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JCPSLP Volume 15, Number 1 2013 3
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