Digital Interventions in Neuro-Rehabilitation (DINR)
Research type
Research Study
Full title
Digital Interventions in Neuro-Rehabilitation: Two digital neuro interventions (DNIs) for word retrieval. The development and testing of two web-based therapy applications for people with naming difficulties caused by Stroke (iTALKbetter) or Mild-Moderate Dementia (Gotcha!).
IRAS ID
237795
Contact name
Alexander P Leff
Contact email
Sponsor organisation
University College London
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
3 years, 1 months, 23 days
Research summary
Summary of Research
The main aim is to test the clinical efficacy of two novel, web-based, rehabilitation applications funded by NIHR that were designed in Phase 1 of this study (REC 17/LO/1846).
iTALKbetter will provide an app-based therapy for people with naming difficulties caused by stroke (naming app for a wide variety of common words and phrases), while Gotcha! will be for patients with dementia (who have difficulty
naming people they know well). These two digital neuro interventions (DNIs) will provide the opportunity for the
necessary increased rehabilitation that help people recover lost function. This will alleviate NHS therapist (SALT) time
and put patients in control of when and where the carry out practice-based language therapy.
While both apps will be aimed at different patient populations, the underlying software and development pipelines are
almost identical, hence our combining them here for the purposes of ethical review.
Each app will go through three separate phases, each of which will require specific patient information sheets and
formal consent: Phase 1 (HRA approved) is development of the app (with patients as co-creators, currently underway); the second phase is a standard,
small-scale phase II clinical trial with randomized allocation of subjects; phase 3 is ‘roll-out’ where the app is made
publicly available. Ethical approval for phase 3 will only be sought after sufficient evidence for the efficacy of the apps is gained from phase 2. During phase 3 we will continue to ask scientific questions about the real-world functioning of the app in this phase.This application seeks approval for phase 2 only.
Summary of Results
iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. People With Aphasia (PWA’s) propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction.Our findings suggested that iTalkBetter significantly improves PWAs’ naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.ucl.ac.uk%252Ficn%252Fresearch%252Fresearch-groups%252Fneurotherapeutics%252Fprojects%252F%2FNBTI%2FpV3CAQ%2FAQ%2Fc7ee006d-e013-4169-94f3-0e3bfd90a22c%2F2%2F75zuUH2Cw3&data=05%7C02%7Capprovals%40hra.nhs.uk%7C94f7c3c787294a4930ac08de46ef87dc%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639026191767387280%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=vvTjq9eXS%2FIMsUHsYcwZzFfX%2FkclsrrMh7QZRKucnZk%3D&reserved=0
digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT.Gotcha!:
Findings: 48 People with Dementia (PwD) were recruited, 38 completed the trial, with a mean age of 75.7 years (SD 10.0). 50% were female. 26/38 had both pre- and post-therapy MEG data. Behaviourally, the group analysis demonstrated a large and statistically significant improvement in free-naming of trained 38%, (95% WS-CI 28-48%) versus untrained faces 3% (95% WS-CI -7-13%). In the single-subject analysis, 23/38 participants (61%) showed statistically significant better name retrieval during the therapy block compared with the pre-therapy block. The behavioural results were associated with a significant reduction in gamma-band activity for trained name retrieval only, in the left anterior temporal lobe (ATL)Interpretation: While a molecular cure for dementia remains an aspirational goal, there are powerful behavioural interventions that can significantly improve the lives of those living with dementia. Using a purpose-built app, we were able to target a common debilitating symptom, allowing users to make large gains in their ability to name some of the people important to them. The behavioural therapy works by engaging a key node within the naming network, the left ATL, which can be harnessed by item-based training, even in those with advanced dementia.
REC name
East of England - Cambridge East Research Ethics Committee
REC reference
18/EE/0228
Date of REC Opinion
5 Sep 2018
REC opinion
Further Information Favourable Opinion