Can iPad therapy mend speech after stroke?
New research suggests that personalized therapy via an iPad app can benefit people with aphasia, a brain disorder that seriously inhibits language.
Each year, an estimated 200,000 people acquire aphasia, which is usually the result of a stroke.
The research further supports the idea that the brain is far more plastic and moldable than previously imagined, and it presents a simple, relatively inexpensive way for people to improve their long-term health.
Researchers at Boston University’s Sargent College gave 51 aphasia sufferers an iPad. The goal of the study was to determine how effective iPads could be in delivering personalized therapy to people with aphasia, and to determine whether a structured iPad-based software therapy program that includes homework leads to significant gains in overall communication.
Participants were split into two groups: a control group and an experimental group. All participants had a weekly one-hour session with a clinician using the iPad therapy. But the people in the experimental group were also asked to practice a set of personalized tasks at home using the iPad software.
They showed significant improvements on a range of standard tests for language, memory, executive function, and attention. The control group did not experience any significant changes on those tests.
The most encouraging sign? The people who were more severely affected showed more improvements after therapy than those who were less impaired, according to speech professor Swathi Kiran, director of the university’s Aphasia Research Laboratory and coauthor of the study.
That’s significant, she says, because people who are worse off after brain damage are the most likely to be written off, and this study shows that they should not be.
The study further finds that even those participating in the control group, who used the iPad therapy only during their weekly meetings with a clinician, experienced some improvement.
Patients on their own
All types of aphasia sufferers need better long-term care, Kiran says. When someone has a stroke or other aphasia-causing injury, insurance typically covers only a patient’s acute care and maybe a couple of months of rehabilitation. Unless you have fantastic insurance, she says, you’re on your own after that.
The result is that there is a huge problem in providing the continued communication rehabilitation that those with aphasia require.
But as neuroscientists are realizing, the brain can be worked and improved even after years of decline or decreased ability. However, Kiran notes, it takes a bit of strategy and a whole lot of work to make progress.
“In the context of what we know about neuroplasticity, the main thing is you have to have repeated practice, repeated exposure, and you need to do it in a very structured way,” she says.
Constant Therapy start-up
Mobile devices loaded with specialized apps could make that crucial practice possible. That’s where Newton, Massachusetts-based start-up Constant Therapy comes in. Constant Therapy, cofounded by Kiran and CEO Veera Anantha, provides personalized iPad-based therapy for people with traumatic brain injuries, stroke, aphasia, and learning disabilities.
So while Kiran’s team designed the rehabilitation tasks, Constant Therapy, one of whose investors is the university, made them available for download.
Constant Therapy users can pick and choose the tasks they want to work on, they can rely on the app to provide tasks for them based on their scores, or a clinician can select tasks personalized to an individual’s needs.
Over four hours a week
Kiran and her colleagues focused on the latter approach for the study. The experimental group had one hour of therapy a week with a Boston University clinician, who assigned tasks based on the patient’s specific performance. Then the patient was free to go home and do the homework—or choose not to.
But overwhelmingly, Kiran says, those patients wanted to work. The average time they spent on the iPad was four hours and eight minutes a week, but a few did much more. Some aphasia sufferers worked a whopping 17 hours a week on the tasks.
With technology that allows them to work on their abilities anytime and anywhere, they’ll often take full advantage, Kiran says. “They’re super-determined to get better.”
The study showed preliminary evidence that structured, tablet-based individualized therapy can be provided to aphasia patients.
Kiran and Constant Therapy are now collaborating with other researchers in the area to apply the apps’ tasks to other types of patients, such as people with dementia, mild cognitive impairment, and epilepsy and children with language deficiencies. Many of the same tasks that helped the aphasia sufferers can be applied to other types of disorders.
And as Kiran notes, patients of all types are eager to improve their skills—they just need the opportunity. “When you empower patients to take control of their rehabilitation, they actually do it,” she says.
The Wallace H. Coulter Foundation contributed funding to the study, which appears in Frontiers in Human Neuroscience.
Source: Boston University