Enhancing Written Communication in Persons With Aphasia

Study Overview
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Brief Summary
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The purpose of this study is to evaluate whether a computerized speech-language treatment delivered by a virtual therapist (Oral Reading for Language in Aphasia (ORLA) + Writing) results in improved written communication skills of study participants with aphasia (i.e., difficulty with the comprehension and expression of spoken and written language).

Detailed Description
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Stroke is the third leading cause of death and the most common cause of disability in the United States. According to the American Stroke Association, the prevalence of stroke in the U.S. is approximately 4.8 million with approximately 700,000 additional strokes occurring annually. Approximately 150,000 to 250,000 stroke survivors becoming severely and permanently disabled each year. A common neurological deficit among stroke survivors, and thus a substantial contributor to post-stroke disability, is aphasia. The loss of, or difficulty with language is extremely debilitating. Adequate written communication skills may be one of the barriers that has prevented individuals with aphasia from returning to work. Writing skills are also important for participation in social roles, such as household management, civic activities, or recreational activities with friends. Individuals with aphasia struggle to compose written documents such as personal letters, memos and reports. Furthermore, society's increased reliance on written forms of communication including email correspondence, instant messaging, texting, Twitter, and social networking sites such as Facebook, exacerbate the challenge that individuals with aphasia have in connecting with others, reestablishing and redefining their social roles and accomplishing their life-participation goals. Computer-directed treatment offers a practical alternative to one-on-one traditional treatment provided by a clinician and may be a cost-effective way of extending therapy beyond the hospital and clinic to meet the needs of the growing numbers of individuals with chronic aphasia and to help them reintegrate into the community and workforce. This project evaluates the efficacy of a theoretically-motivated writing program that has been integrated with novel computer-based virtual therapy systems and that can be provided intensively to individuals with chronic aphasia.

Official Title
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Enhancing Written Communication in Persons With Aphasia: A Clinical Trial

Conditions
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Aphasia, Stroke

Intervention / Treatment
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* Behavioral: ORLA
* Behavioral: ORLA + Writing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: men or women with diagnosis of an aphasia subsequent to a left-hemisphere infarct(s) that is confirmed by CT scan or MRI an Aphasia Quotient score on the Western Aphasia Battery of 50-85. 6 months post injury premorbidly right handed, determined by Edinburgh Handedness Inventory completed at least an eighth grade education premorbidly literate in English visual acuity may be corrected but must be sufficient for reading visual stimuli on computer screen auditory acuity may be aided but must be sufficient for hearing auditory stimuli in ORLA program Exclusion Criteria: any other neurological condition (other than cerebral vascular disease) that could potentially affect cognition or speech, such as Parkinson's Disease, Alzheimer's Dementia, traumatic brain injury. any significant psychiatric history prior to the stroke, such as severe major depression or psychotic disorder requiring hospitalization; subjects with mood disorders who are currently stable on treatment will be considered. active substance abuse. -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: ORLA<br>Practice on ORLA (Oral Reading for Language in Aphasia), a computer-based virtual therapy system, for 90 minutes per day, 6 days per week for 6 weeks. | Behavioral: ORLA<br>* Practice on ORLA (Oral Reading for Language in Aphasia), a computer-based virtual therapy system.<br>|
| Experimental: ORLA + Writing<br>Practice on ORLA + writing computer program, 90 minutes per day, 6 days per week, for 6 weeks. | Behavioral: ORLA + Writing<br>* Treatment includes writing of sentences in combination with ORLA<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Writing Score on the Western Aphasia Battery-Revised (WAB-R) from pre-treatment to post-treatment |  | Change from baseline to 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) |  | Change from baseline to 6 weeks | 
| Written Language Sample Analysis | Written responses on the Picture Description task of the Western Aphasia Battery-Revised and on a written picture-sequenced story retelling task will be scored for Correct Information Units | Change from baseline to 6 weeks | 
| Communicative Effectiveness Index (CETI) |  | Change from baseline to 6 weeks | 
| ASHA Quality of Communication Life Scale (QCL) |  | Change from baseline to 6 weeks | 
| Community Integration Questionnaire (CIQ) |  | Change from baseline to 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aphasia, Stroke, Speech Rehabilitation