On the Importance of Tailor-made Speech Relearning Software for
Stroke Rehabilitation
Awais Ahmad and Peter Mozelius
Department of Computer and System Science, Mid Sweden University, Östersund, Sweden
Keywords: Speech Relearning, Stroke Rehabilitation, User-centred Design, Independent Living, Older Adults.
Abstract: Post stroke rehabilitation is a global issue with increasing challenges today when the percentage of older
adults is increasing. There is a need for new solutions to better assist stroke survivors' normally long way back
to a good and independent life. The various post stroke impairments can be divided into the categories of
cognitive, motoric and speech impairment, and the three also have their interrelations. This position paper has
a focus on rehabilitation of stroke survivors' speech impairments, and the use of technology-enhanced systems
to assist the speech relearning. The current reuse of language learning software for primary school students is
doubtful, and should better be replaced by tailor-made and adaptable tools that fit the target group. Finally,
the recommendation is a long-term strategy where some initial costs should fund the design, development and
evaluation of new digital tools for speech relearning. This should be conducted in a collaboration between
researchers, speech therapists, stroke patients. The approach should be iterative and user-centred, with both
speech therapists and stroke patients as the end-users.
Stroke is a major cause of disabilities in adults where
a stroke survivor may suffer from long term physical
and mental impairments (Palmcrantz et al., 2017).
Due to a rapidly increasing percentage of older adults
all over the world, age-related chronic diseases are
also increased and stroke is one of those diseases
(Ahmad et al., 2019). It has some serious impacts on
the patient’s overall daily life activities and often, the
friends and family of the patients are also affected
(Mozelius et al., 2019). Stroke impairments and their
rehabilitation are generally divided into speech,
motoric and cognitive disabilities (Ahlin et al., 2019).
This position paper focuses on speech
impairments and the use of technology-enhanced
systems to perform different types of rehabilitation
exercises. After the stroke, patients’ ability to read,
write, speak and listen can be decreased (Tousignant
et al., 2018). Consequently, patient’s social and
professional life is deeply affected and usually, they
fail to continue their professional work and social
activities that may lead them to an isolated and
depressed state of mind (Ahmad et al., 2019).
Intensive and long-term rehabilitation is needed
right after the stroke that involves different kinds of
therapies and exercises (Palmcrantz et al., 2017).
However, the human and financial resources needed
for the rehabilitation after stroke are not enough in the
hospitals and rehabilitation centres (Zhang et al.,
2016). The compromised independent life of stroke
survivors is also an issue with traditional speech
rehabilitation therapies where patients need to stay in
the rehabilitation centres for a long time. Recent
studies highlighted that living independently in the
home environment has some positive impacts on the
patient’s health condition and the process of healing
becomes faster and more effective (Christophorou et
al., 2016, Ahlin et al., 2019). Different types of
technology-enhanced systems (TES) such as software
applications to perform relearning exercises can be
useful in this context (Ahmad et al., 2019).
However, several studies highlighted that
acceptance of TES also has some critical factors that
need to be addressed such as trust, e-health literacy,
personal integrity and usability (Ahmad & Mozelius,
2019, De Veer et al., 2015). Another critical factor
that has got less attention is the lack of tailor-made
software solutions for speech learning with a design
that builds on the target group’s special needs. Speech
therapists today, frequently use software applications
that are developed for primary school students in the
relearning process for older adults (Ahlin, Ahmad &
Ahmad, A. and Mozelius, P.
On the Importance of Tailor-made Speech Relearning Software for Stroke Rehabilitation.
DOI: 10.5220/0009561201760179
In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 176-179
ISBN: 978-989-758-420-6
2020 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
Mozelius, 2019). In this position paper authors argue
for the importance of speech relearning software that
is tailor-made for stroke survivors. Arguments have
been gathered in a mix of a literature study, and from
personal reflections on earlier studies on stroke
A stroke patient’s way back to a joyful life and
independent life after stroke is a long and tedious
journey, where patients and relatives have to struggle
hard for a successful relearning of earlier skills and
knowledge (Greveson & James, 1991; Broeren et al.,
2008). The various impairments can be divided into
the categories of cognitive, motoric and speech
impairment, where the cognitive part of the
rehabilitation has a clear relation to both the motoric
and the speech relearning aspects of stroke
rehabilitation (Ahmad, Mozelius & Ahlin, 2019).
Motoric rehabilitation deals with problems using
various body parts, while speech rehabilitation is
related to language and communication issues. Both
these impairments can severely the ability to read,
write, communicate and also stroke patients'
cognitive capacity (Seniów, Litwin & Lesniak, 2009,
Veerbeek et al., 2014, Pollock et al., 2014,
Toussignant et al., 2018). All three types of
rehabilitation ought to be based on an active everyday
treatment schedule, which could be challenging to
provide due to the cost of specialised therapists. An
effective alternative to the traditional long-term
rehabilitation could be the use of various TES.
However, if a TES based relearning should be
successful and effective there must be high quality
standards for both usability and for a design that is
appealing to the target group.
Speech and language impairments are very common
after stroke, and one out of three stroke survivors
suffer from these disabilities (Tousignant et al., 2018,
Greener et al., 1999). People with these impairments
face immense challenges in communication as their
capabilities to speak and listen are affected. The
intensity of these deficiencies may vary from patient
to patient where some people can understand and
speak a few words only, while others can
communicate almost fluently with some minor
problems (Egaji et al., 2019).
After the stroke, the relearning process of speech
skills has always been challenging for patients and
medical caregivers. A patient needs to perform
relearning exercises that can be very difficult with an
already impaired physical condition and medical
caregivers have to spend a lot of time in order to help
the patient with those exercises (Ahlin et al., 2019).
To achieve better efficiency and fast recovery, these
interventions are recommended to start as soon as
possible after the stroke (Ahmad et al., 2019).
After an initial examination and treatment at the
hospital, the patients are usually referred to the
rehabilitation centre, where the speech therapists
make a long-term or a short-term relearning plan
depending on the patients’ level of disability (Egaji et
al., 2019). Several studies showed that intensive and
long-term therapy is needed for an effective
relearning of speech and language skills (Øra et al.,
2018). However, the resources needed for that kind of
intervention are not enough in the rehabilitation
centres and the speech therapists complain that they
do not have enough time for the required therapies of
an increasing number of patients (Ahlin et al., 2019).
Technology-enhanced relearning exercises can play a
vital role in this context.
The use of technology in different types of
rehabilitation processes has been discussed for almost
last two decades and these technologies have shown
some potential benefits such as better accessibility,
improved quality of life, possibilities of independent
living and healthier social life (Zhang et al., 2016,
Tousignant et al., 2018, Rizzo and Kim, 2005).
However, the implementation of these technologies
has certain challenges that need to be addressed. One
challenge is the lack of adaptability and interest in
technology, especially the older population who are
not grown up with computers and smartphones seem
not to be comfortable with the use of software
applications (Ahmad and Mozelius, 2019). The use
of new tools is always difficult for people who
already face the communication problem due to
speech and language deficiencies (Simic et al., 2016).
In order to make TES accessible and useable for the
patients, they should be actively involved in the
development process (Roper et al., 2018).
As for all other tools used for rehabilitation, it is of
great importance that TES solutions for speech
relearning are tailor-made for the target group. There
are today few digital speech relearning tools available
On the Importance of Tailor-made Speech Relearning Software for Stroke Rehabilitation
that are based on both stroke survivors' and speech
therapists' needs. Furthermore, the TES tools should
better also have built-in adaptability to meet the
stroke patients' individual needs
A user-centred design and development seems
essential, with a dual focus on both stroke patients
and speech therapists as users. Some examples from
the speech therapists' wish list are interactive pictures
and video-clips where they can demonstrate the
content and the training instructions. The design
needs to focus on variation, with content and a
graphic design that is relevant for adults and older
adults. Another requirement is that the TES tools also
should be accessible for patients' relatives and
friends, who often play an important role in
successful speech rehabilitation after stroke.
The current habit of reusing language learning
software for primary school students ought to be
broken. This is a short-sighted strategy that in a
narrow perspective might save some costs, but goes
against the grain of fundamental healthcare
principles. At the same time, it can be offending for
someone in her seventies to carry out exercises in a
game designed for lower primary school.
Furthermore, a backstory with exercises related to
stroke survivors' daily tasks would also support the
rehabilitation alignment between speech relearning
and cognitive relearning.
Finally, stroke patients' often limited energy for
relearning should better be used on the actual
relearning. The software must have user-friendly
navigation and intuitive usability, considering the fact
that many stroke patients also suffer from visual
impairments. This should also include the hardware
in TES solutions, where new interfaces on laptops,
tablets and mobile phones can be difficult to navigate.
What already is in use, and can be further extended is
the concept of Bring Your Own Device (BYOD). In
a wider definition, BYOD could be described as “the
practice of people bringing their own laptops, tablets,
smartphones, or other mobile devices with them to
learning or work environments” (Johnson et al. 2016,
p. 36).
In light of recent studies on speech and language
recovery, this position paper emphasized on the
importance of customized digital solutions that are
explicitly built according to the patients’ current
physical and cognitive condition. Since the
rehabilitation exercises for speech impairments can
be performed in the home environment with the help
of tailor-made software applications, patients will be
able to live independently and their quality of life will
also be increased. However, these software
applications should be user-friendly and patients
should feel a sense of enjoyment by using TES.
Therefore, a user-centred design approach should be
adopted for the development of suggested TES.
Authors' recommendation is a long-term strategy
where some initial costs should be spent on design,
development and evaluation of TES for speech
relearning. This should be carried out in collaboration
between researchers, speech therapists and stroke
patients. The approach should be iterative and user-
centred, with both speech therapists, stroke patients
and patients' families and friends as end-users. An
interesting add-on feature would be a built-in analysis
of each patients' learning progression. Further details
for the design and development are described more in
detail here below in the next section.
The study highlighted the importance of tailor-made
software applications to perform exercises for
relearning speech skills after a stroke. Naturally, the
next step would be to develop the suggested software
application. In order to achieve the desired results, a
user-centred design approach should be adopted. A
typical user-centred design consists of five basic
steps: Interviews and observations with different
stakeholders, identifying the requirements, gathering
the ideas for prototype design, designing and
developing the prototype, and usability testing
(Dorrington et al., 2016). The requirements should be
gathered incorporation with researchers, software
developers, medical caregivers, and the patients for
designing an interactive and user-friendly software
The role of user experience (UX) designer and/or
UX researcher is very important in a user-centered
design approach. A UX designer needs to work
parallel both with users (patients and speech
therapists in the current context) as well as with the
software development team (Almughram et al.,
2017). Therefore, UX designers should be involved in
the process of designing a prototype and the software
engineers should work closely with them.
Finally, a comprehensive usability testing should
be conducted for the developed software application.
The input from the user experience will not only be
helpful to increase the ease of use and to provide
better interaction with the suggested TES, but it will
ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health
also give the researchers a better understanding of the
disabilities and limitations of stroke survivors.
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On the Importance of Tailor-made Speech Relearning Software for Stroke Rehabilitation