Integrating Contextually Relevant Visual Scenes Into Aphasia Interventions

Slowed speaking rates in TBI: Motor speech or cognitive-communication deficit? Aimee Dietz, Karen Hux, Tom Carrell, Jordan Green, Jeff Snell, & Samantha Zickefoose Abstract This investigation explored motor and cognitive contributions to speech rate changes following traumatic brain injury (TBI). Participants included seven adult TBI survivors and seven age- and gender-matched adults without TBI histories (NBI). Participants performed four speech tasks and a cognitive processing speed assessment. Results revealed cognitive processing speed, speech rate, and percent pause-time differences between groups during high-cognitive-demand but not during low-cognitive-demand motor tasks. No articulation rate differences occurred and strong negative correlations between processing speed and percent pause-time existed. Findings suggest slow speaking rates among TBI survivors with mild or no apparent dysarthria reflect cognitive rather than motor challenges. Methods Low-Cognitive-Demand Motor Tasks • Highly structured speaking tasks • Participants did not formulate novel utterances. • Diadochokinetic movements (DDK) • Oral reading: Bamboo Passage Statistical Treatment Cognitive Processing • Mann-Whitney U • Word retrieval speed, p = .038 • Auditory processing speed, p = .024 • Processing Speed Index, p = .001 High- vs Low-Cognitive-Demand Tasks Speaking Rate NBI TBI 6 Median Syllables per Second 5 High-Cognitive-Demand Motor Tasks • Limited intrinsic structure • Participants generated novel utterances • Story Retell •I nformal Conversation Low-Cognitive-Demand Motor Tasks • Mann-Whitney U • DDK • syllables/second, p = .456 • articulation rate, p = .805 • Oral reading (10 participants) • syllables/second, p = .222 • communication rate, p = .841 • articulation rate, p = .222 • percent pause time, p = .106 4 3 2 Standardized Tests • Paced Serial Addition Test (PASAT) • Auditory Processing Speed • Boston Naming Test (BNT) • Word Retrieval Speed • Wechsler Adult Intelligence Test-III (WAIS-III) • Processing Speed Index (PSI) 1 0 DDK Oral Reading Story Retell Conversation Purpose Two purposes for this study •To determine the frequency with which survivors of TBI with mild to no perceivable dysarthria had slower speech rates than normal speakers •To explore the relative contribution of motor and cognitive processing speed to the slowed speech rate observed among TBI survivors High-Cognitive-Demand Motor Tasks • Mann-Whitney • Story retell • syllables/second, p = .004 • communication rate, p =.007 • articulation rate, p = .805 • percent pause time, p = .001 • Informal conversation (12 participants) • syllables/second, p = .065 • communication rate, p =.699 • articulation rate, p = .937 • percent pause time, p = .065 6 5 Median Syllables per Second (pauses removed) Articulation Rate Materials • Marantz Professional Solid-State Digital Recorder • Head-mounted Crown microphone • constant mouth-to-microphone distance of 5 cm • Speech Pause Analysis (SPA) • minimum pause event duration = 100ms • minimum speech event duration = 50ms • minimum signal amplitude = 3 STD above average energy value contained in a silent section of each signal NBI TBI 4 3 2 1 0 DDK Oral Reading Story Retell Conversation Participants •7 adult TBI survivors •7 adults without histories of speechlanguage/neurological impairment All participants •were between 19 and 55 years of age •had hearing WNL •were native speakers of American English Dependent Measures • Speaking rate • syllables/second • Articulation rate • syllables/second with pauses removed • Percent Pause Time • oral reading • story retell • conversation • Cognitive Processing Speeds • Word Retrieval Speed • calculated using the BNT • Auditory Processing Speed • calculated using the PASAT • Processing Speed Index (PSI) • calculated using the WAIS-III Processing Speed & Percent Pause • Spearman Rho • Processing Speed Index & Percent pause time • oral reading: rho = -.712, p = .009 • story retell: rho = -.926, p = .001 • conversation: rho = -.542, p = .069 Processing Speed Index (PSI) PSI & Percent Pause Time 140 120 Oral Reading Story Retell Conversation Participants with TBI •were at least 3-months post-injury •had no focal aphasia •had mild to no apparent dysarthria •performed a visual scanning, math computation, and an oral reading screening 100 80 60 Median Test •No significant difference between TBI & NBI groups -education, p = .559 -age, p = 1.0 40 20 0 0 20 40 60 80 100 Percent Pause Time Discussion These findings suggest that slow speaking rates among TBI survivors with little or no apparent dysarthria result from cognitive rather than motor challenges.