Tactus Therapy recently launched a new app called Apraxia Therapy, a program to help people with aphasia and apraxia practice speaking, featuring VAST™ videos. The app has already been incredibly well-received, with therapists saying it gives their clients hope and motivation, and people with aphasia asking to use it when they come in.
We talked with VAST™ creator and speech-language pathologist Darlene Williamson to find out more about her career, the experiences that led her to create VAST™, and why this evidence-based treatment really can and does improve communication for so many stroke survivors.
Darlene Williamson (right) helps a woman with aphasia use VAST on an iPod touch
What is VAST™?
“VAST™ stands for Video Assisted Speech Therapy,” creator Darlene Williamson explains. “It’s a twist on a classic therapy technique that takes advantage of the ubiquity and ease of iDevices.” At a time when most of us were just hearing whispers about the App Store on iTunes, Darlene was already designing and releasing her first speech therapy application for people with aphasia.
Darlene is the founder and executive director of the Stroke Comeback Center in Vienna, Virginia and the President of the National Aphasia Association. She is an industry expert on the treatment of aphasia, who through the years has become a pioneer in the use of mobile technology. The Stroke Comeback Center offers a multitude of treatment groups under a life participation approach, and it was there that Darlene created and refined the VAST™ technique for her clients.
What led you to found the Stroke Comeback Center?
“I worked for many years in acute care in the hospital. I was the person sitting at the table across from the individual with aphasia who had to deliver the message that we were terminating speech therapy – not because the person wasn’t able to continue or didn’t have plenty of progress to make, but because their insurance was telling me they were done.”
Frustrated with the bureaucracy, Darlene transitioned into the university arena by taking a position as the clinic director at George Washington University. It was there that she began running aphasia groups.
“I loved the group concept. It wasn’t revolutionary, but it wasn’t a well-developed concept in the early 90’s either. I ultimately put two and two together – people with aphasia need long term affordable services, and the group model works.”
As most speech pathologists know, learning from a patient can be just as important as teaching. At the Stroke Comeback Center, Darlene found herself lucky enough to learn from one very special client and his camcorder.
What inspired you to create VAST™?
“Probably getting close to 10 years ago, I had a client with a very significant amount of apraxia whose hobby was videoing. He made it his business to carry his video camera (not so portable back then) and take a video of everything. He’d record his doctor appointments and what he did during the day, so he could show his friends. It was his strategy for living life independently. He would bring his video camera to record his speech sessions, go home, and replay our sessions over and over again. He kind of led me into thinking, ‘whoa, why would we use static photos when we have pretty good access to video?’”
When her patient began video recording his speech therapy sessions, Darlene says she absolutely saw improvement. And the concept behind VAST™ was born.
“He had more interest in the ultimate outcome than he did in doing any basic phonemic practice. He wanted me to say functional phrases – things he wanted to communicate. He would video me, then go home and practice. Lo and behold, he’d come back and astound me. He’d turn on the video and speak along with it. At the same time, not repeating after it. I’d never seen anyone do this before, so we just started experimenting with it.”
With the freedom of running her own recovery center, Darlene began experimenting with portable iPods and stored videos of her own lips producing words and phrases for her client to take home. Her client, she says, then began speaking along with the video using headphones so nobody but him could hear it. He became so adept, in fact, that he could give a five or six minute speech, she says, in the absence of other spontaneous speech.
Stroke survivor Howard Snyder using an iPod Touch to speak along with VAST video. Read more of his story and see videos him using VAST.
Darlene thought, “If he can do it- who else can do it?” Alongside her son, a technology professional, Darlene began streamlining her videos and aimed to reach a broader audience with her videos through apps. From the start, VAST™ was a success with therapists who embraced technology. “People who were forward thinking enough to find this app, know about it, and use it – they loved it and started requesting longer phrases and specific utterances. They wanted more.”
How does video modeling work as a therapy technique?
“VAST™ had its roots in very traditional straight-forward modeling for motor speech disorders. It’s based on very basic phonemic and word-level exercises in a program I was using (and we still use) called Mind over Matter. It is reproducing movement in unison with a clinician. What I was doing with people prior to the development of VAST™, was taking static digital pictures for the clients to take home as a model.”
Darlene says at a scientific level, VAST™ adheres to all the principles of motor learning and motor reconnection that are necessary to successfully speak when one has apraxia.
“It’s not a departure from any sort of standard or traditional motor speech therapy. VAST™ is simply a combination of scripting with auditory and visual modeling, being delivered via technology. It works because a) it uses known therapy principles and techniques, and b) it allows for independent and unlimited practice.”
Pairing this therapy technique with technology was a natural fit and evolution with the changing dynamics of speech therapy. VAST™ videos provide an affordable and portable means of audio and visual modeling, with the added benefit of independence for clients and their families.
“Those principle components allow people to successfully say personal scripts after they’ve learned the technique. They’re using a mobile platform that makes them look like everyone else walking around on the streets with a tablet or smartphone. They don’t look like someone who has a communication deficit. Technology is where it’s at. It’s sort of crept up on our field and bit us on the backside. It’s just so obvious that whatever we can do to deliver services through technology only works to maximize the impact of the service. ”
What goes into making VAST™ videos?
While filming scripts may appear to be an easy task, Darlene cautions that it’s taken years of trial and error to perfect the technique. “Each person I used it with taught me something. I learned about the prosody, timing, lip movements – even inhalation prior to speaking so the person can initiate their motor system and get in sync with the video.”
Not everyone has the symmetrical, youthful lips or straight, white teeth that others want to look at over and over either! SpeakinMotion® has very specialized equipment, trained models, and years of experience to create professional and personalized videos for speech therapy.
Using a trained VAST model filmed with professional cameras and lighting makes for videos you won’t mind watching over and over.
Since its inception, VAST™ has become a critical, evidence-based staple of aphasia therapy for many clinicians and caregivers across the world. And with a clinician as passionate and innovative as Darlene Williamson, you know her ideas and innovations will continue to deliver speech therapy support for many years to come.
VAST™ Video Therapy Apps
We’re so pleased to include VAST™ videos in our Apraxia Therapy app. Try it for free with Apraxia Therapy Lite. If you find that the videos help your clients or loved one, be sure to check out the other VAST™ apps from SpeakinMotion® on the App Store.
Apraxia Therapy is now also available for Android! Download Apraxia Therapy Lite for free, or purchase the full version of Apraxia Therapy on Google Play.
Thank you for telling us how Darlene was inspired to use the video modelling.
I had the same revelation 6 years earlier and Multimedia Speech Pathology released the first version of Speech Sounds on Cue on CD ROM in 1999.
As you know our Speech Sounds on Cue targets word level production and gives additional semantic and picture and carrier phrase cues.
I find the Tactus Apraxia app is a great follow on after my clients have gained success at a word level on Speech Sounds on Cue.
Thanks Carol! We use (and recommend) your Speech Sounds on Cue app all the time. The free trial is a great taste of the full app that helps many with apraxia. It’s great how you can focus on one initial sound or on rhymes. Thanks for being another amazing speech therapy pioneer. Through software development, we can help so many more stroke survivors get the practice they need to improve communication.