Eﬀects of Verb Network Strengthening Treatment (VNeST) and Melodic Intona>on Therapy (MIT) on conversa>onal speech in individuals with Aphasia Samantha Hundemer, B.S. & Abbie Olszewski, Ph.D., CCC-‐SLP University of Nevada, Reno Introduction •  The ability to parGcipate in conversaGonal speech originates in the leJ hemisphere in Broca’s area. Strokes that damage this area cause aphasia, which prevents access to this language pathway. • VNeST is a semanGc therapy which seeks to improve lexical retrieval of content words in sentence context by encouraging systemaGc retrieval of verbs (Edmonds et. al, 2009). •  MIT is a sequenGal treatment which combines words with melody to facilitate speech output in those with nonﬂuent aphasia (Conklyn et. al, 2012). Purpose The purpose of this research project was to: Determine if Melodic IntonaGon Therapy (MIT) results in signiﬁcantly improved conversaGonal speech, as measured by words per minute, for people with aphasia as compared with Verb Network Strengthening Treatment (VNeST). Graduate clinician has a 42 year old client with Broca’s aphasia. This semester, her language goals related to conversaGonal speech will be addressed. However, with language goals related to conversaGonal speech will be addressed. However, with various various aapproaches pproaches tto o aaddress ddress tthis his ggoal, oal, iit t iis s cchallenging hallenging tto o d decide ecide w which hich tto o u use. se. There There iis s llimited imited G Gme me lleJ eJ iin n tthe he ssemester emester tto o p provide rovide ttherapy, herapy, sso o tthe he cclinician linician iis s seeking tthe he m most ost eeﬃcient ﬃcient aand nd eeﬀecGve ﬀecGve ttreatment reatment .. seeking •  Search Terms:: aphasia, VNeST, MIT, conversa4onal speech. •  Databases: PubMed and ASHA. •  Ra>ng System: CriGcal Appraisal of Treatment Evidence (CATE form) was used to appraise validity and clinical signiﬁcance with interrater reliability; 14 point raGng scale;10 arGcles appraised. •  Ar>cles: Six arGcles were chosen to assist in EBP decision. Each study had innterater reliability of at least 93%. Authors & Design Edmonds & Babb (2011) MulGple baseline across parGcipants Results Par>cipants (diagnosis, gender, & Appraisal ra>ng age) & interrater reliability N = 2 P1: 42, female, leJ MCA stroke 49 months before study P2: 49, female, leJ MCA stroke 9 months prior Ra>ng: 10/14 SuggesGve (71%) Sentence probes NAVS: Reliability: 100% Untrained sGmuli AdjecGves Edmond, Nadeau, & Kiran (2009) Single subject N = 4 Ra>ng: 9/14 SuggesGve (64%) 2 had moderate transcorGcal aphasia and 3 had moderate conducGon aphasia according to WAB Reliability: 93% All:Monolingual English, had impaired lexical access for nouns and verbs, no other neurological or learning disorder, and right handed Schlaug, Marchina, & Norton N = 2 Ra>ng: 8/13 (2008) SuggesGve (62%) Both severe non-‐ﬂuent aphasia, leJ MCA stroke, classiﬁed as Broca’s, and both Single subject received more than a year of tradiGonal Reliability: 93% speech therapy prior to study. Discussion • VNeST is successful in generalizing to spontaneous speech (Edmonds et. al, 2009), while MIT is more appropriate for motor speech treatment (Zumbansen, Peretz, & Herbert, 2014). • MIT does not enhance auditory comprehension (Wallace & Canter, 1985), nor improve right hemisphere connecGons (Van de Sandt-‐Koenderman et. al, 2010). • Hand tapping engages the sensorimotor network leading to more coordinated orofacial and arGculatory movements, resulGng in an increase in correct producGons, as opposed to MIT facilitaGng increased expressive language (Shlaug et. al, 2008). • Client concerns included daily communicaGon with others and verb use. • Clinician feels comfortable administering both treatments. • VNeST was chosen as the most appropriate therapy for clients with Broca’s Aphasia to increase conversaGonal speech as measured by words per minute. References Edmonds, L.A., Babb, M. (2011). Eﬀect of verb network strengthening treatment in moderate-‐to-‐severe aphasia. American journal of speech-‐language pathology, 20(2), 131-‐145. doi: 10.1044/1058-‐0360(2011/10-‐0036) Edmonds, L.A., Nadeau, S.E. & Kiran, S.(2009). Eﬀect of verb network strengthening treatment (VNeST) on lexical retrieval of content words in sentences in persons with aphasia. Aphasiology, 23,402-‐424. doi:10.1080/02687030802291339 Schlaug, G., Marchina, S. & Norton, A. (2008). From singing to speaking: why singing may lead to recovery of expressive language funcGon in paGents with Broca’s aphasia. Music percep4on: an interdisciplinary journal, 25(4), 315-‐323. doi: 10.1525/mp.2008.25.4.315 Van de Sandt-‐Koenderman, M., Smits, M., Van der Meulen, I., Visch-‐Brink, E., Van der Lugt, A., & Ribbers, G. (2010). A case study of melodic intonaGon therapy (MIT) in the subacute stage of aphasia: early re-‐re acGvaGon of leJ hemisphere structures. Procedia-‐social and behavioral sciences, 6, 241-‐243. doi: 10.1016/j.sbspro.2010.08.121 Wallace, G.L. (1985). Comprehension of neutral, melodically intoned, and aﬀecGvely toned sentences by adults with aphasia. Journal of communica4on disorders, 18(5), 321-‐327. doi: 10.1016/0021-‐9924(85)90023-‐1 Zumbansen, A., Peretz, I., & Hebert, S. (2014). Melodic intonaGon therapy: back to basics for future research. Fron4ers in neurology, 5, 1-‐11. doi: 10.3389/fneur.204.00007 Both had: diagnosis of aphasia, right handed, lexical retrieval deﬁcits, and no history of LD or addicGon. Case Scenario Methods Outcome Measures Van de Sandt-‐Koenderman, Smits, Van der Meulen, Visch-‐Brink, Van der Lugt, & Ribbers (2010) Single subject N = 1 Wallace & Carter (1985) MulGple baseline across parGcipants N = 8 2 weeks post-‐stroke, female, 25 y.o., right handed, severe Broca’s & right-‐sided hemiplegia. 6 paGents with aphasia and leJ CVA and 2 controls, and all between 52 to 74 yrs old. Ra>ng: 9/14 SuggesGve (64%) Reliability: 100% Accuracy on generaliza>on tasks naming, picture descripGon, connected speech sample Behavioral Exams Spontaneous speech measures: conversaGonal interview & picture descripGon Neural Exams fMRI imaging used with bisyllabic word list in 5 condiGons: spoken/sung, repeGGon, delayed rep. with humming and phonaGon. Behavioral Exam Language performance on story retell Correct InformaGon Units (CIUs) per min Neural Exam Changes seen in fMRI imaging Ra>ng: 10/13 SuggesGve (77%) Picture idenGﬁcaGon where sGmuli presented in 3 condiGons: • Neutral Reliability: 100% • Melodic intonaGon Results Sentence probes: P1: Eﬀect size = 5.73 P2: Eﬀect size = 10 Untrained s>muli: P1: Eﬀect sizes = 2.98 (post), 3.86 (5 mo. post) P2: Eﬀect sizes = 5.66 (post), 4.24 (1 mo. post) Adjec>ve control task: P1: Eﬀect sizes = 1.10 (post), 2.01 (5 mo. post) P2: Eﬀect sizes = 1.04 (post), 1.04 (1 mo. post) Generaliza>on tasks v  Improvement on the Noun and Verb Retrieval on sentence producGon tests (picture descripGon and connected speech) were clinically signiﬁcant, but not on the Boston Naming Test. v  p level and eﬀect size not provided. Behavioral v Both intervenGons resulted in signiﬁcant improvement post-‐ treatment in proposiGonal speech that generalized to unpracGced words and phrases, but p levels and eﬀect sizes were not provided. Neural v R hemi sensorimotor network is engaged which may coordinate orofacial and arGculatory movements. Behavioral v  Spontaneous speech, repeGGon, naming, and CIUs/min all improved at p < 0.001. v  Eﬀect sizes were not provided. Neural v  Reduced acGvity in R hemi, reacGvaGon in L. v  Eﬀect sizes were not provided. Picture Iden>ﬁca>on v No signiﬁcant diﬀerence in L hemi damaged auditory comprehension in the 3 condiGons of sGmuli. v  Eﬀect sizes were not provided. • Strong aﬀect Zumbansen, Peretz, & Herbert (2014) SystemaGc review N = 14 studies reviewed CASM score: 4/6 PaGents with L hemi CVA resulGng in aphasia Emerging evidence (usually Broca’s or global) receiving MIT or a with strong similar alternaGve. importance. Reliability: 100% Language Performance: • Connected speech analyses • Sentence recall • Intelligibility • Wh-‐quesGons • ProposiGonal language tests v  This was a systemaGc review, therefore p values and eﬀect sizes were not reported. v  This review found that MIT should be researched as an approach to help apraxia more than aphasia in the future.