Constrained Versus Unconstrained Intensive Language Therapy in Two Individuals With Chronic, Moderate-to-Severe Aphasia and Apraxia of Speech: Behavioral and fMRI Outcomes Purpose This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic ... Supplement Article
Supplement Article  |   May 01, 2012
Constrained Versus Unconstrained Intensive Language Therapy in Two Individuals With Chronic, Moderate-to-Severe Aphasia and Apraxia of Speech: Behavioral and fMRI Outcomes
 
Author Affiliations & Notes
  • Jacquie Kurland
    University of Massachusetts Amherst
  • Friedemann Pulvermüller
    Free University of Berlin, Germany
  • Nicole Silva
    University of Massachusetts Amherst
  • Katherine Burke
    University of Massachusetts Amherst
  • Mary Andrianopoulos
    University of Massachusetts Amherst
  • Correspondence to Jacquie Kurland: jkurland@comdis.umass.edu
  • Editor: Swathi Kiran
    Editor: Swathi Kiran×
  • Associate Editor: Lisa Connor
    Associate Editor: Lisa Connor×
Article Information
Speech, Voice & Prosodic Disorders / Apraxia of Speech & Childhood Apraxia of Speech / Special Populations / Older Adults & Aging / Language Disorders / Aphasia / Supplement: Select Papers From the 41st Clinical Aphasiology Conference
Supplement Article   |   May 01, 2012
Constrained Versus Unconstrained Intensive Language Therapy in Two Individuals With Chronic, Moderate-to-Severe Aphasia and Apraxia of Speech: Behavioral and fMRI Outcomes
American Journal of Speech-Language Pathology, May 2012, Vol. 21, S65-S87. doi:10.1044/1058-0360(2012/11-0113)
History: Received August 22, 2011 , Revised December 7, 2011 , Accepted January 9, 2012
 
American Journal of Speech-Language Pathology, May 2012, Vol. 21, S65-S87. doi:10.1044/1058-0360(2012/11-0113)
History: Received August 22, 2011; Revised December 7, 2011; Accepted January 9, 2012
Web of Science® Times Cited: 22

Purpose This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic aphasia. 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 individuals with persistent severe nonfluent speech and/or AOS.

Method A single-subject multiple-baseline approach was used. Both participants were treated simultaneously, first with Promoting Aphasics' Communicative Effectiveness (PACE; Davis & Wilcox, 1985) and then with CIAT. Pre-/posttreatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to posttreatment 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 the recruitment of perilesional tissue.

Conclusion Participants produced more target words accurately following CIAT than following 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 participants with chronic moderate-to-severe aphasia with comorbid AOS.

Acknowledgment
This work was supported by a Faculty Research/Healey Endowment Grant from the University of Massachusetts Amherst to the PI (JK).
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