Purpose The aim of this study was to examine the effects of dose frequency, an aspect of treatment intensity, on articulation outcomes of sound production treatment (SPT). Method Twelve speakers with apraxia of speech and aphasia received SPT administered with an intense dose frequency and a nonintense/traditional dose frequency (SPT-T). Each participant received both treatment intensities in the context of multiple baseline designs across behaviors. SPT-Intense was provided for 3 hourly sessions per day/3 days per week; and SPT-T for 1 hour-long session per day/3 days per week. Twenty-seven treatment sessions were completed with each phase of treatment. Articulation accuracy was measured in probes of production of treated and untreated words. Results All participants achieved improved articulation of treated words with both intensities; there were no notable differences in magnitude of improvement associated with dose frequency. Positive response generalization to untrained words was found in 21 of 24 treatment applications; the cases of negligible response generalization occurred with SPT-T words. Conclusions Dose frequency (and corresponding total intervention duration) did not appear to impact treatment response for treated items. Disparate response generalization findings for 3 participants in the current study may relate to participant characteristics such as apraxia of speech severity and/or stimuli factors.

Purpose Combined Aphasia and Apraxia of Speech Treatment (CAAST) is a newly developed treatment shown to increase production of accurate content in narrative discourse for persons with aphasia and apraxia of speech. The purpose of this post hoc study was to further describe lexical and morphosyntactic changes associated with changes in content production. Method Existing probe data from 8 persons with aphasia who had completed CAAST were used to complete analyses of morphosyntactic production, lexical diversity, and novelty of content. Language analyses were completed using discourse samples obtained at numerous pretreatment and posttreatment intervals. Results All participants demonstrated gains in morphosyntactic language output for treated items, which extended to untreated sets for 7 participants. All 8 increased in production of novel content. Lexical diversity increases were evident for most participants. Although there were some similarities in language changes, there was substantial variability across response profiles. Conclusion CAAST, previously associated with positive treatment effects for production of accurate content, also appears to facilitate acquisition and generalization of morphosyntactic complexity, lexical diversity, and novelty of content for individuals with nonfluent aphasia. Further investigation is needed to determine causality and appropriate clinical application. Supplemental Material https://doi.org/10.23641/asha.5912530

PURPOSE:The purpose of this investigation was to examine the effects of a modified version of a newly developed therapy for aphasia and acquired apraxia of speech (AOS), Combined Aphasia and Apraxia of Speech Treatment (CAAST).METHOD:Four speakers with chronic AOS and aphasia received CAAST in the context of multiple baseline designs. Dependent variables included language measures (i.e. production of correct information units (CIUs)) and speech production measures (i.e. speech intelligibility and percent correct consonants (PCC) in sentence repetition).RESULT:Three of the participants demonstrated improved CIU production with treated picture sets and two also demonstrated generalization to untreated sets. All participants achieved substantially increased CIU production in an untrained discourse context. Speech intelligibility increased for three of the participants and increases in PCC were observed for all of the participants at two weeks post-treatment. However, PCC improvements were maintained for only two of the speakers at six weeks post-treatment.CONCLUSION:The revised CAAST protocol was associated with improved changes in speech and generalization across contexts in comparison to the previous iteration of CAAST. However, focus on sentence production in generalization practice may have been detrimental to CIU production for one participant.

PurposeThis investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech.MethodFive men with chronic apraxia of speech and aphasia received both intense SPT (3 hr per day/3 days per week) and nonintense/traditional SPT (SPT-T; 1 hr per day/3 days per week) in the context of single-case experimental designs. Each treatment was applied separately to a designated set of experimental words with 1 treatment applied at a time. Twenty-seven treatment sessions were conducted with each phase of treatment. Accuracy of articulation of target sounds within treated and untreated experimental words was measured during the course of the investigation.ResultsAll participants demonstrated improved articulation with both treatment intensities. Better maintenance of gains for treated items was found with SPT-T for 2 participants as measured at an 8-week posttreatment retention probe. Superior maintenance of increased accuracy of production of untreated items was also observed with SPT-T for all participants.ConclusionA less intense (distributed) application of SPT facilitated better maintenance of improved articulatory accuracy for untreated items, and in some cases treated items, than intense SPT.Supplemental Materialshttps://doi.org/10.23641/asha.5734053.

The purpose of this investigation was to compare the effects of schedule of practice (i.e., blocked vs. random) on outcomes of Sound Production Treatment (SPT) for speakers with chronic acquired apraxia of speech and aphasia. A combination of group and single-case experimental designs was used. Twenty participants each received SPT administered with randomized stimuli presentation (SPT-R) and SPT applied with blocked stimuli presentation (SPT-B). Treatment effects were examined with respect to accuracy of articulation as measured in treated and untreated experimental words produced during probes.For more information on the methodology and results, please see the original article. Supplemental Material S1. Participant identifiers used in previous studies.Supplemental Material S2. Participant matching by group.Supplemental Material S3. Probe and treatment stimuli for all participants.Supplemental Material S4. Criteria used to determine severity descriptors.Supplemental Material S5. Accuracy of production of target sounds in experiment words forvarious participants.Wambaugh, J. L., Nessler, C., Wright, S., Mauszycki, S. C., DeLong, C., Berggren, K., & Bailey, D. J. (2017). Effects of blocked and random practice schedule on outcomes of sound production treatment for acquired apraxia of speech: Results of a group investigation. Journal of Speech, Language, and Hearing Research, 60(6S), 1739–1751.

Purpose The purpose of this investigation was to compare the effects of schedule of practice (i.e., blocked vs. random) on outcomes of Sound Production Treatment (SPT; Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998) for speakers with chronic acquired apraxia of speech and aphasia. Method A combination of group and single-case experimental designs was used. Twenty participants each received SPT administered with randomized stimuli presentation (SPT-R) and SPT applied with blocked stimuli presentation (SPT-B). Treatment effects were examined with respect to accuracy of articulation as measured in treated and untreated experimental words produced during probes. Results All participants demonstrated improved articulation of treated items with both practice schedules. Effect sizes were calculated to estimate magnitude of change for treated and untreated items by treatment condition. No significant differences were found for SPT-R and SPT-B relative to effect size. Percent change over the highest baseline performance was also calculated to provide a clinically relevant indication of improvement. Change scores associated with SPT-R were significantly higher than those for SPT-B for treated items but not untreated items. Conclusion SPT can result in improved articulation regardless of schedule of practice. However, SPT-R may result in greater gains for treated items. Supplemental Materials https://doi.org/10.23641/asha.5116831

Purpose: The ability to recognize one's own speech errors has long been considered a clinical feature of acquired apraxia of speech (AOS) despite limited empirical data supporting this notion. This study was designed to (a) investigate the ability of speakers with AOS to self-judge the accuracy of their own word productions and (b) examine the test-retest stability of a measure to quantify the self-judgments of speakers with AOS.Method: Twenty-four speakers with AOS and aphasia repeated mono-and multisyllabic words. After each word, they indicated whether their production was correct or incorrect. This procedure was repeated 1 week later to examine performance stability.Results: Percentage of incorrect word productions was stable for the group across times. Accuracy of judgments ranged from 64% to 100% at Time 1 and from 56% to 100% at Time 2. Inaccurate judgments of error productions (false positives) occurred much more frequently than inaccurate judgments of correct productions (false negatives).Conclusions: Error production was remarkably stable in our participants. As a group, the participants failed to detect almost one third of words produced erroneously. However, accuracy and stability of judgments over sampling times varied across participants. Findings suggest that error awareness might be a worthwhile target for treatment in some individuals with AOS.

Purpose This investigation compared 2 treatment approaches for acquired apraxia of speech. The effects of a treatment that uses an articulatory-kinematic approach in conjunction with visual biofeedback (VBFB) via electropalatography (EPG) were compared to Sound Production Treatment (SPT), an established behavioral treatment that is also an articulatory-kinematic approach. Method A multiple baseline design across behaviors and participants was used with 2 participants with chronic apraxia of speech and aphasia. Accuracy of target speech sounds in treated and untreated words or phrases in probe sessions served as the dependent variable. The effects of 2 treatments based on an articulatory-kinematic approach were compared: (a) VBFB via EPG and (b) SPT. The order of treatments was counterbalanced across participants. Results Positive changes in articulatory accuracy were observed for SPT and VBFB treatment via EPG. Generalization to untreated stimulus items composed of treated speech sounds was also positive for both treatments. However, participants achieved greater articulatory accuracy with SPT during treatment and better long-term maintenance. Discussion Both treatment approaches resulted in improved speech production accuracy, but gains were greater for SPT. However, further research with additional participants is needed due to the small sample size included in this investigation.

Purpose: This study was designed to examine the effects of practice schedule, blocked vs random, on outcomes of a behavioural treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT). Method: SPT was administered to four speakers with chronic AOS and aphasia in the context of multiple baseline designs across behaviours and participants. Treatment was applied to multiple sound errors within three-to-five syllable words. All participants received both practice schedules: SPT-Random (SPT-R) and SPT-Blocked (SPT-B). Result: Improvements in accuracy of word production for trained items were found for both treatment conditions for all participants. One participant demonstrated better maintenance effects associated with SPT-R. Response generalisation to untreated words varied across participants, but was generally modest and unstable. Stimulus generalisation to production of words in sentence completion was positive for three of the participants. Stimulus generalisation to production of phrases was positive for two of the participants. Conclusion: Findings provide additional efficacy data regarding SPT’s effects on articulation of treated items and extend knowledge of the treatment’s effects when applied to multiple targets within multisyllabic words.

PURPOSE:The purpose of this investigation was to systematically examine outcomes associated with Semantic feature analysis, which is an established treatment for word-retrieval deficits in aphasia. Attributes of the experimental design and stimuli were manipulated to evaluate generalized naming of semantically related and unrelated items. In addition, the study was designed to examine changes in production of semantic information.METHOD:Semantic feature analysis was applied in the context of multiple-baseline designs with 5 persons with chronic aphasia. Experimental items were controlled for semantic category membership, number of naming attempts, and provision of item names. Acquisition, generalization, and maintenance effects were measured in probes of naming performance. Production of semantic information was also measured in response to experimental items and in discourse tasks.RESULTS:Treatment was associated with systematic increases in naming of trained items for 4 of the 5 participants. Positive generalization to untrained exemplars of trained categories was found for repeatedly exposed items but not for limited-exposure items. Slight increases in production of semantic content were observed.CONCLUSION:Repeated attempts to name untreated items appeared to play a role in generalization. Provision of the names of untrained items may have enhanced generalized responding for 2 participants.

Purpose: This study was designed to examine the effects of practice schedule, blocked vs random, on outcomes of a behavioural treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT).Method: SPT was administered to four speakers with chronic AOS and aphasia in the context of multiple baseline designs across behaviours and participants. Treatment was applied to multiple sound errors within three-to-five syllable words. All participants received both practice schedules: SPT-Random (SPT-R) and SPT-Blocked (SPT-B).Result: Improvements in accuracy of word production for trained items were found for both treatment conditions for all participants. One participant demonstrated better maintenance effects associated with SPT-R. Response generalisation to untreated words varied across participants, but was generally modest and unstable. Stimulus generalisation to production of words in sentence completion was positive for three of the participants. Stimulus generalisation to production of phrases was positive for two of the participants.Conclusion: Findings provide additional efficacy data regarding SPT's effects on articulation of treated items and extend knowledge of the treatment's effects when applied to multiple targets within multisyllabic words.

PURPOSE:This investigation was designed to further the development of a treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT), by examining the effects of blocked and random practice. METHOD:A multiple-baseline design across participants and behaviors was used with 6 speakers with chronic AOS and aphasia. Accuracy of production of target sounds in treated and untreated words produced in probe sessions served as the primary dependent variable. Stimulus generalization was also measured to phrase production and sentence completion. Participants received SPT applied with blocked presentation of treatment words (SPT-blocked) and SPT applied with random presentation of treatment words (SPT-random). RESULTS:Increases in accuracy of articulation of target sounds in treated words were observed for all participants for both conditions of treatment. SPT-random appeared to be associated with better maintenance for 2 participants. Generalization to untreated words was positive for all participants for SPT-random and SPT-blocked. Stimulus generalization effects varied across participants and measurement conditions; patterns of generalization did not appear to be associated with treatment condition. CONCLUSIONS:There may be an advantage for SPT-random for some speakers with AOS. Findings from the nonspeech motor learning literature may not translate directly to the treatment of AOS.

PURPOSE This investigation was designed to examine the effects of a newly developed treatment for aphasia and acquired apraxia of speech (AOS). Combined Aphasia and Apraxia of Speech Treatment (CAAST) targets language and speech production simultaneously, with treatment techniques derived from Response Elaboration Training (Kearns, 1985) and Sound Production Treatment (Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998). The purpose of this study was to determine whether CAAST was associated with positive changes in verbal language and speech production with speakers with aphasia and AOS. METHOD Four participants with chronic aphasia and AOS received CAAST applied sequentially to sets of pictures in the context of multiple baseline designs. CAAST entailed elaboration of participant-initiated utterances, with sound production training applied as needed to the elaborated productions. The dependent variables were (a) production of correct information units (CIUs; Nicholas & Brookshire, 1993) in response to experimental picture stimuli, (b) percentage of consonants correct in sentence repetition, and (c) speech intelligibility. RESULTS AND CONCLUSIONS CAAST was associated with increased CIU production in trained and untrained picture sets for all participants. Gains in sound production accuracy and speech intelligibility varied across participants; a modification of CAAST to provide additional speech production treatment may be desirable.

Purpose This investigation was designed to examine the effects of a modification of response elaboration training (RET; Kearns, 1985) with speakers with mild to mild–moderate aphasia. The modification entailed application of RET to procedural discourse and personal recounts rather than to narrative discourse. Method Three participants with chronic aphasia received modified RET (M–RET) applied sequentially in the context of multiple baseline designs to the conditions of personal recounts and procedural discourse. Production of correct information units (CIUs; Nicholas & Brookshire, 1993) served as the primary dependent variable. Results Participants 2 and 3 demonstrated increases in the production of CIUs in response to treatment of procedures. M–RET applied to the personal recount condition was not associated with increased production of CIUs in personal recounts in probes. However, Participant 1 demonstrated increased CIU production for previously treated procedures when treatment was applied to personal recounts. Small effect sizes were obtained for procedural sets for Participant 1, and large effect sizes were obtained for procedural sets for Participants 2 and 3. Maintenance of gains at 3 and 6 weeks post treatment was strong. Conclusion Application of M–RET to procedural discourse appears to be a viable treatment option for participants with mild to mild–moderate aphasia. Supplemental Material https://doi.org/10.23641/asha.14963526

Background: Despite advances in the development and testing of therapies for verb retrieval impairments in aphasia, generalisation effects of treatment remain a challenge. Semantic Feature Analysis (SFA) is a word retrieval treatment that has been reported to result in generalised responding to untrained object names with persons with aphasia. The theorised therapeutic mechanisms of SFA appeared to be appropriate for facilitating retrieval of trained and untrained action names.Aims: This investigation was designed to extend pilot research in which SFA was applied to verb retrieval. The primary purpose of the current study was to examine the acquisition and response generalisation effects of SFA applied to action naming with four persons with chronic aphasia. Additional purposes were to examine changes in production of content in discourse and to explore the correspondence of accuracy of naming during treatment to probe performance.Methods & Procedures: SFA was modified slightly to be appropriate for application to action naming as opposed to object naming; several feature categories were changed, but all other procedures were retained. Treatment was applied sequentially to two sets of action names in the context of multiple baseline designs across behaviours and participants. Accuracy of naming of trained and untrained actions in probes was measured repeatedly throughout all phases of the design. Production of correct information units (CIUs) in discourse was measured prior to and following treatment. The relationship of probe-naming performance to naming performance during treatment sessions was examined using correlational analyses.Outcomes & Results: Increased accuracy of naming of trained action names was associated with treatment for three of the four participants. The remaining participant did not demonstrate improvement in naming on probes, despite some gains during treatment. Generalisation to untrained action names did not occur for any of the participants. Increases in CIU production were observed for only one of the participants. For the participants with positive naming outcomes, probe performance correlated well with naming performance during treatment. For the participant who demonstrated some improvements in treatment, but did not show gains in naming on probes, weak correlations were obtained.Conclusions: SFA appears to have potential for promoting improved action naming in aphasia. However, more research is warranted to explore treatment modifications to promote generalisation. Correlational analyses indicated that gains in naming during treatment may not always be reflected in probe performance and thus, require verification through probing in non-treatment conditions.

Apraxia of speech (AOS) is a neurogenic, motor speech disorder that disrupts the planning for speech production. However, there are only a few reports that have described the evolution of stroke-induced AOS symptoms in the acute or sub-acute phase of recovery. The purpose of this report was to provide a data-based description of an individual with sub-acute AOS and aphasia followed from 1 month post-onset a stroke to eight 8 months post-stroke. Six data collection sessions were conducted at periodic intervals using narrative and procedural discourse tasks and a series of speech and language analyses were completed. The language analyses involved measures of language content and efficiency. The speech production analyses examined the percentage and frequency of errors as well as determining the dominant types of errors produced within and across data collection sessions. For this individual, measures of language content and communication efficiency improved over the six sampling occasions. The number of speech production errors significantly declined after the first data collection session and then gradually over the subsequent sessions. This individual produced five dominant error types within and across sessions. The majority of these error types are behaviors that occur in chronic AOS, but do not distinguish AOS from other acquired neurogenic communication disorders. Due to the lack of research involving acute/sub-acute individuals with AOS additional research is warranted to better understand the evolution of AOS including the speech behaviors that are observed in the acute/sub-acute phase vs. the chronic phase of recovery.

Purpose This investigation was designed to examine the generalization effects of semantic treatment for word retrieval deficits in people with aphasia. Semantic feature analysis (SFA; Boyle & Coelho, 1995), typicality treatment (Kiran & Thompson, 2003), and mediating strategy training were combined to maximize potential generalization effects. Method Treatment, which included SFA and a semantic feature judgment task, was conducted with 9 participants with chronic aphasia in the context of multiple baseline designs across behaviors. Typical and atypical exemplars were trained across animate and inanimate categories. Treatment was sequentially modified to overtly train the use of SFA as a mediating strategy. Results Eight of the 9 participants demonstrated improvements in naming of trained stimuli. Positive generalization effects were limited overall; possible response generalization was evident for 5 participants. Instruction in the use of a mediating strategy resulted in improved naming of treated words for all participants; however, generalization to untreated words did not occur. Conclusion Treatment using SFA resulted in improved naming of treated typical and atypical exemplars in both animate and inanimate categories for 8 of 9 participants. Training in a mediating strategy also resulted in improved retrieval of experimental words. Regardless of intervention approach, generalization to untreated items was limited.

Background: Response Elaboration Training (RET; Kearns, ) has been found to consistently result in increased production of content in discourse with persons with aphasia. Positive treatment effects have been reported for persons representing a variety of aphasia types and severities. RET was modified for application with persons with acquired apraxia of speech and aphasia and positive outcomes were also associated with the modified treatment (Wambaugh & Martinez, ). Although RET has received systematic study, its stimulus generalisation effects are not well understood.Aims: This investigation was designed to measure the stimulus generalisation effects of modified RET (M-RET) in a variety of conditions as well as to further study the effects of M-RET applied to a personal recount condition.Methods & Procedures: Multiple baseline designs (across behaviours and participants) were utilised to examine treatment effects. Treatment was applied sequentially to picture sets and a personal recount condition with six persons with chronic aphasia. Production of correct information units (CIUs) was measured in the following conditions: (1) discourse production in response to sets of trained and untrained pictures, (2) home conversations, and (3) production of discourse in structured tasks. Formal measures of functional communication were also completed prior to and following treatment.Outcomes & Results: Increases in production of CIUs in response to pictures were observed for 11 of the 12 applications of M-RET to picture sets. Response generalisation to untrained picture sets was associated with M-RET applied to pictures sets; increases were slight and were greater for untrained sets that were probed more frequently. Maintenance of gains was generally strong for the participants with nonfluent aphasia, but was minimal for the participant with fluent aphasia. Gains were not evident for M-RET applied to personal recounts; only one participant evidenced changes possibly associated with treatment in the personal recount condition. Improvements in structured discourse samples and a functional communication measure were observed for the majority of the participants following treatment. Lack of compliance in completion of recordings of home conversations limited the utility of that measure.Conclusions: M-RET applied to pictures resulted in improvements in production of content in treated and untreated picture conditions for the majority of the participants. Treatment effects extended to additional outcome measures. Although some positive changes were observed for the participant with fluent aphasia, maintenance was problematic. Application of M-RET to a personal recount condition was not associated with improved performance for most of the participants.