Kurland Jacquie, Liu Anna, Stokes Polly
Department of Communication Disorders, University of Massachusetts Amherst.
Department of Mathematics and Statistics, University of Massachusetts Amherst.
J Speech Lang Hear Res. 2018 May 17;61(5):1140-1156. doi: 10.1044/2018_JSLHR-L-17-0277.
The aim of this study was to determine if a tablet-based home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia.
In a pre-post group study of home practice outcomes, 21 individuals with chronic aphasia were examined before and after a 6-month home practice phase and again at follow-up 4 months later. The main outcome measure studied was change in naming previously treated or untreated, practiced or unpracticed pictures of objects and actions. Individualized home practice programs were created in iBooks Author with semantic, phonemic, and orthographic cueing in pictures, words, and videos in order to facilitate naming of previously treated or untreated pictures.
Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements.
Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.
本研究旨在确定一个基于平板电脑的家庭练习计划，辅以每周的远程练习支持，是否能够使中风后失语症患者长期维持近期治疗所取得的成效，并促进新的语言能力提升。
在一项关于家庭练习结果的前后对照分组研究中，对21名慢性失语症患者在为期6个月的家庭练习阶段前后进行了检查，并在4个月后的随访中再次进行检查。所研究的主要结果指标是对之前接受过治疗或未接受过治疗、练习过或未练习过的物体和动作图片进行命名的变化。使用iBooks Author创建个性化的家庭练习计划，在图片、单词和视频中提供语义、音素和正字法提示，以促进对之前接受过治疗或未接受过治疗的图片进行命名。
家庭练习对所有参与者均有效，失语症严重程度会调节治疗效果，即失语症最严重的个体取得并维持的进展较少。熟练使用iPad所需的训练量与练习过和未练习过的图片的改善情况之间呈负相关，而练习依从性与同样的改善情况之间呈正相关。
在每周视频电话会议支持下的无监督家庭练习是有效的。本研究表明，即使是慢性重度失语症患者，包括那些之前没有智能设备甚至计算机使用经验的患者，在治疗结束后也能够获得独立操作能力，继续练习并提高他们的语言技能。这对于没有保险覆盖和/或行动不便而无法获得传统失语症治疗的个体而言，可能是一种低成本的治疗选择。
