Novel Technology for Treating Individuals with Aphasia and Concomitant Cognitive Deficits

Abstract

Purpose-This article describes three individuals with aphasia and concomitant cognitive deficits who used state-of-the-art computer software for training conversational scripts.Method-Participants were assessed before and after 9 weeks of a computer script training program. For each participant, three individualized scripts were developed, recorded on the software, and practiced sequentially at home. Weekly meetings with the speech-language pathologist occurred to monitor practice and assess progress. Baseline and posttreatment scripts were audiotaped, transcribed, and compared to the target scripts for content, grammatical productivity, and rate of production of script-related words. Interviews were conducted at the conclusion of treatment.Results-There was great variability in improvements across scripts, with two participants improving on two of their three scripts in measures of content, grammatical productivity, and rate of production of script-related words. One participant gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from exit interviews: increased verbal communication, improvements in other modalities and situations, communication changes noticed by others, increased confidence, and satisfaction with the software.Conclusion-Computer-based script training potentially may be an effective intervention for persons with chronic aphasia and concomitant cognitive deficits. Keywords aphasia; cognitive deficits; computer treatment; rehabilitation; script training Several studies have established that people with aphasia are able to use computers independently with minimal assistance and with demonstrable benefits. 1-3 This knowledge, combined with recent advances in computer technology, has spurred increased interest in delivery of treatment via computers. Studies assessing this mode of service delivery are addressing feasibility, efficacy, and cost effectiveness. Feasibility includes the potential for translating an aphasia treatment typically provided by a therapist to one that is computer-based without human interaction. Efficacy refers to improvements brought about by carefully conducted research with a sample of rigorously selected patients from a clearly defined clinical population undergoing a specific treatment protocol delivered by a highly trained clinician. 4 Efficacy questions in relation to computer treatment are whether the treatment results in improvement in one or more communication areas and how these improvements compare to those obtained when treatment is delivered by a therapist. Effectiveness refers to improvements NIH Public Access Computerized Conversational Script TrainingAphasiaScripts™ is a software program using an animated agent that serves as a virtual therapist for script training for individuals with aphasia. The virtual therapist is programmed to produce natural speech with correct movements of the speech articulators. 15 With AphasiaScripts™, the individual with aphasia and the therapis...

Oral Reading for Language in Aphasia (ORLA): Evaluating the Efficacy of Computer-Delivered Therapy in Chronic Nonfluent Aphasia

“…19 A group were attributed not only to improved language skills but also to improved confi dence and selfesteem. These fi ndings are consistent with results from other studies done by my colleagues and I 10,11 in which improved confi dence and self-esteem were reported by individuals utilizing a computerbased script-training procedure. Although these results are promising, further investigation into computer delivery of specifi c types of aphasia language treatment is warranted.…”

“…[2][3][4] Several studies have already established that people with aphasia are able to use computers independently with minimal therapist intervention and with demonstrable benefits. [5][6][7][8][9][10][11] Studies designed to assess the feasibility and effi cacy of COT are now emerging. 7,10-12 For example, 7 participants with aphasia of at least 2 years' duration used home computer software designed to improve word retrieval skills.…”

Script Templates

“… * Included the participants with nonfluent aphasia in Cherney (2008), Cherney & Halper (2008), and Manheim (2009) ** Included the 3 participants from Cherney (2008), and 20 participants from Manheim (2009), AAT=Aachen Aphasia Test; ANELT=Amsterdam-Nijmegen Everyday Language Test; AOS=Apraxia of speech; AQ=Aphasia Quotient; BOSS=Burden of Stroke Scale; CADL-2=Communication Activities of Daily Living; CAL=Communicative Activity Log; CETI=Communicative Effectiveness Index; QCL=Quality of Communication Life Scale; SAQOL=Stroke and Aphasia Quality of Life Scale; WAB=Western Aphasia Battery …”

“…Table 1 provides a summary of 13 publications that provide evidence for this approach (Bilda, 2011; Cherney & Halper, 2008; Cherney, Halper, Holland, & Cole, 2008; Cherney, Halper, & Kaye, 2011; Cherney, Kaye & Van Vuuren, 2014; Cherney, Kaye, Lee, & Van Vuuren, 2015; Goldberg, Haley, & Jacks, 2012; Lee, Kaye, & Cherney, 2009; Manheim, Halper, & Cherney, 2009; Nobis-Bosch, Springer, Radermacher, & Huber, 2011; Van Vuuren & Cherney, 2014; Youmans, Holland, Munoz, & Bourgeois, 2005; Youmans et al, 2011). It is important to note that several of the publications present different analyses of data from the same set of subjects (e.g., Cherney et al, 2014, 2015; Van Vuuren & Cherney, 2014); however, overall, the studies were conducted by five different research groups and include over 60 unique participants.…”

Discourse: Assessment and Therapy

“…The studies on discourse intervention that we found comprised three distinct approaches to the improvement of discourse (in some studies, more than one approach is used). One approach targets word and sentence production (simple and complex clauses) within discourse [56,[70][71][72][73][74]; another involves massed practice of whole discourses, using AphasiaScripts [75][76][77] and a third focuses on supporting participants to improve their discourse macrostructure using story grammar [56,64,68,78]. Overall, the findings from these studies were positive, with clients' improving in language use, the amount and quality of information conveyed, and how the information was structured, although it was not the case that all three elements improved in every case.…”