Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) in Persons With Apraxia of Speech

This R21 Proposal will employ a mixed-methods design in 18 individuals with apraxia of speech and mild-moderate co-occurring aphasia to examine two Aims:

Aim 1. Evaluate the acceptability and feasibility of MI-TEE as an adjunct to speech therapy for the rehabilitation of AOS. This Aim will Incorporate observational data, survey responses (self-report) and semi-structured interviews. Specifically, mixed quantitative and qualitative methods will be employed to assess the acceptability and feasibility of MI-TEE. Quantitative data will include observational data and results of survey responses. Qualitative data will include themes that emerge from open-ended survey items and semi-structured interviews. Assessment of acceptability will occur after completion of the 12-week treatment program. Participants will meet individually with a member of the research team to complete acceptability surveys and semi-structured interviews. Acceptability data will include perceived satisfaction, perceived appropriateness, and intent to continue use. Assessment of feasibility will determine the extent to which the treatment, including study design and procedures, is executed effectively. Feasibility data will be collected by research staff and will include recruitment feasibility (percent of eligible individuals agreeing to participate), retention rate, and adherence rates (ability of participants to adhere to MI-TEE).

Aim 2. Compare the efficacy of adjunctive MI-TEE to standard speech therapy (Sound Production Treatment) alone. This aim will employ a single subject experimental design (SSED) with multiple baselines across participants and probes across behaviors will be used to explore the effects of speech therapy alone compared to speech therapy with MI-TEE in 15 stroke survivors with AOS. The treatment design will include multiple phases: (A) no treatment; (B) speech therapy alone; (C) speech therapy plus MI-TEE. The first "A" will consist of pre-treatment baseline testing, while the second will consist of maintenance testing. Following baseline probes, treatment probes will be extended sequentially to each of the two lists of stimuli, which are described in the following section (Experimental Stimuli). Probing will continue throughout the treatment phases. After cessation of all treatment, follow-up probes will be conducted at 2, 6, and 10 weeks. Accuracy of articulation of two lists of experimental stimuli will be measured repeatedly via probes.

This proposal will include 18 adult (≥18 years of age) stroke patients. No subpopulation of adults with apraxia of speech and aphasia will be excluded (see Inclusion of Women and Minorities).

Potential participants will have had a left hemisphere stroke (documented by imaging with either CT or MRI) and be 6 months or more post-stroke, right handed, English as a primary language, high-school education or equivalent, between the ages of 18 and 90, pass a hearing screening at 35 dB hearing level (HL) at 500, 1K, and 2K Hz for at least one ear, and have normal or corrected to normal visual acuity as determined by a vision screen (Tumbling E eye chart).