Augmenting Aphasia Therapy with Language-based Software and Speech Generating Device-Assisted Approaches.
Andrew F. Jinks
UPMC Center for Assistive Technology
Pittsburgh, PA., 15203
ABSTRACT
Three cases are presented of individuals in acute and chronic stages of recovery that benefited from a combination of traditional outpatient aphasia therapy; language therapy software; and use of speech generating device-assisted therapy. Improvements in speech production, word retrieval, repetition skills, oral reading and reading comprehension were demonstrated. Implications for use of assistive technology as an adjunct to traditional aphasia therapy will be reviewed.
KEYWORDS
Aphasia, assistive technology, computer software, speech generating device
BACKGROUND
Provision of language therapy for aphasia remediation has traditionally focused on use of stimulus-response tasks, functional communicative interactions, and workbook activities. Areas of language remediation may include: auditory comprehension, language expression, repetition, word retrieval, reading comprehension, and writing skills. Use of computer-based language therapy activities have been used for a number of decades.
The primary use of speech-generating devices has been for individuals with severe communicative impairments. These synthesized and digitized speech output devices provide text-to-speech or symbol-to-speech communication for individuals who are unable to convey novel utterances. This paper provides incorporation of three methods of therapy: traditional, software-based, and speech generating device-assisted therapy. The combination of these approaches provided language stimulation and therapy in the outpatient regimen of 3 patients who exhibited mild-moderate non-fluent aphasia.
CASES:
- Case 1 – DT is a 44-year.old.woman., 4 years status-post left CVA secondary to an aneurysm rupture. She was ambulatory and lived alone with family nearby. She presented with mild-moderate anomic aphasia and right sided visual field cut.
- Case 2 – WR is a 54 year-old man, who was seen one month post onset ischemic left CVA. He walked with assistance of a cane, lived with his wife, and initially presented with moderate Broca’s aphasia and moderate visual-perceptual deficits.
- Case 3 – ZL is a 59 year-old woman, who was seen one month post onset left brainstem CVA. The patient was ambulatory, lived with friends and presented with moderate anomic aphasia.
METHOD
Figure 1 – Parrot Software (Click for larger view) All patients participated in outpatient therapy on a 2-3 times per week basis, over a 3-6 month period. All patients received all three types (traditional, language software, and speech generating device-assisted) of therapy, throughout their outpatient programs.
Traditional therapy tasks were taken from a number of language therapy workbooks. Speech production tasks included: picture naming; picture description using sentences; and confrontational naming using sentence completion, descriptions and word associates. Reading tasks focusing on comprehension of phrases, sentences, paragraphs and stories was addressed through reading of yes/no, multiple choice, and open-ended questions.
Figure 2 - Lingraphica Speech Generating Device (Click for larger view) Parrot software (Weiner, F. 2007) incorporated in therapy sessions included: Picture Association, Picture Identification, Picture Categories, Category Naming and Comprehension, and Sentence Comprehension. Each of these programs requires the user to read or match words with photographs, pictures, or phrases. Patients typically answered between 10 – 20 items in 1-2 of the above programs during the course of treatment.
The Lingraphica (Steele, 2007) was used for improving word retrieval, oral reading and reading comprehension at the word & sentence level, and for improving spelling and typing skills for 1 and 2-syllable words
| Assessment Measures: | Performance |
|||
|---|---|---|---|---|
Patient |
Evaluation |
Discharge |
Max |
|
Western Aphasia Battery-R A.Q. |
DT |
68.2 |
81.6 |
100 |
WR |
59.0 |
96.2 |
100 |
|
ZL |
84.2 |
93.0 |
100 |
|
Boston Naming Test |
DT |
15 |
21 |
60 |
WR |
23 |
49 |
60 |
|
ZL |
19 |
40 |
60 |
|
CADL II |
DT |
- |
72 |
94 |
WR |
81 |
93 |
94 |
|
ZL |
- |
94 |
94 |
|
Note: Patients DT and ZL were not assessed with the CADL II on evaluation. |
||||
RESULTS
Performance of patients on various language measures is presented in Table 1. All patients were assessed with the Western Aphasia Battery - Revised (Kertesz, A., 1982). Language subtests and Aphasia Quotients were derived at initial evaluation and discharge. All patients demonstrated improvement in language areas of spontaneous speech, auditory comprehension, repetition and naming skills. Patients WR and ZL achieved performance within the normal range (93 and above) by the time of discharge.
The Boston Naming Test (Kaplan, E., Goodglass, H., and Weintraub, S., 1983) is a more specific assessment of confrontational naming. Once again, all patients showed improved scores from evaluation to discharge on this measure. Less improvement was noted by patient DT, who was over 4 years post-onset and had significant visual-perceptual deficits. The Communicative Activities of Daily Living Test – II (Holland, A., Fratalli, C. and Fromm, D., 1998) is a measure of overall communicative ability. It incorporates functional daily tasks, such as a visit to the doctor, shopping, and riding in a car. Patients are required to read words and sentences, or point to pictures to indicate correct responses based on examiner questions. Only one patient (WR) took the measure on evaluation and discharge and demonstrated encouraging improvement in functional communicative activities. While patient ZL showed normal performance on the measure by discharge, patient DT continued to have difficulty with visual tasks requiring reading or recognition of details in drawings or photographs.
Discussion
All patients enjoyed incorporation of each of the therapy approaches as part of their outpatient treatment regimen. Specific preferences were shown for independent use of software that provided performance feedback by patient WR. Patient DT, in contrast, preferred the non-judgmental assisted therapy approach of the Lingraphica device. Exploration of vocabulary organized by visual scenes was particularly more beneficial to her than grid based systems of single pictures as presented on traditional naming worksheet tasks or on other speech generating devices. Patient ZL appreciated the combination of workbook, software and speech-generating device tasks provided throughout her sessions.
Use of language-based software and speech generating device-assisted therapy can serve as a beneficial adjunct to traditional treatment for non-fluent aphasia.
Incorporation of these assistive technology approaches was deemed beneficial by three outpatients in the current study. All three approaches provide means for both clinician monitoring during therapy and for independent practice in home and community. The provision of feedback through digitized speech output, printed names and letter or word cues served to assist patients when a clinician or assistant was not available. Continued exploration of the benefits of language software and use of speech generating devices as adjunct to traditional therapy is warranted.
REFERENCES
- Steele, R. (2007). Clinical Outcome Studies and Evidence-Based Decision-Making for AAC for Aphasia. 8th Annual Conference of the ASHA Division on AAC.
- Weiner, F. (2007) http://www.parrotsoftware.com/
Author Contact Information:
Andrew Jinks, MA, CCC-SLP, University of Pittsburgh Medical Center, Center for Assistive Technology, 3600 Forbes Ave. at Atwood, Pittsburgh, PA. 15203 EMAIL: jinksa@upmc.edu