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1 Use of computers in chronic aphasia Hunter Region Acquired Communication Impairment (ACI) EBP Group Extravaganza 2011.

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Presentation on theme: "1 Use of computers in chronic aphasia Hunter Region Acquired Communication Impairment (ACI) EBP Group Extravaganza 2011."— Presentation transcript:

1 1 Use of computers in chronic aphasia Hunter Region Acquired Communication Impairment (ACI) EBP Group Extravaganza 2011

2 2 "Technophobia be gone?" "Man versus Machine" "Deus ex Machina" "Rise of the Machines"

3 3 Who are we? New clinical EBP group commenced late Focus on active member involvement. SPs from public, private, other government agencies, Newcastle University working in a range of clinical settings in the Newcastle/Hunter Region. Group Leaders: – Georgi Laney: – Sarah Bell:

4 4

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6 6 Clinical question Initial Clinical Question: Is computer-based therapy for word finding difficulties effective for people with aphasia? Education with Professor Alison Ferguson University of Newcastle (ACI EBP group academic affiliate) Final Clinical Question: Is computer-only therapy for people with chronic aphasia efficacious?

7 7 Definitions Computer-only therapy: = relates to treatment which is established & monitored by SP but where SP does not give therapeutic advice/feedback during treatment. Chronic aphasia: = aphasia of duration ≥ 6 months.

8 8 Search parameters Commenced with NSF Guidelines (2010). Usual search engines, evidence-based guidelines etc. Articles more than 15 years old were not reviewed. Single case studies not included in CAT.

9 9 Computer-based interventions: Interventions discussed in computer -based therapy literature: Script training Reading comprehension Naming, spoken naming Multi-modality software incl: spoken word matching, written word to pic matching, semantic associations, verbal naming, reading, spelling

10 10 CAT-articles Script training: Cherney & Halper (2008). Cherney, Halper, Holland and Cole (2008). Lee, Kaye & Cherney (2009). Manheim, Halper & Cherney (2009).

11 11 CAT - articles cont… Reading Comprehension: Cherney (2010). Naming: Mason, Nickels, McDonald, Moses, Makin & Taylor (2010). Ramsberger & Marie (2007).

12 12 CAT- articles cont…. Multiple modalities: Mortley, Wade & Enderby (2004). Pedersen et al (2001).

13 13 ArticleIndependentIntensity/ frequency Concurrent Therapy Target and software used Cherney, L.R., Halper, A.S. (2008). Weekly review with SP. Independent home practice. Minimum 30 mins daily Not clearly indicated Script training Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008). Weekly review with SP. Independent home practice. Minimum 30 mins daily Not clearly indicated Script training Cherney, L.R. (2010). Independent in experimental group. SP delivered therapy in control group. 24 hourly sessions total with 1-3 sessions/week No Reading

14 14 ArticleIndependentIntensity/ frequency Concurrent Therapy Target and software used Lee, J.B., Kaye, R.C., Cherney, L. R. (2009). Weekly review with SP. Independent home practice. Minimum 30 mins daily Not clearly indicated Script training Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009). Weekly review with SP. Independent home practice. Minimum 30 mins daily No Script training Aphasia Scripts Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010). Yes4 sessions/ week No Naming

15 15 ArticleIndependentIntensity/ frequency Concurrent Therapy Target and software used Mortley, J., Wade, J., Enderby, P. (2004). Yes Intensity not prescribed. Average usage of 2.45 hours per week. Not clearly indicated. Auditory processing, reading and spelling. Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001). YesIntensity not prescribed as software relied upon criterion performance. Not clearly indicated. Semantic, written and phonological tasks. Ramsberger & Marie (2007). First 2 sessions with SP, then individual practice. High intensity: 5 days /week. Low intensity: 2 days/week. No Naming.

16 16 ArticleSample size Age range Time post- stroke Design & Level of evidence Outcome Measures Maintena nce Cherney, L.R., Halper, A.S. (2008) years Level IVWAB QCL CADL-2 Exit interview Not assessed Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008) months Level IVWAB QCL CADL-2 Exit interview Not assessed Cherney, L.R. (2010) months Randomised Control trial Level II WAB- AQWAB reading and writing subtests Discourse analysis Not assessed

17 17 ArticleSample size Age range Time post- stroke Design & Level of evidence Outcome Measures Maintena nce Lee, J.B., Kaye, R.C., Cherney, L. R. (2009) months Level IVWAB-AQ.Not assessed Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009) months Delayed treatment design Level IV BOSS: Communicatio n difficulty & Mobility, communication associated psychological distress subtests 6 weeks Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010) years Level IVNaming accuracy. 10 minute speech sample. 3 weeks

18 18 ArticleSample size Age range Time post- stroke Design & Level of evidence Outcome Measures Maintenance Mortley, J., Wade, J., Enderby, P. (2004) years Level IVObject & action naming battery, PALPA 47 & 48, exit interview 1 week & 6 weeks Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001) months Level IVWAB-AQ, PALPA S&V naming 2 months Ramsberger & Marie (2007) months – 6 years Level IVWAB BNT1 month

19 19 Clinical bottom line What we think…. Any person with aphasia (without cognitive impt) can learn to use a computer even if this is a new skill. Computer-only therapy is worth a go! Use of computers can increase therapy intensity and we know intensity is good.

20 20 Clinical bottom line What we don’t know……. Is it the use of computers or increased intensity that is affecting the change? Is one particular program more effective than another? Is there an optimal amount of clinical intervention that should be used in conjunction with computer based therapy? How long does generalisation last?

21 21 What next? Clinical implications….. Further education on levels of evidence & research design. Investigate possibility of research or student project focusing on collating information about available computer therapy programs. Trial in workplace. Review literature and revise CAT in months.

22 22 What next?..... Other….. More communication with Adult Language group in Sydney. Leaders to be more involved in EBP Network Leaders meetings. Encourage other regional groups to be developed.

23 23 CAT-references Cherney, L.R., Halper, A.S. (2008). Novel technology for treating with aphasia and concomitant cognitive deficits. Topics in Stroke Rehabilitation, 15, Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008). Computerized script training for aphasia: Preliminary results. American Journal of Speech Language Pathology, 17(1), Cherney, L.R. (2010). Oral Reading for language in aphasia (ORLA): evaluating the efficacy of computer-delivered therapy in chronic non-fluent aphasia. Topics in Stroke Rehabilitation, Nov-Dec,

24 24 CAT-references Lee, J.B., Kaye, R.C., Cherney, L. R. (2009). Conversational script performance in adults with non-fluent aphasia: Treatment intensity and aphasia severity. Aphasiology, 23 (7- 8), Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009). Patient- reported changes in communication after computer-based script training for aphasia. Archives of Physical and Medical Rehabilitation, 90(4), Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010). Treatment of word retrieval impairments in aphasia: evaluation of a self- administered home programme using personally chosen words. Aphasiology, 1-24.

25 25 CAT-references Mortley, J., Wade, J., Enderby, P. (2004). Superhighway to promoting a client-therapist partnership? Using the internet to deliver word-retrieval computer therapy, monitored remotely with minimal speech and language therapy input. Aphasiology, 18, Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001). Improvement of oral naming by unsupervised computerised rehabilitation. Aphasiology, 15 (2), p Ramsberger, G. & Marie, B. (2007). Self administered cued naming therapy: a single –participant investigation of a computer-based therapy program replicated in four cases. American Journal of Speech Language Pathology, 16,

26 26 Other useful references Archibald, L., Organe, J. B., Jamieson, D. J. (2009). Implementation of computer-based language therapy in aphasia. Therapeutic Advances in Neurological Disorders, 2, Bilda, K. (2011). Video-based conversational script training for aphasia: A therapy study. Aphasiology, 25 (2), Crerar, MA., Ellis, AW., & Dean, EC. (1996). Remediation of Sentence Processing Deficits in Aphasia Using a Computer- Based Microword. Brain & Language, 52,

27 27 Other useful references Katz, R. (2010). Computers in the treatment of chronic aphasia. Seminars in Speech & Language, 31(1), Laganaro, M., Di Pietro, M., & Schnider, A. (2006). Computerised treatment of anomia in acute aphasia: Treatment intensity and training size. Neuropsychological Rehabilitation, 16(6), Mortley, J., Enderby, P., Petheram, B. (2001). Using a computer to improve functional writing in a patient with severe dysgraphia. Aphasiology, 15, Raymer, A.M., Kohen, F.P. & Saffell, D. Computerised training for impairments of word complrehension and retrieval in aphasia. Aphasiology, 2006, 20 (2/3/4),

28 28 Other useful references Wertz, R.T., Katz, R.C. (2004). Outcomes for computer- provided treatment for aphasia. Aphasiology, 18, Please see CAT for complete bibliography. Please see EBP website for table summarising articles included in CAT.

29 29 Thank you! Hunter Region ACI EBP Group members: Kerrie Strong Luisa Renna Megan Alston Renae Mannix Nathan Haywood Jo Steel Paula Machin Danielle Rose Amanda Freund Sue Sherratt Monica Anderson Amanda Schumacher Alison Ferguson Sarah Bell Georgi Laney


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