Using Webcam Interactive Technology to Implement Treatment for Severe Apraxia: A Case Example
Lasker, Joanne P., Stierwalt, A. G. Julie, Spence, Mary, Cavin-Root, Courtney, Journal of Medical Speech - Language Pathology
Outcomes from a prior study with a client with apraxia (Lasker, Stierwalt, Hageman. & LaPointe, 2008) demonstrated the effectiveness of a treatment protocol chat combined the Motor Learning Guided approach (Hageman, Simon, Backer, & Burda, 2002) and daily home practice with a speech generating device (SGD). In this study a similar treatment protocol was implemented with a 28-year-old who presented with severe apraxia of speech and aphasia. The client participated in four treatment sessions a week--two via Skype and two face-to-face sessions. The combined approach of MLG and SGD practice resulted in acceptable productions on trained items. In addition, treatment conducted via Skype and face-to-face sessions resulted in similar outcomes in terms of intelligibility, immediacy, and naturalness ratings. Improvements were noted in the client's overall verbal output in testing and conversations. Results demonstrated both the effectiveness of the MLG/SGD treatment approach and the feasibility of conducting this protocol using webcam interactive technology.
Keywords: apraxia; motor learning; Skype; AAC
Researchers have begun to consider how principles of motor learning might best be incorporated into treatment for motor speech disorders (Schmidt & Bjork, 1992). Based on these principles, Hageman et al. (2002) developed a motor learning guided (MLG) approach to treat a client with acquired apraxia of speech. The MLG approach controlled feedback (type and frequency), incorporated a pause time (so that clients could evaluate their productions), and implemented a fixed practice schedule. In their initial report, the MLG approach was compared to Melodic Intonation Therapy (MIT) (Albert, Sparks, & Helm, 1973), a more traditional approach to treating apraxia of speech. Hageman et al. (2002) reported greater speech gains in their client during the MLG treatment when performance was compared to speech gains using the MIT treatment.
Lasker et al. (2008) combined the MLG approach with a speech generating device (SGD) for home practice. Their study demonstrated that the approach was effective at improving speech production in a client with profound apraxia of speech who was several years post-stroke. This was consistent with other clinical studies that demonstrate an improvement in spoken language output after practice with a SGD (McCall, Shelton, Weinrich, & Cox, 2000).
Another treatment innovation, the use of interactive webcam technology (i.e., Skype), has recently been studied. Hill et al. (2006) explored the feasibility and effectiveness of assessing acquired neurogenic motor speech disorders via an Internet-based telerehabilitation application. To date, however, there has been limited research in using Skype technology to deliver treatments for apraxia of speech.
The purpose of the present study was to determine whether the use of the MLG approach delivered via Skype in combination with practice on an SGD improved spoken productions in a client with severe apraxia of speech.
LG was a 28-year-old electrician who had a left CVA two and a half years prior to this intervention. LG presented with right arm weakness but lived independently, had a cell phone (used primarily for texting) and a desktop computer, and managed many activities of daily living independently Following his stroke, LG participated in a period of inpatient rehabilitation but was discharged when he became ambulatory. When evaluated at our clinic 6 months post-stroke, LG was not receiving treatment due to limited funding options. He demonstrated a moderate to severe nonfluent aphasia and profound apraxia of speech without accompanying limb or oral apraxia. His verbal output was limited to the words "no" and "yeah." He was able to communicate successfully using writing, gestures, and a variety of partner-supported conversation techniques (Garrett & Lasker, 2005). …