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Use of computers in chronic aphasia

Hunter Region Acquired Communication Impairment (ACI) EBP Group

Extravaganza 2011

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• "Technophobia be gone?"• "Man versus Machine"• "Deus ex Machina"• "Rise of the Machines"

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Who are we?

• New clinical EBP group commenced late 2010.• Focus on active member involvement. • SPs from public, private, other government

agencies, Newcastle University working in a range of clinical settings in the Newcastle/Hunter Region.

• Group Leaders: 2010- 2011– Georgi Laney: georgi.laney@hnehealth.nsw.gov.au, – Sarah Bell: sbell@lifetimecare.nsw.gov.au

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Clinical question

Initial Clinical Question: Is computer-based therapy for word finding difficulties effective for people with aphasia?

Education with Professor Alison Ferguson University

of Newcastle (ACI EBP group academic affiliate)

Final Clinical Question: Is computer-only therapy for people with chronic aphasia efficacious?

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Definitions

• Computer-only therapy: = relates to treatment which is established &

monitored by SP but where SP does not give therapeutic advice/feedback during treatment.

• Chronic aphasia: = aphasia of duration ≥ 6 months.

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Search parameters

• Commenced with NSF Guidelines (2010). • Usual search engines, evidence-based

guidelines etc. • Articles more than 15 years old were not

reviewed. • Single case studies not included in CAT.

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Computer-based interventions:

Interventions discussed in computer -basedtherapy literature: • Script training• Reading comprehension• Naming, spoken naming• Multi-modality software incl: spoken word

matching, written word to pic matching, semantic associations, verbal naming, reading, spelling

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CAT-articles

Script training: • Cherney & Halper (2008). • Cherney, Halper, Holland and Cole (2008).• Lee, Kaye & Cherney (2009). • Manheim, Halper & Cherney (2009).

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CAT - articles cont…

Reading Comprehension: • Cherney (2010).

Naming: • Mason, Nickels, McDonald, Moses, Makin &

Taylor (2010). • Ramsberger & Marie (2007).

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CAT- articles cont….

Multiple modalities: • Mortley, Wade & Enderby (2004). • Pedersen et al (2001).

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Article Independent Intensity/ frequency

Concurrent Therapy

Target and software used

Cherney, L.R., Halper, A.S. (2008).

Weekly review with SP. Independent home practice.

Minimum 30 mins daily

Not clearly indicated

Script training

Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008).

Weekly review with SP. Independent home practice.

Minimum 30 mins daily

Not clearly indicated

Script training

Cherney, L.R. (2010).

Independent in experimental group. SP delivered therapy in control group.

24 hourly sessions total with 1-3 sessions/week

No Reading

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Article Independent Intensity/ frequency

Concurrent Therapy

Target and software used

Lee, J.B., Kaye, R.C., Cherney, L. R. (2009).

Weekly review with SP. Independent home practice.

Minimum 30 mins daily

Not clearly indicated

Script training

Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009).

Weekly review with SP. Independent home practice.

Minimum 30 mins daily

No Script training

Aphasia Scripts

Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010).

Yes 4 sessions/ week

No Naming

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Article Independent Intensity/ frequency

Concurrent Therapy

Target and software used

Mortley, J., Wade, J., Enderby, P. (2004).

Yes Intensity not prescribed. Average usage of 2.45 hours per week.

Not clearly indicated.

Auditory processing, reading and spelling.

Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001).

Yes Intensity not prescribed as software relied upon criterion performance.

Not clearly indicated.

Semantic, written and phonological tasks.

Ramsberger & Marie (2007).

First 2 sessions with SP, then individual practice.

High intensity: 5 days /week.Low intensity: 2 days/week.

No Naming.

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Article Sample size

Age range

Time post- stroke

Design & Level of evidence

Outcome Measures

Maintenance

Cherney, L.R., Halper, A.S. (2008).

3 50-75 1-4 years

Level IV WAB QCL CADL-2 Exit interview

Not assessed

Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008).

3 65-78 18-48 months

Level IV WAB QCL CADL-2 Exit interview

Not assessed

Cherney, L.R. (2010).

25 35-81 13 -253 months

Randomised Control trialLevel II

WAB-AQWAB reading and writing subtestsDiscourse analysis

Not assessed

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Article Sample size

Age range

Time post- stroke

Design & Level of evidence

Outcome Measures

Maintenance

Lee, J.B., Kaye, R.C., Cherney, L. R. (2009).

17 31-70 10-273 months

Level IV WAB-AQ. Not assessed

Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009).

20 26-78 10-238 months

Delayed treatment designLevel IV

BOSS: Communication difficulty & Mobility, communication associated psychological distress subtests

6 weeks

Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010).

3 37-59 5-8 years

Level IV Naming accuracy. 10 minute speech sample.

3 weeks

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Article Sample size

Age range

Time post- stroke

Design & Level of evidence

Outcome Measures

Maintenance

Mortley, J., Wade, J., Enderby, P. (2004).

7 53-66 2-12 years

Level IV Object & action naming battery, PALPA 47 & 48, exit interview

1 week & 6 weeks

Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001).

3 57-71 6-18 months

Level IV WAB-AQ, PALPA S&V naming

2 months

Ramsberger & Marie (2007).

4 63-74 6 months – 6 years

Level IV WAB BNT 1 month

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Clinical bottom line

What we think….• Any person with aphasia (without cognitive

impt) can learn to use a computer even if this is a new skill.

• Computer-only therapy is worth a go!• Use of computers can increase therapy

intensity and we know intensity is good.

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Clinical bottom line

What we don’t know…….• Is it the use of computers or increased

intensity that is affecting the change? • Is one particular program more effective than

another? • Is there an optimal amount of clinical

intervention that should be used in conjunction with computer based therapy?

• How long does generalisation last?

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What next? Clinical implications…..• Further education on levels of evidence & research

design. • Investigate possibility of research or student project

focusing on collating information about available computer therapy programs.

• Trial in workplace. • Review literature and revise CAT in 12-18 months.

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What next?.....

Other…..• More communication with Adult Language group in

Sydney. • Leaders to be more involved in EBP Network Leaders

meetings.• Encourage other regional groups to be developed.

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CAT-references

• Cherney, L.R., Halper, A.S. (2008). Novel technology for treating with aphasia and concomitant cognitive deficits. Topics in Stroke Rehabilitation, 15, 542-554.

• Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008). Computerized script training for aphasia: Preliminary results. American Journal of Speech Language Pathology, 17(1), 19-34.

• Cherney, L.R. (2010). Oral Reading for language in aphasia (ORLA): evaluating the efficacy of computer-delivered therapy in chronic non-fluent aphasia. Topics in Stroke Rehabilitation, Nov-Dec, 423-431.

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CAT-references

• Lee, J.B., Kaye, R.C., Cherney, L. R. (2009). Conversational script performance in adults with non-fluent aphasia: Treatment intensity and aphasia severity. Aphasiology, 23 (7-8), 885-897.

• Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009). Patient-reported changes in communication after computer-based script training for aphasia. Archives of Physical and Medical Rehabilitation, 90(4), 623-627.

• Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010). Treatment of word retrieval impairments in aphasia: evaluation of a self- administered home programme using personally chosen words. Aphasiology , 1-24.

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CAT-references

• Mortley, J., Wade, J., Enderby, P. (2004). Superhighway to promoting a client-therapist partnership? Using the internet to deliver word-retrieval computer therapy, monitored remotely with minimal speech and language therapy input. Aphasiology, 18, 193-211.

• Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001). Improvement of oral naming by unsupervised computerised rehabilitation. Aphasiology, 15 (2), p151-169.

• Ramsberger, G. & Marie, B. (2007). Self administered cued naming therapy: a single –participant investigation of a computer-based therapy program replicated in four cases. American Journal of Speech Language Pathology, 16, 343-358.

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Other useful references

• Archibald, L., Organe, J. B., Jamieson, D. J. (2009). Implementation of computer-based language therapy in aphasia. Therapeutic Advances in Neurological Disorders, 2, 229-311.

• Bilda, K. (2011). Video-based conversational script training for aphasia: A therapy study. Aphasiology, 25 (2), 191-201.

• Crerar, MA., Ellis, AW., & Dean, EC. (1996). Remediation of Sentence Processing Deficits in Aphasia Using a Computer- Based Microword. Brain & Language, 52, 229-275.

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Other useful references

• Katz, R. (2010). Computers in the treatment of chronic aphasia. Seminars in Speech & Language, 31(1), 34-41.

• Laganaro, M., Di Pietro, M., & Schnider, A. (2006). Computerised treatment of anomia in acute aphasia: Treatment intensity and training size. Neuropsychological Rehabilitation, 16(6), 630-640.

• Mortley, J., Enderby, P., Petheram, B. (2001). Using a computer to improve functional writing in a patient with severe dysgraphia. Aphasiology, 15, 443-431.

• Raymer, A.M., Kohen, F.P. & Saffell, D. Computerised training for impairments of word complrehension and retrieval in aphasia. Aphasiology, 2006, 20 (2/3/4), 257-268.

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Other useful references

• Wertz, R.T., Katz, R.C. (2004). Outcomes for computer-provided treatment for aphasia. Aphasiology, 18, 229-244.

Please see CAT for complete bibliography. Please see EBP website for table summarising articles included in

CAT.

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Thank you!

Hunter Region ACI EBP Group members: • Kerrie Strong • Luisa Renna• Megan Alston• Renae Mannix• Nathan Haywood• Jo Steel • Paula Machin• Danielle Rose

• Amanda Freund • Sue Sherratt • Monica Anderson• Amanda Schumacher• Alison Ferguson • Sarah Bell• Georgi Laney