Researchers from Texas A&M University-Kingsville, the Medical Center at Vanderbilt University, and Lingraphica recently published a study on practice vs. success patterns in persons with aphasia & co-occurring apraxia of speech (PwA-AOS) when working autonomously with computerized therapy materials on single-word production. The goals were to examine: (a) treatment fidelity/adherence to clinician instructions; (b) patterns of word-utterance success vs. failure vs. observation during autonomous practice; and (c) carry-over to word production success post-practice.

Four PwA-AOS independently practiced single-word production after stimulation via user-initiated interface interactions in three conditions: Condition I – auditory stimuli with static representational drawings; Condition II – auditory stimuli with synchronized articulation videos; and Condition III – users’ choice between the two prior conditions. Clinicians gave initial instructions to subjects, who could then practice autonomously for up to five minutes before attempting the target word without therapeutic support. Sessions were video-recorded for subsequent analysis, which supported the elaboration of emergently refined behavioral taxonomies via an iterative mixed-methods approach.

Analysis of collected data reveals that—in independent practice—subjects only sometimes adhered to clinician instructions; other times improvising their own novel practice activities. These latter sometimes co-occurred with successful productions. Differences in success rates were noted between Conditions I and II across both behaviors and success rates, with articulation videos more frequently associated with treatment fidelity and utterance success. In Condition III, participants tended to choose videos, i.e., the stimulus condition that resulted in better overall performance.

The authors conclude that during independent practice with technology: [1] PwA-AOS do not necessarily comply with clinicians’ practice instructions; [2] treatment fidelity appears only weakly correlated with success or failure; and [3] stimulus types and interaction designs in human-computer user interfaces affect use patterns as well as success patterns. Follow-on studies are indicated, both to advance therapeutic technology designs and to improve clinical applications.

For further reading:  A.L. Ball, M. de Riesthal, & R.D. Steele, 2018. Exploring treatment fidelity in persons with aphasia autonomously practicing with computerized therapy materials. American Journal of Speech-Language Pathology, 27:454–463. 

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