scholarly journals Speech and language therapy approaches to managing primary progressive aphasia

2019 ◽  
Vol 20 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Anna Volkmer ◽  
Emily Rogalski ◽  
Maya Henry ◽  
Cathleen Taylor-Rubin ◽  
Leanne Ruggero ◽  
...  
Keyword(s):  
Primary Progressive Aphasia ◽  
Therapeutic Interventions ◽  
Speech And Language ◽  
Language Therapy ◽  
Compensatory Strategies ◽  
Speech And Language Therapy ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Evidence Based Guidelines ◽  
Improve Access

The term primary progressive aphasia (PPA) describes a group of neurodegenerative disorders with predominant speech and language dysfunction as their main feature. There are three main variants – the semantic variant, the nonfluent or agrammatic variant and the logopenic variant – each with specific linguistic deficits and different neuroanatomical involvement. There are currently no curative treatments or symptomatic pharmacological therapies. However, speech and language therapists have developed several impairment-based interventions and compensatory strategies for use in the clinic. Unfortunately, multiple barriers still need to be overcome to improve access to care for people with PPA, including increasing awareness among referring clinicians, improving training of speech and language therapists and developing evidence-based guidelines for therapeutic interventions. This review highlights this inequity and the reasons why neurologists should refer people with PPA to speech and language therapists.

scholarly journals Speech and language therapy for primary progressive aphasia: Referral patterns and barriers to service provision across the UK

Dementia ◽  
2018 ◽  
Vol 19 (5) ◽  
pp. 1349-1363 ◽  
Author(s):  
Anna Volkmer ◽  
Aimee Spector ◽  
Jason D Warren ◽  
Suzanne Beeke
Keyword(s):  
Primary Progressive Aphasia ◽  
Evidence Base ◽  
Research Literature ◽  
Speech And Language ◽  
Language Therapy ◽  
Eligibility Criteria ◽  
Speech And Language Therapy ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Relevant Evidence

Objective To assess the extent of UK speech and language therapy engagement in assessment and management of primary progressive aphasia, determine the factors contributing to any shortfall and explore a gap in the research literature on current speech and language therapy practices with people with primary progressive aphasia. Methods A 37-item, pilot-tested survey was distributed electronically via clinical networks and through the Royal College of Speech and Language Therapists. Survey items included questions on intervention approaches, referral numbers and demographics, referral sources and access to services. Results One hundred and five speech and language therapists completed the survey. Over the previous 24 months, respondents reported seeing a total of 353 people with primary progressive aphasia (an average of 3.27 per speech and language therapist). Neurologists were the most commonly reported referrers to speech and language therapy (22.5%). Seventy-eight percent of respondents reported that people with primary progressive aphasia experienced barriers to accessing speech and language therapy. Key barriers were a lack of referrer awareness of a speech and language therapist’s role, and restrictive eligibility criteria for services. Conclusions This study highlighted inequities in access to speech and language therapy for people with primary progressive aphasia. The medical and speech and language therapy professions need to develop appropriate care pathways for people with primary progressive aphasia. Speech and language therapists have a duty to develop a relevant evidence base for speech and language interventions for people with primary progressive aphasia.

scholarly journals Rate and rhythm control strategies for apraxia of speech in nonfluent primary progressive aphasia

2018 ◽  
Vol 12 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Bárbara Costa Beber ◽  
Monalise Costa Batista Berbert ◽  
Ruth Siqueira Grawer ◽  
Maria Cristina de Almeida Freitas Cardoso
Keyword(s):  
Control Strategies ◽  
Primary Progressive Aphasia ◽  
Rhythm Control ◽  
Speaking Rate ◽  
Apraxia Of Speech ◽  
Speech And Language ◽  
Language Therapy ◽  
Speech And Language Therapy ◽  
Progressive Aphasia ◽  
Primary Progressive

ABSTRACT The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.

Sleep as a predictor of tDCS and language therapy outcomes

SLEEP ◽  
2021 ◽  
Author(s):  
Olivia Herrmann ◽  
Bronte Ficek ◽  
Kimberly T Webster ◽  
Constantine Frangakis ◽  
Adam P Spira ◽  
...  
Keyword(s):  
Inferior Frontal Gyrus ◽  
Primary Progressive Aphasia ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Language Therapy ◽  
Double Blind ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Time In Bed ◽  
Sham Condition

Abstract Study Objectives To determine whether sleep at baseline (before therapy) predicted improvements in language following either language therapy alone or coupled with transcranial direct current stimulation (tDCS) in individuals with primary progressive aphasia (PPA). Methods Twenty-three participants with PPA (mean age 68.13 ± 6.21) received written naming/spelling therapy coupled with either anodal tDCS over the left inferior frontal gyrus (IFG) or sham condition in a crossover, sham-controlled, double-blind design (ClinicalTrials.gov identifier: NCT02606422). The outcome measure was percent of letters spelled correctly for trained and untrained words retrieved in a naming/spelling task. Given its particular importance as a sleep parameter in older adults, we calculated sleep efficiency (total sleep time/time in bed x100) based on subjective responses on the Pittsburgh Sleep Quality Index (PSQI). We grouped individuals based on a median split: high versus low sleep efficiency. Results Participants with high sleep efficiency benefited more from written naming/spelling therapy than participants with low sleep efficiency in learning therapy materials (trained words). There was no effect of sleep efficiency in generalization of therapy materials to untrained words. Among participants with high sleep efficiency, those who received tDCS benefitted more from therapy than those who received sham condition. There was no additional benefit from tDCS in participants with low sleep efficiency. Conclusion Sleep efficiency modified the effects of language therapy and tDCS on language in participants with PPA. These results suggest sleep is a determinant of neuromodulation effects. Clinical Trial: tDCS Intervention in Primary Progressive Aphasia https://clinicaltrials.gov/ct2/show/NCT02606422

Primary progressive aphasia: a review of neuropsychological tests for the assessment of speech and language disorders

Aphasiology ◽  
2017 ◽  
Vol 31 (12) ◽  
pp. 1359-1378 ◽  
Author(s):  
Petronilla Battista ◽  
Antonio Miozzo ◽  
Marco Piccininni ◽  
Eleonora Catricalà ◽  
Rosa Capozzo ◽  
...  
Keyword(s):  
Neuropsychological Tests ◽  
Primary Progressive Aphasia ◽  
Language Disorders ◽  
Speech And Language ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Speech And Language Disorders

scholarly journals Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Volkmer ◽  
Aimee Spector ◽  
Kate Swinburn ◽  
Jason D. Warren ◽  
Suzanne Beeke
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Primary Progressive Aphasia ◽  
Speech And Language ◽  
Medical Research Council Framework ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Communication Partner ◽  
Communication Partner Training

Abstract Background Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia. Methods The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement. Results Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future. Conclusions Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.

scholarly journals White Matter Integrity Predicts Electrical Stimulation (tDCS) and Language Therapy Effects in Primary Progressive Aphasia

2020 ◽  
Vol 35 (1) ◽  
pp. 44-57
Author(s):  
Yi Zhao ◽  
Bronte Ficek ◽  
Kimberly Webster ◽  
Constantine Frangakis ◽  
Brian Caffo ◽  
...  
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
Inferior Frontal Gyrus ◽  
Mean Diffusivity ◽  
Primary Progressive Aphasia ◽  
White Matter Integrity ◽  
Language Therapy ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Language Pathways

Background Transcranial direct current stimulation (tDCS), in conjunction with language therapy, improves language therapy outcomes in primary progressive aphasia (PPA). However, no studies show whether white matter integrity predicts language therapy or tDCS effects in PPA. Objective We aimed to determine whether white matter integrity, measured by diffusion tensor imaging (DTI), predicts written naming/spelling language therapy effects (letter accuracy on trained and untrained words) with and without tDCS over the left inferior frontal gyrus (IFG) in PPA. Methods Thirty-nine participants with PPA were randomly assigned to tDCS or sham condition, coupled with language therapy for 15 daily sessions. White matter integrity was measured by mean diffusivity (MD) and fractional anisotropy (FA) in DTI scans before therapy. Written naming outcomes were evaluated before, immediately after, 2 weeks, and 2 months posttherapy. To assess tDCS treatment effect, we used a mixed-effects model with treatment evaluation and time interaction. We considered a forward model selection approach to identify brain regions/fasciculi of which white matter integrity can predict improvement in performance of word naming. Results Both sham and tDCS groups significantly improved in trained items immediately after and at 2 months posttherapy. Improvement in the tDCS group was greater and generalized to untrained words. White matter integrity of ventral language pathways predicted tDCS effects in trained items whereas white matter integrity of dorsal language pathways predicted tDCS effects in untrained items. Conclusions White matter integrity influences both language therapy and tDCS effects. Thus, it holds promise as a biomarker for deciding which patients will benefit from language therapy and tDCS.

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