Investigating the utility of teletherapy in individuals with primary progressive aphasia

Abstract

Introduction

Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of speech and language. A growing body of research supports the utility of speech and language intervention in individuals with PPA, although access to these services remains limited. One potential means of increasing treatment accessibility is the delivery of treatment via telemedicine. Evidence supports the use of teletherapy in stroke-induced aphasia, but research examining the application of teletherapy in PPA is limited. In the current study, a non-randomized group comparison design was used to evaluate the feasibility and utility of treatment delivered via teletherapy relative to treatment administered in person for individuals with PPA.

Methods

Two treatment protocols were administered as part of a larger study investigating treatment for speech and language deficits in PPA. Participants with semantic (n=10) and logopenic (n=11) PPA received lexical retrieval treatment and individuals with nonfluent/agrammatic PPA (n=10) received video-implemented script training for aphasia designed to promote speech production and fluency. Treatment was administered via teletherapy for approximately half of the participants receiving each intervention. Treatment outcomes and performance on standardized tests were assessed at pre-treatment and post-treatment, as well as 3, 6, and 12 months post-treatment.

Results

Overall, both treatment approaches resulted in significant gains for primary outcome measures. Critically, comparison of in-person and teletherapy groups revealed comparable outcomes. Generalization to untrained targets and tasks and maintenance of treatment-induced gains were also comparable for traditional vs teletherapy participants.

Conclusion

Overall, treatment outcomes were largely equivalent for individuals receiving treatment via teletherapy vs traditional, in-person delivery. Results support the application of teletherapy for administering restitutive interventions to individuals with mild-to-moderate PPA. Potential implications for using teletherapy in the treatment of cognitive-linguistic and motoric impairments in other disorders and suggestions for administering treatment via telemedicine are discussed.

Keywords:

• PPA
• lexical retrieval treatment
• script training
• telemedicine
• telerehabilitation
• telepractice

Acknowledgments

We wish to the thank members of the University of Texas at Austin Aphasia Research and Treatment Lab and the University of California, San Francisco, Memory and Aging Center who contributed to patient assessment and care. We also thank Gregory Hixon for statistical consultation. Finally, we wish to thank all of our participants with PPA and their families for the time and effort that they have devoted to our research. This work was funded by grants from the National Institutes of Health (NIDCD R01 DC016291 and NIDCD R03 DC013403 to MLH and NINDS R01 NS050915 and NIDCD K24 DC015544 to MLGT) and the Darrell K Royal Research Fund for Alzheimer’s Disease (to MLH).

Disclosure

The authors report no conflicts of interest in this work.

Supplementary materials

Table S1 Demographic characteristics and change scores for trained items for LRT-1 and LRT-2 participants

Table S2 Results of paired-samples permutation tests comparing treatment outcome measures and standardized test scores at each time point relative to pre-treatment and post-treatment for participants who underwent LRT

Table S3 Results of two-tailed paired-samples permutation tests comparing treatment outcome measures and standardized test scores at each time point relative to post-treatment for participants who underwent VISTA

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