Dallin Bailey

Purpose<br>Verb production impairments in aphasia have important implications for sentence production and communication in general. Verbs with low concreteness may be especially important for certain functional uses, and yet limited data regarding their response to treatment are available. This study was designed to examine a novel behavioral treatment approach to improve low concreteness verb naming in persons with aphasia.<br>Method<br>Three persons with nonfluent aphasia participated in a single-subject experimental design research study examining the feasibility of the novel treatment. The treatment was based on approaches that target the verb as the central node of meaning during sentence construction. The primary outcome measure was a sentence completion probe. Effects on untreated stimuli and on general language and naming assessments were also examined.<br>Results<br>Results indicated some limited changes associated with the treatment for two of the participants. Treatment performance data suggested possible improvements in verb processing that were not reflected in the primary outcome measure. Modest decreases in aphasia severity were noted for two of the participants.<br>Conclusions<br>The findings provide further support for targeting verbal production of verbs with low concreteness in aphasia. Several lessons learned may benefit future researchers examining areas related to the topic.

Clinical phonetic transcription is regarded as a highly specialised skill requiring hours of practice for mastery. Although this skill is a critical part of students clinical preparation to become speech-language pathologists, students often report feeling unprepared to apply the skill in clinical practice. Previous studies suggest that increased opportunities for practice and timely feedback on transcriptions are needed in order to develop skill confidence. However, providing more opportunities for practice can be impeded by the limited resources to manage the grading of additional assignments. The purpose of this study is to show the implementation of a web-based learning management system (LMS) designed in our labs for phonetics instruction. The Automated Phonetic Transcription Grading Tool (APTgt LMS) was developed to provide a platform for assignment delivery and automated grading of transcription assignments. The APTgt LMS has three embedded IPA keyboards (basic, advanced, and full IPA) and an automated edit distance algorithm modified by phonetic alignment principles, which allows for individualised scoring and visual course-level feedback in an interactive online environment. For pilot testing, student confidence was queried before and after practice opportunities using APTgt. A concurrent mixed methods research design was used to analyse four Likert scale and three open-ended questions. Student confidence in transcribing disordered speech was found to significantly increase (p <0.001) following additional practice. Students reported concerns related to accurate transcription of disordered speech and that additional practice is still needed. Tools like APTgt can aid in facilitating student learning and increasing student confidence in applied transcription.

Purpose: The purpose of this clinical focus article was to identify clinical practice patterns of speech-language pathologists (SLPs) who use neuromuscular electrical stimulation (NMES) with the high-risk infants, specifically, the modality treatment parameters and physiological rationale.<br>Method: An online survey was disseminated to query use of NMES by licensed SLPs who routinely address swallowing habilitation in high-risk infants.<br>Results: Eleven of the 40 practicing SLPs who completed the survey indicated they have used NMES on neonates and infants. Most survey respondents reported not using NMES with infants. Of the SLPs who used this modality, over half reported they relied on clinical judgment for determination of NMES dose, frequency of treatments, electrode placement, and discharge determination. While SLPs acknowledged that little empirical evidence is available, those who used this modality indicated that the American Speech-Language-Hearing Association should support this modality in infants.<br>Conclusions: Reliance on clinical judgment, as indicated by SLPs who use NMES on high-risk infants, is not consistent with the evidence-based practice triad, which encourages the use of high-quality peer-reviewed published evidence to inform clinical decision-making. Additional basic and applied research is needed to support use of NMES as a therapeutic modality in infants.

Many computerized tools for comparing phonetic transcriptions have been proposed and shared in the past; however, previous tools are relatively difficult to access and incorporate into clinical and research practice, or require users to learn additional phonetic symbol systems. The purpose of this project was to develop and test a readily available web-based application for quantitatively comparing phonetic transcriptions that are input using International Phonetic Alphabet (IPA) symbols. A web-based computer application was developed to allow for IPA phonetic transcription comparison. A point-and-click keyboard was developed to provide support for character input of the full IPA, as well as most symbols in the extIPA set. The application compares phonetic transcriptions using a modified edit distance algorithm following phonologically informed alignment. Visualizations of the algorithm's optimal alignment and scoring operations are shown for each comparison input by a user. The application, named the Automated Phonetic Transcription Comparison Tool (APTct), was thoroughly tested for accurate implementation of the algorithm principles. Validity tests through two sample use cases were also performed by comparison of hand calculations to APTct calculations. In function testing, the APTct showed excellent agreement with an expert's hand scoring using the same algorithm principles. In a validity test, only minor differences between the APTct and hand calculations were observed, primarily due to errors inputting the transcriptions into the APTct. The web-based APTct is a validated and versatile tool for quantitatively comparing even complex IPA phonetic transcriptions. It is freely available to clinicians and researchers, who may find it useful for a variety of potential scenarios. We invite researchers, clinicians, and other individuals to use the tool in their clinical and research work. The permalink for the website is as follows: https://aptct.auburn.edu.

One challenge faced by teachers of phonetics, speech science, and clinical speech disorders courses is providing meaningful instruction that closes the theory to practice gap. One barrier to providing this type of deep learning experience is the lack of publicly available examples of speech recordings that illustrate comparisons between typical and disordered speech production across a broad range of disorder populations. Data of this type exist, but are typically collected for specific research projects under narrowly written IRB protocols that do not allow for release of even de-identified speech recordings to other investigators or teachers. As a partial corrective to this problem, we have developed an approved publicly available database of speech recordings that provides illustrative examples of adult and child speech production from individuals with and without speech disorders. The recorded speech materials were designed to illustrate important clinical concepts, and the recordings were collected under controlled conditions using high-quality equipment. The ultimate goal of creating this corpus is to improve practitioners' and scientists' understanding of the scientific bases of knowledge in our profession and improve our ability to develop clinical scientists and young researchers in the field.

Purpose Verbs with low concreteness are frequent in discourse samples but rarely targeted in aphasia treatments for verbs. These verbs are an important part of functional communication, and recent studies have called for more research regarding aphasia and treatment stimuli with low concreteness. The aim of this study was to pilot the use of verbs with low concreteness in a novel sentence production intervention with persons with aphasia. Method The study took the form of a single-case experimental design with multiple baselines across behaviors and across participants. Three persons with chronic nonfluent aphasia and apraxia of speech participated in the study. Each participant received treatment designed to increase the semantic networks of verbs with high frequency and low concreteness. Sentence production was closely examined over the course of treatment for treated and untreated verbs of varying concreteness levels. Additional measures of language and cognitive functioning were also taken before and after treatment. Results Results indicated improved sentence production with target verbs attributable to the treatment in the 1st phase of 2 phases for 2 of the 3 participants. The increases corresponded with the application of treatment, despite the difference in number of baseline sessions for the participants. Where there were treatment effects, there was also considerable generalization to untreated sets of items during the 1st treatment phase. Word retrieval also improved for 2 participants. Conclusions The results suggest that the novel treatment may improve sentence production and word retrieval in persons with aphasia, even when using target verbs with low concreteness ratings. Future research is warranted into the use of low concreteness verbs. Supplemental Material https://doi.org/10.23641/asha.10870958.

BACKGROUND: Acquired apraxia of speech (AOS) involves speech-production deficits on both the segmental and suprasegmental levels. Recent research has identified a non-linear interaction between the metrical structure of bisyllabic words and word-production accuracy in German speakers with AOS, with trochaic words (strong-weak stress) being resistant to errors compared with iambic words (weak-strong). AIMS: To replicate previous findings in English speakers with AOS, to measure the test-retest reliability of the effect, and to examine the potential impact of different methods of word scoring. METHODS & PROCEDURES: Speech samples were collected from 27 speakers with AOS and aphasia. Participants were at least 12 months post-stroke or penetrating brain injury, and represented a large range of AOS and aphasia severities. Productions were elicited via verbal model. Sampling was conducted on three separate occasions: the initial data-collection session and then repeated samplings at 1- and 4-week intervals. Bisyllabic words with a CVCVC segmental structure were selected. The list was divided into sublists representing differing lexical stress patterns: A list of 42 trochees, and one of 37 iambs. All speech samples were phonetically transcribed and then aligned with canonical transcriptions via an edit distance algorithm that followed transcription alignment principles. Phonetic-level errors (distortions) were penalized less severely than phonemic-level errors. Per cent consonants correct and whole-word accuracy were also examined. Trochee and iamb lists were analysed separately. OUTCOMES & RESULTS: Paired samples t-tests indicated that the modified edit distance was significantly lower for the trochee lists than for the iamb lists. There was a lack of a significant effect of time on the absolute difference between modified edit distance for both lists. Intraclass coefficients suggested the list and procedures used are appropriate as an outcome measure for group research. CONCLUSIONS & IMPLICATIONS: The results suggest that in English, as in German, the trochaic structure is more resistant to segmental errors in persons with AOS and aphasia, providing replication of the findings of Aichert et al. in 2016. Further, this effect is stable over repeated sampling occasions. Implications for clinical management of AOS include possible ways to scaffold item difficulty and potentially improve stimulus generalization.

Purpose: The aim of this study was to describe the clinical assessment recommendations for acquired velopharyngeal dysfunction (AVPD) and, through a literature review and online survey, summarize current practice patterns for evaluation and treatment pathway determination for this target population. Method: An online survey to query current assessment procedures and treatment pathway recommendations for AVPD was developed. Following survey results, a literature review was completed to determine evidence-based recommendations for assessment procedures and intervention recommendations based on assessment findings. Literature search terms included the following: acquired velopharyngeal dysfunction, hypernasality, non-cleft velopharyngeal dysfunction, velopharyngeal dysfunction, velopharyngeal dysfunction AND iatrogenic, velopharyngeal dysfunction AND neurogenic, velopharyngeal dysfunction AND assessment OR evaluation, velopharyngeal dysfunction AND treatment OR intervention, velopharyngeal dysfunction AND practice patterns OR clinical guidelines, velopharyngeal insufficiency. Inclusion criteria were limited to practice patterns/recommendations for assessment and/or treatment recommendations for AVPD, English language articles published between 2000 and 2017, and peer-reviewed journals. Studies regarding solely congenital or cleft palate velopharyngeal dysfunction and intervention outcome studies were excluded. Forty articles met inclusionary criteria. Results: The online survey results indicated lack of consensus for AVPD assessment and treatment recommendation protocols, with 93% of respondents indicating the need for a clinical guide for developing treatment recommendations. The majority of recommendations were filtered into an algorithm for clinical decision making. Conclusions: Clinical uncertainty among speech-language pathologists surveyed and the paucity of published clinical guidelines for assessing individuals with AVPD indicate the need for additional clinical research for this disorder, one that is heterogeneous and distinct from those with congenital velopharyngeal dysfunction. The proposed evidence-based clinical worksheet may assist in determining management for patients with AVPD and may serve as a starting place for validation of a clinical guideline.

Purpose: Awareness of errors has been considered a clinical feature of acquired apraxia of speech (AOS). However, there is limited research examining error awareness in speakers with AOS. The purpose of this investigation was to examine awareness of errors and explore the relationship between awareness of errors and treatment outcomes in speakers with AOS. Method: Twenty speakers with AOS and aphasia produced mono- and multisyllabic words in a repetition task. Following each production, speakers were asked to judge the accuracy of their production (i.e., correct or incorrect). Then, speakers received Sound Production Treatment. Results: Judgment accuracy of productions for the group ranged from 20% to 96%. There was a weak relationship between judgment accuracy and probe performance at posttreatment (r = .47) and a moderate relationship between judgment accuracy and probe performance at follow-up (r = .53). Conclusion: Findings indicate that speakers with AOS varied in their ability to judge the accuracy of their productions. For some speakers, the ability to judge the accuracy of their productions did not coincide with their production accuracy of treatment stimuli at posttreatment and at follow-up. Further research is needed to explore the relationship between error awareness and treatment outcomes.

Purpose: The purpose of this investigation was to compare the effects of schedule of practice (i.e., blocked vs. random) on outcomes of Sound Production Treatment (SPT; Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998) for speakers with chronic acquired apraxia of speech and aphasia. Method: A combination of group and single-case experimental designs was used. Twenty participants each received SPT administered with randomized stimuli presentation (SPT-R) and SPT applied with blocked stimuli presentation (SPT-B). Treatment effects were examined with respect to accuracy of articulation as measured in treated and untreated experimental words produced during probes. Results: All participants demonstrated improved articulation of treated items with both practice schedules. Effect sizes were calculated to estimate magnitude of change for treated and untreated items by treatment condition. No significant differences were found for SPT-R and SPT-B relative to effect size. Percent change over the highest baseline performance was also calculated to provide a clinically relevant indication of improvement. Change scores associated with SPT-R were significantly higher than those for SPT-B for treated items but not untreated items. Conclusion: SPT can result in improved articulation regardless of schedule of practice. However, SPT-R may result in greater gains for treated items. Supplemental Materials: https://doi.org/10.23641/asha.5116831.

Purpose: The purpose of this article is to quantify and describe stuttering-like disfluencies in speakers with acquired apraxia of speech (AOS), utilizing the Lidcombe Behavioural Data Language (LBDL). Additional purposes include measuring test-retest reliability and examining the effect of speech sample type on disfluency rates. Method: Two types of speech samples were elicited from 20 persons with AOS and aphasia: repetition of mono- and multisyllabic words from a protocol for assessing AOS (Duffy, 2013), and connected speech tasks (Nicholas & Brookshire, 1993). Sampling was repeated at 1 and 4 weeks following initial sampling. Stuttering-like disfluencies were coded using the LBDL, which is a taxonomy that focuses on motoric aspects of stuttering. Results: Disfluency rates ranged from 0% to 13.1% for the connected speech task and from 0% to 17% for the word repetition task. There was no significant effect of speech sampling time on disfluency rate in the connected speech task, but there was a significant effect of time for the word repetition task. There was no significant effect of speech sample type. Conclusions: Speakers demonstrated both major types of stuttering-like disfluencies as categorized by the LBDL (fixed postures and repeated movements). Connected speech samples yielded more reliable tallies over repeated measurements. Suggestions are made for modifying the LBDL for use in AOS in order to further add to systematic descriptions of motoric disfluencies in this disorder.

PURPOSE: The purpose of this investigation was to examine the effects of a modified version of a newly developed therapy for aphasia and acquired apraxia of speech (AOS), Combined Aphasia and Apraxia of Speech Treatment (CAAST). METHOD: Four speakers with chronic AOS and aphasia received CAAST in the context of multiple baseline designs. Dependent variables included language measures (i.e. production of correct information units (CIUs)) and speech production measures (i.e. speech intelligibility and percent correct consonants (PCC) in sentence repetition). RESULT: Three of the participants demonstrated improved CIU production with treated picture sets and two also demonstrated generalization to untreated sets. All participants achieved substantially increased CIU production in an untrained discourse context. Speech intelligibility increased for three of the participants and increases in PCC were observed for all of the participants at two weeks post-treatment. However, PCC improvements were maintained for only two of the speakers at six weeks post-treatment. CONCLUSION: The revised CAAST protocol was associated with improved changes in speech and generalization across contexts in comparison to the previous iteration of CAAST. However, focus on sentence production in generalization practice may have been detrimental to CIU production for one participant.

Purpose: The ability to recognize one's own speech errors has long been considered a clinical feature of acquired apraxia of speech (AOS) despite limited empirical data supporting this notion. This study was designed to (a) investigate the ability of speakers with AOS to self-judge the accuracy of their own word productions and (b) examine the test-retest stability of a measure to quantify the self-judgments of speakers with AOS. Method: Twenty-four speakers with AOS and aphasia repeated mono- and multisyllabic words. After each word, they indicated whether their production was correct or incorrect. This procedure was repeated 1 week later to examine performance stability. Results: Percentage of incorrect word productions was stable for the group across times. Accuracy of judgments ranged from 64% to 100% at Time 1 and from 56% to 100% at Time 2. Inaccurate judgments of error productions (false positives) occurred much more frequently than inaccurate judgments of correct productions (false negatives). Conclusions: Error production was remarkably stable in our participants. As a group, the participants failed to detect almost one third of words produced erroneously. However, accuracy and stability of judgments over sampling times varied across participants. Findings suggest that error awareness might be a worthwhile target for treatment in some individuals with AOS.

Purpose: The purpose of this study was to examine divided attention over a large age range by looking at the effects of three non-speech tasks on concurrent speech motor performance. The non-speech tasks were designed to facilitate measurement of bidirectional interference, allowing examination of their sensitivity to speech activity. A cross-sectional design was selected to explore possible changes in divided attention effects associated with age. Method: Sixty healthy participants were separated into three groups of twenty: younger (20s), middle-aged (40s), and older adults (60s). Each participant completed a speech task (sentence repetitions) once in isolation and once concurrently with each of three non-speech tasks: a semantic decision linguistic task, a quantitative comparison cognitive task, and a manual motor task. The non-speech tasks were also performed in isolation. Results: Data from speech kinematics and non-speech task performance indicated significant task-specific divided attention interference, with divided attention impacting speech and non-speech measures in the linguistic and cognitive conditions, and impacting speech measures in the manual motor condition. There was also a significant age effect for utterance duration. Conclusions: The results increase what is known about bidirectional interference between speech and other concurrent tasks, as well as age effects on speech motor control.

PURPOSE: This investigation was designed to provide a quantification and synthesis of a series of single-case experimental design investigations into the effects of sound production treatment, an articulatory-kinematic treatment for acquired apraxia of speech (AOS). The main purpose was to perform a meta-analysis of aggregated sound production treatment data in order to provide benchmarks to serve as indicators of magnitude of change. Additional analyses explored various factors influencing effect sizes and level of performance. METHOD: Effect sizes were calculated for treated and untreated items for 24 participants across 10 investigations. Benchmarks were calculated as the quartiles of the distributions of the effect sizes. Correlational analyses were performed to examine (a) end-of-treatment performance relative to follow-up performance, (b) response of trained items relative to untrained items, and (c) effect size relative to participant variables. RESULTS: Effect sizes were predominantly large and positive; benchmarks for treated items were larger than those for untreated items. End of treatment and follow-up performance were positively correlated, and response generalization was positively correlated with AOS severity. CONCLUSION: These benchmarks may assist in evaluating the effects of interventions for individuals with AOS utilizing similar outcome measures in both clinical and research settings.

The use of innovative technologies in speech-language pathology is revolutionizing diagnostic and treatment approaches for individuals with communication disorders. This evolution has required educators to integrate the use of technologies into the clinical training pedagogy. Phonetic transcription is a foundational skill presented early in the undergraduate speech-pathology curriculum and serves as the basis for advanced course work in clinical diagnostic decision-making. Mastery requires regular practice and performance feedback. One factor that impedes the provision of more practice opportunities is the widely agreed-upon problem of grading phonetic transcription assignments by hand. The development of a computational tool that automatically grades transcription assignments served as the mechanism for an integrated learning opportunity between the departments of Communication Disorders and Computer Science and Software Engineering at Auburn University.