Complexity and Feedback During Script Training in Aphasia: A Feasibility Study.

OBJECTIVE: To explore the effect of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design. SETTING: Freestanding urban rehabilitation hospital. PARTICIPANTS: Adults with fluent and nonfluent aphasia (at least 6 months post onset). INTERVENTIONS: Experimental treatment was AphasiaScripts, a computer-based script training program. Scripts were 10-turns long and developed at different complexity levels to allow for comparison of high vs low complexity. The program was modified to contrast high vs low feedback conditions during sentence practice. Participants were instructed to practice three 30-minute sessions per day, 6 days per week for 3 weeks. MAIN OUTCOME MEASURES: Gains achieved from baseline in accuracy and rate of production of trained and untrained script sentences at post treatment and at 3-, 6-, and 12-weeks after the end of treatment. RESULTS: Sixteen participants completed the intervention. On the trained script, gains were statistically significant for both accuracy and words per minute at post treatment and 3-, 6-, and 12-week maintenance. Gains on the untrained script were smaller than on the trained script; they were statistically significant only for accuracy at post treatment and 3-week maintenance. Complexity had an influence on accuracy at post-treatment (F1=4.8391, P=.0501) and at maintenance (F1=5.3391, P=.0413). Practicing scripts with high complexity increased accuracy by 11.33% at post treatment and by 9.90% at maintenance compared with scripts with low complexity. Participants with nonfluent aphasia made greater gains than those with fluent aphasia. There was no significant effect of feedback. CONCLUSIONS: This study reinforces script training as a treatment option for aphasia. Results highlight the use of more complex scripts to better promote acquisition and maintenance of script production skills. There is a need for further investigation of these variables with larger samples and with other types of aphasia treatments.

Web-based Oral Reading for Language in Aphasia (Web ORLA®): A pilot randomized control trial.

OBJECTIVE: To investigate an intensive asynchronous computer-based treatment delivered remotely with clinician oversight to people with aphasia. DESIGN: Single-blind, randomized placebo-controlled trial. SETTING: Free-standing urban rehabilitation hospital. PARTICIPANTS: Adults with aphasia (at least six months post-onset). INTERVENTIONS: Experimental treatment was Web ORLA® (Oral Reading for Language in Aphasia) which provides repeated choral and independent reading aloud of sentences with a virtual therapist. Placebo was a commercially available computer game. Participants were instructed to practice 90 minutes/day, six days/week for six weeks. MAIN MEASURES: Change in Language Quotient of the Western Aphasia Battery-Revised from pre-treatment to post-treatment and pre-treatment to six weeks following the end of treatment. RESULTS: 32 participants (19 Web ORLA®, 13 Control) completed the intervention and post-treatment assessment; 27 participants (16 Web ORLA®, 11 Control) completed the follow-up assessment six weeks after treatment had ended. Web ORLA® treatment resulted in significant improvements in language performance from pre-treatment to immediately post-treatment (X = 2.96; SD = 4.32; P < 0.01; ES = 0.68) and from pre-treatment to six weeks following the end of treatment (X = 4.53; SD = 3.16; P < 0.001; ES = 1.43). There was no significant difference in the gain from pre-treatment to post-treatment for the Web ORLA® versus Control groups. However, the Web ORLA® group showed significantly greater gains at the six-week follow-up than the control group (X = 2.70; SD = 1.01; P = 0.013; ES = 1.92). CONCLUSION: Results provide evidence for improved language outcomes following intensive, web-based delivery of ORLA® to individuals with chronic aphasia. Findings underscore the value of combining clinician oversight with the flexibility of asynchronous practice.

Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders.

Telerehabilitation (telerehab) offers cost-effective services that potentially can improve access to care for those with acquired neurologic communication disorders. However, regulatory issues including licensure, reimbursement, and threats to privacy and confidentiality hinder the routine implementation of telerehab services into the clinical setting. Despite these barriers, rapid technological advances and a growing body of research regarding the use of telerehab applications support its use. This article reviews the evidence related to acquired neurologic speech and language disorders in adults, focusing on studies that have been published since 2000. Research studies have used telerehab systems to assess and treat disorders including dysarthria, apraxia of speech, aphasia, and mild Alzheimer disease. They show that telerehab is a valid and reliable vehicle for delivering speech and language services. The studies represent a progression of technological advances in computing, Internet, and mobile technologies. They range on a continuum from working synchronously (in real-time) with a speech-language pathologist to working asynchronously (offline) with a stand-in virtual therapist. One such system that uses a virtual therapist for the treatment of aphasia, the Web-ORLA™ (Rehabilitation Institute of Chicago, Chicago, IL) system, is described in detail. Future directions for the advancement of telerehab for clinical practice are discussed.

Optimising recovery in aphasia: Learning following exposure to a single dose of computer-based script training.

Purpose: Intensity of therapy influences outcomes in aphasia treatment, but little is known about optimum dosage across treatment approaches. Improved understanding of the effects of dose could help facilitate clinical decisions that maximise patient outcomes. This study examines learning in individuals with aphasia following exposure to one 60-min dose of computer-delivered script training, with or without a rest break. Method: Twenty participants (6F, 14M; 17 nonfluent, 3 fluent) with chronic aphasia due to left-hemisphere stroke participated. Participants had a mean (SD) age of 56.9 (8.4) years, a mean time post onset of 55.1 (range: 6.4-396.4) months, and a mean (SD) Comprehensive Aphasia Test score of 47.8 (4.0). Participants were exposed to 60 min of training, with or without a rest break, of a three-turn conversational script about either weather or traffic. Treatment was delivered via computer using a virtual clinician that visually modelled speech and guided treatment, promoting treatment fidelity. Oral reading probes for script sentences were administered at baseline (3 times), mid-treatment, immediately post-treatment, and, at various times, up to 2 weeks post-treatment to track script acquisition and maintenance. The study also examined generalisation from a trained script to a conversation with a clinician via a generalisation probe at three time points: baseline, immediately post-treatment, and 2 weeks post-treatment. Result: Following exposure to one dose of script training, participants demonstrated statistically significant improvements in oral reading accuracy and rate of script production on trained probes from baseline to immediately post-treatment and 2 weeks post-treatment. Participants also demonstrated significant change from baseline in generalisation to a conversation with a clinician immediately post-treatment and at 2 weeks post-treatment. Conclusion: Exposure to a single dose of computer-delivered script training may facilitate learning. These results have implications for future research investigating optimal dosage and scheduling parameters.

Impact of Personal Relevance on Acquisition and Generalization of Script Training for Aphasia: A Preliminary Analysis.

PURPOSE: The importance of personalization in script training in aphasia has been assumed but never tested. This study compared acquisition and generalization of personally relevant versus generic words or phrases appearing in the same scripts. METHOD: Eight individuals (6 men; 2 women) with chronic aphasia received 3 weeks of intensive computer-based script training. For each participant, 2 scripts, a trained and an untrained generalization script, were embedded with 4 personally relevant word choices and 2-4 generic items that were similar across participants. Scripts were probed for accuracy at baseline and posttreatment. Significance testing was conducted on baseline and posttreatment scores, and for gains in personally relevant versus generic items. Effect sizes were computed. RESULTS: Both personally relevant and generic items improved significantly on trained scripts. Improvements on untrained scripts were smaller, with only personally relevant items reaching significance. There was no significant difference on gains made on personalized versus generic items for trained scripts (p = .059), but the effect size was large (d = 0.90). For generalization scripts, this effect was small (d = 0.25) and nonsignificant. CONCLUSIONS: Personally relevant words and phrases were acquired, although not generalized, more successfully than generic words and phrases. Data supports the importance of personalization in script training, but the degree of that importance requires further investigation.

A Virtual Therapist for Speech and Language Therapy.

A virtual therapist (VT) capable of modeling visible speech and directing speech and language therapy is presented. Three perspectives of practical and clinical use are described. The first is a description of treatment and typical roles that the VT performs in directing participation, practice and performance. The second is a description of techniques for modeling visible speech and implementing tele-rehabilitation. The third is an analysis of performance of a system (AphasiaRx™) for delivering speech and language therapy to people with aphasia, with results presented from a randomized controlled cross-over study in which the VT provided two levels of cuing. Compared to low cue treatment, high cue treatment resulted in 2.3 times faster learning. The paper concludes with a discussion of the benefits of speech and language therapy delivered by the VT.

Acquisition and maintenance of scripts in aphasia: a comparison of two cuing conditions.

PURPOSE: This study was designed to compare acquisition and maintenance of scripts under two conditions: high cue, which provided numerous multimodality cues designed to minimize errors, and low cue, which provided minimal cues. METHOD: In a randomized controlled crossover study, eight individuals with chronic aphasia received intensive computer-based script training under two cuing conditions. Each condition lasted 3 weeks, with a 3-week washout period. Trained and untrained scripts were probed for accuracy and rate at baseline, during treatment, immediately posttreatment, and at 3 and 6 weeks posttreatment. Significance testing was conducted on gain scores, and effect sizes were calculated. RESULTS: Training resulted in significant gains in script acquisition with maintenance of skills at 3 and 6 weeks posttreatment. Differences between cuing conditions were not significant. When severity of aphasia was considered, there also were no significant differences between conditions, although magnitude of change was greater in the high-cue condition versus the low-cue condition for those with more severe aphasia. CONCLUSIONS: Both cuing conditions were effective in acquisition and maintenance of scripts. The high-cue condition may be advantageous for those with more severe aphasia. Findings support the clinical use of script training and the importance of considering aphasia severity.