Evidence

Advanced Comprehension Therapy

All these activities provide time-tested stimulation of syntax and comprehension. These tasks can be used for assessment to determine where comprehension breaks down, as well as for therapy to bring the user’s attention to their problem and develop strategies for improving performance and skill.

The Boston Diagnostic Aphasia Examination (BDAE) and the Psycholinguistic Assessments of Language Processing in Aphasia (PALPA) contain items similar to the exercises in the Identify activity. Complex syntactic structures and pronouns are more difficult for people with aphasia.

The Northwestern Anagram Test (NAT) and the Verb and Sentence Test (VAST) both examine comprehension of sentences using activities similar to the Build activity in this app. It uses a method free from verbal expression to assemble grammatically-correct sentences.

• Weintraub, S., Mesulam, M. M., Wieneke, C., Rademaker, A., Rogalski, E. J., & Thompson, C. K. (2009). The northwestern anagram test: measuring sentence production in primary progressive aphasia. American journal of Alzheimer’s disease and other dementias.

The Token Test (De Renzi & Vignolo 1962) has activities similar to the Follow activity in this app. Following complex directions is a skill particularly challenging for people with aphasia as every content word must be understood.

Advanced Language Therapy

Please see the evidence for each individual app:

• Advanced Comprehension Therapy
• Advanced Naming Therapy
• Advanced Reading Therapy
• Advanced Writing Therapy

Advanced Naming Therapy

The Create activity is based on the Verb Network Strengthening Treatment (VNeST) developed and researched by Dr. Lisa Edmonds. Some modifications have been made to original protocol for this app. Research on the VNeST protocol shows generalization to words beyond those trained in therapy, and a computerized version has shown similar effects.

• Edmonds, L. A., Mammino, K., & Ojeda, J. (2014). Effect of Verb Network Strengthening Treatment (VNeST) in persons with aphasia: Extension and replication of previous findings. American Journal of Speech-Language Pathology, 23(2), S312-S329. PDF
• Edmonds, L. A. (2014). Tutorial for Verb Network Strengthening Treatment (VNeST): Detailed description of the treatment protocol with corresponding theoretical rationale. SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 24(3), 78-88.
• Furnas, D. W., & Edmonds, L. A. (2014). The effect of computerized Verb Network Strengthening Treatment on lexical retrieval in aphasia. Aphasiology, 28(4), 401-420.

The Generate activity is a verbal fluency task with both semantic and phonological targets. Norms for the FAS and Animal tests were taken from these published studies:

• Tombaugh, T. N., Kozak, J., & Rees, L. (1999). Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Archives of Clinical Neuropsychology, 14(2), 167-177.
• Barry, D., Bates, M. E., & Labouvie, E. (2008). FAS and CFL forms of verbal fluency differ in difficulty: A meta-analytic study. Applied neuropsychology, 15(2), 97-106.

The Describe activity is a picture description task, a common part of aphasia test batteries. These pictures offer a chance to use many different nouns, adjectives, and verbs. They lend themselves well to Response Elaboration Treatment and barrier tasks for PACE therapy. The unexpected elements in many of these “silly” pictures may provoke more language than typical pictures and requires clearly articulated speech to be understood.

• Edelman, G. (1987). Promoting Aphasics Communicative Effectiveness: PACE. Winslow Press.

The Compare activity requires category and semantic feature naming. Semantic feature analysis is a well-established aphasia treatment and strategy for word finding. The photo variations call for more adjectives, whereas the abstract categories require high-level vocabulary and synonyms to explain. Each exercise requires a relationship between concepts in the semantic network to be stated.

• Coelho, C. A., McHugh, R. E., & Boyle, M. (2000). Semantic feature analysis as a treatment for aphasic dysnomia: A replication. Aphasiology, 14(2), 133-142.

Advanced Reading Therapy

These are practice activities that are similar to real-life reading needs. They are graded by reading level and length into 3 levels of difficulty, paired with increasingly difficult questions. The questions give insight into comprehension, memory, and inferencing abilities. The tools available for each passage allow users to listen, get support for individual words, or listen sentence-by-sentence for increased processing time. A self-monitoring prompt after each passage encourages users to monitor their own comprehension with strategies for improving it. All of these parts of the app (highlighting, audio support, self-monitoring, questions, etc) are researched and clinically-useful techniques for improving reading comprehension.

• Watter, K., Copley, A., & Finch, E. (2017). Discourse level reading comprehension interventions following acquired brain injury: a systematic review. Disability and rehabilitation, 39(4), 315-337.
• Watter, K., Copley, A., & Finch, E. (2016). Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management. Journal of communication disorders, 64, 110-132.

Advanced Writing Therapy

• Beeson, P. M., Rising, K., Kim, E. S., & Rapcsak, S. Z. (2010). A treatment sequence for phonological alexia/agraphia. Journal of Speech, Language, and Hearing Research, 53(2), 450-468.
• Thiel, L., Sage, K., & Conroy, P. (2017). Promoting linguistic complexity, greater message length and ease of engagement in email writing in people with aphasia: initial evidence from a study utilizing assistive writing software. International journal of language & communication disorders, 52(1), 106-124.
  

AlphaTopics AAC

Practical Advice & Evidence Review

• Hanson, E. K., & Fager, S. K. (2017). Communication supports for people with motor speech disorders. Topics in Language Disorders, 37(4), 375-388. [PDF]
• Hanson, E. K. (2014). My Client Talks! Do I Still Need to Consider AAC in my Treatment Planning? Speech Supplementation Strategies: AAC for Clients Who Talk!. SIG 12 Perspectives on Augmentative and Alternative Communication, 23(3), 124-131.

Research Reviews

• Hanson, E. K., Beukelman, D. R., & Yorkston, K. M. (2013). Communication support through multimodal supplementation: A scoping review. Augmentative and Alternative Communication, 29(4), 310-321.
• Hanson, E. K., Yorkston, K. M., & Beukelman, D. R. (2004). Speech supplementation techniques for dysarthria: A systematic review. Journal of Medical Speech-Language Pathology, 12(2), IX-XXIX. PDF

Published Studies

• Fercho, K., Baugh, L. A., & Hanson, E. K. (2015). Effects of alphabet-supplemented speech on brain activity of listeners: An fMRI study. Journal of Speech, Language, and Hearing Research, 58(5), 1452-1463. [PDF]
• Hanson, E. K., Beukelman, D. R., Heidemann, J. K., & Shutts-Johnson, E. (2010). The impact of alphabet supplementation and word prediction on sentence intelligiblity of electronically distorted speech. Speech Communication, 52(2), 99-105.
• Tjaden, K. (2008). Speech and swallowing in Parkinson’s disease. Topics in geriatric rehabilitation, 24(2), 115.
• Hustad, K. C., & Lee, J. (2008). Changes in speech production associated with alphabet supplementation. Journal of Speech, Language, and Hearing Research, 51(6), 1438-1450.
• Hustad, K. C., & Garcia, J. M. (2005). Aided and Unaided Speech Supplementation Strategies – Effect of Alphabet Cues and Iconic Hand Gestures on Dysarthric Speech. Journal of Speech, Language, and Hearing Research, 48(5), 996-1012.
• Hustad, K. C. (2005). Effects of speech supplementation strategies on intelligibility and listener attitudes for a speaker with mild dysarthria. Augmentative and Alternative Communication, 21(4), 256-263.
• Hustad, K. C., & Gearhart, K. J. (2004). Listener attitudes toward individuals with cerebral palsy who use speech supplementation strategies. American Journal of Speech-Language Pathology, 13(2), 168-181.
• Hustad, K. C., Jones, T., & Dailey, S. (2003). Implementing Speech Supplementation Strategies – Effects on Intelligibility and Speech Rate of Individuals With Chronic Severe Dysarthria. Journal of Speech, Language, and Hearing Research, 46(2), 462-474.
• Howard, D., & Harding, D. (1998). Self-cueing of word retrieval by a woman with aphasia: Why a letter board works. Aphasiology, 12(4-5), 399-420.

Apraxia Therapy

• Kershenbaum, A., Nicholas, M. L., Hunsaker, E., & Zipse, L. (2017). Speak along without the song: what promotes fluency in people with aphasia?. Aphasiology, 1-24.
• Zumbansen, A., Peretz, I., & Hébert, S. (2014). The combination of rhythm and pitch can account for the beneficial effect of melodic intonation therapy on connected speech improvements in Broca’s aphasia. Frontiers in human neuroscience, 8.
• Fridriksson, J., Hubbard, H. I., Hudspeth, S. G., Holland, A. L., Bonilha, L., Fromm, D., & Rorden, C. (2012). Speech entrainment enables patients with Broca’s aphasia to produce fluent speech. Brain, 135(12), 3815-3829.
• Stahl, B., Kotz, S. A., Henseler, I., Turner, R., & Geyer, S. (2011). Rhythm in disguise: why singing may not hold the key to recovery from aphasia. Brain, 240. (Summary)
• Maas, E., Robin, D. A., Hula, S. N. A., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17(3), 277-298.
• Wambaugh, J., Duffy, J., McNeil, M., Robin, D., & Rogers, M. (2006). Treatment Guidelines for Acquired Apraxia of Speech: Treatment Descriptions and Recommendations. Journal of Medical Speech-Language Pathology, 14(2), xxxv-lxvii.
• Youmans, G., Youmans, S. R., & Hancock, A. B. (2011). Script training treatment for adults with apraxia of speech. American Journal of Speech-Language Pathology, 20(1), 23-37.
• Goldberg, S., Haley, K. L., & Jacks, A. (2012). Script training and generalization for people with aphasia. American Journal of Speech-Language Pathology, 21(3), 222-238.

Category Therapy

• Tyler, L. K., Moss, H. E., Durrant-Peatfield, M. R., Levy, J. P. (2000). Conceptual structure and the structure of concepts: A distributed account of category specific deficits. Brain and Language. 75 195–231
• Grossman, M. (1980). The aphasics’ identification of a superordinate’s referents with basic object level and subordinate level terms. Cortex, 16(3), 459-469.
• Smith, E. E., Shoben, E. J., Rips, L. J. (1974). Structure and process in semantic memory: A featural model of semantic association. Psychological Review. 81 214–241

Comprehension Therapy

• Stark, B. C., & Warburton, E. A. (2018). Improved language in chronic aphasia after self-delivered iPad speech therapy. Neuropsychological rehabilitation, 28(5), 818-831.
• Knollman-Porter, K., Dietz, A., & Lundeen, K. (2011). Severe Chronic Aphasia: An Intensive Treatment Protocol for Auditory Comprehension. https://aphasiology.pitt.edu/archive/00002276/
• Marshall, J. C., Pound, C., White-Thompson, M., Pring, T. (1990). The use of picture matching tasks to assist in word retrieval in aphasic patients. Aphasiology. 4 167–184

Conversation Therapy

• Basso, A. (2010). “Natural” conversation: A treatment for severe aphasia. Aphasiology, 24(4), 466-479.
• Boyle, M. (2011). Discourse treatment for word retrieval impairment in aphasia: The story so far. Aphasiology, 25(11), 1308-1326.
• Hopper, T., Holland, A., & Rewega, M. (2002). Conversational coaching: Treatment outcomes and future directions. Aphasiology, 16(7), 745-761.
• Kempler, D., & Goral, M. (2011). A comparison of drill-and communication-based treatment for aphasia. Aphasiology, 25(11), 1327-1346.
• Turner, S., & Whitworth, A. (2006). Conversational partner training programmes in aphasia: A review of key themes and participants’ roles. Aphasiology, 20(6), 483-510.

Dysphagia Therapy

There are hundreds of selected research references contained in this app specific to each dysphagia therapy technique.

Language Therapy

• Stark, B. C., & Warburton, E. A. (2018). Improved language in chronic aphasia after self-delivered iPad speech therapy. Neuropsychological Rehabilitation, 28(5), 818-831.

Please see the evidence for each individual app:

• Comprehension Therapy
• Naming Therapy
• Reading Therapy
• Writing Therapy

Naming Therapy

• Stark, B. C., & Warburton, E. A. (2018). Improved language in chronic aphasia after self-delivered iPad speech therapy. Neuropsychological Rehabilitation, 28(5), 818-831.
• Boyle, M. (2010). Semantic feature analysis treatment for aphasic word retrieval impairments: What’s in a name? Topics in Stroke Rehabilitation, 17(6), 411–422.
• Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923–947.
• Wambaugh, J. L., Mauszycki, S., & Wright, S. (2014). Semantic feature analysis: Application to confrontation naming of actions in aphasia. Aphasiology, 28(1), 1–24.
• Wisenburn, B., & Mahoney, K. (2009). A meta-analysis of word-finding treatments for aphasia. Aphasiology, 23(11), 1338–1352.

Is this App Evidence-Based?

Anomia, or word-finding problems after stroke, is a frustrating part of aphasia. Review the evidence for treating naming deficits with these therapy ideas.

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Number Therapy

• Ablinger, I., Weniger, D., & Willmes, K. (2006). Treating number transcoding difficulties in a chronic aphasic patient. Aphasiology, 20(1), 37-58.
• Girelli, L., & Seron, X. (2001). Rehabilitation of number processing and calculation skills. Aphasiology, 15(7), 695-712.
• Deloche, G. R., & Seron, X. (1982). From three to 3: A differential analysis of skills in transcoding quantities between patients with Broca’s and Wernicke’s aphasia. Brain, 105(4), 719-733.

Reading Therapy

• Stark, B. C., & Warburton, E. A. (2018). Improved language in chronic aphasia after self-delivered iPad speech therapy. Neuropsychological Rehabilitation, 28(5), 818-831.
• Capitani, E., Laiacona, M., Mahon, B., & Caramazza, A. (2003). What are the facts of semantic category-specific deficits? A critical review of the clinical evidence. Cognitive Neuropsychology, 20(3-6), 213-261.
• Druks, J. (2002). Verbs and nouns—a review of the literature. Journal of Neurolinguistics, 15(3), 289-315.

Spaced Retrieval Therapy

• Benigas, J. E. (2015). Spaced retrieval training: 26 years of growth. Perspectives on Gerontology, 20(1), 34-43.Chicago
• Oren, S., Willerton, C., & Small, J. (2014). Effects of spaced retrieval training on semantic memory in Alzheimer’s disease: a systematic review. Journal of Speech, Language, and Hearing Research.Chicago
• Hopper, T., Mahendra, N., Kim, E., Azuma, T., Bayles, K. A., Cleary, S. J., & Tomoeda, C. K. (2005). Evidence-based practice recommendations for working with individuals with dementia: Spaced-retrieval training. Journal of Medical Speech Language Pathology, 13(4), xxvii.
• Balota, D. A., Duchek, J. M., & Logan, J. M. (2007). Is Expanded Retrieval Practice a Superior Form of Spaced Retrieval? A Critical Review of the Extant Literature.
• Haslam, C., Hodder, K. I., & Yates, P. J. (2011). Errorless learning and spaced retrieval: how do these methods fare in healthy and clinical populations?. Journal of Clinical and Experimental Neuropsychology, 33(4), 432-447.
• Hickey, E., & How, S. (2008). Spaced-retrieval training for persons with dementia: Maintenance and generalization.
• Thivierge, S., Simard, M., Jean, L., & Grandmaison, É. (2008). Errorless learning and spaced retrieval techniques to relearn instrumental activities of daily living in mild Alzheimer’s disease: A case report study. Neuropsychiatric Disease and Treatment, 4(5), 987.
• Olinde, E. (2006). Spaced-retrieval effects on memory for scenes in older adults with probable Alzheimer’s disease.
• Fridriksson, J., Holland, A., Beeson, P., & Morrow, L. (2005). Spaced retrieval treatment of anomia. Aphasiology, 19(2), 99-109.
• Small, J. A. (2012). A new frontier in spaced retrieval memory training for persons with Alzheimer’s disease. Neuropsychological Rehabilitation, 22(3), 329-361.

Speech FlipBook

• Wambaugh, J. L., Duffy, J. R., McNeil, M. R., Robin, D. A., & Rogers, M. A. (2006). Treatment guidelines for acquired apraxia of speech: Treatment descriptions and recommendations. Journal of Medical Speech Language Pathology, 14(2), xxxv.
• Wambaugh, J. L., Martinez, A. L., McNeil, M. R., & Rogers, M. A. (1999). Sound production treatment for apraxia of speech: Overgeneralization and maintenance effects. Aphasiology, 13(9-11), 821-837.
• Wambaugh, J. L., Doyle, P. J., Kalinyak, M. M., & West, J. E. (1996). A minimal contrast treatment for apraxia of speech. Clinical Aphasiology, 24, 97-108.

Visual Attention Therapy

• Cicerone, K. D., Dahlberg, C., Malec, J. F., Langenbahn, D. M., Felicetti, T., Kneipp, S., … & Laatsch, L. (2005). Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Archives of physical medicine and rehabilitation, 86(8), 1681-1692.
• Franceschini, S., Gori, S., Ruffino, M., Pedrolli, K., & Facoetti, A. (2012). A causal link between visual spatial attention and reading acquisition. Current Biology, 22(9), 814-819.
• Kortte, K., & Hillis, A. E. (2009). Recent advances in the understanding of neglect and anosognosia following right hemisphere stroke. Current neurology and neuroscience reports, 9(6), 459.
• Erez, A. B. H., Katz, N., Ring, H., & Soroker, N. (2009). Assessment of spatial neglect using computerised feature and conjunction visual search tasks. Neuropsychological Rehabilitation, 19(5), 677-695.
• Brucki, S. M. D., & Nitrini, R. (2008). Cancellation task in very low educated people. Archives of Clinical Neuropsychology, 23(2), 139-147.
• Bailey, M. J., Riddoch, M. J., & Crome, P. (2002). Treatment of visual neglect in elderly patients with stroke: a single-subject series using either a scanning and cueing strategy or a left-limb activation strategy. Physical Therapy, 82(8), 782-797.
• Murray, L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. American Journal of Speech-Language Pathology.

Writing Therapy

• Stark, B. C., & Warburton, E. A. (2018). Improved language in chronic aphasia after self-delivered iPad speech therapy. Neuropsychological Rehabilitation, 28(5), 818-831.
• Coltheart, M., Sartori, G., & Job, R. (Eds.)(2013). The Cognitive Neuropsychology of Language (Psychology Revivals). Psychology Press.
• Ball, A. L., de Riesthal, M., Breeding, V. E., & Mendoza, D. E. (2011). Modified ACT and CART in severe aphasia. Aphasiology, 25(6-7), 836-848.
• Beeson, P. M., & Egnor, H. (2006). Combining treatment for written and spoken naming. Journal of the International Neuropsychological Society, 12(06), 816-827.
• Beeson, P. M., Hirsch, F. M., & Rewega, M. A. (2002). Successful single-word writing treatment: Experimental analyses of four cases. Aphasiology, 16(4-6), 473-491.
• Robson, J., Marshall, J., Chiat, S., & Pring, T. (2001). Enhancing communication in jargon aphasia: A small group study of writing therapy. International Journal of Language & Communication Disorders, 36(4), 471-488.