Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

The Table to Tablet (T2T) Speech and Language Therapy Software Development Roadmap.

BACKGROUND: Few studies have analyzed gains in using computers in speech and language therapy interventions for children with speech and/or language disorders when compared to a control group, but virtual tutors and computer-based visual feedback have been gaining interest in the literature. Previous systematic reviews mainly focused on development technological details of computer-based speech training systems or the potential of integrating mobile technology into education and rehabilitation, but recent systematic reviews have also evaluated the efficacy of computer-based speech and language therapy for children and how digital technology can support different activities, at school or elsewhere. OBJECTIVE: This study aimed to analyze a continuous communication and joint team approach to develop solutions focused on the real needs of end users, which digitally emulate reliable and validated physical intervention materials for children with speech sound disorders (SSD). METHODS: The Table to Tablet (T2T) software was developed using a design-based research methodology, which included four phases: activities development; ethnographic pretesting with a sample from the target population; software development; and beta-testing. The technology used to develop the software, the method used to ensure satisfaction and replay ability of the intervention materials, and results from the ethnographic and beta-testing phases are presented. RESULTS: Nineteen activities were developed during the first phase, which were then tested, with 7 service users, using a physical prototype. The beta-test approach included extensive testing and reformulation, supported by direct, nonparticipant observation and data collection using a questionnaire designed for children. Feedback was used to improve the software and interaction with users. CONCLUSIONS: The use of T2T-based intervention programmes by speech and language therapists (SLTs) will allow these professionals to make a better and more effective communication intervention, based on proven methodologies, that coexists in a structured physical and a digital version. These versions provide a full, 6-week intervention program, with minimal effort in preparing the session by the SLTs while delivering a very consistent intervention, with high replay value. A continuous communication and joint team approach was beneficial to the project and to the development of a solution focused on the real needs of SLTs and children with SSD. All problems were approached as a team with different skills and expertise, which minimized errors (eg, the developer making choices that would save him from spending time doing something that would not be used) and time spent. To add to this, the importance of integrating the end users as testers and collecting their opinions and actions per session allowed the production of better-targeted activities. TRIAL REGISTRATION: ClinicalTrials.gov NCT02490826; https://clinicaltrials.gov/ct2/show/NCT02490826.