Strategies to Accommodate Reading (STAR)
Condition: Aphasia
MeSH terms: Aphasia
Study type: Interventional

Summary: 
      People with aphasia often understand spoken utterances better than written sentences. They
      also benefit from having content appear in multiple rather than single modalities. Because
      text-to-speech (TTS) systems accommodate both of these functions, it provides an ideal basis
      for a reading intervention. TTS systems convert written text to provide both text and
      auditory information. Research about using TTS supports with people with aphasia has not
      extended beyond basic case studies and our studies of sentence level comprehension. Hence, no
      evidence exists about varying TTS features-such as speech output, speech rate, and text
      highlighting-known to benefit others with reading problems. Also, social acceptance of TTS is
      not well understood, even though it is critical to adoption and long-term use of the
      technology.

      The purpose of this study is to evaluate various aspects of multimodality presentation of
      material through TTS systems used by people with aphasia. The immediate outcome of the
      proposed research will be evidence-based recommendations for selecting and adjusting TTS
      systems and features. This work will enable clinicians to maximize benefits for adults with
      varying aphasia profiles. We also will obtain initial evidence about the social validity and
      perceived value of TTS system use for this population.
    

Detailed description: 
      Experimental Procedures

        -  Phase 1: After completing the assessment session, phase one will include up to 4
           sessions each lasting up to 90 minutes. Across the four sessions, the participants will
           listen to and/or read 36 passages ranging from 4 to 6 sentences each. Then, participants
           will answer 10 multiple choice questions related to the content of the passage. The
           researcher will provide comprehension support via written choice strategy for the
           multiple choice questions (e.g., written and spoken language, nonverbal supports such as
           pointing). Participants will read and/or listen to the stories via a computer. An
           example of these questions appears in Appendix G.

        -  Phase 2: After completing the assessment session, phase two will include 1 to 3 separate
           parts examining 3 different TTS features (e.g., speech presentation rate, text
           highlighting, speech production quality). Participants can choose to participate in 1 or
           more parts within this phase. For each part, participants will first listen to or view
           selected variations of a target feature and choose their preferred variation. For each
           study, participants will then complete five or four experimental sessions lasting up to
           90 minutes each. Parts with up to five sessions (i.e., Part 1 and 2) will include
           features with more variations than those included in Part 3, which will include up to
           four sessions. Participants will read and/or listen to up to 12 reading passages in each
           session and answer multiple choice comprehension questions related to the content of the
           passage. At the conclusion of each session, participants will provide their opinion
           about the optimal targeted feature variation using rating forms and interview questions.
           Participants will read and/or listen to the passages via a computer.

        -  Phase 3: After completing the assessment session and any previous study phases, the
           participants will complete one 2-hour session. Participants will complete three
           activities: (1) education and system exploration guided by a member of the research
           team, (2) satisfaction and predicted use ratings of TTS systems, and (3) semi-structured
           interviews. Ratings of the TTS systems will be complete using Likert ratings scales (see
           Appendix H). Semi-structured interview questions will relate to rationales for system
           ratings and perceived application of TTS systems for functional use.
    

Intervention name(s): Multimodality information comprehension
Intervention type(s): Behavioral
Intervention description(s): Evaluate various aspects of multimodality presentation of materials through text-to-speech systems used by people with aphasia.
Intervention model: Single Group Assignment
Intervention model description: Examination of comprehension differences when information is presented under different conditions: (a) written only, (b) auditory only or (c) combined written and auditory.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: aphasia; comprehension; text-to-speech; social validity