Computational Language Assessment in patients with speech, language, and communication impairments

Speech, language, and communication symptoms enable the early detection, diagnosis, treatment planning, and monitoring of neurocognitive disease progression. Nevertheless, traditional manual neurologic assessment, the speech and language evaluation standard, is time-consuming and resource-intensive for clinicians. We argue that Computational Language Assessment (C.L.A.) is an improvement over conventional manual neurological assessment. Using machine learning, natural language processing, and signal processing, C.L.A. provides a neuro-cognitive evaluation of speech, language, and communication in elderly and high-risk individuals for dementia. ii. facilitates the diagnosis, prognosis, and therapy efficacy in at-risk and language-impaired populations; and iii. allows easier extensibility to assess patients from a wide range of languages. Also, C.L.A. employs Artificial Intelligence models to inform theory on the relationship between language symptoms and their neural bases. It significantly advances our ability to optimize the prevention and treatment of elderly individuals with communication disorders, allowing them to age gracefully with social engagement.Comment: 36 pages, 2 figures, to be submite

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

iPractice: The effectiveness of a tablet-based home program in aphasia treatment

The iPad and other tablet devices have enormous potential for personalized home practice to augment aphasia rehabilitation. The current study investigates the utility of an iPad-based home practice program, implemented post intensive therapy, for people with chronic aphasia. Six of eight subjects are participating in the home program. All participants maintained advances made on words trained during the intensive treatment and additionally were able to learn new words solely by practicing on the iPad. The results have implications for the use of home programs and tablet devices in people with chronic aphasia. Selecting appropriate candidates for tablet-based technology is discussed

Primary progressive aphasia : neuropsychological analysis and evolution

Tese de doutoramento, Ciências Biomédicas (Neurociências), Universidade de Lisboa, Faculdade de Medicina, 2015Frontotemporal lobar degeneration (FTLD) is the second leading cause of early-onset ( 2) revealed some clusters composed mostly by nonfluent or by semantic PPA cases. However, we could not evidence any group chiefly composed of logopenic PPA cases. Hence, findings obtained with the application of unsupervised data mining approaches do not clearly support a logopenic PPA. However further, supervised learning studies may indicate distinct results. Behaviour changes may occur early in PPA but the frequency of these symptoms across the three variants is still controversial. In the third study, 94 consecutive PPA patients (26 nonfluent, 36 semantic, 32 logopenic) underwent language and neuropsychological assessments. The presence of behavioural changes was ascertained by semi-structured informant-based interviews using the Blessed Dementia Rating Scale. Eighty-two percent of the cases endorsed at least one behaviour change. Nonfluent patients presented significantly more behaviour changes and scored more often (46.2%) the item “hobbies relinquished” when compared to logopenic patients. These differences in behaviour symptoms probably reflect distinct underlying neurodegenerative diseases. PPA is a neurodegenerative disorder with no effective pharmacological treatment. Cognition-based interventions are adequate alternatives, but their benefit has not been thoroughly explored. The aim of this last investigation was to study the effect of speech and language therapy (SLT) on naming ability in PPA. An open parallel prospective longitudinal study involving two centers was designed to compare patients with PPA submitted to SLT (1 h/week for 11 months, on average) with patients receiving no therapy. Twenty patients were enrolled and undertook baseline language and neuropsychological assessments; among them, 10 received SLT and 10 constituted an age- and education-matched historical control group. The primary outcome measure was the change in group mean performance on the Snodgrass and Vanderwart Naming Test between baseline and follow-up assessments. Intervention and control groups did not significantly differ on demographic and clinical variables at baseline. A mixed repeated measures ANOVA revealed a significant main effect of therapy (F(1,18) = 10.763; p = 0.005) on the performance on the Snodgrass and Vanderwart Naming Test. Although limited by a non-randomized open study design with a historical control group, the present study suggests that SLT may have a benefit in PPA, and it should prompt a randomized, controlled, rater-blind clinical trial. Conclusion: Despite the recent harmonization efforts, the delineation of certain PPA variants is still controversial. The present results show that neuropsychology is a key instrument not only for the clear definition of PPA subtypes but also for the study of the abnormal mechanisms and features underlying the main forms of PPA. Moreover, a neuropsychological approach to disease management seems to be feasible. Specifically, SLT emerges as an alternative and adequate approach to tackle the increasing language deficits experienced in all PPA phenotypes for some time. The emergence of promising disease-modifying therapies in the context of FTLD, in association with these cognitive-based interventions, will certainly be the future of PPA disease management

Speech and swallowing rehabilitation in the home: A comparison of two service delivery models for stroke survivors

Background and Aims Speech and swallowing difficulties are common sequelae for people who have suffered a stroke. Recently, there has been an increase in early discharge, community rehabilitation and the use of therapy assistants to support health professionals in stroke rehabilitation. However, the impact of these factors on communication and swallowing outcomes remains under researched. This research explored Rehabilitation in the Home (RITH) Speech Pathology (SP) services for stroke survivors with dysarthria and dysphagia. More specifically, this research investigated whether traditional speech pathology interventions, supplemented with a home practice program are effective, as well as compare usual treatment to that provided by a therapy assistant. Additionally, the experiences of the key stakeholders were also examined. Methods and Procedures Stroke survivors and their carers were recruited from RITH services in Perth, Western Australia into this pilot comparative group study. Stroke survivors with a recent stroke diagnosis and associated dysarthria and/or oral stage dysphagia were randomly allocated to either: a) treatment as usual with a speech pathologist (TAU) or b) intensive treatment with a speech pathologist and a supervised therapy assistant (INT). Evidence-based dysarthria and dysphagia treatment program content was controlled for both groups and all participants were encouraged to complete independent home practice daily. The stroke survivors were assessed at three time points, at baseline, immediately post therapy and at two months post stroke with a range of speech, swallowing and psycho-social outcome measures. The perceptions, experiences and preferences of the stroke survivors and the carers were collected through questionnaires after therapy had ceased. The speech and swallowing outcome measures were analysed using a 2x2 mixed model ANOVA and the questionnaires were analysed using qualitative content analysis. Results Ten stroke survivors and their carers (n= 10) were recruited into TAU (n=5) or INT (n=5) intervention groups. The stroke survivors had an average time post onset of stroke of 39.6 days. Stroke survivors participated in regular and intensive levels of RITH SP and all completed some degree of home practice. Therapy was provided over a three week period and TAU participants received M= 470 mins (SD=85.22) and INT participants received M= 909 mins (SD=175.58) of professionally led therapy. Within groups analyses revealed a statistically significant treatment effect over time for scores on the Dysarthria Impact Profile, oral motor function, speech intelligibility, water swallow test and the chewed cookie test. There was no significant difference over time for speech rate. There were no statistically significant differences between the TAU and the INT groups on any of the measures. Carers and stroke survivors gave positive reports of RITH SP with both groups noting improvements in the stroke survivors’ speech and swallowing and commenting on the benefits of receiving rehabilitation in the home. Many stroke survivors valued and desired intensive speech pathology services; with the use of therapy assistants viewed positively by those in the INT group. Stroke survivors reported that they had difficulty practicing independently with most carers being involved with home-based speech pathology intervention. Conclusions Stroke survivors in an early phase of recovery were able to participate in RITH SP and benefitted from a speech pathology intervention program targeting dysarthria and dysphagia. Intensive speech pathology and therapy assistant intervention was as effective as usual care by a speech pathologist with improvements made by all stroke survivors across the majority of speech and swallowing measures. Stroke survivors were able to complete home practice and provided positive reports on the program, staff and setting. Home practice may be difficult for stroke survivors in the early stages post stroke, and may require support with its completion. Further investigation into the effectiveness and acceptability of home based therapy, the use of therapy assistants and the role of the carer as well as the ease and impact of home programs is require

An investigation into the impact of computer therapy on people with aphasia.

Use of computers by the general population continues to increase and computers are now an integral part of communication, leisure activities and work. The majority of research into use of computers by people with aphasia has focussed narrowly on evaluating effects of computer therapy on specific language impairments. Little is known about the broader impacts of computer use by people with aphasia, in terms of levels of social activity and social participation and little is known of the views of people with aphasia on using computers. The research in this thesis investigates the outcome of computer therapy from the perspective of people living with aphasia. Outcome was evaluated using the framework of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF 2001) to investigate impact not just in terms of impairment but on activity and participation as well. The ICF also provided a framework for investigating contextual factors (environmental and personal) which might effect outcome. The investigation took the form of two complementary but contrasting case series studies: an investigation into the outcome of using computers to target word finding abilities (treatment targeting impairment only); and an investigation into the outcome of training to use voice recognition software as a writing aid (treatment aiming to overcome activity limitations but not targeting impairment itself). Both studies comprised a qualitative investigation of the views of participants on the outcome and process of therapy. Both studies supplemented this qualitative data with complementary quantitative evaluations seeking to quantify key aspects of outcome. Study one findings indicated that all six participants perceived benefits to levels of activity, participation and confidence in addition to benefits to language impairment. Although some of this benefit was attributed to improved language skill, benefits were also attributed to increased confidence associated with acquiring skills. Study two found benefits to levels of activity and participation and confidence for all participants. Benefits were perceived even where there was no measured change to language impairment or quality or quantity of language used. Computer use by people with aphasia can therefore bring much broader benefits than just to language impairment. Benefits include increases in leisure and social activity, social participation and confidence. Previous computer experience is not necessary and benefits can be shown many years post stroke. These broader benefits should be borne in mind when selecting who may be appropriate for computer therapy

Web-based physiotherapy for people undergoing stroke rehabilitation

In the UK, disability is a common consequence of stroke. The improvement of post-stroke arm function is one of the top 10 priority research areas for stroke survivors, carers and healthcare professionals. However, current clinical practice in most of the stroke units within the UK does not meet the recommended dose for rehabilitating stroke patients in the acute stage when functional recovery is at its peak. A higher dose of rehabilitation can result in enhanced functional recovery. Therefore, developing interventions to augment current clinical practice in order to increase the dose of rehabilitation without supervision is becoming a necessity, given the anticipated rise in stroke incidence coupled with the reduction in the number of available physiotherapists worldwide. Telerehabilitation has the potential to provide the stroke population with access to rehabilitation without direct supervision, but stroke-related complications, such as aphasia, may hinder their ability to access these services. This thesis aims to do the following: 1) To evaluate whether an existing web-based physiotherapy platform (www.webbasedphysio.com, now www.giraffehealth.com) can be adapted through a user-centred design to be an acceptable medium to deliver exercise programmes for people after a stroke and 2) To evaluate the acceptability and feasibility, and to explore the possible effectiveness, of an individualised 4-week programme of augmented upper-limb rehabilitation, delivered via the modified webbased physiotherapy platform, for the stroke population in acute stroke rehabilitation. The first study adopted a user-centred design, which involved modifying an existing webbased physiotherapy platform by gathering views of seven participants, five stroke survivors and two carers, with the aim of customising the platform to be accessible and appropriate for the stroke population. Three consecutive focus groups were conducted for the same participants and data were analysed based on themes. Four themes were identified, which allowed an understanding of participants’ needs and preferences in using technology as a medium to deliver rehabilitation and highlighted the required platform modifications using iterative consultation. The data captured different experiences toward disability after stroke from public, clinical staff and stroke survivors. The rehabilitation that stroke survivors received prioritised leg mobility exercises, and family members and carers lacked the needed support. The variation of the kind of rehabilitation provided and the influence of geographical areas were reported as the main barriers to access rehabilitation therefore, stroke survivors reported paying for private physiotherapy and practicing non-prescribed exercises including online resources. The key recommendations included modifications to the web-based physiotherapy platform to improve accessibility (format, information, advice) and modelling/image (stroke survivor actors filming exercise video recordings) in order to meet their rehabilitation needs. The study concluded with accessible and positively evaluated platform. The second study was a randomised controlled pilot study to evaluate the feasibility (in terms of recruitment strategy, usage and adherence to the intervention and participants’ attrition and safety), acceptability and potential efficacy of delivering a 4-week individualised webbased upper-limb exercise programme using the modified web-based platform compared to usual care in terms of arm function, trunk function and muscle spasticity for stroke survivors in the acute hospital setting. In addition, questionnaires were used to evaluate the feedback of physiotherapists who prescribed and monitored the web-based augmented intervention and to capture views of carers of stroke survivors in the intervention group. Twenty-six stroke survivors were recruited to the study from three acute stroke units and were randomly allocated and equally divided (n=13) into two groups: an intervention group and a control group. Seven participants used the platform and accessed their exercise programmes. Of those, five were adherent to the intervention during the study; these five adherent participants represented half of the patients in the intervention group. Five participants withdrew from the study before the final assessments, of whom three were participants in the intervention group and two were participants in the control group. Although five adverse events were reported during the study, none of these was considered to be related to the intervention. More participants in the intervention group demonstrated clinically important improvements in the Action Research Arm Test (arm function) than in the control group. In addition, among the participants in the intervention group, those who were adherent showed trends towards improvements in the Trunk Impairment Scale (trunk function). In total, seven stroke survivors, five carers and five physiotherapists reported that the delivery of a nonsupervised, augmented intervention through the modified web-based physiotherapy platform was acceptable. Among the participants who used the platform, web-based physiotherapy was considered more beneficial to stroke survivors who have carers helping them to access their online exercise programmes. To summarise, this thesis indicates that web-based physiotherapy is feasible, safe and acceptable for stroke survivors, carers and physiotherapists; furthermore, it is capable of providing unsupervised augmented interventions. More studies that are adequately powered are needed to examine effectiveness of this intervention and provide further insight to the current findings

New techniques for neuro-rehabilitation: Transcranial Electric Stimulation and Virtual Reality

Recovery of motor and cognitive performances after a neurological illness remains a significant challenge for rehabilitation specialists. The traditional rehabilitative interventions are usually delivered using a multidisciplinary approach, whose results are not always satisfactory. These limitations in functional recovery have led researchers to consider alternative approaches. The hypothesis of providing new therapeutic possibilities in the different patients treated is, as a rehabilitator, very rewarding and represents a challenge for the future. The application of simple and low-cost techniques, defined by the literature as "unconventional" or “novel”, can provide new ideas not only in the field of research but above all of application in clinical reality.A suitable approach to improve the rehabilitation outcome is to utilize these novel rehabilitation techniques that act as a substitute or an addition to the traditional ones. In this context, some recent approaches have been proposed that might increase the effectiveness of a traditional treatment. Among them, two techniques have been demonstrated to be very promising, namely non-invasive brain stimulation (NIBS) and Virtual Reality (VR).In light of the foregoing, my thesis has been divided into two main lines of research, namely: a) the study of the effects of transcranial direct current stimulation (tDCS) in different neurological conditions; b) the application of VR (used alone or combined with tDCS) in the treatment of some neurocognitive disorders. A semi-immersive VR tool (ReMOVES system) has been used as a user-friendly platform providing activities based on exergames

Voice analysis for neurological disorder recognition – a systematic review and perspective on emerging trends

Quantifying neurological disorders from voice is a rapidly growing field of research and holds promise for unobtrusive and large-scale disorder monitoring. The data recording setup and data analysis pipelines are both crucial aspects to effectively obtain relevant information from participants. Therefore, we performed a systematic review to provide a high-level overview of practices across various neurological disorders and highlight emerging trends. PRISMA-based literature searches were conducted through PubMed, Web of Science, and IEEE Xplore to identify publications in which original (i.e., newly recorded) datasets were collected. Disorders of interest were psychiatric as well as neurodegenerative disorders, such as bipolar disorder, depression, and stress, as well as amyotrophic lateral sclerosis amyotrophic lateral sclerosis, Alzheimer's, and Parkinson's disease, and speech impairments (aphasia, dysarthria, and dysphonia). Of the 43 retrieved studies, Parkinson's disease is represented most prominently with 19 discovered datasets. Free speech and read speech tasks are most commonly used across disorders. Besides popular feature extraction toolkits, many studies utilise custom-built feature sets. Correlations of acoustic features with psychiatric and neurodegenerative disorders are presented. In terms of analysis, statistical analysis for significance of individual features is commonly used, as well as predictive modeling approaches, especially with support vector machines and a small number of artificial neural networks. An emerging trend and recommendation for future studies is to collect data in everyday life to facilitate longitudinal data collection and to capture the behavior of participants more naturally. Another emerging trend is to record additional modalities to voice, which can potentially increase analytical performance

Exploration of a stroke population's experiences of a digital cognitive assessment: a think-aloud and interview study

Introduction: With technology advancing, digital cognitive assessments, including unsupervised cognitive assessments, are evolving and being used more frequently in both research and clinical settings. Yet little is known about the experience and perceptions of digital cognitive assessments from the direct perspective of service users who have experienced a stroke. This study aimed to address this gap by investigating how service users, who have had a stroke, experience a digital cognitive screen. Method: The study invited people who have had a stroke to complete a digital fixed battery cognitive assessment called the Amsterdam Cognition Scan (ACS). They were asked to ‘think aloud’ or ‘talk aloud’ about their experiences whilst completing the cognitive assessment, as well as answering a few questions before and after the assessment about their experiences. This data were analysed using reflexive thematic analysis to develop themes and subthemes. Results: The analysis uncovered 3 central themes focused around 1. past experiences: the service user’s previous experiences and how these influence their experience and perception of the cognitive assessment; 2. direct and immediate experiences: responses and feelings evoked by the cognitive assessment and 3. potential future experiences: the utility of digital cognitive assessments with the stroke population going forwards. Discussion: A narrative overview of the key findings is discussed, including the perceived benefits and limitations of digital cognitive assessments; the future of digital cognitive assessments; directly evoked feelings from cognitive assessments such as fear, anger, and sadness; the paradox of knowing cognitive difficulties, and the importance of experts by experience involvement within research. Practitioner recommendations for administering digital cognitive assessments to the stroke population are also discussed