Purpose: This article describes computer software that was developed specifically for training conversational scripts and illustrates its use with 3 individuals with aphasia. Method: Three participants with chronic aphasia (Broca’s, Wernicke’s, and anomic) were assessed before and after 9 weeks of a computer script training program. For each participant, 3 individualized scripts were developed, recorded on the software, and practiced sequentially at home. Weekly meetings with the speech-language pathologist occurred to monitor practice and assess progress. Baseline and posttreatment scripts were audiotaped, transcribed, and compared to the target scripts for content, grammatical productivity, and rate of production of script-related words. Interviews with the person with aphasia and his or her significant other were conducted at the conclusion of treatment. Results: All measures (content, grammatical productivity, and rate of production of script-related words) improved for each participant on every script. Two participants gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from the exit interviews—increased verbal communication, improvements in other modalities and situations, communication changes noticed by others, increased confidence, and satisfaction with the software. Conclusion: Computer-based script training potentially may be an effective intervention for persons with chronic aphasia.

Background: The construct of communication confidence was introduced by participants and family members during qualitative post-treatment interviews as part of a research study using a computer programme to deliver language therapy. However, there was no standardised method of evaluating communication confidence. Therefore the Communication Confidence Rating Scale for Aphasia (CCRSA) was developed, asking persons to self-rate communication confidence. Aims: This study reports data from the second phase of the project in which the CCRSA was revised to include 10 items. This revised 10-item self-rating scale of communication confidence (CCRSA) was evaluated psychometrically. Methods & Procedures: The revised 10-item questionnaire was administered 94 times to 47 participants with aphasia from a variety of settings. Psychometric properties of the 10-item CCRSA were investigated using rating scale (Rasch) analysis. Outcomes & Results: Person reliability of the 10-item CCRSA was .81. The four-category rating scale demonstrated monotonic increases in average measures from low to high ratings. However, one item (“How confident are you that you can participate in discussions about your finances?”) slightly misfitted the construct defined by the other items (mean square infit = 1.54, item-measure correlation = .48). Conclusions: Our findings suggest that the CCRSA is a psychometrically sound tool for assessing participants' self-report of communication confidence. Further evaluation of the CCRSA is warranted to examine sensitivity to change and inter- and intra-rater reliability.

Telerehabilitation (telerehab) offers cost-effective services that potentially can improve access to care for those with acquired neurologic communication disorders. However, regulatory issues including licensure, reimbursement, and threats to privacy and confidentiality hinder the routine implementation of telerehab services into the clinical setting. Despite these barriers, rapid technological advances and a growing body of research regarding the use of telerehab applications support its use. This article reviews the evidence related to acquired neurologic speech and language disorders in adults, focusing on studies that have been published since 2000. Research studies have used telerehab systems to assess and treat disorders including dysarthria, apraxia of speech, aphasia, and mild Alzheimer disease. They show that telerehab is a valid and reliable vehicle for delivering speech and language services. The studies represent a progression of technological advances in computing, Internet, and mobile technologies. They range on a continuum from working synchronously (in real-time) with a speech-language pathologist to working asynchronously (offline) with a stand-in virtual therapist. One such system that uses a virtual therapist for the treatment of aphasia, the Web-ORLA™ (Rehabilitation Institute of Chicago, Chicago, IL) system, is described in detail. Future directions for the advancement of telerehab for clinical practice are discussed.

Studies of aphasia treatment have shown that intensive speech-language therapy is associated with significant improvements. However, there is no standard definition of intensity and the simplistic notion that “more is better” is not necessarily supported by the research. First, current evidence regarding intensity and aphasia treatment was briefly summarized. Second, studies that directly compare conditions of higher- and lower-intensity treatment for aphasia were reviewed with regard to the inclusion of parameters that contribute to a definition of intensity. In addition to five parameters proposed by and highlighted by , total number of sessions was also often documented. The review illustrated the complexity of quantifying the dose of comprehensive treatments that target multiple modalities and utilize a variety of different strategies. Third, data from a study reporting a relationship between intensive computer-based script training and outcomes in aphasia were examined. Results serve to illustrate Baker's contention that intensity alone is insufficient without also considering the active ingredients of the teaching episode. Information about dose, therapeutic inputs, and client acts can lead to better optimization of an intervention.

Background: A growing body of research in aphasia treatment has indicated that greater amount and intensity of treatment is associated with better outcomes in individuals with chronic aphasia. AphasiaScripts^TM is a computerised conversational script training program that simultaneously collects accurate, reliable data about amount and intensity of treatment. Aims: The purpose of this study was first to investigate the relationship between amount of treatment and improvement on conversational script performance in persons with chronic non‐fluent aphasia, and second to investigate the influence of severity of language impairment on this relationship. Methods & Procedures: We collected computer‐generated treatment data from 17 participants with chronic non‐fluent aphasia during the 9‐week AphasiaScripts^TM treatment protocol. Participants practised three individualised conversational scripts for 3 weeks each. We computed two measures of outcome performance: percent change in script content (script‐related words) and percent change in rate (script‐related words per minute). Outcomes & Results: Amount of treatment varied greatly, from 1.9 to 16.9 hours per week. Amount of treatment was significantly correlated with percent change in script content (r = .67, p<.01) and rate (r = .53, p<.05), after an outlier was removed from the analyses. Severity of aphasia, measured by the Western Aphasia Battery Aphasia Quotient (WAB AQ), was negatively correlated with amount of treatment. When the sample was divided into two severity groups based on WAB AQ scores, amount of treatment was significantly correlated with improvement in content in participants with more severe aphasia, and significantly correlated with improvement in rate in participants with less severe aphasia. Conclusions: Results are consistent with previous studies that support the relationship between aphasia treatment intensity and outcomes. Severity of aphasia and individual participants' characteristics also impact the relationship between intensity and improvement. Individual participants' treatment trends and characteristics of participants who benefit the most from conversational script training are discussed.