Centre for Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, UK.
Int J Lang Commun Disord. 2024 May-Jun;59(3):1090-1109. doi: 10.1111/1460-6984.12975. Epub 2023 Nov 15.
BACKGROUND: Stroke profoundly affects quality of life (QOL), including loss of employment, reduced social activity, shrinking social networks and low mood. Dysgraphia (impaired writing) is a common symptom of aphasia yet is rarely targeted in rehabilitation. Recent technological advances might challenge this, since much communication is now conducted digitally through writing. The rehabilitation of writing may therefore help to address the wider consequences of stroke and aphasia. AIMS: Can assistive technology (AT) training for people with dysgraphia: (1) improve written output, and are gains achieved only with AT? (2) improve reading comprehension scores, and are gains achieved only with AT? and (3) affect social participation, mood or QOL METHODS AND PROCEDURES: DESIGN: A mixed-methods, repeated measures, small group study design was adopted (qualitative outcomes will be reported elsewhere). PARTICIPANTS: Recruited from community settings, for example, Stroke Association communication support groups. INCLUSION CRITERIA: over 18 years old, aphasia due to stroke, acquired dysgraphia, writing more impaired than speech, fluent English prior to stroke, access to computer and Internet. EXCLUSION CRITERIA: currently receiving speech and language therapy, significant cognitive impairment, neuromuscular/motor-speech impairments/structural abnormalities, developmental dyslexia, uncorrected visual/auditory impairments. PROCEDURES: Screening and diagnostic assessments at time T1 (first baseline). Outcome measures at T1; repeated at T2 (second baseline), T3 (end of intervention), T4 (3-month follow up). Social participation assessment and cognitive monitoring at T2, T3, T4. INTERVENTION: Seven-ten hours individual therapy weekly and additional email support. Participants were trained to operate Dragon NaturallySpeaking (speech to text package) and ClaroRead (read writing aloud). Outcome measures were administered on pen and paper (control) and on computer, with AT enabled only at T3, T4. OUTCOMES AND RESULTS: Computer narrative writing was significantly improved by AT training (Friedman's χ (3) = 8.27, p = 0.041), indicating a compensatory effect of AT. Though reading comprehension significantly improved in the computer condition (Friedman's χ (3) = 21.07, p = 0.001), gains could not be attributed to the AT. Gains were achieved only when measures were administered on the keyboard, with AT enabled. Thus, a compensatory rather than remediatory effect was suggested. Social network size significantly increased; there were no significant changes in mood/QOL. Individual success rates varied. CONCLUSION AND IMPLICATIONS: The customisable AT training was acceptable to participants and resulted in significantly improved narrative writing. Compensatory AT interventions are a useful adjunct to remediatory writing interventions and may particularly support functional writing. WHAT THIS PAPER ADDS: What is already known on this subject Writing is rarely spared in aphasia and may present as the most impaired communication modality. Yet, people with aphasia report that writing is seldom included in their rehabilitation. Many communication activities are now conducted digitally through writing, therefore rehabilitation of this is more important than ever before. This study sought to address whether an assistive technology (AT) software package can improve writing and whether any changes were compensatory or remediatory. What this study adds to existing knowledge This group study found that AT training led to gains in written discourse and social network in people with aphasia and dysgraphia. Gains were not replicated in handwritten tasks, suggesting this was a compensatory therapeutic approach. What are the clinical implications of this work? AT programs such as this may present speech and language therapists with a practical, pragmatic adjunct to writing or typing therapy, particularly for clients with chronic, intractable impairments for whom remediatory therapy may have a low chance of success.
背景:中风会极大地影响生活质量(QOL),包括失业、社交活动减少、社交网络缩小和情绪低落。失写症(书写障碍)是失语症的常见症状,但在康复中很少受到关注。最近的技术进步可能会对此提出挑战,因为现在很多交流都是通过书写进行的。因此,书写康复可能有助于解决中风和失语症的更广泛后果。
目的:辅助技术(AT)训练能否:(1)改善书写输出,且仅在使用 AT 时才能获得改善?(2)提高阅读理解分数,且仅在使用 AT 时才能获得改善?以及(3)影响社会参与度、情绪或 QOL。
方法和程序:设计:采用混合方法、重复测量、小样本组研究设计(定性结果将在其他地方报告)。
参与者:从社区环境中招募,例如,中风协会的交流支持小组。
纳入标准:年龄在 18 岁以上,因中风导致失语症,获得性失写症,书写比口语更受损,中风前英语流利,能够使用计算机和互联网。
排除标准:目前正在接受言语和语言治疗,认知功能严重受损,神经肌肉/言语运动障碍/结构异常,发育性阅读障碍,未经矫正的视力/听力障碍。
程序:在 T1(首次基线)进行筛选和诊断评估。T1 时进行结果测量;在 T2(第二次基线)、T3(干预结束)、T4(3 个月随访)时重复测量。在 T2、T3、T4 时进行社会参与评估和认知监测。
干预措施:每周进行 7-10 小时的个体治疗和额外的电子邮件支持。参与者接受训练以操作 Dragon NaturallySpeaking(语音到文本包)和 ClaroRead(大声朗读书写内容)。结果测量在纸笔(对照)和计算机上进行,仅在 T3、T4 时启用 AT。
结果和结论:使用 AT 训练显著改善了计算机叙事写作(Friedman 的 χ (3) = 8.27,p = 0.041),表明 AT 具有代偿作用。虽然阅读理解在计算机条件下显著提高(Friedman 的 χ (3) = 21.07,p = 0.001),但增益不能归因于 AT。仅在启用 AT 时,在键盘上进行测量才能获得增益。因此,建议使用代偿而不是矫正的效果。社交网络规模显著增加;情绪/生活质量没有显著变化。个人成功率各不相同。
结论和意义:可定制的 AT 培训受到参与者的欢迎,并导致叙事写作显著改善。代偿性 AT 干预措施是矫正性写作干预措施的有用补充,可能特别支持功能性写作。
这篇论文增加了什么:在这个主题上已经知道的内容:书写在失语症中很少受到影响,可能是最受损的交流方式。然而,失语症患者报告说,书写很少被纳入他们的康复治疗中。现在许多交流活动都是通过书写进行的,因此康复书写比以往任何时候都更加重要。本研究旨在探讨辅助技术(AT)软件包是否可以改善失语症和失写症患者的写作能力,以及任何变化是代偿性的还是矫正性的。这篇论文对现有知识有何补充:这项小组研究发现,AT 训练可使失语症和失写症患者的书面话语和社交网络得到改善。在手写任务中没有复制这些增益,这表明这是一种代偿性的治疗方法。这对临床工作有何影响:这样的 AT 计划可能为言语和语言治疗师提供一种实用、实用的写作或打字治疗的辅助方法,特别是对于那些慢性、顽固性障碍患者,对于这些患者,矫正治疗的成功率可能较低。
Int J Lang Commun Disord. 2024
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