Speech-Language Therapy for Primary Progressive Aphasia

Recruiting at 2 trial locations

Overseen By Sonia-Karin Marqués-Kiderle

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Texas at Austin

Disqualifiers: Other CNS, psychiatric, visual, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to help people with primary progressive aphasia (PPA), a condition that affects speech and language skills. It focuses on bilingual individuals who speak both Spanish and Catalan or Spanish and English. The trial will test two speech-language therapies: Lexical Retrieval Training (LRT), which addresses word-finding difficulties, and Video-Implemented Script Training for Aphasia (VISTA), which aids in forming sentences. Participants will receive therapy in both languages, and researchers will observe their responses. Ideal candidates are bilinguals with PPA who experience speech difficulties and regularly use both languages. As an unphased trial, this study offers a unique opportunity for bilingual individuals to explore innovative therapies tailored to their specific language needs.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these speech-language interventions are safe for individuals with primary progressive aphasia?

Research shows that speech-language treatments like Lexical Retrieval Training (LRT) and Video-Implemented Script Training for Aphasia (VISTA) are generally safe for people with primary progressive aphasia (PPA).

For LRT, studies have examined various speech therapies for PPA and found them well-tolerated. One study showed that language interventions similar to LRT do not cause serious side effects. These therapies aim to help individuals regain some language abilities, which is crucial as PPA progresses.

VISTA also has a good safety record. Research on its use in people with various types of PPA found that it significantly aids language tasks without causing major side effects. This method uses videos to help people practice and improve their speech, proving effective for different forms of PPA.

Both treatments aim to enhance language and communication skills. Current studies suggest they are safe and beneficial for people with PPA, with no significant safety concerns reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Speech-Language Therapy for Primary Progressive Aphasia trial because it explores innovative techniques like Lexical Retrieval Training (LRT) and Video-Implemented Script Training for Aphasia (VISTA). Unlike traditional speech therapy, which often focuses on general communication skills, LRT targets specific naming difficulties for those with logopenic or semantic variant PPA, offering a more tailored approach. VISTA, on the other hand, uses video-based script training to help individuals with nonfluent/agrammatic PPA practice real-life conversations, providing a practical and engaging way to enhance communication. These targeted strategies could offer more personalized and effective improvements compared to existing treatments.

What evidence suggests that this trial's treatments could be effective for bilingual individuals with primary progressive aphasia?

Research has shown that both Lexical Retrieval Training (LRT) and Video-Implemented Script Training for Aphasia (VISTA) can help people with primary progressive aphasia (PPA) improve their language skills. In this trial, participants will join one of these treatment arms. LRT significantly aids people with PPA in naming objects, with improvements lasting even after treatment ends. This suggests LRT effectively addresses naming difficulties in PPA. VISTA, in contrast, focuses on enhancing smooth speech by having patients practice set dialogues. Early results indicate that VISTA helps people speak more naturally and fluently over time. Both treatments aim to tackle speech and language challenges in PPA, offering hope for better communication. ^{6 7 8 9 10}

Who Is on the Research Team?

Stephanie M Grasso, Ph.D.

Principal Investigator

University of Texas at Austin

Miguel Ángel Santos Santos, MD, PhD

Principal Investigator

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Are You a Good Fit for This Trial?

This trial is for bilingual individuals who speak Spanish and Catalan or Spanish and English, diagnosed with Primary Progressive Aphasia (PPA). Participants must have a certain level of cognitive function as measured by the Mini-Mental State Examination. Those with other central nervous system issues, significant sensory impairments, or prominent non-speech-language impairments cannot join.

Inclusion Criteria

I have been diagnosed with Primary Progressive Aphasia.

You score 15 or more on the Mini-Mental State Examination.

Note that this project will also recruit individuals to participate in assessment only, for these individuals the following inclusion criteria applies: Score of 10 or higher on the Mini-Mental State Examination

Exclusion Criteria

Note that this project will also recruit individuals to participate in assessment only, for these individuals the following inclusion criteria applies: Score of less than 10 on the Mini-Mental State Examination

I have a psychiatric condition that causes symptoms.

I have a condition that affects my brain or nerves.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Phase 1

Participants receive tailored speech-language intervention in both languages for bilingual individuals with PPA

4.5 weeks

Multiple visits for intervention and assessments

Treatment Phase 2

Continuation of speech-language intervention with further assessments

4.5 weeks

Multiple visits for intervention and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Assessments at 6 months and 12 months post-treatment

What Are the Treatments Tested in This Trial?

Interventions

• Lexical Retrieval Training (LRT)
• Video-Implemented Script Training for Aphasia (VISTA)

Trial Overview The study tests two speech-language interventions: Video-Implemented Script Training for Aphasia (VISTA) and Lexical Retrieval Training (LRT), tailored for bilingual speakers with PPA. It aims to understand how bilingualism affects treatment response in PPA over time, including follow-ups at 6 and 12 months post-treatment.

How Is the Trial Designed?

Group I: Video Implemented Script Training for Aphasia Experimental Treatment 2 Interventions

Script training intervention for individuals with nonfluent/agrammatic PPA.

Group II: Lexical Retrieval Training Experimental Treatment 2 Interventions

Naming intervention for individuals with logopenic or semantic variant PPA.

Who Is Running the Clinical Trial?

University of Texas at Austin

Lead Sponsor

Trials

387

Recruited

86,100+

Hospital Clinic of Barcelona

Collaborator

Trials

441

Recruited

5,417,000+

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Collaborator

Trials

361

Recruited

169,000+

Published Research Related to This Trial

In a study involving four individuals with Primary Progressive Aphasia (PPA), three participants showed significant improvement in producing treated nouns and verbs after lexical retrieval treatment, indicating the treatment's efficacy.

Two participants with semantic variant PPA demonstrated generalization of treatment effects, improving their use of treated verbs in untreated verb phrases, suggesting that combining noun and verb retrieval strategies may enhance overall language production in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. Taylor-Rubin, C., Nickels, L., Croot, K.[2022]

In a study involving 16 individuals with primary progressive aphasia, both verb and noun cueing significantly improved the production of verb phrases compared to no cue, with verb cueing being the most effective method.

Thirteen participants showed notable improvements in verb phrase production with verb cues, suggesting that targeted cueing techniques can enhance treatment outcomes for individuals with aphasia, particularly in verb retrieval.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is word learning enough? Improved verb phrase production following cueing of verbs and nouns in primary progressive aphasia. Taylor-Rubin, C., Croot, K., Nickels, L.[2021]

The Video-Implemented Script Training for Aphasia (VISTA) significantly improved speech production, accuracy, and intelligibility in a Spanish-English bilingual speaker with aphasia, demonstrating its effectiveness as a treatment method.

Cross-linguistic transfer was observed, meaning improvements in one language also benefited the other; however, using scripts with many cognates reduced this transfer, suggesting that the design of training materials can impact outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Video-Implemented Script Training in a Bilingual Spanish-English Speaker With Aphasia. Grasso, SM., Cruz, DF., Benavidez, R., et al.[2020]

Script training was effective for individuals with apraxia of speech (AOS), as all three participants successfully acquired and retained their client-selected scripts for up to 6 months after treatment.

Participants reported increased confidence and ease in speaking, indicating that script training not only helped with retention but also improved their overall communication experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script training treatment for adults with apraxia of speech. Youmans, G., Youmans, SR., Hancock, AB.[2016]

A study involving eight individuals with chronic non-fluent aphasia demonstrated that using low-difficulty scripts significantly improved oral reading accuracy compared to high-difficulty scripts, regardless of the severity of aphasia.

The results support the effectiveness of using graded script templates tailored to individual abilities, which can enhance communication training for people with aphasia in both clinical and research settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script Templates: A Practical Approach to Script Training in Aphasia. Kaye, RC., Cherney, LR.[2020]

Script training is an effective therapy for individuals with stable and progressive aphasia, allowing them to learn and maintain scripted speech, with evidence of generalization to untrained topics.

The approach utilizes principles of neuroplasticity and can be adapted to various settings, including individual and group therapy, making it a versatile tool for rehabilitation after brain injuries like stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology? Hubbard, HI., Nelson, LA., Richardson, JD.[2021]

A study involving 20 patients with primary progressive aphasia (PPA) showed that those receiving speech and language therapy (SLT) for 1 hour per week over 11 months had significant improvements in naming ability compared to a control group.

The results indicate that SLT may be beneficial for patients with PPA, warranting further investigation through a randomized, controlled clinical trial to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech therapy in primary progressive aphasia: a pilot study. Farrajota, L., Maruta, C., Maroco, J., et al.[2022]

In a meta-analysis of single-case studies involving 142 patients, improvement in the production of treated verbs was linked to pre-treatment scores in verb comprehension and word repetition, as well as the frequency of treatment sessions, suggesting that these factors are crucial for recovery.

For the production of untreated verbs, which involved 166 patients, improvement was associated with the use of morphological cues and the presence of grammatical impairment, indicating that different mechanisms may underlie recovery for treated versus untreated language outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Production of Treated and Untreated Verbs in Aphasia: A Meta-Analysis. de Aguiar, V., Bastiaanse, R., Miceli, G.[2020]

The modified script training intervention, which included both in-person and videoconferencing sessions, significantly improved accuracy, grammatical productivity, speaking rate, and articulatory fluency in two individuals with aphasia over a 3-week period for each script.

Participants also demonstrated the ability to generalize their improved skills to functional conversational tasks, indicating that the intervention was effective not only in structured settings but also in real-life communication scenarios.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script training and generalization for people with aphasia. Goldberg, S., Haley, KL., Jacks, A.[2022]

Lexical retrieval treatments for individuals with primary progressive aphasia (PPA) have shown immediate benefits, with some participants maintaining these gains for months or even years through long-term treatment, based on a review of studies from the 1990s to early 2018.

Five effective behavioral treatment techniques were identified, including standard naming treatment and cueing hierarchies, but there is limited evidence for generalizing these treatments to untreated words, indicating that the focus should be on maintaining a core vocabulary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment for Lexical Retrieval Impairments in Primary Progressive Aphasia: A Research Update with Implications for Clinical Practice. Croot, K.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2942781/

Treatment for lexical retrieval in progressive aphasia - PMC Treatment for lexical retrieval impairment has been shown to yield positive outcomes in individuals with aphasia due to focal lesions, but there has been little ...

2. tandfonline.com tandfonline.com/doi/abs/10.1080/02687038.2018.1491192

A review of lexical retrieval intervention in primary ... Conclusion: This review highlights that individuals with PPA and AD benefit from lexical retrieval intervention, irrespective of the mechanism ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0010945219300280

Lexical retrieval treatment in primary progressive aphasia This Introduction provides an overview of research on, and gaps in our understanding of lexical retrieval treatment outcomes in PPA, and the rationale for and ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6802912/

Treatment for Word Retrieval in Semantic and Logopenic ... Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up ...

5. translationalneurodegeneration.biomedcentral.com translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-021-00248-z

Language training for oral and written naming impairment ... In conclusion, the lexical retrieval treatment, regardless of the type, is effective in treating naming difficulties in several subtypes of PPA.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12072502/

Safety and Efficacy of Different Therapeutic Interventions ... Data on study characteristics, patient demographics, PPA subtypes, therapeutic modalities, and treatment patterns were collected. Results: Fifty ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT06649084

Primary Progressive Aphasia Multicomponent Language ... Most speech-language interventions for individuals with PPA that have been explored in the literature are restitutive, or impairment-based in nature, and have ...

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40364094/

Safety and Efficacy of Different Therapeutic Interventions ... Abstract. Background: Primary progressive aphasia (PPA) is a neurodegenerative disorder that worsens over time without appropriate treatment.

9. pubs.asha.org pubs.asha.org/doi/10.1044/2021_PERSP-20-00296

Counseling and Care Partner Training in Primary ... Program elements included restitutive lexical retrieval intervention for individuals with PPA, community building among care partners ...

10. alz-journals.onlinelibrary.wiley.com alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.70088

Efficacy of Communication Bridge‐2 for primary progressive ... The CB2 trial is the first global RCT showing efficacy for speech-language intervention for individuals with mild-to-moderate PPA and their ...