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• Individuals with language and cognitive deficits following brain damage
likely require long-term rehabilitation. Consequently, it is a huge
practical problem to provide the continued communication therapy
that these individuals require.
• Several studies have examined computerized rehabilitation with small
numbers of aphasiac participants, providing promising preliminary
results for the use of technology in the rehabilitation (Doesborgh et al.,
2004, Fink et al., 2002, Palmer et al., 2012, Pedersen et al., 2001,
Ramsberger and Marie, 2007).
• More recently, the advent of tablet based devices, such as the iPad,
has proved to be promising for rehabilitation (Holland, 2014; Hoover
and Carney, 2014; Kiran et al., 2014; Kurland, 2014; Kurland et al.,
2014; Ramsberger and Messamer, 2014; Szabo and Dittelman, 2014).
• Kurland et al. noted there was often a need for the software to
increase in task difficulty when their participants showed
improvement, demonstrating the need of tailored therapy for
individuals (Kurland et al., 2014).
Introduction
Objectives
Fifty-one individuals with aphasia due to a stroke or traumatic brain injury
were recruited to use an iPad-based software platform, Constant Therapy
(www.constanttherapy.com), for a 10 week treatment program.
Each participant was tested before and after therapy on: Revised-Western
Aphasia Battery, Boston Naming Test, Pyramids and Palm Trees, and
Cognitive Linguistic Quick Test.
Participants
1. Usage data and duration of treatment, 2. participants’ changes on
standardized measures, 3. task effectiveness, 4. individual participant
performance in treatment, 5. co-improvement between tasks.
1. The experimental and control groups did not differ in terms of dosage,
or in terms of percent of compliance out of the ideal time, but
experimental participants completed overall more time than control
participants.
2. Experimental participants showed more significant and positive
changes in their standardized tests than control participants. This
shows that more practice resulted in greater gains in standardized
measures.
3. While both groups showed improvement, experimental participants
showed more changes than control participants when examining just
assisted or both types of sessions.
4. The changes in experimental participants were possibly driven by
language and cognitive standardized measures scores, showing effects
such as tasks where participants with lower R-WAB AQ scores improve
on simpler language tasks. While this may seem obvious, it is
important to show that impairment-based therapy can show benefits.
1. Six tasks show effects where participants with high CLQT
Composite Severity scores and participants with low R-WAB
AQ scores both showed improvement.
2. Five tasks show effects where participants with low CLQT
Composite Severity Scores and participants with high R-WAB
AQ scores both showed improvement.
5. When examining how participants improve on tasks when assigned
together throughout the treatment, several groupings of task co-
improvement appear: reading and naming tasks, arithmetic and
quantitative reasoning tasks, and language and cognitive tasks
(including, memory tasks that use linguistic stimuli with reading and
naming tasks).
These results provide preliminary but important evidence that systematic,
structured, tablet-based and individualized therapy can be provided to
patients.
Selected References
Kurland, J., Wilkins, A.R., and Stokes, P. (2014). iPractice: Piloting the Effectiveness of a
Tablet-Based Home Practice Program in Aphasia Treatment. Seminars in Speech and Language
35, 51-64.
Kiran, S., Des Roches, C., Balachandran, I., and Ascenso, E. (2014). Development of an
Impairment-Based Individualized Treatment Workflow Using an iPad-Based Software Platform.
Seminars in Speech and Language 35, 38-50.
Acknowledgements and Disclosure
Funding for this project from Wallace Coulter Foundation for Translation Research.
Disclosure: SK owns equity in Constant Therapy and serves as the Chair of the Scientific
Advisory Board for Constant Therapy. CD, IB, and EA each own a portion of the stock
equity that BU owns.
In the present project, a large scale preliminary clinical efficacy study was
conducted to examine language and cognitive rehabilitation outcomes in
patients who received continuous, personalized, and self-paced
rehabilitation language and cognitive program using a structured iPad-
based therapy program.
Carrie Des Roches1, Isabel Balachandran1, Elsa Ascenso1, Yorghos Tripodis2, Swathi Kiran1
1 Department of Speech, Language, and Hearing Sciences, Boston University, 2 Department of Biostatistics, School of Public Health, Boston University
Effectiveness of an impairment-based individualized treatment program using an iPad-based software platform
Research Questions
1. Can an iPad-based treatment program be provided in a standardized
but individualized manner. If so, what does treatment dosage and
treatment compliance look like?
2. What is the effect of the treatment on standardized measures and is it
different between the control and experimental groups?
3. Are the individualized therapy tasks for language and cognitive
therapy effective for improving overall language and cognitive
performance?
4. What are profiles of individual responsiveness to treatment?
5. What is the nature of between-task co-improvement across different
therapy tasks across participants?
Intervention
1. Dosage and compliance.
Domain Task DF EXP
ERIM
ENTA
L
Co
nd
itio
nal
Imp
rove
men
t
CO
NTR
OL
Co
nd
itio
nal
Imp
rove
men
t
Dif
fere
nce
in
imp
rove
men
t
bet
wee
n g
rou
ps
DF EXP
ERIM
ENTA
L
Co
nd
itio
nal
Imp
rove
men
t
CO
NTR
OL
Co
nd
itio
nal
Imp
rove
men
t
Dif
fere
nce
in
imp
rove
men
t
bet
wee
n g
rou
ps
Category Matching 90 90
Feature Matching 68 71
Naming Picture 99 109
Rhyming 110 110
Sound Identification 103 103
Syllable Identification 65 65
Category Identification 30 30
Letter to Sound Matching 66 66
Sound to Letter Matching 76 76
Reading Passage 65 65
Long Reading Comprehension 14 14
Word Identification 57 57
Word Copy 16 16
Word Copy Completion
Word Spelling 61 61
Word Spelling Completion 48 48
Picture Spelling 46 46
Picture Spelling Completion
Active Sentence Completion
Passive Sentence Completion
Voice Mail 22 22
Sound Matching 75 75
Picture Matching 80 80
Word Matching 66 66
Clock Reading 37 38
Symbol Matching 63 63
Response InhibitionFlanker
Map Reading 74 74
Picture Ordering 40 40
Word Ordering 6 6
Addition 88 88
Subtraction 50 50
Multiplication 47 47
Division 24 24
Clock Math 28 30
Word Problem 36 36
Executive Skills Instruction Sequencing 30 30
Not enough data to be analyzed
Analytical
Reasoning
Arithmetic
Quantitative
Reasoning
Sentence Planning
Not enough data to be analyzed
Not enough data to be analyzed
Auditory Memory
Visuospatial
Memory
Visual Processing
Accuracy Latency
Naming
Reading
Writing
Not enough data to be analyzed
Not enough data to be analyzed
Domain Task DF Co
nd
itio
nal
Imp
rove
men
t
Effe
ct o
f R
-WA
B
AQ
Effe
ct o
f C
LQT
Co
mp
osi
te
Seve
rity
DF Co
nd
itio
nal
Imp
rove
men
t
Effe
ct o
f R
-WA
B
AQ
Effe
ct o
f C
LQT
Co
mp
osi
te
Seve
rity
Category Matching 1018 1019
Feature Matching 388 393
Naming Picture 392 433
Rhyming 1043 1044
Sound Identification 849 849
Syllable Identification 393 393
Category Identification 721 722
Letter to Sound Matching 593 597
Sound to Letter Matching 690 691
Reading Passage 771 771
Long Reading Comprehension 130 131
Word Identification 647 647
Word Copy 361 361
Word Copy Completion
Word Spelling 503 504
Word Spelling Completion 348 349
Picture Spelling 313 313
Picture Spelling Completion
Active Sentence Completion
Passive Sentence Completion
Voice Mail 138 138
Sound Matching 403 404
Picture Matching 728 728
Word Matching 631 631
Clock Reading 277 279
Symbol Matching 531 532
Response Inhibition Flanker
Map Reading 504 504
Picture Ordering 297 297
Word Ordering 53 53
Addition 638 643
Subtraction 513 517
Multiplication 378 382
Division 246 246
Clock Math 143 143
Word Problem 225 225
Executive Skills Instruction Sequencing 108 109
Not enough data to be analyzed
Analytical Reasoning
Arithmetic
Quantitative Reasoning
Sentence Planning
Not enough data to be analyzed
Not enough data to be analyzed
Auditory Memory
Visuospatial Memory
Visual Processing
Accuracy Latency
Naming
Reading
Writing
Not enough data to be analyzed
Not enough data to be analyzed
Results (continued)
Re
spo
nse
Inh
ibit
ion
Exe
cuti
ve S
kill
s
Category Matching 100% 0% 50% 0% 100% 100% 100% 100%
Feature Matching 100% 100% 100% 100% 100% 100% 100%
Naming Picture 100% 33% 67% 100% 0%
Rhyming 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Sound Identification 100% 100% 100% 100% 0% 100% 0% 0% 50% 100% 100% 0% 100% 0% 50% 100% 100% 100% 100%
Syllable Identification 100% 100% 100% 50% 0% 0% 100% 50% 100% 100% 50% 100% 50%
Category Identification 100% 100% 100% 0% 0% 0% 100% 50% 100% 100% 100% 100%
Letter to Sound Matching 0% 100% 50% 0% 0% 100% 0% 100% 33% 0% 0%
Sound to Letter Matching 0% 0% 0% 0% 50% 100% 0% 100% 0% 0% 0% 50%
Reading Passage 100% 100% 100% 100% 100% 100% 100% 100%
Long Reading Comprehension 0% 0% 0% 0% 0% 100% 100% 100% 100% 100%
Word Identification 100% 100% 100% 100% 100% 100% 0% 100%
Word Copy 0% 0% 100% 0%
Word Copy Completion
Word Spelling 100% 100% 100% 100% 100% 100% 0% 100% 100%
Word Spelling Completion 50% 50% 100% 50% 100% 100% 100% 100% 100%
Picture Spelling 100% 100% 100% 0% 100% 100% 0% 50% 100% 100% 100%
Picture Spelling Completion
Active Sentence Completion
Passive Sentence Completion
Voice Mail
Sound Matching 100% 33% 100% 100% 100% 100% 100% 0% 50% 50% 100% 100%
Picture Matching 100% 100% 100% 100% 100% 100% 100%
Word Matching 100% 67% 100% 0% 50% 0% 0% 100% 0% 100% 100% 50% 0% 100% 100%
Clock Reading 50% 100% 100% 100% 100% 100% 33% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100%
Symbol Matching 0% 100% 0% 0% 0% 100% 100% 100% 100%
Response
Inhibition Flanker
Map Reading 0% 50% 50% 50% 0% 100% 50% 50% 100% 0%
Picture Ordering 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Word Ordering 0% 0% 0%
Addition 100% 100% 100% 0% 0% 100% 100% 0% 100% 100% 100% 0% 100% 100% 100% 100% 100%
Subtraction 100% 100% 0% 100% 100% 100% 100% 100% 100%
Multiplication 100% 100% 50% 100% 100% 100% 100% 100% 100%
Division 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100%
Clock Math 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Word Problem 100% 100% 100% 100% 100% 100% 100% 100% 100%
Executive Skills Instruction Sequencing 100% 100% 100% 100% 100%
Accuracy
Numerator: beneficial significant changes, Denominator:
All significant changes, positive and negative
Ari
thm
eti
c
Qu
anti
tati
ve
Re
aso
nin
g
Language Tasks Cognitive Tasks
Nam
ing
Re
adin
g
Wri
tin
g
Sen
ten
ce P
lan
nin
g
Au
dit
ory
Me
mo
ry
Vis
uo
spat
ial
Me
mo
ry
Vis
ual
Pro
cess
ing
An
alyt
ical
Re
aso
nin
g
Pas
sive
Sen
ten
ce
Co
mp
leti
on
Sou
nd
to
Let
ter
Mat
chin
g
Rea
din
g P
assa
ge
Lon
g R
ead
ing
Co
mp
reh
ensi
on
Wo
rd Id
enti
fica
tio
n
Wo
rd C
op
y
Wo
rd C
op
y C
om
ple
tio
n
Wo
rd S
pel
ling
Wo
rd S
pel
ling
Co
mp
leti
on
Pic
ture
Sp
ellin
g
Pic
ture
Sp
ellin
g
Co
mp
leti
on
Act
ive
Sen
ten
ce
Co
mp
leti
on
Sub
trac
tio
n
Vo
ice
Mai
l
Sou
nd
Mat
chin
g
Pic
ture
Mat
chin
g
Wo
rd M
atch
ing
Clo
ck R
ead
ing
Sym
bo
l Mat
chin
g
Flan
ker
Map
Rea
din
g
Pic
ture
Ord
erin
g
Wo
rd O
rder
ing
Ad
dit
ion
Language
Tasks
Naming
Reading
Writing
Sentence
Planning
Mu
ltip
licat
ion
Div
isio
n
Clo
ck M
ath
Wo
rd P
rob
lem
Inst
ruct
ion
Seq
uen
cin
g
Cognitive
Tasks
Auditory
Memory
Visuospatial
Memory
Visual
Processing
Analytical
Reasoning
Arithmetic
Quantitative
Reasoning
Cat
ego
ry M
atch
ing
Lett
er t
o S
ou
nd
Mat
chin
g
Cat
ego
ry Id
enti
fica
tio
n
Sylla
ble
Iden
tifi
cati
on
Sou
nd
Iden
tifi
cati
on
Rh
ymin
g
Nam
ing
Pic
ture
Feat
ure
Mat
chin
g
Re
spo
nse
Inh
ibit
ion
Exe
cuti
ve S
kill
s
Category Matching 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100%
Feature Matching 0% 100% 100% 100% 0% 100% 0% 100% 100% 100% 100% 100%
Naming Picture 50% 100% 100% 0% 100% 100% 100% 67% 100% 100% 100% 100% 100% 100%
Rhyming 50% 100% 100% 0% 100% 100% 0% 100% 100% 100% 100%
Sound Identification 100% 0% 100% 100% 100% 100% 50% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 100% 100%
Syllable Identification 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0%
Category Identification 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 0% 100% 100%
Letter to Sound Matching 100% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100%
Sound to Letter Matching 100% 0% 50% 100% 100% 100% 0% 0% 100% 0% 50% 100% 100% 50% 100%
Reading Passage 100% 100% 100% 100% 100% 100% 100% 100%
Long Reading Comprehension 100% 100% 100% 100% 100% 100% 0% 100% 100%
Word Identification 0% 0% 0% 100% 0% 100% 0% 50%
Word Copy 0% 100% 0% 100% 100% 0% 0% 100% 100% 100% 100% 100% 100%
Word Copy Completion 100% 100%
Word Spelling 100% 100% 0% 100% 100% 50% 0% 50% 100% 100% 0%
Word Spelling Completion 0% 0% 100% 50% 100%
Picture Spelling 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100%
Picture Spelling Completion 100% 100% 100% 100%
Active Sentence Completion
Passive Sentence Completion
Voice Mail 100% 100% 100% 100% 100% 0% 100% 100% 100%
Sound Matching 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100%
Picture Matching 100% 100% 100% 100% 100% 100% 100% 0% 100% 50% 100% 100% 100% 100% 100% 100% 100%
Word Matching 100% 67% 0% 100% 100% 100% 0% 100% 100% 100% 100% 100% 50% 100%
Clock Reading 100% 100% 100% 50% 0% 100% 100% 100% 100% 100% 100% 100% 100%
Symbol Matching 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100%
Response Inhibition Flanker
Map Reading 100% 100% 100% 0% 100% 0% 50% 50% 0% 100% 100% 100% 100% 100% 100% 100%
Picture Ordering 100% 100% 100% 100% 100% 0% 100% 100% 100% 100%
Word Ordering 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Addition 100% 100% 100% 67% 100% 100% 100% 100% 0% 100% 100% 50% 100% 100% 100% 100% 100% 50% 100% 75% 100% 100% 100% 100% 100% 100% 100%
Subtraction 100% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Multiplication 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Division 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Clock Math
Word Problem 100% 100% 100% 0% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Executive Skills Instruction Sequencing 100% 100% 100%
Numerator: beneficial significant changes, Denominator: All
significant changes, positive and negative
Latency Language Tasks Cognitive Tasks
Nam
ing
Re
adin
g
Wri
tin
g
Sen
ten
ce P
lan
nin
g
Au
dit
ory
Me
mo
ry
Vis
uo
spat
ial M
em
ory
Vis
ual
Pro
cess
ing
An
alyt
ical
Re
aso
nin
g
Ari
thm
eti
c
Qu
anti
tati
ve
Re
aso
nin
g
Cat
ego
ry M
atch
ing
Feat
ure
Mat
chin
g
Nam
ing
Pic
ture
Rh
ymin
g
Sou
nd
Iden
tifi
cati
on
Sylla
ble
Iden
tifi
cati
on
Cat
ego
ry Id
enti
fica
tio
n
Lett
er t
o S
ou
nd
Mat
chin
g
Pas
sive
Sen
ten
ce
Co
mp
leti
on
Sou
nd
to
Let
ter
Mat
chin
g
Rea
din
g P
assa
ge
Lon
g R
ead
ing
Co
mp
reh
ensi
on
Wo
rd Id
enti
fica
tio
n
Wo
rd C
op
y
Wo
rd C
op
y C
om
ple
tio
n
Wo
rd S
pel
ling
Wo
rd S
pel
ling
Co
mp
leti
on
Pic
ture
Sp
ellin
g
Pic
ture
Sp
ellin
g
Co
mp
leti
on
Act
ive
Sen
ten
ce
Co
mp
leti
on
Sub
trac
tio
n
Vo
ice
Mai
l
Sou
nd
Mat
chin
g
Pic
ture
Mat
chin
g
Wo
rd M
atch
ing
Clo
ck R
ead
ing
Sym
bo
l Mat
chin
g
Flan
ker
Map
Rea
din
g
Pic
ture
Ord
erin
g
Wo
rd O
rder
ing
Ad
dit
ion
Language
Tasks
Naming
Reading
Writing
Sentence Planning
Mu
ltip
licat
ion
Div
isio
n
Clo
ck M
ath
Wo
rd P
rob
lem
Inst
ruct
ion
Seq
uen
cin
g
Cognitive
Tasks
Auditory Memory
Visuospatial Memory
Visual Processing
Analytical Reasoning
Arithmetic
Quantitative Reasoning
3-4. Mixed model regression for each task (across patients, collapsing
levels) using log odd of accuracy or latency as the dependent measure. Calculated contrast effect: what is the rate of change per session
• Green- rate of change per session is significantly positive
• Red- red of change per session is significantly negative
Taking into account the effect of R-WAB AQ or CLQT Composite Severity on
treatment outcomes
• Light blue: participants with a low score show more improvement in the task
• Dark blue: participants with a high score show more improvement in the task
5. Accuracy co-improvement table of beneficial and significant slope
values.
2. Changes on standardized measures.
Conclusions
5. Latency co-improvement table of beneficial and significant slope
values.
Results
Thirty-seven treatment tasks were
developed based on a review of
evidence based treatment
recommendations from various
sources, including Speechbite
(http://speechbite.com/), PubMed
(National Center for Biotechnology
Information, U.S. National Library
of Medicine, Bethesda, MD), and
Google Scholar (Google Inc.,
Mountain View, CA)
Data Analytics
Reports provided by the software, which include accuracy and latency by
item, by task, and by week for each participant.
