Academic journal article Journal of Medical Speech - Language Pathology

The Effect of Home Computer Practice on Naming in Individuals with Nonfluent Aphasia and Verbal Apraxia

Academic journal article Journal of Medical Speech - Language Pathology

The Effect of Home Computer Practice on Naming in Individuals with Nonfluent Aphasia and Verbal Apraxia

Article excerpt

This study investigated the impact of daily home computer practice on oral naming of pictures by comparing performance with two other conditions: weekly clinician-only therapy sessions (with no computer) and no treatment. The four participants were diagnosed with nonfluent aphasia and verbal apraxia. For 13 weeks, the participants practiced naming three sets of 10 drawings. Each set was assigned to one of three conditions: independent use of a home computer program (Computer Practice), weekly therapy sessions with a clinician and no computer progr am (Weekly Practice), or no practice (Control). Performance on the stimuli was assessed at the beginning of the study (Baseline), during treatment, at the end of the treatment (Assessment 3), and 5 weeks posttreatment (Maintenance). With Computer Practice, two participants improved statistically (and one approached significance) from Baseline to Assessment 3. From Baseline to Maintenance, three participants maintained statistically significant gains. With Weekly Practice, only one participant improved statistically from Baseline to Assessment 3, and there were no significant improvements from Baseline to Maintenance. The Control condition resulted in no significant improvements in any participant. The results suggest that computer programs are a practical way to provide practice that is relatively independent and appropriate for individuals with aphasia and apraxia.

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As anomia is a consistent feature of aphasia (Davis, 2000), numerous studies have focused on the use of computerized programs in facilitating word retrieval (Adrian, Gonzalez, & Buiza, 2003; Bruce, & Howard, 1987; Colby et al., 1981; Doesborgh et al., 2004; Fink, Brecher, Schwartz, & Robey, 2002; Laganaro, Pietro, & Schnider, 2003; Mortley, Wade, & Enderby, 2004; Pedersen, Vinter, & Olsen, 2001). The results of these studies demonstrate that computer use can yield significant naming improvements across different practice settings (e.g., out-patient vs. in-patient) and different degrees of guidance (e.g., full guidance vs. part-time guidance) (Laganaro et al., 2003; Fink et al., 2002). Even a remotely monitored intervention that was updated over the Internet yielded significant improvements (Mortley et al., 2004)

Overall, the results of these studies show that computerized practice programs have great potential for treating individuals with aphasia. However, a downside to several programs is that patients with aphasia may not be able to operate a computer independently due to knowledge or motor limitations. For example, many elderly adults do not have premorbid exposure to computers. With no background knowledge, they may have difficulty learning basic computer skills due to cognitive deficits related to aphasia or associated brain damage. In addition, if there is right-sided paresis (or paralysis) or limb apraxia, patients may have trouble learning skills requiring fine motor control, such as using a computer mouse. When such limitations are present, there must be a person who can actively assist in the computer therapy. For example, in Adrian et al.'s study (2003), a speech therapist was present throughout the practice to direct the computer program for auditory and written cues as well as to provide feedback on the responses. Having the computer practice dependent on another person may limit opportunities for practice by the patient. The present study was designed to promote independent patient-initiated practice in a home. Participants were provided with a computer program that utilized an automatic presentation of cues and words and required minimal computer skills. Giving patients the ability to practice independently not only increases the opportunities for practice but potentially gives them a stronger sense of control over their own treatment.

The cueing provided in the computer practice program was based on the many studies showing the benefits of semantic, orthographic, and phonological cueing in individuals with nonfluent aphasia. …

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