Efficacy and feasibility of a digital speech therapy for post-stroke dysarthria: protocol for a randomized controlled trial – Frontiers

1 Introduction

Stroke is a number one reason behind mortality and long-term incapacity (1). Stroke can elicit a variety of neurological deficits or handicaps, together with speech and language issues. Dysarthria is a neurologic motor speech dysfunction attributable to disruptions within the cranial nerve and muscular management of the speech mechanism. It’s estimated that roughly 22–60% of stroke sufferers expertise dysarthria inside the first week following a stroke (2–4). Roughly 35% of sufferers proceed to exhibit dysarthria even after 6 months (5). Furthermore, post-stroke dysarthria considerably impairs speech intelligibility and articulation actions (2). This impairment results in substantial communication difficulties, emotional misery, social isolation, and poor high quality of life (6, 7).

Interventions for dysarthria contain a variety of methods, akin to neurorehabilitation, behavioral workout routines, and social help (2). Behavioral speech workout routines strengthen the respiration and oral muscle groups to enhance speech management. Methods akin to slowing down speech or controlling pitch are additionally used to boost speech intelligibility. The remedy plan must be personalised based mostly on the affected person’s prior communication skill, restoration stage, and wishes (8).

Regardless of the crucial want for efficient remedy of dysarthria, conventional therapies are sometimes restricted by their monotonous repeated nature. Consequently, these challenges can lead to decreased remedy adherence (9). Furthermore, the numerous effort and time required by physicians and speech-language pathologists (SLPs), usually restricts affected person entry to vital therapeutic sources (10). Research have indicated that solely roughly one-third of sufferers obtain sufficient speech remedy, with substantial variations in remedy frequency (11). Given these limitations, personalised dysarthria remedy turns into vital due to the various patterns of speech impairment in post-stroke dysarthria attributable to completely different stroke lesions (12). These observations spotlight the pressing want for various approaches, akin to personalised digital speech remedy.

In contrast with conventional in-clinic strategies, these digital functions supply substantial advantages. These embrace the power for sufferers to have interaction in numerous speech workout routines from dwelling. They enhance remedy precision, improve financial effectivity, guarantee affected person security, preserve continuity of care, and help self-management (13, 14). This strategy reduces the necessity for clinic visits and associated bills (15, 16). Moreover, digital remedy is very helpful in the course of the COVID-19 pandemic or endemic because it permits sufferers to proceed their remedy with out interruption (17).

Moreover, there’s a noticeable lack of high-quality, complete analysis on the remedy of post-stroke dysarthria. Many current randomized managed trials on post-stroke dysarthria have been on a small scale, limiting their skill to supply conclusive proof relating to the effectiveness of varied therapies (18). This vital analysis hole highlights the significance of our examine, which goals to analyze each the efficacy and feasibility of a customized digital speech remedy software for individuals with post-stroke dysarthria.

This examine goals to analyze the efficacy and feasibility of a digital speech remedy software for sufferers with post-stroke dysarthria. In the end, our trial seeks to determine our digital speech remedy software as a complete resolution. Our software strives to boost the accessibility and practicality of post-stroke dysarthria. It gives personalised therapies tailor-made to every affected person’s distinctive wants, thereby overcoming the restrictions of conventional rehabilitation strategies (12). We hypothesize that our digital speech remedy software can be non-inferior to standard speech therapies in enhancing affected person speech intelligibility and performance for post-stroke dysarthria. Moreover, we anticipate optimistic impacts of our digital speech remedy software on psychological well-being, akin to decreased despair and improved high quality of life in sufferers with post-stroke dysarthria. Moreover, this trial will assess the feasibility of this modern strategy in a scientific setting. It is going to deal with crucial facets akin to recruitment and retention charges, participant adherence, security, and gathering consumer suggestions.

2 Strategies and evaluation

2.1 Trial design

This examine is a multicenter, potential, randomized, evaluator-blinded, non-inferiority trial designed to judge the efficacy and feasibility of a digital speech remedy software for post-stroke dysarthria (Determine 1). Contributors will likely be recruited from three stroke facilities in South Korea: Ewha Womans College Seoul Hospital, Mokdong Hospital, and Nationwide Rehabilitation Heart. The trial will likely be performed in accordance with the Declaration of Helsinki (19) and obtained ethics approval from the Institutional Evaluation Board (Approval quantity: EUMC 2023–02-002, and NRC-2023-01-007). It’s registered on clinicaltrials.gov as NCT05865106.

Determine 1. Research design.

Contributors will likely be recruited based mostly on eligibility standards (Desk 1). Previous to enrollment, individuals will obtain an in depth clarification of the trial. Following this, written knowledgeable consent will likely be obtained from all individuals. Subsequently, the individuals’ demographic info and medical histories will likely be collected. Subsequent, the individuals will likely be randomly assigned to both the intervention or the management group. Randomization will likely be stratified based mostly on the acute to subacute, and persistent phases of stroke.

www.frontiersin.org

Desk 1. Inclusion and exclusion standards.

2.2 Inclusion process

The principal investigator will display screen and exclude individuals with abnormalities in oral constructions based mostly on speech assessments. A complete listing of eligibility standards is offered in Desk 1. Stroke specialists will determine individuals with dysarthria utilizing the Nationwide Institute of Well being Stroke Scale (NIHSS) standards (23). The NIHSS is utilized for its ease of administration and standardized strategy, which minimizes interpersonal variation in assessments. Additionally, the sub-section of “10. speech” is appropriate for initially figuring out dysarthria severity in stroke sufferers. We intention to recruit individuals with each mild-to-moderate and extreme dysarthria. Gentle-to-moderate dysarthria is characterised by slurred speech that continues to be comprehensible, and extreme dysarthria includes principally unintelligible speech or the shortcoming to talk with out proof of aphasia. The eligible individuals will likely be referred to a analysis coordinator to confirm their suitability for the trial. To coach the individuals, the principal investigator will present detailed details about the examine, akin to intervention choices, related dangers, and anticipated advantages. All recruitment and screening processes will likely be completely documented.

Contributors will likely be clearly knowledgeable that they’ve the correct to withdraw from the examine at any level with none penalties to their future medical care. Withdrawal standards will embrace voluntary withdrawal by the participant, a utilization fee falling beneath 40%, a necessity for rapid medical care that precludes continued participation, and any antagonistic occasions which might be instantly associated to the digital remedy software. Moreover, the analysis workforce reserves the correct to withdraw individuals if there may be vital noncompliance with the examine protocol or if their well being standing modifications to the extent that continued use of the applying is deemed unsuitable or unsafe.

2.3 Randomization

Contributors will likely be randomly allotted in a 1:1 ratio to both the intervention group or management group. An impartial third-party entity will oversee the randomization course of to make sure impartiality.

Moreover, the trial will stratify individuals based mostly on the onset interval of their stroke: acute to subacute section (inside 1 month of onset) and persistent section (from 1 month to six months of onset) (24). After confirming individuals’ eligibility, we are going to assign every participant a sequential quantity for group allocation. For every stratum, we are going to actively allocate individuals in a 1:1 ratio to both the intervention or the management group. A safe computerized system will generate an unpredictable and hid allocation sequence. A blinded researcher will handle this sequence in opaque envelopes, which will likely be opened after the participant’s enrollment and baseline measurements are full.

To make sure group stability and methodological rigor inside every stratum, we are going to use permuted blocks of sizes two and 4 (25). The block measurement and allocation sequence particulars will stay confidential and inaccessible to the workforce members concerned in recruitment, remedy, and evaluation till the conclusion of the examine.

2.4 Blinding

As a result of nature of speech remedy, the entire blinding of individuals to their assigned interventions is difficult. We’ll implement evaluator blinding to mitigate this difficulty and guarantee unbiased final result assessments (26). Evaluators will likely be completely skilled to grasp the examine protocol and acknowledge potential biases. Their position is to investigate the trial outcomes objectively with out affect from different elements. Evaluators won’t work together face-to-face with individuals. As an alternative, they may remotely take heed to affected person recordings through an internet system and consider the outcomes. This methodology ensures evaluators focus completely on final result evaluation. They are going to stay unaware of the individuals’ group assignments and won’t be concerned in different phases of the analysis.

2.5 Intervention strategies

2.5.1 Intervention group

Contributors within the intervention group will use a digital speech remedy software designed explicitly for post-stroke dysarthria. Contributors will use the applying independently, with out requiring steady help from caregivers or medical professionals. As well as, occasional steerage or help from relations will likely be permitted. As a part of our common monitoring course of, researchers will comply with up on the extent of household help to make sure it stays acceptable and constant for the remedy protocol. Nonetheless, the first intention is for individuals to handle the remedy autonomously. This strategy promotes independence and self-reliance throughout remedy. Contributors will interact in speech remedy for 60 min every day, 5 days per week, for 4 weeks. The pliability of the applying ought to allow individuals to finish their remedy in both a single session or a number of periods all through the day. Earlier than remedy begins, researchers will introduce the applying to individuals and information them by means of its utilization. Moreover, we are going to present a guide booklet to make sure that individuals can use the applying confidently and independently.

As the vast majority of stroke sufferers are older adults, the applying is designed to be user-friendly (27). It options elder-friendly functionalities and gives progress updates by means of each textual content and voice descriptions to make sure accessibility. Design components akin to button measurement and spacing are tailor-made to accommodate the potential high-quality motor and imaginative and prescient challenges confronted by older customers (28).

Given the variability in speech impairment patterns on account of completely different stroke lesions in post-stroke dysarthria (29), this software gives a customized strategy to speech remedy. When individuals log into the applying, it prompts them to carry out 4 speech evaluation duties to judge their present speech situations. The appliance makes use of a smartphone microphone to measure the ambient noise ranges earlier than every activity to make sure optimum recording situations. The evaluation proceeds provided that the noise stage is <50 dB. 4 evaluation duties had been tailored from conventional dysarthria assessments. Every activity comes with detailed directions and pattern demonstrations to assist individuals carry out assessments effectively.

Sustained Vowel: Contributors are instructed to maintain the vowels/a/, /i/, and/u/, utilizing their common talking tones. Contributors are to carry out the duty twice, and the longer try between the 2 is recorded for evaluation (30).

Diadochokinetic (DDK) Price: Contributors are required to quickly repeat syllables /pǝ/, /tǝ/, and /kǝ/, together with the sequence/pǝtǝkǝ/ every for a minimum of 5 s. Subsequently, their efficiency is recorded for evaluation (31).

Phrase Studying: Contributors are requested to learn a set of 30 phrases from the Urimal Check of Articulation and Phonology 2 (UTAP2). The UTAP2 is particularly designed to evaluate articulation accuracy in Koreans (32).

Passage Studying: Contributors are instructed to learn the passage in a cushty voice at a pure tempo. This evaluation evaluates the affected person’s articulation and total speech intelligibility. The Gaeul Passage is the usual for inspecting motor speech problems in South Korea (33).

The recorded speech evaluation knowledge will likely be despatched to an internet system. The SLPs will assessment the recorded assessments remotely. This course of allows them to determine particular patterns of dysarthric speech impairment utilizing an internet system, as proven in Determine 2. Primarily based on these evaluations, a customized remedy plan specifies the categories and ranges of train required. As an illustration, individuals with respiratory impairment could also be assigned the “sustained phonation” train. SLPs also can set goal targets, together with phonation length, quantity, and repetition. Conversely, individuals combating articulation might carry out studying workout routines. Contemplating the widespread articulation error patterns noticed in individuals with dysarthria, we organized the minimal pair units. If a affected person has issue stopping sounds, the SLP can set minimal pairs akin to/p/ and /f/, or/b/and/v/. This plan is then uploaded to the affected person’s software. Subsequently, the affected person performs the prescribed speech workout routines. The therapeutic targets are set in the beginning of every week. Primarily based on the affected person’s efficiency, the problem stage of the workout routines is adjusted throughout weekly opinions. If a affected person completes the remedy duties for 1 week, the next week’s workout routines are prescribed at the next issue stage. This adjustment ensures the continual development and adaptation of the affected person’s improved speech expertise.

www.frontiersin.org

Determine 2. Digital speech remedy software system overview.

Our digital speech remedy software integrates a complete behavioral speech remedy train based mostly on the established literature (2, 34). An introductory video in the beginning of the train explains the participant’s goals and processes. The appliance gives real-time visible and auditory suggestions throughout train to boost individuals’ rapid responsiveness. Furthermore, the applying makes use of a classy sign processing algorithm to investigate voice knowledge captured through the smartphone’s microphone. This algorithm assesses numerous speech acoustic variables, akin to sound quantity, pitch, studying velocity, and pronunciation accuracy. Every train comes with predefined thresholds towards which participant efficiency is measured. This permits the applying to supply rapid and personalised suggestions based mostly on the person’s progress and efficiency towards these benchmarks. Moreover, the individuals can take heed to their recordings and obtain extra suggestions. This complete suggestions mechanism promotes affected person engagement and fixed enchancment in speech remedy (35). Detailed procedures for the speech workout routines are offered in Supplementary materials.

Sustaining adherence and persevering with to take part within the examine is a vital aim. Researchers will systematically supply direct suggestions to individuals relating to their efficiency and adherence. This strategy encourages steady affected person engagement all through the therapeutic course of. To keep up affected person adherence, the researchers will monitor the every day progress of every affected person. Researchers will contact individuals at any time when a lower within the utilization of the applying is noticed. They are going to attain out by means of textual content messages or cellphone calls to grasp the explanations behind the discount of their utilization. The researchers will then present encouragement and help to reengage individuals within the remedy course of. Moreover, the applying options every day and month-to-month calendars for visible progress monitoring. It additionally data the length of every day actions, fostering motivation and consistency among the many individuals. Furthermore, the individuals are inspired to contact the analysis workforce for help with software utilization challenges, together with consumer errors and interface navigation. Researchers will promptly reply to issues communicated through cellphone, e mail, or textual content to supply rapid help in resolving points.

2.5.2 Management group

Contributors allotted to the management group will bear standard remedy for post-stroke dysarthria over 4 weeks. Within the absence of a regular protocol for post-stroke dysarthria remedy in South Korea, now we have developed a standard speech remedy workbook. This workbook integrates numerous clinically validated behavioral remedy methods (2, 34). Its content material is aligned with the intervention group’s digital speech remedy software to make sure consistency in remedy approaches. Contributors will interact within the workbook for 60 min every day, 5 days per week, for 4 weeks to match the intervention group’s remedy dose and frequency. The workbook ensures remedy consistency throughout the a number of facilities concerned on this scientific trial. Earlier than beginning remedy, the researchers will information the individuals utilizing the traditional remedy workbook.

According to the intervention group, occasional steerage or help from relations will likely be allowed. This strategy ensures that each teams have entry to comparable ranges of help. By doing so, we promote equality within the remedy situations throughout the teams. Throughout common follow-ups, researchers will monitor the extent and nature of any help relations present. This monitoring will assist be certain that the extent of help stays balanced and acceptable for each teams.

Researchers will conduct every day comply with ups to make sure adherence to standard remedy workbook. Throughout these interactions, researchers will focus on the individuals’ progress, handle challenges, and supply help and encouragement to keep up constant participation in remedy. This strategy ensures that the management group receives the identical stage of consideration and help because the intervention group, thereby sustaining trial integrity. After the scientific trial, individuals within the management group may even have entry to the digital speech remedy software.

2.6 Consequence measurements

The examine will span 4 weeks, and the main points are offered in Desk 2. Three evaluation phases will likely be performed in the course of the course of.

www.frontiersin.org

Desk 2. Schedule of enrollment, interventions, and assessments.

Demographic and scientific traits will likely be recorded after enrollment within the examine. This preliminary recording consists of demographic knowledge (age and intercourse), medical historical past, stroke info (kind and placement of stroke and post-stroke length), stage of impairment measured utilizing the NIHSS (23), cognitive standing decided utilizing the Korean Mini-Psychological State Examination (Ok-MMSE) rating (20), and Medical Dementia Score (CDR) assessments (36). The demographic and scientific traits of the individuals are proven in Desk 3.

www.frontiersin.org

Desk 3. Variables evaluated at baseline and examine interval.

Subsequently, the individuals will bear a complete evaluation for post-stroke dysarthria. Psychological well-being questionnaires may even be administered to evaluate despair and high quality of life. Contributors will interact within the post-evaluation section 4 weeks after the baseline evaluation. We’ll repeat the speech assessments and psychological questionnaires from the baseline evaluations. Further evaluations of usability and adherence charges will likely be performed.

2.6.1 Outcomes

The first final result is the change in speech intelligibility following the intervention. Speech intelligibility is essential for efficient communication and displays how nicely a listener understands a affected person’s speech (37). Speech intelligibility will likely be calculated utilizing a passage-reading evaluation. Contributors will likely be instructed to learn a passage aloud comfortably and naturally utilizing the applying for evaluation. The appliance will report their speech and routinely add the recordings to a safe server. Subsequent, three impartial SLPs will take heed to the recordings through an internet system. After listening to the passage as soon as, they may transcribe it as they perceive it. We’ll evaluate these transcriptions with the unique passages to calculate the proportion of accurately transcribed phrases. Every participant’s closing rating would be the common of the scores of all three evaluators (38).

For secondary outcomes, the examine will assess the individuals’ speech perform and psychological well-being by means of voice recordings and surveys through the applying. The SLPs will take heed to the recorded voices of the individuals and fee every speech perform measure. The utmost phonation time (MPT) assesses the power to maintain vowel sound (39). Oral diadochokinetic (DDK) fee evaluates the velocity, regularity, and accuracy of articulatory actions, with efficiency quantified by the variety of syllables repeated quickly and precisely (31). The proportion of consonants right (PCC) is set by evaluating transcriptions from word-reading duties with the unique textual content to objectively assess the accuracy of consonant sounds (32, 40).

Self-report questionnaires will likely be used to evaluate psychological well-being. The Affected person Well being Questionnaire-9 (PHQ-9) evaluates the severity of depressive signs (41). The High quality of Life within the Dysarthric Speaker (QOL-Dys) scale quantifies how dysarthria impacts numerous facets of life. It particularly assesses the influence on every day actions (42, 43). These measures offered important insights into the consequences of interventions on communication and psychological well being.

2.6.2 Feasibility

A complete analysis will likely be performed to evaluate the feasibility of this trial. First, the trial will estimate the variety of potential individuals, the length of recruitment, and the success fee of screening to safe a consultant pattern measurement. Moreover, retention charges will likely be monitored all through the trial. These measurements will guarantee a rigorous pattern measurement for future research. Second, the individuals’ adherence to digital remedy functions will likely be measured. It will embrace monitoring the frequency and completeness of the applying utilization and participant engagement with the remedy protocol utilizing a sturdy knowledge assortment and administration system. Third, participant suggestions will likely be collected to evaluate the acceptability and effectiveness of the digital remedy. We’ll use the System Usability Scale (SUS) questionnaire to measure the usability of the digital speech remedy software when it comes to effectivity and consumer satisfaction (44). Moreover, interviews will likely be performed with the applying consumer to gather qualitative insights akin to individuals’ experiences, challenges, and options for enchancment. This complete suggestions will assist in a greater understanding of the applying’s usability and effectiveness and contribute to future improvement and enhancements. Lastly, we are going to monitor affected person security and potential antagonistic occasions and uphold moral requirements. Digital speech remedy functions embrace the real-time monitoring of affected person log knowledge to swiftly determine and handle utilization errors or technical points. Rigorous testing of the applying’s efficiency may even deal with stability and consumer interface to evaluate its influence on remedy effectiveness and consumer expertise. This strategy ensures the security and reliability of the digital instruments all through the examine.

2.7 Evaluation

The first goal of this trial is to analyze the non-inferiority of the intervention group in comparison with the management group when it comes to modifications in speech intelligibility from baseline to post-treatment. The speculation is as follows:

H
0

:

μ
t

μ
c

<
δ

v
s

H
1

:

μ
t

μ
c


δ

The place μt is the imply change in speech intelligibility rating within the intervention group utilizing the digital speech remedy software, and μc is the imply change within the management group receiving standard speech remedy. It’s assumed that there is no such thing as a distinction between the 2 teams, and this examine seeks to determine the non-inferiority of the teams. The non-inferiority margin δ is about at 19 factors, based mostly on the idea {that a} distinction of 1 to 19 factors on the speech intelligibility scale is clinically non-inferior (45).

The pattern measurement required for the non-inferiority trial was decided utilizing a statistical system (46). This concerned setting the importance stage (alpha) to 0.025 for a one-sided check and concentrating on an influence of 80% (β = 0.2) (47) with a regular deviation of 24.9 (48). This calculation revealed that 28 individuals are required for every group. A complete of 56 individuals are required for the trial. To account for a attainable dropout fee of 30%, we intention to recruit a complete of 76 individuals, with 38 individuals in every group.

n
=

2

z
α

+

z
β

2

σ
2

μ
t

μ
c


δ

2


28

Analyses will likely be carried out utilizing SPSS software program (model 27; IBM Corp., Armonk, New York). Descriptive statistics will summarize the demographic knowledge and final result measures. For interval estimates, 95% confidence intervals will likely be offered. An intention-to-treat (ITT) evaluation will embrace all randomized individuals. Moreover, we are going to conduct a per-protocol (PP) evaluation which incorporates solely individuals who totally adhered to the supposed protocol.

First, the Shapiro–Wilk check will assess of the normality of the distributions. Primarily based on these outcomes, the suitable parametric (impartial two-sample t-test) or non-parametric check (Mann–Whitney U check) will likely be chosen for between-group comparisons. Then, combined repeated-measures evaluation of variance (ANOVA) will consider the modifications over time inside topics and between teams, with mounted results for time, group, and their interactions. Mauchly’s check will verify sphericity by making use of the Greenhouse–Geisser, if vital. For vital findings, Tukey’s HSD assessments will conduct post-hoc analyses with Bonferroni correction to manage for the general kind I error fee at 0.05. The benchmark for statistical significance is about at p < 0.05.

We’ll handle lacking knowledge utilizing a number of imputation methods and the Final Statement Carried Ahead (LOCF) methodology. This strategy goals to reduce bias and make sure the robustness of efficacy outcomes (49). Subgroup and sensitivity analyses will likely be performed to discover the consequences of participant traits and institutional elements on the first efficacy outcomes. Along with the first evaluation, we are going to conduct subgroup analyses to look at the efficacy of our digital speech remedy software in numerous settings. Subgroup analyses embrace evaluating its use throughout hospitalization with post-discharge dwelling use. These analyses intention to supply a deeper understanding of how the setting influences the effectiveness of the remedy.

Moreover, extra subgroup analyses will deal with the consequences of the interventions throughout completely different stroke phases. Since individuals are stratified based mostly on the onset interval of their stroke into acute to subacute, and persistent phases, these subgroup analyses will discover how the efficacy of the intervention varies between these two distinct stroke phases. We’ll carry out regression analyses inside every group stratified by the stroke onset interval. If the statistical evaluation reveals vital imply variations between numerous teams, post-hoc assessments will likely be performed to determine the particular teams amongst which these variations exist. This strategy will present precious insights into whether or not the timing of a post-stroke intervention influences the efficacy of digital speech remedy. No interim analyses are deliberate to keep up the integrity of the non-inferiority margin or management for kind I error fee.

3 Dialogue

This protocol goals to judge a digital speech remedy software for post-stroke dysarthria in a randomized scientific trial. It will set up the efficacy and feasibility of the intervention and contribute important knowledge to tell future trials. The shortage of rigorous analysis on post-stroke dysarthria remedy implies that these findings will likely be vital for researchers and clinicians on this discipline (18, 50).

Earlier analysis has demonstrated the efficacy of behavioral speech remedy in sufferers with persistent post-stroke dysarthria. For example, earlier examine confirmed a major enchancment in sufferers with post-stroke dysarthria after 16 periods over 4 weeks (51). Equally, one other examine reported optimistic outcomes from 60-min periods administered 4 occasions per week for 1 month in sufferers with a minimum of 6 months of post-stroke dysarthria (52). Nonetheless, these research might not totally handle error patterns and stroke lesion traits throughout stroke restoration phases (53–55). They acknowledged the significance of early intervention, which has been proven to considerably improve outcomes (34, 56, 57). Our protocol goals to fill this analysis hole by stratifying sufferers into acute to subacute, and persistent phases. This strategy gives a complete view of the impact of remedy on the stroke restoration spectrum.

Our examine proposes digital speech remedy designed to deal with the restrictions of conventional in-clinic or in-hospital therapies for post-stroke dysarthria. Contemplating the various error patterns in individuals with post-stroke dysarthria, our system emphasizes the supply of personalised therapies by means of speech evaluation. We intention to boost remedy efficacy and enhance affected person adherence utilizing a affected person’s smartphone software.

Sustaining long-term dedication to post-stroke remedy might be difficult (58, 59). Sufferers might train much less ceaselessly than recommended (60), wrestle to realize every day remedy targets (61), or discontinue remedy fully (59). Digital options provided for consolation in sufferers’ houses are anticipated to encourage extra intensive speech remedy (6) and higher adherence. Digital speech remedy functions allow simpler entry to speech remedy, improve engagement, and will cut back prices (62, 63). Nonetheless, this examine has a number of limitations. First, the restricted pattern measurement may restrict the applicability of our outcomes. Second, our digital speech remedy software is designed completely for Koreans and focused at native Korean audio system. This language limitation may restrict the generalizability to non-Korean populations. Third, the dearth of direct supervision by clinicians or SLPs in digital speech remedy interventions may have an effect on affected person motivation and lead to larger dropout charges (59, 64). Lastly, a major problem arises from the excessive proportion of older individuals, which is typical in stroke affected person demographics (65). Regardless of contemplating the design of our software for the aged inhabitants, these individuals might expertise decrease usability and adherence to digital remedy due to their unfamiliarity with digital expertise.

Regardless of these limitations, this examine has a number of strengths. First, it goals to supply new proof for using digital speech remedy within the remedy of post-stroke dysarthria. This might improve the adoption of digital remedy within the discipline. Second, the examine is designed to analyze whether or not a digital speech remedy software is efficient and possible for stroke individuals, no matter their severity and restoration stage.

In conclusion, this trial explores the efficacy and feasibility of digital speech remedy functions in treating post-stroke dysarthria. Our examine goals to supply vital insights that can assist future analysis by refining impact measurement estimates and enhancing energy evaluation. By addressing the complexities of post-stroke speech remedy by means of a digital software, we anticipate to boost remedy methods. By our trial, we anticipate to have the ability to present proof of digital therapeutics for the remedy of post-stroke dysarthria.

Ethics assertion

The research involving people had been authorized by the EWHA Womans College Seoul Hospital Institutional Evaluation Board (EUSMC-2021-12-011) and the Nationwide Rehabilitation Heart Institutional Evaluation Board (NRC-2023-01-007). The research had been performed in accordance with the native laws and institutional necessities. The individuals offered their written knowledgeable consent to take part on this examine. Written knowledgeable consent was obtained from the people for the publication of any doubtlessly identifiable photographs or knowledge included on this article.

Writer contributions

YK: Conceptualization, Methodology, Software program, Writing – authentic draft, Writing – assessment & enhancing. MK: Writing – authentic draft, Writing – assessment & enhancing. JK: Funding acquisition, Writing – assessment & enhancing. T-JS: Supervision, Writing – assessment & enhancing.

Funding

The creator(s) declare monetary help was obtained for the analysis, authorship, and/or publication of this text. This work was supported by the Expertise improvement Program (S3301230) funded by the Ministry of SMEs and Startups (MSS, Korea). This analysis was supported by a grant from the Korea Well being Expertise R&D Challenge by means of the Korea Well being Business Growth Institute (KHIDI), funded by the Ministry of Well being and Welfare, Republic of Korea (grant quantity: HI22C073600, RS-2023-00262087 to TS).

Battle of curiosity

The authors declare the next monetary pursuits/private relationships, which can be thought of as potential competing pursuits: JK is a founding father of the HAII Corp, makers of digital speech remedy software. YK, and MK are partly employed by HAII Corp.

The remaining creator declares that the analysis was performed within the absence of any industrial or monetary relationships that may very well be construed as a possible battle of curiosity.

Writer’s be aware

All claims expressed on this article are solely these of the authors and don’t essentially characterize these of their affiliated organizations, or these of the writer, the editors and the reviewers. Any product which may be evaluated on this article, or declare which may be made by its producer, just isn’t assured or endorsed by the writer.

Supplementary materials

The Supplementary materials for this text might be discovered on-line at: https://www.frontiersin.org/articles/10.3389/fneur.2024.1305297/full#supplementary-material

References

1. Feigin, VL, Brainin, M, Norrving, B, Martins, S, Sacco, RL, Hacke, W, et al. World stroke group (WSO): world stroke reality sheet 2022. Int J Stroke. (2022) 17:18–29. doi: 10.1177/17474930211065917

PubMed Summary | Crossref Full Textual content | Google Scholar

2. Duffy, JR
. Motor speech problems: substrates, differential analysis, and administration. 4th Edn.) ed. St. Louis, Missouri: Elsevier (2020).

Google Scholar

3. Mackenzie, C
. Dysarthria in stroke: a story assessment of its description and the result of intervention. Int J Speech Lang Pathol. (2011) 13:125–36. doi: 10.3109/17549507.2011.524940

PubMed Summary | Crossref Full Textual content | Google Scholar

4. Darley, FL, Aronson, AE, and Brown, JR. Differential diagnostic patterns of dysarthria. J Speech Hear Res. (1969) 12:246–69. doi: 10.1044/jshr.1202.246

Crossref Full Textual content | Google Scholar

5. O’Mahony, PG, Thomson, RG, Dobson, R, and Rodgers, HJames OF. The prevalence of stroke and related incapacity. J Public Well being. (1999) 21:166–71. doi: 10.1093/pubmed/21.2.166

Crossref Full Textual content | Google Scholar

6. Dickson, S, Barbour, RS, Brady, M, Clark, AM, and Paton, G. Sufferers’ experiences of disruptions related to post-stroke dysarthria. Int J Lang Commun Disord. (2008) 43:135–53. doi: 10.1080/13682820701862228

Crossref Full Textual content | Google Scholar

7. Mackenzie, C, Kelly, S, Paton, G, Brady, M, and Muir, M. The residing with dysarthria group for post-stroke dysarthria: the participant voice. Int J Lang Commun Disord. (2013) 48:402–20. doi: 10.1111/1460-6984.12017

PubMed Summary | Crossref Full Textual content | Google Scholar

8. Brady, MC, Clark, AM, Dickson, S, Paton, G, and Barbour, RS. Dysarthria following stroke: the affected person’s perspective on administration and rehabilitation. Clin Rehabil. (2011) 25:935–52. doi: 10.1177/0269215511405079

PubMed Summary | Crossref Full Textual content | Google Scholar

9. Tamayo-Serrano, P, Garbaya, S, Bouakaz, S, and Blazevic, P. A game-based rehabilitation remedy for post-stroke sufferers: an strategy for bettering affected person motivation and engagement. IEEE Syst Man Cyber Magaz. (2020) 6:54–62. doi: 10.1109/MSMC.2020.3002519

Crossref Full Textual content | Google Scholar

10. Avan, A, Digaleh, H, Napoli, MD, Stranges, S, Behrouz, R, Shojaeianbabaei, G, et al. Socioeconomic standing and stroke incidence, prevalence, mortality, and worldwide burden: an ecological evaluation from the worldwide burden of illness examine 2017. BMC Med. (2019) 17:191.doi: 10.1186/s12916-019-1397-3

Crossref Full Textual content | Google Scholar

11. Dobkin, BH, and Dorsch, A. New proof for therapies in stroke rehabilitation. Curr Atheroscler Rep. (2013) 15:1–9. doi: 10.1007/s11883-013-0331-y

Crossref Full Textual content | Google Scholar

12. Macoir, J, Lavoie, M, Routhier, S, and Bier, N. Key elements for the success of self-administered therapies of Poststroke aphasia utilizing applied sciences. Telemed e-Well being. (2019) 25:663–70. doi: 10.1089/tmj.2018.0116

PubMed Summary | Crossref Full Textual content | Google Scholar

13. Karlsen, C, Ludvigsen, MS, Moe, CE, Haraldstad, Ok, and Thygesen, E. Experiences of community-dwelling older adults with using telecare in dwelling care providers: a qualitative systematic assessment. JBI Evid Synth. (2017) 15:2913–80. doi: 10.11124/JBISRIR-2017-003345

Crossref Full Textual content | Google Scholar

14. Griffin, M, Bentley, J, Shanks, J, and Wooden, C. The effectiveness of Lee Silverman voice remedy remedy issued interactively by means of an iPad system: a non-inferiority examine. J Telemed Telecare. (2018) 24:209–15. doi: 10.1177/1357633X17691865

PubMed Summary | Crossref Full Textual content | Google Scholar

15. Abelson, JS, Kaufman, E, Symer, M, Peters, A, Charlson, M, and Yeo, H. Obstacles and advantages to utilizing cellular well being expertise after operation: a qualitative examine. Surgical procedure. (2017) 162:605–11. doi: 10.1016/j.surg.2017.05.007

PubMed Summary | Crossref Full Textual content | Google Scholar

16. Bowser, DM, Shepard, DS, Nandakumar, A, Okunogbe, A, Morrill, T, Halasa-Rappell, Y, et al. Value effectiveness of Cell well being for antenatal care and facility births in Nigeria. Ann Glob Well being. (2018) 84:592–602. doi: 10.9204/aogh.2364

Crossref Full Textual content | Google Scholar

17. Zhou, X, Snoswell, CL, Harding, LE, Bambling, M, Edirippulige, S, Bai, X, et al. The position of telehealth in decreasing the psychological well being burden from COVID-19. Telemed e-Well being. (2020) 26:377–9. doi: 10.1089/tmj.2020.0068

PubMed Summary | Crossref Full Textual content | Google Scholar

18. Mitchell, C, Bowen, A, Tyson, S, Butterfint, Z, and Conroy, P. Interventions for dysarthria on account of stroke and different adult-acquired, non-progressive mind harm. Cochrane Database Syst Rev. (2017) 2017. doi: 10.1002/14651858.CD002088.pub3

Crossref Full Textual content | Google Scholar

19. World Medical A
. World medical affiliation declaration of Helsinki: moral rules for medical analysis involving human topics. JAMA. (2013) 310:2191–4. doi: 10.1001/jama.2013.281053

Crossref Full Textual content | Google Scholar

20. Kim, JM, Shin, IS, Yoon, JS, and Lee, HY. Comparability of diagnostic validities between MMSE-Ok and Ok-MMSE for screening of dementia. J Korean Neuropsychiatr Assoc. (2003) 46:124–30. doi: 10.5124/jkma.2003.46.2.124

Crossref Full Textual content | Google Scholar

21. Rowe, F, Model, D, Jackson, CA, Value, A, Walker, L, Harrison, S, et al. Visible impairment following stroke: do stroke sufferers require imaginative and prescient evaluation? Age Ageing. (2008) 38:188–93. doi: 10.1093/ageing/afn230

PubMed Summary | Crossref Full Textual content | Google Scholar

22. Isaacson, J, and Vora, NM. Differential analysis and remedy of listening to loss. Am Fam Doctor. (2003) 68:1125–32.

PubMed Summary | Google Scholar

23. Oh, MS, Yu, Ok-H, Lee, J-H, Jung, S, Ko, I-S, Shin, J-H, et al. Validity and reliability of a Korean model of the Nationwide Institutes of Well being stroke scale. J Clin Neurol. (2012) 8:177–83. doi: 10.3988/jcn.2012.8.3.177

PubMed Summary | Crossref Full Textual content | Google Scholar

24. Bernhardt, J, Hayward, KS, Kwakkel, G, Ward, NS, Wolf, SL, Borschmann, Ok, et al. Agreed definitions and a shared imaginative and prescient for brand new requirements in stroke restoration analysis: the stroke restoration and rehabilitation roundtable taskforce. Int J Stroke. (2017) 12:444–50. doi: 10.1177/1747493017711816

PubMed Summary | Crossref Full Textual content | Google Scholar

25. Broglio, Ok
. Randomization in scientific trials: permuted blocks and stratification. JAMA. (2018) 319:2223–4. doi: 10.1001/jama.2018.6360

Crossref Full Textual content | Google Scholar

27. Wildenbos, GA, Jaspers, MWM, Schijven, MP, and Dusseljee-Peute, LW. Cell well being for older grownup sufferers: utilizing an getting older boundaries framework to categorise usability issues. Int J Med Inform. (2019) 124:68–77. doi: 10.1016/j.ijmedinf.2019.01.006

PubMed Summary | Crossref Full Textual content | Google Scholar

28. Barros, AC, Leitão, R, and Ribeiro, J. Design and analysis of a Cell consumer Interface for older adults: navigation, interplay and visible design suggestions. Proced. Comp. Sci. (2014) 27:369–78. doi: 10.1016/j.procs.2014.02.041

Crossref Full Textual content | Google Scholar

29. Palmer, R, and Enderby, P. Strategies of speech remedy remedy for secure dysarthria: a assessment. Adv. Speech Lang. Pathol. (2007) 9:140–53. doi: 10.1080/14417040600970606

Crossref Full Textual content | Google Scholar

30. Kwon, YG, Do, KH, Park, SJ, Chang, MC, and Chun, MH. Impact of repetitive transcranial magnetic stimulation on sufferers with dysarthria after subacute stroke. Annals of Rehabilitation Drugs. (2015) 39:793–9. doi: 10.5535/arm.2015.39.5.793

PubMed Summary | Crossref Full Textual content | Google Scholar

31. Ziegler, W
. Job-related elements in oral motor management: speech and oral diadochokinesis in dysarthria and apraxia of speech. Mind Lang. (2002) 80:556–75. doi: 10.1006/brln.2001.2614

PubMed Summary | Crossref Full Textual content | Google Scholar

32. Kim, YT, Park, H, Kang, JK, Kim, JA, Shin, MJ, Kim, S-J, et al. Validity and reliability analyses for the event of Urimal check of articulation and Phonology-2. Commun. Sci. Disord. (2018) 23:959–70. doi: 10.12963/csd.18545

Crossref Full Textual content | Google Scholar

33. Kim, HH
, Perceptual, Acoustical, and Physiological Instruments in Ataxic Dysarthria Administration; A Case Report. Proceedings of the Korean society of phonetic sciences and speech expertise convention. (1996) 2:9–22.

Google Scholar

34. Godecke, E, Armstrong, E, Rai, T, Ciccone, N, Rose, ML, Middleton, S, et al. A randomized management trial of intensive aphasia remedy after acute stroke: the very early rehabilitation for SpEech (VERSE) examine. Int J Stroke. (2021) 16:556–72. doi: 10.1177/1747493020961926

PubMed Summary | Crossref Full Textual content | Google Scholar

35. Maas, E, Robin, DA, Hula, SNA, Freedman, SE, Wulf, G, Ballard, KJ, et al. Rules of motor studying in remedy of motor speech problems. Am J Speech Lang Pathol. (2008) 17:277–98. doi: 10.1044/1058-0360(2008/025)

Crossref Full Textual content | Google Scholar

36. Morris, JC
. The scientific dementia score (CDR): present model and scoring guidelines. Neurology. (1993) 43:2412–4. doi: 10.1212/WNL.43.11.2412-a

Crossref Full Textual content | Google Scholar

37. Yorkston, KM, Dowden, PA, and Beukelman, DR. Intelligibility measurement as a instrument within the scientific administration of dysarthric audio system. Intellig. Speech Disord. (1992) 1:265–85. doi: 10.1075/sspcl.1.08yor

Crossref Full Textual content | Google Scholar

38. Hirsch, ME, Thompson, A, Kim, Y, and Lansford, KL. The reliability and validity of speech-language pathologists&rsquo; estimations of intelligibility in dysarthria. Mind Sci. (2022) 12:1011. doi: 10.3390/brainsci12081011

PubMed Summary | Crossref Full Textual content | Google Scholar

39. Shin, MJ, Kim, JO, Lee, SB, and Lee, SY. Speech mechanism screening check. Seoul: Hakjisa (2010).

Google Scholar

40. Namasivayam, AK, Huynh, A, Granata, F, Regulation, V, and van Lieshout, P. PROMPT intervention for kids with extreme speech motor delay: a randomized management trial. Pediatr Res. (2021) 89:613–21. doi: 10.1038/s41390-020-0924-4

PubMed Summary | Crossref Full Textual content | Google Scholar

41. Spitzer, RL, Kroenke, Ok, and Williams, JB. Validation and utility of a self-report model of PRIME-MD: the PHQ main care examine. Main care analysis of psychological problems. Affected person well being questionnaire. JAMA. (1999) 282:1737–44. doi: 10.1001/jama.282.18.1737

Crossref Full Textual content | Google Scholar

42. Piacentini, V, Zuin, A, Cattaneo, D, and Schindler, A. Reliability and validity of an instrument to measure high quality of life within the dysarthric speaker. Folia Phoniatr Logop. (2011) 63:289–95. doi: 10.1159/000322800

PubMed Summary | Crossref Full Textual content | Google Scholar

43. Lengthy, A, Hesketh, A, and Bowen, AStudy ANR. Communication final result after stroke: a brand new measure of the carer’s perspective. Clin Rehabil. (2009) 23:846–56. doi: 10.1177/0269215509336055

Crossref Full Textual content | Google Scholar

44. Brooke, J
. SUS: a fast and soiled usability scale. Usability Eval Ind. (1995):189.

Google Scholar

45. Lousada, M, Jesus, LMT, Corridor, A, and Joffe, V. Intelligibility as a scientific final result measure following intervention with youngsters with phonologically based mostly speech–sound problems. Int J Lang Commun Disord. (2014) 49:584–601. doi: 10.1111/1460-6984.12095

Crossref Full Textual content | Google Scholar

46. Flight, L, and Julious, SA. Sensible information to pattern measurement calculations: non-inferiority and equivalence trials. Pharm Stat. (2016) 15:80–9. doi: 10.1002/pst.1716

Crossref Full Textual content | Google Scholar

47. Muller, KE, Lavange, LM, Ramey, SL, and Ramey, CT. Energy calculations for common linear multivariate fashions together with repeated measures functions. J Am Stat Assoc. (1992) 87:1209–26. doi: 10.1080/01621459.1992.10476281

PubMed Summary | Crossref Full Textual content | Google Scholar

48. Levy, ES, Moya-Galé, G, Chang, YHM, Freeman, Ok, Forrest, Ok, Brin, MF, et al. The consequences of intensive speech remedy on intelligibility in Parkinson’s illness: a randomised managed trial. eClinicalMedicine. (2020) 24:100429. doi: 10.1016/j.eclinm.2020.100429

PubMed Summary | Crossref Full Textual content | Google Scholar

49. Hamer, RM, and Simpson, PM. Final commentary carried ahead versus combined fashions within the evaluation of psychiatric scientific trials. Am J Psychiatr. (2009) 166:639–41. doi: 10.1176/appi.ajp.2009.09040458

Crossref Full Textual content | Google Scholar

50. Finch, E, Rumbach, AF, and Park, S. Speech pathology administration of non-progressive dysarthria: a scientific assessment of the literature. Disabil Rehabil. (2020) 42:296–306. doi: 10.1080/09638288.2018.1497714

PubMed Summary | Crossref Full Textual content | Google Scholar

51. Mahler, LA, and Ramig, LO. Intensive remedy of dysarthria secondary to stroke. Clin Linguist Phon. (2012) 26:681–94. doi: 10.3109/02699206.2012.696173

Crossref Full Textual content | Google Scholar

52. Park, S, Theodoros, D, Finch, E, and Cardell, E. Be clear: a brand new intensive speech remedy for adults with nonprogressive dysarthria. Am J Speech Lang Pathol. (2016) 25:97–110. doi: 10.1044/2015_AJSLP-14-0113

PubMed Summary | Crossref Full Textual content | Google Scholar

53. Cramer, SC
. Repairing the human mind after stroke: I. Mechanisms Spontaneous Recov Ann Neurol. (2008) 63:272–87. doi: 10.1002/ana.21393

Crossref Full Textual content | Google Scholar

54. Kiran, S, and Thompson, CK. Neuroplasticity of language networks in aphasia: advances, updates, and future challenges. Entrance Neurol. (2019) 10:295. doi: 10.3389/fneur.2019.00295

PubMed Summary | Crossref Full Textual content | Google Scholar

55. Robertson, SJ, and Thomson, F. Speech remedy in Parkinson’s illness: a examine of the efficacy advert long run results of intensive remedy. Br J Disord Commun. (1984) 19:213–24. doi: 10.3109/13682828409029837

PubMed Summary | Crossref Full Textual content | Google Scholar

56. Lancaster, GA, Dodd, S, and Williamson, PR. Design and evaluation of pilot research: suggestions for good observe. J Eval Clin Pract. (2004) 10:307–12. doi: 10.1111/j.2002.384.doc.x

Crossref Full Textual content | Google Scholar

57. Coleman, ER, Moudgal, R, Lang, Ok, Hyacinth, HI, Awosika, OO, Kissela, BM, et al. Early rehabilitation after stroke: a story assessment. Curr Atheroscler Rep. (2017) 19:1–12. doi: 10.1007/s11883-017-0686-6

Crossref Full Textual content | Google Scholar

58. Behrman, A, Rutledge, J, Hembree, A, and Sheridan, S. Vocal hygiene schooling, voice manufacturing remedy, and the position of affected person adherence: a remedy effectiveness examine in ladies with phonotrauma. J Speech Lang Hear Res. (2008) 51:350–66. doi: 10.1044/1092-4388(2008/026)

Crossref Full Textual content | Google Scholar

59. Hapner, E, Portone-Maira, C, and Johns, MM III. A examine of voice remedy dropout. J Voice. (2009) 23:337–40. doi: 10.1016/j.jvoice.2007.10.009

Crossref Full Textual content | Google Scholar

60. Leer, EV, and Connor, NP. Predicting and influencing voice remedy adherence utilizing social–cognitive elements and cellular video. Am J Speech Lang Pathol. (2015) 24:164–76. doi: 10.1044/2015_AJSLP-12-0123

PubMed Summary | Crossref Full Textual content | Google Scholar

62. Abbadessa, G, Brigo, F, Clerico, M, De Mercanti, S, Trojsi, F, Tedeschi, G, et al. Digital therapeutics in neurology. J Neurol. (2022) 269:1209–24. doi: 10.1007/s00415-021-10608-4

PubMed Summary | Crossref Full Textual content | Google Scholar

63. Kamoen, O, Maqueda, V, Yperzeele, L, Pottel, H, Cras, P, Vanhooren, G, et al. Stroke coach: a pilot examine of a private digital teaching program for sufferers after ischemic stroke. Acta Neurol Belg. (2020) 120:91–7. doi: 10.1007/s13760-019-01218-z

Crossref Full Textual content | Google Scholar

64. Ramsberger, G, and Marie, B. Self-administered cued naming remedy: a single-participant investigation of a computer-based remedy program replicated in 4 circumstances. Am J Speech Lang Pathol. (2007) 16:343–58. doi: 10.1044/1058-0360(2007/038)

PubMed Summary | Crossref Full Textual content | Google Scholar

65. Tsao, CW, Aday, AW, Almarzooq, ZI, Alonso, A, Beaton, AZ, Bittencourt, MS, et al. Coronary heart illness and stroke statistics—2022 replace: a report from the American Coronary heart Affiliation. Circulation. (2022) 145:e153–639. doi: 10.1161/CIR.0000000000001052

PubMed Summary | Crossref Full Textual content | Google Scholar

Adblock check (Why?)

Leave a Reply

Your email address will not be published. Required fields are marked *