Telemedicine Interventions for Aphasia

(PICTURE IT Trial)

Overseen By Argye E Hillis, MD, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Johns Hopkins University

Disqualifiers: Neurologic disease, Psychiatric illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 30 sessions

70 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment CoDeLT and PICTURE-IT for aphasia?

Research shows that computer-based and telemedicine treatments for aphasia, like CoDeLT and PICTURE-IT, can improve communication skills. Studies found that participants using similar remote therapies showed significant improvements in language abilities and reported high satisfaction with the treatment. ^{1 2 3 4 5}

Is telemedicine for aphasia safe for humans?

The studies on telemedicine interventions for aphasia, including remote therapy and computer-based treatments, do not report any safety concerns, suggesting that these treatments are generally safe for humans. ^{2 3 4 6 7}

What makes the CoDeLT, PICTURE-IT treatment unique for aphasia?

The CoDeLT, PICTURE-IT treatment is unique because it uses telemedicine to deliver therapy remotely, allowing patients to receive treatment from home, which can be more convenient and accessible compared to traditional in-person therapy. This approach leverages technology to engage the right hemisphere of the brain, which is different from many standard therapies that focus on face-to-face interactions. ^{2 5 7 8 9}

What is the purpose of this trial?

This trial is testing two types of speech therapy for stroke patients who have trouble speaking. One therapy engages the right side of the brain, and the other helps with naming objects. The goal is to see which therapy improves speech better.

Research Team

Argye E Hillis, MD, MA

Principal Investigator

Johns Hopkins University

Eligibility Criteria

This trial is for adults over 18 who've had a stroke between 1 to 4 months ago, leading to aphasia with difficulty in naming objects. Participants must be able to give consent and understand therapy tasks. It's not for those with severe vision/hearing loss, non-English speakers, or individuals with other brain-affecting diseases or severe psychiatric conditions.

Inclusion Criteria

I have trouble finding words due to a stroke.

I can give my own consent or appoint someone to do it for me.

My stroke happened 1-4 months ago or more than 6 months ago.

Exclusion Criteria

Prior history of severe psychiatric illness, developmental disorders or intellectual disability (e.g., PTSD, schizophrenia, obsessive-compulsive disorder, autism spectrum disorders)

Lack of English proficiency (by self/legally authorized representative report)

I have had a brain-related condition before, but not a stroke.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Computer Delivered Lexical Treatment (CoDeLT) Intervention for 15 sessions followed by PICTURE IT Intervention for 15 sessions, or vice versa

30 sessions

Follow-up

Participants are monitored for changes in discourse and naming abilities post-treatment

2 months

Treatment Details

Interventions

• CoDeLT
• PICTURE-IT

Trial Overview The PICTURE IT study tests two language therapies using telemedicine for post-stroke aphasia: one stimulates the right side of the brain (PICTURE IT) and another computer-based treatment improves naming (CoDeLT). The effectiveness of each will be compared in a randomized order with blinded assessors.

Participant Groups

Group I: PICTURE IT Intervention-CoDeLT Intervention Experimental Treatment 2 Interventions

Participants will receive PICTURE IT Intervention for 15 sessions followed by Computer Delivered Lexical Treatment (CoDeLT)Intervention for 15 sessions

Group II: CoDeLT Intervention-PICTURE IT Intervention Active Control 2 Interventions

Participants will receive Computer Delivered Lexical Treatment (CoDeLT) Intervention for 15 sessions followed by PICTURE IT Intervention for 15 sessions

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

Findings from Research

A home-based, computer-delivered intervention significantly reduced communication difficulties in 20 adults with chronic aphasia, showing a decrease of 6.79 points on the Communication Difficulty subscale of the Burden of Stroke Scale during the intervention (P=.038).

The improvements in communication were maintained during the follow-up period, suggesting that this intervention could be a promising approach for enhancing conversational skills in individuals with aphasia, although further research is needed to confirm its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-reported changes in communication after computer-based script training for aphasia. Manheim, LM., Halper, AS., Cherney, L.[2022]

The Web ORLA® treatment significantly improved language performance in adults with chronic aphasia, showing notable gains both immediately after treatment and six weeks later, with effect sizes indicating meaningful improvements.

While the initial gains from treatment were similar to the control group, the Web ORLA® group demonstrated significantly greater language improvements at the six-week follow-up, highlighting the long-term benefits of this intensive, remote therapy combined with clinician oversight.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Web-based Oral Reading for Language in Aphasia (Web ORLA®): A pilot randomized control trial. Cherney, LR., Lee, JB., Kim, KA., et al.[2022]

In a 12-week study involving nine individuals with chronic aphasia, participants showed significant improvements in communication skills, with the Communicative Effectiveness Index increasing by an average of 17.8 points (p = .01) and the Communication Confidence Rating Scale improving by 10.4 points (p = .0004).

Participants also reported high satisfaction with the teletherapy services, and their independent practice of online language exercises increased over the course of the study, indicating that the combined approach of therapy and self-practice was effective.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study. Steele, RD., Baird, A., McCall, D., et al.[2020]

In a case series study involving seven participants with long-standing aphasia due to a cerebrovascular accident, all individuals showed improvement in word finding after receiving home-based language therapy monitored via the Internet.

Additionally, four out of the seven participants experienced enhancements in their overall communication skills, suggesting that this therapy approach can be effective for individuals with aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of computerised rehabilitation for long-term aphasia: a case series study. Mortley, J., Wade, J., Enderby, P., et al.[2018]

Telerehabilitation (telerehab) for treating reading deficits in patients with phonological alexia was successfully implemented, showing significant improvements in reading similar to traditional in-person methods.

Participants reported high satisfaction with the telerehab approach, indicating that it is not only feasible but may also be as effective as face-to-face treatment while saving resources for both patients and clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful remote delivery of a treatment for phonological alexia via telerehab. Getz, H., Snider, S., Brennan, D., et al.[2018]

In a study involving 23 chronic aphasic patients, the use of a computer-based treatment system led to significant improvements in language function, as measured by standardized assessment tools like the Porch Index of Communicative Ability and the Boston Naming Test.

The therapy sessions, conducted by speech-language pathologists, demonstrated that innovative technology can effectively enhance communication abilities in patients who had previously received traditional therapy, indicating a promising approach for long-term rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting recovery in chronic aphasia with an interactive technology. Aftonomos, LB., Steele, RD., Wertz, RT.[2019]

A feasibility study involving 21 participants with aphasia showed that word finding therapy delivered remotely via video conferencing significantly improved picture naming abilities compared to an attention control group.

The study demonstrated high treatment fidelity and participant satisfaction, indicating that both remote and face-to-face therapy methods are effective for delivering this type of intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: a quasi-randomised controlled feasibility study. Woolf, C., Caute, A., Haigh, Z., et al.[2022]

In a pilot study involving 62 participants with post-stroke aphasia, speech-language telerehabilitation delivered via videoconference showed significant improvements in repetition and sentence production scores compared to usual care alone, indicating potential efficacy in language rehabilitation.

No adverse events were reported during the study, suggesting that telerehabilitation is a safe intervention; however, a larger definitive trial with 230 participants is necessary to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia-a pilot randomized controlled trial. Øra, HP., Kirmess, M., Brady, MC., et al.[2022]

The study demonstrated that standardized assessments for aphasia can be effectively conducted online via videoconferencing, showing no significant differences in scores compared to face-to-face assessments among 32 participants with aphasia.

Participants reported high satisfaction with the online assessment experience, indicating that telerehabilitation could be a viable and effective alternative for ongoing treatment of aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing acquired language disorders in adults via the Internet. Theodoros, D., Hill, A., Russell, T., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Patient-reported changes in communication after computer-based script training for aphasia. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Web-based Oral Reading for Language in Aphasia (Web ORLA®): A pilot randomized control trial. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Effectiveness of computerised rehabilitation for long-term aphasia: a case series study. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Successful remote delivery of a treatment for phonological alexia via telerehab. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Promoting recovery in chronic aphasia with an interactive technology. [2019]

7. England pubmed.ncbi.nlm.nih.gov

A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: a quasi-randomised controlled feasibility study. [2022]

8. England pubmed.ncbi.nlm.nih.gov

The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia-a pilot randomized controlled trial. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Assessing acquired language disorders in adults via the Internet. [2022]