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sessions to supplement clinician-delivered therapy targeting the same therapy goals you have established together. You also provide feedback regarding the evidence you found to other speech-language pathologists at your monthly journal club and local aphasia special interest group, and share it with your line manager in supervision to assist with future service planning and provision of resources. Conclusion Following the EBP process helped answer a clinical question which may arise for clinicians working in aphasia rehabilitation. The use of the hospital librarian ensured a comprehensive literature search was undertaken; however, use of a simple speechBITE search revealed similar relevant articles and may have sufficed in answering the clinical question where time restrictions are posed. Consultation with research and EBP champions within the hospital/ health service in addition to librarians can also assist with the critical appraisal process. A team approach to EBP is useful in sharing findings with the clinical community to increase uptake of evidence into practice. References Armstrong, E., C. (1999). The well-built clinical question: The key to finding the best evidence efficiently. Wisconsin Medical Journal , 98 (2), 25–28. Cherney, L. R. (2010). Oral reading for language in aphasia (ORLA): Evaluating the efficacy of computer- delivered therapy in chronic nonfluent aphasia. Topics in Stroke Rehabilitation , 17 (16), 423–431. Davis, L., & Copeland, K. (2006). Computer use in the management of aphasia: A survey of practice patterns and opinions. Contemporary Issues in Communication Science and Disorders , 33 , 138–146. Finch, E., & Hill, A. J. (2014). Computer use by people with aphasia: A survey investigation. Brain Impairment , 15 (2), 107–119. Holland, A. L. (2014). iRehab: Incorporating iPads and other tablets in aphasia treatment. Seminars in Speech and Language , 35 (1), 1–2. Hoover, E. L., & Carney, A. (2014). Integrating the iPad into an intensive, comprehensive aphasia program. Seminars in Speech and Language , 35 , 25–37. Loverso, F., & Prescott, T. (1992). Microcomputer treatment applications in aphasiology. Aphasiology , 6 (2), 155–163. Marshall, J., Booth, T., Devane, N., Galliers, J., Greenwood, H., Hilari, K., . . . Woolf, C. (2016). Evaluating the benefits of aphasia intervention delivered in virtual reality: results of a quasi-randomised study. PLoS ONE , 11 (8). https://doi.org/10.1371/journal.pone.0160381 McKissock, S., & Ward, J. (2007). Do errors matter? Errorless and errorful learning in anomic picture naming. Neuropsychological Rehabilitation , 17 (3), 355–373. National Health and Medical Research Council. (2014). Aphasia rehabilitation best practice statements 2014. Comprehensive supplement to the Australian Aphasia Rehabilitation Pathway . Retrieved 11th April, 2017 http:// www.aphasiapathway.com.au/flux-content/aarp/pdf/2014- COMPREHENSIVE-FINAL-01-10-2014-1.pdf Power, E., Thomas, E., Worrall, L., Rose, M., Togher, L., Nickels, L., . . . Clarke, K. (2015). Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method. BMJ Open , 5 (7).

to determine the client’s confidence and experience in using technology. The severity of the person’s aphasia and the presence of other cognitive, communication, perceptual or physical impairments which may impact on their ability to participate in computer therapy need to be determined. The type of computer therapy programs available within their local service or to the person with aphasia is another factor to consider (Zheng et al., 2016). Selection of the appropriate clinical software programs and tasks for each patient needs to target the patient’s specific areas of deficit and therapy goals. When looking for software programs which target specific language domains, websites such as aphasiasoftwarefinder.org may be useful for speech- language pathologists; however, clinicians should be aware that many available commercial programs have not been evaluated within a research framework. The type and amount of feedback and cueing hierarchies within the software is also an important consideration, being a crucial component to language performance in aphasia (McKissock & Ward, 2007). Clinicians may need to be cognisant that some of advantages of clinician- delivered therapy, such as “the presence of immediate and specific feedback and online analysis of responses to enable adaption of task difficulty”, may not be as accessible in all computer programs (Zheng et al., 2016, p. 239 ). The level of clinician support (which may range from set up and troubleshooting support to provision of cueing) which can be provided in computer therapy should also be considered. The intensity of therapy that can be offered and whether or not the patient will undertake computer therapy independently as part of their own home practice needs to be determined (dependent on their access to resources and level of support required). Indeed, the optimal level of supervision and intensity varies widely in studies of computer therapy and is yet to be established in the literature (Zheng et al., 2016). Lastly, the clinician should consider their own training and confidence in using computer therapy and seek support where necessary (Davis & Copeland, 2006). To determine the efficacy of computer therapy in aphasia, further controlled studies are needed comparing computer therapy with clinician-delivered therapy, particularly in the acute and subacute stages of aphasia and other types of aphasia (i.e., fluent types). Evaluation of the cost effectiveness and maintenance effects of computer therapy would also be useful for clinicians and service managers. While guidelines such as the Aphasia Rehabilitation Best Practice Statements (2014) support the use of computer therapy as a therapy option for people with aphasia (Power et al., 2015), further synthesis of important factors clinicians should consider when implementing computer therapy in practice, would be helpful. Case scenario revisited Returning to the original clinical scenario, at your next appointment you explain to your client and their husband that there is some early research which suggests computer therapy could be as effective as clinician-delivered therapy for certain types of longstanding aphasia, but until more research is done we cannot say it is definitely as effective for all people with aphasia. Although your client is older than what was suggested by the evidence to gain benefit, considering their motivation, preferences, lack of other concomitant disorders and good computer literacy, you would recommend she trial additional computer therapy

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