JCPSLP VOL 15 No 1 March 2013

completed all assessments and a short therapy block (P1 and P2). P1 was a 53-year-old male who experienced a left thalamic and internal capsule haemorrhage on 30 March 2011 secondary to hypertension. P1 had been previously employed as the manager of a store, but had not been working for approximately 3 months prior to his stroke. At the time of entry into the study (approximately 10 months post-stroke), P1 was attending weekly outpatient speech pathology rehabilitation services. P1 reported that he had not used a computer previously. P2 was a 65-year-old male who experienced a left posterior cerebral artery infarct extending to middle cerebral artery territory on 16 February 2012 while in intensive care for a spinal injury resulting from a fall, which affected upper and lower limbs. P2 was employed as a civil engineer at the time of his hospital admission. At the time of P2’s entry into the study (approximately 1 month post-stroke), P2 was an inpatient in the spinal rehabilitation ward with limited communication therapy from acute services. P2 reported that he had used a computer extensively prior to the study including for work, leisure, Skype, banking and email. Procedure Ethical clearance was obtained from the Queensland Health Metro South Human Research Ethics Committee and the University of Queensland Medical Research Ethics Committee. Participants completed an initial assessment session, a block of computer-based therapy (originally designed to be up to 2 months long), and a final assessment session. The initial and final assessment sessions involved the Western Aphasia Battery (WAB; Kertesz, 1982), a 200-item naming battery (Whiting, Chenery, Chalk, & Copland, 2007), and a customised questionnaire about participants’ previous use of computers, and their attitudes and confidence towards using computers. The questionnaires included items about how comfortable participants felt using a computer (visual analogue scale ranging from not comfortable through to very comfortable), whether participants had used a computer in the past (yes/no; if yes – what had they used a computer for in multiple choice format), and whether they liked doing therapy on their own (visual analogue scale ranging from dislike through to like). The post questionnaire included additional items about whether participants needed help to use the computer (yes/no), whether participants felt that the computer therapy was helpful (yes/ no), whether participants would be happy using a computer for therapy again (yes/no), whether participants would be happier having all their therapy with a speech pathologist (yes/no), and what participants liked and disliked about computer therapy (free text responses). From the 200 naming battery, 24 items that were named incorrectly were randomly selected as target items. The treated items were then randomly divided into two lists (each of 12 items) for input into the computer-based exercises. The lists were limited to sets of 12 items at a time as this was the maximum number of items allowed by the software program StepByStep©. The two sets of 12 items were treated consecutively. The computer-based therapy exercises were provided on a Motion CL900 tablet computer loaded with StepByStep home version 4.5 software (Mortley et al., 2004). StepByStep was selected for this study because of its capacity for customisation of tasks and the fact that it was developed specifically for independent use by

et al., 2004; Wade et al., 2003). There has been limited research into the effects of computer-based therapy for patients during the earlier recovery stage. Of this limited body of research, the studies by Laganaro, Di Pietro, and Schnider (2003 and 2006) looked at providing computer- based anomia therapy as an adjunct to standard speech pathology intervention in very small patient numbers and used unsupervised practice of computer tasks at scheduled times with a speech pathologist available for assistance. Additionally, in Laganaro et al. (2006) the computer-therapy was conducted over a short period of time (one week of therapy for each of the two stimulus lists). There are no reports of research that has investigated the use of tablet computers with self-directed therapy schedules. Tablet computers present a number of benefits over more conventional desktop computers and laptops. For example, tablet computers offer the ability to increase therapy accessibility (beyond that of a desktop computer), as the tablet can be used in virtually any location including at the patient’s bedside and any time, including over the weekend; thus, negating the need to organise computer room bookings. Another advantage of tablet computers is that they often weigh less than laptop computers and can easily be transported home with patients. The touch screen input of a tablet computer may provide an easier input mode than traditional keyboards or mice for patients with fine motor limitations. However, it is also possible that this new way of navigating (i.e., using a touch screen) may be more difficult for some individuals, at least during the learning phase. 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) participants’ attitudes towards computer-based therapy, and whether these attitudes changed following a block of self-directed computer-based therapy. Methodology Participants Participants were recruited from the inpatient rehabilitation services at a tertiary hospital. Inclusion criteria included a primary diagnosis of mild to moderate anomic aphasia and cognitive status adequate to learn to use the program (with the aid of an aphasia-friendly guide). Potential participants were excluded if they presented with global aphasia, moderate-severe comprehension difficulties, moderate- severe apraxia of speech, or moderate-severe cognitive problems. It was anticipated that 10 inpatient rehabilitation patients would be recruited over approximately 10 months. Recruitment was slower than anticipated in the clinical environment due to a number of factors including difficulties obtaining consent (either from patients with aphasia or their relatives) and unexpected discharges or transfers to other facilities resulting in cessation of the program. Due to slow recruitment, outpatient rehabilitation patients were also approached. However, over the course of 12 months only eight individuals were identified as potential participants by their treating clinicians, of which five consented and undertook baseline assessment. Scheduling issues with other rehabilitation services led to three participants withdrawing from the study; thus only two participants

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JCPSLP Volume 15, Number 1 2013

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