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Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy.Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups.Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality.Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population.

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Introduction: Intensive Communication Therapy (ICT) is a technique developed to treat post-stroke aphasia in adults, which builds on the idea that more hours of therapy yields greater improvements over time. However, there is little evidence to support the duration (time in treatment), dose (person-hours of treatment), or density (person-hours/ time) of treatment necessary to demonstrate improvement in symptoms. Method: A retrospective sample of 150 individuals with aphasia who completed 8 or more weeks of outpatient ICT at a single provider agency in Texas was analyzed. Deficit was measured at baseline and with repeated measures of a unique, standardized screener for language, reading and writing. Improvement was defined as either a) an a priori threshold or b) any improvement over two consecutive measurement intervals. Treatment exposure was calculated as a) total hours in treatment, b) person-hours of treatment attended, and c) person-hours divided by time. Survival analysis and Kaplan Meier curves were used to determine incidence rate functions; tested by age, gender, severity, and time post-stroke. Results: 51% of the sample was female, and the mean age at start of treatment was 58.5 (range=18-90). Of subjects with 2 consecutive measurements obtained (approximately 10 weeks apart), threshold improvement was met 75.8% of the time. The estimated rate of person-time in treatment to threshold improvement was 153 hours (IR=0.0065) and 360 hours to achieve consistent improvement over two sessions (IR=0.0028). Cases who demonstrated either measure of improvement received significantly greater treatment density during the course of their treatment up to that point (both p<0.05). Multiple tests of improvement varied by initial stroke severity and time post-stroke. Conclusions: These findings support the ability of ICT to improve symptoms in patients with speech or communication deficits post-stroke. However, the time in treatment required to show improvement is considerable and may vary depending on how long a survivor waits to initiate treatment and the initial severity of the stroke. Service providers and insurers may both need to examine their treatment plans and advocate for more intensive or longer durations of therapy based on these findings.