Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study

Abstract

Background Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer–based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists. Objective The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient’s progress as well as creation of new individual exercises. Methods The system consists of two main parts: (1) the patient’s interface, which allows the patient to exercise, and (2) the therapist’s interface, which allows the therapist to assign new exercises to the patient and supervise the patient’s progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory). Results A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z =–1.90; P =.03) and therapists rated the app as good (score >85; Z =–1.75; P =.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z =–1.66; P =.049). Conclusions Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer–based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy.

Does COVID-19 Impact Less on Post-stroke Aphasia? This Is Not the Case

“…A very recent study (Bersano and Pantoni, 2020) also confirmed this need for acute stroke patients who, due to COVID-19, suffered from a shortage of services and delays in time-dependent treatments and diagnostic work-up. In order to circumscribe the consequences of the COVID-19 pandemic, one possible strategy might be to set up tele-rehabilitation and home-based services, which have been already successfully implemented for aphasia rehabilitation (Zhou et al, 2018;Gerber et al, 2019;Chang and Boudier-Revéret, 2020) and to focus on specific rehabilitation programs which allow the patients, who are no longer followedup in therapy, to keep training their communication skills, and avoiding further deterioration. This would not add excessive costs to the healthcare system since it could be easily supported by the patients' families.…”

Investigating a new tablet-based telerehabilitation app in patients with aphasia: a randomised, controlled, evaluator-blinded, multicentre trial protocol

“…In a usability study, it was shown that the app is well accepted by patients and therapists. 28 Patients are provided with an overview of exercise collections assigned by a speech and language therapist. Collections are intended to train a specific language impairment (eg, semantically categorising items).…”

“…The exercise types cover all levels of language organisation, that is, phonology, grammar (consisting of morphology and syntax) and semantics. 28 Exercises consist of fixed (eg, written language, placeholders), supportive (eg, videos, audio tracks, images) and response elements (eg, unarranged letters), except exercises of the type word repetition which exclusively provide videos as fixed elements. Unmovable and required elements to solve the exercise are referred to as fixed elements.…”

“…The teleSLT application which started as a master thesis 27 was evaluated for usability by 15 healthy controls, 5 patients with aphasia, and 5 speech therapists. Results from the usability study 28 (patient's subjective experience, enjoyment and stress experienced) showed excellent usability, high acceptability and motivation for training independently by 15 patients. The usability of the teleCT used in this study has already been demonstrated for participants of different age groups.…”

“…Description of exercise types adapted from Gerber et al28 Uslu AS, et al BMJ Open 2020;10:e037702. doi:10.1136/bmjopen-2020-037702…”