Clinical trial NCT05274360: Remote Neurobased Approach to Aphasia Therapy
Official title: Neuroscience-Based Aphasia Therapy Adapted to Remote, Mobile-Based Treatment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Aphasia, Broca
Aphasia, Wernicke
Aphasia, Fluent
Aphasia, Nonfluent
Aphasia
Lead sponsor: Institute for Bioengineering of Catalonia
Sponsor class: OTHER
Collaborators: name: Hospital Universitari Joan XXIII de Tarragona.
name: Universitat Pompeu Fabra
First posted: 2022-03-10
Enrollment: 15
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
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.
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Patients with any type of aphasia
* 6 or more months have passed since the stroke (chronic stage)
* Age between 18 and 90 years

Exclusion Criteria:

* Non-compliance with some of the inclusion criteria
* Presence of major perceptual, cognitive, motor, cognitive or neuropsychological pathology that can interfere with aphasia or make it difficult to interact with the system, including severe forms of motor impairments and apraxia, visual processing deficits, planning deficits, learning deficits, memory deficits, or attentional deficits
* Inability to understand the study participation
* Patients with an Android phone or tablet

Primary outcomes:
measure: Within-group changes of language function
timeFrame: This will be assessed one day before starting the treatment and at the end of the treatment protocol (after two weeks)
measure: Within-group changes of communication
timeFrame: This will be assessed one day before starting the treatment and at the end of the treatment protocol (after two weeks)
Secondary outcomes:
measure: Between-group change of language function
timeFrame: This will be assessed one day before starting the treatment and at the end of the treatment protocol (after two weeks)
measure: Between-group change of communication
timeFrame: This will be assessed one day before starting the treatment and at the end of the treatment protocol (after two weeks)
measure: Validation of usability of the technologies used
timeFrame: This will be assessed at the end of the treatment protocol (after two weeks) for the experimental group.
measure: Validation of usability, acceptability, and usefulness of the technologies used
timeFrame: This will be assessed at the end of the treatment protocol (after two weeks) for the experimental group.
measure: Amount and time of use
timeFrame: This will be measured continuously through the use of the application during the two weeks of use.
measure: Cues used per practice session
timeFrame: This will be measured continuously through the use of the application during the two weeks of use.
measure: Reaction time on tasks in the application
timeFrame: This will be measured continuously through the use of the application during the two weeks of use.
measure: Subjects' own validation score of voice recordings
timeFrame: This will be measured continuously through the use of the application during the two weeks of use.
measure: Risk assessment
timeFrame: This will be assessed at the end of the treatment protocol (after two weeks) for the experimental group.
Other outcomes:
Locations:
city: Barcelona
country: Spain
facility: Institute for Bioengineering of Catalonia - Specs Lab
Study officials:
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