Abstract
An advantage of rehabilitation administered on computers or tablets is that the tasks can be self-administered and the cueing required to complete the tasks can be monitored. Though there are many types of cueing, few studies have examined how participants’ response to rehabilitation is influenced by self-administered cueing, which is cueing that is always available but the individual decides when and which cue to administer. In this study, participants received a tablet-based rehabilitation where the tasks were selfpaced and remotely monitored by a clinician. The results of the effectiveness of this study were published previously (Des Roches et al., 2015). The current study looks at the effect of cues on accuracy and rehabilitation outcomes. Fifty-one individuals with aphasia completed a 10-week program using Constant Therapy on an iPad targeted at improving language and cognitive deficits. Three questions were examined. The first examined the effect of cues on accuracy collapsed across time. Results showed a trend where the greater the cue use, the lower the accuracy, although some participants showed the opposite effect. This analysis divided participants into profiles based on cue use and accuracy. The second question examined how each profile differed in percent cue use and on standardized measures at baseline. Results showed that the four profiles were significantly different in frequency of cues and scores on WAB-R, CLQT, BNT, and ASHA-FACS, indicating that participants with lower scores on the standardized tests used a higher percentage of cues, which were not beneficial, while participants with higher scores on the standardized tests used a lower frequency of cues, which were beneficial. The third question examined how the relationship between cues and accuracy was affected by the course of treatment. Results showed that both more and less severe participants showed a decrease in cue use and an increase in accuracy over time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation. time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation.
Highlights
Each year nearly 800,000 individuals suffer a stroke (Winstein et al, 2016) and roughly 1.3 million individuals suffer from brain injury (Corrigan et al, 2010)
Another important factor contributing to our lack of complete understanding of who benefits from treatment and who does not is the inherent heterogeneity of individual patients in terms of their profile that can impact performance (Goodglass et al, 1966; Hanson et al, 1989; Schwartz and Brecher, 2000; Hilari et al, 2003; Pedersen et al, 2003; Murray, 2012; Hachioui et al, 2014)
More severe participants used more cues than less severe participants over time, and the number of cues used per session was higher compared to the less severe participants as treatment sessions progressed
Summary
Each year nearly 800,000 individuals suffer a stroke (Winstein et al, 2016) and roughly 1.3 million individuals suffer from brain injury (Corrigan et al, 2010). Despite significant advances in aphasia rehabilitation approaches, it is still difficult to predict and explain which individuals benefit from treatment and which individuals do not due to the vast differences in the way rehabilitation is provided to patients (Best and Nickels, 2000; Carlomagno et al, 2001; Lazar et al, 2008) Another important factor contributing to our lack of complete understanding of who benefits from treatment and who does not is the inherent heterogeneity of individual patients in terms of their profile (e.g., age, months post stroke, severity of language impairment, levels of motivation, etc.) that can impact performance (Goodglass et al, 1966; Hanson et al, 1989; Schwartz and Brecher, 2000; Hilari et al, 2003; Pedersen et al, 2003; Murray, 2012; Hachioui et al, 2014). At the right end of the continuum is no cueing, which is when the participant can perform tasks independent of any cues
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