Efficacy of Language Games as Therapy for Post-Stroke Aphasia - - PowerPoint PPT Presentation

Efficacy of Language Games as Therapy for Post-Stroke Aphasia

Louise Lander Moor Green Outpatient Brain Injury Unit- Birmingham Community Healthcare NHS Foundation Trust

 A novel, clinically relevant intervention  Collaboration between public healthcare provider and

universities

 Funded by the National Institute for Health Research

Dr Cristina Romani Samantha Tyler Iman Idrees Dr Andrew Olson Louise Lander

The context:



Rising demand for healthcare, with limited resources



An urgent need for new and productive ways of delivering aphasia therapy



Focus on word-retrieval: an extremely common and distressing symptom, which is extensively treated with cued picture-naming therapies (eg Wisenburn & Mahony, 2009)

Word retrieval therapy:

• Clinically effective
• at impairment and functional levels
• deliver improvement in quality of

life, reduce social isolation

• Cost effective
• delivered efficiently to enable

increased intensity

• Acceptable to patients
• be motivating and engaging

We used:

• Impairment based cued word-

retrieval

• Group therapy
• A game mode

Design: Language game therapy

 Charade-like games  Picture cards: 90 nouns 90 verbs  3 matched word groups for 3 games

 Game P- phonemic cueing  Game G- phonemic+gesture cueing  Game S- phonemic+semantic cueing

 Each game played for 18 hours over 2 weeks  Two teams of 3 patients, with mod-severe, expressive

chronic aphasia

Assessment

 Assessment specific to game

therapy:  Picture-naming of 180 treated words  Description of 9 pictured scenarios

 Assessment of general language

function:  Comprehensive Aphasia Test  Boston Naming Test  Cinderella Story Re-tell

 Subjective assessment:

 Participant Satisfaction Questionnaire

Picture naming: Gains by treatment order

10 20 30 40 50 60 Time 1 Time 2-After Game P Time 3-After Game G Time 4-After Game S Time 5-After standard therapy

Percent correct Treatment order Word set P Word set G Word set S Group scores for each word set Interaction between word set and game type: p<0.001

Scenario description: Gains by treatment order

5 10 15 20 25 30 35 Time 1 Time 2- after game P Time 3- after game G Time 4- after game S Time 5- after standard therapy

Percent targets achieved Treatment order Word set P Word set G Word set S Interaction between word set and game type: p<0.001 Group scores for each word set

Picture naming: Gains by participants

10 20 30 40 50 60 70 80 90 Baseline After game therapy Maintenance After standard therapy

Percent correct Therapy phase Participant data combined across game type

P1 P2 P3 P4 P5 P6 mean

Main effect of therapy phase: p<0.001

Scenario description: Gains by participants

5 10 15 20 25 30 35 40 45 50 Baseline After game therapy Maintenance After standard therapy

Percent targets achieved Therapy phase P1 P2 P3 P4 P5 P6 mean Participant data combined across game type Main effect of therapy phase: p<0.001

Summary of all language testing

* * * * 20 40 60 80 100 120 % change in average score

5 10 15 20 25 30 35 40 Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree Number of responses

Participant satisfaction with therapy

Standard therapy Game therapy

Example statements:

• The therapy improved

my talking

• The therapy was suited

to me

• The therapy helped me

achieve my goals

• I am satisfied with the

therapy

• I did not get tired

Summary

 Picture-naming score almost doubled: sits favourably with other

studies (eg Ramsberger & Marie 2007, Rider et al 2008, Best et al 2013, Raymer et al 2006)

 This therapy is distinguished from others in that it is delivered

intensively and efficiently to a group in a game format

 The improvements were largely item-specific, similar for types of

cueing

 Gains were largely long-lasting and generalised to a connected

speech context

 This supports the validity of our game therapy for improving word-

retrieval in connected speech.

 Some participants improved content of unsupported narrative.  It was clinically effective, cost effective and had strong patient

acceptability

References

Best, W., Greenwood, A., Grassly, J., Herbert, R., Hickin, J. & Howard, D. 2013, "Aphasia rehabilitation: does generalisation from anomia therapy occur and is it predictable? A case series study.", Cortex, vol. 49, no. 9, pp. 2345-2357. Carragher, M., Conroy, P., Sage, K. & Wilkinson, R. 2012, "Can impairment-focused therapy change the everyday conversations of people with aphasia? A review of the literature and future directions", Aphasiology, vol. 26, no. 7, pp. 895-916. Conroy, P., Sage, K. & Lambon Ralph, M. 2009a, "The effects of decreasing and increasing cue therapy on improving naming speed and accuracy for verbs and nouns in aphasia", Aphasiology, vol. 23, no. 6, pp. 707-730. Conroy, P., Sage, K. & Lambon Ralph, M. 2009b, "Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalize to connected speech?.", International Journal of Language & Communication Disorders, vol. 44, no. 6, pp. 1036-1062. Enderby, P., Pickstone, C., John, A., Fryer, K., Cantrell, A. & Papaioannou, D. 2009, "Resource manual for commissioning and planning services for SLCN", . Lanyon, L.E., Rose, M.L. & Worrall, L. 2013, "The efficacy of outpatient and community- based aphasia group interventions: a systematic review", International Journal of Speechlanguage Pathology, vol. 15, no. 4, pp. 359-374. McKevitt, C., Fudge, N., Redfern, J., Sheldenkar, A., Crichton, S., Rudd, A., Forster, A., Young, J., Nazareth, I., Silver, L., Rothwell, P. & Wolfe, C. 2011, "Self-reported long-term needs after stroke", Stroke, vol. 42, pp. 1398-1403.

References

Nickels, L. 2002, "Therapy for naming disorders: Revisiting, revising, and reviewing", Aphasiology, vol. 16, no. 10-11, pp. 935-979. Pert, S. 2010, "Supporting Staff to Balance Caseloads" in Embedding Evidence-Based Practice in Speech and Language Therapy: International Examples, eds. H. Roddam & J. Skeat, 1st edn, John Wiley & Sons Ltd, Chichester, pp. 72-78. Pulvermüller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P. & Taub, E. 2001, "Constraint-induced therapy for chronic aphasia after stroke", Stroke (00392499), vol. 32, no. 7, pp. 1621-1626. Ramsberger, G. & Marie, B. 2007, "Self-administered cued naming therapy: a single- participant investigation of a computer-based therapy program replicated in four cases", American Journal of Speech-Language Pathology, vol. 16, no. 4, pp. 343-358. Raymer, A., Singletary, F., Rodriguez, A., Ciampitti, M., Heilman, K. & Rothi, L. 2006, "Effects

• f gesture+verbal treatment for noun and verb retrieval in aphasia.", Journal of the

International Neuropsychological Society, vol. 12, no. 6, pp. 867-882. Rider, J.D., Wright, H.H., Marshall, R.C. & Page, J.L. 2008, "Using semantic feature analysis to improve contextual discourse in adults with aphasia", American Journal of Speech- Language Pathology, vol. 17, no. 2, pp. 161-172. Wisenburn, B. & Mahoney, K. 2009, "A meta-analysis of word-finding treatments for aphasia", Aphasiology, vol. 23, no. 11, pp. 1338-1352.