Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial

Emily Upton; Catherine Doogan; Victoria Fleming; Pedro Quijada Leyton; David Barbera; Peter Zeidman; Tom Hope; William Latham; Henry Coley-Fisher; Cathy Price; Jennifer Crinion; Alex Leff

doi:10.1016/j.eclinm.2024.102483

Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial

EClinicalMedicine. 2024 Feb 21:70:102483. doi: 10.1016/j.eclinm.2024.102483. eCollection 2024 Apr.

Authors

Emily Upton^{1

2

3}, Catherine Doogan^{1

2

4}, Victoria Fleming³, Pedro Quijada Leyton¹, David Barbera², Peter Zeidman⁵, Tom Hope^{5

6}, William Latham⁷, Henry Coley-Fisher⁸, Cathy Price⁵, Jennifer Crinion^{2

3}, Alex Leff^{1

2

9}

Affiliations

¹ UCL Queen Square Institute of Neurology, University College London, UK.
² Institute of Cognitive Neuroscience, University College London, UK.
³ Department of Psychology and Language Sciences, University College London, UK.
⁴ St George's, University of London, UK.
⁵ Wellcome Centre for Human Neuroimaging, University College London, UK.
⁶ Department of Psychology and Social Science, John Cabot University, Rome, Italy.
⁷ Department of Computing, Goldsmiths, University of London, UK.
⁸ The Information Lab, UK.
⁹ University College London Hospitals NHS Trust, UK.

Abstract

Background: Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this 'dosage' problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy.

Methods: Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, 'iTalkBetter', which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of 'trained' and 'untrained' items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081).

Findings: iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA's propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction.

Interpretation: Our findings suggested that iTalkBetter significantly improves PWAs' naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT.

Funding: National Institute for Health and Care Research, Wellcome Centre for Human Neuroimaging.

Keywords: Aphasia; Computerised therapy; Functional MRI; Randomised controlled trial; Speech production; Structural MRI.

Associated data

ClinicalTrials.gov/NCT04566081