Rehabilitation and Prosthetic Services

Device Review: TalkPath Therapy by The Aphasia Company

Reviewed on September 5th, 2017

By Catie Kane, Stacy Gross

Overview

TalkPath Therapy is a comprehensive application established following 30 years of research on evidence based activities to improve language and cognitive function. It is accessed through an iPad or a web browser, and designed primarily for individuals with language or cognitive deficits secondary to stroke, injury, or illness. TalkPath Therapy includes eight major areas of focus: speaking, reading, writing, listening, memory, reasoning, news, and daily living. Each of these areas has multiple tasks that can be completed at varying difficulty levels, allowing patients or providers to create customizable activity lists tailored to individual needs. A TalkPath account can be created by an individual seeking additional practice or with guidance from a speech language pathologist who can create customizable treatment plans, provide feedback, track progress, and determine readiness for discharge or need for further intervention.

Indications

In general, the following criteria should be met for a veteran to use the TalkPath Therapy application:

1. Veteran should be evaluated by a speech-language pathologist to assess language and cognitive skills.
2. Evaluation must indicate language impairment interfering with veteran's ability to communicate and interact with others, or cognitive deficits impacting ability to safely and efficiently complete ADLs.
3. The veteran must have adequate vision, hearing, and dexterity (or an alternate method) to successfully and easily access an iPad or computer.
4. If using outside of therapy sessions, the veteran must demonstrate independent understanding and use of the application.
5. The veteran must demonstrate motivation and willingness to use TalkPath Therapy as indicated.

Contraindications

In general, TalkPath should not be used when:

1. Veteran does not demonstrate a language or cognitive impairment as determined by assessment.
2. Veteran does not own or have access to an iPad or computer (if using outside of therapy sessions).
3. Veteran does not have a physical access method to an iPad or computer (i.e. efficient hand movement).
4. Veteran is unable to demonstrate comprehension and utilization of application due to cognitive or physical barrier.
5. Veteran should not use TalkPath as a replacement for speech therapy services provided by a speech language pathologist.

Criteria for Evaluation of Assistive Technology Device

Affordability: TalkPath Therapy can be downloaded from the iTunes store at no charge with no hidden fees to create or update an account. However, it must be accessed on an iPad or computer, which can cost anywhere from $300-$1200. Because the application does not act as a direct source of alternate communication (as a text-to-speech application would), the cost of an iPad would not be covered for the use of this application alone. If a software malfunction arises, the Lingraphica customer service department can be contacted during business hours to troubleshoot the issue for free. If there is a repair needed for the device itself (iPad or PC), the price may vary depending on cause and extent of damage.

Compatibility: The application operates by PC or iPad only. There is no mention of the application being available by other means in the future; however, because iPads and desktop computers have become commonplace in most work and home settings, and are available at some public facilities (i.e. public library) at no charge, it is unlikely that the use of this application will become obsolete. That being said, because the development of applications is a relatively new phenomenon, it is possible that some of the veteran population may be unfamiliar or uncomfortable with the use of this technology.

Consumer Repairability: If there is an issue with the application, there is a 'Help' button on the main page to assist with general inquiries including set-up, navigation, settings, etc. If the 'Help' button does not include the desired information, it is likely that the Lingraphica customer service department would need to be contacted to assist in solving the issue.

Dependability: In order for consistent and dependable use with predictable levels of accuracy, the user must have access to an iPad or PC. The iPad must have a charged battery and is unable to be used in extreme temperatures or in water. Volume should be on and screen brightness should enable adequate sight of the screen. There are no other additional factors or special considerations for reliable use of the application.

Durability: The application is aimed to never expire or require major updates or changes. The durability of the application is also dependent on the durability of the device upon which the application is accessed.

Ease of Assembly: A Lingraphica Account must be created in order to access the application. To create an account as a speech therapist, personal information, occupational setting, and ASHA number are required for credibility. To set up an account as a patient, assistance from a speech therapist or caregiver may be beneficial, as typing/spelling ability is required as well as adequate insight into deficits. Account information for patients includes: personal information, medical diagnosis, onset of diagnosis, rate of recovery, and areas of desired improvement. 'General Settings' can be adjusted easily by caregiver or patient to fit individual preferences and maximize benefit (ex. # of tasks per exercise set, news categories, automation, timing, etc.).

Ease of Maintenance: The application in general is easy to maintain; software updates may be recommended at regular intervals at no cost. Maintenance of the workload on the application as a patient may depend on factors including the number of tasks assigned. Maintenance of the application as a speech therapist may become more difficult as number of clients on caseload increase.

Effectiveness: The application is evidence-based and includes tasks that mimic activities that would be completed during face-to-face speech therapy sessions. Objective data reports are created following activities that can be analyzed by a speech therapist to guide treatment plans or make adjustments. Due to the wide variety of tasks available, activity lists assigned to patients are customizable. However, because no two diagnoses present exactly the same, it is impossible for any standardized system to include every individual patient need. For example, a veteran may be able to practice repeating single syllable words, but would not be able to practice repeating his/her spouse's name. Although no studies were found that compare performance outcomes of patients using TalkPath Therapy application vs. other speech/language applications, Lingraphica does suggest that use of the application in conjunction with a speech therapist is likely to provide more benefit than independent use of the application without input from a specialist. The extent/rate of recovery of skills depends on many factors (i.e. severity of injury, date of onset, frequency of therapy, etc.) and varies by patient.

Flexibility: The application is fairly flexible for both providers and patients. There are four areas of rehabilitation included with this application: speech, language, cognition, and news. Each of the areas includes different sub-categories and each sub category includes multiple tasks. Each task can be completed at varying difficulty levels. Again, because of the variety available, it is possible for therapists to create individualized treatment plans based on patient needs. However, the application is unable to include all possible areas of improvement, as severity and type of deficits differ from individual to individual. Within the settings, the application also gives flexible options tailored to patient and provider preferences including number of tasks in sets, difficulty level, level/type of cueing, etc.

Learnability: The application is designed to be user friendly and provides step-by-step directions for set-up and use. Each button is clearly labeled on the page sets. For speech therapists, it is easy to create an account, add clients, and create an activity list for a patient. A 'Help' button provides additional general information. As a patient, each activity has a demonstration available to clarify instructions and expectations. However, in general, because the application is heavily language-based, it may be difficult for a veteran with Aphasia or other language/cognitive deficits to use effectively without guidance from an SLP or caregiver. In addition, if a patient is not savvy with technology, the application can be overwhelming due to large number of stimuli on each page. It is likely a veteran with language/cognitive deficits or one who is not familiar with technology in general, would need guidance and practice to be able to navigate and use the application effectively.

Operability: The application is designed to be easy and straight forward to operate. Controls and displays can be adjusted within the settings to fit patient preferences. Again, level of comfort operating the application may depend on familiarity with it. Someone with no technology knowledge may have difficulty with set up and navigation without guidance and practice.

Personal Acceptability: The application can be accessed via web browser on a desktop, laptop, or iPad. Because all of these devices are relatively mainstream in society, use of the application is usually deemed psychologically comfortable. Acceptability with use and practice of the application in public areas may differ based on individual comfort level and preferences.

Physical Comfort: Because the application does not need to be accessed constantly, there is no significant risk of physical or mental damage or strain. The application can be started and stopped whenever the user pleases.

Portability: A main goal of the application is to make speech therapy services a more portable option. The application allows for patients to complete customized treatment activities with the guidance and feedback of a professional while in the convenience of their own home. However, the portability of the application also depends on the device on which it is accessed. For example, while an iPad Mini can fit in a purse or backpack, a desktop computer is stationary and will be a less portable option.

Securability: In order to log in to the application one must enter a secure log in username and password. An email account is linked to the application in case this information is forgotten. The application is HIPAA compliant by allowing only the clinician to see the patient information entered. However, by nature, because the application must be used on an iPad or PC, the value and cost of these devices put it at higher risk for theft. If an iPad or computer is shared between colleagues, it is important that the client or clinician log out so no personal information is visable by another individual. In addition, some iPads have passcode and fingerprint technology that is utilized for increased security.

Supplier Repairability: If there is an issue with the application, Lingraphica can be contacted to provide assistance through the phone or via an instant message option on their website. If they are unable to solve the issue, they may require the device be sent in to their office to be repaired.

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