CACTUS: Computerised assisted language therapy pilot study

The Challenges

To test the feasibility of conducting a randomized controlled trial
to study the effectiveness of self-managed computer treatment for people with long-standing aphasia after stroke.

The incidence of aphasia after stroke is estimated to be one
third of those who survive. Aphasia affects all aspects of
communication including the ability to understand spoken
and written language, speaking, and writing. Fifty people per
100 000 population will still have aphasia 6 months post-stroke,
limiting full participation in activities of daily living.

There is evidence that although most recovery takes place in
the first 6 months, people can continue to improve their
language skills for several years. However, continued
treatment places high demands on often limited resources and
can therefore be costly and difficult to achieve with face-to-face
speech and language therapy.

The Research

In this pilot single-blinded, parallel-group, randomized controlled trial participants with aphasia were allocated to self-managed computer treatment with volunteer support or usual care (everyday language activity). The 5-month intervention period was followed by 3 months without intervention to investigate treatment maintenance.

The Results

Thirty-four participants were recruited. Eligible participants were identified from local support groups and speech and language therapy department records in South Yorkshire and Newcastle & North Tyneside, UK.

Seventeen participants were allocated to each group. Thirteen participants from the usual care group and 15 from the computer treatment group were followed up at 5 months. An average of 4 hours 43 minutes speech and language therapy time and 4 hours volunteer support time enabled an average of 25 hours of independent practice. The difference in percentage change in naming ability from baseline at 5 months between groups was 19.8% (95% CI, 4.4 –35.2; P0.014) in favour of the treatment group. Participants with more severe aphasia showed little benefit. Results demonstrate early indications of cost-effectiveness of self-managed computer therapy.

The Impact

The results of the pilot CACTUS study were cited in the 2012 Royal College of Physicians Stroke Guidelines.

The new clinical approach to providing therapy for people with communication difficulties was implemented into local speech and language therapy services in Sheffield Teaching Hospitals NHS Trust in 2013/2014. A service evaluation showed an improvement in the quantity of tailored treatment provided, leading to patients achieving goals related to participation in activities of daily life and return to work, improving outcomes from existing service provision.

The volunteer training package tested in the pilot study was the basis for the volunteer training and handbook adopted by the charity SpeakwithIT and the results of the pilot study underpinned their charities work. The impact of the CACTUS pilot study on SpeakwithIT was reported as a case study in the document: The National Institute for Health Research at 10 years: An impact synthesis:
100 Impact case studies. http://www.rand.org/randeurope/research/projects/nihr-ten-years.html

Publications

  • Computer Therapy Compared With Usual Care for People With Long-Standing Aphasia Post stroke. A Pilot Randomized Controlled Trial. Palmer R, Enderby P, Cooper C et al. Stroke. 2012;43:1904-1911.)
  • Cost-Utility of Self-Managed Computer Therapy for People with Aphasia Latimer N, Dixon S, Palmer R. International Journal of Technology Assessment in Health Care, 29:4 (2013), 402–409.
  • Using computers to enable self-management of aphasia therapy exercises for word finding: the patient and carer perspective. Palmer R, Enderby P and Paterson G. Int J Lang Commun Disord, Sep–Oct 2013, Vol. 48, No. 5, 508–521
  • Volunteer involvement in the support of self-managed computerised aphasia treatment: The volunteer perspective. Palmer R & Enderby Int Journal Speech-Language Pathology, 2016; 18: 411–419