University:
Boston University
Course:
SAR HP 151 | Introduction to Health Professions
Academic year:

2023
Views:

113

Pages:

33
Author:

epperston5gb0

HOW CAN TECHNOLOGY ENABLE REHABILITATION IN CHRONIC APHASIA? A REVIEW OF THE LITERATURE • The adaptive capacity of the Central Nervous System • The mechanism by which the brain encodes experiences and learns new behaviors • The mechanism by which the damaged brain “relearns” lost behavior in response to rehabilitation “Neuroplasticity is often experience dependent, time-sensitive and strongly influenced by features of environment. Motivation and attention can be critical modulators of plasticity. Skills training can improve behavioural outcomes on the backbone of neuroplasticity; in many cases, maintenance of behavioural gains depends on continued therapeutic exposure. ê 1.Use it or lose it 2.Use it and improve it 3.Specificity 4.Repetition 5.Intensity 6.Time 7.Salience 8.Age 9.Transference 10.Interference § Review studies of rehabilitation outcomes in individuals with chronic aphasia report that therapy is indeed effective for these individuals Allen L, Mehta S, McClure JA, Teasell R. Therapeutic interventions for aphasia initiated more than six months post stroke: a review of the evidence. Top Stroke Rehabil 2012;19(6): 523–535; Teasell R, Mehta S, Pereira S, et al. Time to rethink long-term rehabilitation management of stroke patients. Top Stroke Rehabil 2012;19(6): 457–462 § More intense therapy for patients results in greater outcomes in acute and chronic aphasic patients § ICAP aphasia Persad, C., Wozniak, L., & Kostopoulos, E. (2013). Retrospective analysis of outcomes from two intensive comprehensive aphasia programs. Topics in Stroke Rehabilitation, 20(5), 388-397. doi:10.1310/tsr2005-388 § Very early aphasia therapy in acute aphasia Godecke, E., Rai, T., Ciccone, N., Armstrong, E., Granger, A., & Hankey, G. J. (2013). Amount of therapy matters in very early aphasia rehabilitation after stroke: a clinical prognostic model. Semin Speech Lang, 34(3), 129-141. doi:10.1055/s-0033-1358369 § Systematic review of constrained induced aphasia therapy Cherney LR, Patterson JP, Raymer A, Frymark T, Schooling T. Evidence-based systematic review effects of intensity of treatment and constraint nduce language therapy for individuals with stroke-induced aphasia. J Speech Lang Hear Res 2008;51(5):1282–1299 § Systematic review of aphasia therapy studies Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke 2003; 34(4):987–993; § A recent influential study (ACTNOW) suggested that rehabilitation was no more effective in promoting change on the measured outcomes than everyday communication with hospital volunteers in acute stroke survivors § A best-practice, flexible intervention by NHS SL therapists, up to three contacts per week for up to 16 weeks compared with a similar number of AC contacts by employed visitors § There was no evidence, on any measure, of added benefit of early communication therapy beyond that from AC. § Functional communication improved for both groups Bowen, A., Hesketh, A., Patchick, E., Young, A., Davies, L., Vail, A., . . . Tyrrell, P. (2012). Clinical effectiveness, cost-effectiveness and service users' perceptions of early, well-resourced communication therapy following a stroke: a randomised controlled trial (the ACT NoW Study). Health technology assessment, 16(26), 1-160. doi:10.3310/hta16260 COCHRANE REVIEWS: BRADY ET AL., 2012, 2016 RCTs Randomised comparisons n SLT v No SLT SLT v Social Support SLT v SLT 2012 39 2016 57 51 74 2518 19 comparisons n=1414 7 comparisons n=432 25 comparisons n=910 3002 27 comparisons n=1620 9 comparisons n=447 38 comparisons n=1242 SLT v No SLT (10 RCTs) Primary Outcome: Functional Communication HIGHER V LOWER INTENSITY: APHASIA SEVERITY Intervention approaches for aphasia Which treatments work for which patients?? Standardize & personalize intervention Age Lesion location Lesion size/volume Months post stroke Education Severity of impairment Amount of therapy Type of treatment Therapy Outcomes Population analysis Small cohort analysis Main advantage is to provide therapy to people who cannot travel to obtain rehabilitation services. Speech language pathology services are particularly suited to telerehabilitation due to the emphasis on auditory/visual interaction Thus far, videoconferencing services between client and clinician for audiology, stuttering, and motor speech have been reported (Georgeadis et al., 2004; Hill et al., 2006) Several centers set up for providing aphasia therapy over the internet § Computer programs also provide an opportunity for patients to practice more intensely and consistently than what is typical in weekly/biweekly visits to a clinical location. § Swales Q14 MA, Hill AJ, Finch E. Feature rich, but user-friendly: speech pathologists’ preferences for computer-based aphasia therapy. Int J Speech Lang Pathol 2015:1–14 § “As more and better software programs for the delivery of therapy are developed, there is the possibility to achieve the intensive levels of stimulation and practice necessary to trigger reorganization of neuronal assemblies.” § “In particular, if programs can be devised that allow users under the guidance of clinicians to self-administer the therapy, then limitations of therapists and therapy time can be circumvented.” Varley R. Rethinking aphasia therapy: a neuroscience perspective. Int J Speech-Language Pathol 2011;13(1):11–20 Recent reviews of technological applications Computer based- Single program applications Computer based- Multiprogram applications Computer based cognitive rehabilitation Lingraphica • Aftonomos et al., 1997 MossTalk Constant Therapy Cogmed • Des Roches, et al., 2015 • Akerlund et al., 2013; Bjorkldahl, 2013; De Luca 2014; Lundqvist et al., 2010; Westerberg et al., 2007 • Fink et al., 2002; Raymer et al., 2006; Ramsberger & Marie, 2007 Multicue • Doesborgh et al., 2004 Tactus Therapy • Stark & Warburton, 2016 • Lebow itz et al., 2012 AphasiaScripts • Cherney & Halper, 2008; Manheim et al., 2009; Cherney et al., 2014 Sentactics Lingraphica TalkPath • Steele et al., 2014 Lumosity • Thompson et al., 2010 SentenceShaper • Linebarger et al., (2007) Posit Science StepByStep • Mortley et al., 200; Palmer et al., 2012 • Zickefoose et al., 2013 Sentactics is a computer--automated program that trains patients in comprehension and production of complex sentences based on TUF “Sabrina,” an automated clinician, presents the patient with stimuli and gives feedback about the patient’s performance Thompson CK, Choy JJ, Holland A, Cole R. Sentactics(R): Computer-Automated Treatment of Underlying Forms. Aphasiology. 2010;24(10):1242-1266. Cherney LR. Oral reading for language in aphasia (ORLA): evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Top Stroke Rehabil. 2010;17(6):423-431. § Multicue softw are § Makes different types of cues (semantic, phonemic, general information) available to patients as they practice word retrieval. Results from18 patients with aphasia who received Multicue therapist improved on the Boston Naming Test (BNT), but the changes were not significant when compared with the control group. Doesborgh S, van de Sandt-Koenderman M, Dippel D, van Harskamp F, Koudstaal P, Visch-Brink E. Cues on request: The efficacy of Multicue, a computer program for wordfinding therapy. Aphasiology. 2004;18(3):213-222.; Vanmourik M, Vandesandtkoenderman WME. Multicue. Aphasiology. 1992;6(2):179-183. § MossTalk § Also provides patient initiated cues during word retrieval. This program was shown to be effective in increasing patients’ comprehension and lessening word retrieval deficits in aphasic individuals and those who had semantic dementia. Fink RB, Brecher A, Schwartz MF, Robey RR. A computer-implemented protocol for treatment of naming disorders: Evaluation of clinician-guided and partially selfguided instruction. Aphasiology. 2002;16(10-11):1061-1086; Fink R, Brecher A, Sobel P, Schwartz M. Computer-assisted treatment of word retrieval deficits in aphasia. Aphasiology. 2005;19(10):943 - 954.; Raymer AM, Kohen FP, Saffell D. Computerised training for impairments of word comprehension and retrieval in aphasia. Aphasiology. 2006;20(2-4):257-268.;Jokel R, Rochon E, Anderson ND. Errorless learning of computer-generated words in a patient with semantic dementia. Neuropsychological Rehabilitation. 2010;20(1):16-41. § StepByStep § Palmer et al found the 15 patients assigned to a computer treatment group showed more improvement on their naming ability than did 13 patients who practiced everyday language activities, including conversation and support groups and reading and writing activities. Palmer R, Enderby P, Cooper C, et al. Computer therapy compared with usual care for people with long-standing aphasia poststroke: a pilot randomized controlled trial. Stroke. 2012;43(7):1904-1911. § Lingraphica § Structured language therapy to 50 patients in community settings showed improvements on standardized tests such as the WAB and CETI. Aftonomos, L. B., Appelbaum, J. S., & Steele, R. D. (1999). Improving outcomes for persons with aphasia in advanced community-based treatment programs. Stroke, 30(7), 1370-1379. § Constant Therapy § Standardized and individualized treatment for 51 patients using the software showed significant changes on WAB, CLQT, BNT etc Des Roches CA, Balachandran I, Ascenso EM, Tripodis Y, Kiran S. Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform. Frontiers in Human Neuroscience. 2015;8. These studies highlight- These studies do not answer - Remotely delivered therapy is effective - Is therapy at home as good as therapy in the clinic - Does therapy result in improvements beyond targeted behavior? - Homework is typically practiced - Who does the therapy benefit? - Intensity of treatment is varied across studies - What is the optimal intensity/frequency of therapy? - Improvements in impairment based measures - Treatment is typically tailored for the patient Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform 51 Participants with aphasia after stroke or TBI 42 Participants in Experimental Group In-Clinic Visit 1x/w eek Constant Therapy as a home program 9 Participants in Control Group In-Clinic Visit 1x/w eek § Experimental patients show more significant changes on standardized tests than control patients. § Patients with lower initial scores showed more improvements than patients with higher initial scores. Computer-based treatment of poststroke language disorders: a non-inferiority study of telerehabilitation compared to in-person service delivery • 12 weeks of treatment, either through telerehabilitation or through in person treatment. • Worked on various exercises from Lingraphica (Talkpath software), training with communication partner and other traditional language therapy tasks • Participants improved on all measures (language and cognitive linguistic deficits) • Equivalent gains between telerehabilitation and inperson treatment • CCRSA questionnaire showed an advantage for in person treatment • Improvements on WAB correlate with amount of homework practice § Treatment Intensity § Personalizing Treatment § Taking ownership of one's care

How Can Technology Enable Rehabilitation in Chronic Aphasia

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