Remote Neurobased Approach to Aphasia Therapy
Condition: Aphasia, Broca; Aphasia, Wernicke; Aphasia, Fluent; Aphasia, Nonfluent; Aphasia
MeSH terms: Aphasia; Aphasia, Broca; Aphasia, Wernicke
Study type: Interventional

Summary: 
      The purpose of this study is the development and validation of an evidence-based mobile
      application, based on the core premises of Intensive Language-Action Therapy (ILAT) for
      aphasia, for the training and improvement of chronic aphasia patients administered at the
      patient's home. It aims at testing the beneficial effect on the linguistic performance (as
      assessed by the Barcelona and CAL clinical tests) counteracting learned non-use and the
      usability of the application as a tool for training once discharged from hospital care.
    

Detailed description: 
      Acquired brain lesions such as stroke often result in the most common disabling neurological
      damages. Up to 42% of stroke patients suffer serious language deficits and patients are
      frequently left with chronic disabilities which adversely impact their quality of life. One
      of the main challenges in aphasia rehabilitation includes long-term effects. After a certain
      time (i.e., 3-6mo, chronic phase), the frequency of therapy will decrease or stop, even if
      the patient has not always reached the expected or desired level of recovery. After this, a
      body of evidence suggests that the person with aphasia might decrease the use of verbal
      language given the negative reinforcement when trying to use the deteriorated function and
      failing to achieve a successful communication. This might lead to relying on other forms of
      communication (e.g., gestures) and to a vicious cycle of deterioration of verbal skills known
      as Learned Non-Use principle. Together with the pandemic socioeconomic situation and limited
      resources at healthcare facilities, this calls for the need of effective and efficient
      interventions that can be deployed at the house of the patients, in the form of
      auto-administered therapy. Despite the limited exploration of portable technologies in
      aphasia recovery, their use has been extensive and successful in other domains such as motor
      rehabilitation. Importantly, patients with aphasia report that the number 1 topic they would
      like to know more about is how to keep recovering after therapy ends.

      Following recent evidence on experience-dependent plasticity mechanisms for successful stroke
      recovery and well-established theory-grounded interventions, such as ILAT, the present study
      aims to study the usability and improvement potential of a mobile-based aphasia
      rehabilitation app for stroke patients, used at home. A previous collaboration between both
      centers (SPECS lab and Hospital Joan XIII) used a computer-based setup. In this study by
      Grechuta et al. (2019), the Rehabilitation Gaming System for aphasia (RGSa) shows positive
      significant results on language (P= 0.001) and communication (P<0.05) compared to
      conventional therapy in the long term (16 weeks). This study will assess the usability,
      risks, and clinical outcome of the same principles applied to a mobile application that is
      prescribed to be used at home for two twenty-minutes session per day during two weeks.
    

Intervention name(s): Mobile evidence-based aphasia therapy; Conventional aphasia rehabilitation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Use of mobile application to practice language for 2 weeks with a recommendation of 2 sessions per day of 20 minutes. The Android application, which is a Unity-based 2D game, will be installed on the patient's own phone, and they will play individually with the support of a family member if needed. The patients are free to start and stop using the application at any time. The application is safe to use, and it consists of therapeutic training methods such as object-matching, word search, writing, and manual voice recordings.; Control Group (conventional aphasia rehabilitation). No therapy as patients are in the chronic stage, where they do not receive healthcare rehabilitation training.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants are assigned to either an experimental group or a control group. In the experimental group the participants will receive mobile-based aphasia therapy for two weeks. In the control group participants will receive no additional therapy apart from the conventional aphasia therapy that they are already receiving.
Masking: None (Open Label)
Primary purpose: Treatment