Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment
Phase: NA
Conditions: Apraxia of Speech, Aphasia, Acquired, Speech Disorders
Sponsor: VA Office of Research and Development

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
 
 
 
MARCH 12, 2020 
 
Clinical Trials:  C2068-P 
Apraxia of Speech: A Comparison of EPG Treatment & Sound 
Production Treatment  
 
PI:  Shannon C. Mauszycki 
Aphasia/Apraxia of Speech Research Program 
VA Salt Lake City Health Care System 
Salt Lake City, UT 
 
 
 
Statistical Analysis Plan 
 
& Treatment Protocols 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
 
Statistical - Data Analysis Plan 
 
Conservative Dual Criterion (CDC) method  
 
The CDC method was used as an objective method to assist in assigning treatment effects 
(Fisher et al., 2003). Application of the CDC method involved using the baseline probe values to 
create a trend line and a mean (level) line for each set of data. These criterion lines were then 
adjusted upwards in the direction of the expected treatment effect by 0.25 standard deviations 
and were extended into each corresponding treatment phase. That is, the lines serve to predict 
continued performance, in the absence of treatment, based upon the baseline data. Assigning 
positive treatment effects requires that a pre-specified number of data points fall above both 
lines (see Fisher et al., 2003; Swoboda, Kratochwill, & Levin, 2010 for a more detailed 
explanation of the CDC method). For example, with five data points per treatment phase, all five 
points must fall above both CDC lines (Fisher et al., 2003). For this investigation, each 
treatment phase had 12 data points (i.e., probes), at least nine data points are required to be 
above both lines to assign positive treatment effects (Fisher et al., 2003). 
 
Effect sizes were calculated to estimate magnitude of change that was associated with 
treatment. d-Index values (Bloom, Fischer, & Orme, 2006; Cohen, 1988) were calculated for 
each target speech sound for the treated and untreated stimulus items to measure the changes 
associated with the treatment phase and the follow-up phase (in comparison to the baseline 
phase). The d-index is a modification of Cohen’s d formula that allows for greater precision in 
calculating effect sizes when there are a smaller number of baseline data points (Bloom et al., 
2006). For effect size calculations associated with changes that occurred in the treatment 
phases, the five data points immediately preceding the application of treatment and the last 
three data points at the end of the treatment phase were used. For effect size calculations 
associated with changes in the follow-up phases, all baseline points in the initial baseline phase 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
(i.e., all data points preceding the start of the first treatment phase) and the three follow-up data 
points were utilized (i.e., 2, 6, 10 week probes).  
  
Effect sizes are reported for the purpose of comparison within and across participants. 
Benchmarks have been established for SPT (Bailey, Eatchel, & Wambaugh, 2015) and 
benchmarks for treatment involving VBFB may be established in the future.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
Treatment Protocols  
Electropalatography Treatment Protocol: Phases 1, 2, & 3 
EPG: Treatment Phase 1  
Both the clinician and participant wear their pseudopalate 
 
Feedback on all (100%) treatment items (Knowledge of Results (accuracy in producing the 
stimulus item) & Knowledge of Performance (accuracy in articulation [correct tongue 
placement]) 
 
1. The clinician will model/produce the treatment item (word) three times via EPG (i.e. 
visually displaying production) while the participant observes  
 
Three unison productions of the treatment item (word) by the clinician and participant 
• 
If correct, give feedback → Go to Step 6  
• 
If incorrect, give feedback → Go to Steps 2 
 
2. The clinician will model the target sound & vowel three times via EPG (i.e., visually 
displaying production) while the participant observes  
 
Three unison productions of the target sound & vowel by clinician & participant  
• 
If correct, give feedback  → Go to Step 5 
• 
If incorrect, give feedback → Go to Step 3 
 
3. Breakdown Target Sound  
• 
First practicing tongue placement up to 5 times → Go to Step 4 
 
4. The clinician will model the target sound & vowel three times via EPG (i.e., visually 
displaying production) while the participant observes  
 
Three unison productions of the target sound & vowel by clinician & participant  
• 
If correct, give feedback → Go to Step 5 
• 
If incorrect, give feedback → Go to Step 5 (try again at word level) 
 
5. The clinician will model/produce the treatment item (word) three times via EPG (i.e. 
visually displaying production) while the participant observes (Step 5 – same as Step 1) 
 
Three unison productions of the treatment item (word) by the clinician and participant 
• 
If correct, give feedback → Go to Step 6 
• 
If incorrect, give feedback → Go to next item 
 
6. The clinician will model/produce the treatment item (word) one time   
 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
The participant will produce the treatment item (word) three times after model is provided 
• 
If correct or incorrect, give feedback → Go to the next treatment item 
EPG: Treatment Phase 2 
Both the clinician and participant wear their pseudopalate 
 
Feedback on 66% of treatment items (i.e., 20 of 30 treatment items will receive verbal feedback 
specifically Knowledge of Results & Performance) on steps 1-3 (Items that receive feedback will 
be randomly selected by the clinician).  
 
1. 
The clinician will model/produce the word or phrase (one word with treatment word) 
treatment item three times via EPG while the participant observes the screen.  
 
Three unison productions of the word or phrase by the clinician and participant  
• If correct, provide feedback - if item is selected for feedback → Go to Step 4 
• If incorrect, provide feedback - if item is selected for feedback → Go to Step 2 
 
2. 
The clinician will model/produce the syllable with target sound (word level target) or  
treatment word (phrase level target) three times via EPG while the participant observes the 
screen 
 
Three unison productions of the target three times by clinician & participant 
• 
If correct, provide feedback - if item is selected for feedback → Go to Step 3 
• 
If incorrect, provide feedback - if item is selected for feedback → Go to next treatment 
item  
 
3. 
The clinician will model/produce the word or phrase (one word with treatment word) 
treatment item three times via EPG while the participant observes the screen. 
 Three unison productions of the word or phrase by the clinician & participant 
• 
If correct, provide feedback - if item is selected for feedback → Go to Step 4 
• 
If incorrect, provide feedback - if item is selected for feedback → Go to next treatment  
item  
 
4. 
The clinician will model/produce the word or phrase one time 
 
The participant will produce the treatment item three times after model is provided 
• The participant will self-evaluate the perceptual accuracy of all (i.e., 100%) their  
     productions with a particular focus on the final production  
 
➢ If the participant judges production accurately – Go to next treatment item 
➢ If the participant inaccurately judges/unable to judge production – spatial/temporal 
(S/T) goals demonstrated by clinician via visual feedback   
 
➢ Correct production – incorrect evaluation: SLP reviews S/T goals & how they were met 
➢ Incorrect production – incorrect evaluation: SLP review S/T goals & how they were not met  
 
5. 
If inaccurate evaluation of production:  

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
a. 
Participant attempts target three times & again evaluates the accuracy of their final 
production compared to spatial/temporal goals  
i.   Regardless of accuracy of production or evaluation, SLP gives feedback → Go to 
next treatment item  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
EPG: Treatment Phase 3 
Only the participant will wear their pseudopalate 
 
*Current treatment list is treated in conjunction with filler list (i.e., alternate back & forth 
randomly)  
 
Feedback on 66% of treatment items (i.e., 20 of 30 treatment items will receive verbal feedback 
specifically Knowledge of Results & Performance) on steps 1-3 (Items that receive feedback will 
be randomly selected by the clinician).  
 
1.  The clinician will model/produce the word or phrase (one word with treatment item) 
treatment item one time while the participant observes.  
 
 
Three productions of the word or phrase by the participant.  
• If correct, provide feedback - if item is selected for feedback → Go to Step 4 
• If incorrect, provide feedback - if item is selected for feedback → Go to Step 2 
 
2. The clinician will model/produce the syllable with target sound (word level target) or 
treatment word (phrase level target) one time while the participant observes  
 
Three productions of the syllable or word three times by the participant 
• 
If correct, provide feedback - if item is selected for feedback → Go to Step 3 
• 
If incorrect, provide feedback – if item is selected for feedback → Go to Step A  
➢ A) Three unison productions of target word, feedback given → Attempt two 
word combination again with Step 3 
 
3. The clinician will model/produce the word or phrase (one word with treatment word) 
treatment item three time via EPG while the participant observes.  
 
 Three productions of the word or phrase by the participant.  
• 
If correct, provide feedback - if item is selected for feedback → Go to Step 4 
• 
If incorrect, provide feedback - if item is selected for feedback → Go to next treatment 
item  
4.  The clinician will model/produce the word or phrase one time 
 
The participant will produce the word or phrase three times after model is provided 
• The participant will self-evaluate the perceptual accuracy of all (i.e., 100%) their  
     productions with a particular focus on the final production  
 
➢ If the participant judges production accurately – Go to the next treatment item 
➢ If the participant inaccurately judges/unable to judge production – spatial/temporal 
(S/T) goals demonstrated by clinician via visual feedback   
 
➢ Correct production – incorrect evaluation: SLP reviews S/T goals & how they were met 
➢ Incorrect production – incorrect evaluation: SLP reviews S/T goals & how they were not met  
 
5. If inaccurate evaluation of production:  
a. Participant attempts word or phrase three times & again evaluates the accuracy of their  
final production compared to spatial/temporal goals/SLPs production  

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
i. Regardless of accuracy of production/evaluation, give feedback → Go to next  
treatment item 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

C2068-P - Apraxia of Speech: A Comparison of EPG Treatment & Sound Production Treatment (3-12-2020)  
 
Sound Production Treatment – Protocol 
 
Instructions: I’m going to say a word (or phrase) and I would like you to repeat the word (or 
phrase) as accurately as you can 
 
Treatment Hierarchy: 
 
1) Say word or phrase and request repetition   
a) If correct, request 5 repetitions, go to the next item. 
b) If incorrect, give feedback and go to step 2. 
 
2) Show word or phrase, indicate target word and underline the target sound, 
say word or phrase, and request repetition 
a) If correct, request 5 repetitions, go to the next item. 
b) If incorrect, go to step 3. 
 
3) Integral stimulation – “Watch me, listen to me, and say it with me” up to 3 
times. Say word or phrase with the word with the target sound that is the 
focus 
a) If correct, request 5 repetitions, go to the next item. 
b) If incorrect, go to step 4. 
 
4) Give Articulatory Placement Cues, attempt word again (for phrase level 
stimuli only the word with the target sound is attempted here) after 
cueing using integral stimulation 
a) If correct, request 5 repetitions of word or phrase, go to the next item 
b) If incorrect, go to the next item 
 
**Feedback: Initially 100%. Fade as appropriate. Clinician’s discretion as to the      
amount of feedback provided (can decrease to 50-60%). Items that receive feedback 
will be randomly selected by the clinician (i.e., approximately 15 to 20 out of 30 
treatment items will receive feedback). Clinician’s feedback is always verbal.