Using voice recognition software to treat dysgraphia in a patient with conduction aphasia

Background: Augmentative and alternative communication (AAC) has primarily been utilised for motor speech deficits or as an aid for communicating basic needs in the acute stages of aphasia rehabilitation. However, AAC strategies can be employed for individuals with aphasia across a wide range of severity levels and at different stages of recovery. For individuals with chronic impairments in language, voice recognition software can further enhance communication by providing an alternative means for written expression. Aims: To investigate the functional and linguistic effects of a treatment program that used voice recognition software to improve written communication in an individual with chronic aphasia. Methods & Procedures: A 65-year-old woman with conduction aphasia participated in a prospective case study. During baseline testing the individual was evaluated on measures of language (i.e., Boston Diagnostic Aphasia Examination, 3rd edition, Goodglass, Kaplan, & Baressi, 2001 Goodglass, H., Kaplan, E. and Barresi, B. 2001. Boston Diagnostic Aphasia Examination, 3rd, Baltimore, MD: Lippincott Williams & Wilkins. [Google Scholar]; Boston Naming Test, Kaplan, Goodglass, & Weintraub, 2001 Kaplan, E., Goodglass, H. and Weintraub, S. 2001. Boston Naming Test, 2nd, Philadelphia, PA: Lippincott Williams & Wilkins. [Google Scholar]), computer skills, and functional communication (i.e., ASHA FACs, Frattali et al., 1995 Frattali, C., Thompson, C. K., Holland, A. L., Wohl, C. B. and Ferketic, M. K. 1995. American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults, Rockville, MD: American Speech-Language-Hearing Association. [Google Scholar]; Quality of Communication Life Scales, Paul et al., 2004 Paul, D., Frattali, C., Holland, A., Thompson, C., Caperton, C. and Slater, S. 2004. Quality of Communication Life Scale (ASHA QCL), Rockville, MD: American Speech-Language-Hearing Association. [Google Scholar]). A cursory examination of the oral peripheral structure was administered. Treatment consisted of 10 one-hour sessions of training on the Dragon NaturallySpeaking© Program. Following treatment, measures of language, computer skills, quality of life, and functional communication were re-administered. Further, to evaluate if skills in written expression could be utilised to communicate via e-mail, a distance-learning program was implemented. Outcomes & Results: Findings revealed that, with intensive instruction, the participant was able to independently access the computer and the Dragon NaturallySpeaking© Program. At the conclusion of the treatment phase, functional writing abilities approximated spoken communication. Some minor changes in reading, repetition, and conversation were suggested on formal and informal assessment measures. The participant made substantial gains in using the program in her activities of daily living, but only achieved minor success in demonstrating her skills during distance learning. Conclusions: The potential benefits of AAC devices may change throughout the course of recovery from aphasia. New technologies may facilitate gains in communication in individuals with aphasia throughout their lifespan. This study demonstrated that intensive training in the use of voice recognition software can enhance functional writing in an individual with chronic aphasia. Although marked progress in written expression was achieved, transfer of skills for use on the Internet was limited. Clinical management should include assessment of various assistive technologies across different modalities of communication for people at different stages of recovery from aphasia.