Script training in a case of

1
Script training in a case of PPAOS with
progressive aphasia
ABSTRACT
RESULTS
Baseline performance on the seven scripts ranged
from 0 to 40 accuracy. He reached 100 accuracy
on each script over the 15 session treatment
program. Some variability was noted during the
maintenance phase of the first scripts targeted
in treatment. The variability was determined to
be related to a decrease in the amount of home
practice during one period of treatment. The
participant and his wife reported that he was
communicating more effectively at work, both with
customers and staff members, and in the targeted
social interactions. In particular, he had less
difficulty initiating communication in these
situations.
Primary progressive apraxia of speech (PPAOS) is
defined as the gradual onset of AOS symptoms in
the absence of significant non-language cognitive
deficits, resulting from a neurodegenerative
disease1. It may occur as a separate entity or
in conjunction with a progressive aphasia. When
the symptoms of AOS are more prominent than
aphasia the appropriate label is PPAOS with
aphasia1. The purpose of this case study is to
report the successful application of script
training to an individual with PPAOS with
progressive aphasia. Script training was
selected because it targets functional
communication interactions, requires repetitive
practice of words, phrases, and sentences in a
meaningful context, and promotes automaticity of
trained stimuli. Five scripts related to work
place interactions and two scripts related to
social interactions were developed and trained
using a modified script training protocol in a
multiple baseline design. The data suggest that
the repetitive practice, articulatory modeling,
and functional context involved in script
training may improve articulation and fluency of
trained stimuli and generalization to functional
communication interactions.
Michael de Riesthal and C. Elizabeth Brookshire
Pi Beta Phi Rehabilitation Institute at
Vanderbilt Bill Wilkerson Center, Nashville, TN
The purpose of this case study is to report the
successful application of script traininga
procedure developed for individuals with
non-progressive aphasiato an individual with
PPAOS with progressive aphasia. Script training
was selected because it targets functional
communication interactions, requires repetitive
practice of words, phrases, and sentences in a
meaningful context, and promotes automaticity of
trained stimuli.
Motor speech evaluation Slow rate, inconsistent
articulatory errors, distorted subsitutions,
sound repetitions, and excess and equal
stress. Spoken narrative-Story retell The woman
was doing grocery shopping uhthe wallet
droppedout of her purse she went to the
checkout counterand uh she didnt have the
wallet with herand she put the groceries
backand she left the storeand she went
homeand the phone rangand the little girl told
herthe womanshe had found her purseher
walletand she was relieved. Written
narrative-Story retell The raven was sitting on a
log with a piece of cheese in his beak. The fox
saw the raven with cheese in his beak. The fox
wanted the piece of cheese, so he told the raven
he should be king, he told the raven he could
speak in order to bark out orders. The raven
dropped the piece of cheese from his mouth, the
fox ran off with it.
A modified script training protocol7 included
1. Reading 2. Repetition 3. Choral reading 4.
Immediate spontaneous production 5. Delayed
spontaneous production Daily home practice was
encouraged. Baseline and treatment probes
measured the percentage of script lines that were
produced accurately and fluently. Fifteen
treatment sessions were completed over 9 months.
DISCUSSION
RESULTS
Previous studies have demonstrated the
therapeutic effect of script training in
improving the production of trained scripts in
individuals with aphasia (e.g., Youmans et al.,
2005). Production became more automatic, fluent,
and communicative. The present data suggest that
script training can be successful in improving
the communication of an individual with PPAOS and
progressive aphasia. The repetitive practice,
articulatory modeling, and the functional context
involved in script training permitted improved
production and fluency of trained stimuli, which
generalized to functional interactions. This
finding supports the position that treatments
designed for static, non-progressive aphasia, may
be useful in the treatment of progressive
language disorders.
PARTICIPANT
Baseline

• Biographical and medical data
• 64-year-old, right handed male
• Employed as a Pharmacist
• Diagnosed with PPAOS and PA
• MRI revealed minimal ischemic white
• matter changes in left periventricular
• regions
• Participants concerns
• Initial difficulty getting his words out
• Four year decline in communication
• function
• Difficulty with initiating speech and
• word retrieval
• Denied auditory comprehension and
• memory deficits
• Primary concern was increased
• difficulty communicating with
• customers and pharmacy techs at

Treatment
Maintenance
Script 1
INTRODUCTION
Script 2
PPAOS is the gradual onset of AOS symptoms in the
absence of significant non-language cognitive
deficits, resulting from a neurodegenerative
disease1. Symptoms may include slow rate,
distorted substitutions, syllable segmentation,
excess and equal stress, poorly sequenced SMRs,
off-target errors with increased length of
utterance, false starts/restarts, sound
repetitions, sound prolongations, and effortful
orofacial movements2. PPAOS may occur as a
separate entity or in conjunction with a
progressive aphasia. When the symptoms of AOS
are more prominent than aphasia the appropriate
label is PPAOS with aphasia1. There are no
published reports addressing the management of
communication deficits in PPAOS. In the PPA
literature, several studies have reported
successful use of treatments developed for
individuals with non-progressive aphasia3,4,5,6.
It is unknown whether the same principles apply
to the treatment of PPAOS.
INTERVENTION
Script training was selected because it permitted
targeting the patients scripted daily
interactions and allowed for home
practice. Seven scripts ranging from three to
five lines in length were trained. Five scripts
related to work-place interactions and two
scripts related to social interactions. One or
two scripts were trained at time.
Example Script 1 Patient Hi, have you been
waited on? Customer No, I havent. Patient How
can I help you? Customer I have a prescription
to fill. Patient Do you have the script
number? Customer Yes, here it is. Patient This
medication is out of refills. Ill fax your
doctor. Customer How long will that
take? Patient It depends on when the doctor
gets it.
Script 3
Script 4
REFERENCES
Script 5

• Duffy, J.R., McNeil, M.R. (2008). Primary
  progressive aphasia and apraxia of speech. In
  R.Chapey (Ed.), Language Intervention Strategies
  in Aphasia and Related Neurogenic Communication
  Disorders, Fifth Edition (pp. 543-564).
  Baltimore, MD Lippincott Willaims Wilkins.
• Duffy, J.R. (2006). Apraxia of speech in
  degenerative neurologic disease. Aphasiology, 6,
  511-527.
• McNeil, M.R., Small, S.L., Masterson, R.J.,
  Fossett, T.R.D. (1995). Behavioral and
  pharmacological treatment of lexical-semantic
  deficits in a single patient with primary
  progressive aphasia. American Journal of
  Speech-Language Pathology, 4, 76-87.
• Schneider, S.L,, Thompson, C.K., Luring, B.
  (1996). Case study Effects of verbal plus
  gestural matrix training on sentence production
  in a patient with primary progressive aphasia.
  Aphasiology, 10(3). 297-317.
• Henry, M.L., Beeson, P.M., Rapcsak, S.Z.
  (2008). Treatment for lexical retrieval in
  progressive aphasia. Aphasiology, 22(7-8),
  826-838.
• Rogalski, Y., Edmonds, L.A. (2008). Attentive
  reading and constrained summarization (ARCS)
  treatment in primary progressive aphasia A case
  study. Aphasiology, 22(7-8), 763-775.
• Youmans, G., Holland, A., Muñoz, M.L.,
  Bourgeois, M. (2005). Script training and
  automaticity in two individuals with aphasia.
  Aphasiology, 19 (3/4/5), 435-450.

Script 6
Script 7
Session