Brain Biomarkers of Response to Treatment for Apraxia of Speech (SPT)

VA Office of Research and Development

Status: Completed

Conditions: Stroke; Aphasia

Treatments: Behavioral: Speech Production Treatment

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT02046941

C1532-I

Details and patient eligibility

About

The study will use MRI brain imaging to identify brain changes associated in stroke patients after they receive speech-language treatment for their speech difficulties.

Full description

The goals of the current study are to identify grey and white matter regions that are predictive of speech treatment response and measure neural plasticity in response to speech treatment, using state-of-the-art neuroimaging and statistical processing techniques in a group of well-characterized left hemisphere patients meeting strict inclusionary criteria. Specifically, the investigators will use voxel-based lesion symptom mapping to identify lesion sites most predictive of a positive response to speech treatment and advanced diffusion imaging techniques to map changes in the integrity of white matter tracts from pre- to post-treatment.

Enrollment: 17 patients

Sex: All

Ages: 40 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Inclusion criteria are age 40-90
• primary English speaker since < age 5
• a history of a single left hemisphere stroke
• at least 1 year post-stroke
• at least 12 years of education
• pre-morbidly right-handed (Edinburgh Handedness Questionnaire)
• within normal limits on the Test of Non-Verbal Intelligence

Exclusion criteria

• Exclusion criteria will include a pre-morbid neurologic or psychiatric history
• history/current substance abuse disorder
• MRI contraindications
• other motor speech disorders (e.g., dysarthria)
• current or recent (<2 months) speech/language therapy
• prior SPT
• pre-morbid history of speech/language disorders
• significant hearing disabilities (based on a pure-tone audiological screen at 35 dB HL at 500, 1K, and 2K Hz for at least one ear)
• aphasia severity resulting in <30th percentile performance on the Porch Index of Communicative Ability-R

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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17 participants in 1 patient group

Speech Production Treatment

Experimental group

Description:

This treatment employs a response-contingent hierarchy made up of verbal modeling/repetition, graphic cueing, integral stimulation, and articulatory placement instruction. The investigators chose this treatment for the following reasons: 1) rigor of development demonstrated across multiple studies, 2) large and predictable effects with published, quantified effect sizes, 3) a demonstrated pattern of generalization to untrained items, illustrating experimental control, 4) an established multi-modal stimulation protocol, and 5) use of repeated practice, which is associated with neural plasticity.

Treatment:

Behavioral: Speech Production Treatment