JMIR Publications

ABSTRACT

Background:

People with aphasia (PwA) present with language and communication deficits, most notably in lexical retrieval (naming). Although positive outcomes in naming have been observed following speech-language treatment, many individuals with aphasia continue to face impairments after the acute phase of rehabilitation. Mobile application-based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia (PwA) as an adjunct or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment and have been shown to result in meaningful outcomes across several domains.

Objective:

VoiceAdapt is a mobile therapy app addressing naming impairments, designed within a user-centered design framework. The VoiceAdapt app uses two evidence-based lexical retrieval treatments to engage PwA to improve their naming abilities through interaction with the app. The purpose of this study was to conduct a randomized controlled trial (RCT) to examine the preliminary clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia.

Methods:

A two-arm, waitlist-controlled, crossover group RCT was conducted at two sites within Canada. Participants were randomized into an intervention group or a waitlist control group following baseline assessment. Intervention group participants completed five weeks of training with the app, followed by post-treatment assessment and follow-up assessment after an additional five weeks of no training. Those in the waitlist control group had five weeks of no training, followed by a pre-treatment assessment, training for five weeks and a post-treatment assessment. The primary outcome measure was naming performance; secondary outcomes included measures of overall language, communication and quality of life.

Results:

Thirty-seven PwA in the chronic stages participated in this study. Participants used the app for an average of 20 hours over the 5-week intervention phase. Training with VoiceAdapt resulted in an increase of 1.6 points on the Boston Naming Test (BNT) (Cohen’s d = 0.3). Evidence for improved naming was also observed on trained items as well as subtests of naming/word-finding on the Western Aphasia Battery-Revised (WAB-R). Training with the app also resulted in a significant increase in participants’ perceptions of their communication quality of life (increase of 0.1 points, Cohen’s d = 0.3) but no other measures (WAB-R Aphasia Quotient, Communicative Effectiveness Index) were significant.

Conclusions:

Individuals with aphasia who used the VoiceAdapt app for five weeks to target naming skills demonstrated measurable gains in naming and communication-based quality of life. Notably, these changes were observed in a remotely delivered program, in participants who were in the chronic stages of aphasia. These findings inform the profession on the use of app-based home therapy programs as an accessible cost-effective option for individuals in the chronic stages of recovery who often have limited options for rehabilitation. Clinical Trial: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364