JCPSLP VOL 15 No 1 March 2013

was not undertaken as originally planned. Difficulties with recruitment and the time constraints of a full clinical load may lead to recruitment to research projects receiving a lower priority. Consideration also needs to be given to natural fluctuations in participant recruitment and to the potential of some disorders (e.g., stroke) to experience seasonal variations in incidence (Saloheimo, Tetri, Juvela, Pyhtinen, & Hillbom, 2009). The likelihood of successful study completion can be maximised through careful design of clinical research projects with the recruitment and scheduling of participants embedded into the clinical pathway. Conclusion Overall, both participants displayed improved naming of treated items, and a non-significant improvement in general language scores, suggesting that item-specific improvements in naming occurred, rather than a broad improvement in general language function. Interestingly, despite unlimited access to the program and tablet, participants used the program less than expected. Nevertheless, participants displayed positive reactions to the computer program StepByStep and to the use of a computer tablet for delivering therapy. Both participants reported being willing to use computer-based aphasia therapy again. 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. Acknowledgements The tablet computers and software were purchased with the assistance of a Rural Stroke Outreach Service Adrian, J. A., Gonzalez, M., & Buiza, J. J. (2003). The use of computer-assisted therapy in anomia rehabilitation: A single case report. Aphasiology , 17 (10), 981–1002. Adrian, J. A., Gonzalez, M., Buiza, J. J., & Sage, K. (2011). Extending the use of Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) in people with aphasia. Journal of Communication Disorders , 44 , 666–677. Archibald, L. M. D., Orange, J. B., & Jamieson, D. J. (2009). Implementation of computer-based language therapy in aphasia. Therapeutic Advances in Neurological Disorders , 2 (5), 299–311. Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery. Stroke , 34 , 987–993. Brady, M. C., Kelly, H., Godwin, J., & Enderby, P. (2012). Speech and language therapy following stroke. Cochrane database of systematic reviews . Issue 5. Art. No.: CD000425. doi: 10.1002/14651858.CD000425.pub3. Denes, G., Perazzolo, C., Piani, A., & Piccione, F. (1996). Intensive versus regular speech therapy in global aphasia: A controlled study, Aphasiology , 10 (4), 385–394. Fink, R., Brecher, A., Sobel, P., & Schwartz, M. (2005). Computer-assisted treatment of word retrieval deficits in aphasia, Aphasiology , 19 (10–11), 943–954. Kertesz, A. (1982). The Western Aphasia Battery . Stratton, New York: Psychological Corporation. Equipment grant. References

minimised if the research design used multiple baseline assessment along with treated and untreated naming lists. The potential influence of the traditional interventions that the participants were also receiving cannot be discounted and future research should make use of research designs that isolate treatment effects. One of the most interesting findings of the study was that despite participants being provided with unlimited access to the computer-based aphasia therapy, participants used the program much less than expected and requested by the researchers. These findings are in contrast to the literature which reports higher intensity of use of the StepByStep therapy program (Mortley et al., 2004). The reasons for the current study’s results remain unclear, although P2 did report some boredom with the tasks and the interruptions due to technical problems may have discouraged ongoing use. It is also important to note that P2 had a busy rehabilitation schedule within the spinal unit. In the case of P1 his lack of experience using computers may have led to his limited use of the tablet for therapy. However, despite not using the program as much as directed P1 reported being able to complete the therapy on the tablet independently, as well as increased willingness to use technology. Some important considerations for further studies and clinical practice utilising self-directed therapy will be issues of saliency of tasks and individual motivation. Overall, the participants reported enjoying completing the therapy program on the tablets. Interestingly, P1 who had not previously used a computer reported increased confidence with computers, whereas P2 who had previously used a computer extensively reported being less confident with computers following the program. It is possible that in the case of P1, using the computer program reduced some of his apprehension about computers, while P2 may have become more aware of his current functional limitations, with respect to technology compared to his previous ease of use. P2 also reported needing assistance from his spouse. It is an interesting sidenote that P2 did go on to purchase his own mobile touch device after completing the study. From the perspective of the speech-language pathologist who programmed the therapy tasks, there were a couple of initial challenges in using the StepByStep program. While the tablet computer had an adequate screen resolution for the therapy program, its 10-inch screen was slightly too small for easy touch use when inputting the therapy tasks. A larger screen (e.g., 12-inch) would overcome this and reduce the time taken to input the therapy items. Another challenge was that only 12 stimulus items were able to be included in the exercises at any given time. This limitation resulted in more frequent changes to therapy tasks in order to maintain participant interest and progress. This in turn had implications for scheduling sessions. As with other devices loaned to patients, issues of infection control and insurance presented themselves in this study. Closely related to this were the warranties for the tablets to ensure that any breakdowns were repaired at no cost to the hospital. However, it is important to note that the tablet used in this study was the first with the Windows operating system to be released in Australia, and inherent within that is the potential for emerging technology to experience more technical problems. The implementation of clinical research can be difficult. In the case of this study clinical realities and technical problems overwhelmed the research design and the study

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JCPSLP Volume 15, Number 1 2013

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