The impact of intensive treatment on non-progressive dysarthric speakers: A pilot study

1. 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

2. 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)

3. Introduction •  evidence to support intensive training/exercise for motor skill learning • Facilitates neuroplasticity (adaptive capacity of CNS) (Cotman & Berchtold 2002) • Long-term structural changes (cortical synaptogenesis & motor map reorganisation) in neural functioning occur following continued practice (Kleim et al 2004) •  expression neurotrophic factors  cell survival (Ying et al 2005)

4. 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

5. Aim To investigate the immediate & long-term effects of intensive dysarthria treatment on speech, voice & everyday communication in non-progressive dysarthric speakers

6. 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

7. 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

8. Procedure Pre treatment Ax 1 Pre treatment Ax 2 Pre treatment Assmt 1 Dysarthria Treatment Post treatment Ax 1 Post treatment Ax 2 6 month Follow up Ax 1 6 month Follow up Ax 2

9. 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

10. 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)

11. 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

12. 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

13. 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

14. ResultsStatistical 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

15. Results - Perceptual AnalysisGeometric means Significant Pre/Post p<.05 Significant Pre/FU p<.05

16. Results - AssIDS   12.5%  9.4%  Significant Pre/Post p<.05

17. Results - Acoustic Duration phonation = NS     Mean SPL (dB) Significant Pre/Post p<.05Significant Pre/FU p<.05

18. Results - AusTOMS      Improvement   Significant Pre/Post p<.05Significant Pre/FU p<.05

19. Results – Participant Ques       Improvement  Significant Pre/Post p<.05 Significant Pre/FU p<.05

20. Results – Communication Partner Ques  Improvement  Significant Pre/Post p<.05

21. Discussion • Positive short & long-term effects of intensive dysarthria treatment • Articulatory precision • Speech intelligibility • Loudness during reading • Activity limitation (AusTOMS) • Slurring (Part. Ques) • How well understood (Part. Ques) • Initiate conversation (Part. Ques) • Intensive treatment led to greater acquisition & learning of motor speech behaviours

22. 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

23. 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