JMIR Publications

ABSTRACT

Background:

Dysarthria is a common post-stroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of post-stroke dysarthria.

Objective:

This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute post-stroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting.

Methods:

Participants were divided into two groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy application for one hour per day, five days per week, for four weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated-measures Analysis of variance.

Results:

In this study, 40 patients with post-stroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1, 30 =34.35; P <.001), between-group differences (F1, 30 =6.18; P=.02), and notable time-by-group interactions (F1, 30 =6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1, 30 = 5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1, 30 =21.18; P<.001), with a pronounced group effect (F1, 30 =5.52; P=.03) and time-by-group interaction (F1, 30 =5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by three-level EuroQol five-dimensional questionnaire (F1, 30 =13.25; P<.001) and EuroQol visual analog scale (F1, 30 =7.74; P=.009) over time. The adherence rate to the smartphone-based application was 64%, with over half of the participants completing all the sessions. The usability of the application was rated high (system usability score=80.78). In addition, the intervention group reported increased self-efficacy in using the application compared with the control group (F1, 30 =10.81; P=.003).

Conclusions:

The smartphone-based speech therapy application significantly improved speech intelligibility, articulation, and quality of life in patients with post-stroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of post-stroke dysarthria, particularly in the acute and early subacute stroke stages. Clinical Trial: ClinicalTrials.gov NCT05146765