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Communication changes in progressive AOS & aphasia (Utianski et al., 2021)

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posted on 07.09.2021, 17:40 by Rene L. Utianski, Peter R. Martin, Joseph R. Duffy, Hugo Botha, Heather M. Clark, Keith A. Josephs
Purpose: Individuals with primary progressive apraxia of speech have apraxia of speech (AOS) as the initial and predominant symptom. Many develop aphasia and/or dysarthria later in the disease course. It was previously demonstrated that patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits (Utianski et al., 2020). Measures of disease severity did not necessarily correlate with measures of participation restrictions. The aim of this follow-up study was to describe changes in communication limitations in these patients, again measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association’s (ASHA’s) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating to determine if there are significant changes in these and other objective speech and language measures at follow-up after 1 year.
Method: Of the 24 patients reported in the study of Utianski et al. (2020), 17 (10 men, seven women) returned for a second visit approximately 1 year following the first visit. Identical procedures were utilized; the communication measures collected at each visit were statistically compared. Correlations were calculated between the participation ratings and other clinical assessment measures at the second visit and for the change in scores on those measures between the first and second visits.
Results: There were statistically significant differences in AOS and aphasia severity between visits. There were significant changes in clinical assessments, MSD severity rating, and all ASHA FCMs between visits, but not the CPIB. Correlation analyses suggest the relationships among clinical and participation measures are complex; overall, patients with more severe changes in AOS experienced greater changes in participation restrictions.
Conclusions: The findings of this study support the use of patient-reported outcome measures as they may better reflect the patient experience, including the influence of factors such as ongoing speech therapy and the emergence of neuropsychiatric features, and associated changes in day-to-day functioning, when other measures may simply index the progression of the disease.

Supplemental Material S1. Individual scores on language and speech measures. Point at 0 years indicates performance at the first visit; individual data point for second visit is placed at interval of second visit. AOS subtype is indicated by colored dots; lines are color coded to diagnosis at the first visit. The medians of each group are presented in the thick, overlaid line. WABAQ = Western Aphasia Battery-Revised Aphasia Quotient; ASRS-3 = Apraxia of Speech Rating Scale - Version 3.

Supplemental Material S2. Individual scores on communication measures. Point at 0 years indicates performance at the first visit; individual data point for second visit is placed at interval of second visit. AOS subtype is indicated by colored dots; lines are color coded to diagnosis at the first visit. The medians of each group are presented in the thick, overlaid line. CPIB = raw score on Communicative Participation Item Bank short form; MSD = Motor Speech Disorder; FCM = Functional Communication Measure.

Utianski, R. L., Martin, P. R., Duffy, J. R., Botha, H., Clark, H. M., & Josephs, K. A. (2021). Assessing change in communication limitations in primary progressive apraxia of speech and aphasia: A 1-year follow-up study. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-20-00402

Funding

This study was funded by National Institute on Deafness and Other Communication Disorders Grants R01 DC014942 Principal Investigator [PI]: K. A. Josephs) and R01 DC012519 (PI: J. L. Whitwell).

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