Improving Electronic Written Communication in Aphasia

An acquired impairment in writing, also known as agraphia, is a characteristic symptom of
aphasia, i.e., a language disorder resulting from damage to the language centers of the
brain. Written communication via text and instant messaging, electronic mail, and various
types of social media has become an increasingly important part of everyday life in our
technology driven society. Consequently, difficulty with written expression can significantly
restrict people with aphasia from participation in community life, including social,
professional, and educational realms. Improving writing in persons with aphasia could improve
communication, increase access to information, reduce isolation and facilitate social
connectedness. Furthermore, delivering writing treatment via an electronic modality, such as
texting, could be particularly advantageous given the increasing reliance on electronic
communication. This study investigates the efficacy of T-WRITE, a computer-based writing
treatment for aphasia that targets phrase/sentence level writing using texting. Its aims are
to: 1) evaluate the efficacy of computer-based texting treatment for improving written
communication in persons with aphasia and 2) assess the extent to which improvements in
electronic written communication impact social connectedness and health-related quality of
life (HRQOL). This will be accomplished via a randomized controlled trial across two sites
that compares computer-based texting treatment (T-WRITE) to a control group that receives a
hand-writing treatment (ORLA+WTG).

The intervention is delivered via computer using state-of-the-art virtual therapist
technology. A perceptive, life-like animated computer agent (virtual therapist), using
visible speech, guides the participant so he or she can independently work through the set of
choral reading and writing activities (see figure above showing a screen shot of the virtual
therapist). The objective is to assure an optimal learning experience in the comfort of the
participant's home by using a virtual therapist with accurate visible speech feedback. The
virtual therapist reads aloud, speaks with accurate visible speech, highlights and repeats
words and sentences, directs the participant to copy/write phrases or sentences, and provides
guidance much like a real therapist. The sequence of steps in the ORLA+WTG and the T-WRITE
treatments are identical. The output modality for participants randomized to T-WRITE is
texting using a cellular phone whereas participants in the ORLA+WTG will hand-write their
responses using pen and paper. Participants will practice their writing for 90 minutes a day,
6 days a week for 4 weeks.

Inclusion Criteria:

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

2. Aphasia Quotient score on the Western Aphasia Battery-Revised of 40-85.

3. > 6 months post injury

4. premorbidly right handed, determined by Edinburgh Handedness Inventory

5. completed at least an eighth grade education

6. premorbid proficiency in English by self-report

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. active substance abuse.