A feasibility study of a novel computer-based treatment for sentence production deficits in aphasia, delivered by a combination of clinician-led and self-managed treatment sessions

Figures & data

Table 1. Participants’ demographic information.

	Ian	Jennie	Wendy	Dave	Andy	Peggy
Gender	M	F	F	M	M	F
Age	53	49	54	59	57	81
Aetiology	CVA (embolic)	CVA (haemorrhagic)	CVA (embolic)	CVA (embolic)	CVA (embolic)	CVA (embolic)
Years Post-onset	10	3	3	2	7	4
Aphasia Type	Non-fluent + mild dysarthria	Non-fluent + mild apraxia	Non-fluent	Non-fluent	Fluent	Fluent/anomic
CAT Object Naming Score^a (n=48)	35 (73%)	42 (87.5%)	43 (89.5%)	18 (37.5%)	16 (33%)	48 (100%)
OANB Verb Naming ^a (n=43)	26 (60%)	28 (75%)	29 (68%)	9 (21%)	11 (26%)	31 (72%)
CAT Spoken Sentence Comprehension Score ^a (n=32)	25 (78%)	24 (75%)	28 (87.5%)	28 (87.5%)	21 (65.5%)	23 (72%)
CAT Word Repetition^b (n=32)	30 (94%)	24 (75%)	32 (100%)	32 (100%)	24 (75%)	28 (88%)

(^aPalmer et al. (2019) in an RCT of self-delivered anomia treatment found that <18 on CAT Object Naming & <10% on OANB Verb Naming resulted in poorer response to treatment; >26/32 on comprehension = better response to treatment. ^bConroy et al, (2009a, b & c). regard >75% on repetition = better response to anomia treatment)

Figure 1. Study Design (Tx = treatment).

Table 2. Outcome measures.

Research Question	Outcome Measure	Administration of OM
Is it feasible to self-deliver SPT by computer?	ease of participant recruitment participant attrition log of technical difficulties self-reported compliance with treatment	Throughout study
(2) Is the SPT acceptable to the participants with aphasia and their SOs.	Questionnaire and semi-structured interview with participants and their SOs (Palmer et al., 2013)	After treatment completed for each participant and their SO
(3) What factors influence compliance with self-delivered computer treatment?	Logging of potential influential factors on compliance: age severity of aphasia whether a participant was already a frequent computer user need for help to resolve technical issues with the SPT access to someone who could help with technical issues	After treatment completed for each participant
(4) Were treatment procedures carried out during the SPT administered with acceptable fidelity?	self-rating by clinician of face-to-face treatment sessions using fidelity checklist of presence/absence of expected behaviours	During and after treatment phase
(5) Is the SPT efficacious i.e., does it result in statistically significant improvement in the production of: 5a i) trained and untrained verbs	picture naming score (using single word) for trained and untrained verbs verb subtest of the Object Action Naming Battery (OANB: Druks & Masterson, 2000)	T1, 2, 3 and 4
5b ii) untrained nouns	noun subtest of the OANB	T1, 2, 3 and 4
5c iii) sentence production using trained and untrained verbs	Picture naming score (using a sentence) of trained and untrained verbs Sentence Construction Test of the Verb And Sentence Test (VAST: Bastiaanse et al., 2002)	T1, 2, 3 and 4
5d iv) verb and sentence production in discourse	Comprehensive Aphasia Test (CAT) Picture Description Score (Swinburn et al., 2004) Predicate Argument Structure (PAS) analysis of CAT Picture Description (Webster et al, 2007) PAS analysis (ibid) of The Autobiographical Memory Interview (AMI: Kopelman et al,1989).	T1, 2, 3 and 4
5e v) functional communication as perceived by i) the participants with aphasia themselves and ii) their SOs?	Participant Communicative Index (CETI) score (Lomas et al., 1989) SO CETI score	T1, 2, 3 and 4

Table 3. The topics to which the PR verbs chosen by participants belonged (based on the classification system used in Palmer et al., 2017).

Verb Topic	Number of verbs chosen (n=120)
Entertainment/Hobbies	24 (20%)
Food & Drink	24 (20%)
Nature & Gardening	15 (12.5%)
Feelings & Senses	14 (11.7%)
Communication Mediums & Modes	12 (10%)
Work	9 (7.5%)
Health	7 (5.8%)
Travel	6 (5%)
Shopping	5 (4.2%)
House	2 (1.7%)
Money	2 (1.7%)
Housework	1 (0.8%)
Personal Care	1 (0.8%)

Table 4. Reasons screened participants did not participate in the research project.

Gender	Reason for non-participation	Recruited via:
F	Repetition <75% on CAT Repetition of Words	City Aphasia Lab Research Register
M	Verb naming <15% on OANB screening	Referred by wife
F	Verb naming >80% on OANB screening	City Aphasia Lab Research Register
F	Suitable but decided not to participate as secured a volunteer post with aim of resuming employment	Aphasia self-help group
M	Suitable but unable to participate due to a 4 month sailing holiday	Aphasia self-help group
F	Verb naming >80% on OANB screening	City Aphasia Lab Research Register

Table 5. Feasibility of the SPT (participants reported in order of amount of self-managed practice completed).

	1 Device used to self-deliver SPT	2 Frequent computer user	3 Needed help to solve IT issues	4 Access to carer who could help with IT issues	5 Amount of sessions delivered F2F	6 Duration over which treatment delivered (weeks)	7 Total amount of treatment self-delivered	8 Average amount of self-delivered treatment per week	9 Range of amount of self-delivered treatment per week
Wendy	Android Tablet	Yes	No	Yes	8	11	59 hours 6 mins	5 hrs 23 mins	2 hrs 56 mins - 7 hrs 55 mins
Dave	Windows Laptop	Yes	No	No	8	11	45 hrs 29 mins	4 hrs 8 mins	1 hr 46 mins - 9 hrs 1 min
Andy	Windows Desktop & iPad	Yes	Yes	Yes	6	8	28 hours 40 mins	2 hrs 36 mins	2 hrs - 3 hrs 30 mins
Jennie	iPad & Smart Phone	Yes	No	Yes	8	9	17 hours 40 mins	1 hr 46 mins	2 hrs 55 mins – 4 hrs
Ian	iPad	Yes	Yes	No	8	11	11 hours	1 hour	0- 2 hours
Peggy	Windows Laptop	No	Yes	No	8	17	6 hours 47 minutes	24 mins	0 - 2 hrs 13 mins

Figure 2. Participants’ responses to rating scale questions on the acceptability of the SPT.

Table 6. Summary of the effect of the SPT on participants’ language and communication.

	PR Verbs Treated		PR Verbs Untreated		Personally Irrelevant Verbs		Personally Irrelevant Nouns		Lexical Retrieval In Sentences: Treated PR Verbs		Lexical Retrieval In Sentences: Untreated PR Verbs		Lexical Retrieval In Sentences: Personally Irrelevant Verbs		PAS: Treated PR Verbs		PAS: Untreated PR Verbs		PAS: Personally Irrelevant Verbs		Picture Description (CAT)		Narrative Production (AMI)		CETI PwA		CETI SO
	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4	T3	T4
Ian	S**	S**	NS	S*	NS	NS	NS	NS	S**	S**	S**	S**	NS	S*	S*	S**	S*	S*	NS	NS	NS	NS	NS	NS	NS	NS	NA	NA
Jennie	S**	S*	NS	NS	NS	NS	S**	S*	S***	S**	NS	S***	NA	NS	S**	S*	NS	NS	NA	NS	S**	S**	NA	✓	S***	S***	S***	S***
Wendy^a	S***	S***	NS	S**	NS	NS	NS	NS	NA	S**	NA	NS	NA	NS	NA	S*	NA	NS	NA	NS	✓	✓	✓	✓	✓	NS	S**	NS
Dave^a	✓	✓	NS	✓	NS	S*	NS	NS	S**	S*	S***	NS	NA	NS	✓	✓	✓	✓	NA	✓	NS	NS	NA	NA	S***	NS	NA	NA
Andy	S*	NS	NS	NS	NS	NS	✓	NS	✓	✓	NS	✓	NS	NS	✓	✓	✓	✓	S**	S*	✓	✓	✓	NS	NS	NA	NA	NA
Peggy^a	S*	NS	NS	NS	NS	NS	NS	NS	NS	NS	NS	S*	NS	NS	NS	NS	NS	✓	NS	NS	NS	NS	NS	NS	NS	S*	NA	NA

(S = significant; *=p<.05; ** =p<.01; ***p=<.001; NS = non-significant; NA = not assessed; ✓ = non-significant trend of improvement. McNemar’s Test: lexical retrieval of nouns & verbs; Chi Square: PAS; Friedman’s Test: CAT picture description & the CETI. ^aThese participants continued to carry out SPT exercises between T3 and T4 so this is not a maintenance phase for them).

Palmer, R., Dimairo, M., Cooper, C., Enderby, P., Brady, M., Bowen, A. et al. (2019). Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurology, 18, 821–33

 PubMed Web of Science ®Google Scholar

Conroy, P., Sage, K., & Lambon-Ralph, M. (2009a). A comparison of word versus sentence cues as therapy for verb naming in aphasia. Aphasiology, 23, 462–482 .

 Web of Science ®Google Scholar

Palmer, R., Enderby, P. & Paterson, G. (2013). Using computers to enable self-management of aphasia therapy exercises for word finding: the patient and carer perspective. International Journal of Language & Communication Disorders, 48, 508–521.

 PubMed Web of Science ®Google Scholar

Druks, J. & Masterson, J. (2000) An Object Action Naming Battery. Hove: Psychology Press.

 Google Scholar

Bastiaanse, R., Edwards, S. & Rispens, J. (2002). The Verb and Sentence Test. Bury St Edmunds: Thames Valley Test Company Limited.

 Google Scholar

Swinburn, K., Porter, G., and Howard, D., (2004). The Comprehensive Aphasia Test. Hove: Psychology Press.

 Google Scholar

Webster, J., Franklin. S. & Howard, D. (2007) An analysis of thematic and phrasal structure in people with aphasia: What more can we learn from the story of Cinderella? Journal of Neurolinguistics, 20, 363–394.

 Web of Science ®Google Scholar

Kopelman, M.D., Wilson, B.A. & Baddeley, A.D. (1989). The autobiographical memory interview: A new assessment of autobiographical and personal semantic memory in amnesic patients, Journal of Clinical and Experimental Neuropsychology, 11, 724–744, DOI: 10.1080/01688638908400928

 PubMed Web of Science ®Google Scholar

Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A. & Zoghaib, C. (1989) The Communicative Effectiveness Index: development and psychometric evaluation of a functional communication measure for adult aphasia. Journal of Speech and Hearing Disorders, 54, 113–124.

 PubMedGoogle Scholar