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


    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.


    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.


    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.


    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.


    • 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.
    • Basso, A., & Caporali, A. (2001). Aphasia therapy or the importance of being earnest.Aphasiology, 15(4), 307–332.
    • 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.
    • Berthier, M. L., & Pulvermuller, F. (2011). Neuroscience insights improve neurorehabilitation of poststroke aphasia.Nature Reviews Neurology, 7, 86–97.
    • Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery.Stroke, 34(4), 987–993.
    • Brady, A. (2007). Moving toward the future: Providing speech-language pathology services via telehealth.Home Healthcare Nurse, 25(4), 240–244.
    • 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.
    • 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.
    • 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.
    • 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.
    • Dabul, B. (2000). Apraxia Battery for Adults–Second Edition (ABA-2). Austin, TX: PRO-ED.
    • Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders (3rd ed.). Philadelphia, PA: Saunders.
    • Davis, A., & Wilcox, M. (1985). Adult aphasia rehabilitation: Applied pragmatics. San Diego, CA: Singular.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Duffy, J. R. (2012). Motor speech disorders, substrates, differential diagnosis, and management (3rd ed.). St. Louis, MO: Elsevier Mosby.
    • 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.
    • 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.
    • Goodglass, H., Kaplan, E., & Barresi, B. (2001). The assessment of aphasia and related disorders (3rd ed.). Austin, TX: Pro-Ed.
    • 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.
    • 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.
    • Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test. San Antonio, TX: Pearson.
    • 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.
    • 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.
    • Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test–Second Edition. Philadelphia, PA: Lea & Febiger.
    • 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.
    • Kertesz, A. (2006). Western Aphasia Battery–Revised. San Antonio, TX: Pearson.
    • 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.
    • Kirmess, M., & Maher, L. M. (2010). Constraint induced language therapy in early aphasia rehabilitation.Aphasiology, 24(6–8), 725–736.
    • 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.
    • Kurland, J. (2014). iRehab in aphasia treatment.Seminars in Speech and Language, 35, 3–4.
    • 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.
    • Kurland, J., Liu, A., & Stokes, P. (2018). Practice effects in healthy older adults: Implications for treatment-induced neuroplasticity in aphasia.Neuropsychologia, 109, 116–125.
    • 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.
    • 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.
    • 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.
    • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data.Biometrics, 33, 159–174.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Mashima, P. A., & Doarn, C. R. (2008). Overview of telehealth activities in speech-language pathology.Telemedicine Journal and e-Health, 14(10), 1101–1117.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Oldfield, R. C. (1971). The assessment and analysis of handedness: The Edinburgh Inventory.Neuropsychologia, 9(1), 97–113.
    • 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.
    • Pulvermüller, F., & Berthier, M. L. (2008). Aphasia therapy on a neuroscience basis.Aphasiology, 22(6), 563–599.
    • 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.
    • 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.
    • Rende, B., & Ramsberger, G. (2011). Telepractice experiences in a university training clinic.Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 21, 120–129.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Wambaugh, J. L. (2006). Treatment guidelines for apraxia of speech: Lessons for future research.Journal of Medical Speech-Language Pathology, 14, 317.
    • 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.
    • 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.

    Additional Resources