ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia

Abstract

Background Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care—ClearSpeechTogether—is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. Method This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. Results Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. Discussion ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.

ClearSpeechTogether versus standard NHS speech intervention: Study protocol for a single, mixed method, rater blinded pilot randomised controlled trial for people living with MSA-C

“…This is inclusive of pre, post, and follow-up assessments. Arm 1 will involve ClearSpeechTogether, a speech therapy approach originally piloted with speakers with progressive ataxia [13]. ClearSpeechTogether is an interactive, patient centric telehealth model of care that combines individual Speech & Language Therapy (SLT) intervention with peer led group therapy.…”

“…Using this as a baseline, it is necessary for the study to be have sufficient power to detect a mean increase in CPIB scores of 3.6-points. The previous ClearSpeechTogether pilot [13] had a sample size of 11, and retention of 9 participants. The mean difference between pre and post-therapy assessments in this study was 6.33 points (SD = 1.25).…”

The use of the Voice trainer app for vocal control in people with a degenerative ataxia: a pilot intervention study.

“…The speech characteristics in ataxic dysarthria differ between patients along the aspects of speech production (articulation, voice, nasal resonance, prosody and breathing). Still, recent studies show that there can be positive effects of speech therapy interventions [3][4][5][6], but more than for any other dysarthria, we may have to apply individually tailored rather than standardized speech interventions for patients with ataxic dysarthria.…”

“…A survey by Ataxia UK revealed that speech problems are one of the most frequent symptoms with a high impact [2]. Four recent studies demonstrated that a relatively short and intensive speech therapy program can accomplish positive changes in speech or psychosocial aspects in patients with degenerative ataxia [3][4][5][6]. However, results were inconsistent and the stability or duration of the reported improvements is unknown.…”

“…When the same treatment was offered to patients with spinocerebellar ataxias due to CAG repeat expansions, both intelligibility and acoustic measurements improved [6]. In a mixed individual-group therapy, there were some improvements in intelligibility, but the most consistent effect was at the psychosocial level, with improvement of communication participation and con dence [3]. Based on these studies, speech therapy has the potential to accomplish meaningful changes in degenerative ataxias.…”