Telerehabilitation of aphasia: A systematic review of the literature

Co-designing solutions to the challenges speech pathologists and interpreters encounter when they collaborate to deliver aphasia therapy

PURPOSE

Aphasia caseloads worldwide are becoming increasingly diverse. Both speech pathologists and professional interpreters have identified challenges when working together in the delivery of aphasia rehabilitation to culturally and linguistically diverse people with aphasia. In this study we aimed to co-design solutions to the challenges that speech pathologists and interpreters encounter when they collaborate to adapt and deliver aphasia rehabilitation.

METHODS

A series of five co-design workshops were conducted online via Zoom with 4 Australian speech pathologists and 4 certified interpreters, purposively sampled across language, workplace, gender, and experience levels.

RESULTS

The co-designers generated a total of 23 solutions to address issues of inadequate training, lack of culturally and linguistically appropriate therapy materials, variability in briefing practices, navigating debriefing and feedback, difficulty accessing interpreters, and insufficient time. The solutions were rated for perceived impact and feasibility. Furthermore, the co-designers proposed potential avenues for implementation of these solutions through the consideration of agencies responsible for change.

CONCLUSIONS

This co-design study identified solutions that have the potential to enhance aphasia rehabilitation practices for culturally and linguistically diverse clients. However, achieving change in this area is complex. This research highlights the need for a whole-of-system approach with collaborative engagement from multiple organisations.

A systematic review of Phonological Components Analysis therapy studies for aphasia

Among the wide range of anomia treatments for persons with aphasia (PWA), Phonological Components Analysis (PCA) is a well-known alternative. A systematic review of PCA efficacy studies for PWA was conducted to extract treatment-related and participant-related characteristics, to synthesise immediate and long-term outcomes and to assess the methodological quality of PCA studies (PROSPERO pre-registration CRD42024552047). Experimental studies on adults with post-stroke aphasia focusing on the efficacy of PCA published in English were included. Studies combining PCA with other treatment approaches, involving people with neurodegenerative disorders, without efficacy measures, or in dissertations, theses, and conference papers were excluded. The EBSCOhost platform and citations of the original PCA paper were last searched in November 2024. In total, thirteen studies were selected involving 89 PWA. Participants were at least 6 months post-stroke, and 75 % of them presented with Broca's or anomic aphasia. The quality of PCA efficacy studies was relatively high according to the Single Case Experimental Design scale (mean 8.6 ± 1.0, range 7-10). Picture naming improved to reach at least a small effect size in 74 % of PWA (58/85) for trained items immediately after PCA and in 55 % of PWA (38/71) in the maintenance phase. Generalisation to untrained items occurred in 37 % of participants (22/59). Overall, PCA led to positive outcomes in the majority of PWA, which were often item-specific. As experimental designs were highly heterogeneous, further research is needed to better understand the optimal target population for PCA, the ideal dosage distribution, the key ingredients driving the improvement, and their neural correlates.

Experiences and perspectives of UK speech and language therapists on telehealth assessment with people living with post-stroke aphasia

BACKGROUND

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia.

AIMS

To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs' perspectives on what makes for a positive patient experience.

METHODS & PROCEDURES

Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment.

OUTCOMES & RESULTS

A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience.

CONCLUSIONS & IMPLICATIONS

This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery.

WHAT THIS PAPER ADDS

What is already known on the subject There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs' experience of delivering telehealth assessments to PWA. What this paper adds to existing knowledge This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided. What are the potential or actual clinical implications of this work? Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

Computer- and Smart-Tablet-Based Self-Administered Treatments in Chronic Post-Stroke Aphasia: A Systematic Review

BACKGROUND

In current clinical practice, resources remain limited and are insufficient to address the needs of people with chronic post-stroke aphasia. To improve access to speech therapy, self-administered therapies using computers or smart tablets are increasingly recommended. In addition to enabling more intensive and prolonged treatment, computer- and smart-tablet-delivered therapies can be highly enjoyable and motivating for patients.

AIMS

This systematic review aimed to identify computer- and smart-tablet-based self-administered treatments and analyze the proposed interventions in terms of treatment targets, effectiveness (considering specificity, generalization, transfer, and maintenance), and clinician involvement (during and/or prior self-administered therapies).

METHODS

Terms encompassing three main concepts (rehabilitation, self-administration, and aphasia) were used to search three electronic databases (Scopus, PubMed, and PsycINFO). Two reviewers independently screened titles and abstracts against eligibility criteria. Data extraction of included studies was completed by three reviewers.

RESULTS

Thirty-nine studies were included in this study. In terms of treatment targets, anomia is the most treated symptom in published studies (n = 24), but the existence of promising studies for other disorders means that the targets can be broadened. Therapies are effective for trained items, and gains are maintained. There is some evidence of transfer effects for treatments targeting the sentence level. Most studies offer training sessions, previous self-administered therapy, and/or observation and monitoring sessions during therapy; more rarely, self-administered therapy is supplemented with face-to-face therapy.

CONCLUSIONS

This systematic review is the first to focus specifically on self-administered technology-based therapies. It provides important evidence-based information for clinical practice in self-administered therapies via computer or smart tablet.

Telepractice-delivered communication training for informal caregivers of people with aphasia: A pilot study

PURPOSE

To establish proof of concept of a student-led, telepractice-delivered communication partner training towards enhancing communication between people with aphasia and their informal caregivers in everyday conversations.

METHOD

Two dyads were recruited, each consisting of a person with aphasia and their caregiver. A pre-training questionnaire was completed by caregivers, followed by a weekly communication training session delivered by graduate student clinicians via telepractice to each dyad over 12 weeks. The caregivers then completed a post-training questionnaire. Both questionnaires included 13 Likert-scale questions and one open-ended question requiring an extended response.

RESULT

Pre- to post-training improvements for both dyads were identified on two domains of the questionnaire: (a) frustrations of the caregiver and person with aphasia and (b) caregivers' knowledge and confidence in using communication strategies. This quantitative data was supported by additional extended responses regarding informal caregivers' current communication strategies when communicating with the person with aphasia.

CONCLUSION

Both informal caregivers reported integrating communication strategies learned as part of the training in their interactions with the person with aphasia and experiencing fewer communication breakdowns during the two weeks following the training. The pilot study offers proof of concept for incorporating telepractice-delivered caregiver communication training as part of aphasia rehabilitation.