Computerised therapy for acquired apraxia of speech
Professor Rosemary Varley and Dr Sandra Whiteside from Human Communication Sciences saw room for improvement in the way apraxia was understood and treated. Working with software engineer Geoff Cookmartin, they developed SWORD (Sheffield WORD), a carefully structured therapeutic software program.
Apraxia is a motor speech disorder that can arise following stroke. People with the condition have difficulty initiating and formulating speech, visibly groping for the right speech movements. Any speech that is produced can be slow, effortful and contain speech errors. Traditional therapy methods focus on training the patient to form words by breaking them down into their component sounds.
Dr Whiteside has been researching apraxia for over 20 years. As a speech scientist, she is interested in the psycholinguistic aspects of the condition and how it can be remedied. Funding from the Health Foundation in the early 2000s enabled trials of a prototype programme of structured therapy, leading to the development of SWORD.
A structured therapy programme
SWORD’s holistic approach trains the whole movements involved in speaking rather than focusing on the subcomponents of speech. Effective apraxia therapy needs intensive stimulation to trigger the reorganization of a damaged speech production system and encourage spontaneous word production. To do this, the software includes visual, written and spoken multimedia elements that deliver high intensity therapy in a cost-effective way. It is designed so that anyone can interact with the program and self-manage their treatment.
A strong evidence base supports the programme. In 2008, BUPA funded a clinical trial with over 50 participants. Results showed that using SWORD led to significant gains in people’s speech accuracy and fluency, as well as reduced articulatory groping and struggle behaviours. These were maintained after the therapy had stopped.
To make sure this valuable programme was available more widely, the research team worked with knowledge transfer company Fusion IP to find a commercial partner. Speech and language software company Propeller was identified as the best fit to market the product, and a contract was signed in October 2008.
SWORD is available in two versions: professional and home-user. The popular professional version, used by speech therapists in the UK and Ireland, can be tailored to create an individualised programme of therapy for the patient. By importing their own media, the therapist can incorporate special vocabulary or focus on particular items. The home-user version of the program allows people with post-stroke speech difficulties to access the therapy independently.
Both versions use standard British English pronunciation. User feedback has highlighted the difficulty in accounting for regional differences in accent, for example words like ‘bath’. A version for US users is in development to expand the programme’s reach.
Dr Whiteside believes that people with apraxia are benefitting from SWORD’s holistic approach: “There aren’t any other similar products. Not like this. This is unique because it’s a full intervention programme.”