Acquired Apraxia of Speech: What Is the Best Treatment Option?
I wish there was an evidenced-based answer to this question, but currently no one acquired apraxia of speech (AOS) treatment is superior to another. However, there has been an encouraging increase in the evidence supporting AOS treatments in general. That is, we can expect treatment for AOS to result in improvements for our patients, even when their condition is chronic.2-4 A careful consideration of your patient’s speech production strengths and weaknesses, treatment history, preferences, and goals along with knowledge of AOS treatment evidence can result in an effective treatment program.
Acquired Apraxia of Speech Treatments Options
To date, there are almost 100 AOS treatment studies covering a variety of treatment approaches. The first AOS treatment guidelines were published in 20063,4 and a systematic review was recently completed to update those guidelines.2 Currently, the empirical evidence supports the following types of AOS treatment:
- Articulatory-Kinematic
- Rate/Rhythm Control
- Intersystemic reorganization
- Alternative-Augmentative Communication
Articulatory-Kinematic Treatments
The vast majority of research has addressed the effects of articulatory-kinematic treatments on AOS. These therapies use techniques such as modeling, articulatory cueing, and integral stimulation to improve articulation. Approximately two-thirds of the available evidence supporting the effects of AOS treatment comes from articulatory-kinematic approaches, with a much smaller percentage of studies representing the other types of treatments.
We know much more about the expected effects of articulatory kinematic treatments than we do about other types of treatments. We also know more about the effects of certain articulatory-kinematic treatments than we do about others. For example, a meta-analysis of Sound Production Treatment (SPT)5 recently provided effect sizes for SPT which give an indication of the magnitude of change that can be expected for both treated and untreated items.1
The Need for More Research
More evidence does not mean one treatment approach is better than another for a particular patient. There have been very few AOS treatment comparison studies, and the few that exist have limited clinical applicability. Our research has a long way to go before we can predict which treatment is better suited for a specific patient.
The Best Practice for Selecting a Treatment
Given the lack of comparative AOS treatment research, the speech-language pathologist must rely on his/her knowledge of the patient, the treatment research literature, and their own clinical expertise to select and tailor a treatment program. All individuals with AOS will have unique:
- Presentation of AOS symptoms
- Probable language therapy needs
- Motivation and goals for treatment
- Previous therapy history
Consequently, there cannot be a one-size-fits-all approach to devising a treatment program. All of the preceding factors should come into play in the process of treatment development.
- Bailey, D., Eatchel, K., & Wambaugh, J.L. (2015). Sound Production Treatment: Synthesis and quantification of outcomes. American Journal of Speech-Language Pathology, 24, S798-S814.
- Ballard, K., Wambaugh, J., Duffy, J., Layfield, C., Maas, E., Mauszycki, S., & McNeil, M. (2015). Updated treatment guidelines for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24, 316-337.
- Wambaugh, J.L., Duffy, J.R., McNeil, M.R., Robin, D.A., & Rogers, M.(2006a). Treatment guidelines for acquired apraxia of speech: A synthesis and evaluation of the evidence. Journal of Medical Speech Language Pathology, 14(2), xv-xxxiii.
- Wambaugh, J.L., Duffy, J.R., McNeil, M.R., Robin, D.A., & Rogers, M.(2006b). Treatment guidelines for acquired apraxia of speech: Treatment descriptions and recommendations. Journal of Medical Speech Language Pathology, 14(2), xxxv-ixvii.
- Wambaugh, J.L., Kalinyak-Fliszar, M.M., West, J.E., & Doyle, P.J. (1998). Effects of treatment for sound errors in apraxia of speech. Journal of Speech, Language, and Hearing Research, 41, 725-743.
