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Source publication
Purpose
The aim of this study was to prove the efficacy of supervised self-training for individuals with aphasia. Linguistic and communicative performance in structured dialogues represented the main study parameters.
Method
In a cross-over design for randomized matched pairs, 18 individuals with chronic aphasia were examined during 12 weeks of su...
Similar publications
Under optimal conditions, providing language therapy to persons with aphasia (PWA) is an intensive and dynamic process which results in improved verbal communication and greater participation in everyday life. However, due to cuts in health care spending, PWAs are not receiving the necessary amount of language therapy to achieve significant gains i...
Citations
... Finally, the intervention was computerized to allow opportunities for self-managed home practice. This may increase the frequency with which participants engage with intervention activities (Nobis-Bosch et al., 2011). High-intensity aphasia therapy (8.8 h per week for 11 weeks) has been found to be more effective compared with lower intensity therapy, administered over a longer time span (Bhogal et al., 2003). ...
Background
Many speakers with non-fluent aphasia (NFA) are able to produce some well-formed word combinations such as ‘I like it’ or ‘I don't know’, although they may not use variations such as ‘He likes it’ or ‘I don't know that person’. This suggests that these utterances represent fixed forms.
Aims
This case series investigation explored the impact of a novel intervention aimed at enhancing the connected speech of individuals with NFA. The intervention, motivated by usage-based principles, involved filling open slots in semi-fixed sentence frames.
Methods & Procedures
Five participants with NFA completed a 6-week intervention programme. The intervention trained participants to insert a range of different lexical items into the open slots of high-frequency phrases such as ‘I like it’ to enable more productive sentences (e.g., ‘they like flowers’). The outcomes and acceptability were examined: The primary outcome measure focused on changes in connected narrative, and the availability of trained constructions (e.g., ‘I like it’) was explored through a story completion test. Two baseline measures of behaviour were taken prior to intervention, and outcomes assessed immediately after intervention and at a 6-week maintenance assessment.
Outcome & Results
A pre-/post-treatment comparison of connected speech measures showed evidence of enhanced connected speech for two of the five participants (P2 and P5). An analysis of story completion test scores revealed positive change for two participants (P1 and P2). Findings were mixed with regard to baseline stability of outcome measures and post-intervention stability of language changes. The intervention was acceptable to all participants.
Conclusion & Implications
While this pilot study yielded promising findings with regard to the intervention's acceptability and increased connected speech for some participants, the findings were mixed across the sample of five participants. This research helps inform hypotheses and selection criteria for future studies.
What this paper adds
What is already known on the subject
• Despite difficulties producing grammatically correct sentences, many speakers with aphasia are able to produce well-formed utterances, often representing familiar expressions such as ‘I don't know’ and ‘I like it’. In usage-based Construction Grammar (CxG) theories, familiar utterances are assumed to be processed as one unit and are therefore more resilient to brain damage. CxG assumes that residual utterances such as ‘I like it’ map onto more abstract sentence frames (e.g., ‘[REFERENT] like-TENSE [THING]’).
What this paper adds to existing knowledge
• Sentence therapy, informed by CxG principles, is novel in aphasiology, and usage-based interventions need to be evaluated with regard to their impact on language processing at the connected speech level. This case series report explores the acceptability and outcomes of a usage-based sentence therapy. We also introduce and explore the value of an automated, frequency-based analysis tool for evaluating connected speech outcomes in aphasia therapy.
What are the potential or actual clinical implications of this work?
• The findings inform further development of usage-based aphasia interventions targeting word combinations.
... It contrasted success in naming the symbols depending on whether the participants were given cues or developed personalised cues. The other study, by Nobis-Bosch et al. (2011) looks at the use of barcoded pictures to allow the participants to be able to practice repeating dialogues. ...
Background: Recent reviews conclude that aphasia intervention is effective. However, replication and implementation require detailed reporting of intervention is and a specification of participant profiles. To date, reviews concentrate more on efficacy than on intervention reporting quality.
Aims : The aim of this project is to review the descriptions of aphasia interventions and participants appearing in recent systematic reviews of aphasia intervention effectiveness. The relationship between the quality of these descriptions and the robustness of research design is explored, and the replicability of aphasia interventions is evaluated.
Methods and Procedures : The scope of our search was an analysis of the aphasia intervention studies included in the and EBRSR 2018 systematic reviews, and in the RCSLT 2014 literature synthesis. Intervention descriptions published separately from the intervention study (i.e. published online, in clinical tools, or a separate trial protocols) were not included. The criteria for inclusion were that participants had aphasia, the intervention involved language and/or communication, and included the following research designs: Randomised Controlled Trial (RCT), comparison or control, crossover design, case series. Exclusion criteria included non-SLT interventions, studies involving fewer than four participants, conference abstracts, studies not available in English. Studies were evaluated for completeness of intervention description using the TIDieR Checklist. Additionally, we rated the quality of patient and intervention description, with particular reference to replicability.
Outcomes and Results: Ninety-three studies were included. Only 14 studies (15%) had >50 participants. Fifty-six studies (60%) did not select participants with a specific aphasia profile, and a further 10 studies only described participants as non-fluent. Across the studies, an average of eight (of 12) TIDieR checklist items were given but information on where, tailoring, modification and fidelity items was rarely available. Studies that evaluated general aphasia intervention approaches tended to use RCT designs, whereas more specific intervention studies were more likely to use case series designs.
Conclusions: Group studies were generally under-powered and there was a paucity of research looking at specific aphasia interventions for specific aphasia profiles. There was a trade-off between the robustness of the design and the level of specificity of the intervention described. While the TIDieR framework is a useful guide to information which should be included in an intervention study, it is insufficiently sensitive for assessing replicability. We consider possible solutions to the challenges of making large-scale trials more useful for determining effective aphasia intervention.
... In the digital age and its applications on tablets and smartphones, it is important to investigate modern treatment options especially in the neurologic field. A small population study investigating the effect of computer-assisted self-training vs. nonlinguistic cognitive therapy in 18 patients showed improved communication skills (17,18). Due to different limitations concerning the population, further investigations are necessary in the future (19). ...
Rationale: Treatment of aphasia is still challenging for clinicians and patients. So far, there is proven evidence for “face-to-face” speech therapy. However, the digital age potentially offers new and complementary strategies that may add to treatment outcome in a cost-effective way. Neolexon® is a commercial tablet-based software for treatment of aphasia, which can be applied with the help of a therapist or as self-training by the patient.
Aims and hypothesis: In the Lexi study, we aim to determine whether treatment with Neolexon® is superior to standard therapy in acute post-stroke aphasia.
Sample size estimates: A sample size of 180 patients, 90 for each group, will be included with an assumed dropout rate of ~20%.
Methods and design: Prospective, randomized, parallel group, open-label, blinded-endpoint clinical, and experimental controlled non-invasive trial (PROBE). Adult German native speakers with acute aphasia after stroke are included. Computer-generated, blocked, and stratified randomization by aphasia severity will assign patients to one of two groups: 4 weeks of either standard logopedic speech therapy or logopedic speech therapy with the app version of Neolexon®. Both groups will be instructed in self-training: the frequency and duration of self-training will be documented. Screening for aphasia will be performed using the Language Screening Test (LAST). The severity of aphasia in general and in subitems will be assessed using the Bielefelder Aphasie Screening (BIAS) and the Aphasia Check List (ACL). Follow-up will be assessed after 3 months.
Study outcomes: Based on the consensus in our study team, we considered a 10% mean difference in the change of percentile rank (PR) of BIAS to be a minimal and clinically important difference. The primary endpoint is defined as a significant difference in BIAS comparing the two groups. Differences in quality of life, Beck Depression Inventory (BDI), and modified Ranking Scale (mRS) will be evaluated as secondary outcome parameters.
Discussion: This trial will determine whether speech therapy with the use of Neolexon® is superior to standard logopedic therapy. Subgroups with the greatest response to Neolexon® will be described. The trial was prospectively registered on the “EU Clinical Trials Register” (NCT04080817)¹.
... Denn abstrakte Aufgaben (z. B. die Suche nach Reimwörtern), die sich nur mit einer (kognitiven) Distanz zur jeweiligen Situationen lösen lassen, stellen für Patienten mit einer Aphasie eine sehr viel Um die Frequenz der Aphasietherapie zu erhöhen, können zusätzlich zur klassischen Einzeltherapie computerbasierte Therapien eingesetzt werden, für die inzwischen einige Effektivitätsnachweise existieren [14]. Die Computertherapie lässt sich jedoch in der stationären neurologischen Rehabilitation nicht zulasten der Deutschen Rentenversicherung abrechnen, da sie in der derzeit gültigen Klassifikation therapeutischer Leistungen (KTL-Katalog) nicht enthalten ist [15]. ...
Clinical reasoning (CR) aims to examine thinking and decision processes in the course of planning speech-language interventions. In comparison, Evidence-based practice (EBP) consists of the task to transport scientific results into everyday language therapy routines. There exists a strong relationship between CR and EBP. Thus, EBP provides scientific evidence and medical guidelines to support speech and language therapists in choosing effective treatments. Moreover, EBP strengthens speech and language therapists to use their expert knowledge for solving clinical problems and to respect the preferences of the patients.
... Thus, we expect that for PWAs with a percentile rank of at least 25 as measured by AAT subtest comprehension, the SAPS-based home training is well feasible. This accords with the recommendations for the B.A.Bar home training from Nobis-Bosch et al. (2011) for which low language comprehension (at least percentile rank 30 in the AAT subtest comprehension) also was an exclusion criteria. Although the home training was constructed to take about 30 min per cell and run, some participants completed the daily home training sessions faster, and some of them even repeated the home training tasks on the same day. ...
Background:
SAPS-'Sprachsystematisches Aphasiescreening'-is a novel language-systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality-specific psycholinguistic components at different levels of complexity and the derivation of impairment-based treatment foci from the individual performance profile. However, SAPS has not yet been evaluated in combination with the new SAPS-based treatment.
Aims:
To replicate the practicality of SAPS and to investigate the effectiveness of a SAPS-based face-to-face therapy combined with computerised home training in a feasibility study. To examine the soundness of the treatment design, to determine treatment-induced changes in patient performance as measured by SAPS, to assess parallel changes in communicative abilities, and to differentiate therapy effects achieved by face-to-face therapy versus add-on effects achieved by later home training.
Methods & procedures:
Sixteen participants with post-stroke aphasia (PWAs) were included into the study. They were administered the SAPS and communicative testing before and after the treatment regimen. Each PWA received one therapy session followed by home training per day, with the individual treatment foci being determined according to initial SAPS profile, and duration of treatment and possible change of focus dependent on performance assessed by continuous therapy monitoring.
Outcomes & results:
The combination of therapy and home training based on the SAPS was effective for all participants. We showed significant improvements for impairment-based SAPS performance and, with high inter-individual variability, in everyday communication. These two main targets of speech and language therapy were correlated and SAPS improvements after therapy were significantly higher than after home training.
Conclusions & implications:
SAPS offers the assessment of an individual performance profile in order to derive sufficiently diversified, well-founded and specific treatment foci and to follow up changes in performance. The appending treatment regimen has shown to be effective for our participants. Thus, the study revealed feasibility of our approach.
... There are randomized controlled study comparing computer-based therapy to no treatment, speech and language therapy, or nonlinguistic computer training. In these studies, beneficial effect is expected on computerized treatment [6][7][8][9][10][11]. ...
... Neben der Therapie mit professionellen Sprachtherapeuten kann supervidiertes Heimtraining (u. a. mit dem Einsatz elektronischer Hilfsmittel wie Tablet/PC, dem Strichcodeleser B.A.Bar [66] oder der Kommunikationshilfe TouchSpeak [67]) zur kontinuierlichen sprachlichen Stimulation in therapiefreien Intervallen sowie einer verbesserten Teilhabe im sozialen Leben beitragen. Eine Übersicht der für den deutschen Sprachraum verfügbaren Kommunikationstechnologien, z. ...
Dank der Fortschritte der modernen Medizin ist die unmittelbare Mortalitätsrate nach einem Schlaganfall in den vergangenen Jahrzehnten kontinuierlich gesunken. Kehrseite dieser Entwicklung ist, dass die den Schlaganfall überlebenden Patienten für die verbliebene Lebensspanne teilweise erhebliche funktionelle motorische und/oder sprachliche Einschränkungen aufweisen. Im vorliegenden Beitrag werden evidenzbasierte Methoden der Neurorehabilitation zur Förderung motorischer und sprachlicher Funktionen in der akuten sowie chronischen Phase nach einem Schlaganfall vorgestellt. Neben intensiv durchgeführten Trainingsansätzen zählen dazu neuropharmakologische Ansätze und nichtinvasive Hirnstimulationstechniken, wie die transkranielle Magnet- oder Gleichstromstimulation (TMS, tDCS). Zusätzlich erfolgt ein Ausblick auf vielversprechende, derzeit noch als experimentell anzusehende Interventionen.
... At one end of the continuum, the PWA may identify the script topic and contribute to the development of its content with the assistance of a clinician or family member (e.g., Goldberg et al., 2012;Lee & Cherney, 2008;Youmans, Youmans, & Hancock, 2011). In contrast, script training of conversational dialogues has been successfully conducted without much personalization of the content (Bilda, 2011;Nobis-Bosch, Springer, Radermacher, & Huber, 2011). Although personalization has been assumed by many to be an essential component of script training, to date, there is no experimental evidence that personalization results in more successful acquisition or generalization of script content. ...
... Other studies, including this one, have incorporated the use of template-based scripts in which personally relevant words are inserted into a pre-established script on a given topic Youmans et al., 2005). Still others have carried out script training of conversational dialogues without personalizing the content for participants to any degree (Bilda, 2011;Nobis-Bosch et al., 2011). Diversity in the way scripts are personalized as well as differences in how performance is measured may account for differences in results across studies with regard to acquisition and generalization. ...
Purpose
The importance of personalization in script training in aphasia has been assumed but never tested. This study compared acquisition and generalization of personally relevant versus generic words or phrases appearing in the same scripts.
Method
Eight individuals (6 men; 2 women) with chronic aphasia received 3 weeks of intensive computer-based script training. For each participant, 2 scripts, a trained and an untrained generalization script, were embedded with 4 personally relevant word choices and 2–4 generic items that were similar across participants. Scripts were probed for accuracy at baseline and posttreatment. Significance testing was conducted on baseline and posttreatment scores, and for gains in personally relevant versus generic items. Effect sizes were computed.
Results
Both personally relevant and generic items improved significantly on trained scripts. Improvements on untrained scripts were smaller, with only personally relevant items reaching significance. There was no significant difference on gains made on personalized versus generic items for trained scripts (p = .059), but the effect size was large (d = 0.90). For generalization scripts, this effect was small (d = 0.25) and nonsignificant.
Conclusions
Personally relevant words and phrases were acquired, although not generalized, more successfully than generic words and phrases. Data supports the importance of personalization in script training, but the degree of that importance requires further investigation.
... Outside of therapy, many patients practice using commercial software exclusively designed for aphasia treatment. These programs, which are developed for personal computers and, more recently, mobile devices, have exhibited positive effects on aphasia rehabilitation [3] [4] [5] [6]. However, most commercial applications lack the ability to provide users with feedback regarding their verbal output. ...
Patients with aphasia often have impaired speech-language production skills, resulting in tremendous difficulties in tasks that require verbal communication. To facilitate rehabilitation outside of therapy, we are collaborating with the University of Michigan Aphasia Program (UMAP) to develop an automated system capable of providing feedback regarding the patient's verbal output. In this paper we introduce a robust method for extracting rhythm and intonation features from aphasic speech based on template matching. These features, combined with Goodness of Pronunciation (GOP) scores and our previous feature set, help our system achieve human-level performance in classifying the quality of speech produced by patients attending UMAP. The results presented in this work demonstrate the efficacy of our technique and the potential of this system for handling natural speech data recorded in non-ideal conditions as well as the unpredictability in aphasic speech patterns.
... Die identifizierten Studien mit Ausnahme der Studie von Corsten und Kollegen [23] Nachfolgende Studien noch ohne Ergebnisbewertung • Nobis-Bosch et al. [38]: n = 18; intensive Sprachtherapie mit elektronischer Unterstützung vs. keine linguistische Therapie; primäre Endpunkte sprachliche, kommunikative und kognitive Fähigkeiten. • Godecke et al. [39]: n = 59; intensive Sprachtherapie vs. reguläre Sprachtherapie; der Compliance der Klienten sein, welche möglicherweise mit der Intensität des Angebotes sowie deren Akzeptanz einhergeht. ...
