Script Training for Aphasia
(MIDAS Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Shirley Ryan AbilityLab
Disqualifiers: Parkinson's, Alzheimer's, Brain injury, others
No Placebo Group
Approved in 3 Jurisdictions
Trial Summary
What is the purpose of this trial?The purpose of this study is to evaluate how changing conditions of speech-language treatment (namely, amount of repetition and distribution of practice schedule) affects the language outcome of participants with aphasia following a stroke. Using a computer based speech and language therapy program, participants will practice conversational scripts that are either short or long. Participants will practice for either 2 weeks (5 days a week) or for 5 weeks (2 days a week).
Do I need to stop my current medications for the trial?
The trial protocol does not specify whether you need to stop taking your current medications. However, it does mention that participants should not be receiving speech-language therapy at the time of the study.
What data supports the effectiveness of the treatment Script Training for Aphasia?
Research shows that script training, including computer-based methods, can significantly improve speech and language skills in people with aphasia, helping them use practiced phrases in real conversations. This approach is effective for both stable and progressive forms of aphasia, and improvements can be maintained over time.
12345Is script training for aphasia safe for humans?
The research does not report any safety concerns related to script training for aphasia, suggesting it is generally safe for humans.
14567How is script training for aphasia different from other treatments?
Script training for aphasia is unique because it involves practicing specific phrases and sentences repeatedly, which can be used in real-life conversations. This treatment can be delivered via computer with a virtual clinician, allowing for flexible and intensive practice, and it has been shown to improve communication in both stable and progressive forms of aphasia.
12358Eligibility Criteria
This trial is for men and women who have aphasia after a left-hemisphere stroke. They should be at least 6 months post-stroke, with an Aphasia Quotient score of 40-80 on the Western Aphasia Battery-Revised. Participants must have completed eighth grade, be literate in English, not currently receiving speech therapy, and have adequate vision and hearing. Those with active substance abuse, other neurological conditions affecting cognition/speech or significant psychiatric history are excluded.Inclusion Criteria
Completed at least eighth grade education
Premorbidly literate in English
I am not currently undergoing speech-language therapy.
+6 more
Exclusion Criteria
I have a psychiatric history but am stable on treatment.
You are currently using drugs or alcohol excessively.
I do not have any brain conditions like Parkinson's or Alzheimer's that affect my thinking or speech.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants practice conversational scripts using a computer-based speech and language therapy program. The practice varies between 2 weeks (5 days a week) and 5 weeks (2 days a week) depending on the assigned group.
2-5 weeks
10-25 sessions (virtual)
Follow-up
Participants are monitored for maintenance of trained script and generalization of conversation skills.
6 weeks
Participant Groups
The study tests how different speech-language treatment schedules affect language recovery in aphasic patients post-stroke. Using computer-based therapy to practice conversational scripts that vary in length, participants will follow either a high-intensity schedule (5 days/week for 2 weeks) or a low-intensity schedule (2 days/week for 5 weeks).
4Treatment groups
Experimental Treatment
Group I: Massed, Short ScriptExperimental Treatment1 Intervention
Participant practices for 1 hour, 5 days a week for 2 weeks using a 5 sentence-long script.
Group II: Massed, Long ScriptExperimental Treatment1 Intervention
Participant practices for 1 hour, 5 days a week for 2 weeks using a 10 sentence-long script.
Group III: Distributed, Short ScriptExperimental Treatment1 Intervention
Participant practices for 1 hour, 2 days a week for 5 weeks using a 5 sentence-long script.
Group IV: Distributed, Long ScriptExperimental Treatment1 Intervention
Participant practices for 1 hour, 2 days a week for 5 weeks using a 10 sentence-long script.
Modulating Intensity and Dosage of Aphasia Scripts is already approved in United States, European Union, Canada for the following indications:
🇺🇸 Approved in United States as Speech-Language Therapy for:
- Aphasia following stroke
🇪🇺 Approved in European Union as Speech-Language Therapy for:
- Aphasia following stroke
- Language disorders
🇨🇦 Approved in Canada as Speech-Language Therapy for:
- Aphasia following stroke
- Language disorders
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Shirley Ryan AbilitylabChicago, IL
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Who Is Running the Clinical Trial?
Shirley Ryan AbilityLabLead Sponsor
Northwestern UniversityCollaborator
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
University of Colorado, BoulderCollaborator
References
Optimising recovery in aphasia: Learning following exposure to a single dose of computer-based script training. [2022]Purpose: Intensity of therapy influences outcomes in aphasia treatment, but little is known about optimum dosage across treatment approaches. Improved understanding of the effects of dose could help facilitate clinical decisions that maximise patient outcomes. This study examines learning in individuals with aphasia following exposure to one 60-min dose of computer-delivered script training, with or without a rest break. Method: Twenty participants (6F, 14M; 17 nonfluent, 3 fluent) with chronic aphasia due to left-hemisphere stroke participated. Participants had a mean (SD) age of 56.9 (8.4) years, a mean time post onset of 55.1 (range: 6.4-396.4) months, and a mean (SD) Comprehensive Aphasia Test score of 47.8 (4.0). Participants were exposed to 60 min of training, with or without a rest break, of a three-turn conversational script about either weather or traffic. Treatment was delivered via computer using a virtual clinician that visually modelled speech and guided treatment, promoting treatment fidelity. Oral reading probes for script sentences were administered at baseline (3 times), mid-treatment, immediately post-treatment, and, at various times, up to 2 weeks post-treatment to track script acquisition and maintenance. The study also examined generalisation from a trained script to a conversation with a clinician via a generalisation probe at three time points: baseline, immediately post-treatment, and 2 weeks post-treatment. Result: Following exposure to one dose of script training, participants demonstrated statistically significant improvements in oral reading accuracy and rate of script production on trained probes from baseline to immediately post-treatment and 2 weeks post-treatment. Participants also demonstrated significant change from baseline in generalisation to a conversation with a clinician immediately post-treatment and at 2 weeks post-treatment. Conclusion: Exposure to a single dose of computer-delivered script training may facilitate learning. These results have implications for future research investigating optimal dosage and scheduling parameters.
Can Script Training Improve Narrative and Conversation in Aphasia across Etiology? [2021]Script training is an effective treatment of stable (e.g., stroke-induced) and progressive aphasia of varying severities and subtypes. The theoretical underpinnings of script training are discussed and include fluency-inducing conditions, speech shadowing, principles of neuroplasticity, and automatization. Script training outcomes are reviewed, with a focus on discourse in persons with stable aphasia (PWSAs) and in persons with primary progressive aphasia (PWPPAs). PWSAs and PWPPAs are able to acquire and maintain short scripted monologues or conversational dialogues, with some evidence of generalization to untrained topics and settings. Advances in both technology and access have enriched script training protocols, so they now range from no-tech written script approaches to high-tech audiovisual support and avatars. Advances in audio and/or visual support promote large amounts of practice of less errorful whole-message language processing during a fluent language inducing condition. With enough practice, users decrease reliance on supports and independently produce scripted content. Script training can be delivered in a variety of settings (individual, group, telepractice), lends itself well to homework programs, and is in accordance with the principles of neuroplasticity for neurorehabilitation. Incorporating script training into therapy programming is advantageous throughout aphasia recovery following brain injuries such as stroke. It is also beneficial for persons with progressive disease for prophylaxis, remediation, and compensation. Recommendations for implementing script training in clinical practice and future research directions are presented.
Script training treatment for adults with apraxia of speech. [2016]Outcomes of script training for individuals with apraxia of speech (AOS) and mild anomic aphasia were investigated. Script training is a functional treatment that has been successful for individuals with aphasia but has not been applied to individuals with AOS. Principles of motor learning were incorporated into training to promote long-term retention of scripts.
Script training and generalization for people with aphasia. [2022]To examine the effects and generalization of a modified script training intervention, delivered partly via videoconferencing, on dialogue scripts that were produced by 2 individuals with aphasia.
Script Templates: A Practical Approach to Script Training in Aphasia. [2020]Script training for aphasia involves repeated practice of relevant phrases and sentences that, when mastered, can potentially be used in other communicative situations. Although an increasingly popular approach, script development can be time-consuming. We provide a detailed summary of the evidence supporting this approach. We then describe a method in which scripts at various levels of difficulty are created by systematically manipulating readability and grammatical and semantic components. We assess the appropriateness of using these template-based scripts with persons with aphasia of differing severities.
Intensive Versus Distributed Aphasia Therapy: A Nonrandomized, Parallel-Group, Dosage-Controlled Study. [2016]Most studies comparing different levels of aphasia treatment intensity have not controlled the dosage of therapy provided. Consequently, the true effect of treatment intensity in aphasia rehabilitation remains unknown. Aphasia Language Impairment and Functioning Therapy is an intensive, comprehensive aphasia program. We investigated the efficacy of a dosage-controlled trial of Aphasia Language Impairment and Functioning Therapy, when delivered in an intensive versus distributed therapy schedule, on communication outcomes in participants with chronic aphasia.
Aphasia treatment: intensity, dose parameters, and script training. [2021]Studies of aphasia treatment have shown that intensive speech-language therapy is associated with significant improvements. However, there is no standard definition of intensity and the simplistic notion that "more is better" is not necessarily supported by the research. First, current evidence regarding intensity and aphasia treatment was briefly summarized. Second, studies that directly compare conditions of higher- and lower-intensity treatment for aphasia were reviewed with regard to the inclusion of parameters that contribute to a definition of intensity. In addition to five parameters proposed by Warren, Fey, and Yoder (2007) and highlighted by Baker (2012) , total number of sessions was also often documented. The review illustrated the complexity of quantifying the dose of comprehensive treatments that target multiple modalities and utilize a variety of different strategies. Third, data from a study reporting a relationship between intensive computer-based script training and outcomes in aphasia were examined. Results serve to illustrate Baker's contention that intensity alone is insufficient without also considering the active ingredients of the teaching episode. Information about dose, therapeutic inputs, and client acts can lead to better optimization of an intervention.
Impact of Personal Relevance on Acquisition and Generalization of Script Training for Aphasia: A Preliminary Analysis. [2019]The importance of personalization in script training in aphasia has been assumed but never tested. This study compared acquisition and generalization of personally relevant versus generic words or phrases appearing in the same scripts.