Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study

Stephan Moreno Gerber; Narayan Schütz; Arif Sinan Uslu; Nadine Schmidt; Carina Röthlisberger; Patric Wyss; Sandra Perny; Corina Wyss; Monica Koenig-Bruhin; Prabitha Urwyler; Thomas Nyffeler; Laura Marchal-Crespo; Urs Peter Mosimann; René Martin Müri; Tobias Nef

doi:10.2196/13163

Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study

JMIR Rehabil Assist Technol. 2019 Apr 26;6(1):e13163. doi: 10.2196/13163.

Authors

Stephan Moreno Gerber¹, Narayan Schütz¹, Arif Sinan Uslu¹, Nadine Schmidt¹, Carina Röthlisberger¹, Patric Wyss¹, Sandra Perny², Corina Wyss², Monica Koenig-Bruhin³, Prabitha Urwyler¹, Thomas Nyffeler³, Laura Marchal-Crespo^{1

4}, Urs Peter Mosimann¹, René Martin Müri², Tobias Nef^{1

4}

Affiliations

¹ Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.
² Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland.
³ Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland.
⁴ ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.

PMID: 31025946
PMCID: PMC6658255
DOI: 10.2196/13163

Abstract

Background: Aphasia is the loss or impairment of language functions and affects everyday 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, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer-based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists.

Objective: The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient's progress as well as creation of new individual exercises.

Methods: The system consists of two main parts: (1) the patient's interface, which allows the patient to exercise, and (2) the therapist's interface, which allows the therapist to assign new exercises to the patient and supervise the patient's progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory).

Results: A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z=-1.90; P=.03) and therapists rated the app as good (score >85; Z=-1.75; P=.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z=-1.66; P=.049).

Conclusions: Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer-based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy.

Keywords: aphasia; high-intensity training; multiplatform system; telerehabilitation.

©Stephan Moreno Gerber, Narayan Schütz, Arif Sinan Uslu, Nadine Schmidt, Carina Röthlisberger, Patric Wyss, Sandra Perny, Corina Wyss, Monica Koenig-Bruhin, Prabitha Urwyler, Thomas Nyffeler, Laura Marchal-Crespo, Urs Peter Mosimann, René Martin Müri, Tobias Nef. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 26.04.2019.