Efficacy of a treatment protocol for stroke-related Foreign Accent Syndrome
Tracks
Concurrent session M2
Adult
Motor speech disorders
Neurological disorders
Research
Stroke
Therapy
| Monday, May 27, 2024 |
| 12:10 PM - 12:25 PM |
| Meeting Room 01 |
Overview
Kirrie Ballard
Details
⏫ Research insights
📚 Assumed knowledge of attendees: Foundational (new/casual familiarity with the topic e.g. treated a single case)
📚 Assumed knowledge of attendees: Foundational (new/casual familiarity with the topic e.g. treated a single case)
Presenter
Professor Kirrie Ballard
Founder
Say66 Pty Ltd
Efficacy of a treatment protocol for stroke-related Foreign Accent Syndrome
12:10 PM - 12:25 PMPresentation summary
Background: Foreign Accent Syndrome (FAS) can arise from stroke impairing speech motor planning/programming. It has been associated with damage to left premotor and motor cortex, anterior insula, internal capsule, and basal ganglia. To date, no studies have experimentally tested efficacy of behavioural intervention to return FAS to the premorbid state. This study describes using single-case experimental design with a case of stroke-related FAS, using objective acoustic analysis to document treatment-related speech changes.
Methods: The case was an Australian-born 40-year-old female, 4-months post-onset left ICA dissection and anterior choroidal artery infarction, with residual FAS. Accent post-stroke was described as predominantly Jamaican and French. Baseline acoustic analysis identified a) reduced proximity of 1st and 2nd vowel formants to standard accent and b) slowed speech rate, both stable over three baselines in 1-month. Two consecutive 4-week phases of treatment were provided, with a month break between, and follow-up 1-month post. A Principles of Motor Learning (PML) protocol was used to train three vowels in words and short sentences (Phase I) and in connected speech (Phase II). Treatment included 1 high-intensity session a week SLP-directed and 3 high-intensity self-directed sessions. Acoustic analyses of weekly probes measured treatment effects for vowels, generalisation to untreated tasks and vowels, experimental control, and 1-month maintenance.
Results: Phase I: Accuracy in words/sentences improved, but generalisation to connected speech was weak. Phase II: Accuracy in connected speech improved and speech rate increased. Experimental control was demonstrated. Results were maintained with accent perceptually rated as predominantly Australian at study end.
Conclusion: A PML-based high-intensity intervention for articulation of vowels was efficacious in returning foreign-accented speech to premorbid accent. However, robust functional change was not observed until tasks targeted conversational speech. Success of treatment was likely related to strict adherence to the minimum prescribed dosage and completing daily transfer tasks.
Methods: The case was an Australian-born 40-year-old female, 4-months post-onset left ICA dissection and anterior choroidal artery infarction, with residual FAS. Accent post-stroke was described as predominantly Jamaican and French. Baseline acoustic analysis identified a) reduced proximity of 1st and 2nd vowel formants to standard accent and b) slowed speech rate, both stable over three baselines in 1-month. Two consecutive 4-week phases of treatment were provided, with a month break between, and follow-up 1-month post. A Principles of Motor Learning (PML) protocol was used to train three vowels in words and short sentences (Phase I) and in connected speech (Phase II). Treatment included 1 high-intensity session a week SLP-directed and 3 high-intensity self-directed sessions. Acoustic analyses of weekly probes measured treatment effects for vowels, generalisation to untreated tasks and vowels, experimental control, and 1-month maintenance.
Results: Phase I: Accuracy in words/sentences improved, but generalisation to connected speech was weak. Phase II: Accuracy in connected speech improved and speech rate increased. Experimental control was demonstrated. Results were maintained with accent perceptually rated as predominantly Australian at study end.
Conclusion: A PML-based high-intensity intervention for articulation of vowels was efficacious in returning foreign-accented speech to premorbid accent. However, robust functional change was not observed until tasks targeted conversational speech. Success of treatment was likely related to strict adherence to the minimum prescribed dosage and completing daily transfer tasks.
Key messages
Foreign accent syndrome can be objectively profiled using acoustic measures.
A high intensity motor learning treatment protocol can be efficacious in reversing the foreign accent.
Success of treatment is likely related to adherence to dosage and practice at connected speech level.
A high intensity motor learning treatment protocol can be efficacious in reversing the foreign accent.
Success of treatment is likely related to adherence to dosage and practice at connected speech level.
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Kirrie J. Ballard, Professor at The University of Sydney in Australia, PhD Northwestern University 1997, MA Northwestern University 1994, BSpThy The University of Queensland 1983. Ballard has worked clinically in metropolitan and rural Australia and in the USA, completed a National Institutes of Health-funded postdoctoral fellowship at the National Center for Voice and Speech at The University of Iowa USA (1998-99), and has held academic positions at Indiana University USA (2000), University of Iowa (2001-2005), and The University of Sydney Australia (2006-present, Head of Speech Pathology 2009-12). She served as Editor in Chief for the International Journal of Speech-Language Pathology 2014-2019. Her research focuses on nature, diagnosis and treatment of apraxia of speech in adults and children, and aphasia in stroke and atypical dementias. She has published over 140 journal articles and book chapters. She is a Fellow of Speech Pathology Australia and holds clinical practice certificates for both Australia (CPSP) and the USA (CCC-SLP).
Session chair
Deborah Hersh
Professor, Speech Pathology
Curtin University
Student volunteer(s)
Eddie Carey
Curtin University
Tanvi Patel
Curtin University
The information contained in this program is current at of the time of publishing but is subject to changes made without notice.
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