The Best of Both Worlds: Combining Synchronous and Asynchronous Telepractice in the Treatment of Aphasia Telepractice is an appropriate model of service delivery for a person with aphasia (PWA). We define telepractice and its two modes of delivery (i.e., synchronous and asynchronous). We detail a technology, web-Oral Reading for Language in Aphasia (web-ORLA™), developed to provide aphasia treatment intensively from a distance and subsequently evaluated ... Article
Article  |   October 01, 2011
The Best of Both Worlds: Combining Synchronous and Asynchronous Telepractice in the Treatment of Aphasia
Author Affiliations & Notes
  • Leora R. Cherney
    Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL
    Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL
  • Rosalind C. Kaye
    Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL
  • Rachel S. Hitch
    Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL
  • Leora R. Cherney is professor of physical medicine and rehabilitation at Northwestern University's Feinberg School of Medicine and a senior clinical research scientist at the Rehabilitation Institute of Chicago, Chicago, IL. She has had more than 30 years of clinical experience working with adults with neurogenic communication disorders and presently directs the Center for Aphasia Research and Treatment at the Rehabilitation Institute of Chicago. Cherney is board-certified in neurologic communication disorders by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) and a fellow of both ASHA and the Illinois Speech-Language Hearing Association.
    Leora R. Cherney is professor of physical medicine and rehabilitation at Northwestern University's Feinberg School of Medicine and a senior clinical research scientist at the Rehabilitation Institute of Chicago, Chicago, IL. She has had more than 30 years of clinical experience working with adults with neurogenic communication disorders and presently directs the Center for Aphasia Research and Treatment at the Rehabilitation Institute of Chicago. Cherney is board-certified in neurologic communication disorders by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) and a fellow of both ASHA and the Illinois Speech-Language Hearing Association.×
  • Rosalind Kaye is project coordinator at the Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL. She was trained as an educational and clinical psychologist, and is the author or coauthor of a number of journal articles.
    Rosalind Kaye is project coordinator at the Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL. She was trained as an educational and clinical psychologist, and is the author or coauthor of a number of journal articles.×
  • Rachel Hitch has been an SLP for over 20 years. She has worked with both adult and pediatric patients with stroke, brain injury, brain tumors, and other neurological problems. Her practice has focused on re-entry into the community including return to school, return to employment, and, presently, community groups for persons with aphasia. In addition to clinical work, she has taught at the undergraduate level. Most recently, Rachel has been a research SLP at the Rehabilitation Institute of Chicago's Center for Aphasia Research and Treatment.
    Rachel Hitch has been an SLP for over 20 years. She has worked with both adult and pediatric patients with stroke, brain injury, brain tumors, and other neurological problems. Her practice has focused on re-entry into the community including return to school, return to employment, and, presently, community groups for persons with aphasia. In addition to clinical work, she has taught at the undergraduate level. Most recently, Rachel has been a research SLP at the Rehabilitation Institute of Chicago's Center for Aphasia Research and Treatment.×
Article Information
Telepractice & Computer-Based Approaches / Language Disorders / Aphasia / Articles
Article   |   October 01, 2011
The Best of Both Worlds: Combining Synchronous and Asynchronous Telepractice in the Treatment of Aphasia
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2011, Vol. 21, 83-93. doi:10.1044/nnsld21.3.83
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2011, Vol. 21, 83-93. doi:10.1044/nnsld21.3.83

Telepractice is an appropriate model of service delivery for a person with aphasia (PWA). We define telepractice and its two modes of delivery (i.e., synchronous and asynchronous). We detail a technology, web-Oral Reading for Language in Aphasia (web-ORLA™), developed to provide aphasia treatment intensively from a distance and subsequently evaluated during a clinical trial. In this article, we describe our experiences using web-ORLA™, highlighting the role of the speech-language pathologist (SLP) and discussing the advantages and disadvantages of this unique combination of synchronous and asynchronous telepractice. Web-ORLA™ was delivered to PWAs in their homes by a digital agent, or “virtual therapist,” who served as a model and provided instructions similarly to a real therapist. An SLP at a distant geographical location monitored the sessions remotely, either synchronously or asynchronously, provided feedback, made appropriate adjustments to the difficulty level of the stimuli, and conducted weekly probe assessments of the participants' performance. Advantages of web-ORLA™ include increased practice, SLP oversight, guidance by the agent, program simplicity, and a level of autonomy and flexibility afforded to the PWA. Given the rapid advances in technology, current technological problems that were encountered are likely to be mitigated.

Acknowledgments
This study was supported by Grant H133G060055 from the National Institute on Disability and Rehabilitation Research (NIDRR), Department of Education. Manuscript preparation was supported by Grant H133G070074 from NIDRR and Grant R21DC9876 from the National Institute on Deafness and Other Communication Disorders. We thank Edie Babbitt, Rosalind Hurwitz, and Jaime Lee, SLPs in the Center for Aphasia Research and Treatment at the Rehabilitation Institute of Chicago, for their assistance with testing and treatment of the participants with aphasia. Special thanks to Sarel van Vuuren, Nattawut Ngampatipatpong, and Jariya Tuantranont at The Institute of Cognitive Science at the University of Colorado Boulder for developing the telerehabilitation software and for their technical support.
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