Table 1.
Information about previous technology-based rehabilitation studies that have provided language rehabilitation to individuals with aphasia.
| Study | Participants | Treatment | Main results | ||||
|---|---|---|---|---|---|---|---|
| N, age, MPO* | Etiology and severity | Control group | Type | Duration and intensity | |||
| Language, single domain, naming | Aftonomos et al., 1997 | N:23, age:64.3, MPO:46.3 (all chronic) | Stroke* (mostly) Mixed levels of severity and aphasia type | No | Lingraphica Interactive lexical items in the major linguistic categories that appear in a field of semantically related items; works on word retrieval on multiple levels | Mean duration:16.8 weeks (varied), intensity mean:1.99 sessions per week in clinic, variable intensity decided by patient for homework | All standardized tests (WAB*, BNT*, BDAE*) showed gains for most patients |
| Fink et al., 2002 | N:6, age:60.5, MPO:49.2 (all chronic) | Stroke Mixed levels of severity and aphasia type | No, two equal groups (full clinician guidance vs. partial guidance) | MossTalk Words Cued naming | 4 weeks or until criterion, 3 times per week; variable intensity decided by patient for independent practice in partial guidance group | Both groups showed gains on trained words (as measured by PNT*), gains on PRT* for one clinician-guided and on PORT* for two partial-guided patients | |
| Raymer et al., 2006 | N:5, age:70.8, MPO:92 (2 were subacute, 3 were chronic) | Stroke Mixed levels of severity and aphasia type | No, two levels of intensity (crossed design) | MossTalk Multimode matching exercises | Each training phase: 12 sessions, lower intensity: 1–2 times per week, higher intensity: 3–4 times per week | All patients improved in trained items, more in higher intensity phase, one patient showed gains on WAB AQ* and BNT | |
| Ramsberger and Marie, 2007 | N:4, age:67.5, MPO:31.5 (all chronic) | Stroke Mixed levels of severity and aphasia type, | No, two levels of intensity (crossed design) | MossTalk Words Self-cued naming with partial clinician guidance | 15–20 sessions per word list Lower intensity: 2 times per week Higher intensity: 5 times per week | Three patients showed gains in naming, regardless of intensity | |
| Doesborgh et al., 2004 | N:18, age:62 (EG*), 65 (CG*), MPO:13 (EG), 13 (CG) (all chronic) | Stroke Moderate to severe, global aphasia excluded | Yes No treatment (N:10) | Multicue Self-cued naming | 2 months, 2-3 times per week | EG showed gains on BNT, but no between group differences | |
| Loverso et al., 1992 | N:21 (all chronic) | Stroke Mixed levels of severity and aphasia type | No, alternating between clinician and computer/clinician delivered | Cueing Verb Treatment, incorporates both semantic and syntactic structures | Until reached criterion, varied by patient | Clinician was more effective than computer for treatment improvement, gains for 18/21 patients on PICA* | |
| Bruce and Howard, 1987 | N:5, age:47.9, MPO:~28.32 (all chronic) | Stroke Broca's aphasia | No | Microcomputer as an aid to generate phonemic cues | 5 sessions total | All patients improved, four were better on trained words and untrained words, four were better at indicating first letter of names in trained set than untrained | |
| Fridriksson et al., 2009 | N:10, age:59.2, MPO:85.3 (all chronic) | Stroke Non-fluent aphasia, mixed levels of severity | No, alternating between two treatment conditions | Picture/word matching tasks: AV treatment: audio-visual speech stimuli, AO treatment: audio only speech stimuli | 3–6 weeks, 5 days a week for 30 min | Naming of trained items and PNT improved after AV but not AO, no between group differences | |
| Harnish et al., 2014 | N:8, age:56.5, MPO:52.5 (all chronic) | Stroke Mixed levels of severity and aphasia type | No | Computerized confrontation naming with multiple levels of cues | 2 weeks, 4 days a week for 60 min | All patients showed an improvement on trained items during treatment after 1–3 sessions, with all patients showing significant ES* on trained items varying from small to large | |
| Kurland et al., 2014 | N:5 (8 completed but only 3 in data analysis), age:67.4, MPO:31.9 (all chronic) | Stroke Mixed levels of severity and aphasia type | No | Self-managed iPad task for maintaining and improving object and verb naming with cues | 6 months, variable intensity decided by patient, average practice: 18 min per day | All patients maintained previous gains and gained new trained words, BDAE and BNT scores equal to or better than baseline | |
| Woolf et al., 2016 | N:20, age:53–67 MPO:20.2–53.4 (depends on cohort) (all chronic) | Stroke | Yes 4 groups: Remote treatment from university or clinic, face-to-face, and attention control group (N:5 per group) | Remote treatment delivered via FaceTime, homework practice: PowerPoint with cues built in to improve spoken word production; attention CG: conversation sessions only | 4 weeks, 2 times per week, variable intensity decided by patient for homework | Trained items improved in all treatment groups but not CG, clinic EG scored higher than other two groups and face-to-face scored higher than univ.EG; no change in POWERS* for any group | |
| Language, Single domain, Reading | Katz and Wertz, 1992 | N:43, age:59.5–65.6, MPO:45.2–81.84 (depends on cohort) (all chronic) | Stroke Between 15th and 90th overall percentile on PICA | Yes 2 CGs: Computerized non-verbal games and cognitive tasks, (stim EG (N:15)); No treatment (N:15) | Computerized reading treatment that involved visual matching and reading comprehension tasks; with adjustable task difficulty | 6 months, 3 h per week | Reading EG showed gains on trained items, PICA and WAB AQ; with more gains on PICA than other groups |
| Katz and Wertz, 1997 | N:55, age:60's, MPO:64.8–102 (depends on cohort) (all chronic) | Stroke Between 15th and 90th overall percentile on PICA | Yes 2 CGs: Computerized non-verbal games and cognitive tasks, (stim EG (N:19)); No treatment (N:15) | Computerized reading treatment that involved visual matching and reading comprehension tasks; with adjustable task difficulty | 26 weeks, 3 h per week | Reading EG showed more gains than other groups on PICA and WAB Repetition and AQ | |
| Cherney, 2010 | N:25, age:56.6 (EG), 61.1 (SLP), MPO:66.7 (EG), 41.3 (SLP) (all chronic) | Stroke Non-fluent aphasia (global excluded) | Yes Computer vs. clinician delivered (N:11), no treatment period for both groups | ORLA (oral reading for language in aphasia) on computer: reading aloud sentences and paragraphs with computer-voice and then independently | 24 sessions, 1–3 times per week | Groups had equal gains in WAB-R* AQ and discourse measures compared to no treatment; no between group difference | |
| Language, Single domain, Sentence Processing and Production | Cherney and Halper, 2008 | N:3, age:64, MPO:36 (all chronic) | Stroke Two non-fluent, one fluent | No | AphasiaScripts Virtual therapist for script training with diminishing cues | 3 weeks, variable intensity decided by patient | 2 had gains on trained scripts, 1 improved on WAB AQ and CETI* and 1 improved on QCL* |
| Manheim et al., 2009 | N:20, age:54.8, MPO:53.0 (all chronic) | Stroke Mixed levels of severity and aphasia type | No, though delayed treatment for all participants | AphasiaScripts Virtual therapist for script training with diminishing cues | 9 weeks, variable intensity decided by patient, average: 44 h total | CD* subscale of BOSS* had no change during delay period and gains during treatment period | |
| Cherney et al., 2014 | N:8, age:52, MPO:26.5 (all chronic) | Stroke Mixed levels of severity and aphasia type | No, though comparing two conditions of cueing | AphasiaScripts Virtual therapist for script training with diminishing cues High cue: normal program, Low cue: written cue until 3 independent trails | 3 weeks per condition with 3 weeks in between | Trained scripts increased in accuracy and rate; conditions were no different in results | |
| Kalinyak-Fliszar et al., 2015 | N:4, age:50, MPO:55.5 (all chronic) | Stroke Mixed levels of severity and aphasia type (no global) | No, comparing virtual clinician (VC) to human clinician (HC) (crossed design) | Computer-delivered scripts with virtual clinician, and real clinician controlling computer output | 1 week, 4 sessions of 30–40 min each | Trained script results varied by patient; two patients made gains on discourse narratives | |
| Thompson et al., 2010 | N:12, age:49.5, MPO:46.1 (all chronic) | Stroke Agrammatic aphasics, mixed levels of severity and aphasia type | Yes No treatment (N:6), and previously studied clinician-delivered treatment (N:8) | Sentactics TUF (treatment of underlying forms) delivered by virtual clinician | 6–8 weeks, 4 1 h sessions per week or until criterion | EG showed more gains on trained items than CG, no difference with clinician delivered; EG showed gains on Cinderella narrative and OR* sentences on NAVS* | |
| Linebarger et al., 2007 | N:6, age:49.8, MPO:~35 (all chronic) | Stroke Non-fluent aphasia | Yes Healthy controls | SentenceShaper Records words or phrases in the patient's voice, represented with visual icons to replay and order into larger units; word-finding assistance | 11–23 weeks; variable intensity decided by patient; average: 29.43 h total | Results varied; most showed some gains on trained narratives | |
| Crerar et al., 1996 | N:14, age:52.4, MPO:~52 (all chronic) | Stroke (mostly) Mixed levels of severity and aphasia type (no global) | No | Picture-building and sentence-building modes in both verb and preposition treatment | 6 weeks (3 weeks of each type of treatment), two 1 h sessions per week | Probe measures varied by patient regardless of treatment given first; treating verbs first showed clearer gains | |
| Language, Single domain, Writing | Seron et al., 1980 | N:5, age:42.8, MPO: ranged (all but one chronic) | Stroke (mostly) Mixed levels of severity | No | Keyboard writing to dictation with adaptive different levels of cueing | Ranged from 4 to 10 weeks, total sessions ranged from 7 to 30 | Probe measures of words with at least one error and total number of errors decreased from pre to post testing |
| Laganaro et al., 2006 | N:8, age:49.6, MPO:1-2 (all acute) | Stroke and TBI Mixed levels of severity and aphasia type | No, alternating between treatment sets of differing lengths | Computerized written naming program with cues provided on either a set of 48 or 96 items | 2 weeks, 5 days a week for 30–60 min | All but one patient improved in picture naming after treatment and this improvement was limited to the list that was trained at each assessment period | |
| Language, Multiple domains | Choi et al., 2016 | N:8, age:50.8, MPO:30 (most were chronic) | Stroke Mixed levels of severity and aphasia type | No | iAphasia Six domains of tasks with differing levels of difficulty, hints provided | 4 weeks, variable intensity decided by patient, average: 30.3 h total | K-WAB* AQ scores improved |
| Stark and Warburton, 2016 | N:10 (3 pilot), age:63.6, MPO:39.2 (all chronic) | Stroke Expressive aphasia with intact comprehension | No, crossed design comparing treatment to Bejeweled game app (except for pilot patients) | Language Therapy (Tactus Therapy Solutions) Reading, naming, comprehension, and writing tasks | 8 weeks (4 of each), variable intensity decided by patient | Significant gains on CAT*, improved on narrative measures; ES greater than control period | |
| Steele et al., 2014 | N:9, age:61.4, MPO:66.8 (all were chronic) | Stroke Mixed levels of severity and aphasia type | No | Lingraphica TalkPath Various exercises with varied difficulty and self-administered hints; remote treatment (group and individual) with WebEx and GoToMeeting | 12 weeks, 1 remote group session per week, every 4th week: individual, variable intensity decided by patient for homework | CETI and NOMS* showed gains on most items administered, one item and overall score of RIC-CCRSA* showed gains | |
| Corwin et al., 2014 | N:6, age:52, MPO:37 (all chronic) | Stroke (1 RH*) Mixed levels of severity and aphasia type | No, alternated between computer-based and no treatment (crossed design) | Parrot software Semantic feature, confrontation naming, and sentence completion tasks | 4 weeks, 4 sessions of 2 h/week | BNT and WAB Naming and Word Finding subtests improved (trained words excluded) | |
| Mortley et al., 2004 | N:7, age:61.7, MPO:~60 (all chronic) | Stroke | No | StepByStep Exercises involving word-to-picture matching, semantic association, naming, reading, and spelling | 27 weeks, variable intensity decided by patient, average:2 h and 45 min per week | Gains in trained words for all pts | |
| Palmer et al., 2012 | N:28 (33 at baseline), age:69.5 (EG), 66.2 (CG), MPO:74.4 (EG), 79.2 (CG) (all chronic) | Stroke Mixed levels of severity and aphasia type | Yes Usual care treatment (N:13) | StepByStep Self-managed computer word finding with cues | 5 months, variable intensity decided by patient, average practice: 25 h total | EG showed more gains on naming in treatment than CG | |
| Language and Cognitive | Des Roches et al., 2015 | N:51, age:64.2, MPO:59.6 (most were chronic) | Stroke (mostly) Mixed levels of severity and aphasia type | Yes Only received treatment in clinic (N:9) | Constant Therapy 37 evidence-based cognitive and language tasks with different levels of difficulty; self-administered hints | 10 weeks CG: 1 h/week, EG:1 h/week + homework: variable intensity decided by patient, average:4 h 8 min per week | Almost all patients showed gains on treatment tasks, EG more than control; EG showed more gains on standardized measures (WAB-R CQ*, AQ, several CLQT* scores) than CG (PAPT*) |
| Hoover and Carney, 2014 | N:20 (3 cohorts), age:55–61, MPO:44–70 (depending on cohort) (all chronic) | Stroke Severity ranged from mild to moderate-severe | No | ICAP combined with multiple applications (Language Builder, SmallTalk, VASTtx, Language Therapy, and Constant Therapy) | 4 weeks, 5 days/week for 6 h/day plus homework | Gains on narrative measures, several PALs*, PNT*, VNT*, F-A-S Word Fluency Task, DCT*, SIS*, and ALA* or ASHA-FACS* | |
| Wcislo et al., 2010 | N:63 | Stroke, 33 with aphasia: mixed levels of severity and aphasia type, 30 with cognitive dysfunctions | No | Logopedic, physical, and cognitive exercises | 3 months | Patients with aphasia showed 10 point change on comprehension test and 16 point change on verbal expression scores | |
| Wenke et al., 2014 | N:39 (overlap in cohorts), age:60's, MPO:6–27.5 (depending on cohort) | Stroke, Varied severity | Yes, standardized service compared to three EGs: computer treatment (N:13), group treatment (N:11), and SPTA treatment (N:7) | Computer group used multiple online treatment programs: REACT-2, Aphasia Tutor, Language Links, and Synonyms, Homonyms, and Antonyms | 8–10 weeks, 3–4 sessions per week on average for experimental groups | All groups showed gains on language production CAT subtests, all three EG groups showed gains on Disability questionnaire of CAT; no between group differences on either measure | |
*
MPO, Months past onset; Stroke, unless noted, stroke is in left hemisphere; WAB, Western Aphasia Battery; BNT, Boston Naming Test; BDAE, Boston Diagnostic Aphasia Examination; PNT, Philadelphia Naming Test; PRT, Philadelphia Repetition Test; PORT, Philadelphia Oral Reading Test; AQ, Aphasia Quotient; EG, Experimental (technology-based) group; CG, Control group; PICA, The Porch Index of Communicative Ability; ES, Effect Size; POWERS, Profile of word errors and retrieval in speech; WAB-R, Revised Western Aphasia Battery; CETI, Communicative Effectiveness Index; QCL, Quality of Communication Life Scale; CD, Communication Difficulty; BOSS, The Burden of Stroke Scale; OR, Object Relative; NAVS, Northwestern Assessment of Verbs and Sentences; CADL, Communication Activities of Daily Living; K-WAB, Korean version of the Western Aphasia Battery; CAT, Comprehensive Aphasia Test; NOMS, National Outcomes Measurement System; RIC-CCRSA, Rehabilitation Institute of Chicago—Communication Confidence Rating Scale for Aphasia; RH, Right Hemisphere; CQ, Cortical Quotient; CLQT, Cognitive Linguistic Quick Test; PAPT, Pyramids and Palm Trees; ICAP, Intensive comprehensive aphasia programs; PALs, Psycholinguistic Assessment of Language; VNT, Verb Naming Test; DCT, Discourse Comprehension Test; SIS, Stroke Impact Scale; ALA, Assessment of Living with Aphasia; ASHA-FACS, American Speech-Language-Hearing Association—Functional Assessment of Communication Skills for Adults.