Structured Abstract
Clinical Question: Would individuals with acquired apraxia of speech (AOS) demonstrate greater improvements for speech production with an articulatory kinematic approach or a rate/rhythm approach?
Method: EBP Intervention Comparison Review
Study Sources: ASHA journal, Google Scholar, PubMed, CINAHL Plus with Full Text, Web of Science, Ovid, and Scopus
Search Terms: apraxia AND adult OR acquired, and intervention OR therapy
Number of Included Studies: 18
Primary Results: Articulatory kinematic and rate/rhythm approaches are beneficial to individuals with AOS. Sound Production Therapy (SPT) is one articulatory kinematic approach with data from a meta-analysis that demonstrates large and positive results for individuals with AOS. This approach incorporates a majority of the strategies included in most of the articulatory kinematic approaches. Rate/rhythm approaches have produced positive results for some individuals with AOS. There are fewer studies examining rate/rhythm approaches. One study by Brendel & Ziegler (2008) demonstrates support for the use of one rate/rhythm approach.
Conclusions: Research supports the use of articulatory kinematic and rate/rhythm approaches for AOS. Choose the best intervention based on the patient’s level of functioning and goals. For example, current rate/rhythm approaches include the production of phrases with a metronome, hand tapping, or a sequence of tones. If the patient demonstrates severe AOS and only produces utterances at the single-syllable word level, then a rate/rhythm approach may not be the best first choice.
Clinical Scenario
Carole is a speech-language pathologist (SLP) working in the outpatient department of a stroke rehabilitation center. She recently evaluated Joyce, a 70-year-old female patient, who demonstrated severe expressive speech deficits. Her spontaneous speech consisted of a few words and automatic phrases.
At the time of her evaluation, Joyce was eight months post onset of a left hemisphere stroke. She demonstrated severe acquired apraxia of speech (AOS) as measured by the Apraxia Battery for Adults–Second Edition (ABA-2; Dabul, 2000) and criteria for AOS diagnosis outlined by McNeil, Robin, and Schmidt (1997): disturbed prosody, prolonged segment durations, prolonged intersegment durations, and sound distortions. On the Western Aphasia Battery–Revised (WAB–R; Kertesz, 2006), Joyce demonstrated moderate Broca’s aphasia as measured by her Aphasia Quotient (AQ) of 53.8 and other subtest scores (Kertesz, 2006).
Scores on the following subtests determined the AQ of 53.8: Spontaneous Speech, Auditory Verbal Comprehension, Repetition, and Naming/Word Finding. Her AQ was low due to the reduced scores on the expressive language subtests. Her ability to write several words suggested that her difficulty was not with the retrieval of the word, but with the production of the word.
It is possible that her moderate aphasia severity rating was due to her AOS. When factoring in written words to the scores on the WAB–R (Kertesz, 2006), her AQ was 61.4. Even with this, her low score on the repetition task was still the main reason for her lower AQ and seemingly higher aphasia severity rating. Dabul (2000) suggested that a person with aphasia without AOS is usually able to repeat words following a model, but an individual with AOS and aphasia will continue to demonstrate difficulty with production. Overall, Joyce demonstrated limited abilities to verbally answer questions or make requests, and her repetition skills were inconsistent. Through yes/no questioning and written information, she was able to communicate that she knew, but could not say words. Auditory comprehension subtests were within normal limits as measured by subtests of the WAB–R (Kertesz, 2006). Collectively, results from Joyce’s evaluation suggested that her main communication deficit was related to AOS. Joyce was highly motivated to participate in skilled speech therapy and indicated that her main goal was to verbally communicate. Joyce was active in many social groups and played bridge at least twice a week, but the quality of her interactions was diminished by her reduced ability to participate in conversations.