Listen in: Developing and Testing a Therapy Application for Patients With Speech Comprehension Deficits After Stroke.

Study Overview
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Brief Summary
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The main aim is to develop and test the clinical efficacy of a novel, web based, rehabilitation application. Listen-In will provide an effective speech comprehension training tool that patients with aphasia can use to practice independently. This will free up therapists time to provide additional assessment, supervision and functional intervention in a highly cost effective manner.

Detailed Description
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The main aim is to develop and test the clinical efficacy of a novel, web based, rehabilitation application. Listen In will provide an effective speech comprehension training tool that patients can use to practice independently. This will free up SALT time to provide additional assessment, supervision and functional intervention in a highly cost effective manner. Phase 1 (24 months. London, Newcastle, Cambridge): Development of Listen In, including diagnostic and therapeutic components, driven by patient user's feedback (alpha and beta testing). The intervention is detailed below and is based on current SALT practice. It will be adaptive, provide feedback and target auditory perception at many levels: the phonemic, lexical and sentence level processing of heard verbal stimuli, as well as auditory short term memory and nonverbal sound discrimination. Phase 2 (12 months. London and Cambridge): A pilot, randomised, crossover, clinical trial of Listen-In in a group of aphasic patients in the chronic post-stroke period. A power calculation suggests that we will need 36 patents, 18 in each arm. The comparison will be standard SALT clinical care. The main outcome measure is a clinically relevant improvement on the comprehension of spoken language score of the Comprehensive Aphasia Test (Swinburn, 2004). Secondary outcomes include improvements in social activity and participation. The milestones for this phase will be: 50% recruitment into study and last patient, last visit. Phase 3 (funded outside i4i grant) will be the rollout of the therapy application on the internet with a pragmatic trial of whether therapy gains can be made outside the confines of a clinical trial. The comparison will be on similar outcome measures as Phase 2 with a control test on sustained attention (internal control) that we predict will not improve with therapy.

Official Title
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Listen-In: the Development and Testing of a Web-based Therapy Application for Patients With Impaired Speech Comprehension Caused by Stroke

Conditions
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Aphasia

Intervention / Treatment
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* Behavioral: Auditory comprehension therapy.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any type of stroke but greater than 6 months post onset evidence of receptive aphasia English as their main language able to give informed consent age 18 years or above no diagnosis of degenerative brain disease. Exclusion Criteria: Stroke less than 6 months post onset No evidence of receptive aphasia English not their main language Unable to give informed consent Less than 18 years old diagnosis of degenerative brain disease.

Ages Eligible for Study
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Minimum Age: 18 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: Non-Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: trial arm<br>100 hours of therapy. | Behavioral: Auditory comprehension therapy.<br>* 100 hours of Auditory comprehension therapy embedded within a computer game.<br>|
| No Intervention: Normal therapy arm<br>12 weeks of normal therapy. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in auditory comprehension on the comprehensive aphasia test. | Investigation of improvement on a functionally relevant area of a widely used test of aphasia. | Measured over 36 weeks (0,12,24,36) weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in functional communication | Using patient reported outcomes to look at functional communication changes. | Measured over 36 weeks (0,12,24,36) weeks | 
| Improvement in production of language | Investigation of improvement on a functionally relevant area of a widely used test of aphasia. | Measured over 36 weeks (0,12,24,36) weeks | 
| Performance on the Sustained attention to response task | Investigation of improvement on sustained attention using the SART. | Measured over 36 weeks (0,12,24,36) weeks | 
| Environmental sounds test | Investigation of improvement on the non verbal environmental sounds test. | Measured over 36 weeks (0,12,24,36) weeks | 
| Test of semantics | Investigation of improvement in semantics knowledge. | Measured over 36 weeks (0,12,24,36) weeks | 
| Improvement in written language comprehension | Investigation of improvement on a functionally relevant area of a widely used test of aphasia. | Measured over 36 weeks (0,12,24,36) weeks | 
| Improvement on auditory descrimination | Investigation of improvement on a test of auditory discrimination developed by Dr Holly Robson. | Measured over 36 weeks (0,12,24,36) weeks |