Emotional Prosody Treatment in Right Hemisphere Stroke and Dementia
Emotional Prosody Treatment in Right Hemisphere Stroke and Dementia
This study is a preliminary investigation of a new behavioral speech and language treatment
 for emotional prosody recognition and production deficits in right hemisphere stroke and
 dementia.
The phrase, "it's not what you say, but how you say it" neatly sums up prosody - the changes
 to one's tone of voice that transmit meaning. Changes to speech rate, rhythm, volume, and
 pitch to convey emotion fall into the category of affective, or emotional, prosody. That is,
 the changes made to the voice to express feelings, such as happy or sad.

 Following damage to the right side of the brain, such as in stroke and in some types of
 dementia, difficulties in affective prosody understanding and use have been observed. These
 findings have led researchers to view the right hemisphere as playing a critical role for
 emotional prosody. Affective prosody difficulties do not always spontaneously improve after
 acute right hemisphere stroke, and only a few evidenced-based treatments are available for
 these individuals as well as individuals living with dementia. It is also understood that
 affective prosody difficulties can negatively impact social interactions and relationships,
 including those who care for individuals with emotional prosody difficulties. With
 miscommunication frequently occurring between those living with affective prosody disorders
 and those with whom these people interact, the risk of reduced quality of life and social
 isolation is possible and could be related to poorer health outcomes. Not only might there be
 personal burdens associated with poor management of communication difficulties in right
 hemisphere stroke and dementia, but there might also be economic burdens as well. In addition
 to counseling caregivers, family, and friends about the communication changes of loved ones,
 more evidenced-based speech and language treatment options are needed for those living with
 affective prosody disorders.

 The current study aims to investigate a new treatment for individuals with emotional prosody
 impairments due to right hemisphere stroke or dementia. After informed consent is received,
 multiple screening assessments will be completed to determine if the study is a good fit for
 the participant. If the participant qualifies for the study, additional assessments will be
 completed to gather baseline cognitive-linguistic performance. Pre-treatment assessments will
 occur for about 1-2 weeks (Visits 1-4). Emotional prosody treatment will occur for 4 weeks
 (Visits 5-16) and will focus on production (2 weeks) and recognition (2 weeks) of emotional
 prosody. Participants will be randomly assigned to treatment order (production-recognition,
 recognition-production), and all participants will complete all components of the treatment.
 After completion of treatment, participants will be asked to come in for follow-up visits one
 week (Visit 17) and one month (Visit 18) after completion of treatment to assess changes in
 cognitive-linguistic performance. Emotional prosody recognition and production will also be
 tracked during treatment. Participation in all study-related activities lasts about 2.5
 months (10 weeks).
Inclusion Criteria (for all participants unless otherwise noted):

 -  Expressive and/or receptive aprosodia as confirmed by the Montreal Evaluation of
 Communication and trained expert opinion

 -  Age 18-89

 -  Proficient speaker of English

 -  Ability to provide informed consent

 -  Ability to participant in language assessment and therapy tasks

 -  Participants with right hemisphere stroke: Majority of stroke occurring the right
 hemisphere of the brain

 -  Participants with dementia: Mild to moderate-severe cognitive impairment as confirmed
 by the Montreal Cognitive Assessment

 Exclusion Criteria (for all participants unless otherwise noted):

 -  Not medically stable

 -  Unable to provide informed consent

 -  Severe cognitive impairment as confirmed by the Montreal Cognitive Assessment

 -  Severe depression as confirmed by the Patient Health Questionnaire-9

 -  Severe motor speech impairment as confirmed by the Apraxia Speech Rating Scale

 -  Uncorrected vision and/or hearing impairments by failing of screen

 -  Significant reading and/or auditory comprehension deficits as confirmed by the
 Comprehensive Aphasia Test

 -  Current use of anti-psychotic medication that may negatively impact emotional prosody
 performance (self report)

 -  Participants with right hemisphere stroke: Prior history of neurological or
 psychiatric problems affecting the brain (excluding previous right hemisphere strokes
 or previous asymptomatic strokes outside the right hemisphere)

 -  Participants with dementia: Prior history of neurological or psychiatric problems
 affecting the brain (other than dementia)