Post-discharge home therapy for aphasia: new research is encouraging

Aphasia affects speaking, listening, reading or writing skills, usually due to a stroke or other brain injury. An estimated two million Americans live with aphasia, with an estimated 180,000 added every year. Because communication is so critical to daily life, researchers continue to study the most effective ways to improve the lives of persons living with aphasia. A new pre-post group study out of the University of Massachusetts Amherst investigated the efficacy of tablet-based home practice. 

We’ve identified key findings from this study and incorporated thoughts on what the results mean for you and your patients.

Making the case for home practice

Prior studies have shown that personalized, self-paced language home practice between therapy sessions can be effective in improving outcomes for people with aphasia. For instance, a study published in Frontiers in Human Neuroscience showed that patients who practiced an average of four hours per week made significantly more recovery progress than those who didn’t practice as much.

In short, more practice equals more progress. It makes sense! And it’s documented. In a paper titled Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage, Kleim and Jones write that in order for the brain to form new connections, those neurons must be stimulated through specialized, intensive tasks, and consistent practice.

New research: home practice brings improvement after discharge

In their 2018 study, Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia, Kurland, Lui, and Stokes looked at whether tablet-based home practice programs with weekly telepractice support could “enable long-term maintenance of treatment gains and foster new language gains in post-stroke aphasia.”

In this study, 21 individuals with aphasia who completed an intensive aphasia program were examined before and after a six-month home practice phase, and again at a four-month follow-up. These individuals completed a tablet-based unsupervised home practice with weekly video teleconferencing support.

Researchers concluded that home practice with weekly video teleconferencing support was effective for all participants, with severity-moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains.

4 takeaways from the study

1. Individuals with chronic aphasia, including those with limited experience with technology, who continue practicing after discharge, can continue to improve their language skills.
2. Home practice with weekly teleconferencing support protects against lapses in skills gained in previous therapy.
3. Halting home practice over a period of months is detrimental to maintaining recovery progress.
4. Post-discharge home practice may represent a low-cost therapy option for individuals without insurance coverage, and/or those for whom mobility is an issue in getting in-clinic therapy.

Preparing patients for discharge

During therapy, clinicians typically assign home programs with the goal of generalizing skills outside of the clinic, and promoting independence and autonomy. As a patient nears discharge, many clinicians focus on how clients can continue work when formal therapy is done. For example, they’ll use session time to educate the patient and family members about available resources, such as programs, ways to practice, and support groups.

In this vein, programs such as those on the Constant Therapy app can be a valuable way for individuals to continue to work on skills outside of the clinic. With the Constant Therapy home program, patients can engage in regular cognitive, speech and language practice anytime and anywhere that they choose. The program adapts and changes with performance, so users continue to practice varied exercises at the right challenge level. 

Key outcomes for patients who practice at home include:

• Enabling the brain to repair itself. Regular practice uses the principle of neuroplasticity to allow the brain to compensate for injury by reorganizing the neurons that remain intact.
  
• Encouraging generalization of new skills and strategies. Patients learn to transfer a learned skill or task from the clinical setting to a more natural setting, such as their home or work.
• Providing caregivers a way to stay connected with their loved one’s recovery. Home practice provides family members or caregivers with insight on progress that may otherwise not be observed.

We’ve heard instances of patients having their therapy halted as a perceived plateau is hit, or due to insurance limitations. Constant Therapy enables clinicians to amplify and extend their efforts for patients even when they have discharged them under less than optimal circumstances. With their clinician’s help, these patients can now continue their progress gained in therapy, without limitations.

References:

• Des Roches, C., and Balachandran, I. (2015). Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform, Frontiers in Human Neuroscience, doi.org/10.3389/fnhum.2014.01015.
• Kleim, J., & Jones, T. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, S225-S239.
• Kurland, J., Liu, A., and Stokes, P. (2018). Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia, Journal of Speech, Language, and Hearing Research, Vol. 61, pp.1140–1156.
• For more on aphasia, read An Overview of this Common but Misunderstood Language Disorder.