title: Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: behavioral and fMRI outcomes.
abstract: OBJECTIVE
  This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic aphasia. Whether constraint to the speech modality or treatment intensity is responsible for such gains is still under investigation. Moreover, it remains to be seen whether CIAT is effective in individuals with persistent severe nonfluent speech and/or AOS.
  
  
  METHODS
  A single-subject multiple-baseline approach was used. Both participants were treated simultaneously, first with Promoting Aphasics' Communicative Effectiveness (PACE; Davis & Wilcox, 1985) and then with CIAT. Pre-/posttreatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to posttreatment phases and maintenance where available.
  
  
  RESULTS
  Both participants made more and faster gains in naming following CIAT. Treatment-induced changes in BOLD activation suggested that better naming was correlated with the recruitment of perilesional tissue.
  
  
  CONCLUSIONS
  Participants produced more target words accurately following CIAT than following PACE. Behavioral and fMRI results support the notion that the intense and repetitive nature of obligatory speech production in CIAT has a positive effect on word retrieval, even in participants with chronic moderate-to-severe aphasia with comorbid AOS.
authors.affiliation: University of Massachusetts Amherst, USA. jkurland@comdis.umass.edu
authors.forename: Jacquie
authors.initials: J
authors.lastname: Kurland
authors.forename: Friedemann
authors.initials: F
authors.lastname: Pulvermüller
authors.forename: Nicole
authors.initials: N
authors.lastname: Silva
authors.forename: Katherine
authors.initials: K
authors.lastname: Burke
authors.forename: Mary
authors.initials: M
authors.lastname: Andrianopoulos
mesh_terms: D000368:Aged; D000849:Anomia / Q000503:physiopathology / Q000534:rehabilitation*; D001039:Aphasia, Broca / Q000503:physiopathology / Q000534:rehabilitation*; D001072:Apraxias / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007808:Language Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D009473:Neuronal Plasticity / Q000502:physiology; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014705:Verbal Behavior / Q000502:physiology