Outcomes of an App-Based Intervention to Target Naming Among Individuals With Poststroke Aphasia: Virtual Randomized Controlled Trial.

Abstract

Background: People with aphasia present with language and communication deficits, most notably in lexical retrieval (naming). Although positive outcomes in naming have been observed following speech-language treatment, many individuals with aphasia continue to face impairments after the acute phase of rehabilitation. Mobile app-based therapies are increasingly being used by speech-language pathologists in the rehabilitation of people with aphasia as an adjunct to or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment and have been shown to result in meaningful outcomes across several domains.

Objective: VoiceAdapt is a mobile therapy app addressing naming impairments, designed within a user-centered design framework. The VoiceAdapt app uses two evidence-based lexical retrieval treatments to engage people with aphasia to improve their naming abilities through interaction with the app. The purpose of this study was to conduct a randomized controlled trial to examine the preliminary clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia.

Methods: A two-arm, waitlist-controlled, crossover group randomized controlled trial was conducted at two sites within Canada. During the intervention phase, participants completed 5 weeks of independent training with the app, which involved naming practice using Semantic Features Analysis and Phonological Components Analysis. The primary outcome measure was naming performance (Boston Naming Test); secondary outcomes included measures of overall language and naming (Western Aphasia Battery-Revised), communication (Communication Effectiveness Index), and quality of life (Stroke and Aphasia Quality of Life Scale-39).

Results: A total of 37 people with aphasia in the chronic stages (average 4.6 y postonset of aphasia) participated in this study. Participants used the app for an average of 20 hours over the 5-week intervention phase. Training with VoiceAdapt resulted in an increase of 1.6 points on the Boston Naming Test (Cohen d=0.3). Evidence for improved naming was also observed on trained items, as well as subtests of naming or word-finding on the WAB-R. Training with the app also resulted in a significant increase in participants' perceptions of their communication quality of life (increase of 0.1 points; Cohen d=0.3), but no other measures (WAB-R Aphasia Quotient, Communicative Effectiveness Index) were significant.

Conclusions: Individuals with aphasia who used the VoiceAdapt app for 5 weeks to target naming skills demonstrated measurable gains in naming and communication-based quality of life. Notably, these changes were observed in a remotely delivered program, in participants who were in the chronic stages of aphasia. These findings inform the profession on the use of app-based home therapy programs as an accessible, cost-effective option for individuals in the chronic stages of recovery who often have limited options for rehabilitation.