ICYMI: Digital therapy offers the potential to fill the post-therapy gap

Read the second in our In Case You Missed It Series, where we review previously published scientific research about Constant Therapy and brain rehabilitation. ICYMI is written by The Learning Corp scientific advisor Paul Wicks, Ph.D., a neuropsychologist and expert in digital health, clinical trials, and patient centricity. Paul’s work has been profiled by the BBC, NPR, CNN, BBC Radio 4, the Wall Street Journal, and the New York Times. He was awarded MIT Technology Review’s TR35 “Humanitarian of the Year” award, recognized as a TED Fellow, and recently joined the inaugural FLIER Program at the Academy of Medical Sciences. He sits on the editorial boards of the BMJ, BMC Medicine, JMIR, Digital Biomarkers, and The Patient. You can read the first in our In Case You Missed It Series here.

When’s the last time you had to do homework?

Were you always on top of your assignments or were you scribbling away on the bus into school the morning it was due? For many of us, homework is a distant memory, but for many people who have experienced aphasia or cognitive problems resulting from a stroke, homework is now a part of daily life. That’s because while we know that intensive speech-language therapy from a licensed professional remains the gold standard intervention for recovering functional speech and language, most insurance companies only cover this crucial service in the first few weeks after a stroke. That’s a tragedy because we know that longer and more sustained interventions have the potential to significantly improve speech and language beyond the acute phase of recovery. Once that coverage runs out, people living with aphasia are often left to find their own ways to practice their skills and are often left only with a paper workbook of homework assignments to complete in their own time.

The problem is, a paper workbook can’t give you feedback on how you’re doing, it can’t alter the difficulty level as you improve, and particularly in the context of issues like apathy, low mood, memory problems, and executive dysfunction, adherence to prescribed treatment is known to be low following a stroke. “Digital therapy” delivered via a tablet computer offers the potential to fill this gap, with engaging exercises with built-in cues and reminders to keep patients on track, dynamic difficulty settings to encourage neuroplasticity, and the ability to share data with healthcare professionals and family caregivers. That said, rigorous studies are needed to establish efficacy and adherence.

Research shows the benefits of digital therapy over paper therapy

In this preliminary study, 51 people with aphasia were divided into experimental (N=42) and control (N=9) groups to test the effectiveness of Constant Therapy compared to usual clinic-based care over the course of 10 weeks. The control group received the typical single clinic visit per week while the experimental group received the weekly in-clinic visit plus use of Constant Therapy at home. 

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While both groups showed improvement in language and cognitive tasks over the 10-week therapy program, the Constant Therapy users practiced more (around 4 hours a week) than clinic-based users (around 40 minutes a week) and showed greater changes in task accuracy and response latency. Those differences were detectable not only in the app itself but also on standardized neuropsychological tests like the Western Aphasia Battery and the Cognitive Linguistic Quick Test, suggesting that the improvements from therapy were “generalizing” to rather than simply showing that practice meant participants were doing better at the tasks. What’s more, users of virtual therapy get to recover at home rather than organizing what can be a long, difficult, and expensive journey to receive therapy as an outpatient at a hospital or specialist clinic, particularly for those living in rural areas. 

The right tools = motivation to do homework for recovery

Although 4 hours a week might not sound like a lot, that’s more than most Americans spend doing housework, preparing meals, or even shopping! And considering the average stroke survivor receives about 2 or less outpatient sessions or less per week in the U.S., that 4 hours of homework is critical to supplement therapy, This study illustrates how motivated people are after they’ve had a stroke to work hard on their recovery if only they have the right tools at their fingertips.