Self-Delivered Speech Therapy Feasible for Aphasia in Stroke

June 17, 2015

A speech therapy program self delivered daily by use of an application for tablet computer significantly improved language scores in chronic stroke patients with aphasia, in a new pilot study.

Brielle Stark, a PhD student, at the University of Cambridge in the United Kingdom (UK), concluded that such self-delivered app-based programs may be an effective and affordable way of ensuring that chronic stroke patients gain access to the regular high-dose speech therapy they need.

"Speech therapy is hugely labor intensive," she said. "This program would not replace speech therapists but would be complementary to them. The speech therapist could set exercises to do on a tablet as homework between sessions."

The study was presented at the recent 24th European Stroke Conference (ESC).

Commenting for Medscape Medical News, Pam Enderby, MBE DSc, professor of speech therapy at Sheffield University, UK, called the study "a great contribution."

"It is so important to be looking at technology for aphasia," she said. "Intensity of therapy is vital for stroke patients with aphasia, but costs do not allow daily sessions with a speech therapist. Aphasia therapy is therefore definitely going to have incorporate technology."

Stark explained that about one third of patients with stroke develop aphasia, and only 20% fully recover, so it often becomes a chronic condition. "Language and speech therapy is effective in aphasia and high dosage is most effective, but access to speech therapy is very variable."

She added that in the UK, most patients with aphasia will have to wait up to 6 months for speech therapy, and then will only get one session a week for about 8 weeks. "I'm sure this is not just a UK problem," she said. "In the US similar problems occur because health insurance often does not cover speech therapy past a certain number of months."

She noted that the introduction of tablet technology makes self-delivered high-dosage speech therapy available.

The current study, known as CATCH (Computerized Aphasia Therapy in CHronic stroke), was a proof-of-concept study to see whether self-delivered tablet-based speech therapy is effective and feasible.

Participants were recruited from Addenbrookes Hospital, Cambridge, UK, discharge records. They were aged 54 to 85 years and had persistent expressive aphasia after having had a left middle cerebral artery territory stroke more than 12 months previously. They had good comprehension.

The first phase of the study, which aimed to test dosage parameters, included three patients who underwent 20 minutes of therapy every day for 4 weeks. The speech therapy was delivered by an application known as Language Therapy, developed by Tactus Therapy Solutions, a company driven by a speech therapist. The program provided feedback after each exercise.

This first phase dosage proved effective, so a second crossover phase in seven patients was performed where the speech therapy program was compared with a nonlanguage brain training game involving spatial and pattern recognition.

Patients underwent baseline language tests and were then allocated to 20 minutes of language or nonlanguage exercises every day for 4 weeks. They then crossed over to the other intervention. They underwent assessment by Comprehensive Aphasia Test (CAT) at end of each 4-week period.

Spoken language scores significantly improved in the speech therapy period, but there was no percentage change in language scores in the nonlanguage brain training period.

All but one of the patients who did the speech therapy first had no significant change in language scores after the second phase (nonlanguage brain training) but importantly, they maintained the improvement achieved during the first period of speech therapy.

One patient had further language improvement during the second nonlanguage period, but this patient was by far the most impaired patient at the start, so the gain may have appeared larger, Stark reported.

"A small amount of therapy every day seems to be effective," she said. "Brain training alone didn't seem to show any effect on language scores but did seem to enable gains to be maintained."

She added: "Our results suggest that that we can now go forward to a much larger clinical trial." She also pointed out that use of tablets was feasible in these mid-aged to older stroke patients.

"Going into this, there was a feeling that these older individuals would not like using a tablet, but we did not find this at all," she noted. "Compliance was great. No one did not achieve the recommended dosage of 20 minutes a day, and some patients were doing up to 2 hours a day. All said they found it easy to use."

Ms Stark reports she is personally funded by the Gates Cambridge Trust. Funding for tablet computers was provided by the Department of Clinical Neurosciences, Cambridge. Ms Stark has disclosed no relevant financial relationships.

24th European Stroke Conference (ESC). Presented May 14, 2015.

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