Title: A qualitative evaluation of participant views of technology-enhanced therapy for people with aphasia
Degree: BSc (Hons) in Speech and Language Therapy, Research Dissertation 2017
Author: Lindsay Hunt
Supervisor: Professor Jane Marshall
Background
There is a growing number of therapy studies investigating the use of assistive technology in reading and writing therapy for people with aphasia. The literature to date has reported encouraging intervention efficacy, but few have reported participant experience. Qualitative methodologies in aphasia research are useful for illuminating the thoughts of people with aphasia, particularly enabling researchers to understand the real experience of living with a chronic communication disability. The present study applied a similar methodology in order to understand participant’s views of technology use, therapy processes and outcomes.
Aims
The study aimed to identify what participant’s views were of using assistive reading and writing technology in aphasia therapy, thoughts about the therapy process, and any self-perceived change to language, communication and social activity and participation.
Methods and Procedures
This is a small-scale study of six participant’s with chronic aphasia and acquired dysgraphia and dyslexia post-stroke. Participants were invited to attend exit interviews after completing reading or writing therapy as part of a university-based aphasia research project using technology. Semi-structured interviews were conducted by a student speech and language therapist and questions were presented from a topic guide. All interviews were video-recorded, fully transcribed and analysed thematically.
Outcomes and Results
Results suggest that people with aphasia and acquired dysgraphia and dyslexia give great value to using technology for pleasure and social communication. Reading and writing technologies resulted in few challenges, positive literary gains and a notable generalisation of improved confidence levels. Improved confidence resulted in increased activity, social participation and motivation to embark on different life pursuits.
Conclusions and Implications
This small-scale study demonstrates the use of assistive reading and writing technologies in aphasia therapy may be valuable in enabling people with aphasia to reconnect with pre-stroke identities by enhancing reading and writing efficiency, communication skills and social participation. Further research is needed to ascertain the views of a larger number of people with aphasia.
Title: Collecting normative data on measures of writing – CommuniCATE Project
Degree: BSc (Hons) in Speech and Language Therapy, Research Dissertation 2016
Author: Sarah Doyle
Supervisor: Professor Jane Marshall
The aim of this study was to collect normative data on writing measure. There is limited research looking at normative writing skills of adults as well as a lack in writing measures for writing therapy. This data is intended for use as a measure for Speech and Language Therapists carrying out writing therapy with clients. Forty participants were recruited who completed a questionnaire and three writing tasks, both typed and handwritten (these tasks are currently being used in an ongoing research project at City University London – the CommuniCATE Project).
The writing tasks were analysed and given a variety of linguistic scores (the four main areas – Total Word Count, Token Count Ratio, Syntactic Variety and Grammatical Well Formedness) and Social Validity scores (the four constructs – Effectiveness, Informativeness, Grammaticality and Comfort). Blind-raters carried out Social Validity scoring on a random selection of scripts to ensure inter-rater reliability. These scores were then compared to the demographics collected with the questionnaires and the two scoring systems were compared to ensure agreement.
The results showed that there is little effect of demographics on writing abilities in both typed and handwritten tasks. Age is a factor in writing skills with more formal and grammatically correct writing produced by the older generations but with younger generations having a wider variety and higher frequency in the use of writing. Writing abilities appear better when typed rather than handwritten in most areas except grammar. The two scoring systems have a strong agreement with correlations between the four constructs of Social Validity and the four key areas in the linguistic score.
This study reflects the rise in the use of technology and the internet. This appears to be impacting the use of writing and the flexibility in use of language. As well as this, there is the reflection of a higher number of people staying on into higher education however, the population used is biased towards older generations who have been through higher education.
The implications for this study, though based on a narrow sample, are that the combined use of the linguistic measures and social validity measures can be used to analyse these writing tasks. This indicates that the data can be used in the host project as a comparison to the performance on these tasks by people with aphasia.
Title: Conducting and analysing exit interviews with CommuniCATE participants: Reading and writing therapy strands
Degree: BSc (Hons) in Speech and Language Therapy, Research Dissertation 2016
Author: Nasrin Ahmed
Supervisor: Professor Jane Marshall
Aims
This study explored CommuniCATE participants’ perceptions and views of their experiences in the reading and writing therapy strands of the project.
Background:
Technology enhanced therapy is a relatively new and emerging field in aphasia rehabilitation. The evidence is therefore still being collected. Some researchers have used interviews to explore PWAs views on therapy, despite the criticisms raised over use of this methodology within this population.
Methods:
Semi-structured interviews were conducted with nine PWA who completed therapy.
Results:
Nine themes were identified from interviews using framework analysis. Participants reported on both the benefits and difficulties faced when using technologies. Interviewees highlighted the compensatory role assistive technologies had in helping to enhance their impaired modalities. Few comments were made on changes to their underlying language impairment. Most participants reported that their reading or writing activities increased when they used technologies. Although not all interviewees had maintained use of technologies, all expressed general confidence in using technologies independently in the future. All participants were generally satisfied with the therapy received.
Discussion and conclusion:
Regardless of the limitations faced in the conduct and analyses of interviews, interviewees’ positive reports on the technologies suggests that the use of technology in therapy ought to be considered by clinicians. More research is required to explore the effectiveness of this therapy further, with ideally both quantitative and qualitative research used.
Title: Conducting Exit Interviews With CommuniCATE Participants
Degree: BSc (Hons) in Speech and Language Therapy, Research Dissertation 2016
Author: Warda Farah
Supervisor: Professor Jane Marshall
Background:
This study will involved interviewing individuals who have received therapy as part of the CommuniCATE project, in order to capture their experiences and views about intervention. This is in line with the recent fundemental shift in focus to give greater emphasis in involving patients in the care they receive (Brédart , Marrel, Abetz-Webb, Lasch, Acquadro,2014). This shift emphasizes the need for those who have had a stroke to actively engage in discussions about the healthcare they are receiving (Chapey et al., 2008; Larsson Lung, Tamm, & Branholm, 2001; Threats, 2007). Through involving patients in the decision making process, improvments in quality, efficiency, and health outcomes are said to improve ( Department of Health, 2010).
Methods:
This study consisted of qualitative data analysis (Sandelowski, 2000) of semi-structured interviews (DiCicco-Bloom & Crabtree, 2006) of nine participants with aphasia. Supported conversation techniques (Kagan, 1998; Simmons- Mackie & Kagan, 1999). The participants were recruited from the wider CommuniCATE study. Interviews were video-recorded and transcribed verbatim. Framework analysis was then used to analyse the data.
Results:
This study found that participants in both strands had differing views and experiences with the technology they used in therapy. The participants also differed in the amount of information they could provide with regards to their views and experiences. All of the participants expressed positive opinion on the therapy they received in general, with only a few negative comments being expressed. Many highlighted different aspects of the therapy they liked. All of the participants felt that therapy was well organised, resulting in them being less anxious. Many also cited the support provided by the therapist/family as being an essential part of the therapeutic process. There was a differences of opinions expressed on the technologies, with regards to ease and functionality of its use.
Conclusion:
This study found that after a six-week period of therapy participants in both strands reported a range of changes in the areas of language, activity and participation. Participants reported on a range of pros and cons of using technology enhance therapy. The main difficulty reported was learning how to use the technology and then for some people it was about maintaining use of that technology.
Title: Normative Data for Email Writing: Investigating the Impact of Demographic Factors on Writing in Neurologically Healthy Adults and Novel Test Psychometrics
Degree: BSc (Hons) in Speech and Language Therapy, Research Dissertation 2017
Author: Anna Cackett
Supervisor: Professor Jane Marshall
Background:
Research has shown that demographic factors, such as educational attainment, age and gender impact upon writing in the neurologically healthy population. A widespread knowledge of computers has been shown, with levels of use affected by age. Writing can be affected following a stroke, referred to as dysgraphia. This is often classified by the impairment observed, as most studies and therapies are informed by psycholinguistic models. Dysgraphia can also be described by how it affects functional or ‘every day’ writing. There is a variety of outcome measures used, some of which have limited psychometrics, leading to difficulty making comparisons between therapies. As a result, there is a need to develop one single tool to assess functional writing.
Aims:
This study aimed to explore a number of areas, using three writing tests designed by the CommuniCATE Project as an outcome measure of therapy. Firstly, whether demographic factors impacted writing performance in a neurologically healthy sample. Secondly, whether scores showed differences between modes of administration, handwritten and typed. Thirdly, whether scores would be stable across a test-retest time frame.
Methods and Procedure:
30 neurologically healthy participants were recruited from London, Surrey and Essex, 23 of which agreed to be re-tested. Participants completed demographic and computer use questionnaires. Writing tests were carried out and scored using a linguistic scoring protocol. Analyses completed reflected the aims of the study. Firstly, scores of graduates and non-graduates, age groups and males and females were compared. Secondly, scores were compared with respect to modality. Thirdly, analysis explored the test-retest reliability, again with respect to modality.
Outcomes and Results:
Graduates outperformed non-graduates on all variables, with more significant differences in the handwritten modality. There were limited participants recruited in the older age groups, however, older participants performed worse than younger participants on all variables. Women produced significantly more handwritten words and content words than men. Participants wrote significantly more function words when typing than when handwriting, however, there was no significant differences or interactions when considering levels of computer use. Excellent Intra-class Correlation Coefficient (ICC) values were seen for 13 of the 16 variables, showing good test-retest reliability, with no difference observed across modalities.
Conclusions:
Demographic factors impacted highly on writing performance on tests used within this study, particularly education. Modality effects have been partially shown, with respect to the level of computer use, however demographic factors were hypothesised to be impacting results. The writing tests showed good test-retest reliability with the neurologically healthy sample, adding to the evidence that these can be used as an outcome measure by CommuniCATE, as well as being used in future research of functional writin