Lauren Bislick

Do principles of motor learning enhance retention and transfer of speech skills? A systematic review

Background: It is well documented in limb motor research that providing the optimal practice and feedback conditions can have positive outcomes for the learning of new movements. However, it remains unclear if the training conditions used for limb movements can be directly applied to the speech motor system of healthy adults and individuals with acquired motor speech disorders. Collectively these practice and feedback conditions are known as the principles of motor learning (PML), and they have recently been applied to the rehabilitation of motor speech disorders with promising results. Aims: The purpose of this systematic review is to identify which PML have been examined in the speech motor learning literature, to determine the effectiveness of these principles, and to ascertain future lines of research. Methods & Procedures: A systematic search of the literature was completed that involved the combination of a primary search term with a secondary search term. All articles were independently reviewed and scored by the first two authors. To guide the selection process strict inclusion and exclusion criteria were implemented. Additionally, authors used a 15-category evidence-rating system to judge the overall quality of each study. After the study was scored, points were totalled into an overall quality rating of high, intermediate, or low with respect to methodological rigour and interpretability. Outcomes & Results: Seven articles met inclusion criteria, including three randomised controlled trials and four single-participant designs. Five of the articles focused on motor speech disorders, including investigations of apraxia of speech (four studies) and hypokinetic dysarthria from Parkinsons disease (one study), while two studies focused on speech motor performance in healthy adults. Five of the articles were judged to be of high quality while two were judged to be of intermediate quality. Conclusions: Although limited, the current level of evidence for the application of the PML to speech motor learning in both healthy adults and individuals with motor speech disorders is promising and continued investigation is warranted.

An investigation of aphasic naming error evolution following phonomotor treatment

Background: Though treatments for anomia in aphasia typically use accuracy of trained and untrained targets to determine treatment efficacy, researchers have begun to employ error analyses in order to more closely delineate the mechanisms involved in anomia recovery. Aims: The aim of this study was to examine changes in naming errors of 24 individuals with aphasia after phonomotor treatment (14 new individuals and 10 individuals whose word retrieval error data were previously reported in a separate manuscript). Methods & Procedures: Twenty-four individuals with aphasia received phonomotor treatment. Confrontation naming was assessed pre-treatment, immediately post-treatment, and 3 months post-treatment. Responses were scored for accuracy and error type. Paired-samples t tests comparing pre-treatment versus immediately post-treatment and 3 months post-treatment accuracy and error-type proportions were conducted. Additionally, the role of language severity in error-type proportion shifts was examined through analyses of subgroups and correlational analyses between language measures and error-type change scores. Outcomes & Results: Trained and untrained naming accuracy improved significantly immediately post-treatment, and gains were maintained 3 months post-treatment. No significant changes in error-type proportions were noted; however, trends towards decreases in proportions of omissions were noted immediately post-treatment (trained items) and 3 months post-treatment (trained and untrained items). In a post hoc subgroup analysis, a significant decrease in the proportion of omissions on trained items was noted 3 months post-treatment for the subgroup of individuals with lower lexical retrieval ability. Conclusions: Results are indicative of a shift in linguistic processing in which the linguistic network was holistically altered as a result of phonomotor treatment.

Influence of Linguistic and Nonlinguistic Variables on Generalization and Maintenance Following Phonomotor Treatment for Aphasia

Purpose Although phonomotor treatment shows promise as an effective intervention for anomia in people with aphasia, responses to this treatment are not consistent across individuals. To better understand this variability, we examined the influence of 5 participant characteristics-age, time postonset, aphasia severity, naming impairment, and error profile-on generalization and maintenance of confrontation naming and discourse abilities following phonomotor treatment. Method Using retrospective data from 26 participants with aphasia who completed a 6-week phonomotor treatment program, we examined the relationships between participant characteristics of interest and change scores on confrontation naming and discourse tasks, measured pretreatment, immediately following treatment, and 3 months following treatment. Results Although the participant characteristics of aphasia severity and error profile appeared to predict generalization to improved confrontation naming of untrained items and discourse performance, a post hoc analysis revealed that no one characteristic predicted generalization across participants at 3 months posttreatment. Conclusions Response to phonomotor treatment does not appear to be influenced by aphasia and anomia severity level, error profile, participant age, or time postonset. Other factors, however, may influence response to intensive aphasia treatment and are worthy of continued exploration.

Language treatment prior to anterior temporal lobe surgery: Can naming skills be preserved?

Epilepsy affects 1% of the general population and is highly prevalent among Veterans. The purpose of this phase I study was to investigate a presurgical linguistically distributed language treatment program that could potentially diminish effects of proper-name retrieval deficits following left anterior temporal lobe resection for intractable epilepsy. A single-subject multiple-baseline design was employed for three individuals with late-onset chronic left temporal lobe epilepsy. Word retrieval treatment was administered prior to anterior temporal lobe resection. The primary outcome measure was confrontation naming of proper nouns. Immediately posttreatment (before surgery), there was a positive effect for all trained stimuli in the form of improved naming as compared with pretreatment. In addition, trained stimuli were found to be better after surgery than they were at pretreatment baseline, which would not be expected had language treatment not been provided. This series of case studies introduces two fundamentally novel concept: that commonly occurring deficits associated with left temporal lobe epilepsy can be treated despite the presence of damaged neural tissue and that providing this treatment prior to surgery can lead to better preservation of language function after surgery than would be expected if the treatment were not provided.

Can intensive phonomotor therapy modify accent? A phase I study

Abstract A variety of accent modification approaches exist for non-native English speakers. The training program developed for this study, phonomotor treatment, is based on a parallel distributed processing model of phonology and was hypothesized to modify accent via improved sound production in a non-native English speaker. The participant was a 20-year-old native Wuhan and Mandarin Chinese speaker. In the context of a single-subject repeated probe design, he received probes prior to, during, and immediately following training. Training was intensive and delivered for 20 hours over 2 weeks. Post-training results revealed statistically significant improvements in trained phoneme production in isolation and reduced listener effort at the sentence level. Generalization results were limited, suggesting that future participants may benefit from an increased training period and additional program development. Data gathered from this study may also help to inform the development of subsequent trials of the same program.