ABSTRACT
Purpose: Current computer technologies permit independent practice for people with cognitive-communicative disorders. Previous research has investigated compliance rates and outcome changes but not treatment fidelity per se during practice. Our aim was to examine adherence to procedures (treatment fidelity) and accuracy while persons with aphasia independently practiced word production using interactive, multimodal, user-controlled, word-level icons on computers. Method: Four persons with aphasia independently practiced single-word production after stimulation via user-initiated interactions in 3 conditions: (I) auditory stimulus with static representational drawing; (II) auditory stimulus with synchronized articulation video; and (III) users' choice between the 2 prior conditions. Sessions were video-recorded for subsequent analysis, which established emergently refined behavioral taxonomies using an iterative, mixed-methods approach. Results: In independent practice, users only sometimes adhere to modeled behaviors, other times improvising novel behaviors. The latter sometimes co-occurred with successful productions. Differences in success rates were noted between Conditions I and II across behaviors with Condition II generally favored. In Condition III, participants tended to choose the stimulus that resulted in highest success rates. Conclusions: During independent practice with technology, persons with aphasia do not necessarily comply with clinicians' practice instructions, and treatment fidelity does not determine success. Autonomy and choice in practice may reveal unanticipated dimensions for computerized aphasia treatment.
Subject(s)
Anomia/rehabilitation , Aphasia, Broca/rehabilitation , Aphasia, Wernicke/rehabilitation , Language Therapy/methods , Patient Compliance , Personal Autonomy , Speech , Therapy, Computer-Assisted/methods , Acoustic Stimulation , Aged , Anomia/diagnosis , Anomia/psychology , Aphasia, Broca/diagnosis , Aphasia, Broca/psychology , Aphasia, Wernicke/diagnosis , Aphasia, Wernicke/psychology , Auditory Perception , Choice Behavior , Female , Humans , Male , Middle Aged , Photic Stimulation , Pilot Projects , Task Performance and Analysis , Treatment Outcome , Video Recording , Visual PerceptionABSTRACT
Dysphagia can negatively affect quality of life, nutritional status, and pulmonary status of individuals. The most common intervention for dysphagia is the use of thickening agents for liquids. This group study (n = 43) investigated the taste preference, taste ratings, and ranking for nectar-thick hot and cold beverages using three types of thickeners: SimplyThick, Thick-It, and noncommercially prepared natural thickeners. Results demonstrated a significant difference between the taste ratings of two commercial thickeners and between one commercial and the natural thickener for the ranking of taste with hot beverages. Every participant rated at least one of the thickener beverages as having an acceptable taste for the hot chocolate and fruit juice beverages. Exploring individual preferences is critical to selecting a beverage that increases compliance to clinical recommendations.