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Speaking of Technology

Jan 29, 2016 | by Lingraphica

By Jon Caswell, Stroke Connection Magazine

Jan. 2016

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In the past two decades, we’ve seen an enormous surge in technology designed to support almost every aspect of our day-today lives. Now, more than ever, it is becoming an integral part of speech-language therapy. And because of limitations to insurance coverage for speech therapy, its importance is likely to increase.

How Technology Supports Speech-Language Therapy

Carol Persad, Ph.D. is a neuropsychologist and director of the University Center for Language and Literacy at the University of Michigan. Keli Licata, MS, CCC-SLP is a speech and language pathologist (SLP) in the university’s Aphasia Program (UMAP), which is part of the Center for Language and Literacy. Persad and Licata emphasized this about technology: In no way does it replace the need for a speech-language therapist.

But that doesn’t mean it’s not a necessary and valuable part of speech therapy for survivors.

“Tech tools can be used in therapy . . . or to supplement therapy as part of a home program designed and monitored by an SLP,” Licata said. They can also be used as assistive devices for a survivor when communicating with others.

Computer programs have long been part of speech-language therapy. But today’s portable and handheld devices — laptops, smartphones and tablet computers — allow survivors to venture beyond the boundaries of the rehab setting.

Having the ability to practice outside of the therapy session is key to recovery.

SLPs customize therapy by incorporating applications and web-based materials to target specific goals. For example, tablets are a good supplement to workbooks, picture cards, newspapers and hard copy books. Apps can be more practical than workbooks, because there are more options available for practice and exercises can be repeated easily. Computerized therapy usually provides feedback on the survivor’s performance, which can increase self-confidence.

“You can also store audio/video files of the therapist producing a certain set of words or phrases so they can practice at home,” Licata said.

The ability to incorporate things from the Internet and sites like YouTube is “something that is very important for maintaining motivation and engagement in therapy,” Licata said. For instance, developing picture dictionaries that include actual photos of family, friends, objects and realistic situations. These are common tools that are personally meaningful and useful for the survivor in therapy as well as in other environments.

“It is important that all clinicians learn how to incorporate technology into their daily practice to maximize motivation and potential for success,” Persad said. “Researchers at UMAP and other programs have demonstrated that intensive therapy is key to better recovery in people with aphasia, and technology can help us provide that intensity.”

Research shows that a minimum of nine hours of speech and language therapy is needed. But this often doesn’t happen due to limited resources and insurance constraints. Technology, directed by a speech therapist, is a great way to help survivors get additional hours.

How Technology Supports Independence

“Smartphones and tablet computers such as the iPad are very popular, and we have found them to be extremely beneficial and practical for many survivors,” Licata said. They’re small and light-weight compared to devices designed specifically to assist with communication and nothing else. This makes them easier to carry for those with physical limitations.

“These tools are used by many different people for many different reasons, and our survivors feel they stand out less in a crowd when using one,” Licata said.

There is a wide variety of useful applications (apps), with new ones becoming available all the time. The use of features on smartphones such as calendars, notes, reminders and alarms can be very helpful to people with language and other cognitive deficits.

Because the devices are portable, they can be used in many different settings. “That promotes independence and increased participation in daily activities, in line with the Life Participation Approach to Aphasia.”

How Technology Supports Communication and Quality of Life

“We encourage survivors and caregivers to use any means possible to communicate with each other — speech whenever possible, but also writing, drawing, gesturing, referencing family photos, maps, picture dictionaries, personalized communication books and other things,” Licata said.

On their smartphones or tablets, survivors can store family photos or access personal emails, texts and Facebook.

Text-to-speech features are available on Kindle and Apple devices. Similar apps can also be found for Android devices. These features may help with reading comprehension. They highlight the text as it is read aloud, and the reading rate can be controlled by the user.

Survivors can access Google, including Google maps and images, and store links to frequently referenced pages.

This type of information can help survivors communicate where they are going or where they live. This can be particularly important in an emergency situation.

Apps like the Oxford Picture Dictionary let people click on a picture or word and hear the word pronounced. This can help them improve naming and listening skills as well as convey a message to others.

If survivors write or draw to communicate, they can get a sketch-pad app for writing and drawing with their finger on the screen of their tablet or computer. This allows them to save a writing or drawing that may be helpful later and eliminates the need to always have paper and pencil on hand.

Some apps assist with self-cueing, which increases independence. For example, an app called Lingraphica SmallTalk Phonemes plays the first sound of a word along with a video of someone producing that sound. For some people with aphasia, hearing the initial sound can help them say the rest of the word. “The nice thing is the app gives the cue instead of relying on a person, who may not know what word they want to say,” Licata said. “This is a good example of a strategy [used] in therapy and the app allowing that person to use the strategy outside the clinic.”

Using word prediction software or dictation software to help with writing can also be very helpful, as are features such as spell check. Apps like Touchchat use pictures, symbols and texts that the survivor can use to construct a message.

“Often, if a person has difficulty with producing or comprehending speech and language, he or she may also have difficulty with reading and writing,” Licata said. “That’s where having a program with pictures and symbols can be really important, because they can look on the screen and find a picture of what they want to say.” Some programs will even output directly to email and text.

How Technology Supports Socialization 

Often survivors with aphasia become socially isolated because they can’t communicate easily. This can lead to depression, anxiety and stress, as well as an overall decrease in quality of life. Technology can help open doors for people with aphasia and help them re-integrate into their lives. Programs such as Skype and FaceTime are easier than using the phone because it allows people with aphasia to use facial expressions and gestures to get their message across.

Online communities are great ways to find support and keep in touch with family and friends. The American Heart Association/ American Stroke Association’s Support Network is a great way to connect with others. It’s a private, monitored community. You can sign up for free and become part of our group specifically for survivors with aphasia and their caregivers.

Popular social networks like Pinterest, Instagram and Facebook may also have supportive communities for sharing resources with other people with aphasia. One example is the Aphasia Recovery Connection on Facebook, where people with aphasia share resources and support, have video conferences and organize gatherings.

Email and texting are commonplace these days. Shorter messages can provide a good communication format that may be less anxiety provoking for people with aphasia than longer formats. We mentioned some tools earlier in this article that assist with writing. Those tools can help people with aphasia communicate this way.

Technologies that assist with reading help survivors enjoy books and news articles. This allows the survivor to keep up with current events and communicate with others about how they feel about them.

How Technology Supports Caregivers and Families

There are online resources about aphasia and related conditions that can help caregivers, family members and friends better understand the challenges of aphasia. Technology can be used to enable supportive conversation between survivors and loved ones. And importantly, family members can find support from others living with someone with aphasia; they can share their stories and get advice through the AHA/ASA Support Network, blogs, Facebook and other social media.

Technology can help survivors with aphasia lead a more productive and happy life. “Seeing survivors leave our program not only able to communicate better but having a greater sense of self-confidence to live life to its fullest is exceptionally rewarding, and technology helps us achieve that goal,” Persad said.

Todd Lillie

This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Stroke Association.

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