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.

1 INTRODUCTION

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 &

176

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

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

rehabilitation.

2 STROKE REHABILITATION

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.

3 SPEECH RELEARNING

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).

4 THE IMPORTANCE OF

TAILOR-MADE SPEECH

RELEARNING SOFTWARE

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

177

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).

5 CONCLUSION

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.

6 RECOMMENDATION

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.

7 FUTURE WORK

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

application.

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

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also give the researchers a better understanding of the

disabilities and limitations of stroke survivors.

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