Computer-based treatment of poststroke language disorders: a non-inferiority study of telerehabilitation compared to in-person service delivery

摘要

Background: Telerehabilitation promises to greatly expand access of underserved populations to speech therapy, but concerns remain about the effectiveness of services delivered remotely compared to in-person treatment.Aims: To evaluate the effectiveness of telerehabilitation, we conducted a randomized non-inferiority trial for chronic poststroke communication disorders, testing whether equivalent gains can be expected from in-person vs. telerehabilitative clinical service delivery, with both groups completing homework exercises outside of therapist contact time.Methods & Procedures: We treated 44 participants with aphasia or cognitive-linguistic communication disorder (CLCD). Treatment comprised tablet-based homework exercises and realistic, customized treatment plans tailored to the needs of each individual client. Clients had weekly 1-h sessions with the therapist over 10weeks, with the interaction randomized to in-person and telerehabilitation conditions. Objective gains were assessed with the Western Aphasia Battery aphasia quotient (WAB-AQ) (for aphasia) and Cognitive-Linguistic Quick Test (CLQT) (for CLCD) and subjective gains with the Communication Confidence Rating Scale for Aphasia (CCRSA) (self-rating) and Communication Effectiveness Index (CETI) (partner rating).Outcomes & Results: Participants improved significantly on all of these measures, with statistically equivalent gains between in-person and telerehabilitation groups for WAB-AQ, CLQT, and CETI. Only the CCRSA showed an advantage for the in-person group. Gains on WAB-AQ were correlated with total time spent on offline exercises.Conclusions: Clinician-guided computer-based treatment is effective for producing widespread gains in language and communication skills in chronic stroke. Linguistic gains are equivalent whether clinician services are provided via telerehabilitation equipment or in person. Communicative confidence may still benefit from in-person treatment, reinforcing the need for social engagement in addition to deficit-focused linguistic treatment.