1. Running Head: THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION !1
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The Effects of Computer Software Intervention on Patients with Chronic Aphasia on Sentence
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Structure and Spoken Language
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Samantha Singh
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California State University, Chico
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2. THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION !2
Chronic aphasia patients struggle with their expressive language. Although they desire to
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communicate with others, they often lack the skills and confidence to produce significant verbal
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output. With the progression of technology, a new form of intervention has surfaced: computer
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software intervention. Specifically, there have been studies conducted to improve spoken
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language and sentence structure in order to provide patients with practice and a newfound
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confidence to communicate. In studies administered by Linebarger, Schwartz, and Kohn (2001)
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a computerized language therapy program was used by patients to improve their sentence
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structure. Additionally, in two separate studies by Palmer (2015) and Nicolas, Sinotte, and Helm-
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Estabrooks computer software programs were used to increase their verbal output. Despite these
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studies, the idea of computer software intervention still requires additional research in order to
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confirm its positives effects on patients’ language.
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Furthermore, computer software intervention for aphasia has grown so much that there
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has been a software finder developed. This software finder is called the Aphasia Software Finder
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and it was designed by and maintained by speech language pathologists. “The site helps potential
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software users identify options available to meet their language practice requirements” (Palmer,
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2015, p. 40). Another study that highlights the positive effects of computer software is a
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study that was done using a program called StepbyStep. StepbyStep allows speech language
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pathologists to “tailor the computerised therapy exercises to the patient’s linguistic needs using
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personally relevant vocabulary…” (Palmer, 2015, p. 40). Then, the specified software is given to
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the patient to use for daily practice within their home. Also, in order to help with computer
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accessibility and support for language practice, there were volunteers involved, like relatives.
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The pilot study of StepbyStep on its patients occurred in 2012. There were 34 patients

3. THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION !3
and they were evaluated over a period of 5 months. Compared to their beginning use of spoken
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words, the patients improved significantly. “The study suggested that self-managed computer
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therapy, supported by volunteers could help people with aphasia to continue to practise,
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improving their vocabulary and confidence talking” (Palmer, 2015, p. 40-41). In addition, it was
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found that the study was cost effective, while still improving the quality of life of the patients.
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The results of this study were mirrored when this same program was used in a clinical
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practice in England. It was found that patients were able to practice significantly more than they
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could with a therapist face to face. Also, the patients were able to use this therapy for years after
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to continue improving their spoken words. Overall, this software allows for a cost effective,
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continuous treatment for patients with aphasia, while still allowing for large gains with their
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ability to use spoken words.
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Additionally, another computer software intervention that has shown improvements in
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patients with aphasia is a program called C-Speak Aphasia. This program seeks to help chronic
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aphasia patients with very limited verbal output by using C-Speak Aphasia to express
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themselves. “Using C-Speak Aphasia, patients learn to select icons from semantic category
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groups and put them together to create novel messages in the form of statements, commands, and
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questions” (Nicolas, Sinotte, & Helm-Estabrooks, 2005, p. 1054). After creating these messages,
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the user is able to select the message display and the message is spoken for them.
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There were five patients followed in the study, each of the patient had suffered from left-
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hemisphere stroke and had chronic non-fluent aphasia as a result. When beginning the program,
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all of the patients had less than one word of spontaneous verbal output. The program consisted of
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“generative language, in which the participant learns how to produce statements, ask questions,

4. THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION !4
and give commands using C-Speak Aphasia and learns to use the personalized autobiography
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screen; communicating on the telephone using C-Speak Aphasia; and communicating via
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writing and/or email” (Nicolas, Sinotte, & Helm-Estabrooks, 2005, p. 1056). In order to measure
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the effects of using the program, the quantity of expressions was compared between when
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patients used the computer program and when they didn’t. There were five tasks the researchers
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focused on when measuring results including, “responding to a set of seven autobiographical
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questions, describing a set of five pictures, describing a 1-minute non-verbal video showing a
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mother and two children in a kitchen, making two telephone calls, and writing a birthday card
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and a grocery list” (Nicolas, Sinotte, & Helm-Estabrooks, 2005, p. 1057). The results of the
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study conveyed that three of the five patients had significant improvements and were able to
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express more than they had prior to using C-Speak Aphasia.
In addition, an exploratory study by Linebarger, Schwartz and Kohn (2001) administered
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a computer software described as a “computerised language therapy system incorporating natural
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language understanding(NLU), software which allows the computer to process spoken sentences
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by means of speech recognition (conversion of spoken sounds into text) combined with
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interpretation (analysis of linguistic structure)” (Linebarger, Schwartz, & Kohn, 2001). This
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software intervention was given alone without other communication system therapy to three
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patients. This software intervention was intended to be used at home by the patient and for them
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to work on it independently.
In order to measure the results of the intervention, pre-post tests were administered. The
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measures that were used to record success were “number of correct locative picture descriptions,
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5. THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION 5
number of locative descriptions (correct and incorrect) that contain semantically appropriate
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prepositions… and incorrect picture descriptions incorporating the trained structure” (Linebarger,
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Schwartz, & Kohn, 2001). Following the intervention, all three subjects showed improved, more
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complex sentence structure. In addition, the subjects found the computer software to be user
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friendly and were able to master its use quickly.
These results encourage the use of computer software as intervention for chronic aphasia.
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It suggests that improved language production is possible, even when intervention occurs within
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a patient’s home and independently. Furthermore, this article mentions that it has been previously
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thought that independent therapy must be combined with face to face therapy to in order to be
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effective. These results challenge those beliefs and suggest the exploration of other forms of
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independent computer software intervention.
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Although these studies reveal the potential of using computer software intervention for
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patients with chronic aphasia, the research still has some limitations. For example, in all of the
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studies described above, there was never a large sample of people using the intervention. It is
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unclear if the same results would occur if the computer programs were administered on larger
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groups. Another limitation is that there are not many computer softwares for patients with
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chronic aphasia used yet, since this form of technology appeared within the past two decades.
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Lastly, the research has a significant limitation, all of the studies have a different procedure of
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measuring improvement, it is difficult to compare the studies to each other.
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As mentioned previously, the use of computer software intervention is a new, developing
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procedure. Despite this, the studies have shown improved sentence structure and verbal output in
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the patients that have utilized these programs. The programs allow for patients to work

6. THE EFFECTS OF COMPUTER SOFTWARE INTERVENTION 6
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independently, within the comfort of their home, at their own pace, and without the limitations of
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constant face to face meetings. Because of this, more studies should be conducted to confirm the
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positive effects of computer software intervention. Specifically the computer software programs
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should be administered to a larger sample and the studies should measure the results in the same
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way, in order to compare the results more effectively.
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Patients with chronic aphasia have limited verbal output and difficulties producing
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complex sentences. In order to combat this problem, computer software interventions should be
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studied further to evaluate their effectiveness on the patients’ language. Future studies should be
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conducted on a larger sample of patients and measure results similarly in order to eliminate the
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limitations of past studies and reveal patients’ improvements from using the computer software
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intervention.
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References
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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. doi:
10.1080/09602010042000178
Nicholas, M., Sinotte, M., & Helm-Estabrooks, N. (2005). Using a computer to communicate:
Effect of executive function impairments in people with severe aphasia. Aphasiology,
19(10-11), 1052-1065. doi:10.1080/02687030544000245
Palmer, R. (2015). Innovations in aphasia treatment after stroke: technology to the rescue. British
Journal of Neuroscience Nursing, 38-42.
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