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JCPSLP Volume 15, Number 1 2013 5
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
Equipment grant.
References
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.
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