Technology-based rehabilitation to improve communication after acquired brain injury

The utilization of technology has allowed for several advances in aphasia rehabilitation for individuals with acquired brain injury. Thirty-one previous studies that provide technology-based language or language and cognitive rehabilitation are examined in terms of the domains addressed, the types of treatments that were provided, details about the methods and the results, including which types of outcomes are reported. From this, we address questions about how different aspects of the delivery of treatment can influence rehabilitation outcomes, such as whether the treatment was standardized or tailored, whether the participants were prescribed homework or not, and whether intensity was varied. Results differed by these aspects of treatment delivery but ultimately the studies demonstrated consistent improvement on various outcome measures. With these aspects of technology-based treatment in mind, the ultimate goal of personalized rehabilitation is discussed.This project was funded by the Coulter Foundation for Translational Research. (Coulter Foundation for Translational Research

Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study

Introduction This study evaluated an intervention for people with aphasia delivered in a novel virtual reality platform called EVA Park. EVA Park contains a number of functional and fantastic locations and allows for interactive communication between multiple users. Twenty people with aphasia had 5 weeks’ intervention, during which they received daily language stimulation sessions in EVA Park from a support worker. The study employed a quasi randomised design, which compared a group that received immediate intervention with a waitlist control group. Outcome measures explored the effects of intervention on communication and language skills, communicative confidence and feelings of social isolation. Compliance with the intervention was also explored through attrition and usage data. Results There was excellent compliance with the intervention, with no participants lost to follow up and most (18/20) receiving at least 88% of the intended treatment dose. Intervention brought about significant gains on a measure of functional communication. Gains were achieved by both groups of participants, once intervention was received, and were well maintained. Changes on the measures of communicative confidence and feelings of social isolation were not achieved. Results are discussed with reference to previous aphasia therapy findings

Considerations For Implementing a Telerehabilitation Treatment Program For Individuals With Chronic Aphasia

The purpose of this research project is to identify the considerations that speech-language pathologists (SLPs) need to review before beginning to use telerehabilitation services to treat patients with chronic aphasia. This research will specifically target therapy treatments for patients with chronic aphasia and the technology adaptations and adjustments necessary for this population. This research project includes a systematic literature review as well as an in-service presentation. As telerehabilitation will continue to develop and grow, practicing SLPs need to have a foundational understanding of what teletherapy is, the patients suitable for services, and the benefits it has the potential to provide. This research project serves to provide SLPs with the foundational information necessary when beginning to learn about telerehabilitation services

Diagnosing and Managing Post-Stroke Aphasia

Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery

Anomia Treatment Platform as Behavioral Engine for Use in Research on Physiological Adjuvants to Neurorehabilitation

The purpose of this study was to create a behavioral treatment engine for future use in research on physiological adjuvants in aphasia rehabilitation. We chose the behavioral target anomia, which is a feature displayed by many persons who have aphasia. Further, we wished to saturate the treatment approach with many strategies and cues that have been empirically reported to have a positive influence on aphasia outcome, with the goal being to optimize the potential for positive response in most participants. A single-subject multiple baseline design with replication across eight participants was employed. Four men and four women, with an average age of 62 yr and an average of 63.13 mo poststroke onset, served as participants. Word-retrieval treatment was administered 3 d/wk, 1 h/d for a total of 20 treatment hours (6-7 wk). Positive acquisition effects were evident in all eight participants (d effect size [ES] = 5.40). Treatment effects were maintained 3 mo after treatment termination for five participants (d ES = 2.94). Within and across semantic category, generalization was minimal (d ES = 0.43 within and 1.09 across). This study demonstrates that this behavioral treatment engine provides a solid platform on which to base future studies whereby various treatment conditions are manipulated and pharmacologic support is added

NUVA: A Naming Utterance Verifier for Aphasia Treatment

Anomia (word-finding difficulties) is the hallmark of aphasia, an acquired language disorder most commonly caused by stroke. Assessment of speech performance using picture naming tasks is a key method for both diagnosis and monitoring of responses to treatment interventions by people with aphasia (PWA). Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in automatic speech recognition (ASR) and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present NUVA, an utterance verification system incorporating a deep learning element that classifies 'correct' versus' incorrect' naming attempts from aphasic stroke patients. When tested on eight native British-English speaking PWA the system's performance accuracy ranged between 83.6% to 93.6%, with a 10-fold cross-validation mean of 89.5%. This performance was not only significantly better than a baseline created for this study using one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset

Perception and Language: Using the Rorschach with People with Aphasia

This study explored the use of the Rorschach with eight individuals diagnosed with mild to moderate fluent or non-fluent types of aphasia to consider the extent to which the Rorschach captured aspects of language impairment not otherwise probed by traditional neurolinguistic measures. A ninth participant, with Wernicke’s aphasia, produced non-scorable responses and was therefore left out of all analyses. Of primary interest was whether the Rorschach, historically understood as a projective psychological instrument, would allow individuals living with language impairment to recognize, retrieve and coherently express words that reflected their thoughts. At the same time, this study sought to explore how the ambiguous nature of Rorschach inkblots could be leveraged together with traditional neuropsychological and linguistic measures, to provide insight into the relationship between perception, thought, psychological process and language - a multimethod assessment approach to describe the complex phenomena surrounding aphasia. This study demonstrated that individuals with reduced language function were able to provide responses to inkblots presented in a Rorschach assessment that were sufficient in number and quality to allow scoring and interpretation. Spearman’s rank-order correlation coefficients were calculated for WAB-R AQ score, CLQT Language Functions Domain Scores, the Rorschach cognitive processing simplicity, complexity scores and, the thought and perception EII and severe cognitive scores. Correlations among neurolinguistic and Rorschach cognitive processing and thought and perception variables, indicate a clear and intuitive relationship between these different measures. Finally, participants were administered a confrontation naming task in which a series of 10 black and white line drawings representing images of the most popular responses for each of the 10 Rorschach cards were presented. Results from that task confirmed that study participants could accurately retrieve the word for the most common responses, suggesting that object naming is not a limitation in the population of individuals with mild to moderate aphasia. Although differences between small groups of individuals with fluent and non-fluent aphasia could not be validated with significance testing, descriptive analyses showed some differences in means and standard deviations of Rorschach variable scores between the two groups. Specifically, individuals in the non-fluent aphasia group, who had more impairment in language ability, provided more vague responses, were typically only able to provide one defining characteristic of the blot (i.e., blends), and produced more communicative distortions (as measured by the thought and perception variables) than compared to individuals in the fluent aphasia group. The participant group, as a whole, produced a high degree of vague responses, was found to produce more simplistic descriptions of the blot, and typically only produced one defining characteristic of the blot (i.e., blends) - as compared to the neurotypical population. This study shows that the Rorschach can be administered to a population of individuals with mild to moderate fluent or non-fluent aphasia to generate scoreable results, with named objects comparable to those in norms derived from a neurotypical population. Limited amount and quality of supporting description of those named objects provided by the participants, however, limits the utility of the Rorschach from a psychological assessment perspective. In light of the dependence of this instrument on verbal ability, future studies might consider modified application of the Rorschach with administration that allows non-verbal responses (e.g., drawing, picture taking) as a means of supplementing participant verbal responses – to develop a richer understanding of the individual’s perception, and insight into their psychological state

Telerehabilitation for word retrieval deficits in bilinguals with aphasia: Effectiveness and reliability as compared to in-person language therapy

Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy. Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups. Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality. Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population

Telepractice in the Communication Treatment of Individuals with Post-stroke Aphasia: Systematic Review

Telepractice, a branch of telehealth, which is the delivery of services to distant sites employing telecommunication, has been developing rapidly nowadays. Owing to the nature of the condition and treatment foci in aphasia, telepractice has been identified as a potential mode for intervention to persons with aphasia (PWA) in the field of speech-language pathology. Based on the American Speech-Language Hearing Association (2005), telepractice is considered a means to extend services to a wider context overcoming the barriers of transportation, costs, and limited availability of services. Thus, exploration of treatment accessibility to underserved populations in middle/low-income countries or rural areas via telepractice is warranted. The primary objectives of this study are to systematically review literature on telepractice of speech-language pathology services for PWA, with a focus to synthesize and analyze data that will be useful to low-income countries to consider telepractice as an alternate option and also to contribute to broaden the evidence base of aphasia practices via telepractice and include the newest available evidence. A systematic review was conducted in this study following the guidelines of Cochrane Handbook (Higgins et al., 2020). The study utilized a systematic search based on PRISMA guidelines and included 11 articles following a thorough screen for eligibility. A pre-designed coding manual was utilized in order to extract relevant data. All the included studies evaluated the feasibility of telepractice in intervention and to investigate the effectiveness of treatment programs conducted via teletherapy. A majority of the participants (72%) included in the review are PWA secondary to strokes. The treatment areas studies targeted are word retrieval, language skills, communication skills and language and communication skills, with communication skills being the area covered in highest number of studies. The review found that telepractice in the targeted treatment programs is feasible and effective. However, the included articles lack strong methodological designs limiting the certainty of the evidence. Participant-perceived data indicated some advantages of telepractice, such as overcoming transport/cost barriers, receival of higher intensity of treatment, and facilitations for non-verbal strategies to improve language and communication skills. In addition, the results revealed that all but one of the included studies was completed in a high-income country. Most of the findings also lack adequate details on therapy receival and delivery setting dynamics from a standpoint of replicating the studies or in order to generalize the findings. In conclusion, the current review shows limited evidence guidelines for the use of telepractice in rural and middle/low-income countries. There is a need to explore simple affordable technology options in telepractice and evaluate their effectiveness in low/middle-income contexts. Empirical data on efficacy of telepractice for PWA drawn from strong methodological designs should also be considered to encourage evidence-based clinical practice using telepractice in those contexts