Experiencing EVA Park, A Multi-User Virtual World For People With Aphasia

Virtual worlds are used in wide-ranging ways by many people with long-term health conditions but their use by people with aphasia (PWA) has been limited. In contrast, this paper reports the use of EVA Park, a multi-user virtual world designed for PWA to practice conversations, focusing on people's emotional, social, and conversational experiences. An analysis of observation and interview data collected from 20 people with aphasia who participated in a 5 week therapy intervention revealed key themes related to user experience. The themes offer a rich insight into aspects of the virtual world experience for PWA that go beyond therapeutic outcomes. They are: affect (positive and negative), types of conversation, miscommunication and misunderstanding, immersion in the virtual world, social presence and initiative and flow. Overall, the study showed that participants experienced positive emotional and social outcomes. We argue that this was achieved as a consequence of EVA Park being not only accessible but also a varied and entertaining environment within which PWA experienced both the realistic and the quirky whilst engaging with others and having fun

Empowering Expression for Users with Aphasia through Constrained Creativity

Creative activities allow people to express themselves in rich, nuanced ways. However, being creative does not always come easily. For example, people with speech and language impairments, such as aphasia, face challenges in creative activities that involve language. In this paper, we explore the concept of constrained creativity as a way of addressing this challenge and enabling creative writing. We report an app, MakeWrite, that supports the constrained creation of digital texts through automated redaction. The app was co-designed with and for people with aphasia and was subsequently explored in a workshop with a group of people with aphasia. Participants were not only successful in crafting novel language, but, importantly, self-reported that the app was crucial in enabling them to do so. We refect on the potential of technology-supported constrained creativity as a means of empowering expression amongst users with diverse needs

Co-Created Personas: Engaging and Empowering Users with Diverse Needs Within the Design Process

Personas are powerful tools for designing technology and envisioning its usage. They are widely used to imagine archetypal users around whom to orient design work. We have been exploring co-created personas as a technique to use in co-design with users who have diverse needs. Our vision was that this would broaden the demographic and liberate co-designers of their personal relationship with a health condition. This paper reports three studies where we investigated using co-created personas with people who had Parkinson’s disease, dementia or aphasia. Observational data of co-design sessions were collected and analysed. Findings revealed that the co-created personas encouraged users with diverse needs to engage with co-designing. Importantly, they also aforded additional benefts including empowering users within a more accessible design process. Refecting on the outcomes from the diferent user groups, we conclude with a discussion of the potential for co-created personas to be applied more broadly

Speech and Language

This chapter introduces speech and language from a clinical speech and language therapy perspective. It describes key challenges that can impact upon speech and language with a focus on the needs of individuals with aphasia, an acquired language disorder. The spe-cific impact that aphasia may have upon Web accessibility is dis-cussed with reference to existing work which illuminates what we currently do and do not know about speech, language and Web ac-cessibility. The authors provide guidance for accommodating the needs of users with aphasia within the design of Web interactions and propose future directions for development and research

CreaTable Content and Tangible Interaction in Aphasia

Multimedia digital content (combining pictures, text and music) is ubiquitous. The process of creating such content using existing tools typically requires complex, language-laden interactions which pose a challenge for users with aphasia (a language impairment following brain injury). Tangible interactions offer a potential means to address this challenge, however, there has been little work exploring their potential for this purpose. In this paper, we present CreaTable – a platform that enables us to explore tangible interaction as a means of supporting digital content creation for people with aphasia. We report details of the co-design of CreaTable and findings from a digital creativity workshop. Workshop findings indicated that CreaTable enabled people with aphasia to create something they would not otherwise have been able to. We report how users’ aphasia profiles affected their experience, describe tensions in collaborative content creation and provide insight into more accessible content creation using tangibles

A review of virtual reality technologies in the field of communication disability: implications for practice and research.

BACKGROUND: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability. AIMS: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology. MAIN CONTRIBUTION: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered. CONCLUSIONS: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists. Implications for rehabilitation Immersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills. The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations. Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research

Semiotically Adaptive Computer-Mediated Speech Therapy with Patients in Aphasia in the Light of Ecolinguistics

The article describes the theory behind the design of a computer application for speech therapy of patients in aphasia. The project novelty consists in its data: to build up the training tasks, the authors used speech patterns that were semiotically relevant for the patients and visual supports obtained in experimental work.  The research featured target-groups of healthy people whose gender, age, and social profile corresponded with those of patients undergoing neurorehabilitation at the Federal Siberian Research and Clinical Center of the Federal Medical and Biological Agency of Russia. The material included statistical data on the sociological characteristics of patients of the neurorehabilitation center in 2014-2018, as well as 18 questionnaires filled in by relatives of patients who were in rehabilitation from February to March 2019. It also involved scripts of interviews with 40 neurologically healthy native speakers of the Russian language of two gender-socio-professional groups that coincided in the language biography and collective speech profile with the most frequent groups of patients with complex motor aphasia. The data were processed using Sketch Engine corpus manager tools.  The main methods of analysis included linguistic experiment, questioning, description, modeling, and design.  The article introduces a methodological linguistic basis and a design project for a novel computer application that organizes speech therapy for patients with aphasia at home. The research was based on the ecolinguistic principle of relevance, which demonstrated good practical application prospects

Receiving Aphasia Intervention in a Virtual Environment: The Participants’ Perspective

Background: Digital technology is making an increasing contribution to aphasia therapy. However applications of virtual reality are rare. EVA Park is a virtual island developed with and for people with aphasia. It is a multi-user environment, which enables people with aphasia to interact with support workers, therapists and each other. The first study to use EVA Park in aphasia rehabilitation demonstrated significant gains in functional communication. This paper augments the findings of that study, by reporting results from qualitative interviews conducted with the 20 study participants. Aims: This study aimed to determine the views of participants about the intervention that they received in EVA Park, and the impacts of that intervention. Long-term retrospective views were also explored. Methods & Procedures: Participants took part in 1:1, semi-structured interviews two weeks before (Entry) and to weeks after (Exit) the intervention. Questions focussed on activities undertaken by participants, communication, changes since the stroke and uses of technology. Exit interviews additionally explored participants’ views and experiences of EVA Park and any perceived impacts of the intervention. A sub-set of 5 participants was interviewed at least one year later, to explore long term recollections of the EVA Park intervention and any perceived long term impacts. Interview data were transcribed and subject to framework analysis. Outcomes & Results: The thematic framework comprised 10 parent themes and 33 sub-themes. Following ‘affect’, the largest single theme related to EVA Park, with 636 coded references. Comments were overwhelmingly positive. EVA Park intervention was strongly associated with fun and enjoyment. Participants particularly valued their relationship with the support workers who delivered the intervention. The virtual locations and activities in EVA Park were also appreciated, together with the contact with other participants. Perceived impacts related to communication, activity, computer use and confidence. Most participants in the long term interviews described maintained impacts. Conclusions: These interview results indicate that the first intervention delivered in EVA Park was highly acceptable to participants and perceived as beneficial. They augment the findings of our experimental study and suggest that EVA Park could be a valuable addition to the resources available to practising clinician

Delivering word retrieval therapies for people with aphasia in a virtual communication environment

Background: Delivering therapy remotely, via digital technology, can enhance provision for people with aphasia. EVA Park is a multi-user virtual island that can be used for such delivery. The first EVA Park study showed that daily language stimulation delivered via the platform improved functional communication and was positively received by users (Marshall et al, 2016; Amaya et al, 2018). This paper reports two single case studies, evaluating its capacity to deliver targeted language interventions. The first employed therapy for noun retrieval, using cued picture naming and modified Sematic Feature Analysis. The second employed modified Verb Network Strengthening Treatment (VNeST). Aims: This study aimed to determine if treatment delivery was feasible in EVA Park, as assessed by participant compliance, treatment fidelity and participants’ views. It explored the impact of the therapies on treated and untreated word production, connected speech and functional communication. Methods & Procedures: Two participants with aphasia each received 20 sessions of individual therapy in EVA Park, delivered over 5 weeks. Feasibility was assessed by measuring compliance with the therapy regime, recording and checking the fidelity of 20% of treatment sessions, and using post therapy interviews to explore participant views. Treatment outcomes were evaluated via repeated measures single case designs, in which assessments were administered twice before therapy, immediately post therapy and five weeks later. Outcome measures included Object Picture Naming (study 1), Sentence Elicitation Pictures (study 2), Naming 84 items from the Object and Action Naming Battery (study 2), Narrative Production (Study 2), the Northwestern Assessment of Verb and Sentences: Argument Structure Production Test (Study 2) and Communication Activities of Daily Living – 2 (Study 1 & 2). Outcomes & Results: Feasibility results were excellent. Both participants were fully compliant with the therapy regime. There was at least 90% fidelity with the treatment protocols and participant views were positive. Outcomes varied across the studies. The noun therapy significantly improved the naming of treated words, with good maintenance. Lexical gains were less evident on the Sentence Elicitation Pictures used in the VNeST study. Neither study demonstrated generalisation to untreated words, connected speech or functional communication. Conclusions: Two treatment approaches, designed for face to face delivery, could be delivered remotely in EVA Park. Outcomes for the noun treatment were comparable to previous evaluations. Comparisons with previous research were more challenging for VNeST, owing to differences in methodology. Further evaluations of other treatment approaches are warranted