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This is IT.

This is IT.

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Wade J, Woodward S. (2002)
The range of specialist software available for people with aphasia is limited. Software designed for other groups may nonetheless be useful to people with aphasia, and this article describes an evaluation protocol for clinicians to assess software and provides a review of a limited selection of seven software titles (My House, Smart Start English, Speech Sounds on Cue, Jigsaw, Co:Writer, Clicker 4, and Out and About). Ten questions were used in developing the protocol: (1) what language tasks are targeted?, (2) which client group will benefit? (3) hardware/software requirements and costs, (4) the ability required of the client, (5) clarity of visual presentation, (6) the feedback provided for correct/incorrect answers, (7) how are the results recorded and presented? (8) are software menu options customisable? (9) does the software have an authoring component to allow the clinician's exercises to be developed? and (10) Does the program allow different input devices to be used? A case example is provided, illustrating the use of the protocol to select appropriate software for a 73 year old aphasic and dyspraxic lady.
Wade J, Woodward S. (2002)
The range of specialist software available for people with aphasia is limited. Software designed for other groups may nonetheless be useful to people with aphasia, and this article describes an evaluation protocol for clinicians to assess software and provides a review of a limited selection of seven software titles (My House, Smart Start English, Speech Sounds on Cue, Jigsaw, Co:Writer, Clicker 4, and Out and About). Ten questions were used in developing the protocol: (1) what language tasks are targeted?, (2) which client group will benefit? (3) hardware/software requirements and costs, (4) the ability required of the client, (5) clarity of visual presentation, (6) the feedback provided for correct/incorrect answers, (7) how are the results recorded and presented? (8) are software menu options customisable? (9) does the software have an authoring component to allow the clinician's exercises to be developed? and (10) Does the program allow different input devices to be used? A case example is provided, illustrating the use of the protocol to select appropriate software for a 73 year old aphasic and dyspraxic lady.

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Published by: Speech & Language Therapy in Practice on Jul 04, 2013
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SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
13
computers
hatever we as therapists feel about them, computers are hereto stay. We are increasingly being asked about the possibili-ties of using a computer in therapy. But how does a busy clin-ician keep abreast of new software that becomes available soas to be able to respond to this in an informed and informa-tive way? And, given that software resources specific to individual client groups arelimited, could we be borrowing more from what is available to other client groups?Software reviews which evaluate the potential for application in speech and lan-guage therapy do exist. Wren (2001a; 2001b) provides a review of software for work-ing with children which was carried out as part of the ‘Hear IT, Sound IT’ project todevelop software appropriate for working on phonological difficulties in children.The Software Evaluation Booklet produced by the Aphasia Computer Team (1999) atthe Speech and Language Therapy Research Unit at Frenchay Hospital reviews soft-ware appropriate for people with aphasia. It covers some of the most widely knownsoftware such as
INTACT, REACT, Parrot 
and
Bungalow 
(see resources) as well as somerecreational and word-processing software. The evaluation process involved peoplewith aphasia giving their views.Therapists often report frustration at the limited choice and quality of specialistaphasia software available, not to mention the cost. The number of software titlesdesigned specifically for aphasia therapy, though growing, is still limited and is smallcompared to the number designed for the education sector in general. This articletherefore draws attention to the fact that software designed for other groups maynonetheless by useful to people with aphasia. We review a limited selection of seventitles (
My House, Smart Start English, Speech Sounds on Cue, Jigsaw, Co:Writer, Clicker 4
and
Out and About 
), none specifically designed for users with aphasia, and demon-strate in what ways these may be useful to them.There is a risk in any evaluation that the software reviewed is quickly superseded.We hope that our explanation of our evaluation protocol will enable readers to applyevaluation procedures independently, thus keeping abreast of innovation. In review-ing non-specialist software, we want to encourage readers to think broadly when itcomes to software resources.The task of systematically reviewing software taken from such diverse categories astherapy software, word processing software and recreational software is a challeng-ing one and inevitably results in distilling information to a summary. However, 10questions were borne in mind when developing the evaluation protocol:
1. What language tasks are targeted?
Software may target auditory language comprehension, written language compre-hension, speech sound production, word processing skills or visual skills. Just as withconventional therapy programmes, it is likely that you will get most from the softwareby picking and choosing aspects suitable for individual clients.
2. What is the intended client group and what other client groupsmay benefit?
Some software (for example,
My House
) has been designed primarily for children anduses cartoon type drawings, but may be useful with other client groups. If you havereservations regarding the suitability of software for adult clients, demonstrate it,explaining it was designed for use by children as well as adults, and let the user decidewhether it is acceptable or not. Even if aspects of the software are clearly appropri-ate, you may need to select and leave out those that are not. Certain parts of
Out and  About 
, which is designed for people with learning difficulties, are appropriate forpeople with head injury but will not necessarily be appropriate for people with apha-sia following a stroke.
if you want tokeep abreast of information technologyopen up newopportunities for clientsoffer therapy at bothimpairment andfunctional levels
Read this
With the range of software forpeople with aphasia limited,
 Julia Wade
and
Sarah Woodward 
use an evaluation protocol tocheck out packages designed forother markets. So, have youembraced the age ofinformation technology?Or is IT still just a pronoun incapitals? Whatever your level ofexperience and client group,read on to wise up to thepotential of computers.
 
W
Julia Wade and Sarah Woodward
This is
IT
 
computers
SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
14
strategy by the user. Trial and error is possible in
My House
when the instruction is simply repeatedtaking no account of the nature of the error. Inmost software, a maximum of three incorrectresponses is allowed before the target is demon-strated so, even where no informative feedback isgiven, the user knows the correct response will berevealed after three attempts.In
 Jigsaw 
no information is given as to why anyattempt at placing a piece of the jigsaw might be incor-rect and the piece is simply removed again. In
SpeechSounds on Cue
the users’ attempts are not recordedtherefore no feedback on production is given.This question does not apply to the adaptedword processing software because there is no pre-determined correct answer.
7. How are the results recorded andpresented?
Ideally the number of correct responses will bepresented graphically in a form accessible to thenon reader, as in
Out and About 
and
Smart Start 
.
My House
also gives the response time in secondsbut all feedback is in the written word which is afar less use-friendly medium for people with com-munication impairments.
Out and About 
alsoreports the time taken to complete the activityand whether a prompt has been needed.The recording and presentation of results doesnot apply to the adaptive word processing softwareas the purpose of this software is simply to facilitate
3. What are the hardware/softwarerequirements of the therapy software andcost of the software/extra user licenses?i) Hardware/software
If the software uses sound output, the computer willneed a sound card and speakers. Many recently pro-duced software packages will only run on Windows95 or later and may at some point become incom-patible with future versions of Windows.
ii) Software costs
Costs vary tremendously. It is worth consideringwhether you are likely to want to install the soft-ware on a person’s home computer or just use inclinic - and examining the price structure for multi-ple user licenses. For example, the cost of
My House
is £129 for a single user license, £449 for the5 user license, and £645 for a 35 user licence, a pricestructure clearly favouring large scale use in schoolsover home usage. By contrast, for the software
Out and About 
a single user licence costs £59, addi-tional user licenses are available at £10 each andthe recently introduced single license home user of£20 has allowed cheaper access for use at home.
4. What level of ability does the user need?
This is a very gross categorisation to act as a gen-eral guide. We have used a three point scale oflow-moderate-high. We felt some of the soft-ware reviewed could be appropriate for a broadrange of ability depending on how it is used.
5. How clear is visual presentation?
In
Co:Writer 
, an assistive word processing package,several windows need to be open simultaneouslyand users can be confused as to which windowthey are working in. As a result they may needsupport and facilitation for longer before beingable to use the software independently. However,in
Speech Sounds on Cue
, information on screen islimited to a visual demonstration of the lip shapethat corresponds to the target sound and the letterthat corresponds to this sound. Users thereforeneed fewer demonstrations before they are ableto use the software independently. We used asimple three star rating system to indicate clarityof presentation with one star indicating poorestand three stars greatest clarity.
6. Does the software provide interventionand feedback for incorrect/correctresponses?
In
Out and About 
the feedback given relates tothe nature of the error made. For example, theresponse “No, you need to find something towear when it’s
hot 
” is given when the user hasmistakenly selected an overcoat to wear in hotweather.
Smart Start 
also has some exerciseswhere the feedback relates to the error made,such as, “No that’s the banana, you want theapple”. This encourages linguistic processing offeedback rather than a repeat trial and error
      
Figure 1 Summary of evaluations
PackageMy House seriesSmart Start Speech Sounds JigsawCo:WriterClicker 4Out & AboutEnglishon CueDescription ofTask/SoftwareAppropriateclient groupsSupplierPrice(single licence)HardwarerequirementsLevel targetedVisual interface
*****************
Feedback
****0*N/AN/A***
on errorPresentation
****0N/AN/AN/A***
of resultsMenu
**000N/AN/A***
customisationpossibilitiesAuthoring
000***N/A***0
componentInput device
M K T S MMM K T SM KM K T SM K
Adapted wordprocessingsoftware designedfor all ages withlimited literacy skillsStroke, head injury,learning difficultiesCrick software£90W95, soundcard
Low-mod
Speech and languagetherapy softwaredesigned for the learningdisabled for work on allareas of auditorylanguage and memory
Stroke, head injury,learning difficultiesSemerc£59 (£20 homelicence)W95, soundcard
Low-mod
Adapted wordprocessingsoftware designedfor all ages whoneed some helpwith their writingStroke, head injury,learning difficultiesDon Johnston£149W95, soundcard
Mod-high
Software for doing jigsaws on thecomputer for allagesAllCrick software£30W95
Low-mod
Speech andlanguage therapysoftware designedfor work ondyspraxiaDyspraxiaPropellerMultimedia£90W95, soundcard
Low
English as a foreignlanguage softwaredesigned for anylearner to work onEnglish languageskillsStroke, head injury,learning difficultiesAVP£34W95, soundcard,SVGA video card
High
Speech andlanguage therapysoftware designedfor children towork on auditorycomprehensionStroke, head injury,learning difficulties,developmentallanguageLaureate Learning£129W95, soundcardMod
 p.16 
Ratings key:0=none*=poor**=good***=excellentInput device key:M=mouseK=keyboardT=touchscreenS=switch
 
SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
15
computers
Figure 2 Case example
Background
J, a 73 year old lady who had a left cerebrovascularaccident about 18 months ago, was referred to the secondauthor who provides a Computer Assessment and Trainingservice from Frenchay Hospital to support clients andtherapists in using computers in therapy. She has aphasiaand dyspraxia, which have severely affected her spoken andwritten output. She is ambulant around the house, butneeds a wheelchair to get about for longer trips. She hasgood functional use of both her hands.
Communication history
J’s levels of comprehension are compromised in formalassessment but rarely affect her social and functionalcommunication. Her speech is very limited and the few wordsshe has are often difficult to understand due to her dyspraxia.Her writing is restricted to initial one to three letter spelling.She reads well at sentence level. She is an active participant inall communication settings.
Current communication
J is a very sociable, confident and effective total communicator.She rates well in terms of communicative competence and usesher various strategies to respond, ask questions, initiate newtopics and indulge in general ‘banter’. However she obviouslyhas frustrations. J uses a combination of spoken single wordsaugmented with lots of clear, functional gesture; pointing; useof a communication book; use of a diary; use of a dictionary;and writing (initial one to three letter spelling). She has excel-lent levels of attention and concentration, anddemonstrates good potential for new learning.
Speech and language therapy input
When J was first referred, she was working on improving herwriting at a single word level, improving her reading atparagraph level and increasing her speech output.
Previous computer knowledge
J had never used a computer before and indeed was extremelynervous about doing so. Her husband felt similarly. Her speechand language therapist had some limited experience of usingcomputers, but did not feel certain of how to introduce theminto J’s therapy.
Reason for referral
J was referred to us by her speech and language therapistbecause she appeared to have so much potential and was soeager to try everything possible to increase her communicationabilities.
J’s aims:
to learn how to use a computerto then use the computer to work on the same areas as inspeech and language therapy sessions, independentlyto increase leisure opportunitiesto improve written output.
Software we looked at
1.
REACT 
(specific speech and language therapy language programme): We looked atusing this for work on reading comprehension, spelling and whole word sentencebuilding.2.
Co:Writer 
(word prediction package): We examined this to see if J could use herinitial letter spelling and whole word reading to generate some of her own writing.3.
Clicker 
(supportive writing tool): We considered using this for work on sentencebuilding skills in a functional way (writing cards and letters).4.
WAPS 
(basic keyboard familiarisation): We looked at this to see if it would help Jpractise finding her way around the keyboard.With help from the local speech and language therapist, we put together a therapyprogramme using a combination of three of these software packages (WAPS, REACT andClicker) which J would find motivating and of immediate functional use. The aim wasfor her to improve skills on some packages while putting these new skills to functional use,for example when writing cards and letters. Long-term, we will review progress withspelling and sentence structure with a view to introducing the fourth package (Co:Writer).We set up a loan computer at J’s home and trained J and her husband inoperating the various packages. We left a folder with detailed, user-friendly, step bystep, picture supported instructions for them to follow.
Outcome
J and her husband quickly became familiar with the operation of the computer and thelayout of the keyboard. J was able to find her way in and out of the software packagesand the various exercises we had set her with ease. J and her husband only neededone session of two hours to be using the computer independently (bearing in mind NOprevious experience). This was followed by four home visits each lasting 1
1
 / 
2
hours.Within a month they were eager to purchase their own computer and three monthsafter they had first set foot in the computer assessment and training service they werefully set up with their own PC (personal computer)and printer.J now uses the computer daily for:working on her spelling and sentence building skillswriting her Christmas (and now starting on her Easter) cardswriting to her family who live far awaycarrying out new hobbies such as making cards and playing games onthe computer. (J and her husband have now purchased varioussoftware packages themselves which they have figured out how to usewith minimal help.)J and her husband have also attended free IT lessons at the local library to boost theirskills and confidence. J feels extremely proud of her achievement given her age, lackof previous experience and language difficulties. She has mastered somethingwithout difficulty that others, without any language impairment, are still challengedby. She feels it has helped her work independently on certain skills thus giving hermore therapy. She also feels it has opened up new pastimes for which she is gratefulgiven that, like many people in her situation, a lot of her previous hobbies such asgardening and cooking are now impossible to realise.

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