A Trial Investigating Telerehabilitation as an add-on to Face-to-face Speech and Language Therapy in Post-stroke Aphasia.

Recruiting

Phase N/A Results N/A

Trial Description

The aim of this study is to investigate the effects of high-frequency short duration tablet-based speech and language therapy (teleSLT) mixed with cognitive training (teleCT) in chronic stroke patients. Recent studies suggest that chronic stroke patients benefit from SLT with high frequency and that cognitive abilities can play a role in sentence comprehension and production by individuals with aphasia. To investigate the effects of the distribution of training time for teleSLT and teleCT the investigators use two combinations. In the experimental group 80% of the training time will be devoted to teleSLT and 20% to teleCT whereas in the control group 20% of the training time will be devoted to teleSLT and 80% to teleCT. Both groups receive the same total amount and frequency of intervention but with different distributions. At three time points (pre-, post-test and 8 week follow-up) the patients' word finding ability is measured.

Detailed Description

A recent Cochrane intervention review revealed evidence for the effectiveness of using speech and language therapy (SLT) for people with aphasia following stroke in terms of functional communication, receptive and expressive language. The authors highlight positive effects of higher training frequency on functional outcome. Also other authors emphasizes the importance of training frequency. In the meta-analysis with 968 patients the authors found that only intervention studies with more than five hours training per week lead to positive effects on speech and language function. They highlighted that it might be better to train short but with a high frequency than long with a low frequency. While some researchers emphasizes the benefit of early intervention, several studies found that also chronic stroke patients can benefit from intensive SLT. One possible approach to increase training frequency and duration is to complement therapist delivered usual care SLT (ucSLT) with telerehabilitation SLT (teleSLT) delivered in the patient's home.
Aphasia is frequently accompanied by deficits of working memory (WM), speed of processing (SP) and executive functions (EF). Recent studies suggest that these cognitive abilities can play a role in sentence comprehension and production by individuals with aphasia and that WM, SP and EF can be enhanced with intensive practice. The authors suggest that SLT therapy should be accompanied with cognitive training (CT). It remains however unclear what percentage of the training time should be devoted to SLT and to cognitive training respectively. For the current study the investigators will use two combinations of teleSLT and telerehabilitation cognitive training (teleCT), where one combination will have a higher percentage of time devoted to teleSLT and the other a higher percentage devoted to teleCT. The latter will serve as the control group to examine the effect of teleSLT.

Conditions

Interventions

  • UcSLT Behavioral
    Intervention Desc: The psychological intervention consists of usual care SLT (ucSLT). During four weeks the patients in both arms will receive a 45 minutes ucSLT once a week
    ARM 1: Kind: Experimental
    Label: High teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the experimental group 80% of the training time will be devoted to teleSLT and 20% to teleCT. Both groups receive the same amount of ucSLT.
    ARM 2: Kind: Experimental
    Label: Low teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the control group 20% of the training time will be devoted to teleSLT and 80% to teleCT. Both groups receive the same amount of ucSLT.
  • TeleSLT Device
    Intervention Desc: The teleSLT intervention consists of a daily training session with a tablet computer at the patients' home. The teleSLT application that will be used for this study was developed within a multidisciplinary team of speech and language therapists, neurologists and computer engineers that have transferred well-established SLT exercises to a tablet computer. The investigators call this application Bern Aphasia App (BAA). During the four weeks the training time with the BAA differs between the two arms. The experimental group trains for 96 minutes per day (80% of an hour) and the control group for 24 minutes per day (20% of an hour).
    ARM 1: Kind: Experimental
    Label: High teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the experimental group 80% of the training time will be devoted to teleSLT and 20% to teleCT. Both groups receive the same amount of ucSLT.
    ARM 2: Kind: Experimental
    Label: Low teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the control group 20% of the training time will be devoted to teleSLT and 80% to teleCT. Both groups receive the same amount of ucSLT.
  • TeleCT Device
    Intervention Desc: For the cognitive training the investigators will use two custom-made versions of popular commercial casual puzzle video games: Flow Free (Big Duck Games LCC) and Bejeweled (PopCap Games). The video games are also delivered on tablet-computers. Again, during the four weeks the training time differs between the two arms. The experimental group trains for 24 minutes and the control group for 96 minutes per day.
    ARM 1: Kind: Experimental
    Label: High teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the experimental group 80% of the training time will be devoted to teleSLT and 20% to teleCT. Both groups receive the same amount of ucSLT.
    ARM 2: Kind: Experimental
    Label: Low teleSLT frequency
    Description: During four weeks all patients will receive a 45 minutes ucSLT once a week and will do a daily one-hour training session with a tablet computer (consisting of teleSLT and teleCT) at their home. In the control group 20% of the training time will be devoted to teleSLT and 80% to teleCT. Both groups receive the same amount of ucSLT.

Outcomes

Type Measure Time Frame Safety Issue
Primary Word Finding Ability Pre-test (Baseline, week 0)
Secondary Functional Communication Pre-test (Baseline, week 0)
Secondary Change In Patient Perception Of Communication And Quality Of Life Post-test (First measurement, week 4)
Primary Understandability of verbal communication Pre-test (Baseline, week 0)
Secondary Intelligibility of verbal communication Pre-test (Baseline, week 0)
Secondary Impairment specific language measures Pre-test (Baseline, week 0)
Secondary Perceived quality of life Pre-test (Baseline, week 0)

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