Enhancing Written Communication in Persons With Aphasia

Stroke is the third leading cause of death and the most common cause of disability in the
United States. According to the American Stroke Association, the prevalence of stroke in the
U.S. is approximately 4.8 million with approximately 700,000 additional strokes occurring
annually. Approximately 150,000 to 250,000 stroke survivors becoming severely and permanently
disabled each year. A common neurological deficit among stroke survivors, and thus a
substantial contributor to post-stroke disability, is aphasia. The loss of, or difficulty
with language is extremely debilitating.

Adequate written communication skills may be one of the barriers that has prevented
individuals with aphasia from returning to work. Writing skills are also important for
participation in social roles, such as household management, civic activities, or
recreational activities with friends. Individuals with aphasia struggle to compose written
documents such as personal letters, memos and reports. Furthermore, society's increased
reliance on written forms of communication including email correspondence, instant messaging,
texting, Twitter, and social networking sites such as Facebook, exacerbate the challenge that
individuals with aphasia have in connecting with others, reestablishing and redefining their
social roles and accomplishing their life-participation goals.

Computer-directed treatment offers a practical alternative to one-on-one traditional
treatment provided by a clinician and may be a cost-effective way of extending therapy beyond
the hospital and clinic to meet the needs of the growing numbers of individuals with chronic
aphasia and to help them reintegrate into the community and workforce. This project evaluates
the efficacy of a theoretically-motivated writing program that has been integrated with novel
computer-based virtual therapy systems and that can be provided intensively to individuals
with chronic aphasia.

Inclusion Criteria:

1. men or women with diagnosis of an aphasia subsequent to a left-hemisphere infarct(s)
that is confirmed by CT scan or MRI

2. an Aphasia Quotient score on the Western Aphasia Battery of 50-85.

3. 6 months post injury

4. premorbidly right handed, determined by Edinburgh Handedness Inventory

5. completed at least an eighth grade education

6. premorbidly literate in English

7. visual acuity may be corrected but must be sufficient for reading visual stimuli on
computer screen

8. auditory acuity may be aided but must be sufficient for hearing auditory stimuli in
ORLA program

Exclusion Criteria:

1. any other neurological condition (other than cerebral vascular disease) that could
potentially affect cognition or speech, such as Parkinson's Disease, Alzheimer's
Dementia, traumatic brain injury.

2. any significant psychiatric history prior to the stroke, such as severe major
depression or psychotic disorder requiring hospitalization; subjects with mood
disorders who are currently stable on treatment will be considered.

3. active substance abuse.