Self-managed computer therapy to help people with aphasia find words

Person with aphasia and a helper practising saying words with computer therapy

Authors: Rebecca Palmer Munyaradzi Dimairo Prof Cindy Cooper Prof Pam Enderby Prof Marian Brady Prof Audrey Bowen Nicholas Latimer Prof Steven Julious Elizabeth Cross Abualbishr Alshreef Madeleine Harrison Ellen Bradley Helen Witts Tim Chater

Summary by: r.l.palmer The author of this summary states they are an author on the original paper

What the researchers wanted to find out

We wanted to find out...

  • If computer therapy makes it easier to find words
  • If it helps everyday conversations
  • If it is good value for money



Results of the research

  • 90% of people used the computer therapy they were given
  • The software enabled people to do more therapy (28 hours on average). One person did 105 hours
  • 61% of people carried on using the comptuer after 6 months
  • Computer therapy helped people with aphasia to learn new words
  • It did not matter how long ago the stroke happened
  • 1 in 3 people used their new words in conversation but most people did not use their new words in conversation
  • we need to help people to use the new words they learn to say
  • people with aphasia get better at what they practise saying
  • they may not get better at saying words they did not practice
  • it is important to practise useful words
  • the computer therapy may be good value for people with mild and moderate aphasia. It is not good value for money for everyone.
  • Our computer therapy approach is half the cost of face to face therapy

What type of research was done?

We compared 3 treatments:

1) usual speech therapy

2) computer word finding therapy as well as usual speech therapy

3) puzzle activities as well as usual speech therapy


The computer therapy consisted of:

1) A computer with the StepbyStep word finding programme on it

2) A speech and language therapist chose the most useful exercises to practise. The therapist made sure the words a person wanted to learn were in the therapy.

3) The person with aphasia was advised to practise for 20 minutes every day

4) A volunteer was offered to help use the computer and practise using the words.


Why the research was done

People with aphasia often cannot find the words they want to say.

We know speech therapy can help. Many hours of practice is needed to make a difference.

We found that only 42% of people with aphasia after stroke had speech therapy after 4 months.

Those who did have therapy only had about 5 hours over 12 weeks.

People with aphasia often want more therapy than is available.

Our goal was to use to computers to give people the opportunity to have more speech therapy practice.



What does the research mean for me and others?

You can learn new words if you want to.

It doesn't matter when your stroke was.

Computer word finding therapy can help you to say words that are important to you.

If you learn new words on the computer remember to practise using them in every day life too!


What research methods were used?

We used a randomised controlled trial.

People with aphasia were randomly allocated to:

1) usual speech therapy

or

2) computer word finding therapy as well as usual speech therapy

or

3) puzzle activities as well as usual speech therapy

A computer did the random allocation.

We assessed how well people could find words.

We assessed how well people could have conversations.

We made these assessments before and after the therapy. 

The people who did the assessments after the therapy did not know which therapy the person had. They did not know how well someone did on the assessments before the therapy.


How to obtain the treatment detailed in the research

The StepbyStep word finding computer therapy we used has been updated with learning from the study.

The word finding therapy is now available as an app.

There is also an app called TotalChat to help with using your new words in conversation.

You can find these apps at this website:

https://www.steps.uk/aboutapps


Background information on the research topic



Risks related to the research

no section text supplied by researcher

Is the research trustworthy?

no section text supplied by researcher

Information about the people who took part

278 people with aphasia yook part in the study.

177 carers took part in the study.

61% were men, 39% were women.

The people with aphasia were between 23 and 92 years old.

44% had mild word finding difficulties.

30% had moderate word finding difficulties.

26% had severe word finding difficulties.

They had a stroke between 4 months and 36 years before they took part in the study.



Who was allowed to take part in the research?

People with aphasia after a stroke.

with word finding difficulties

over 18 years old

at least 4 months after a stroke


Why was the research done this way?

A randomised controlled trial was carried out in usual speech and language therapy services in the UK (National Health Service). The therapy was delivered by practising speech and language therapists.

We did the research in this way to see how well computer therapy worked in real world settings.


When was the research done?

People took part in the study between October 2014 and September 2017


Problems with the research

Only one piece of software was used. 

Technology develops all the time.

The results may be different with different or new software/apps.


Next steps

Further analysis of the Big CACTUS data showed that:

People are most likely to improve word finding if 

  • they practice finding words in sentences
  • if the computer therapy is tailored to their needs by a speech and language therapist

Harrison M, Palmer R, Cooper C. Identifying the Active Ingredients of a Computerized Speech and Language Therapy Intervention for Poststroke Aphasia: Multiple Methods Investigation Alongside a Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2023 Dec 5;10:e47542

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731555/


Next, we need to find out what helps people to use new words in their conversations.


Where was the research done?

21 Speech and language therapy departments in the UK National Health Service (NHS).

Across England, Scotland, Northern Ireland and Wales.


Where the money came from

The project was funded by the NIHR Health Technology Assessment Programme (12/21/01).

Additional funding support was provided by the Tavistock Trust for Aphasia.

The views and opinions expressed are those of the authors.

They do not necessarily reflect those of:

  • the Health Technology Assessment Programme,
  • the NIHR,
  • the National Health Service,
  • the Department of Health and Social Care,
  • the Tavistock Trust for Aphasia.



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