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Computer-assisted assessment and intervention
2
JCPSLP
Volume 15, Number 1 2013
Journal of Clinical Practice in Speech-Language Pathology
Emma Finch
(top), Kathy
Clark (centre)
and Anne J. Hill
This article
has been
peer-
reviewed
Keywords
anomia
aphasia
clinical
research
computer
therapy
tablet
computer
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
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
Using computer-based
therapy as an adjunct to
standard anomia therapy
Emma Finch, Kathy Clark and Anne J. Hill