Evidence-Based Speech Therapy Software

Research Evidence Basis for Bungalow's Speech Therapy Software

Therapists are concerned (as they should be!) about the evidence basis for treatments they either recommend or implement. People therefore frequently ask us if we have any evidence basis for our software. To answer that question, first we must be sure to look at the complete definition of evidence-based practice, per ASHA:

"Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values."
(Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1)

The two parts of Evidence Based Therapy

Design of the software
In some cases, we can show that the design of the software is based on specific research. In some cases, the software is the only practical way to provide some types of therapy.
Treatment with the Software
Speech therapy software is a tool, just like flash cards or worksheets. So we'll look at the evidence basis for the actual use of the tool in therapy. For example, research showing the benefit of picture naming would apply to flashcards or speech therapy software that works in the same manner.

1. Evidence Basis in the Design

Bungalow Software products are intended to be treatment or practice materials used within the context of treatment (and as home program activities). They were developed based on research supported, evidence-based treatments used every day in clinics and hospitals. In today’s climate of restrictive insurance reimbursement, they exemplify an emphasis on the third aspect of the evidence-based medicine triad: patient values. Patients tell us every day how important independent home practice is in their overall recovery.

What follows is a resource outlining the research basis which shaped the development of the software, and the specific treatment paradigms it was designed to support. Because Bungalow Software has always had the mission of providing cost-effective tools for therapists and home-use customers in the treatment of speech and language disorders, many of the programs have been developed with maximum user flexibility. This allows therapists to configure a single program in many different ways, so that it may conform to a variety of treatment paradigms, as well as a range of patients’ levels of function.

One program, Sentence Shaper 2, is in itself an evidence-based treatment. Research studies have shown improved speech for those with aphasia, improving their Mean Sentence Length from 3.6 words per sentence to 11.56 word per sentence.The treatment paradigm is dependent upon software function in order to be implemented – the treatment cannot be implemented without the software.

All of our products have years of clinical experience and testimonials (of both patients AND therapists), confirming their usefulness as part of an overall treatment program. All of the programs offer cost-effective resources for patients to pursue continued speech and language stimulation and practice, with appropriate clinical feedback and cueing – without regard to insurance coverage issues, and without the barriers of transportation and limited access to services in any specific geographic area.

Evidence Basis for MoreSpeech.com

MoreSpeech.com is our newest therapy software. It's web-based, allowing it to run on just about any modern device.

Apraxia lessons based on the Rosenbek Hierarchy

The treatment used in this app incorporates the stimulation/facilitation model. Duffy & Coelho's (2001) provides an excellent description and analysis of Schuell's (1953, 1964, 1974) original theory and the subsequent work of researchers who support the concepts that

Sensory stimulation influences brain activity;
Repetition of sensory stimulation is needed for acquisition, organization, and retrieval of patterns of behavior;
The auditory modality is central to acquisition and maintenance of language;
The auditory modality is severely compromised for most aphasic people; and
If aphasia is defined as a multimodal language impairment, then intense stimulation treatment should be directed through the auditory modality because of its essential role in language processing.

All lessons use an easy-to-understand match-to-sample format, which remains virtually unchanged throughout the app so as to minimize task and response requirements, allowing the user to focus solely on the content of each lesson.

The Motor Speech/Apraxia of Speech lesson block is adapted for the app from the 8-step treatment continuum described by Rosenbek and his colleagues in their classic 1973 article. Visual modeling of articulatory posture and movement (referred to in their article as v1) is provided in the app by videos detailing closeups of the speaker's lips, tongue and jaw. Auditory (referred to as a) and printed text (referred to as v2) are also presented during presentation of the appropriate steps.

Try the Rosenbek Hiearchy, free in Morespeech

Or watch a demo video of it.

Research References

Coelho, C.A., Sinotte, M. P. & Duffy, J. R. Duffy (2001). Schuell's Stimulation Approach to Rehabilitation (403-449). In Chapey, R. (Ed.), Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders (Fifth Edition). Philadelphia: Wolters Kluwer/Lippincott Willians & Wilkins.

Rosenbek, J. C., Lemme, M. L., Ahern, M. B., Harris, E. H., & Wertz, R. T. (1973). A treatment for apraxia of speech in adults. Journal of Speech and Hearing Disorders, 38, 462–472.

Schuell, H. (1953). Auditory impairment in aphasia: Significance and retraining techniques. Journal of Speech and Hearing Disorders, 18, 14-21.

Schuell, H., Jenkins, J. J., & Jiménez-Pabón, E. (1964). Aphasia In Adults. New York: Harper & Row.

Schuell, H. (1974). Aphasia theory and therapy: Selected lectures and papers of Hildred Schuell (Sies, L. F., Ed.). Baltimore: University Park Press

Sentence Shaper 2
This software was designed upon a theory of aphasia which hypothesized that persons with aphasia (PWA) have expressive language difficulties rooted in slowed language processing, taking longer to think of words, and having those words vanish from memory before they can be combined into sentences. The software allows users to record spoken fragments, play them back, and build them into sentences by manipulating icons on the computer screen.

For a more complete description view the SentenceShaper research summary.

List of publications specific to Sentence Shaper:

Linebarger, M.C., Schwartz, M.F., Romania, J.F., Kohn, S.E., & Stephens, D.L. (2000). Grammatical encoding in
aphasia: Evidence from a "processing prosthesis". Brain and Language, 75, 416-427.
Linebarger, M.C., Schwartz, M.F., & Kohn, S. E. (2001). Computer-based training of language production: An
exploratory study. Neuropsychological Rehabilitation, 11(1), 57-96.
Linebarger, M.C., McCall, D., & Berndt, R.S. (2004). The role of processing support in the remediation of
aphasic language production disorders. Cognitive Neuropsychology, 21, 267-282.
Linebarger, M.C., & Schwartz, M.F. (2005). AAC for hypothesis-testing and treatment of aphasic language
production: Lessons from a processing prosthesis. Aphasiology, 19, 930-942.
Bartlett, M.R., Fink, R.B., Schwartz, M.F., & Linebarger, M.C. (2007). Informativeness ratings of messages
created on an AAC processing prosthesis. Aphasiology, 21:5, 475-498.
Linebarger, M.C., McCall, D., Virata, T., & Berndt, R.S. (2007). Widening the temporal window: Processing
support in the treatment of aphasic language production. Brain and Language, 100, 53-68.
Fink, R.B., Bartlett, M.R., Lowery, J.S., Linebarger, M.C., and Schwartz, M.F. (2008) Aphasic speech with and
without SentenceShaper: Two methods for assessing informativeness. Aphasiology, 22, 679-690.
Albright, E., & Purves, B. (2008) Exploring SentenceShaper: Treatment and augmentative possibilities.
Aphasiology, 22, 741-752.
Linebarger, M.C., Romania, J.R., Fink, R.B., Bartlett, M., & Schwartz, M.F. (2008) Building on residual speech:
A portable processing prosthesis for aphasia. Journal of Rehabilitation Research and Development, 45:9, 1401-
1414.
Dahl, D.A., Linebarger, M.C., and Berndt, R.S. (2008) Improving automatic recognition of aphasic
speech through the use of a processing prosthesis. Technology and Disability, 20, 283-294.
McCall, D., Virata, T., Linebarger, M., & Berndt, R.S. (2009) Integrating technology and targeted treatment to
improve narrative production in aphasia: A case study. Aphasiology, 23(4), 438-461.
True, G., Bartlett, M. R., Fink, R. B., Linebarger, M. C. & Schwartz, M. (2010). Perspectives of persons with
aphasia towards SentenceShaper To Go: A qualitative study. Aphasiology, 24(9), 1032-1050.

2. Evidence-Basis for use in Treatment

References arranged by deficit area
General articles supporting the improvement in patient engagement in treatment, and language outcomes of unsupervised computer use for:

Acquired Reading Disorders

Verbal Expression
Written Expression
Apraxia & Dysarthria

Pederson, P.M., Vinter, K., & Olsen, T.S. (2001), Improvement of oral naming by unsupervised computerized rehabilitation. Aphasiology, 15, 151-169

Petheram, B. (1996). Exploring the home-based use of microcomputers in aphasia therapy. Aphasiology, 18, 187-191.

Katz, R.C. (2001). Computer applications in aphasia treatment. In R. Chapey (Ed.) Language intervention strategies in aphasia and related neurogenic communication disorders (pp. 718-741). Philadelphia: Lippincott, Williams, & Wilkins

General Articles supporting patient improvement through massed or distributed practice to improve carryover of compensatory strategies:

Hinckley, J. and Carr, T.H. (2011 ASHA Convention) Attentional Systems that Support Communication and Intervention.

Treatment of Acquired Reading Disorders:

Using these programs:
Aphasia Tutor 1: Words
Aphasia Tutor 2: Sentences
Aphasia Tutor 3: Paragraphs and Stories
Aphasia Tutor 4: Functional Reading
These 4 programs implement the evidence-based approach of allowing a client to move systematically from recognition of letters and single words, through sentences and paragraphs. Tasks begin with simple matching, progressing to comprehension (assessed through multiple choice questioning), with each level building upon semantic and syntactic complexity from previous levels. Software allows easy adjustment of text size and font, contrast, and provides assistance with visual scanning.
References:
Webb, W.G., and Love, R.J., Treatment of acquired reading disorders. Language Intervention Strategies in Adult Aphasia, Third Edition Chapey, R., ed., 446-455
Katz, R.C., and Wertz, R.T. The efficacy of computer-provided reading treatment for chronic aphasic adults. Journal of Speech, Language, and Hearing Research, 40, 493-507.

Treatment of Verbal Expression

Using these programs:
Sights ‘n Sounds 1
Sights ‘n Sounds 2
These 2 programs have been designed with flexibility to work on verbal expression skills in conjunction with a variety of evidence-based treatment approaches. Sights ‘n Sounds 1 focuses on the single word level, and Sights ‘n Sounds 2 at the phrase and sentence level.

Specific user settings allow them to be used for:

Constraint Induced Language Treatmenet (CILT):
This treatment requires a verbal-only response (speech), requiring production of a target word, phrase, or sentence, from a picture cue. An important component of CILT is massed practice, with several hours per day of activities eliciting specific verbal responses, usually in picture naming or description tasks. When configured to display a picture only, with no model or text, the user is required to produce target vocabulary or syntactic structures. Their productions are recorded, then played back for them, immediately followed by a pre-recorded model for comparison. Use of computer activities for CILT allows users to attain the intensity of treatment which has been proven to enhance success, regardless of insurance coverage limitations.
Oral Reading for Language in Aphasia (ORLA):
This treatment approach utilizes choral reading aloud, shaped to independent oral reading, to enhance verbal production. Both Sights ‘n Sounds 1 and Sights ‘n Sounds 2 can be configured to “hide” picture cues, and require the user to read text cues aloud. The program can initially be set to play the model text, timed synchronously with display of the text on the screen (for the choral reading component). This can then be faded, requiring the user to read independently. Again, productions are recorded and played back for the user to compare with the pre-recorded model. Further, Sights ‘n Sounds 1 vocabulary is arranged by syntactic category (nouns, verbs, and a lesson of adjectives and adverbs) , and in Sights ‘n Sounds 2 text may be displayed with either content words or functor words “masked,” to promote focus on specific syntactic categories.

Script Training:
Both Sights ‘n Sounds 1 and Sights ‘n Sounds 2 allow the development of custom lessons, allowing users to practice custom vocabulary, and complete scripts. The “partner” portion of the script can be displayed as text first, with the “patient” portion displayed during training (with the click of a button), and then faded as performance improves.

Additional programs for verbal expression:

Categories and Word Relationships provides extensive practice with high specificity vocabulary and semantic analysis, which has been shown to improve word retrieval.
Additionally, the programs Aphasia Tutor 1 and 2 employ practice with computerized expressive typing tasks, which have been shown to enhance verbal (spoken) expression.

Research References:

Cherney, L. R. (1995). Efficacy of oral reading in the treatment of two patients with chronic Broca’s aphasia. Topics in Stroke Rehabilitation, 2(1), 57-67.
Cherney, L.R., et al. (2011) Telepractice & aphasia treatment: A randomized placebo-controlled clinical trial. ASHA convention
Cherney, L.R., et al. (2008) Evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. Journal of Speech, Language, and Hearing Research, (15), 1282-1299.
Cherney, L.R., Holland, A., and Cole, R. (2008). Computerized script training for aphasia: Preliminary results. American Journal of Speech-Language Pathology, (17) 19-34.
Cherney, L. R,. (2010a). Oral reading for language in aphasia (ORLA): Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia. Seminars in Speech-Language Pathology, 31, 42-51
Cherney, L. R. (2010b). Oral reading for language in aphasia (ORLA): Evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Topics ins Stroke Rehabilitation, 17(6), 423-431.
King, R.M., Henry, M.L., Rapcsak, S.Z., and Beeson, P.M. (2009 ASHA Convention) Effects of semantically-based lexical retrieval treatment.
Markley, E. and Drew, R. (2008 ASHA Convention). Model-based treatment of lexical-semantic reading deficits in aphasia.

Treatment of Written Expression

The programs Aphasia Tutor 1, Aphasia Tutor 2, and Synonyms, Antonyms, and Homonyms can all be used to facilitate graphemic representations of single words in a supported approach, progressing from copying letters and words through confrontation naming tasks, phrase, and sentence completion. Numerous citations exist which support the training of spelling and written naming skills, both as an end in themselves, and as a support to spoken language. The programs utilize a stimulation approach, enhancing the stimulus until it can produce a correct response from the client.

References:

Beeson, P.M. (1999) Treating acquired writing impairment: Strengthening graphemic representations. Aphasiology, 13, 367-386.
Beeson, P.M., Rising, K. & Volk, J. (2003). Writing treatment for severe aphasia: Who benefits? Journal of Speech-Language-Hearing Research, 46, 1038-1060.
Pederson, P.M., Vinter, K., & Olsen, T.S. (2001), Improvement of oral naming by unsupervised computerized rehabilitation. Aphasiology, 15, 151-169

Treatment of Apraxia and Dysarthria

Speech Sounds on Cue employs proven articulatory-kinematic treatments, including a dynamic visual model, graphemic and cloze cue, and articulatory placement instruction.
Speech Pacer gives users a choice of metronomic or metrical pacing, to be tailored to the needs of the client.

References:

Brendel, B., & Ziegler, W. (2008). Effectiveness of metrical pacing in the treatment of apraxia of speech. Aphasiaology, 22(1), 1-26.
Brendel, B., Ziegler, W. & Deger, K. (2000). The synchronization paradigm in the treatment of apraxia of speech. Journal of Neurolinguistics, 13, 241-327.
Duffy, J.R. (2005). Motor speech disorders: Substrates, differenctial diagnosis, and management (2nd ed.) St. Louis, MO: Elsevier Mosby.
Dworkin, J.P., Abkarian, G.G., & Johns, D.F. (1988) Apraxia of speech: The effectiveness of a treatment regime. Journal of Speech and Hearing Disorders, 53, 280-294.