Treatment for speech production and fluency in two individuals with non-fluent primary progressive aphasia



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Purpose: The current study examined the utility of a script-based treatment protocol for improving speech production and fluency in two individuals with the non-fluent variant of primary progressive aphasia (PPA). Method: The treatment protocol was a modified version of the "speech entrainment" technique examined in non-fluent stroke aphasia by Fridriksson and colleagues (2012). Personalized scripts were recorded as videos of a healthy speaker's mouth. Scripts were rehearsed via synchronized spoken production in daily homework. Treatment sessions with the clinician targeted memorization and conversational usage. The protocol was modified from the original study in its use of 1.) topics of interest to the participant, 2.) tailored speech rate based on the participant's habitual rate of speech in reading and spontaneous speech tasks, and 3.) tailored level of script difficulty based on the participants' motor and linguistic profile. Speech entrainment is a homework-based treatment and required participants to practice thirty minutes per day over the course of nine weeks of treatment in addition to receiving in-person treatment twice per week. Outcome measures for trained and untrained scripts were percent correct and intelligible scripted words, errors by word class, total number of grammatical errors, and total percent intelligibility. Results: Both participants showed significant improvement in intelligibility and accuracy of trained scripts and generalized improvement on untrained scripts was observed in one participant. Participants showed a significant reduction in grammatical errors after treatment. One participant showed significant changes in overall intelligibility after treatment, and maintenance of intelligibility and script accuracy at three months post treatment. Conclusion: Script training using speech entrainment resulted in improved intelligibility, grammaticality, and overall accuracy for scripted material in two participants with PPA. Speech entrainment may be a viable treatment method for individuals with non-fluent PPA, particularly with modifications to support increased intelligibility for those with concomitant motor speech deficits. Because speech entrainment is homework-based, the frequency and dosage of treatment are maximized without necessitating an increase in face-to-face treatment sessions. This has promising implications for individuals facing limited reimbursement for treatment and for individuals who have mobility issues.