RR&D Research Career Scientist Award Application

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The over-arching goal of Dr. Wambaugh's research program is to advance understanding and management of acquired apraxia of speech (AOS) and aphasia. Her current research activities are focused on the development and testing of clinically-applicable therapies for AOS and aphasia using sound theoretical bases for treatment and rigorous experimental methods. Her on-going VA RR&D merit project, “Effects of intensity of treatment on rehabilitation of acquired apraxia of speech” continues her work with Sound Production Treatment (SPT). SPT is a behavioral treatment for AOS which was developed by Dr. Wambaugh; it has been shown to consistently result in improved speech production with persons with AOS representing broad ranges of AOS severity, aphasia severity, chronicity, and age. In order to move SPT toward randomized controlled clinical trials, Dr. Wambaugh has been studying ways to maximize its outcomes. Treatment intensity is a potentially critical factor to consider in the administration of treatment. Dr. Wambaugh and her colleagues are currently evaluating the relative effects of intense administration of SPT (3 hours per day/ 3 days per week / 3 weeks) versus non-intense (“traditional”) SPT (1 hour per day/ 3 days per week/ 9 weeks). Dose frequency and treatment duration are being compared in terms of short and longer term maintenance of production of treated and untreated items (word/phrases). Dr. Wambaugh and her colleague, Dr. Mauszycki, are also comparing the effects of SPT to the effects of electropalatographic (EPG) treatment for AOS. EPG is a method for providing visual biofeedback concerning tongue to palate contact. Some speakers with AOS may have disrupted feedback associated with speech production and may benefit more from visual biofeedback in comparison to clinician-provided feedback. Dr. Wambaugh is also collaborating with researchers from the VA Northern California Health Care System to examine the role of site of lesion in predicting response to SPT and to identify neural plasticity changes associated with treatment. This line of research is the first to address brain biomarkers of treatment response in AOS. Because AOS typically co-occurs with aphasia and it is currently difficult for clinicians to determine how to allocate valuable therapy time among the two disorders, Dr. Wambaugh recently developed a treatment that simultaneously targets speech (AOS) and language (aphasia) symptoms – Combined Aphasia and Apraxia of Speech Treatment (CAAST). Dr. Wambaugh is continuing to refine the CAAST protocol and is conducting additional in-depth analyses of outcomes associated with this treatment with the aim of bringing this new treatment to randomized controlled clinical trials. In another area of aphasia treatment, Dr. Wambaugh has been extending her work with word-retrieval treatments to identify participant characteristics associated with response to treatment. She and her colleagues have recently begun to study practice effects as a predictor of ability to change (and ultimately benefit from treatment). Her pending RR&D merit submission is designed to address practice effects as a predictor of treatment response as well as a factor influencing generalized responding. Dr. Wambaugh's lab is also engaged in the development of reliable outcome measures for use in evaluating treatment outcomes. As part of Dr. Wambaugh's recent SPiRE award, “A novel treatment for aphasia and apraxia of speech: Measurement of Outcomes” her lab has collected repeated speech/language samples (over time) from a group of 30 speakers with AOS-aphasia and will be completing stability analyses for numerous outcome measures.