ASHAWire
Advanced search
Skip main navigation
No AccessJournal of Speech, Language, and Hearing ResearchResearch Article17 May 2018

Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia

    https://doi.org/10.1044/2018_JSLHR-L-17-0277

    Abstract

    Purpose

    The aim of this study was to determine if a tablet-based home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia.

    Method

    In a pre–post group study of home practice outcomes, 21 individuals with chronic aphasia were examined before and after a 6-month home practice phase and again at follow-up 4 months later. The main outcome measure studied was change in naming previously treated or untreated, practiced or unpracticed pictures of objects and actions. Individualized home practice programs were created in iBooks Author with semantic, phonemic, and orthographic cueing in pictures, words, and videos in order to facilitate naming of previously treated or untreated pictures.

    Results

    Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements.

    Conclusion

    Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.

    References

    • Baron, C., Hatfield, B., & Georgeadis, A. (2005). Management of communication disorders using family member input, group treatment, and telerehabilitation.Topics in Stroke Rehabilitation, 12(2), 49–56.
      CrossrefMedlineGoogle Scholar
    • Basso, A., & Caporali, A. (2001). Aphasia therapy or the importance of being earnest.Aphasiology, 15(4), 307–332.
      CrossrefGoogle Scholar
    • Basso, G., Magon, S., Reggiani, F., Capasso, R., Monittola, G., Yang, F. J., & Miceli, G. (2013). Distinguishable neurofunctional effects of task practice and item practice in picture naming: A BOLD fMRI study in healthy subjects.Brain and Language, 126(3), 302–313.
      CrossrefMedlineGoogle Scholar
    • Berthier, M. L., & Pulvermuller, F. (2011). Neuroscience insights improve neurorehabilitation of poststroke aphasia.Nature Reviews Neurology, 7, 86–97.
      CrossrefMedlineGoogle Scholar
    • Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery.Stroke, 34(4), 987–993.
      CrossrefMedlineGoogle Scholar
    • Brady, A. (2007). Moving toward the future: Providing speech-language pathology services via telehealth.Home Healthcare Nurse, 25(4), 240–244.
      CrossrefMedlineGoogle Scholar
    • Brady, M. C., Kelly, H., Godwin, J., Enderby, P., & Campbell, P. (2016). Speech and language therapy for aphasia following stroke.Cochrane Database of Systematic Reviews, 1469–1493. https://doi.org/10.1002/14651858.CD000425.pub4
      Google Scholar
    • Brennan, D., Georgeadis, A., & Baron, C. (2002). Telerehabilitation tools for the provision of remote speech-language treatment.Topics in Stroke Rehabilitation, 8(4), 71–78.
      CrossrefMedlineGoogle Scholar
    • Cherney, L. R., Patterson, J. P., Raymer, A. M., Frymark, T., & Schooling, T. (2010, October). Updated evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia.ASHA's National Center for Evidence-Based Practice in Communication Disorders, October 2010.
      Google Scholar
    • Choi, Y. H., Park, H. K., & Paik, N. J. (2016). A telerehabilitation approach for chronic aphasia following stroke.Telemedicine Journal and e-Health, 22(5), 434–440.
      CrossrefMedlineGoogle Scholar
    • Dabul, B. (2000). Apraxia Battery for Adults–Second Edition (ABA-2). Austin, TX: PRO-ED.
      Google Scholar
    • Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders (3rd ed.). Philadelphia, PA: Saunders.
      Google Scholar
    • Davis, A., & Wilcox, M. (1985). Adult aphasia rehabilitation: Applied pragmatics. San Diego, CA: Singular.
      Google Scholar
    • Davis, C., Farias, D., & Baynes, K. (2009). Implicit phoneme manipulation for the treatment of apraxia of speech and co-occurring aphasia.Aphasiology, 23, 503–528.
      CrossrefGoogle Scholar
    • Dechene, L., Tousignant, M., Boissy, P., Macoir, J., Heroux, S., Hamel, M., … Pagé, C. (2011). Simulated in-home teletreatment for anomia.International Journal of Telerehabilitation, 3(2), 3–10.
      CrossrefMedlineGoogle Scholar
    • Des Roches, C. A., Balachandran, I., Ascenso, E. M., Tripodis, Y., & Kiran, S. (2015). Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform.Frontiers in Human Neuroscience, 8, 1015.
      CrossrefMedlineGoogle Scholar
    • Dignam, J., Copland, D., McKinnon, E., Burfein, P., O'Brien, K., Farrell, A., & Rodriguez, A. D. (2015). Intensive versus distributed aphasia therapy: A nonrandomized, parallel-group, dosage-controlled study.Stroke, 46, 2206–2211.
      CrossrefMedlineGoogle Scholar
    • Dignam, J., Copland, D., O'Brien, K., Burfein, P., Khan, A., & Rodriguez, A. D. (2017). Influence of cognitive ability on therapy outcomes for anomia in adults with chronic poststroke aphasia.Journal of Speech, Language, and Hearing Research, 60(2), 406–421.
      ASHAWireGoogle Scholar
    • Duffy, J. R. (2012). Motor speech disorders, substrates, differential diagnosis, and management (3rd ed.). St. Louis, MO: Elsevier Mosby.
      Google Scholar
    • Fridriksson, J., Moser, D., Bonilha, L., Morrow-Odom, K. L., Shaw, H., Fridriksson, A., … Rorden, C. (2007). Neural correlates of phonological and semantic-based anomia treatment in aphasia.Neuropsychologia, 45(8), 1812–1822.
      CrossrefMedlineGoogle Scholar
    • Goldberg, S., Haley, K. L., & Jacks, A. (2012). Script training and generalization for people with aphasia.American Journal of Speech-Language Pathology, 21(3), 222–238.
      ASHAWireGoogle Scholar
    • Goodglass, H., Kaplan, E., & Barresi, B. (2001). The assessment of aphasia and related disorders (3rd ed.). Austin, TX: Pro-Ed.
      Google Scholar
    • Hall, N., Boisvert, M., & Steele, R. (2013). Telepractice in the assessment and treatment of individuals with aphasia: A systematic review.International Journal of Telerehabilitation, 5(1), 27–38.
      CrossrefMedlineGoogle Scholar
    • Harnish, S. M., Morgan, J., Lundine, J. P., Bauer, A., Singletary, F., Benjamin, M. L., … Crosson, B. (2014). Dosing of a cued picture-naming treatment for anomia.American Journal of Speech-Language Pathology, 23(2), S285–S299.
      ASHAWireGoogle Scholar
    • Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test. San Antonio, TX: Pearson.
      Google Scholar
    • Heuer, S., Ivanova, M. V., & Hallowell, B. (2017). More than the verbal stimulus matters: Visual attention in language assessment for people with aphasia using multiple-choice image displays.Journal of Speech, Language, and Hearing Research, 60(5), 1348–1361.
      ASHAWireGoogle Scholar
    • Hill, A. J., & Breslin, H. M. (2016). Refining an asynchronous telerehabilitation platform for speech-language pathology: Engaging end-users in the process.Frontiers in Human Neuroscience, 10, 640.
      CrossrefMedlineGoogle Scholar
    • Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test–Second Edition. Philadelphia, PA: Lea & Febiger.
      Google Scholar
    • Karni, A., Meyer, G., Jezzard, P., Adams, M. M., Turner, R., & Ungerleider, L. G. (1995). Functional MRI evidence for adult motor cortex plasticity during motor skill learning.Nature, 377(6545), 155–158.
      CrossrefMedlineGoogle Scholar
    • Kertesz, A. (2006). Western Aphasia Battery–Revised. San Antonio, TX: Pearson.
      Google Scholar
    • Kiran, S., Des Roches, C., Balachandran, I., & Ascenso, E. (2014). Development of an impairment-based individualized treatment workflow using an iPad-based software platform.Seminars in Speech and Language, 35(1), 38–50.
      CrossrefMedlineGoogle Scholar
    • Kirmess, M., & Maher, L. M. (2010). Constraint induced language therapy in early aphasia rehabilitation.Aphasiology, 24(6–8), 725–736.
      CrossrefGoogle Scholar
    • Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage.Journal of Speech, Language, and Hearing Research, 51, S225–S239.
      ASHAWireGoogle Scholar
    • Kurland, J. (2014). iRehab in aphasia treatment.Seminars in Speech and Language, 35, 3–4.
      CrossrefMedlineGoogle Scholar
    • Kurland, J., Cortes, C. R., Wilke, M., Sperling, A. J., Lott, S., Tagamets, M. A., … Friedman, R. B. (2008). Neural mechanisms underlying learning and maintenance of learning following semantic mediation treatment in a case of phonologic alexia.Brain Imaging and Behavior, 2, 147–162.
      CrossrefMedlineGoogle Scholar
    • Kurland, J., Liu, A., & Stokes, P. (2018). Practice effects in healthy older adults: Implications for treatment-induced neuroplasticity in aphasia.Neuropsychologia, 109, 116–125.
      CrossrefMedlineGoogle Scholar
    • Kurland, J., Pulvermüller, F., Silva, N., Burke, K., & Andrianopoulos, M. (2012). Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: Behavioral and fMRI outcomes.American Journal of Speech-Language Pathology, 21(2), S65–S87.
      ASHAWireGoogle Scholar
    • Kurland, J., Stanek, E. J., III, Stokes, P., Li, M., & Andrianopoulos, M. (2016). Intensive language action therapy in chronic aphasia: A randomized clinical trial examining guidance by constraint.American Journal of Speech-Language Pathology, 25(4S), S798–S812.
      ASHAWireGoogle Scholar
    • Kurland, J., Wilkins, A. R., & Stokes, P. (2014). iPractice: Piloting the effectiveness of a tablet-based home practice program in aphasia treatment.Seminars in Speech and Language, 35, 51–64.
      CrossrefMedlineGoogle Scholar
    • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data.Biometrics, 33, 159–174.
      CrossrefMedlineGoogle Scholar
    • Lavoie, M., Macoir, J., & Bier, N. (2017). Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review.Journal of Communication Disorders, 65, 43–53.
      CrossrefMedlineGoogle Scholar
    • Lavoie, M., Routhier, S., Legare, A., & Macoir, J. (2016). Treatment of verb anomia in aphasia: Efficacy of self-administered therapy using a smart tablet.Neurocase, 22(1), 109–118.
      CrossrefMedlineGoogle Scholar
    • Maas, E., Robin, D. A., Ausermann Hula, S. N., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders.American Journal of Speech-Language Pathology, 17, 277–298.
      ASHAWireGoogle Scholar
    • MacDonald, A. D., Heath, S., McMahon, K. L., Nickels, L., Angwin, A. J., van Hees, S., … Copland, D. A. (2015). Neuroimaging the short- and long-term effects of repeated picture naming in healthy older adults.Neuropsychologia, 75, 170–178.
      CrossrefMedlineGoogle Scholar
    • Macoir, J., Martel Sauvageau, V., Boissy, P., Tousignant, M., & Tousignant, M. (2017). In-home synchronous telespeech therapy to improve functional communication in chronic poststroke aphasia: Results from a quasi-experimental study.Telemedicine Journal and e-Health, 23(8), 630–639.
      CrossrefMedlineGoogle Scholar
    • Mashima, P. A., & Doarn, C. R. (2008). Overview of telehealth activities in speech-language pathology.Telemedicine Journal and e-Health, 14(10), 1101–1117.
      CrossrefMedlineGoogle Scholar
    • Masterson, J., & Druks, J. (1998). Description of a set of 164 nouns and 102 verbs matched for printed word frequency, familiarity and age-of-acquisition.Journal of Neurolinguistics, 11(4), 331–354.
      CrossrefGoogle Scholar
    • McGrath, N., Dowds, M. M., Jr., & Goldstein, R. (2008). Clinical supervision of a client with traumatic brain injury in a host home placement using video teleconferencing: A case study.The Journal of Head Trauma Rehabilitation, 23(6), 388–393.
      CrossrefMedlineGoogle Scholar
    • McNeil, M. R., Doyle, P. J., Spencer, K., Goda, J., Flores, D., & Small, S. L. (1998). Effects of training multiple form classes on acquisition, generalization, and maintenance of word retrieval in a single subject.Aphasiology, 12, 57–585.
      CrossrefGoogle Scholar
    • McNeil, M. R., Robin, D. A., & Schmidt, R. A. (2009). Apraxia of speech: Definition and differential diagnosis.In M. R. McNeil (Ed.), Clinical management of sensorimotor speech disorders (2nd ed., pp. 331–354). New York, NY: Thieme.
      Google Scholar
    • Middleton, E. L., Schwartz, M. F., Rawson, K. A., Traut, H., & Verkuilen, J. (2016). Towards a theory of learning for naming rehabilitation: Retrieval practice and spacing effects.Journal of Speech, Language, and Hearing Research, 59, 1111–1122.
      ASHAWireGoogle Scholar
    • Minkina, I., Rosenberg, S., Kalinyak-Fliszar, M., & Martin, N. (2017). Short-term memory and aphasia: From theory to treatment.Seminars in Speech and Language, 38(1), 17–28.
      CrossrefMedlineGoogle Scholar
    • Monfils, M. H., Plautz, E. J., & Kleim, J. A. (2005). In search of the motor engram: Motor map plasticity as a mechanism for encoding motor experience.The Neuroscientist, 11, 471–483.
      CrossrefMedlineGoogle Scholar
    • Oldfield, R. C. (1971). The assessment and analysis of handedness: The Edinburgh Inventory.Neuropsychologia, 9(1), 97–113.
      CrossrefMedlineGoogle Scholar
    • Poldrack, R. A., Desmond, J. E., Glover, G. H., & Gabrieli, J. D. (1998). The neural basis of visual skill learning: An fMRI study of mirror reading.Cerebral Cortex, 8(1), 1–10.
      CrossrefMedlineGoogle Scholar
    • Pulvermüller, F., & Berthier, M. L. (2008). Aphasia therapy on a neuroscience basis.Aphasiology, 22(6), 563–599.
      CrossrefMedlineGoogle Scholar
    • Pulvermüller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., & Taub, E. (2001). Constraint-induced therapy of chronic aphasia after stroke.Stroke, 32(7), 1621–1626.
      CrossrefMedlineGoogle Scholar
    • Raichle, M. E., Fiez, J. A., Videen, T. O., MacLeod, A. M., Pardo, J. V., Fox, P. T., & Petersen, S. E. (1994). Practice-related changes in human brain functional anatomy during non-motor learning.Cerebral Cortex, 4(1), 8–26.
      CrossrefMedlineGoogle Scholar
    • Rende, B., & Ramsberger, G. (2011). Telepractice experiences in a university training clinic.Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 21, 120–129.
      ASHAWireGoogle Scholar
    • Routhier, S., Bier, N., & Macoir, J. (2016). Smart tablet for smart self-administered treatment of verbal anomia: Two single case studies in aphasia.Aphasiology, 30(2–3), 269–289.
      Google Scholar
    • Sakai, K., Hikosaka, O., Miyauchi, S., Takino, R., Sasaki, Y., & Putz, B. (1998). Transition of brain activation from frontal to parietal areas in visuomotor sequence learning.The Journal of Neuroscience, 18(5), 1827–1840.
      CrossrefMedlineGoogle Scholar
    • Sandberg, C. W. (2017). Hypo-connectivity of resting-state networks in persons with aphasia compared with healthy age-matched adults.Frontiers in Human Neuroscience, 11, 91.
      CrossrefMedlineGoogle Scholar
    • Shors, T. J., Anderson, M. L., Curlik, D. M., & Nokia, M. S. (2012). Use it or lose it: How neurogenesis keeps the brain fit for learning.Behavioural Brain Research, 227(2), 450–458.
      CrossrefMedlineGoogle Scholar
    • Sickert, A., Anders, L. C., Munte, T. F., & Sailer, M. (2014). Constraint-induced aphasia therapy following sub-acute stroke: A single-blind, randomised clinical trial of a modified therapy schedule.Journal of Neurology, Neurosurgery, and Psychiatry, 85(1), 51–55.
      CrossrefMedlineGoogle Scholar
    • Simic, T., Leonard, C., Laird, L., Cupit, J., Hobler, F., & Rochon, E. (2016). A usability study of Internet-based therapy for naming deficits in aphasia.American Journal of Speech-Language Pathology, 25(4), 642–653.
      ASHAWireGoogle Scholar
    • Snodgrass, J. G., & Vanderwart, M. (1980). A standardized set of 260 pictures: Norms for name agreement, image agreement, familiarity, and visual complexity.Journal of Experimental Psychology: Human Learning and Memory, 6(2), 174–215.
      CrossrefMedlineGoogle Scholar
    • Taub, E., Crago, J. E., Burdio, L. D., Groomes, T. E., Cook, E. W., III, DeLuca, S. C., & Miller, N. E. (1994). An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping.Journal of the Experimental Analysis of Behavior, 61, 281–293.
      CrossrefMedlineGoogle Scholar
    • Van de Sandt-Koenderman, W. M. E. (2011). Aphasia rehabilitation and the role of computer technology: Can we keep up with modern times?.International Journal of Speech-Language Pathology, 13, 21–27.
      CrossrefMedlineGoogle Scholar
    • Wambaugh, J. L. (2006). Treatment guidelines for apraxia of speech: Lessons for future research.Journal of Medical Speech-Language Pathology, 14, 317.
      Google Scholar
    • Wambaugh, J. L., Martinez, A. L., McNeil, M. R., & Rogers, M. A. (1999). Sound production treatment for apraxia of speech: Overgeneralization and maintenance effects.Aphasiology, 13, 821–837.
      CrossrefGoogle Scholar
    • Woolf, C., Caute, A., Haigh, Z., Galliers, J., Wilson, S., Kessie, A., … Marshall, J. (2016). A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study.Clinical Rehabilitation, 30(4), 359–373.
      CrossrefMedlineGoogle Scholar

    Additional Resources