Investigating the utility of teletherapy in individuals with primary progressive aphasia

Heather R Dial, Holly A Hinshelwood, Stephanie M Grasso, H Isabel Hubbard, Maria-Luisa Gorno-Tempini, Maya L Henry, Heather R Dial, Holly A Hinshelwood, Stephanie M Grasso, H Isabel Hubbard, Maria-Luisa Gorno-Tempini, Maya L Henry

Abstract

Introduction: Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of speech and language. A growing body of research supports the utility of speech and language intervention in individuals with PPA, although access to these services remains limited. One potential means of increasing treatment accessibility is the delivery of treatment via telemedicine. Evidence supports the use of teletherapy in stroke-induced aphasia, but research examining the application of teletherapy in PPA is limited. In the current study, a non-randomized group comparison design was used to evaluate the feasibility and utility of treatment delivered via teletherapy relative to treatment administered in person for individuals with PPA.

Methods: Two treatment protocols were administered as part of a larger study investigating treatment for speech and language deficits in PPA. Participants with semantic (n=10) and logopenic (n=11) PPA received lexical retrieval treatment and individuals with nonfluent/agrammatic PPA (n=10) received video-implemented script training for aphasia designed to promote speech production and fluency. Treatment was administered via teletherapy for approximately half of the participants receiving each intervention. Treatment outcomes and performance on standardized tests were assessed at pre-treatment and post-treatment, as well as 3, 6, and 12 months post-treatment.

Results: Overall, both treatment approaches resulted in significant gains for primary outcome measures. Critically, comparison of in-person and teletherapy groups revealed comparable outcomes. Generalization to untrained targets and tasks and maintenance of treatment-induced gains were also comparable for traditional vs teletherapy participants.

Conclusion: Overall, treatment outcomes were largely equivalent for individuals receiving treatment via teletherapy vs traditional, in-person delivery. Results support the application of teletherapy for administering restitutive interventions to individuals with mild-to-moderate PPA. Potential implications for using teletherapy in the treatment of cognitive-linguistic and motoric impairments in other disorders and suggestions for administering treatment via telemedicine are discussed.

Keywords: PPA; lexical retrieval treatment; script training; telemedicine; telepractice; telerehabilitation.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Mean performance on pre-treatment, post-treatment, and follow-up measures for all LRT participants. Note: 95% confidence intervals around the mean were derived using n=1000 bootstrapped samples. Abbreviations: LRT, lexical retrieval treatment; BNT, Boston Naming Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 2
Figure 2
Mean pre- to post-treatment change scores (post minus pre) for participants completing LRT in person or via teletherapy. Notes: Positive values indicate higher scores at post-treatment than pre-treatment. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: LRT, lexical retrieval treatment; BNT, Boston Naming Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 3
Figure 3
Mean change scores from post-treatment to 3-month follow-up (3 months minus post) for participants completing LRT in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 3-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: LRT, lexical retrieval treatment; BNT, Boston Naming Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 4
Figure 4
Mean change scores from post-treatment to 6-month follow-up (6 months minus post) for participants completing LRT in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 6-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: LRT, lexical retrieval treatment; BNT, Boston Naming Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 5
Figure 5
Mean change scores from post-treatment to 12-month follow-up (12 months minus post) for participants completing LRT in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 12-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: LRT, lexical retrieval treatment; BNT, Boston Naming Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 6
Figure 6
Mean performance on pre-treatment, post-treatment, and follow-up measures for VISTA participants. Note: 95% confidence intervals around the mean were derived using n=1,000 bootstrapped samples. Abbreviations: VISTA, video-implemented script training for aphasia; NAT, Northwestern Anagram Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 7
Figure 7
Mean pre- to post-treatment change scores (post minus pre) for participants completing VISTA in person or via teletherapy. Notes: Positive values indicate higher scores at post-treatment than pre-treatment. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: VISTA, video-implemented script training for aphasia; NAT, Northwestern Anagram Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 8
Figure 8
Mean change scores from post-treatment to 3-month follow-up (3 months minus post) for participants completing VISTA in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 3-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: VISTA, video-implemented script training for aphasia; NAT, Northwestern Anagram Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 9
Figure 9
Mean change scores from post-treatment to 6-month follow-up (6 months minus post) for participants completing VISTA in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 6-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: VISTA, video-implemented script training for aphasia; NAT, Northwestern Anagram Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.
Figure 10
Figure 10
Mean change scores from post-treatment to 12-month follow-up (12 months minus post) for participants completing VISTA in-person or via teletherapy. Notes: Negative values indicate higher scores at post-treatment than 12-month follow-up. Error bars are not presented as significance was derived via permutation tests. The 95% CIs obtained via permutation are presented in the text. Abbreviations: VISTA, video-implemented script training for aphasia; NAT, Northwestern Anagram Test; WAB AQ, Western Aphasia Battery Aphasia Quotient.

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