JCPSLP VOL 15 No 1 March 2013

Computer-assisted assessment and intervention

Using computer-based therapy as an adjunct to standard anomia therapy Emma Finch, Kathy Clark and Anne J. Hill

Computer-based therapy has the potential to increase the intensity of therapy for individuals with aphasia. The aim of our project was to investigate the effectiveness of providing computer-based aphasia therapy as an adjunct to standard speech pathology treatment approaches in the inpatient rehabilitation ward setting. Secondary aims were to 1) investigate the frequency and length of usage of the self-directed computer therapy exercises by participants, and 2) investigate participants’ attitudes towards computer-based therapy, and whether these attitudes changed following a block of self-directed computer-based therapy. Two participant cases will be presented. Both participants displayed improved naming of treated items, and a non-significant change in general language function. The benefits and challenges encountered implementing computer-based therapy research in a hospital rehabilitation setting will also be discussed. The current paper suggests that computer-based aphasia therapy delivered by a tablet computer may have potential as a useful adjunct to standard clinical practice; however, a number of factors need to be considered before embarking on the implementation process. S troke is currently the second highest cause of death in Australia and a leading source of disability (National Stroke Foundation, 2010). Evidence suggests that up to 38% of stroke patients will experience aphasia, an acquired language disorder (Pedersen, Jorgensen, Nakayama, Raaschou, & Olsen, 1995) with debilitating social and psychological implications. Given Australia’s ageing population, there is increasing pressure on speech pathology services to meet these demands within existing staffing and funding levels. One health care area where this is experienced particularly strongly is in the adult hospital rehabilitation setting. As a result, there is a need to rapidly develop new service delivery models to meet this need. A

potential solution to this critical problem may be the use of computer-based therapy. Computer-based therapy has a number of potential benefits, including the potential to increase therapy intensity without a simultaneous increase in face-to-face clinician time (Adrian, Gonzalez, Buiza, & Sage, 2011). This is particularly relevant for aphasia therapy, as research suggests that high intensity therapy may be associated with positive communication outcomes (Bhogal, Teasel, & Speechley, 2003; Denes, Perazzolo, Piani, & Piccione, 1996); however, the optimal intensity remains unknown (Brady, Kelly, Goodwin, & Enderby, 2012). At a patient level, other potential benefits of computer-based therapy include the ability to provide mass exposure to items and a range of multi-sensory tasks; and a high level of self- direction with patients being able to control their own progress through the tasks, receive specific online feedback about task performance and select how to do the therapy (Adrian, Gonzales, & Buiza, 2003). At a service delivery level, computers can be used to extend the length of time that patients receive rehabilitation (Fink, Brecher, Sobel, & Schwartz, 2005) and enable rural and remote patients to receive a speech pathology service without a clinician being physically present. Despite the numerous benefits, a number of potential challenges to implementing computer-based therapy clinically have also been identified. These potential challenges include limited access to computers, financial costs associated with purchasing and maintaining technological equipment, and patients (especially older patients) viewing computers as intimidating (Fink et al., 2005). It has also been suggested that clinical time constraints may be a challenge as time is required to master the technology; however, once mastered it is generally found that computer-based therapy can be time efficient for clinicians (Fink et al., 2005; Mortley, Wade, & Enderby, 2004). Overseas research has demonstrated that computer- based therapy may be an effective rehabilitation approach for people with naming difficulties associated with aphasia (Adrian et al., 2011; Archibald, Orange, & Jamieson, 2009; Mortley et al., 2004; Wade, Mortley, & Enderby, 2003). Yet to date minimal research has investigated the effectiveness of computer-based aphasia naming therapy within an Australian hospital rehabilitation context. Furthermore, most previous research into computer-based therapy has focused on patients in the chronic stage of recovery (e.g., Adrian et al., 2011; Archibald et al., 2009; Mortley

Keywords anomia aphasia clinical research computer therapy tablet computer

This article has been peer- reviewed

Emma Finch (top), Kathy Clark (centre) and Anne J. Hill

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JCPSLP Volume 15, Number 1 2013

Journal of Clinical Practice in Speech-Language Pathology