What’s the future of brain injury rehabilitation for people who have had a stroke, traumatic brain injury, or aphasia? While science has shown that a combination of cognitive and speech therapy helps people recover, how do we address the joint problems of not enough resources and personnel to deliver that therapy as well as lack of access to care? Dr. Swathi Kiran, PhD, CCC-SLP, presented a solution at a recent TEDx talk at Boston University.
Using examples of real patients, she discusses the research conducted by her lab (the Aphasia Research Laboratory at the Sargent College of Health and Rehabilitation Sciences at BU) on people with left hemisphere strokes. The Lab’s primary goal is to understand language processing and communication following brain injury, making use of Neuroimaging, neurolinguistic, psycholinguistic and neurobehavioral tools to investigate Aphasia.
People who have had a stroke and have aphasia have trouble communicating, understanding speech and reading. She plays a video of a patient speaking with his therapist to demonstrate how aphasia manifests. You can hear the frustration as he tries to say the words out loud which he has in his head. The good news is that work done in Dr. Kiran’s lab shows that because the brain is plastic, it can recover language skills.
To study this, people with left hemisphere stroke come into her lab and do simple tasks. Their brains are scanned while doing these tasks at 10-week intervals, between which they practice rehabilitation therapy. From this research, Dr. Kiran finds that different parts of the brain work together as a “tag team” so that one part steps up to help out in function as another has stepped back. In fact, there are multiple regions of the brain that are not traditionally involved with language but that step up in these cases to help recover language.
She’s also learned that individuals recovering from stroke also have issues with attention, problem-solving, planning, and inhibiting distractions, which makes language recovery that much harder, and which must be addressed as part of rehabilitation therapy.
Dr. Kiran’s research has shown that providing evidence-based brain rehabilitation therapy on smartphones and tablets is one way to reach larger numbers of patients that need therapy. As she says, “technology allows patients access to therapy much like they can access Uber or online shopping”.
She describes one study whose results show that stroke patients who use a therapy app on a tablet, Chromebook, or smartphone to practice at home get significantly more therapy overall and that this translates into significant improvements in recovery. The study also shows that patients who are mildly impaired after stroke, as well as patients who are significantly impaired, can achieve language mastery with practice, giving hope to people who are written off by the insurance system as unable to get better.
And using the data derived from technology, she says we can also make predictions about each individual’s recovery trajectory, based on their demographics, time since injury, and a number of other factors. So that going forward, we can come up with successful customized therapy plans for each patient. “The future of brain rehabilitation is on-demand, data-driven and personalized”, she says.