Investigating changes in connected speech in nonfluent/agrammatic primary progressive aphasia following script training

Stephanie M Grasso; Karinne Berstis; Kristin Schaffer Mendez; Willa R Keegan-Rodewald; Lisa D Wauters; Eduardo Europa; H Isabel Hubbard; Heather R Dial; J Gregory Hixon; Maria Luisa Gorno-Tempini; Adam Vogel; Maya L Henry

doi:10.1016/j.cortex.2024.09.019

Investigating changes in connected speech in nonfluent/agrammatic primary progressive aphasia following script training

Cortex. 2024 Dec 4:183:193-210. doi: 10.1016/j.cortex.2024.09.019. Online ahead of print.

Affiliations

¹ Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States. Electronic address: [email protected].
² Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States; Department of Neurology, Dell Medical School, University of Texas at Austin, United States.
³ Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States; College of Rehabilitative Sciences, The University of St. Augustine for Health Sciences, United States.
⁴ Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States; West Contra Costa Unified School District, United States.
⁵ Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States.
⁶ Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Communication Sciences and Disorders, California State University, Chico, United States.
⁷ Department of Speech & Hearing Sciences, University of New Mexico, United States.
⁸ Department of Speech, Language and Hearing Sciences, University of Texas at Austin, United States; Department of Speech and Hearing, University of Houston, United States.
⁹ Department of Psychology, University of Texas at Austin, United States.
¹⁰ Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Dyslexia Center, Department of Neurology and Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
¹¹ Health Sciences, The University of Melbourne, Redenlab Inc, Australia.

PMID: 39729649
DOI: 10.1016/j.cortex.2024.09.019

Abstract

Script training is a speech-language intervention designed to promote fluent connected speech via repeated rehearsal of functional content. This type of treatment has proven beneficial for individuals with aphasia and apraxia of speech caused by stroke and, more recently, for individuals with primary progressive aphasia (PPA). In the largest study to-date evaluating the efficacy of script training in individuals with nonfluent/agrammatic primary progressive aphasia (nfvPPA; Henry et al., 2018), robust treatment effects were observed, with maintenance of gains up to one year post-treatment. However, outcomes were constrained to measures of script accuracy, intelligibility, and grammaticality, providing a limited view of potential treatment benefit to connected speech. The current study evaluated the utility of a broader set of connected speech measures for characterizing script training outcomes in 20 individuals with nfvPPA who were administered Video-Implemented Script Training for Aphasia (VISTA). Probes of trained and untrained script topics from pre- and post-treatment were transcribed, coded, and analyzed using Computerized Language ANalysis (CLAN, MacWhinney, 2000) to extract measures of fluency, grammar, and informativeness. Speech timing measures (e.g., articulation rate, mean pause duration) were derived from audio files. Participants demonstrated significant changes for trained topics from pre-to post-treatment in words per minute, fluency disruptions per hundred words, mean length of utterance in morphemes, grammatical complexity, and proportion of open to closed class words. Reductions were observed in mean and variability of syllable duration and mean pause duration, and speech to pause ratio increased. These findings lend additional support for script training as a means to promote fluency of connected speech in individuals with nfvPPA and illustrate the utility of automated and semi-automated measures for characterizing treatment effects following intervention.

Keywords: Connected speech; Nonfluent/agrammatic PPA; Primary progressive aphasia; Script training; Speech timing measures.