Severe Aphasia Speech Therapy Apps - Treat Global Aphasia

Using Speech Therapy Apps to Treat Severe Aphasia

 9 min read


Aphasia can be devastating in all its forms, but there are some who lose more of their language skills than others after a stroke or brain injury. For these people diagnosed with severe aphasia, there are notable problems in all areas of language.

In this video-enriched resource, we’ll take you through what severe aphasia is and how it impacts language, and show you 10 Tactus Therapy apps that can help. And remember – you can try these apps for free by downloading the Lite version to see if the person with aphasia in your life can benefit.

Download this guide to using apps to treat severe aphasia

This free PDF handout contains the details about which activities & settings to use in each of the recommended apps. Perfect to print & give to families or use to help your loved one with severe aphasia.

Using apps to treat severe aphasia free PDF handout

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Defining Severe Aphasia

Severe aphasia means the person cannot effectively get their message across most of the time. Unfortunately, severe aphasia is also often accompanied by other problems in mobility, vision, and cognition. Those with severe aphasia are also at a higher risk of depression, social isolation, and loss of meaningful activities and relationships.

Not everyone with severe aphasia will have severe impairments in all four areas of language. Some have relative strengths in understanding and reading (comprehension), but their difficulties in talking and writing (expression) result in severe problems in communication – this is called severe non-fluent aphasia. Others speak easily, but it doesn’t make much sense, and they have trouble understanding – this is severe fluent aphasia. And many people have trouble both producing and understanding language, a condition known as global aphasia.

Here’s what severe impairments might look like in each of the four major language skills:

Talking (also known as verbal, spoken, or oral expression) includes thinking of the words you want to say and saying them.

  • Severe: Tries to speak, but usually can’t get anything meaningful out. Sometimes can say automatic words or phrases spontaneously.
  • Moderate-Severe: With effort and help, can say some appropriate words and phrases.

Understanding (aka spoken, listening, or auditory comprehension) is the ability to make sense of what you hear. It’s important to assess understanding without cues from context as many people with aphasia appear to understand better than they do.

  • Severe: Follows simple, personally-relevant directions and answers simple yes/no questions in context, but needs slow, simplified speech and visual supports.
  • Moderate-Severe: Follows simple directions and answers yes/no questions most of the time with some help. Struggles with complex messages and less-frequent words.

Writing, or written expression, is the ability to put words into written form. This can be through handwriting, printing, or typing and requires spelling skills.

  • Severe: Can write their own name with help, and copies letters and words.
  • Moderate-Severe: Can write common words independently, but needs help for longer or less familiar ones.

Reading is making sense of the written word. Oral reading (aka reading aloud) is a different skill from reading comprehension, but both skills can be affected by aphasia.

  • Severe: Recognizes letters and common words with help.
  • Moderate-Severe: Reads common words, but needs help for less familiar words.

Some people have even more trouble in each area than what’s described here. This is referred to as profound aphasia, and these individuals are typically not ready for speech therapy using apps. Context-based treatments may be more appropriate.

Using Apps to Treat Severe Aphasia

It’s important to know that severe aphasia can improve over time. It tends to be slower to improve than other forms of aphasia, but never give up hope! Motivation, social engagement, and life participation are all needed to make progress on functional language goals, along with the right kinds of exercises. That’s where we’ve got you covered.

  1. Language Therapy 4-in-1
  2. Apraxia Therapy
  3. Category Therapy
  4. Conversation Therapy

Bonus Apps

1) Language Therapy 4-in-1

Language Therapy is our best-selling app that helps people with severe and moderate-severe aphasia in all four areas of language. For the most severe, here are some tips on how to use the app in its simplest form.

Focus & Personalize

For Naming Therapy and Writing Therapy (the 2 expressive apps included in this suite), it’s often helpful to pick just 5-10 words to focus on. You can turn off all items in the apps and turn on only the ones you want to practice (touch Customize Word List in the settings), and you can add your own pictures and words to each app (touch Add/Edit Custom on the category set-up tab).

Here’s a video showing you step-by-step how to add a custom item in Naming Therapy, and a similar one showing the process in Writing Therapy.

Limit the Answer Choices

In Comprehension Therapy and Reading Therapy (the 2 receptive apps included in the Language suite), you can change the number of choices to 2, making each exercise easier by eliminating the choices closest to the answer. In Writing Therapy, the Easy difficulty setting will limit the number of letter tiles you see. In Naming Therapy, turn on only the most helpful cues (usually the last 4) in Naming Practice for earlier success. 

Adjust the Difficulty

In Comprehension Therapy, change the Difficulty to Easy to ensure all other choices come from other categories. You can limit the number of syllables in the words in Naming Therapy, and in Writing Therapy, you can select only 3 and 4 letter words to make the exercises easier.

Build-in Talking

After hearing the word in Comprehension Therapy, try to say it. Read the choices in Reading Therapy aloud. Say each letter you touch in Writing Therapy. There are always chances to repeat or read aloud.

Get Creative

Use the Flashcards activity in Naming Therapy to play an adapted version of 20 questions. Ask yes/no questions for the person with aphasia to answer – either verbally, by nodding, or by pointing to a yes/no visual aid. If you are looking at a picture of an apple together, you can ask: “is it blue?”, “is it something you eat?”, “does it grow on trees?” and “is it made of wood?”.

Use the Hints

Every app offers hints to help people get to the right answer on their own. Remind the person you’re helping that the hint is available, and show them where it is so they can begin to decide when they need help and ask for it themselves. This is a very important skill to learn!

Language Therapy 4-in-1

Language Therapy 4-in-1

Boost speaking, listening, reading, & writing for words with a scientifically proven speech therapy app for people with aphasia.

Learn more about the evidence-based speech therapy techniques that can help with severe aphasia using this app:

2) Apraxia Therapy

Apraxia Therapy is a popular evidence-based app that can be used independently by many people with severe aphasia. Here’s what to focus on:

Sequences

Use the Sequences activity, but turn off all steps except for Words. Using a very familiar sequence (e.g. numbers, days, or months), touch each word in order in your own time to recite the sequence.

Phrases

Focus only on Level 1 (2-syllable) and Level 2 (3-syllable) phrases. Pick a small handful of phrases that are the most personally meaningful. Work on these phrases over and over.

Adjust the Settings

Set the Text Cues to Constant to keep the text on-screen for each step. Change the Speech Rate to Slow if that helps.

Apraxia Therapy

Apraxia Therapy

Speak more easily and build independence with video-assisted speech therapy to help people with apraxia after a stroke.

Learn more about the evidence-based speech therapy technique that can help with severe aphasia using this app:

3) Category Therapy

Category Therapy is a good app for people with severe aphasia because it doesn’t require any verbal output. This app helps to strengthen the meaning of words in the brain by focusing on the categories that words belong to, and in so doing, stimulating the properties (aka semantic features) of the word. It ranges from simple to complex, so let’s look at the easiest way to use the app:

Find & Classify

Use only the Find and Classify activities for people who are struggling the most. They’ll be asked to find the category member or decide which category an item belongs to. The other two activities require inferencing, making them more challenging.

Adjust the Settings

On the Settings tab, set the Number of Choices to Small for these two activities to limit the choices. For Target Type, select Words & Pictures for the most support.  This will work on total comprehension by providing written names, a clear photo, and audio support (if you touch the speaker button).

Adjust the Difficulty

You’ll want to stay on the Easy/Concrete level of difficulty to start. This focuses on categories such as foods, animals, and clothing. Some people may find Medium/Subcategories just as easy, with more specific categories like desserts, pets, and footwear.

Category Therapy

Category Therapy

Strengthen connections between words with flexible exercises to improve language and reasoning skills.

Learn more about why we work on categorization skills:

4) Conversation Therapy

Conversation Therapy requires at least 2 people to use, making it an ideal app for practicing communication strategies and good partner facilitation skills. Since no question can be answered with just a yes or no response, it pushes people with severe aphasia to express themselves and their opinions. Here are some tips for using this app with moderate-severe aphasia:

Skip Around

Set the Number of Trials to All, then browse through the images until you find an image or topic that resonates with the person with aphasia. There’s no sense talking about things they don’t care about. Keep motivation high!

Focus on the Left

The questions on the left side of the screen are easier to answer than the ones on the right, so stick to those for severe aphasia.

Explore Non-Verbal Responses

This is the time to practice gestures, drawing, referencing objects or photos, and other communication strategies. Answer using a communication app if you have one, and keep a pencil and paper handy.

Partner-Assisted Communication

There are many things a communication partner can do to be better understood and to help the person with aphasia get their message out. Provide written choices, offer visual supports, and write keywords as you go.

Learn more: https://praacticalaac.org/strategy/aphasia-supported-communication-written-choice-strategy-variations/

Go Off Script

You don’t have to stick to the questions in the app. You can touch the question button again to hide the question, or just focus on the picture. Many of the pictures containing people are nice to use for a technique called Response Elaboration Training.

Conversation Therapy

Conversation Therapy

Engage in real-life discussions with pictures & questions that get people talking to practice communication strategies.

Learn more about the evidence-based speech therapy techniques that can help with severe aphasia using this app:

Bonus Apps for Severe Aphasia

While the apps above are made with severe aphasia in mind, these apps can be used if you’re looking to expand your treatment.

1) AlphaTopics – AAC

AlphaTopics is a simple and affordable augmentative communication app that ensures you have a copy of the alphabet, a whiteboard, and a list of common topics with you at all times. For severe aphasia:

Establish the Topic

It’s often a good idea to establish the topic of the conversation first. This can prevent runaway yes/no guessing games that are seriously off-track. Use the customizable topic board to get on the same page first. Change the topics to suit the needs of the person with severe aphasia.

Write or Draw

The whiteboard allows for impromptu attempts at writing or drawing. When a person with aphasia starts using their finger to write or draw in the air or on the table, break out this app so you’ll have a visual record of what they’re trying to convey.

AlphaTopics AAC

AlphaTopics AAC

Enhance & clarify natural speech with this simple yet powerful augmentative communication app for dysarthria & aphasia.

2) Answering Therapy

Answering Therapy (available for iOS only) focuses on the critical ability to answer yes/no questions. Seeing how accurate a person is at each level of difficulty with these concrete questions can help to gauge accuracy on questions that you aren’t sure of the answer. For severe aphasia:

Personalize It

This app contains a personal survey that allows you to enter personally-relevant information about the user – ideal for severe aphasia. Complete the survey to fill in details of family members, location, appearance, and age. Passcode-protect this data for extra security.

Add Your Own Questions

This app has full customization to add your own questions to the Yes/No and Wh-questions. Add a familiar person to ask: “Is this Mary? Yes or No?”

Using “tagged questions” means each answer is presented before answering. This is very helpful to slow down people who may answer impulsively or not know what kind of response is expected.

Answering Therapy

Answering Therapy

Give accurate answers when you understand the question using these wh- and yes/no questions.

3) Visual Attention Therapy

Visual Attention Therapy is designed to help stroke survivors with a condition called left neglect, but it can also help with scanning, focus, and reducing impulsivity in those with severe aphasia.

Start Simple

In the settings, choose 5 trials per level and a low field size number. Try levels 3 and 4 first, using just 1 target.

Test, then Practice

Use the Test first to see if a visual scanning problem is evident, but then switch to Practice to ensure left-to-right, top-to-bottom scanning, like we do when reading.

Visual Attention Therapy

Visual Attention Therapy

Retrain the brain with interactive cancellation exercises that help you assess and treat left neglect.

Found this article useful? Download the guide now.

This handout contains all the key information about what to do in each of the recommended apps.

Using apps to treat severe aphasia

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Megan S. Sutton, MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. She is an international speaker, writer, and educator on the use of technology in adult medical speech therapy. Megan believes that technology plays a critical role in improving aphasia outcomes and humanizing clinical services.