Therapist-guided Tablet-based Tele-rehabilitation for Patients with Aphasia: Proof of Concept and Usability Study (Preprint)

BACKGROUND Aphasia is the loss or impairment of language functions and affects every day social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, the training must be adapted individually and dynamically to the patient needs. An important factor for a successful aphasia therapy is dose frequency. Computer-based applications allow patients to train independently with high intensity at home. But most of the newest tele-rehabilitation applications focus on one linguistic modality, whereas there is currently a lack of validated tele-rehabilitation systems that focus on multimodal linguistic modalities. OBJECTIVE The aim of this project was to develop a multimodal system that enables aphasic patients to train at home using language-related tasks autonomously and also allows therapists to remotely assign new tasks and track the patient’s progress as well as to create new individual exercises. METHODS The system consists of two main parts. First, the patient’s interface, which allows the patient to exercise. Second, the therapist’s interface, which allows the therapist to allocate new exercises to the patient and supervise the progress of the patient. The system has been evaluated by therapists and patients by validated questionnaires in terms of usability and motivation. RESULTS A total of 11 speech and language therapists (age, MD = 28, SD =7) and 15 patients (age, MD = 53, SD =10) with diagnosed aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale zero to hundred) as excellent (score above 70, 95% CI 85.9 to 100.0, t (14) = 2.16, P = .024) and therapists as good (score above 85, 95% CI 70.5 to 100.0, t (10) = 2.21, P = .026). Furthermore, patients highly enjoyed (scale zero to six) solving the exercises (score above 3, 95% CI 3.1 to 6.0, t (4) = 2.58, P = .031). CONCLUSIONS Based on the questionnaire scores, the developed system is well accepted and simple to use by patients and therapists. Furthermore, the new system allows patients with different types of aphasia to train with a high intensity independently at home. Thus, the novel system has potential for treatment of aphasic patients as a supplement to face-to-face therapy.