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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
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
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).
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://
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).