The use of technology to facilitate writing in aphasia

In an age when digital technology is becoming central to communication, writing is increasingly important, with messaging and emailing often replacing phone calls [1]. As written communication shifts to the digital modality, technology poses both challenges and opportunities to people with aphasia. The cognitive and linguistic demands of using technology present potential barriers [2], but recent research has also explored the potential of technology to facilitate writing. This mini-review will describe the evidence base for using technology to support writing in aphasia therapy. It will describe a variety of applications, designed to remediate the impairment, facilitate functional writing skills and compensatory approaches which aim to bypass impaired writing skills. It will explore the role of the speech and language therapist in selecting the most suitable technology for an individual’s needs and in training people with aphasia to use the technology. In addition, it will discuss methods of assessing people with aphasia’s technology proficiency and functional writing skills, and the challenges inherent in these

Does mode of administration affect health-related quality-of-life outcomes after stroke?

Telephone interviews and postal surveys may be a resource-efficient way of assessing health-related quality-of-life post-stroke, if they produce data equivalent to face-to-face interviews. This study explored whether telephone interviews and postal surveys of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g) yielded similar results to face-to-face interviews. Participants included people with aphasia and comprised two groups: group one (n =22) were 3-6 months post-stroke; group two (n =26) were ≥1 year post-stroke. They completed either a face-to-face and a telephone interview or a face-to-face interview and a postal survey of the SAQOL-39g. Response rates were higher for group two (87%) than for group one (72-77%). There were no significant differences between respondents and non-respondents on demographics, co-morbidities, stroke severity, or communication impairment. Concordance between face-to-face and telephone administrations (.90-.98) was excellent; and very good-excellent between face-to-face and postal administrations (.84-.96), although scores in postal administrations were lower (significant for psychosocial domain and overall SAQOL-39g in group two). These findings suggest that the SAQOL-39g yields similar results in different modes of administration. Researchers and clinicians may employ alternative modes, particularly in the longer term post-stroke, in order to reduce costs or facilitate clients with access difficulties

Operationalising routinely collected patient data in research to further the pursuit of social justice and health equity: a team-based scoping review

Background Vast volumes of routinely collected data (RCD) about patients are collated by health professionals. Leveraging this data – a form of real-world data - can be valuable for quality improvement and contributing to the evidence-base to inform practice. Examining routine data may be especially useful for examining issues related to social justice such as health inequities. However, little is known about the extent to which RCD is utilised in health fields and published for wider dissemination. Objectives The objective of this scoping review is to document the peer-reviewed published research in allied health fields which utilise RCD and evaluate the extent to which these studies have addressed issues pertaining to social justice. Methods An enhanced version of the Arksey and O’Malley’s framework, put forth by Westphalm et al. guided the scoping review. A comprehensive literature search of three databases identified 1584 articles. Application of inclusion and exclusion criteria was piloted on 5% of the papers by three researchers. All titles and abstracts were screened independently by 2 team members, as were full texts. A data charting framework, developed to address the research questions, was piloted by three researchers with data extraction being completed by the lead researcher. A sample of papers were independently charted by a second researcher for reliability checking. Results One hundred and ninety papers were included in the review. The literature was diverse in terms of the professions that were represented: physiotherapy (33.7%) and psychology/mental health professions (15.8%) predominated. Many studies were first authored by clinicians (44.2%), often with clinical-academic teams. Some (33.25%) directly referenced the use of their studies to examine translation of research to practice. Few studies (14.2%) specifically tackled issues pertaining to social justice, though many collected variables that could have been utilised for this purpose. Conclusion Studies operationalising RCD can meaningfully address research to practice gaps and provide new evidence about issues related to social justice. However, RCD is underutilised for these purposes. Given that vast volumes of relevant data are routinely collected, more needs to be done to leverage it, which would be supported by greater acknowledgement of the value of RCD studies

Enhancing communication through gesture and naming therapy

Purpose: This study investigated whether gesture, naming and strategic treatment improved the communication skills of 14 people with severe aphasia. Method: All participants received 15 hours of gesture and naming treatment (reported in a companion paper). Half the group received a further 15 hours of strategic therapy, while the remaining seven participants received no further input. The effects of therapy on communication were assessed with two novel measures. These required participants to convey simple messages and narratives to their communication partner. In both assessments a subset of the stimuli featured items that had been targets in gesture or naming treatment. Results: Performance on the communication measures was stable over two baseline assessments, but improved after gesture and naming treatment. Those who received additional strategic therapy made further gains on the message but not the narrative task. Communication gains were not specific to the stimuli featuring trained items. Conclusions: This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear cut, but did impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills, rather than the use of trained gestures and/or words

Gesture and naming therapy for people with severe aphasia: a group study

In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures

Preliminary outcomes from a pilot study of personalised online supported conversation for participation intervention for people with Aphasia

Background Aphasia negatively impacts face-to-face social participation and the difficulties that people experience using the phone exacerbate these challenges in staying in touch with family and friends. Videoconferencing enables multimodal communication, and teamed with supported conversation, could facilitate access to conversation and thereby increase social participation for people with chronic aphasia. Aims This pilot study examined whether supported conversation provided over Skype could improve people’s social participation. It reports on preliminary outcomes of this intervention on people’s social network, communication confidence, aphasia-related quality of life, and mood. Methods & Procedures 29 participants with chronic aphasia received an initial 2-hour technology training session followed by 16hours of online supported conversation for participation intervention provided by qualified or student speech and language therapists. The intervention was personalised by individualising goals in technology, communication, and participation. An observational prospective cohort study design was used with baseline, immediately post-intervention, and 8-week follow-up assessments. Measures of social network and communication confidence (primary outcome measures), and aphasia-related quality of life, life participation, and mood (secondary outcome measures) were undertaken. Shapiro-Wilk tests were conducted to examine normality of distribution of each variable. Where data were normally distributed, one-way repeated-measures ANOVAs were used to examine the effect of time. Where data were not normally distributed, Wilcoxon Signed Ranks test was used. Outcomes & Results: 27 participants completed the intervention. As a group, participants reported significantly more social contacts, more life participation, and higher aphasia-related quality of life post-intervention, which were maintained. There was a group gain on the measure of communication confidence post-intervention, although this was not maintained. As a group, the participants’ mood did not significantly change through intervention and follow-up. Individual variability was noted across all outcome measures. Conclusions: These preliminary findings suggest that relatively low dose and non-intensive online supported conversation for participation intervention delivered by qualified or student speech and language therapists improved social participation in some people with aphasia and improved their quality of life. Communication confidence also improved for some, although benefits were short term. Findings make novel contributions to the existing supported conversation evidence base with positive social participation and quality of life outcomes, likely achieved by the explicit participation focus. Whilst preliminary findings are positive, study limitations need addressing. Further investigations are merited to refine the intervention and outcome measure choice and capture feasibility data. Finally, a definitive controlled trial is needed to explore the clinical efficacy and cost-effectiveness

Technology-Enhanced Reading Therapy for People With Aphasia: Findings From a Quasirandomized Waitlist Controlled Study.

Purpose This study investigated the effects of technology-enhanced reading therapy for people with reading impairments, using mainstream assistive reading technologies alongside reading strategies. Method The study used a quasirandomized waitlist controlled design. Twenty-one people with reading impairments following stroke were randomly assigned to receive 14 hr of therapy immediately or after a 6-week delay. During therapy, participants were trained to use assistive reading technology that offered a range of features to support reading comprehension. They developed skills in using the technology independently and in applying the technology to their personal reading goals. The primary outcome measure assessed reading comprehension, using Gray Oral Reading Test-Fourth Edition (GORT-4). Secondary measures were as follows: Reading Comprehension Battery for Aphasia-Second Edition, Reading Confidence and Emotions Questionnaire, Communication Activities of Daily Living-Second Edition, Visual Analog Mood Scales, and Assessment of Living With Aphasia. Matched texts were used with the GORT-4 to compare technology-assisted and unassisted reading comprehension. Mixed analyses of variance explored change between T1 and T2, when the immediate group had received therapy but the delayed group had not, thus serving as untreated controls. Pretherapy, posttherapy, and follow-up scores on the measures were also examined for all participants. Results GORT-4 results indicated that the immediately treated group improved significantly in technology-assisted reading following therapy, but not in unassisted reading. However, the data were not normally distributed, and secondary nonparametric analysis was not significant. The control group was unstable over the baseline, improving significantly in unassisted reading. The whole-group analysis showed significant gains in assisted (but not unassisted) reading after therapy that were maintained at follow-up. The Reading Confidence and Emotions Questionnaire results improved significantly following therapy, with good maintenance of change. Results on all other secondary measures were not significant. Conclusions Technology-assisted reading comprehension improved following the intervention, with treatment compensating for, rather than remediating, the reading impairment. Participants' confidence and emotions associated with reading also improved. Gains were achieved after 14 therapy sessions, using assistive technologies that are widely available and relatively affordable, meaning that this approach could be implemented in clinical practice