Efficacy of Language Games as Therapy for Post-Stroke Aphasia - PowerPoint PPT Presentation

Efficacy of Language Games as Therapy for Post-Stroke Aphasia Louise Lander Moor Green Outpatient Brain Injury Unit- Birmingham Community Healthcare NHS Foundation Trust

 A novel, clinically relevant intervention  Collaboration between public healthcare provider and universities  Funded by the National Institute for Health Research Dr Andrew Olson Dr Cristina Romani Samantha Tyler Iman Idrees Louise Lander

The context:  Rising demand for healthcare, with limited resources  An urgent need for new and productive ways of delivering aphasia therapy  Focus on word-retrieval: an extremely common and distressing symptom, which is extensively treated with cued picture-naming therapies (eg Wisenburn & Mahony, 2009) Word retrieval therapy: We used: • • Clinically effective Impairment based cued word- • at impairment and functional levels retrieval • deliver improvement in quality of life, reduce social isolation • • Cost effective Group therapy • delivered efficiently to enable increased intensity • • Acceptable to patients A game mode • be motivating and engaging

Design: Language game therapy  Charade-like games  Picture cards: 90 nouns 90 verbs  3 matched word groups for 3 games  Game P- phonemic cueing  Game G- phonemic+gesture cueing  Game S- phonemic+semantic cueing  Each game played for 18 hours over 2 weeks  Two teams of 3 patients, with mod-severe, expressive chronic aphasia

Assessment  Assessment specific to game therapy:  Picture-naming of 180 treated words  Description of 9 pictured scenarios  Assessment of general language function:  Comprehensive Aphasia Test  Boston Naming Test  Cinderella Story Re-tell  Subjective assessment:  Participant Satisfaction Questionnaire

Picture naming: Gains by treatment order Group scores for each word set 60 Interaction between word set and game type: 50 p<0.001 40 Word set P Percent correct Word set G 30 Word set S 20 10 0 Time 1 Time 2-After Time 3-After Time 4-After Time 5-After Game P Game G Game S standard therapy Treatment order

Scenario description: Gains by treatment order Group scores for each word set 35 Interaction between word set 30 and game type: p<0.001 Percent targets achieved 25 20 Word set P Word set G 15 Word set S 10 5 0 Time 1 Time 2- after Time 3- after Time 4- after Time 5- after game P game G game S standard therapy Treatment order

Picture naming: Gains by participants Participant data combined across game type 90 Main effect of therapy phase: 80 p<0.001 70 60 Percent correct P1 50 P2 P3 40 P4 P5 30 P6 20 mean 10 0 Baseline After game Maintenance After standard therapy therapy Therapy phase

Scenario description: Gains by participants Participant data combined across game type 50 Main effect of 45 therapy phase: 40 p<0.001 Percent targets achieved 35 P1 30 P2 25 P3 P4 20 P5 15 P6 10 mean 5 0 Baseline After game Maintenance After standard therapy therapy Therapy phase

Summary of all language testing 120 % change in average score * 100 * * 80 60 * 40 20 0

Participant satisfaction with therapy 40 Example statements: 35 Standard therapy -The therapy improved Game therapy 30 my talking Number of responses -The therapy was suited 25 to me 20 -The therapy helped me achieve my goals 15 -I am satisfied with the therapy 10 -I did not get tired 5 0 Strongly Disagree Neither Agree Strongly disagree agree nor agree disagree

Summary  Picture-naming score almost doubled: sits favourably with other studies (eg Ramsberger & Marie 2007, Rider et al 2008, Best et al 2013, Raymer et al 2006)  This therapy is distinguished from others in that it is delivered intensively and efficiently to a group in a game format  The improvements were largely item-specific, similar for types of cueing  Gains were largely long-lasting and generalised to a connected speech context  This supports the validity of our game therapy for improving word- retrieval in connected speech.  Some participants improved content of unsupported narrative.  It was clinically effective, cost effective and had strong patient acceptability

References Best, W., Greenwood, A., Grassly, J., Herbert, R., Hickin, J. & Howard, D. 2013, "Aphasia rehabilitation: does generalisation from anomia therapy occur and is it predictable? A case series study.", Cortex, vol. 49, no. 9, pp. 2345-2357. Carragher, M., Conroy, P., Sage, K. & Wilkinson, R. 2012, "Can impairment-focused therapy change the everyday conversations of people with aphasia? A review of the literature and future directions", Aphasiology, vol. 26, no. 7, pp. 895-916. Conroy, P., Sage, K. & Lambon Ralph, M. 2009a, "The effects of decreasing and increasing cue therapy on improving naming speed and accuracy for verbs and nouns in aphasia", Aphasiology, vol. 23, no. 6, pp. 707-730. Conroy, P., Sage, K. & Lambon Ralph, M. 2009b, "Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalize to connected speech?.", International Journal of Language & Communication Disorders, vol. 44, no. 6, pp. 1036-1062. Enderby, P., Pickstone, C., John, A., Fryer, K., Cantrell, A. & Papaioannou, D. 2009, "Resource manual for commissioning and planning services for SLCN", . Lanyon, L.E., Rose, M.L. & Worrall, L. 2013, "The efficacy of outpatient and community- based aphasia group interventions: a systematic review", International Journal of Speechlanguage Pathology, vol. 15, no. 4, pp. 359-374. McKevitt, C., Fudge, N., Redfern, J., Sheldenkar, A., Crichton, S., Rudd, A., Forster, A., Young, J., Nazareth, I., Silver, L., Rothwell, P. & Wolfe, C. 2011, "Self-reported long-term needs after stroke", Stroke, vol. 42, pp. 1398-1403.

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