Editor's Note:
Austin White is a speech-language pathologist at Aphasia Toolbox, and with the Veteran's Hospital Administration in Pittsburgh, PA, where he is a clinician in the distinguished Program for Intensive Residential Aphasia Treatment and Education (PIRATE).
In this article entitled "I have an iPad. So now what?", Austin writes about the current state of affairs in aphasia-directed applications for the iPad.
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Type in the word "aphasia" in the Apple App Store, press enter, and you will immediately be inundated with an overwhelming array of applications. Which one should you choose? Why is this one free and that one costs $19.99?
Navigating through the host of apps-all claiming one virtue or another-is daunting enough for the speech-language pathologist let alone the lay consumer. In hopes of making your search more manageable and fruitful, it first will help to learn a bit about the all-too brief history of mobile application use in aphasia treatment, the different ways apps are currently used by speech-language pathologists, and the continued importance of using evidence-based, Brain Compatible Aphasia Treatment-whether you are using the latest iPad app or lead pencil.
Given the ubiquity of mobile tablet technology, it is easy to forget that the first iPad was released only a few short years ago in April of 2010. The filed of speech-language pathology, as part of the larger field of health and rehabilitation sciences, was and still is particularly suited both to drive treatment application development and benefit from it. This is because, unlike many (and arguably most) other disciplines in the health and rehabilitation sciences, it is speech-language pathology's heavy focus on the neuropsychological/cognitive processes of human communication that so well lend themselves to mobile application technology. Indeed, I must admit mobile treatment applications have been a rather tantalizing notion ever since the iPad was released. Their allure is made all the more potent given the need for cost-effective treatment solutions for the tens of thousands of people living with chronic aphasia.
Clinicians and researchers are only beginning to develop an evidence base for tablets as treatment tools, though computer-based treatment in aphasia is nothing new. It is indeed critical to "...ensure their efficacy in treating aphasia" (Wilkins,.Kurland, Stokes, & Polly, 2013), but any lack of specific evidence does not mean mobile technology isn't currently useful in aphasia treatment. It is important to note that speech-language pathologists use both aphasia-specific and non-aphasia specific tablet applications in treatment. In fact, much of the research being done on the potential for personalized home practice to augment aphasia rehabilitation are not with so-called aphasia-specific applications at all, but applications not specifically designed for speech or language rehabilitation (i.e., Mental Case, a notecard application primarily for high school and university students). Speech-language pathologists and researchers should and will continue the discussion of treatment efficacy vis-�-vis tablet technology. In the meantime, the question is not, which is the best app for treating aphasia, but, how can the principles of neuro- plasticity and evidence-based practice be applied to application design and application use?
It is not an unfair generalization that the current quality and availability of evidence-based, aphasia-specific applications is rather dismal. Aphasia-specific applications on the whole tend to be over-simplistic in design, in content, and in function. Most are based on repetition and imitation and do not integrate language comprehension and expression. In addition, a significant number are not adaptable to the individual and grossly underestimate a person's previous knowledge base. This deficient combination has resulted in a smorgasbord of exceptionally useless applications, none of which on their own provide any benefit for the person with aphasia.
Certainly not all aphasia-specific applications are useless? No, there are a few that stand out as reasonably useful, and they tend to share the same characteristics described below. But whether aphasia-specific or not, there is no application or computer program that can take the place of working with a good speech-language pathologist. In the study I alluded to earlier, the home practice programs were not aphasia-specific, and were "...carefully designed with the clients' needs and skills in mind".
So while there is not one particular application I will recommend, here are some good questions that a speech-language pathologist, coach, or person with aphasia should ask themselves when selecting an application:
1. Does the application allow for personalization of content? If not, is the content relevant?
2. Does the application rely too heavily on single-word naming tasks of concrete nouns (i.e., car, bus)?
3. Are verbs targeted in any way?
4. Are the treatment tasks based too heavily on repetition and/or imitation, or does the app encourage generative communication?
5. Does the app capitalize on a person's current skills, motivations, and new skills they hope to gain?
6. What language area does the application purport to treat? Can all areas of language be targeted (spoken & written language, auditory comprehension, reading comprehension), or must these be purchased separately?