Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study
We report a 12-week outcome study in which nine persons with long-term chronic aphasia received individual and group speech-language teletherapy services, and also used on-line language exercises to practice from home between therapy sessions. Participants were assessed at study initiation and completion using the Western Aphasia Battery, a portion of the Communicative Effectiveness Index, ASHA National Outcome Measurement System, and RIC Communication Confidence Rating Scale for Aphasia; additionally participants were polled regarding satisfaction at discharge. Pre-treatment and post-treatment means were calculated and compared, and matched t-tests were used to determine significance of improvements following treatment, with patterns of independent on-line activity analyzed. Analysis of scores shows that means improved on most measures following treatment, generally significantly: the WAB AQ improved +3.5 (p = .057); the CETI Overall (of items administered) — +17.8 (p = .01), and CCRSA Overall — + 10.4 (p = .0004). Independent work increased with time, and user satisfaction following participation was high.
Aftonomos, L. B., Steele, R. D., & Wertz, R. T. (1997). Promoting recovery in chronic aphasia with an interactive technology. Archives of Physical Medicine and Rehabilitation. 78, 841–846.
Aftonomos, L. B., Appelbaum, J. S., & Steele, R. D. (1999). Improving outcomes for persons with aphasia in advanced community-based treatment programs. Stroke, 30, 1370–1379.
Aftonomos, L. B., Steele, R. D., Appelbaum, J. S., & Harris, V. N. (2001). Relationships between impairment-level assessments and functional-level assessments in aphasia. Aphasiology. 15, 951–964.
Alarcon, N. B., & Rogers, M. A. (2012). Supported Communication Intervention for Aphasia. Rockville, MD: American Speech-Language-Hearing Association.
ASHA - American Speech-Language-Hearing Association. (2003). National Outcomes Measurement System (NOMS);
Adult Speech-Language Pathology User’s Guide. Available from www.redocsoftware.com/files/customers/sllp-adult-noms-for-redoc-suite-v78.pdf
Babbitt, E. M., Heinemann, A. W., Semik, P., & Cherney, L. R. (2011). Psychometric properties of the communication confidence rating scale for aphasia (CCRSA): Phase 2. Aphasiology, 25, 727-735.
Chapey, R., Duchan, J.F., Elman, R.J., Garcia, L.J., Kagan, A., Lyon, J.G., & Simmons-Mackie, N. (2001). Life participation approach to aphasia. In R. Chapey (ed.). Language intervention strategies in aphasia and related neurogenic communication disorders (4th ed.; pp. 235-245). Philadelphia, PA: Lippincott Williams & Wilkins.
Cherney, L.R., Patterson, J.P., Raymer, A., Frymark, T., & Schooling, T. (2008). Evidence-based systematic review: effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. Journal of Speech, Language, and Hearing Research, 51, 1282-1299.
Cherney, L.R., Babbitt, E.M., Semik, P., & Heinemann, A.W. (2011). Psychometric properties of the Communication Confidence Rating Scale for Aphasia (CCRSA): Phase 1. Topics in Stroke Rehabilitation, 18, 352–360.
Cherney, L.R., & vanVuuren, S. (2012). Telerehabilitation, Virtual Therapists, and Acquired Neurologic Speech and Language Disorders. Seminars in Speech and Language, 33, 243–257.
Duffy, J.R., Werven, G.W., & Aronson, A.E. (1997). Telemedicine and the diagnosis of speech and language disorders. Mayo Clinic Proceedings, 72, 1116–1122.
Elman, R. J. (2007). The importance of aphasia group treatment for rebuilding community and health. Topics in Language Disorders, 27, 300-308.
Elman, R. J., & Bernstein-Ellis, E. (1999). The efficacy of group communication treatment in adults with chronic aphasia. Journal of Speech, Language, and Hearing Research, 42, 411-419.
Frattali, C. M., ed. (1998). Measuring Outcomes in Speech-Language Pathology. New York, NY: Thieme.
Gaddie, A., Kearns, K., & Yedor, K. (1991). A qualitative analysis of response elaboration training effects. In T. E. Prescott (Ed.), Clinical Aphasiology (Vol. 21, pp. 171-184). Austin, TX: PRO-ED
Georgeadis, A. C., Brenna, D. M., Barker, L. M., Baron, C. R. (2004). Telerehabilitation and its effect on story retelling by adults with neurogenic communication disorders. Aphasiology, 18, 639-652.
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.
Hatch, E., & Farhady, H. (1982). Research design and statistics for applied linguistics. Rowley, MA: Newbury House Publishers.
Helm-Estabrooks, N., & Ramsberger, G. (1986). Aphasia treatment delivered by telephone. Archives of Physical Medication and Rehabilitation, 67(1), 51-53.
Hill, A., Theodoros, D., Russell, T., Ward, E, & Wootton, R. (2009). The effects of aphasia severity on the ability to assess language disorders via telerehabilitation. Aphasiology, 23, 627-642.
James, J. V. (1998). Tracking the right clues with exploratory data analysis. IEEE Spectrum, 38(8), 58-65.
Kagan, A. (1998). Supported communication for adults with aphasia: methods and resources for training conversation partners. Aphasiology, 12, 816-830.
Kearns, K. P. (1985). Response elaboration training for patient initiated utterances. In R.H. Brookshire (Ed.). Clinical Aphasiology (Vol. 15, pp. 196-204). Minneapolis, MN: BRK Publishers.
Kertesz, A. (1982). Western Aphasia Battery. New York, NY: Grune & Stratton.
Kertesz, A. (2006). Western Aphasia Battery–Revised. San Antonio, TX: PsychCorp.
Kiran, S., Des Roches, C., Balachandran, I., & Ascenso, E. (2013). Validation of an iPad-based therapy for language and cognitive rehabilitation in individuals with brain damage. Poster presented at the 2013 Annual Convention, American Speech-Language-Hearing Association, Chicago, IL.
Lasker, J. P., Stierwalt, A. G., Spence, M., & Calvin-Root, C. (2010). Using webcam interactive technology to implement treatment for severe apraxia: A case example. Journal of Medical Speech-Language Pathology, 18(4), 4-10.
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, 14, 885-897.
Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C. (1989). The communicative effectiveness index: development and psychometric evaluation of a functional measure for adult aphasia. Journal of Speech and Hearing Disorders. 54, 113–124.
McCall, D. (2012). Steps to Success with Technology for Individuals with Aphasia. Seminars in Speech and Language. 33, 234-242.
Naeser, M. A. (1975). A structured approach teaching aphasics basic sentence types. British Journal of Disorders of Communication. 10, 70-76.
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, 1621-1626.
Shewan, C., & Kertesz, A. (1984). Validity and reliability characteristics of the Western Aphasia Battery (WAB). Journal of Speech and Hearing Disorders. 45, 308–324.
Steele, R. D. (1995). Lingraphic methods in interface design. Proceedings of the International Workshop on Human Interface Technology IWHIT’95. Aizu, Japan: University of Aizu, 53–58.
Steele, R. D., Aftonomos, L. B., & Munk, M. W. (2003). Evaluation and treatment of aphasia among the elderly with stroke. Topics in Geriatric Rehabilitation. 19(2), 98–108.
Steele, R. D., Aftonomos, L. B., & Koul, R. K. (2010). Outcome improvements in persons with chronic global aphasia following the use of a speech-generating device. Acta Neuropsychologica. 8, 342–359.
Theodoros, D., Hill, A., Russell, T., Ward, E., & Wootton, R. (2008). Assessing acquired language disorders in adults via the internet. Telemedicine and e-Health. 14, 552-557. DOI: 10.1089/tmj.2007.0091
Tukey, J. (1977). Exploratory data analysis. Reading, MA: Addison Wesley.
Vaughn, G. R. (1976). Tel-communicology: Health-care delivery system for persons with communicative disorders. ASHA, 18,13–17.
Wertz, R. T., Dronkers, N. F., Bernstein-Ellis, E., Sterling, L.K. Shubitowski, Y., Elman, R., Shenaut, G. K., Knight, R.T., &
Deal, J.L. (1992). Potential of telephonic and television technology for appraising and diagnosing neurogenic communication disorders in remote settings. Aphasiology, 6, 195-202.
Youmans, G., Holland, A., Munoz, M., & Bourgeois, M. (2005). Script training and automaticity in two individuals with aphasia. Aphasiology, 10, 435-450.
Copyright (c) 2015 Richard D. Steele, Allison Baird, Denise McCall, Lisa Haynes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.