Case study: Hope for stroke patients with aphasia
More than 350,000 people in the UK are living with a language disorder known as aphasia. One in three people are affected by the condition after a stroke and can have difficulties talking, reading, writing and understanding. This can lead to feelings of frustration and isolation through the inability to communicate meaningfully.
Speech and language therapy available for stroke patients can be limited, and a lot of people with aphasia want and need more therapy than they receive.
NIHR-funded researchers based at the University of Sheffield’s School of Health and Related Research (ScHARR), trialled a self-managed computer therapy programme where patients could complete personalised tasks at home.
The computer therapy approach consisted of a speech and language therapist to tailor the software, regular self-managed practice by the patient, and support from a volunteer or assistant.
More than 270 people from 21 NHS Speech and Language departments across the UK took part in The Big CACTUS trial - all were between four months and 36 years post-stroke.
Making a difference
The researchers found a number of significant benefits to using computer therapy for people affected by aphasia, in comparison to usual speech and language therapy alone.
On average, patients practised their speech and language exercises for 28 hours when using the programme, compared with 3.8 hours of usual speech and language therapy over a six-month period. Over half of the participants continued to use the computer programme after six months which helped them even if their stroke had been some years ago.
Patients significantly improved their ability to say the words they chose to practise. This showed that people with aphasia can learn new words even after a long time post-stroke with computer therapy. They could also still say the words six months after the computer therapy had finished. However, there was no evidence of improvement in general conversation.
Only a third of people used more words in conversation, and were limited to the words they had practised. This suggests that patients need encouragement to use words they’ve learned in everyday conversation.
Although unlikely to be cost-effective for everyone with aphasia, computer therapy is most likely to be a good value for money option for people with mild to moderate difficulties and costs half as much as providing the same amount of extra therapy face to face.
You can't beat having a professional coming in, but you can’t have a professional with you 24 hours a day.
I think the programme is helpful in as much as it kick-started Sue's progress again.
- Richard Hutchings, patient's husband
Dr Rebecca Palmer, from ScHARR at the University of Sheffield and Chief Investigator of the study, said: “Our study showed that 61 percent of people continued to use the computer therapy after the end of the trial intervention period showing that people with aphasia want to continue learning words and can do this independently.”
“I hope the results of this study give both speech and language therapists and people with aphasia and their carers hope for further recovery.”
In this video Dr Rebecca Palmer talks more about the study, and patients recruited to the study talk about how the computer therapy has helped them. This is a shortened version of the film. The full version can be viewed on the University of Sheffield website.
More NIHR research on this topic
Researchers are looking to see how various patient characteristics could have an impact on how quickly they recover language skills after stroke: journalslibrary.nihr.ac.uk/programmes/hsdr/140422/#/summary-of-research
To see the therapy in practice, watch the full video and to hear patient stories, please see: sheffield.ac.uk/scharr/sections/dts/ctru/bigcactus