ClearSpeechTogether – an SLT/peer supported speech intervention model for people with progressive ataxias

Anja Lowit, Jessica Cox, Aisling Egan, Marios Hadjivassiliou

Research output: Contribution to conferencePosterpeer-review

Abstract

Background: Progressive ataxias such as Friedreich’s Ataxia or Spino-Cerebellar Ataxia frequently result in speech difficulties. Ataxic dysarthria affects all articulatory systems, i.e. breath support, voice quality and articulation. It is characterised by uncontrolled movements, resulting in excess pitch and loudness excursions and rhythm disturbances (Duffy, 2019). As with all dysarthrias, these problems can impact on communication participation and psycho-social wellbeing. Whilst there is a lack of a reliable evidence base for effective speech intervention (Vogel et al. 2014), a number of small scale studies have recently demonstrated the potential for improvements in physiological function, intelligibility as well as dysarthria impact across a wider range of ataxia types. However, with one exception, these treatments all required intensive input from clinicians over an extended period of time, which can reduce patient access to such treatment. One study employed a home practice app, which reduces clinician time, but at the same time provides less opportunities to practise speaking in real life contexts and psycho-social support. We propose a new model of care – ClearSpeechTogether – which combines individual SLT and peer led group therapy to maximise patient practice whilst minimising pressure on clinicians’ workloads.
This study piloted ClearSpeechTogether to establish feasibility and accessibility of the approach as well as potential benefits and adverse effects on patients with progressive ataxia.
Method: We aimed to recruit 10 participants to run two groups. All had progressive ataxia of various causes, and mild-moderate speech and gross motor impairment. Intervention consisted of 4 individual sessions over 2 weeks, followed by 20 patient led, clinician supported group sessions over 4 weeks. Treatment focused on “Loud and Clear”. Communication outcome measures included maximum phonation time (MPT), voice quality, reading and monologue intelligibility, and communication participation and confidence.

Results: Recruitment was effective with a waiting list to join the study. Attrition was at 20% with one person dropping out after assessment and another after completing the individual therapy phase. The former could be replaced and 11 participants were thus recruited and 9 completed treatment. Acceptability was high and no adverse effects were reported. Statistical tests indicated no change in MPT, but significantly reduced strain in voice quality, improved intelligibility in reading (but not the monologue) and increased participation and confidence (Figure 1). Participant interviews highlighted the added value of the group sessions, both from a psycho-social perspective as well as to support internalisation and carry over of speech strategies.

Discussion: ClearSpeechTogether presented an effective intervention approach for a small sample of people with progressive ataxia. It matched, if not exceeded the communication outcomes previously reported for intensive, individual therapy and did so at a considerably lower cost in terms of clinician time. In addition, it provided added value in tackling psycho-social issue that can be difficult to address in one-to-one therapy. ClearSpeechTogether focuses on generic speech strategies involving effective voice production and clear articulation, and should thus be applicable to a wide range of patients with acquired motor speech disorders. We hope to validate this in a future randomised controlled trial.
Original languageEnglish
Publication statusPublished - 24 Aug 2022
Event8th International Conference on Speech Motor Control - Groningen, Netherlands
Duration: 24 Aug 202227 Aug 2022
https://slp-nijmegen.nl/smc2022/

Conference

Conference8th International Conference on Speech Motor Control
Country/TerritoryNetherlands
CityGroningen
Period24/08/2227/08/22
Internet address

Keywords

  • progressive ataxias
  • speech intervention
  • psycho-social wellbeing

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