series). During the treatment, both tests were administered weekly. Outcomes & Results: Intelligibility of verbal communication for all participating individuals, as well as comprehensibility in four out of five participants, improved after 24 SMTA treatment sessions. All measures of MDT and repetition of AAT showed significant improvement for all participants. Four participants also improved on the test for articulation of phonemes and the diadochokinesis test of the DIAS. Furthermore, two participants improved on the articulation of words (DIAS). The improvement remained stable after treatment ended (follow-up). For three out of the five participants, no improvement was found on the control tests. Two participants also showed improvement on almost all outcome measures, but also improved on the control tests. SMTA not only affected articulation but also positively influenced the severity of the aphasia in four out of five participants. Conclusions: SMTA seems an effective treatment programme for at least three of the five individuals that were treated in the current study. This treatment led not only to better articulation, but more importantly, also to improvement in communication in daily life.

Assessing the treatment effects in apraxia of speech

BACKGROUND The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. AIMS To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. METHODS The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. RESULTS The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. CONCLUSIONS & IMPLICATIONS The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech.

The effect of static versus dynamic depictions of actions in verb and sentence production in aphasia

ABSTRACT Background: There is a shortage of material for the treatment of verb and sentence production in persons with aphasia (PWAs). In therapy, pictures or photographs depicting actions are often used, even though the meaning of certain verbs clearly involves movement. This aspect of movement is difficult to depict on static material. In a case study, Druks, J., & Shallice, T. (2000). Selective preservation of naming from description and the “Restricted Preverbal Message”. Brain and Language, 72, 100–128. doi:10.1006/brln.1999.2165 reported a patient who had difficulties naming actions. However, when the actions were performed, the patient was better at naming performed actions compared to naming actions depicted in still pictures. Aims: In the current study, we tested the hypothesis that PWAs are more accurate in naming verbs in isolation as well as in sentence context in a dynamic condition rather than in a static condition. In a second experiment, we examined whether the use of verbs that express specific types of movement has any influence on the production of verbs when using static and dynamic depiction. Verbs in three semantic categories were included, namely action verbs relating to arm, leg and face movements. Methods & Procedures: In the first experiment, verb production was examined in a static (photographs) condition and a dynamic (videos) condition. An action-naming task and a sentence production task of 20 items each were administered to 18 PWAs. In the second experiment, an action-naming task of 60 items was administered to 13 PWAs. Outcomes & Results: PWAs scored significantly better in the dynamic condition compared to the static condition on both the action-naming task and the sentence-production task in Experiment 1. Considering the three semantic categories that were considered in Experiment 2, PWAs only scored significantly better on the category “arm” in the dynamic condition as compared to the static condition. Conclusions: These results suggest that semantic information of an action’s specific aspects, such as movement, is activated while watching an action. We assume that PWAs profit from this depiction of movement. This study implicates that in clinical practice, dynamic material, rather than static material, should be used in diagnosis and therapy involving action naming and sentence production.