in my experience

If a week is a long time in

politics, says Shirley Cotton, six years is a lifetime in

computer software, yet we are nothing like exploiting its INTACT package for people potential. Evaluation of the with aphasia shows that consultation and partnership with users - in this case speech and language therapists - is vital in finding out where you want to be and how best to get there.

Where do you want to go today? I

NTACT is a software package designed specifically for people with aphasia, developed in 1993 by our multidisciplinary Aphasia Computer Team. The software contains a library of over 500 exercises consisting of text, picture and sound based tasks to cover a range of activities from single word or picture matching to paragraph level tasks, and was used by Jane Mortley (1998) in her investigation of aphasia therapy. By the beginning of 2001, one hundred and fifty licensed copies of INTACT had been sold to speech and language therapists. As information officer, I had been involved in the development and marketing of the software and providing the support/training. During its early years INTACT was at the cutting edge of technology but if a week is a long time in politics, six years in computer software is a lifetime! In 1996 the operating systems DOS and Windows 3.1 were standard but during the following five years Windows 95, 98, 2000, ME and XP have superseded them. At the time of development INTACTs features were pushing technology to the very limit so the picture-based exercises were restricted to one picture on screen and sound samples were limited because the software was produced on 31/2 floppy discs.

The general observation was that good support is vital for software systems and one therapist reported that she would have given up long ago without it.

Read this
if you need to make a case for more computers want more appropriate software for your clients are wondering whether to upgrade or start from scratch

Questions
Over recent months a number of questions were beginning to emerge in terms of the future of INTACT as a therapy tool, so we decided to investigate its current usefulness through a questionnaire to speech and language therapists who had purchased it. The questions covered a range of issues including the installation of INTACT, number of clients using it, usefulness in therapy, ease of use, technical problems experienced, exercise types, training and improvements. During July 2001 the questionnaire was sent to the 150 named speech and language therapists who had purchased the software.

Sixty-eight therapists (45.3 per cent) responded and they broadly fell into three groups: those who are using INTACT as a clinical tool - 63.4 per cent using it with between 1-10 clients - 26.5 per cent using it with between 11-15 clients therapists who have progressed as far as installation but have still to introduce it into their clinical work those who have tried to use it but technical problems have not allowed them to progress. The majority (75.4 per cent) reported that INTACT had been installed within a month of purchase, 12.3 per cent took more than a month and 4.6 per cent had not yet installed the software. A high percentage (68.8 per cent) reported using INTACT with their clients within a month after purchase. Take-up for the free INTACT training course was high as over half (50.8 per cent) had already attended and 42.9 per cent stated they wanted to. However, the survey revealed that due to staff turnover there are often no therapists remaining in the department who have attended the INTACT course and this influences whether the software is used or not. It also appears that INTACT needs to have a consistency of use within speech and language therapy departments so that new members of those departments are routinely exposed to it as a therapy tool. Of the respondents who had used INTACT (89.9 per cent), 74.2 per cent reported that they had found it useful in therapy, with 63.3 per cent using it with between 1-10 clients. The responses revealed it is being used with clients with high, moderate and low levels of language ability. Over 71 per cent reported that they found the Exercise Finder (where the therapist provides a set of criteria and asks the software to suggest exercise titles) to be useful in selecting appropriate exercises, while 31.3 per cent reported that clients found INTACT easy to use, and 40.6 per cent that clients found it neither easy nor difficult to use. Altogether about two thirds of respondents had experienced technical problems. Of these, about

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SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2002

in my experience

Figure 1 Respondents suggestions

half have now been resolved whereas for the other half the problem is still outstanding. This has had an impact on therapists overall impression on how easy INTACT is to use with only 40 per cent describing it as very easy to use or easy to use. The early installation method by 18 floppy discs was long-winded (this was replaced by CD-ROM installation in later editions), and there are reports of interference with other programs and vice versa and occasional unexplained shut downs of the program. More recent computers were incompatible with the INTACT disk operating system, while older PCs had insufficient memory for INTACT. Soundcard incompatibility caused the most difficulty with 39.7 per cent of therapists reporting this problem. When INTACT was written DOS (Disk Operating System) was the most recent operating system and, as Plug & Play hadnt been invented, INTACT had to directly manipulate the soundcard by using a procedure that is now obsolete. For the early users of INTACT this didnt pose any difficulty, as more often than not their computer didnt have a soundcard already fitted and the required one was easy to obtain. However, as time went on, computers were being purchased complete with soundcards and these were sometimes incompatible.

(a) New exercise types spoken word - picture matching more functional vocabulary more picture based low level exercises linked with voice recognition software to give clients a written representation of speech attempts linking in with theory of cognitive neuropsychology higher level activities - auditory comprehension - verbs and prepositions - construction of sentences in response to pictures/sentence processing tasks - syntax and grammatical structures/correct word order - non-word tasks - written and auditory - compound words - picture rhyming - written phrase choices - sequencing exercises - inferencing exercises - conversation based exercises - phonological exercises - sorting by initial sound, rhyme judgements - embedded clauses - responses to semantically/pragmatically rich pictures - functional therapy exercises (e.g. writing cheques) - low frequency word exercises

(b) technical capabilities/design alterations: windows format to allow easier installation use of high quality photographs and video to cover different parts of speech incorporation of still/video pictures of gestural systems ability to record and hear spoken attempts/use of patients voice for activating exercises more auditory and visual instructions and rewards easier authoring of exercises clearer categorisation of exercises according to purpose/what they aim to achieve phonemic/graphemic cueing (c) selection/user interface for both clients and therapists: picture icons for selection of exercises by client simpler way to locate exercises in an Exercise Finder as categorisation can be a problem in INTACT larger buttons, cursors and text clearer menu page instructions to be more aphasia and user friendly use of clients voice for activating exercises more interactivity - symbols/videos/audio
easy to use reliable easily upgraded supported. With these needs met and the incredible advances that have already taken place in computer technology, the skys the limit for the next generation of software for people with aphasia. Shirley Cotton is Information Officer for the Aphasia Computer Team at the Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol.

Good support is vital

Therapists were asked to indicate how the Aphasia Computer Team help desk dealt with their technical problems. Overall it was reported that, with the exception of the soundcard difficulty, they resolved most technical problems. The general observation was that good support is vital for software systems and one therapist reported that she would have given up long ago without it. The therapists responses to the questionnaire showed they have clear ideas about what they need from software for therapy. Their suggestions (figure 1) fell into three areas:

a) new exercise types b) technical capabilities/design alterations c) selection/user interface for both clients and therapists. Although comments from therapists indicated that they found the INTACT concept a brilliant one, there are now too many barriers to its continued use in therapy. To remain a useful therapy tool INTACT would need to be extensively modified to take advantage of the new technology. It has been decided not to do this and so sales of INTACT have been suspended. We will of course continue to provide support for the software for as long as it is feasible. The Speech & Language Therapy Research Unit has collaborated in the production of the Step-by-Step software program used by Dr Jane Mortley in the Remote Based Therapy project. Step-by-Step will be available to speech and language therapists soon after September 2002 from Steps Consulting Ltd. The survey revealed that, overall, therapists like the concept of using computers to augment therapy but that a lack of resources affects how exploitable therapy software is. From the data gathered in the survey and from my experience of supporting and training therapists using INTACT it is clear therapists need/require: easy access to computers in clinic time to try out therapy software to explore the potential benefits time for training in understanding the basics of using computers and that they need therapy software that is:

Acknowledgement
I would like to thank the speech and language therapists who returned the completed questionnaires.

Reflections
Do I attempt to investigate further if I suspect something is no longer working? Do I take into account the time needed for familiarisation when buying resources? Do I give feedback to manufacturers about the usefulness of their products?

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2002

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