Effects’of’Verb’NetworkStrengthening’Treatment’(VNeST)’and ... ·...
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Effects of Verb Network Strengthening Treatment (VNeST) and Melodic Intona>on Therapy (MIT) on conversa>onal speech in individuals with Aphasia Samantha Hundemer, B.S. & Abbie Olszewski, Ph.D., CCCSLP University of Nevada, Reno Introduction • The ability to parGcipate in conversaGonal speech originates in the leJ hemisphere in Broca’s area. Strokes that damage this area cause aphasia, which prevents access to this language pathway. •VNeST is a semanGc therapy which seeks to improve lexical retrieval of content words in sentence context by encouraging systemaGc retrieval of verbs (Edmonds et. al, 2009). • MIT is a sequenGal treatment which combines words with melody to facilitate speech output in those with nonfluent aphasia (Conklyn et. al, 2012). The purpose of this research project was to: Determine if Melodic IntonaGon Therapy (MIT) results in significantly improved conversaGonal speech, as measured by words per minute, for people with aphasia as compared with Verb Network Strengthening Treatment (VNeST). Case Scenario Authors & Design Par>cipants (diagnosis, gender, & age) Appraisal ra>ng & interrater reliability Outcome Measures Results Edmonds & Babb (2011) MulGple baseline across parGcipants N=2 P1: 42, female, leJ MCA stroke 49 months before study P2: 49, female, leJ MCA stroke 9 months prior Both had: diagnosis of aphasia, right handed, lexical retrieval deficits, and no history of LD or addicGon. Ra>ng: 10/14 SuggesGve (71%) Reliability: 100% Sentence probes NAVS: Untrained sGmuli AdjecGves Sentence probes: P1: Effect size = 5.73 P2: Effect size = 10 Untrained s>muli: P1: Effect sizes = 2.98 (post), 3.86 (5 mo. post) P2: Effect sizes = 5.66 (post), 4.24 (1 mo. post) Adjec>ve control task: P1: Effect sizes = 1.10 (post), 2.01 (5 mo. post) P2: Effect sizes = 1.04 (post), 1.04 (1 mo. post) Edmond, Nadeau, & Kiran (2009) Single subject N=4 2 had moderate transcorGcal aphasia and 3 had moderate conducGon aphasia according to WAB All:Monolingual English, had impaired lexical access for nouns and verbs, no other neurological or learning disorder, and right handed Ra>ng: 9/14 SuggesGve (64%) Reliability: 93% Accuracy on generaliza>on tasks naming, picture descripGon, connected speech sample Generaliza>on tasks Improvement on the Noun and Verb Retrieval on sentence producGon tests (picture descripGon and connected speech) were clinically significant, but not on the Boston Naming Test. p level and effect size not provided. Schlaug, Marchina, & Norton (2008) Single subject N=2 Both severe nonfluent aphasia, leJ MCA stroke, classified as Broca’s, and both received more than a year of tradiGonal speech therapy prior to study. Ra>ng: 8/13 SuggesGve (62%) Reliability: 93% Behavioral Exams Spontaneous speech measures: conversaGonal interview & picture descripGon Neural Exams fMRI imaging used with bisyllabic word list in 5 condiGons: spoken/sung, repeGGon, delayed rep. with humming and phonaGon. Behavioral Both intervenGons resulted in significant improvement post treatment in proposiGonal speech that generalized to unpracGced words and phrases, but p levels and effect sizes were not provided. Neural R hemi sensorimotor network is engaged which may coordinate orofacial and arGculatory movements. Van de SandtKoenderman, Smits, Van der Meulen, VischBrink, Van der Lugt, & Ribbers (2010) Single subject N=1 2 weeks poststroke, female, 25 y.o., right handed, severe Broca’s & rightsided hemiplegia. Ra>ng: 9/14 SuggesGve (64%) Reliability: 100% Behavioral Exam Language performance on story retell Correct InformaGon Units (CIUs) per min Neural Exam Changes seen in fMRI imaging Behavioral Spontaneous speech, repeGGon, naming, and CIUs/min all improved at p < 0.001. Effect sizes were not provided. Neural Reduced acGvity in R hemi, reacGvaGon in L. Effect sizes were not provided. Wallace & Carter (1985) MulGple baseline across parGcipants N=8 6 paGents with aphasia and leJ CVA and 2 controls, and all between 52 to 74 yrs old. Ra>ng: 10/13 SuggesGve (77%) Reliability: 100% Picture idenGficaGon where sGmuli presented in 3 condiGons: • Neutral • Melodic intonaGon • Strong affect Picture Iden>fica>on No significant difference in L hemi damaged auditory comprehension in the 3 condiGons of sGmuli. Effect sizes were not provided. Zumbansen, Peretz, & Herbert (2014) SystemaGc review N = 14 studies reviewed PaGents with L hemi CVA resulGng in aphasia (usually Broca’s or global) receiving MIT or a similar alternaGve. CASM score: 4/6 Emerging evidence with strong importance. Reliability: 100% Language Performance: • Connected speech analyses • Sentence recall • Intelligibility • WhquesGons • ProposiGonal language tests This was a systemaGc review, therefore p values and effect sizes were not reported. This review found that MIT should be researched as an approach to help apraxia more than aphasia in the future. Methods • Search Terms:: aphasia, VNeST, MIT, conversa4onal speech. • Databases: PubMed and ASHA. • Ra>ng System: CriGcal Appraisal of Treatment Evidence (CATE form) was used to appraise validity and clinical significance with interrater reliability; 14 point raGng scale;10 arGcles appraised. • Ar>cles: Six arGcles were chosen to assist in EBP decision. Each study had innterater reliability of at least 93%. Discussion •VNeST is successful in generalizing to spontaneous speech (Edmonds et. al, 2009), while MIT is more appropriate for motor speech treatment (Zumbansen, Peretz, & Herbert, 2014). •MIT does not enhance auditory comprehension (Wallace & Canter, 1985), nor improve right hemisphere connecGons (Van de SandtKoenderman et. al, 2010). •Hand tapping engages the sensorimotor network leading to more coordinated orofacial and arGculatory movements, resulGng in an increase in correct producGons, as opposed to MIT facilitaGng increased expressive language (Shlaug et. al, 2008). •Client concerns included daily communicaGon with others and verb use. •Clinician feels comfortable administering both treatments. •VNeST was chosen as the most appropriate therapy for clients with Broca’s Aphasia to increase conversaGonal speech as measured by words per minute. Results References Edmonds, L.A., Babb, M. (2011). Effect of verb network strengthening treatment in moderatetosevere aphasia. American journal of speechlanguage pathology, 20(2), 131145. doi: 10.1044/10580360(2011/100036) Edmonds, L.A., Nadeau, S.E. & Kiran, S.(2009). Effect of verb network strengthening treatment (VNeST) on lexical retrieval of content words in sentences in persons with aphasia. Aphasiology, 23,402424. doi:10.1080/02687030802291339 Schlaug, G., Marchina, S. & Norton, A. (2008). From singing to speaking: why singing may lead to recovery of expressive language funcGon in paGents with Broca’s aphasia. Music percep4on: an interdisciplinary journal, 25(4), 315323. doi: 10.1525/mp.2008.25.4.315 Van de SandtKoenderman, M., Smits, M., Van der Meulen, I., VischBrink, E., Van der Lugt, A., & Ribbers, G. (2010). A case study of melodic intonaGon therapy (MIT) in the subacute stage of aphasia: early rere acGvaGon of leJ hemisphere structures. Procediasocial and behavioral sciences, 6, 241243. doi: 10.1016/j.sbspro.2010.08.121 Wallace, G.L. (1985). Comprehension of neutral, melodically intoned, and affecGvely toned sentences by adults with aphasia. Journal of communica4on disorders, 18(5), 321327. doi: 10.1016/00219924(85)900231 Zumbansen, A., Peretz, I., & Hebert, S. (2014). Melodic intonaGon therapy: back to basics for future research. Fron4ers in neurology, 5, 111. doi: 10.3389/fneur.204.00007 Purpose Graduate clinician has a 42 year old client with Broca’s aphasia. This semester, her language goals related to conversaGonal speech will be addressed. However, with various approaches to address this goal, it is challenging to decide which to use. There is limited Gme leJ in the semester to provide therapy, so the clinician is seeking the most efficient and effecGve treatment .
Transcript of Effects’of’Verb’NetworkStrengthening’Treatment’(VNeST)’and ... ·...
Effects of Verb Network Strengthening Treatment (VNeST) and Melodic Intona>on Therapy (MIT) on conversa>onal speech in individuals with Aphasia
Samantha Hundemer, B.S. & Abbie Olszewski, Ph.D., CCC-‐SLP University of Nevada, Reno
Introduction • The ability to parGcipate in conversaGonal speech originates in the leJ hemisphere in Broca’s area. Strokes that damage this area cause aphasia, which prevents access to this language pathway. • VNeST is a semanGc therapy which seeks to improve lexical retrieval of content words in sentence context by encouraging systemaGc retrieval of verbs (Edmonds et. al, 2009). • MIT is a sequenGal treatment which combines words with melody to facilitate speech output in those with nonfluent aphasia (Conklyn et. al, 2012).
The purpose of this research project was to:
Determine if Melodic IntonaGon Therapy (MIT) results in significantly improved conversaGonal speech, as measured by words per minute, for people with aphasia as compared with Verb Network Strengthening Treatment (VNeST).
Graduate clinician has a 42 year old client with Broca’s aphasia. This semester, her
language goals related to conversaGonal speech will be addressed. However, with various approaches to address this goal, it is challenging to decide which to use. There is limited Gme leJ in the semester to provide therapy, so the clinician is seeking the most efficient and effecGve treatment .
Case Scenario
Authors & Design
Par>cipants (diagnosis, gender, & age)
Appraisal ra>ng & interrater reliability
Outcome Measures Results
Edmonds & Babb (2011) MulGple baseline across parGcipants
N = 2 P1: 42, female, leJ MCA stroke 49 months before study P2: 49, female, leJ MCA stroke 9 months prior Both had: diagnosis of aphasia, right handed, lexical retrieval deficits, and no history of LD or addicGon.
Ra>ng: 10/14 SuggesGve (71%)
Reliability: 100%
Sentence probes
NAVS:
Untrained sGmuli
AdjecGves
Sentence probes: P1: Effect size = 5.73 P2: Effect size = 10 Untrained s>muli: P1: Effect sizes = 2.98 (post), 3.86 (5 mo. post) P2: Effect sizes = 5.66 (post), 4.24 (1 mo. post) Adjec>ve control task: P1: Effect sizes = 1.10 (post), 2.01 (5 mo. post) P2: Effect sizes = 1.04 (post), 1.04 (1 mo. post)
Edmond, Nadeau, & Kiran (2009) Single subject
N = 4 2 had moderate transcorGcal aphasia and 3 had moderate conducGon aphasia according to WAB All:Monolingual English, had impaired lexical access for nouns and verbs, no other neurological or learning disorder, and right handed
Ra>ng: 9/14 SuggesGve (64%)
Reliability: 93%
Accuracy on generaliza>on tasks naming, picture descripGon, connected speech sample
Generaliza>on tasks v Improvement on the Noun and Verb Retrieval on sentence producGon tests (picture descripGon and connected speech) were clinically significant, but not on the Boston Naming Test. v p level and effect size not provided.
Schlaug, Marchina, & Norton (2008) Single subject
N = 2 Both severe non-‐fluent aphasia, leJ MCA stroke, classified as Broca’s, and both received more than a year of tradiGonal speech therapy prior to study.
Ra>ng: 8/13 SuggesGve (62%)
Reliability: 93%
Behavioral Exams Spontaneous speech measures: conversaGonal interview & picture descripGon Neural Exams fMRI imaging used with bisyllabic word list in 5 condiGons: spoken/sung, repeGGon, delayed rep. with humming and phonaGon.
Behavioral
v Both intervenGons resulted in significant improvement post-‐treatment in proposiGonal speech that generalized to unpracGced words and phrases, but p levels and effect sizes were not provided. Neural v R hemi sensorimotor network is engaged which may coordinate orofacial and arGculatory movements.
Van de Sandt-‐Koenderman, Smits, Van der Meulen, Visch-‐Brink, Van der Lugt, & Ribbers (2010) Single subject
N = 1 2 weeks post-‐stroke, female, 25 y.o., right handed, severe Broca’s & right-‐sided hemiplegia.
Ra>ng: 9/14 SuggesGve (64%)
Reliability: 100%
Behavioral Exam Language performance on story retell Correct InformaGon Units (CIUs) per min Neural Exam Changes seen in fMRI imaging
Behavioral v Spontaneous speech, repeGGon, naming, and CIUs/min all improved at p < 0.001. v Effect sizes were not provided.
Neural v Reduced acGvity in R hemi, reacGvaGon in L. v Effect sizes were not provided.
Wallace & Carter (1985) MulGple baseline across parGcipants
N = 8 6 paGents with aphasia and leJ CVA and 2 controls, and all between 52 to 74 yrs old.
Ra>ng: 10/13 SuggesGve (77%)
Reliability: 100%
Picture idenGficaGon where sGmuli presented in 3 condiGons:
• Neutral
• Melodic intonaGon
• Strong affect
Picture Iden>fica>on v No significant difference in L hemi damaged auditory comprehension in the 3 condiGons of sGmuli. v Effect sizes were not provided.
Zumbansen, Peretz, & Herbert (2014)
SystemaGc review
N = 14 studies reviewed PaGents with L hemi CVA resulGng in aphasia (usually Broca’s or global) receiving MIT or a similar alternaGve.
CASM score: 4/6 Emerging evidence with strong importance.
Reliability: 100%
Language Performance: • Connected speech analyses • Sentence recall • Intelligibility • Wh-‐quesGons • ProposiGonal language tests
v This was a systemaGc review, therefore p values and effect sizes were not reported.
v This review found that MIT should be researched as an approach to help apraxia more than aphasia in the future.
Methods • Search Terms:: aphasia, VNeST, MIT, conversa4onal speech. • Databases: PubMed and ASHA. • Ra>ng System: CriGcal Appraisal of Treatment Evidence (CATE form) was used to
appraise validity and clinical significance with interrater reliability; 14 point raGng scale;10 arGcles appraised.
• Ar>cles: Six arGcles were chosen to assist in EBP decision. Each study had innterater reliability of at least 93%.
Discussion • VNeST is successful in generalizing to spontaneous speech (Edmonds et. al, 2009), while MIT is more appropriate for motor speech treatment (Zumbansen, Peretz, & Herbert, 2014). • MIT does not enhance auditory comprehension (Wallace & Canter, 1985), nor improve right hemisphere connecGons (Van de Sandt-‐Koenderman et. al, 2010). • Hand tapping engages the sensorimotor network leading to more coordinated orofacial and arGculatory movements, resulGng in an increase in correct producGons, as opposed to MIT facilitaGng increased expressive language (Shlaug et. al, 2008). • Client concerns included daily communicaGon with others and verb use. • Clinician feels comfortable administering both treatments. • VNeST was chosen as the most appropriate therapy for clients with Broca’s Aphasia to increase conversaGonal speech as measured by words per minute.
Results
References Edmonds, L.A., Babb, M. (2011). Effect of verb network strengthening treatment in moderate-‐to-‐severe aphasia. American journal of speech-‐language pathology, 20(2), 131-‐145. doi: 10.1044/1058-‐0360(2011/10-‐0036) Edmonds, L.A., Nadeau, S.E. & Kiran, S.(2009). Effect of verb network strengthening treatment (VNeST) on lexical retrieval of content words in sentences in persons with aphasia. Aphasiology, 23,402-‐424. doi:10.1080/02687030802291339 Schlaug, G., Marchina, S. & Norton, A. (2008). From singing to speaking: why singing may lead to recovery of expressive language funcGon in paGents with Broca’s aphasia. Music percep4on: an interdisciplinary journal, 25(4), 315-‐323. doi: 10.1525/mp.2008.25.4.315 Van de Sandt-‐Koenderman, M., Smits, M., Van der Meulen, I., Visch-‐Brink, E., Van der Lugt, A., & Ribbers, G. (2010). A case study of melodic intonaGon therapy (MIT) in the subacute stage of aphasia: early re-‐re acGvaGon of leJ hemisphere structures. Procedia-‐social and behavioral sciences, 6, 241-‐243. doi: 10.1016/j.sbspro.2010.08.121 Wallace, G.L. (1985). Comprehension of neutral, melodically intoned, and affecGvely toned sentences by adults with aphasia. Journal of communica4on disorders, 18(5), 321-‐327. doi: 10.1016/0021-‐9924(85)90023-‐1 Zumbansen, A., Peretz, I., & Hebert, S. (2014). Melodic intonaGon therapy: back to basics for future research. Fron4ers in neurology, 5, 1-‐11. doi: 10.3389/fneur.204.00007
Purpose
Graduate clinician has a 42 year old client with Broca’s aphasia. This semester, her language goals related to conversaGonal speech will be addressed. However, with various approaches to address this goal, it is challenging to decide which to use. There is limited Gme leJ in the semester to provide therapy, so the clinician is seeking the most efficient and effecGve treatment .
