Research Shows Constant Therapy Homework Improves Patient Outcomes Significantly

An important study published in Frontiers in Human Neuroscience shows that stroke and brain injury survivors using Constant Therapy at home improved significantly more compared to patients who only received therapy in the clinic. These patients were able to complete many more hours of therapy (six times more actually) compared to patients who got therapy in the clinic alone. Why is this important? The more therapy patients get, the more recovery gains they make.

Key Research Findings

The results of the study are really quite exciting for a number of reasons. We’ve summarized them in a few bullet points below:

• The experimental group did, on average, 4 hours of homework per week. That is four more hours of therapy EVERY WEEK. And that’s just on average. One participant did 17 hours per week. That is a MUCH bigger number than patients who were in the control group, who only came into the clinic. On average they received 41 minutes of therapy per week (within an hour session, time is always lost in transitions, set up, etc.). So, patients who had a homework option got an average of FOUR TIMES as much therapy.
• The more you practice, the more improvement you make. Both groups made significant improvements on the standardized tests, but the experimental group (the homework group) made SIGNIFICANTLY more progress. This is a big deal because it really does prove that practice makes perfect.
• The more impaired patients improved more. So often I hear from patients that they think that because they are so impaired, because their language and cognitive skills are so low, they won’t be able to improve. This study proves that the OPPOSITE is true. The patients who had lower scores on tests actually made more improvement relative to others with higher test scores.
• The “you have one year to improve” myth IS NOT TRUE. Many people are told, even by members of the medical community, that you have one year to improve after acquiring aphasia. And that’s it. That’s the improvement you’re going to make. But it’s just not true. Patients in this study were many years post-stroke or TBI and STILL made huge improvements.
• Cognitive and language tasks co-improved. What does that mean? Well, we saw co-improvements (tasks that both improved together) that we expected – the more someone worked on arithmetic, the more they improved on quantitative reasoning (word problems) – these are both cognitive tasks; the more someone worked on sound identification, the more they improved on letter-to-sound matching – these are both language tasks. But here’s the fascinating thing – some language tasks co-improved with cognitive tasks. This suggests that language and cognitive processing are inter-related and depend on each other, which is pretty fascinating for therapy planning. These findings, perhaps for the first time, show that language and cognitive functions can co-improve in patients after brain damage after rehabilitation.

Detail of Research Process

• Research Goal
  • Examine the effectiveness an iPad-based therapy platform (Constant Therapy) for language and cognition skills

• Participants
  • 51 individuals with aphasia caused by a stroke or traumatic brain injury
  • Divided into two groups: control and experimental
    • Control group only had 1 hour of therapy using Constant Therapy per week in the clinic with a clinician
    • Experimental group had the same 1 hour of therapy in the clinic, but ALSO go to practice at home
  • Wide range of how long they’d had aphasia – anywhere from 1 month to 359 month

• Measures of Improvement
  • So how did the authors know if people improved? They used standardized tests, which evaluate the language and cognitive skills of individuals and compare them to scores from persons with typical language and cognitive skills. These tests basically allow a clinician to see if a person’s language and cognition are within normal limits, or if there are certain areas within those skills that are weak. Here are the tests they used:
    • Revised-Western Aphasia Battery – assesses spoken and written language
    • Cognitive Linguistic Quick Test – assesses attention, memory, executive function skills, language, and visuospatial skills
    • Boston Naming Test – assesses the ability to name nouns
    • Pyramids and Palm Trees Test – assesses how well a person can retrieve semantic (meaning) information from pictures; this checks the semantic system while removing the need to specifically name pictures
  • Participants were given these tests before and after treatment to see how much improvement was made

• What did therapy entail?
  • Assess – First patients were assessed using the measures outlined above, and then clinicians selected appropriate Constant Therapy tasks for them given their strengths and weaknesses
  • Assign – Then, clinicians trialed tasks with patients; if they scored below 80%, that task was assigned for practice; if they scored lower than 40%, they were given an easier level or task
  • Act – Then, depending on group, patients began practice in the clinic and/or at home. Once a patient got 95% or higher accuracy on a task, they were assigned a harder level or a harder task. This lasted for 11 weeks.
  • Therefore, therapy was delivered in a standardized format; for every task, every item at every level was presented, once the patient responded, accuracy and latency feedback was provided. At the same time, therapy was individualized; each patient received a therapy program individualized based on their language and cognitive profile.

Reference

• Des Roches CA, Balachandran I, Ascenso EM, Tripodis Y and Kiran S (2015) Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform. Front. Hum. Neurosci. 8:1015. doi: 10.3389/fnhum.2014.01015.