Exploring Treatment Fidelity in Persons With Aphasia Autonomously Practicing With Computerized Therapy Materials Purpose Current computer technologies permit independent practice for people with cognitive–communicative disorders. Previous research has investigated compliance rates and outcome changes but not treatment fidelity per se during practice. Our aim was to examine adherence to procedures (treatment fidelity) and accuracy while persons with aphasia independently practiced word production using ... Research Article
Research Article  |   March 01, 2018
Exploring Treatment Fidelity in Persons With Aphasia Autonomously Practicing With Computerized Therapy Materials
 
Author Affiliations & Notes
  • Angel L. Ball
    Department of Clinical Health Sciences, Texas A&M University–Kingsville
  • Michael de Riesthal
    Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
  • Richard D. Steele
    Lingraphica, Princeton, NJ
  • Disclosure: Dr. Richard Steele is Chief Scientist at Lingraphica, a company that offers a range of commercial products and services for use in the rehabilitation of persons with aphasia and other communication disorders. Lingraphica technologies were used in this study.
    Disclosure: Dr. Richard Steele is Chief Scientist at Lingraphica, a company that offers a range of commercial products and services for use in the rehabilitation of persons with aphasia and other communication disorders. Lingraphica technologies were used in this study. ×
  • Correspondence to Angel L. Ball: angel.ball@tamuk.edu
  • Editor: Margaret Blake
    Editor: Margaret Blake×
  • Associate Editor: Anastasia Raymer
    Associate Editor: Anastasia Raymer×
  • Publisher Note: This article is part of the Special Issue: Select Papers From the 46th Clinical Aphasiology Conference.
    Publisher Note: This article is part of the Special Issue: Select Papers From the 46th Clinical Aphasiology Conference.×
Article Information
Language Disorders / Aphasia / Special Issue: Select Papers From the 46th Clinical Aphasiology Conference / Research Articles
Research Article   |   March 01, 2018
Exploring Treatment Fidelity in Persons With Aphasia Autonomously Practicing With Computerized Therapy Materials
American Journal of Speech-Language Pathology, March 2018, Vol. 27, 454-463. doi:10.1044/2017_AJSLP-16-0204
History: Received October 31, 2016 , Revised March 12, 2017 , Accepted September 7, 2017
 
American Journal of Speech-Language Pathology, March 2018, Vol. 27, 454-463. doi:10.1044/2017_AJSLP-16-0204
History: Received October 31, 2016; Revised March 12, 2017; Accepted September 7, 2017

Purpose Current computer technologies permit independent practice for people with cognitive–communicative disorders. Previous research has investigated compliance rates and outcome changes but not treatment fidelity per se during practice. Our aim was to examine adherence to procedures (treatment fidelity) and accuracy while persons with aphasia independently practiced word production using interactive, multimodal, user-controlled, word-level icons on computers.

Method Four persons with aphasia independently practiced single-word production after stimulation via user-initiated interactions in 3 conditions: (I) auditory stimulus with static representational drawing; (II) auditory stimulus with synchronized articulation video; and (III) users' choice between the 2 prior conditions. Sessions were video-recorded for subsequent analysis, which established emergently refined behavioral taxonomies using an iterative, mixed-methods approach.

Results In independent practice, users only sometimes adhere to modeled behaviors, other times improvising novel behaviors. The latter sometimes co-occurred with successful productions. Differences in success rates were noted between Conditions I and II across behaviors with Condition II generally favored. In Condition III, participants tended to choose the stimulus that resulted in highest success rates.

Conclusions During independent practice with technology, persons with aphasia do not necessarily comply with clinicians' practice instructions, and treatment fidelity does not determine success. Autonomy and choice in practice may reveal unanticipated dimensions for computerized aphasia treatment.

Acknowledgments
This research was funded in part by a University Research Award, from the office of Research and Graduate Studies at Texas A&M University–Kingsville, and from an internal award from the Office of Title V–The Promoting Post baccalaureate Opportunities for Hispanic Americans program, given to Angel Ball. The authors also wish to thank the many students of the Communication Sciences and Disorders at Texas A&M University–Kingsville, particularly then-students Alejandra Figueroa, Virginia Diaz de Leon, and Gretchen (Williams) Ramirez, for participation in this project.
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