A scoping review on aphasia and technology: exploring mechanisms enhancing quality of life

Abstract

Purpose

People with aphasia are at an increased risk for reduced quality of life (QoL) because of their change in communication abilities (Lancioni et al. in Curr Dev Disord Rep 6:126–130, 2019). The present study aims to review the current evidence supporting assistive technology as a tool to improve QoL for people with aphasia, while investigating the various mechanisms technology may impact that lead to increased QoL for people with aphasia. The primary aim is to investigate the underlying mechanisms impacted by assistive technology that may improve QoL for people with aphasia.

Methods

We conducted a scoping review using Embase, CINAHL, PubMed, and PsycINFO databases to identify relevant studies on assistive technology and QoL for people with aphasia, screening a total of 103 articles for inclusion.

Results

A total of 25 articles fit inclusion criteria for the scoping review following initial and secondary screenings. Evidence from past studies suggests self-management, social interaction and virtual communication as mechanisms enhanced by technology potentially leading to improved QoL outcomes for people with aphasia.

Conclusion

This review emphasizes the role mechanisms such as self-management, social interaction, and virtual communication play in improving QoL for people with aphasia, while emphasizing the role technology plays in impacting the function of these mechanisms. In turn, the literature supports assistive technology as a tool to improve QoL for people with aphasia. However, for this assistive technology to be impactful, it must be person centered and thoroughly trained based on the current body of evidence.

Introduction

For the past 30 years researchers have been investigating the role of assistive technology in the management and rehabilitation of aphasia. Aphasia is an acquired language disorder following a sudden injury to the brain and may impact any or all the four domains of language (listening, speaking, reading, and writing) [8]. Assistive technology is defined as equipment or devices that help people participate in daily activities. Communication related assistive technology ranges from high to low tech, such as a paper photo board, a hand-held device like a cell phone, or an eye tracking device [24]. Different communication needs and patient preferences warrant the use of different types of devices.

Speech language pathologists (SLP) are responsible for recommending and training people with aphasia (PWA) on how to use assistive technology. Qualitative studies investigating perspectives of SLPs on their role, and the function of AAC for people with aphasia indicate that SLPs use AAC in therapy to improve holistic self-management of aphasia by increasing avenues for service delivery, communication, and learning, with the ultimate goal of increasing life participation [31]. AAC is evidence-based and has wide support from researchers and clinical service providers around the globe [15, 30]. However, insufficient SLP training on AAC use and implementation, as well as lack of access to technology resources, were mentioned as barriers to successful AAC use across countries [21, 29, 30]. Research on more readily available technology, such as free apps on cell phones or iPads, may increase the number of patients that can access this technology. With improved knowledge and training on these readily available devices in the context of communication, SLPs may facilitate greater access to language and self-management for their patients.

A recent review found that AAC encourages life participation for PWA while also serving as a therapeutic tool targeting brain reorganization and improvement of language function [9]. That is, AAC can serve as both a compensatory strategy for language use and a catalyst for restored language functions. Moreover, AAC can improve self-management for people with aphasia, which has been shown to improve QoL [31].

Quality of life (QoL) is defined as a multidimensional concept aiming to define the combination of an individual’s mental, physical, and social health at one point in time (Center for Disease Control, 2025). People with aphasia are at an increased risk for reduced QoL secondary to their loss of ability to utilize language [25]. PWA are more likely to experience social isolation and depression [5]. While past scoping reviews have been conducted to examine self-management and aphasia [32], artificial intelligence in aphasia rehabilitation [4], and assistive communication devices for people with aphasia [36], there has yet to be a scoping review addressing the specific ways that assistive technology may influence QoL through various mechanisms. The present study aims to fill this gap by investigating the current evidence supporting assistive technology as a method to improve QoL for PWA. In doing so, we will highlight the specific mechanisms influenced by assistive technology that may improve QoL.

Methods

The literature search for the present study was completed in January 2025. The study utilized Arksey & O’Malley’s [3] scoping review methodological framework, as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides during literature review and analysis. Our team also followed Levac et al., [26] six stage framework to advance the methodology of the present scoping review as well as Peters et al., [34] guidelines, which are aligned with the PRISMA ScR framework. A librarian at The Ohio State University was consulted to assist in identifying the best search terms and databases to complete the aims of the study. The librarian was also consulted to discuss the completion of a scoping review versus a systematic review. Due to the qualitative nature of the questions and broad focus of the aims, a scoping approach was determined to best fit the goals of the present review. PubMed, PsycINFO, Embase, and CINAHL Plus databases were searched for articles addressing QoL with aphasia and assistive technology. See Table 1 for the search terms utilized in each database.

Table 1.

Search strategy utilized for PubMed, PsycINFO, Embase, and CINAHL databases

Data base	Terminology
PubMed	(aphasia) AND ((assistive technology) OR (augmentative and alternative communication) OR (AAC)) AND ((Quality of Life) OR (life participation))
PsycINFO	(aphasia) AND ((assistive technology) OR (augmentative and alternative communication) OR (AAC)) AND ((Quality of Life) OR (life participation))
Embase	(aphasia) AND ((assistive technology) OR (augmentative and alternative communication) OR (AAC)) AND ((Quality of Life) OR (life participation))
CINAHL Plus	(aphasia) AND ((assistive technology) OR (augmentative and alternative communication) OR (AAC)) AND ((Quality of Life) OR (life participation))

Inclusion and exclusion criteria were established prior to completing the literature review. The first, second, and third authors discussed criteria and agreed on inclusion and exclusion criteria prior to beginning the search. Studies were included in the scoping review if they met the following criteria: (1) participant(s) were diagnosed with aphasia, (2) participant(s) with aphasia were analyzed separately from any participants without aphasia, (3) participants were 18 years of age or older, (4) articles addressed some form of assistive technology targeted to enhance communication function in some way, (5) articles address QoL or some aspect of life participation, (6) articles presented new data. Studies were excluded from the scoping review if they met any of the following criteria: (1) participants had primary progressive aphasia; (2) participants had a neurodegenerative diagnosis such as dementia or Alzheimer’s disease.

Search results were exported from research databases to Mendeley, and duplicates were removed. Abstracts were initially screened for inclusion and exclusion criteria by the author GT. Then, approximately 20% of exported articles were screened by GA for reliability (n = 28). The agreement between these two authors was 93%. Disagreements were settled by GT and GA by discussing the full text until a consensus was reached. After final inclusion/exclusion decisions were agreed upon, the following details were sorted from each article into a spreadsheet: (1) title, (2) author names, (3) year of publication, (4) methodological approach, (5) number of participants, (6) type of aphasia of participants (if applicable), QoL measures utilized, and (7) language domain technology the article aimed to impact. The authors collaborated to verify these details and expand upon them to formulate the results of the present review.

Articles were examined throughout the scoping review process for evidence of mechanisms impacting QoL. Throughout the scoping review process, articles were examined for evidence of mechanisms impacting QoL. Thematic analysis was utilized to guide pattern identification in the body of literature presented, while aiding in the formulation of a theoretical model regarding how assistive technology impacts various mechanisms, increasing QoL. Upon full review of the articles, three potential mechanisms were identified. Included articles were initially screened for mechanisms by the author GT. Then, approximately 20% of included articles were screened by GA for reliability (n = 5). Code agreement between these two authors was 90%. Disagreements were settled by GT and GA by discussing the full text until a consensus was reached. After finalizing the identified mechanisms impacting QoL through assistive technology, each article was sorted into a spreadsheet including the following sections: (1) study, (2) number of participants, (3) QoL measure (if included), and (4) mechanisms impacting QoL based on results. Notably, not all articles highlighted a QoL mechanism, and others indicated more than one mechanism of QoL.

Results begin with a summary of details about participants and standardized measures used to gauge QoL, followed by descriptions of various mechanisms influenced by technology that impact QoL for PWA.

Results

A total of 138 articles were exported into Mendeley Software, 27 from Embase, 23 from CINAHL, 72 from PubMed and 16 from PsycINFO. Following thorough screenings, 25 studies are included in the present scoping review. See Fig. 1 for details of the exclusion process. Publication years of the articles ranged from 1998–2025.

Fig. 1.

PRISMA flow diagram: article exclusion process

Mechanisms in this review are defined as the underlying process that leads to a specific outcome, in this case that outcome in increased QoL. Each study was coded for themes, including the relevant mechanism influencing QoL. 17/25 articles indicated that increased social and/or functional communication was a mechanism of QoL, 18/25 indicated increased self-management as a mechanism of increasing QoL, and 4/25 indicated increased virtual communication as a mechanism increasing QoL. Each mechanism is discussed.

Participants

From the 25 studies included in the present review, aphasia severity ranged from mild- severe. Of note, not all studies reported aphasia severity, or type of aphasia. Reporting varied across included studies, and the present participant data are based on the available reports in each study. Average time post onset of aphasia ranged from 6.3 to 98.83 months. None of the present studies examined participants in the acute stage of aphasia onset (one to seven days); however, articles did include the subacute (seven days—6 months) and chronic stages (6 months and beyond). Notably, a study started in 2021 by Huang et al. [20] is included in the table; however, much of the demographic information was not reported as the study was in progress at the time of publication. The study was kept in the scoping review as it utilizes a specific tool to investigate QoL of PWA, which fits the aims of the present review. Participant demographics are summarized in Table 2, organized in alphabetical order by the last name of the first author. In Table 3, a summary table presenting each studies aims, type of assistive technology or intervention investigated, and results are presented, studies are again organized in alphabetical order by last name.

Table 2.

Participant demographics

References	N	Months post onset (mean)	Age of PWA in years (mean)	Gender	Type of aphasia	Severity of aphasia
Alam et al., [1]	10 PWA	9.8	50.8	10 males 0 females	Broca’s	Mild-severe
Bartlett et al., [6]	5 PWA	105.8	51.6	2 males 3 females	Broca’s, Anomic	Mild-moderate
Dada et al., [7]	12 PWA	38.6	63.9	8 males 4 females	Broca’s, Conduction, Anomic	Mild-moderate
Dietz et al., [12]	3 PWA, 3 Primary Caregivers 3 people from social network	88	56.3	Not reported	Broca’s, global	Moderate-severe
Dietz et al., [11]	5 PWA	144	57.8	3 males 2 females	Broca’s, Transcortical sensory, Transcortical motor	Mild-moderate
Dietz et al., [10]	12 PWA	77.2	57.1	5 males 7 females	Global, Broca’s, Conduction, Wernicke’s, Anomic	Moderate-severe
Estes et al., [13]	1 PWA	132	65	1 female	Conduction	Moderate
Griffith et al., [15]	4 PWA	56.5	58.25	1 male 3 females	Not reported	Mild-severe
Hough et al., [17]	1 PWA	24	56	1 male	Not reported	Severe
Huang et al., [19]	12 PWA	6.3	57.9	6 males 6 females	Subcortical, Broca’s, Global, Conduction	Moderate-severe
Huang et al., [20]	22 PWA (In progress)	In progress	In progress	In progress	In progress	In progress
Johnson et al., [21]	3 PWA	52.7	67.7	1 male 2 females	Mixed, Broca’s	Moderate-severe
Koul et al., [23]	9 PWA	54	67.4	3 males 6 females	Broca’s, Global	Severe
Marshall et al., [27]	21 PWA	57.21	56	12 males 9 females	Dysgraphia	Mild-severe
Moss et al., [29]	10 PWA	70.8	58.2	6 males 4 females	Dysgraphia	Moderate-severe
Nakkawita et al., [30]	9 PWA	Range of 9 months to 19 years	66.22	4 males 5 females	Broca’s, Conduction, Wernicke’s, transcortical sensory, transcortical motor	Mild-moderate
Nichol et al., [31]	15 speech language pathologists (SLP)	Not applicable (SLP Reports)	Not applicable (SLP Reports)	Not applicable (SLP Reports)	Not applicable (SLP Reports)	Not applicable (SLP Reports)
Shamim et al., [37]	8 PWA	Mean not reported, within 3 months of diagnosis	Mean not reported, 40+ years of age	Not reported	Broca’s	Severe
Thiessen et al., [39]	10 PWA	43.2	52	7 males 3 females	Not reported	Mild-severe
Van de Sandt-Koenderman et al., [40]	34 PWA	31.4	61	19 males 15 females	Broca’s, Global, Conduction, Non-classifiable	Severe
Van de Sandt-Koenderman et al., [41]	28 PWA	30	57	20 males 8 females	Not reported	Not reported
Velez et al., [42]	16 PWA	72	56.9	8 males 8 females	Anomic, transcortical motor, transcortical sensory, Conduction, Broca’s	Mild-severe
Wallace et al., [44]	2 PWA	16	55	2 males	Wernicke’s, non-fluent	Severe
Wallace et al., [43]	6 PWA	98.83	56	3 males 3 females	Broca’s, anomic, conduction	Mild-Severe
Waller et al., [45]	4 PWA	45.25	64.75	3 males 1 female	Non-fluent	Mild-moderate

Table 3.

A summary of aims, assistive technology type, and findings of included studies

References	Aim(s)	Assistive technology type	Results
Alam et al., [1]	Aimed to determine the benefits of the Jellow App as a facilitator of stimulus therapy to improve language and QoL outcomes for PWA	Jellow Stimulus Therapy App	After Jellow App use, improvement seen in study group on the Western Aphasia Battery, and on the SAQOL Communication section
Bartlett et al., [6]	Aimed to demonstrate aided effects in functional narratives from a first-person perspective	High Tech AAC: SentenceShaper Language Production Support Program	The sentence shaper may improve PWA’s ability to communicate functional narrative stories
Dada et al., [7]	Aimed to identify if caregivers emphasizing augmented input material was beneficial to PWA	Supplementation of auditory input with visual supports	Some people benefit from caregiver involvement in auditory comprehension support, while others do not. More evidence needed
Dietz et al., [12]	Aimed to explore the social role changes experienced by PWA, and understand the use of communication strategies when attempting to reclaim previous social roles through qualitative interviews of PWA, their primary caregivers, and their loved ones	Variety	AAC strategies provided PWA with a way to communicate their opinions and needs to the people in their lives
Dietz et al., [11]	Aimed to describe communication behaviors of PWA when they retold a story using a visual screen display device	High Tech AAC Visual Scene Display Interface	PWA utilized spoken language and visual screen display assistance such as pictures and text boxes to supplement retell
Dietz et al., [10]	Aimed to examine the feasibility of providing a high-tech AAC treatment to people with chronic aphasia, with the goal of evoking changes in spoken language and to identify evidence of AAC-induced changes in brain activation	High Tech AAC device	Trend toward greater left-brain lateralization, increased activation on visual processing regions for PWA
Estes et al., [13]	Aimed to investigate the functional and linguistic effects of treatment that used voice recognition software to improve written communication in an individual with chronic aphasia	Dragon NaturallySpeaking Program	With intensive instruction participant could utilize Dragon program. Functional writing abilities improved with use of Dragon Naturally-Speaking Program to approximate spoken language
Griffith et al., [15]	Aimed to determine what visual interface of AAC devices is most beneficial in story retell for PWA	High Tech AAC device	Photos and line drawings were used to aid in story retell, photos were used more, but both were reported as helpful by PWA. Personalized assessment is optimal to create these tools
Hough et al., [17]	Aimed to investigate if an hour of use, 4 days a week for 6 months of Dialect by Zygo device would improve language outcomes for PWA	High Tech AAC device called Dialect by Zygo with Speaking Dynamically Program	Participant performance improved based on Western Aphasia Battery Scores
Huang et al., [19]	Aimed to evaluate combination of low-tech AAC combined with speech-language therapy on language and QoL	Low Tech AAC device	Greater language gains were made in the groups that utilized low technology AAC in combination with speech therapy than the groups that did not use AAC
Huang et al., [20]	Aims to explore the effectiveness of AAC treatment in regular speech-language therapy for in-patient PWA, 1 h of therapy for 10 days with and without AAC training	High Tech AAC device	In progress, no results
Johnson et al., [21]	Aims to explore the use of dynamic display AAC devices for people with non-fluent aphasia	High tech AAC Dynamic Display AAC device	An improvement was noted in the quality and effectiveness of participant communication with use of dynamic display device that was tailored to their needs
Koul et al., [23]	Aimed to examine the ability of people with severe aphasia to identify graphic symbols on a computer that generated speech output	High Tech AAC Computer-Based AAC device	People with severe aphasia are able to access, manipulate, and combine graphic symbols on computed based AAC device to produce phrases of varying complexity given adequate training
Marshall et al., [27]	Aimed to investigate writing outcomes of PWA post-therapy when trained to use computer-based writing assistive tech vs no assistive tech	High Tech AAC Computer-based assistive writing technology	Participants writing ability improved following therapy when using assistive writing technology, but did not improve without the use of assistive tech
Moss et al., [29]	Aimed to investigate if narrative writing and auditory comprehension could improve when PWA were trained on assistive technology targeting both areas	Dragon NaturallySpeaking ClaroRead	Computer narrative writing was significantly improved following training and use of Dragon software Reading comprehension improvements may not be attributable to the use of ClaroRead technology
Nakkawita et al., [30]	Aimed to assess symbol finding on AAC apps for PWA	High tech AAC Speech Apps: Proloquo2go Speak For Yourself	Neither app showed significant learning of symbols after only two training sessions
Nichol et al., [31]	Aimed to describe speech language pathologist perspectives of assistive technology use for their patients with aphasia	Variety	Three themes were identified: 1. tech supports holistic aphasia self- management by providing additional avenues for service delivery, communication, and learning opportunities therefore increasing life participation; 2. tech benefits SLP and Communication partner; and 3. there are some barriers for use of tech in PWA
Shamim et al., [37]	Aimed to determine the efficacy of VESMP in improving the QoL of PWA post-stroke	Verbal Expressive Skills Management Program (VESMP)	VESMP served as an adequate tool for augmenting aphasia management
Thiessen et al., [39]	Aimed to compare visual attention patterns of adults with aphasia vs without aphasia to investigate implications for AAC interface	Variety	PWA spent more time looking at backgrounds in scenes vs the subject of the scene than people without aphasia. These differences in visual attention should be considered when designing an AAC device for a PWA
Van de Sandt-Koender-man et al., [40]	Aimed to investigate efficacy of TouchSpeak when used by PWA in self-chosen communication scenarios	High tech AAC: TouchSpeak (Handheld communication device)	Communicative ability and quality of communication was higher with use of TouchSpeak device. People with severe aphasia were able to learn to navigate the device with training
Van de Sandt-Koender-man et al., [41]	Aimed to investigate efficacy of computerized communication aid use for PWA in self-chosen communication settings	High tech AAC: Computerized communication aid	All participants successfully learned to operate the communication an
Velez et al., [42]	Aimed to examine and app that evokes and sustains health information processing through AAC to supplement auditory comprehension with augmented input	High tech AAC: Visual Interactive Narrative Intervention (VINI) App	PWA had better processing of health info when using the VINI app
Wallace et al., [44]	Aimed to investigate the interface of AAC static layout vs navigation ring layout for PWA	High tech AAC	Both interfaces were able to be learned by PWA with adequate training, however, the navigation ring design was a more efficient learning process
Wallace et al., [43]	Aimed to examine the experience of people with aphasia who used text-to-speech (TTS) support to read a novel for virtual book club participation. friendship	Text-to-speech technology	Participants believed TTS support promoted faster reading than otherwise possible. Participants liked adjustable features affecting speech output rate, word or sentence highlighting, and font size. Psychosocial benefits included decreased isolation and increased friendship
Waller et al., [45]	Aimed to evaluate TalkBac computer-based AAC for use by PWA	High tech AAC: TalkBac computer-based communication software	Underlying language abilities did not improve after 9 months of TalkBac use, however TalkBac did improve conversational abilities in function of 50% of participants

^*In the above table, high tech AAC is defined as an electronic device that helps PWA communicate via augmentation of verbal communication, while low tech AAC is defined as a device that is non-electronic that helps PWA communicate via augmentation of verbal communication

QoL assessments and assistive technology

Each of the 25 included studies were examined for inclusion of a participant reported outcome measures investigating QoL. Of the 25 included articles, all commented in some capacity on the impact of technology on QoL for participants with aphasia; however, only 24% of the articles (6/25) included participant reported a formal QoL measure. QoL measures utilized included the Stroke and Aphasia Quality of Life Scale 39 (SAQOL-39), ASHA Quality of Life Communication Scale, Stroke Specific Quality of Life Questionnaire (SS-QOL), Stroke Aphasic Depression Questionnaire Hospital Version (SADQ-H 10) and the Assessment of Living with Aphasia [38] Of the six studies that included participant reported QoL measures, three reported significant gains in QoL with the use of technology; one showed inconclusive results; one showed insignificant results; and one is still in progress. The other 19 studies included in this review provided anecdotal insights, or verbal reports via qualitative interview, into the ways assistive technology may impact QoL for people with aphasia, including proposed mechanisms. This highlights the need for increased use of patient reported QoL measures, or standardized QoL measures to supplement qualitative reports and anecdotal comments on QoL for PWA. Following a thorough thematic analysis of each article’s QoL results and discussion, three significant mechanisms of assistive technology influences that may impact PWA’s QoL were identified. These mechanisms include (1) Increased functional/social communication, (2) Increased virtual communication, and (3) Increased self-management. See Table 4 for QoL measures utilized, and QoL mechanisms identified across each study.

Table 4.

Mechanisms assistive technology impact that influence QoL

References	QoL measure	Mechanism
Alam et al., [1]	Stroke and aphasia quality of life scale 39 (SAQOL-39)	Increased functional communication (via AAC as adjunctive therapy) Self-management
Bartlett et al., [6]	Anecdotal/interview	Functional/Social communication Self-management
Dietz et al., [10]	Anecdotal/interview	Increased functional communication (via AAC as adjunctive therapy) Self-management
Dietz et al., [11]	Anecdotal/interview	Functional/Social communication Self-management
Dietz et al., [12]	Anecdotal/interview	Functional/social communication
Estes et al., [13]	Anecdotal/interview	Virtual communication Self-management
Griffith et al., [15]	Anecdotal/interview	Functional/Social communication Self-management
Hough et al., [17]	ASHA quality of life communication scale	Increased functional communication (via AAC as adjunctive therapy) Self-management
Huang et al., [19]	Stroke specific quality of life questionnaire (SS-QOL)	Increased functional communication (via AAC as adjunctive therapy) Self-management
Johnson et al., [21]	Anecdotal/interview	Functional/Social communication Self-management
Koul et al., [23]	Anecdotal/interview	Increased functional communication (via AAC as adjunctive therapy) Self-management
Marshall et al., [27]	Assessment of living with aphasia	Virtual communication Self-management
Moss et al., [29]	Stroke and aphasia quality of life scale 39 (SAQOL-39)	Functional Communication Virtual Communication Self-management
Nichol et al., [31]	Anecdotal/interview	Functional/Social communication Self-management
Shamim et al., [37]	Anecdotal/interview	Functional/Social Communication
Van de Sandt-Koenderman et al., [40]	Anecdotal/interview	Functional/Social Communication Self-management
Van de Sandt-Koenderman et al., [41]	Anecdotal/interview	Functional/Social communication Self-management
Velez et al., [42]	Anecdotal/interview	Self-management
Wallace et al., [43]	Anecdotal/interview	Functional/ Social communication Virtual communication Self-management
Waller et al., [45]	Anecdotal/interview	Increased functional communication (via AAC as adjunctive therapy) Self-management

Discussion

Assistive technology improves QoL for individuals with aphasia via three mechanisms, based on our review: Increased functional and/or social communication, increased virtual communication, and increased self-management. Each mechanism is discussed below.

Increased functional and/or social communication

In this review, functional and social communication are defined as the language we express or receive through any communicative modality. The present scoping review indicates that technology influences QoL for people with aphasia through increasing functional and social communication abilities. In the present review, studies demonstrate how AAC allows participants to increase their narrative retell abilities and express themselves functionally and socially in their daily lives. This increase in communication abilities serves as a mechanism for increasing QoL and life participation. The literature demonstrates that assistive technology serves not only as a tool to augment participants’ linguistic abilities but also serves to improve language outcomes by increasing therapeutic opportunities and aiding in the remapping of brain function during language recovery. Language technology targeting picture naming and other language functions serve as a tool for increased dosage of aphasia therapy outside of the formal therapy setting. Multiple studies in the present review found that utilizing assistive technology as a tool within aphasia therapy led to language gains for PWA. This increase in communication ability secondary to the use of assistive technology in therapy may lead to increased QoL For PWA. Functional and social communication are the foundation for formation and maintenance of relationships and are an essential piece in increasing people with aphasia’s access to engagement with their community. Based on the function technology serves in real-life contexts of PWA through the QoL and assistive technology literature reviewed in the present study, there is a clear evidence base that supports the use of technology in and outside the context of a therapy session to increase QoL for PWA.

Increased virtual communication

Virtual communication in the present study is defined as the use of technology (i.e. phone, computer, iPad) to express or receive communication. In the present review, virtual communication naturally also increased functional and/or social communication, and articles were coded as such. The literature demonstrates that assistive technology improves virtual communication for PWA, which then serves as a mechanism for improving QoL. Writing is an essential mode of communication that fosters independence and social participation, especially in the times of increasing virtual communication use (e.g. texts, emails, etc.). However, research on the application and effectiveness of writing technologies, despite its importance for people with aphasia (PWA), remains limited. Many of the studies in the present review addressing writing examined software such as Dragon Dictation, which was not specifically designed for PWA, but has shown to be positively impactful in specific cases. Reading is also an essential piece of virtual communication; however, the scoping review highlighted a clear lack of evidence surrounding assistive technology enhancing the reading of virtual texts. One study in the present review discussed the positive impact on both language and psychosocial outcomes with the use of text-to-speech software for people with aphasia when participating in a book club [43]. Text-to-speech programs are potentially useful across other contexts to further increase virtual communication, however more research is needed in this area.

Findings examined in the present review indicate that assistive technologies can improve written expression and reading comprehension, but more research is needed to further understand long term outcomes, generalization of skills, and the role of writing and reading technology in supporting functional communication across environments. Furthermore, formulation of writing and reading supports designed specifically for people with aphasia may be impactful and should be considered.

Increased self-management

Self-management is defined as having control and responsibility over one’s behavior, actions, and well-being. Based on the findings in the present scoping review, technology increases self-management, which then leads to improved QoL for people with aphasia. In 2019, Nichol and colleagues completed a scoping review examining self-management and aphasia, which concluded that technology-based aphasia interventions incorporated principles of self-management, along with group/community interventions and aphasia partner training [32].This previous scoping review conclusion further supports self-management as a mechanism of assistive technology impacting QoL for people with aphasia. Further, a study completed by Nichol et al. in [31] surveyed speech-language pathologists on their perception of the role technology plays in aphasia management. SLP’s reported that technology supported the holistic self-management of aphasia for their patients by not only providing increased communication, but also service delivery, independence, and life participation. The reports of speech language pathologists in Nichol’s study are consistent with the findings of the present scoping review.

The review highlights how self-management supports autonomy and as such, is paramount in the QoL of people with aphasia. Multiple examples of this are examined in the present review, one of which is a study completed by Velez et al. [42]. This study investigated an app that enhances the comprehension of important medical information by storing it, synthesizing it, and repeating it as needed. The app is used to increase PWA’s access to their health information, therefore increasing their self-management in an aspect of their lives that is essential for them to understand. This tool enables PWA to make their own medical decisions despite difficulty with communication that they experience secondary to aphasia.

The present review suggests that while assistive technology may directly improve self-management separate from other factors, often, self-management is improved through the other mechanisms that technology influences to increase QoL. For example, increased functional communication may lead to increased self-management as the PWA is able to advocate for their needs independently of their care partner. Increased virtual communication may also lead to increased self-management, as the PWA is able to send their own emails for work, schedule their own appointments online, or answer their own text messages. Gains in therapy augmented by AAC may lead to increased communication (virtual, social, or functional), promoting increased self-management and QoL for PWA. See Fig. 2 for a visual representation of how these mechanisms relate to one another, and impact QoL for PWA based on the results of this scoping review.

Fig. 2.

Mechanisms of QoL from assistive technology

Key findings

The literature suggests that PWA can learn new technologies given adequate support, and that assistive technology serves to improve QoL for people with aphasia through multiple mechanisms. These mechanisms include technology’s role in increasing virtual communication, increasing self-management, and increasing functional and social communication via augmentation and/or as an adjunctive therapy tool. While there is a foundation of literature examining assistive technology for PWA specifically as it impacts QoL, this area of the field is still in its infancy. QoL and life participation are the primary goal for many people living with aphasia. Further investigation of how technology not only improves language outcomes but specifically impacts QoLis an essential next step in growing life-participation approaches in aphasiology.

Limitations

While the present study summarizes the current body of literature on QoL and assistive technology for PWA, there are several limitations. First, the scope of this study was to specifically investigate QoL; therefore, we excluded articles on assistive technology that did not fit into the QoL search terminology. Second, we attempted to code each study for individual QoL mechanisms; however, it is difficult to parse mechanisms, as the scope of QoL is vast and intertwined within each participant’s life experience. Third, each study was hand coded for themes, allowing for the impact of the authors’ lenses on data extraction. While we attempted to mitigate this concern via reliability coding, our perceptions impact the results due to the qualitative nature of the review. Lastly, this review is limited by the current body of literature. Many sample sizes were small and demographically heterogenous. There was also broad variability in study methods, making it difficult to generalize and synthesize results across studies. Also, many included studies did not use an evidence-based or patient reported measure of QoL and commented anecdotally on observed or perceived outcomes.

Future directions

The present review demonstrates the mechanisms enhanced by assistive technology to improve QoL for people with aphasia. Clinicians should consider these mechanisms, and QoL, as significant factors when deciding on a treatment plan for their patients with aphasia.

Future research should continue to investigate the role assistive technology can play in the QoL of PWA utilizing evidence-based QoL measures and patient reported outcome measures investigating QoL. Notably, the cost of technological devices, SLP training, and therapeutic intervention creates disparities in access to assistive technology for some individuals. In the USA, a developed country, 70% of SLPs reported use of high-tech AAC at some point in their career, whereas in India, a developing country, 58% of SLP’s reported use of high-tech AAC [22]. This discrepancy in access is likely not exclusive to country lines; rather, it is likely also happening regionally between states and cities due to differences in funding and education of staff and patients. A study on AAC use found that Black children with developmental disabilities receive less access to AAC than their white peers [35]. Unfortunately, there is a lack of this type of research in the literature on individuals with aphasia. Further studies are needed to investigate the impact of personal and community resources on assistive technology use, and posit ways to better fund AAC devices, or work around inequities in the system. It is the ethical responsibility of SLP’s to best serve each patient [2]. SLP’s have an obligation to create person-centered plans of care that target the best QoL outcomes for each patient. These plans should often include some kind of training in technology, as it has been shown to increase self-management for PWA [Nichol et al., [31]]. Future work should address these disparities and continue to investigate how to reduce them in practice. Further research is needed to investigate the implementation and dosage that is most effective for PWA to learn new technology systems. Research should also guide clinicians to select assistive technologies that best fit the needs of their patients with aphasia, while emphasizing the need for funding and accessibility of these devices. It is critical that we create new technology that fits PWA’s needs more broadly and effectively, as there are limited studies investigating the role that the common handheld device (i.e. cell phone, tablet, app, etc.) can play in improving QoL for people with aphasia. Research is needed to aid in the designing of apps that use simple, clear language, and include culturally diverse images to best serve PWA. An expansion of collaborative partnerships will play a crucial role in bringing new technology to fruition and should be investigated and emphasized in future work. Further, we suspect that as more studies are conducted on assistive technology and QoL for PWA, more mechanisms enhancing QoL will be uncovered, allowing clinicians and researchers to provide PWA with more tools to live well with aphasia.

Data Availability

No new data was collected for the present scoping review. All data presented is from previous studies.