Acceptance and Commitment Therapy for Aphasia. For stroke survivors with aphasia, their psychosocial response to sudden and unexpected loss of language can inhibit or promote their ability to adapt and adjust post stroke. There is currently a critical need to better address psychosocial factors in aphasia rehabilitation and recovery. To meet this need, the current NIH-funded pilot project (1R03HD 104246-01) seeks to adapt Acceptance and Commitment Therapy (ACT) for stroke survivors with aphasia by integrating language compensation training. ACT is a behavioral intervention designed to improve psychological flexibility, allowing people to take meaningful action consistent with their values, even in the presence of emotional distress.
We believe that integrating ACT and language compensation training will be more than the sum of its parts. Language compensation training is only effective when generalized to often stressful real-world situations while ACT is only accessible to people with aphasia if language needs are deliberately supported. However, while ACT is effective for stroke survivors in general, no prior work has adapted ACT to meet the specific needs of people with aphasia, thereby excluding a large and vulnerable subset of stroke survivors.
Speed-accuracy tradeoffs and adaptation deficits in aphasia. People with aphasia (PWA) can experience large changes in their language abilities. Some PWA adapt well to these changes, while others do not, which can exacerbate their language deficits, or even create new maladaptive symptoms and behaviors. For example, when it comes to language processing speed, some PWA tend to respond impulsively, increasing the number of errors they make, while others tend to be overly conservation, spending much long than is necessary or helpful. In joint work with the Pittsburgh VA (PI: Evans), we are working on addressing this form of adaptation deficit by developing a new adaptive computer-based aphasia naming games designed help PWA more optimally balance the speed and accuracy of their performance during therapy.
Adaptive Scheduling and Stimuli Variability in Aphasia Treatment. Word-finding treatments for people with aphasia (PWA) often target treatment efficiency by training small sets of words in ways designed to improve production of both trained and related untrained words. Direct training effects tend to be large, but generalization to untrained words is much less consistent and effects tend to be smaller. Instead, we’re exploring a promising alternative in this pilot study: directly training a much larger set of words by adaptively scheduling how often individual words are practiced. Secondly, the language development literature has shown clear benefits of stimuli variability for the learning and generalization of new vocabulary and grammatical rules. However, most aphasia word-finding treatments involve practice naming a single picture exemplar, likely overtraining a stimulus-response mapping at the cost of treatment generalization. Therefore, we're also manipulating stimuli variability to see if presenting different versions and types of stimuli during treatment promotes improved word-finding for trained words in other contexts, such as discourse.
We believe the combination of stimuli variability and adaptive scheduling will help PWA regain many more words than is typical in current word-finding treatments, and will do so in ways that better generalize to real-world contexts. Finally, to help make this treatment accessible to clinicians and PWA, this project is using open-source flashcard software (Anki), which has been used successfully in the clinic (Evans et al., 2016) and is already freely available to the general public.
Aphasia Games for Health! Games are a powerful way to connect with others and improve psychosocial outcomes, and the Games for Health movement has used social games to improve healthcare outcomes. In this project, we are working to improve language and fight social isolation at the same time by creating new card-based aphasia treatment games people with aphasia will be able to play together in person, or remotely using existing video-conferencing software. This past fall, our team was selected as a finalist for the Pitt Innovation Challenge and received pilot funding to begin developing and prototyping Aphasia Games for Health. Our team consists of David Dow and Carol Dow-Richards from Aphasia Recovery Connection game design researcher Jess Hammer from Carnegie Mellon, award-winning indie game designers Hakan Seyalioglu and Kathryn Hymes from Thorny Games, and the members of Pitt LRCL. Together, we will be developing professional games based on rehab science, with the aphasia community as co-designers. Find out more about this collaboration at our website: https://www.aphasiagamesforhealth.com/