Constrained vs. Unconstrained Intensive Language Therapy in Two Individuals with Chronic, Moderate-to-Severe Aphasia and Apraxia of Speech: Behavioral and fMRI Outcomes.

Am J Speech Lang Pathol. 2012 Jan 31;

Authors: Kurland J, Pulvermüller F, Silva N, Burke K, Andrianopoulos M

Abstract
PURPOSE: This Phase I study investigated behavioral and fMRI outcomes of two intensive treatment programs to improve naming in two participants with chronic moderate-to-severe aphasia with co-morbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT) has demonstrated positive outcomes in some chronically aphasic individuals. Whether constraint to the speech modality or treatment intensity is responsible for such gains is still under investigation. Moreover, it remains to be seen whether CIAT is effective in persons with persistent severe nonfluent speech, and/or AOS. METHOD: A single-subject multiple baseline approach was utilized. Participants were treated simultaneously, first with PACE, and then CIAT. Pre/post-treatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to post-treatment phases, and maintenance where available. RESULTS: Both participants made more and faster gains in naming following CIAT. Treatment-induced changes in BOLD activation suggested that better naming was correlated with recruitment of perilesional tissue. CONCLUSIONS: Participants accurately produced more target words post-CIAT than post-PACE. Behavioral and fMRI results support the notion that the intense and repetitive nature of obligatory speech production in CIAT has a positive effect on word retrieval, even in chronic moderate-to-severe aphasia with co-morbid AOS.

PMID: 22294409 [PubMed - as supplied by publisher]