A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology

Robey, Randall R.; Schultz, Martin C.

doi:10.1080/02687039808249573

Cited by 195 publications

(116 citation statements)

References 59 publications

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“…Such lack of absolute balance in prognostic attributes is unfortunately an unavoidable consequence of randomization in small clinical trials, especially when there are so many endogenous variables (e.g., site and size of lesion, aphasia classification and severity, time postonset, presence and severity of AOS, education) that can potentially affect treatment outcomes. One plausible solution is a larger controlled clinical trial, such as described by Robey and Schultz (1998), a solution that might also have a better chance of conclusively answering the question of the role of guidance by constraint. It is important to note that for the current study, there were no statistically significant differences between the groups along these demographic and clinical characteristics.…”

Section: Mixed-model Analysesmentioning

confidence: 99%

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Kurland

Stanek

Stokes

et al. 2016

Am J Speech Lang Pathol

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Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

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Section: Mixed-model Analysesmentioning

confidence: 99%

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Kurland

Stanek

Stokes

et al. 2016

Am J Speech Lang Pathol

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“…The comparison treatment used repetition of a spoken model to improve oral naming of target words (Repetition Only). This exploration of the therapeutic effect of the CART + Repetition protocol was considered a Phase 1 study relative to the rubric for aphasia treatment research described by Robey and Schultz (1998). It was expected to provide insight regarding the value of promoting interaction between orthographic and phonological representations in the remediation of lexical retrieval impairments.…”

Section: Introductionmentioning

confidence: 99%

Combining treatment for written and spoken naming

Beeson

Egnor

2006

J. Inter. Neuropsych. Soc.

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Individuals with left-hemisphere damage often have concomitant impairment of spoken and written language. Whereas some treatment studies have shown that reading paired with spoken naming can benefit both language modalities, little systematic research has been directed toward the treatment of spelling combined with spoken naming. The purpose of this study was to examine the therapeutic effect of pairing a lexical spelling treatment referred to as Copy and Recall Treatment (CART) with verbal repetition of target words. This approach (CART + Repetition) was compared with treatment using verbal repetition without the inclusion of orthographic training (Repetition Only). Two individuals with moderate aphasia and severe impairment of spelling participated in the study using a multiple baseline design across stimulus sets and treatment conditions. Both participants improved spelling of targeted words as well as spoken naming of those items, but improvement in spoken naming was marked for one individual in the CART + Repetition condition, while the other participant made smaller gains in spoken than written naming irrespective of treatment condition. Consideration of the participant profiles suggested that CART + Repetition provides greater benefit when there is some residual phonological ability and the treatment serves to stimulate links between orthography and phonology.

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“…Due to the demand for evidence-based clinical practice in SpeechLanguage Pathology a writing committee was appointed by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) in 2001 to examine the current state-of-the-art and to develop evidence-based treatment guidelines for AOS (Wambaugh, Duffy, McNeil, Robin, & Rogers, 2005;2006). After scrutinizing the corpus of published treatment studies, the committee came to the conclusion that AOS treatment is still at the Phase-I or Phase-II levels of the five-phase model of clinical outcomes research (Robey & Schultz, 1998).…”

Section: Outcomes and Resultsmentioning

confidence: 99%

“…The SML approach is imbedded in the theoretical framework for the characterization of pathological speech sensorimotor control (Van der Merwe, 2009; briefly named the four-level framework -FL framework), draws on evidence from motor control and speech motor control research, incorporates traditional articulatory-kinematic methods (Rosenbek et al, 1973;Wambaugh & Nessler, 2004), utilizes motor learning principles (Schmidt & Lee, 2005) and graphic stimuli (a form of inter-systemic reorganization), and includes a focus on speech prosody. According to Robey and Schultz (1998) the primary objectives of Phase 1 clinical outcomes research are to develop critical research hypotheses for later testing, to establish the safety of the new 4 treatment and to detect the activity of a treatment. The aims of the present paper are (1) to explain and justify the theoretical rationale underlying the SML approach, (2) describe the methods of application, and (3) to explore the effects of this treatment on the speech of an adult with AOS.…”

mentioning

confidence: 99%

A speech motor learning approach to treating apraxia of speech: Rationale and effects of intervention with an adult with acquired apraxia of speech

Merwe

2011

Aphasiology

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Background: In this paper the rationale for a treatment of apraxia of speech, the speech motor learning (SML) approach, is described and the effects of its application explored. The SML approach endeavours to address the underlying inability to plan and program the production of different speech motor targets (SMTs) in changing phonetic contexts and in utterances exceeding a single word/nonword in length.Aims: The aims of the study were to determine 1) if treatment effects generalized to untreated nonwords and untreated real words with trained vowels and consonants, 2) if a learning effect was maintained, 3) if the treatment task hierarchy of the SML approach could be confirmed, and 4) if the number of speech errors judged perceptually declined across the treatment period on treated and untreated stages. Methods & Procedures:A multiple baseline single-subject design across behaviours and contexts was used to assess the effects of treatment with a speaker with chronic pure AOS. The first six stages of an eleven-stage treatment hierarchy were consecutively treated. The last five remained untreated. Outcomes & Results:During treatment, production of untrained nonwords and words containing trained and untrained SMTs improved. For three treated stages, the improvement was greater during the treatment phase than during baseline, for words, nonwords, or both. Stage 4 vowels only improved once treatment commenced. Conclusions: Preliminary evidence is provided supporting a general improvement in speech motor planning and programming ability for this participant. The relative value of components of the SML approach, need to be verified in future.Key words: apraxia of speech, treatment, speech motor planning Since the first report on the treatment of acquired apraxia of speech (AOS) (Rosenbek, Lemme, Ahern, Harris, & Wertz, 1973), there has been a growing interest in this field. Due to the demand for evidence-based clinical practice in SpeechLanguage Pathology a writing committee was appointed by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) in 2001 to examine the current state-of-the-art and to develop evidence-based treatment guidelines for AOS (Wambaugh, Duffy, McNeil, Robin, & Rogers, 2005;2006). After scrutinizing the corpus of published treatment studies, the committee came to the conclusion that AOS treatment is still at the Phase-I or Phase-II levels of the five-phase model of clinical outcomes research (Robey & Schultz, 1998).Four general treatment approaches were identified. These were articulatorykinematic approaches, rate and/or rhythm treatments, alternative and augmentative communication treatments and intersystemic reorganization. Articulatory-kinematic treatment was the only approach that was "recommended" by the working committee of the ANCDS. Recommendation implies that benefits clearly exceed risks, but the evidence is less strong than in the case of a "strongly recommended" approach. The other three approaches were considered as treatment "options". 3Most articulatory-kinematic ...

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A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology

Cited by 195 publications

References 59 publications

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Combining treatment for written and spoken naming

A speech motor learning approach to treating apraxia of speech: Rationale and effects of intervention with an adult with acquired apraxia of speech

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