Patient-reported changes in communication after computer-based script training for aphasia.

OBJECTIVE: To evaluate changes in patient-reported communication difficulty after a home-based, computer-delivered intervention designed to improve conversational skills in adults with aphasia. DESIGN: Delayed treatment design with baseline, preintervention, postintervention, and follow-up observations. SETTING: Outpatient rehabilitation. PARTICIPANTS: Twenty subjects with chronic aphasia. INTERVENTIONS: Sessions with the speech-language pathologist to develop personally relevant conversational scripts, followed by 9 weeks of intensive home practice using a computer program loaded on a laptop, and weekly monitoring visits with the speech-language pathologist. MAIN OUTCOME MEASURE: Communication Difficulty (CD) subscale of the Burden of Stroke Scale (BOSS). RESULTS: The intervention resulted in a statistically and clinically significant decrease of 6.79 points (P=.038) in the CD subscale of the BOSS during the intervention, maintained during the follow-up period. CONCLUSIONS: The findings of this study provide positive albeit preliminary and limited support for the use of a home-based, computer-delivered language intervention program for improving patient-reported communication outcomes in adults with chronic aphasia. Additional research will be required to examine the efficacy and effectiveness of this intervention.

Novel technology for treating individuals with aphasia and concomitant cognitive deficits.

PURPOSE: This article describes three individuals with aphasia and concomitant cognitive deficits who used state-of-theart 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 scriptrelated 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.

Computerized script training for aphasia: preliminary results.

PURPOSE: This article describes computer software that was developed specifically for training conversational scripts and illustrates its use with 3 individuals with aphasia. METHOD: Three participants with chronic aphasia (Broca's, Wernicke's, and anomic) were assessed before and after 9 weeks of a computer script training program. For each participant, 3 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 with the person with aphasia and his or her significant other were conducted at the conclusion of treatment. RESULTS: All measures (content, grammatical productivity, and rate of production of script-related words) improved for each participant on every script. Two participants gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from the 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.

Right hemisphere stroke and the California Verbal Learning Test: a preliminary study.

METHOD: This study examines group and individual performance on word list recall and recognition in 52 patients with unilateral right hemisphere stroke. RESULTS: On the California Verbal Learning Test, List A, Trials 1-5, patients achieved a mean score of 30.31 (SD = 13.94), which is below the mean standard score of 50 (SD = 10) in a normal population. Patients demonstrated below-average performance on other immediate and delayed recall trials and on free- and cued-recall tasks. 67% of patients showed improved performance across learning trials. CONCLUSION: Results provide support for encoding deficits with reduced rate of learning and inconsistent recall across trials.

Performance on the California Verbal Learning Test following right hemisphere stroke: a longitudinal study.

PURPOSE: This longitudinal study examines performance of individuals with right hemisphere damage (RHD) on the California Verbal Learning Test (CVLT). METHOD: 18 participants were administered the CVLT during the acute phase (<3 months post onset) and then at subsequent times up to 2 years post onset. RESULTS: Using List A, Trials 1-5, as a global measure of learning, participants at first testing demonstrated recall skills below the mean standard score of 50 (M = 32.56, SD = 13.90). There was significant improvement between initial and second testing (t = -2.92, p = .01). Changes between second and third testing and third and fourth testing were not significant.

Two approaches to treating unilateral neglect after right hemisphere stroke: a preliminary investigation.

PURPOSE: This preliminary study assessed the efficacy of two treatment methods for persistent unilateral or hemispatial neglect following right hemisphere stroke. METHOD: Two patients received an intervention focusing on the underlying impairment of attention during visual scanning. Two other participants received an intervention that provided repetitive practice during a functional task of oral reading. Standardized tests of attention and neglect were administered before and after treatment. Performance on a functional task assessing generalization of treatment was probed at every session. RESULTS: Results indicate no clear conclusions regarding the efficacy of either approach. Factors contributing to these equivocal findings are addressed.

Computer-based script training for aphasia: emerging themes from post-treatment interviews.

This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded comments that were categorized into ten themes. Five of the themes related to the communication behaviors of the participant, whereas the other five related to the computer program and study procedures. Examples of each theme are presented. The themes provide qualitative evidence of change and generalization, supporting the use of this computer-based script training program.

Tell me your story: analysis of script topics selected by persons with aphasia.

PURPOSE: This study examined the content of 100 short scripts, co-constructed by persons with aphasia (PWA) and a clinician. The PWA subsequently learned the scripts by interacting with a computerized virtual therapist. The goal was to provide clinicians with ideas regarding content for treatment that is meaningful to PWAs. METHOD: Thirty-three PWAs generated the scripts, typically including 1 monologue and 2 dialogues in which the PWA was either the initiator or the responder. Scripts were analyzed for common topics and themes. RESULTS: Thirty topics were identified and categorized into 10 themes. For the monologues, the largest category was personal stories (68%), with 12 of the 19 addressing their stroke and aphasia. For the dialogues, conversations with family were dominant (21%), followed by seeking or providing information (18%), and discussion of outside interests (14%). CONCLUSION: PWAs choose to speak about their life experiences, choose to reconnect with their families, and tend to focus on communication that can help them to negotiate mundane normal life. Independent of how this content is used in treatment, materials should emphasize matters of high personal relevance to those treated.

An assessment tool for evaluating cognitive-communicative problems in patients with right hemisphere damage: Preliminary findings.

This article briefly describes the primary characteristics ofthe communication problems associated with right hemisphere damage. It presents a test battery, the RIC Evaluation of Communication Problems in Right Hemisphere Dysfunction-2 (RICE-2; Halper, Burns, Cherney, & Mogil, 1991), that has been developed for this population. Preliminary results of a study to validate the RICE-2 indicate that the tool is sensitive to measuring the differences between nonneurologically impaired individuals and right hemisphere stroke patients. Test scores of individual subjects who are representative of different cognitive-communicative severity levels are presented to illustrate variability in patterns of performance.