Use of computers in chronic aphasia

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					   Use of computers in
     chronic aphasia
Hunter Region Acquired Communication
     Impairment (ACI) EBP Group
            Extravaganza 2011




                                       1
•   "Technophobia be gone?"
•   "Man versus Machine"
•   "Deus ex Machina"
•   "Rise of the Machines"




                              2
                     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

                                                          3
4
5
                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?                                                 6
                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.



                                                    7
           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.



                                             8
  Computer-based interventions:
Interventions discussed in computer -based
therapy 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


                                                 9
                CAT-articles
Script training:
• Cherney & Halper (2008).
• Cherney, Halper, Holland and Cole (2008).
• Lee, Kaye & Cherney (2009).
• Manheim, Halper & Cherney (2009).




                                              10
          CAT - articles cont…
Reading Comprehension:
• Cherney (2010).

Naming:
• Mason, Nickels, McDonald, Moses, Makin &
  Taylor (2010).
• Ramsberger & Marie (2007).

                                             11
          CAT- articles cont….
Multiple modalities:
• Mortley, Wade & Enderby (2004).
• Pedersen et al (2001).




                                    12
Article            Independent      Intensity/       Concurrent    Target and
                                    frequency        Therapy       software used
Cherney, L.R.,     Weekly review    Minimum 30       Not clearly   Script training
Halper, A.S.       with SP.         mins daily       indicated
(2008).            Independent
                   home practice.



Cherney, L. R.,    Weekly review    Minimum 30       Not clearly   Script training
Halper, A. S.,     with SP.         mins daily       indicated
Holland, A., &     Independent
Cole, R. (2008).   home practice.



Cherney, L.R.      Independent in   24 hourly        No               Reading
(2010).            experimental     sessions total
                   group.           with 1-3
                   SP delivered     sessions/week
                   therapy in
                   control group.

                                                                                13
Article            Independent      Intensity/    Concurrent    Target and
                                    frequency     Therapy       software used
Lee, J.B., Kaye,   Weekly review    Minimum 30    Not clearly   Script training
R.C., Cherney,     with SP.         mins daily    indicated
L. R. (2009).      Independent
                   home practice.
Manheim, L.        Weekly review    Minimum 30    No            Script training
M., Halper, A.     with SP.         mins daily
S., & Cherney,     Independent                                  Aphasia
L. R. (2009).      home practice.                               Scripts
Mason, C.,         Yes              4 sessions/   No            Naming
Nichels, L.,                        week
McDonald, B.,
Moses, M.,
Makin, K &
Taylor, C.
(2010).



                                                                             14
Article         Independent        Intensity/        Concurrent    Target and
                                   frequency         Therapy       software used
Mortley, J.,    Yes                Intensity not     Not clearly   Auditory
Wade, J.,                          prescribed.       indicated.    processing,
Enderby, P.                        Average usage                   reading and
(2004).                            of 2.45 hours                   spelling.
                                   per week.
Pendersen, P.,   Yes               Intensity not     Not clearly   Semantic,
Vinter, K. &                       prescribed as     indicated.    written and
Skyhoj Olsen, T.                   software relied                 phonological
(2001).                            upon criterion                  tasks.
                                   performance.
Ramsberger &    First 2 sessions   High              No            Naming.
Marie (2007).   with SP, then      intensity: 5
                individual         days /week.
                practice.          Low intensity:
                                   2 days/week.




                                                                                  15
Article          Sample Age     Time     Design & Level   Outcome     Maintena
                 size   range   post-    of evidence      Measures    nce
                                stroke
Cherney, L.R., 3        50-75   1-4      Level IV         WAB QCL     Not
Halper, A.S.                    years                     CADL-2      assessed
(2008).                                                   Exit
                                                          interview
Cherney, L.      3      65-78   18-48  Level IV           WAB QCL     Not
R., Halper, A.                  months                    CADL-2      assessed
S., Holland,                                              Exit
A., & Cole, R.                                            interview
(2008).
Cherney, L.R.    25     35-81   13 -253 Randomised        WAB-        Not
(2010).                         months Control trial      AQWAB       assessed
                                        Level II          reading and
                                                          writing
                                                          subtests
                                                          Discourse
                                                          analysis



                                                                                 16
Article        Sample Age     Time     Design & Level Outcome       Maintena
               size   range   post-    of evidence    Measures      nce
                              stroke
Lee, J.B.,     17     31-70   10-273   Level IV      WAB-AQ.        Not
Kaye, R.C.,                   months                                assessed
Cherney, L. R.
(2009).
Manheim, L. 20        26-78   10-238   Delayed       BOSS:          6 weeks
                              months   treatment     Communicatio
M., Halper, A.                                       n difficulty &
                                       design
S., &                                                Mobility,
                                       Level IV      communication
Cherney, L. R.
                                                     associated
(2009).                                              psychological
                                                     distress
                                                     subtests
Mason, C.,     3      37-59   5-8      Level IV      Naming         3 weeks
Nichels, L.,                  years                  accuracy. 10
                                                     minute
McDonald,
                                                     speech
B., Moses,                                           sample.
M., Makin, K
& Taylor, C.
(2010).
                                                                               17
Article          Sample Age     Time      Design & Level   Outcome      Maintenance
                 size   range   post-     of evidence      Measures
                                stroke
Mortley, J.,     7      53-66   2-12     Level IV          Object &     1 week &
Wade, J.,                       years                      action       6 weeks
                                                           naming
Enderby, P.
                                                           battery,
(2004).                                                    PALPA 47
                                                           & 48, exit
                                                           interview
Pendersen,       3      57-71   6-18     Level IV          WAB-AQ,      2 months
P., Vinter, K.                  months                     PALPA
                                                           S&V
& Skyhoj
                                                           naming
Olsen, T.
(2001).
Ramsberger       4      63-74   6 months Level IV          WAB BNT      1 month
& Marie                         – 6 years
(2007).




                                                                                   18
           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.


                                                   19
          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?
                                                  20
                   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.



                                                           21
               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.




                                                   22
                  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.

                                                                23
                   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.
                                                                 24
                 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.
                                                             25
           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.




                                                                 26
          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.
                                                               27
          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.




                                                               28
                Thank you!
Hunter Region ACI EBP Group members:
• Kerrie Strong            • Amanda Freund
• Luisa Renna              • Sue Sherratt
• Megan Alston             • Monica Anderson
• Renae Mannix             • Amanda Schumacher
• Nathan Haywood           • Alison Ferguson
• Jo Steel                 • Sarah Bell
• Paula Machin             • Georgi Laney
• Danielle Rose

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