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Transcript of 1 Use of computers in chronic aphasia Hunter Region Acquired Communication Impairment (ACI) EBP...
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Use of computers in chronic aphasia
Hunter Region Acquired Communication Impairment (ACI) EBP Group
Extravaganza 2011
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• "Technophobia be gone?"• "Man versus Machine"• "Deus ex Machina"• "Rise of the Machines"
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Who are we?
• New clinical EBP group commenced late 2010.• 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: 2010- 2011– Georgi Laney: [email protected], – Sarah Bell: [email protected]
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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?
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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.
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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.
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Computer-based interventions:
Interventions discussed in computer -basedtherapy 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
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CAT-articles
Script training: • Cherney & Halper (2008). • Cherney, Halper, Holland and Cole (2008).• Lee, Kaye & Cherney (2009). • Manheim, Halper & Cherney (2009).
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CAT - articles cont…
Reading Comprehension: • Cherney (2010).
Naming: • Mason, Nickels, McDonald, Moses, Makin &
Taylor (2010). • Ramsberger & Marie (2007).
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CAT- articles cont….
Multiple modalities: • Mortley, Wade & Enderby (2004). • Pedersen et al (2001).
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Article Independent Intensity/ 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
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Article Independent Intensity/ 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).
Yes 4 sessions/ week
No Naming
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Article Independent Intensity/ 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).
Yes Intensity 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.
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Article Sample size
Age range
Time post- stroke
Design & Level of evidence
Outcome Measures
Maintenance
Cherney, L.R., Halper, A.S. (2008).
3 50-75 1-4 years
Level IV WAB QCL CADL-2 Exit interview
Not assessed
Cherney, L. R., Halper, A. S., Holland, A., & Cole, R. (2008).
3 65-78 18-48 months
Level IV WAB QCL CADL-2 Exit interview
Not assessed
Cherney, L.R. (2010).
25 35-81 13 -253 months
Randomised Control trialLevel II
WAB-AQWAB reading and writing subtestsDiscourse analysis
Not assessed
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Article Sample size
Age range
Time post- stroke
Design & Level of evidence
Outcome Measures
Maintenance
Lee, J.B., Kaye, R.C., Cherney, L. R. (2009).
17 31-70 10-273 months
Level IV WAB-AQ. Not assessed
Manheim, L. M., Halper, A. S., & Cherney, L. R. (2009).
20 26-78 10-238 months
Delayed treatment designLevel IV
BOSS: Communication difficulty & Mobility, communication associated psychological distress subtests
6 weeks
Mason, C., Nichels, L., McDonald, B., Moses, M., Makin, K & Taylor, C. (2010).
3 37-59 5-8 years
Level IV Naming accuracy. 10 minute speech sample.
3 weeks
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Article Sample size
Age range
Time post- stroke
Design & Level of evidence
Outcome Measures
Maintenance
Mortley, J., Wade, J., Enderby, P. (2004).
7 53-66 2-12 years
Level IV Object & action naming battery, PALPA 47 & 48, exit interview
1 week & 6 weeks
Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001).
3 57-71 6-18 months
Level IV WAB-AQ, PALPA S&V naming
2 months
Ramsberger & Marie (2007).
4 63-74 6 months – 6 years
Level IV WAB BNT 1 month
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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.
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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?
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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 12-18 months.
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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.
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CAT-references
• Cherney, L.R., Halper, A.S. (2008). Novel technology for treating with aphasia and concomitant cognitive deficits. Topics in Stroke Rehabilitation, 15, 542-554.
• 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), 19-34.
• 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, 423-431.
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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), 885-897.
• 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), 623-627.
• 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.
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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, 193-211.
• Pendersen, P., Vinter, K. & Skyhoj Olsen, T. (2001). Improvement of oral naming by unsupervised computerised rehabilitation. Aphasiology, 15 (2), p151-169.
• 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, 343-358.
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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, 229-311.
• Bilda, K. (2011). Video-based conversational script training for aphasia: A therapy study. Aphasiology, 25 (2), 191-201.
• Crerar, MA., Ellis, AW., & Dean, EC. (1996). Remediation of Sentence Processing Deficits in Aphasia Using a Computer- Based Microword. Brain & Language, 52, 229-275.
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Other useful references
• Katz, R. (2010). Computers in the treatment of chronic aphasia. Seminars in Speech & Language, 31(1), 34-41.
• Laganaro, M., Di Pietro, M., & Schnider, A. (2006). Computerised treatment of anomia in acute aphasia: Treatment intensity and training size. Neuropsychological Rehabilitation, 16(6), 630-640.
• Mortley, J., Enderby, P., Petheram, B. (2001). Using a computer to improve functional writing in a patient with severe dysgraphia. Aphasiology, 15, 443-431.
• 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), 257-268.
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Other useful references
• Wertz, R.T., Katz, R.C. (2004). Outcomes for computer-provided treatment for aphasia. Aphasiology, 18, 229-244.
Please see CAT for complete bibliography. Please see EBP website for table summarising articles included in
CAT.
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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