From the Department of Clinical Neurosciences at the University of Cambridge comes a new study on iPad speech therapy for patient’s with chronic aphasia resulting from a stroke. It follows other studies we’ve covered using gamification apps in stroke care.
The road to recovery after a stroke can be tough in part because the effects of the stroke often manifest in ways that have a profound impact on day to day life. While the ubiquity and accessibility mobile technology & apps make them appealing platforms through which to deliver support and therapy, the quality of stroke apps on the market now leaves much to be desired. Clearly there is a need for more validated stroke apps.
In this study, researchers recruited patients who were at least 1-year post left MCA stroke, with English as their first-language, and expressive (Broca’s) aphasia from a 200-patient sample at the Addenbrookes Hospital stroke service in the UK. Patients were screened for cognitive impairment and also their performance on the popular Cookie Theft Description test (CTPD) and the Comprehensive Aphasia Test (CAT). Patients were selected at 1-year after the stroke to decrease effects of normal recovery on the aphasia from altering the data. Patients who were excluded from the test based on this screening were primarily too high-functioning in terms of aphasia level, although one was excluded due to poor comprehension. 10 patients, ranged from 54 to 87 in age, at 12-67 months post-stroke, were included in the study.
The Language Therapy app by Tactus Therapy Solutions, along with an iPad, was provided to each patient (app was donated by company for study). Reading, Naming, Comprehension, and Writing categories are all included within the app, with over 700 nouns, verbs, and adjectives, in addition to UK or US English versions.
Initially, a pilot study was conducted with 3 patients, using the therapy app. This was followed by a crossover study with 7 patients, comparing the app with a non-language mind-game app, the popular Bejeweled puzzle game. Patients were allowed to self-select their use of the speech app, after it was recommended they spend 20 minutes daily with it, providing for a self-delivered therapy model.
Both the CAT and CTPD scores improved significantly for the speech therapy app, with no improvement noted for the mind-game app. No relationship was found between the amount of training on the speech app and the improvements seen. Interestingly, only 3 of the 10 patients had ever used an iPad prior to the study. Also of note is Bejeweled was shown, strangely enough, to also have an effect when used after completing Language Therapy app training, and could be utilized as a “maintenance” mechanism post-therapy per the authors. Finally, data from five patients was reviewed again at 6 months post-therapy, and found to have maintained the gains they made.
This study is interesting, not only for its encouraging findings for stroke care, self-directed aphasia therapy through a handy iPad app but also in regards to its patient population. The patients were primarily elderly and had little to no experience with a tablet prior to the study, yet they did well in self-reported adherence and follow-up after just a short instructional on the app. It would be great to see how such an app could be utilized within not only the chronic aphasia population but also within patients in acute rehabilitation settings in future studies.