Suggested approach for establishing a rehabilitation engineering information service for the state of California

An ever expanding body of rehabilitation engineering technology is developing in this country, but it rarely reaches the people for whom it is intended. The increasing concern of state and federal departments of rehabilitation for this technology lag was the stimulus for a series of problem-solving workshops held in California during 1977. As a result of the workshops, the recommendation emerged that the California Department of Rehabilitation take the lead in the development of a coordinated delivery system that would eventually serve the entire state and be a model for similar systems across the nation

Speech and language therapy for aphasia following stroke

Background  Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.  Objectives  To assess the effects of speech and language therapy (SLT) for aphasia following stroke.  Search methods  We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched theInternational Journal of Language and Communication Disorders(1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions.  Selection criteria  Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach).  Data collection and analysis  We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators.  Main results  We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes.  Authors' conclusions  Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all

Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study

We report a 12-week outcome study in which nine persons with long-term chronic aphasia received individual and group speech-language teletherapy services, and also used on-line language exercises to practice from home between therapy sessions.  Participants were assessed at study initiation and completion using the Western Aphasia Battery, a portion of the Communicative Effectiveness Index, ASHA National Outcome Measurement System, and RIC Communication Confidence Rating Scale for Aphasia; additionally participants were polled regarding satisfaction at discharge.  Pre-treatment and post-treatment means were calculated and compared, and matched t-tests were used to determine significance of improvements following treatment, with patterns of independent on-line activity analyzed.  Analysis of scores shows that means improved on most measures following treatment, generally significantly: the WAB AQ improved +3.5 (p = .057); the CETI Overall (of items administered) — +17.8 (p = .01), and CCRSA Overall — + 10.4 (p = .0004).  Independent work increased with time, and user satisfaction following participation was high

Student Perspectives on Learning Language Sample Analysis Using LENA

Language sample analysis (LSA) is valuable clinical tool and an important component of comprehensive language assessment. However, LSA is underutilized in real-world practice. SLPs have identified time constraints, insufficient training, and lack of confidence in LSA skills as barriers to regular LSA implementation. Communication science and disorders (CSD) programs have opportunities to provide LSA instruction to address these barriers and prepare students to reliably, feasibly, and confidently use LSA in clinical practice. This pilot study examined CSD students’ perspectives on LSA instruction using the Language ENvironment Analysis System (LENA). Undergraduate students (n = 38) completed a series of two electronic surveys prior to and following LSA instruction using LENA. Changes in students’ self-ratings of knowledge and skills in collecting and analyzing language samples, attitudes towards studying LSA and child language development, and critical thinking skills were assessed. Significantly higher student ratings were found for all items measuring language sampling knowledge and skills following digital LSA instruction compared to baseline. In addition, student ratings of enthusiasm for and confidence in studying LSA and child language development were also significantly higher. Students’ self-ratings of critical thinking skills did not increase significantly following instruction in digital LSA. Implications for LSA teaching and learning are discussed

Assistive and Augmentative Communication: Ethics and Possibilities in Music Therapy with Non-Speaking clients

Music therapy is a healthcare field wherein music experiences and the myriad relationships formed between client(s), board-certified music therapist(s), and music activates health-oriented changes (Bruscia, 2014). Within this field there are multiple facets that directly impact the client’s experiences; these include: arrangement of the therapy environment, role and function of music experiences, therapeutic relationships, and communication in verbal and non-verbal forms. However, there is a gap in the education and training of music therapists concerning alternatives to verbal communication, and the use of these alternatives in therapy. Through interviews and analysis, this thesis presents findings regarding the experiences of one non-speaking music therapy participant, and three board certified music therapists with relevant expertise, to empower professional and student music therapists to advance their engagement with non-speaking clients in music therapy

A Pilot Study with a Novel Setup for Collaborative Play of the Humanoid Robot KASPAR with children with autism

This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article describes a pilot study in which a novel experimental setup, involving an autonomous humanoid robot, KASPAR, participating in a collaborative, dyadic video game, was implemented and tested with children with autism, all of whom had impairments in playing socially and communicating with others. The children alternated between playing the collaborative video game with a neurotypical adult and playing the same game with the humanoid robot, being exposed to each condition twice. The equipment and experimental setup were designed to observe whether the children would engage in more collaborative behaviours while playing the video game and interacting with the adult than performing the same activities with the humanoid robot. The article describes the development of the experimental setup and its first evaluation in a small-scale exploratory pilot study. The purpose of the study was to gain experience with the operational limits of the robot as well as the dyadic video game, to determine what changes should be made to the systems, and to gain experience with analyzing the data from this study in order to conduct a more extensive evaluation in the future. Based on our observations of the childrens’ experiences in playing the cooperative game, we determined that while the children enjoyed both playing the game and interacting with the robot, the game should be made simpler to play as well as more explicitly collaborative in its mechanics. Also, the robot should be more explicit in its speech as well as more structured in its interactions. Results show that the children found the activity to be more entertaining, appeared more engaged in playing, and displayed better collaborative behaviours with their partners (For the purposes of this article, ‘partner’ refers to the human/robotic agent which interacts with the children with autism. We are not using the term’s other meanings that refer to specific relationships or emotional involvement between two individuals.) in the second sessions of playing with human adults than during their first sessions. One way of explaining these findings is that the children’s intermediary play session with the humanoid robot impacted their subsequent play session with the human adult. However, another longer and more thorough study would have to be conducted in order to better re-interpret these findings. Furthermore, although the children with autism were more interested in and entertained by the robotic partner, the children showed more examples of collaborative play and cooperation while playing with the human adult.Peer reviewe

Bridging the gap in internet treatments for mental health: A fully automated online cognitive behaviour therapy for social anxiety for those who stutter.

Introduction: CBTpsych.com is a fully functional intervention that aims at bridging the gap between Eliza (Weizenbaum, 1966) and modern internet treatments for anxiety disorders (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009a). A Phase I trial demonstrated that two participants no longer met the diagnosis of social phobia on the DSM-IV and ICD-10 after being treated by CBTpsych.com. The quality of the interaction appeared to be similar to face-to-face therapy. The automated techniques were successful in engaging the participants and in encouraging them to log on regularly and complete the treatment (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009b). The current study is a phase II trial targeting social anxiety in stuttering. Method: File audit data were gathered from 10 years of experience in the psychological management of social anxiety and stuttering (St Clare et al., 2008). This data was used to create a fully automated human-like intervention using algorithms alone. CBTpsych.com creates cognitive restructuring exercises, behavioural experiments, and negative thoughts checklists for the automated treatment program. Furthermore, other features such as imagery rescripting were incorporated to adhere to the Clark D. M. and Wells (1995) model of social anxiety treatment. 18 participants presenting for treatment of stuttering with social anxiety at the Australian Stuttering Research Centre (ASRC) were offered 5 months access to the “computer psychologist”. 16 participants started using the computer program. The treatment did not involve any contact with clinical psychologists at the ASRC. Results: Post-treatment analysis revealed that of the 16 participants who started using the program, 78% no longer met the criteria for social phobia. Furthermore, none of the 10 participants who completed all 7 sections of the computer program within 5 months had social phobia diagnosis at post-treatment. Consequently, in this study the “computer psychologist” was able to identify the specific problem areas participants reported and to design individualized formulations and tailored treatment components with corrective feedback. Furthermore, participants were able to engage in highly specific cognitive restructuring exercises, and with the help of the computer psychologist managed to build behavioural experiments to test out unhelpful cognitions. Data from this Phase II trial suggest that the computerised treatment protocol can lead to substantial reductions in anxiety and avoidance, and improve mood and quality of life as measured by the FNE, SPAI, BDI-II, UTBAS, SASS and OASES. Conclusions: The computer psychologist motivated people both to log on regularly (with use of an automated email process) and to complete the program. It engaged clients in detailed cognitive restructuring work, creating successful behavioural experiments for exposure, and producing promising preliminary results. However, these results need to be tested in a randomized controlled trial to establish efficacy. A RCT is currently under way. The preliminary findings presented here suggest that it would be viable to develop this type of treatment intervention for other anxiety disorders. Limitations of this approach and suggestions for future research are discussed

Intelligent assistive technology devices for persons with dementia : a scoping review

Assistive technology with context-aware computing and artificial intelligence capabilities can be applied to address cognitive and communication impairments experienced by persons with dementia (PwD). This research aims to provide an overview of current literature regarding characteristics of intelligent assistive technology devices (IATDs) for cognitive and communicative impairments of PwD as well as of the areas of impairment addressed by the IATDS. A multi-faceted systematic search strategy involving three electronic database platforms, two electronic databases and three electronic journals yielded records produced over the past decade. Predefined criteria were applied for inclusion and data extraction. Data was thematically analysed and synthesised. This review demonstrates that the bulk of research involving IATDs over the past decade has focused on cognitive impairments of PwD and has not yet evolved past the conceptual or prototype stages of development. A summary of commercially available IATDs for PwD is provided at the end of this review. This research concluded that IATDs for PwD primarily focus on social robots, especially PARO, and that they address cognitive impairments of attention and affect, as well as social-pragmatic communicative impairments. Few IATDs address the linguistic impairments experienced by PwD. Future research should involve collaboration between computer engineering and health practitioners to address the identified gaps and to contribute to evidence-based decision making for PwD.Mini Dissertation (MAAC)--University of Pretoria, 2019.Centre for Augmentative and Alternative Communication (CAAC)MAACUnrestricte