JMIR Publications

ABSTRACT

Background:

Aphasia is a language deficit, most often caused by stroke. Speech-language therapy is effective in helping people recover lost language and should lead to generalization to untrained tasks and gains in functional language. However, not everyone is able to receive therapy due to lack of finances, insurance coverage or, most recently, COVID-19.

Objective:

This study has three aims. In aim one we investigated whether a person with moderate to severe aphasia could manage the set-up of an app-based treatment independently. Our second aim was to evaluate whether conducting an intensive treatment without speech-language pathologist (SLP) involvement was feasible. Participants with aphasia (PWA) were asked to utilize the apps for 2 hours a day for 10 days and we were interested to see if they could maintain this regimen, or if frustration or boredom would promote drop-out. In the third aim we determined whether PWA in our digital treatment would make the same kinds of language gains they would if they were working with an SLP and whether treatment gains would generalize to other language modalities, indicating neuroplastic changes have occurred due to treatment.

Methods:

Our pilot study used a single-subject design, with three participants with nonfluent aphasia, each at least one-year post-stroke. Participants were trained to use a comprehension and production app and with instructions to use them for 2 hours a day, for 10 days (20 hours total treatment time). Multiple standardized assessments were taken at three-time points: pre-treatment, one-week post-treatment, and 10 weeks post-treatment. A recording device was used to capture pre- and 10-week post-treatment at-home conversations between the PWA and conversational partner.

Results:

Data were variable among our three participants (P1, P2, P3). P1 and P3 showed clinically significant improvements on several measurements of language; P2 did not. P1 and P3 also decreased in aphasia severity. Analysis of the discourse recorded in the home environments showed P1 and P3 each made use of the app-trained words in spontaneous conversation (increase>63%). All three PWA reported positive increases in quality-of-life and all continued to use the app even after the treatment period ended.

Conclusions:

Independently administered, intensive treatment had salubrious effects on three PWA. P2’s lack of improvement on language measures were attributed to not feeling challenged enough by the app. In general, the participants in this study were able to guide themselves in an independent manner to complete an intensive study, without using any SLP support. Though this study was only piloted on three individuals, it lays the groundwork for future studies assessing the independence of PWA in managing their own treatment.