2002 Conference Proceedings

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Returning To Work With Aphasia Through The Use Of Assistive Technology

Norman Rothstein, MS, OTR/L
Rehabilitation Technologist
Cerebral Palsy of New Jersey
354 South Broad Street
Trenton, NJ 08608
888-322-1918
Nrothstein@cpofnj.org

Colleen Koeppel, MS, CCC/SLP
Clinical Case Manager
MossRehab Hospital
Drucker Brain Injury Center
Community Re-Entry Program
135 S. Broad Street
Woodbury, NJ 08096
856-853-9900 x201

Background Information

Aphasia following a stroke leaves an impact on an individual's whole life. The ability to communicate following an acquired brain injury is a critical factor with regard to success in returning to work. A person with aphasia often knows what he/she would like to express but is unable to formulate this idea by written or verbal means. This presentation is a case study of an individual with non-fluent aphasia and how she uses technology to maximize productivity at work. It will cover two specific software titles (Clicker 4 and TextHelp Read & Write 5) used concurrently in a non-traditional manner to support the individual communication needs of someone with aphasia.

At the time of the initial assistive technology assessment, Leigh showed deficits in all four language modalities (speaking, listening, reading, writing), with language production somewhat more impaired that language comprehension, and written language more impaired than spoken language. Functionally, Leigh was able to verbally produce sentences to make herself understood, by using very simple vocabulary. She typically produced errors in every novel sentence, characterized either by word retrieval difficulty, verbal apraxia or syntactic errors. Typical syntactic errors were in choice of prepositions, subject-verb agreement, and verb tense. Her ability to understand information was good for short utterances and approximately 70% for paragraph length material. In writing, Leigh experienced similar, but more severe, difficulty. Apraxia was significant and sound-letter correspondence was poor, so that she often faced the challenge of writing the first letter of a word without the ability to determine the correct vowel to continue. Leigh was able to generate single words at times to supplement verbal expression, and sentences such as "He is eating" with good reliability. Error recognition for writing was more impaired than speech, so that if Leigh was able to generate a functor word, and it was incorrect, she was not able to correct her mistakes even if complete word substitutions were made. The only wholly reliable method of generating writing was by copying. Reading comprehension at the paragraph level was similar to listening comprehension, also affected by vocabulary choice and length of written material.

Technology Use

Clicker grids are grids that appear on the computer's screen. A benefit of Clicker is that a grid can contain pictures, words or any type of multimedia to aid the user with aphasia by bridging the gap between knowing what an item is by its appearance and knowing it by its name. When an item is clicked upon, the computer speaks the word aloud. Leigh can then hear how it sounds thus helping her determine if it is the desired word.

Initial Clicker grids were built by dividing lists of problematic words into syntactic categories. The first grid included sections for temporal adverbs, subjective pronouns, forms of "to be," and objective pronouns; using this grid, simple sentences could be built by adding content words. Other grids included demonstrative pronouns, question words, common verbs, and prepositions related to location. Categories of words are added to new grids as Leigh's writing improves.

Clicker was set up to remain the top window on the computer at all times. After clicking on an item within her clicker grids, Leigh uses Read & Write 5 in its traditional manner. Read & Write is a grammar and reading assistance program that is specifically designed to aid individuals with specific learning disabilities. Leigh relies on Read & Write's word prediction (word completion assistance based on rules of grammar and frequency of use) so that she can complete a word by knowing only the initial letters of the word. Leigh will also use Read & Write's word wizard (interactive thesaurus and dictionary) to get additional information on the word, including synonyms, thus solidifying her word choice. An integral portion of Leigh's computer setup is the use of Read & Write's text to speech capabilities (ability to have the computer read documents aloud). A large part of Leigh's workday is using the computer for both writing and reading purposes. Leigh's computer is set up with Read & Write always available, thus allowing her to use text to speech to assist her with reading emails and proofreading work documents. In addition, if Leigh encounters a word she is unable to say clearly due to apraxia, she will use text to speech to practice listening to the word, and thus improving speech output.

The combination of using Read & Write for text to speech to increase comprehension, word prediction to aid generation of words, and the word wizard for determining synonyms of common words, along with Clicker 4's ability to help Leigh with sentence syntax enables Leigh to perform typical work tasks.

This presentation will discuss in depth Leigh's computer setup, how her software was chosen and how her software is set up at work. Additionally, this presentation will include a case study segment including video segments depicting Leigh's writing abilities both before and after she started using the software.

ENDNOTES E. 1) Read & Write Version 5, TextHelp Inc. 2) Clicker 4, Crick Software


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