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Aphasia Apps Take a Big Leap Forward

  • Broadcast in Health



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If you liked this show, you should follow Lingraphica.

Lingraphica's TalkPath Suite of Speech Therapy Apps for the iPad are the culmination of 22+ years of dedicated research.

During those years, we've learned so much about how those with aphasia can improve their communication abilities so they can return to their communities.

In this quick and informative show you'll learn how unique the Lingraphica apps are. You'll learn how our unique approach to customer support makes a huge difference. And you'll learn how a different kind of company is making a lot of noise in the aphasia therapy market.

Speech-language pathologists will find this show very informative.


0:22 Steve St. Clair

Hi everyone. Welcome back to Lingraphica Radio. My name is Steve St Clair. With us today is Andrew Gomory, the CEO of Lingraphica. How is it going Andrew?

0:31 Andrew Gomory

Really well Steve. Thanks.

0:33 Steve St. Clair

Well, in this episode, we've got a lot to talk about. We wanted to get more in depth about the new speech therapy apps you announced recently at the ISAAC 2012 show. Those of you who have just joined, feel free to call in if you want at 347-850-1792. That's for the live show. So Andrew, let me ask you a couple of quick questions. Can you briefly tell us why Lingraphica is known as the Aphasia Company?

1:02 Andrew Gomory

Sure. You know, Lingraphica, during its 22-year existence, has only focused on aphasia and really, in particular, older adults with aphasia. So going back to the research on which the whole company is based, it was done in the Palo Alto VA from 1985 to 1990, which followed up on a long line of research on aphasia. Originally, we worked within the VA where the research was done, ultimately expanded out to a number of therapy clinics and we always of course had our various speech-generating devices, our talking computers and now with the apps and the new therapeutic apps. But the focus all along has always been adults with aphasia. And it's a very specific small niche. We really have got to know what -- you know, for example, the reimbursement realm, what people want, what kind of vocabulary is used, what style of communicators people are and a lot of their social issues around dealing with as most of this is from a stroke, how people are dealing and coping with stroke, the change in their loved ones, who are the really effective caregivers are, so it's really a very interesting world and it's one that we have kept ourselves to. You know, there are other companies out there that do wonderful jobs with other disabilities like autism and ALS and we let them be the experts in that and we try and stay the experts in aphasia.

2:26 Steve St. Clair

So within that world, you're working directly with people with aphasia but you're also working with speech-language pathologists, is that correct?

2:34 Andrew Gomory

You can just say SLPs. Yes, that's absolutely. Yeah. We really have -- we kind of think of three main groups of people that we spend a lot of time with. One is of course the people with aphasia, sometimes called PWAs. The second group is their caregivers. Often, that's a spouse but depending on the situation, it could be another relative, a child or a grandchild or a friend or if they're in a facility, could be professional clinical caregivers, and then of course the SLPs or the speech-language pathologists themselves, and of course the clinicians are very important to us especially in our device business. They are the gate keepers to providing our users with access to the insurance benefits. But those are the three groups and we work with them all pretty closely.

3:30 Steve St. Clair

You're proud of yourself on something you call the patient-centered approach. Can you tell us more about that?

3:37 Andrew Gomory

Yeah. You know, when you have a stroke, it really turned your world upside down. Often, these families are really turned upside down under tremendous stress. So we always try and keep an eye on what is happening. You know, from the point of view of a person with aphasia, it sort of work out to their family and ultimately to the clinicians that they worked with. So for example, in getting someone a device, we really feel ourselves as caseworkers who let people know about their benefits, run a trial and see the whole thing through beginning to end and support them for life. Because often, we either are going to train the caregivers or if there is no caregiver present, we really become the caregiver. And we have the same kind of view with our apps that, you know, having spent a lot of time with patients. We want them to -- we have a good feel for what's going to make them successful really both on their own, doing things by themselves and independently and working with caregivers or with clinicians. So we spent -- I want to spend a lot of time but we learned a lot over the years about how to effectively help people with aphasia, to both help themselves and for the people around them to give them help.

4:49 Steve St. Clair

Now you mentioned something, just in what you're just saying is that in certain cases you become the caregiver, I think that's illustrative of the point of what your days are like in Lingraphica when that phone rings and it is a person with aphasia using a Lingraphica product, isn't it?

5:05 Andrew Gomory

It really is. You know, we found that the caregivers -- there's probably a minority of caregivers who really have both the energy and the aware with all, to spend a lot of time helping in the rehab of their loved one. You know, mostly, they are really helping them to survive, be comfortable, feel loved, all the sort of -- you know, I'm trying to get too technical here, but more of like the social kinds of things, they really make life worth living. And that often times, we've seen that when someone is brought to speech therapy, for example, every time when a caregiver can have an hour to themselves, we charge their batteries which is critical. So we take a lot of the same approach with both our devices and our apps that we want to make easy for caregivers to help but we also want it. It's crucial that a person with aphasia can run things themselves either with no input from a caregiver or with a minimal input. So times of like a lot of times in our exercises, you might -- a caregiver might set someone up and then they're going to get 20 or 30 minutes to themselves while the person with aphasia goes through those, goes through the exercise and that leads to a lot of design decisions and a lot of learning on our part about how to make sure that someone with aphasia and you know, depending on how severe the stroke, you know, some brain damage, can really go through our software and not get stuck, not feel frustrated and of course ultimately benefit from it.

6:33 Steve St. Clair

Andrew, I think we have a caller on the line. I believe it's Diane. Diane, are you there?

6:39 Diane

Yes, my name is Diane.

6:42 Steve St. Clair

Hi Diane. Do you have a question for Andrew?

6:44 Diane

Yes, I do. Yes, I'm in the situation. I can really empathize with what you said about the world being turned upside down because we've recently had a stroke in the family with my mother-in-law who is 85 and she has lost speech. I guess the thing is, I mean, this all sounds very good but you know what? I wonder if she's 85 and she will use the computer, you know. And I'm not the best techy person around there so is there anything about these products that make it easy for someone like my mother-in-law of course but also me who is not a techy person, you know.

7:27 Andrew Gomory

Well, you know, first of all, I'll let you know that your situation is far from being - far from hopeless. From many of the people that we work with, our device or our apps may be the first computer they have ever gotten in their life.

7:41 Diane

Yeah, yeah.

7:42 Andrew Gomory

And it's very daunting, you know, for someone who said I never needed a computer when I was well. Now after I've had a stroke, you start using this thing.

7:51 Diane


7:52 Andrew Gomory

So I can say that we absolutely designed everything with that in mind and it is really doable. So you know, the kinds of things that go into that just to give you a little of a feel for it, you know our apps of course come out on an iPad tablet and those are -- the wonderful thing about the iPad is there's only one button.

8:10 Diane


8:11 Andrew Gomory

You just hit it, you see what happens and you know, if you don't like what happened, you hit it again and it takes you back to where you were. So there's not a lot of ways to go wrong and not a lot of ways to go wrong is a real guiding principle on our design. There's nothing that someone can hit or touch that's going to blow things up, takes them to a mysterious place that they can't return from and what we've seen and I think the research is pouring out that most older adults are very cautious computer users. They really want to know what's going to happen when they touch something before they do it because they are fearful and often rightfully so that -- I think that's just saying something that it's basically going to happen then. I don't know how I'm ever getting back. So we're very careful that our software really never does that. A number of other things that, you know, depending on someone's condition, when you go into one of our exercises, it's still even hard to know what exactly they do and you know, especially the first time through. So we have a nice and simple instructions, they're spoken out loud and you know, often, people have trouble reading if you didn't have the instructions the first time, they are spoken very slowly but you can touch them again and they will speak themselves out loud again. So there're a lot of things like that to really help people not get stuck and keep going. These things are also very configurable and now, you know, this would probably be more of a role for you but you know, we have trainings, it's all free. We'll talk to you as long as you need and as many times as you need, it is never an issue. But for example, we can make it so that when you're done with one exercise, it automatically goes to the next or if that's quickened, if that's too disorienting, and you're going to work with someone, we can leave it on that exercise, you can take it all in, continue to sort of reinforce it and then go on to the next. So there are a lot of -- we can make this sort of as automatic as needed or as slow and manually-driven as it is needed as well.

10:07 Andrew Gomory

And other than that, sort of basic things you'd expect, all the text is really big. All of the research shows that the most important thing in helping someone with a stroke read is the size of the text and the amount of white space around it. So we're very conscious of that. And finally, in terms of -- ultimately, it's got to be fun. We have our own set of images, all of our exercises and all of our software in fact is based on a whole picture of language which makes it easy to understand especially for people are having trouble with word recall. They're all designed art-biased. Most of the other symbols that you see out there are designed for children. And a big part of what makes, this stuff appealing is that it's designed for an adult. You know, someone -- a lot of our patients have experienced to try to re-acquire language they're being given. It's a great workbook. They really want to see something that is appropriate for adult, has appropriate adult vocabulary around the issues and it's that important to them like their health, medications, things like that as opposed to dinosaurs and birds in nest which is (Crosstalk)

11:14 Diane

Yeah. They don't want to be patronized.

11:15 Andrew Gomory

Exactly. I mean, they are intelligent people. They learned language. They've had accomplished lives and now they've had to sit back as opposed to someone who is growing up and doing this all for the first time.

11:28 Diane

Right. But even with a brain -- stroke is a brain injury so it's compounded with the person who doesn't know computers and now happen to deal with literal brain injury. What you're saying is they can go at their own pace?

11:44 Andrew Gomory

They can absolutely go at their own pace and it is -- you know, let's face it, we've been doing it for 20 years with people for whom -- you know, this is their first experience with a computer. We also have learned a lot about how to make it work, how to introduce things slowly, how to reinforce them and of course how to design software that people can actually run and benefit from. Ultimately, the only way to really know is to try it. People do have an emotional response. Sometimes people say, you know what, I never like the computer and I would be darned if it's going to help me now. Other people really appreciate in some ways the anonymity in the -- you know, I can work with this machine, it's not judgmental, I don't have to show my wife or my SLP that I'm making progress, they can work like you said before at their own speed, as often as they want, when they want. But getting in control of their lives in general is such a big issue, getting control of their therapy. That is a big part of that and having just a computer that is yours, you use it when you want, you make progress, often, that can be a really compelling part of the whole experience for them.

12:54 Diane

Alright then.

12:55 Steve St. Clair

Andrew, I was speaking to Dr. Richard Steele, your chief scientist and he mentioned that after a person with aphasia has been with their speech-language pathologist and then they come home and they've got this device, they're learning at their own pace and has actual therapeutic value in them choosing the time when their receptives do it. Is that correct?

13:18 Andrew Gomory

Yeah, I think, you know, that's absolutely right but part of that I think is just very practical which is maybe I know I'm at my best in the mornings so it's great to be able to do my therapy then as opposed to -- you know, the only time I could get an appointment with my SLP was in the afternoon or whatever -- it's like making a feeling until I can get a ride. And then I do think there is a volitional aspect which is "If I am in charge, I'm deciding what to do next." I'm more in control, I'm more committed and I think we simply often will apply our creativity, learning, you're an active participant as opposed to a potentially passive participant. I think all of those things work sort of as outside agents to really help make that therapy more effective.

14:05 Steve St. Clair

Diane, any other questions?

14:08 Diane

Yeah, I'm just trying to -- my mother and I, we're just pressing a button so in other words, this is obviously has been tested on people who have aphasia and also were not familiar with computers before so. Oh, absolutely.

14:22 Andrew Gomory

Oh, absolutely.

14:24 Diane

So it's design-friendly then?

14:25 Andrew Gomory

We've had patients over 100 years old.

14:28 Diane

Oh really?

14:29 Andrew Gomory

There's many and many of them who had never touched a computer before.

14:32 Diane

So just touch the screen and they feel comfortable?

14:36 Andrew Gomory

Absolutely. You know, the touch screens are often a nice simplifying way to work with the computer. It's, in some ways much -- you know, typically, our exercises work around looking at pictures, understanding them and then looking at other picture answers. And when you sort of look at it, you say, alright, that's the picture I want and you're pointing at it with your finger. It's a small extension to just touch the screen. As opposed to say flex this up. I move my hand that moves the mouse that moves the cursor and now, I'm gonna push this button to click that funny thing that is disconnected from me, depending on how you know, what someone's cognitive level is. All that sort of linkage can often be an impediment to using the device intuitively. So touchscreens and pictures are a big help.

15:24 Diane

Okay. Alright then.

15:26 Andrew Gomory

Alright then. Good luck, well.

15:28 Diane

Okay. Thank you.

15:32 Steve St. Clair

Andrew, we have also heard that everything talks when I'm using one of these devices. What's the advantage of that?

15:39 Andrew Gomory

Well, there are really, you know, sort of two big ways to okay, three to put ideas across to anyone especially to people with aphasia which is you know, you can read it, you can hear it and you can see it. So a lot of people with aphasia have are able to understand things better than they are able to read. So you know, pictures are one way around, the lack of reading, but hearing things is as well and there is a lot of sort of subconscious processing that goes on when you hear things like you can often hear a sentence and it'll just sound ungrammatical to you and you're not even sure why. So listening engages a lot of language facilities at a subconscious level. They're really important. So one of the things we've done is to take advantage of that is that everything in the Lingraphica talks. Giving instructions are a critical area where they are spoken slowly and you hear them. It's very easy then to when you get very engaged in an exercise and you go on to the next one and you can stop and say, "What was I supposed to do again?" Instructions are always there, always ready to be re-spoken and the other big thing is every picture we ever have no matter what the circumstances, if you touch it, it will tell you what it is. If it's a picture of a blender on a counter, you touch it, it'll say blender. You can always it's one of the ways that we avoid frustration if in a word recall, it's typically such a big part of aphasia that, you know, we don't want someone looking at it. We'd like them to struggle as long as they want to struggle because that's also a big part of learning. But we'd also want them to know that they always have a way out to get the answer or if they'd produced the answer themselves, to be able to check it. It's one of the ways we prevent people from getting stuck.

17:27 Steve St. Clair

Okay. So these apps, all for real depth, right? I mean there's a comprehensive set of learning exercises here that people will have, right? How deep are these things?

17:41 Andrew Gomory

Well, the first set that we're putting out, we kind of think of covering the basics. So if we think of sort of two big areas which are expressive that's outgoing language, speaking and writing, and receptive which is incoming language that's reading and listening. So we have one app for each. We've got a reading, listening, writing and speaking app. And with that as I say, we've really covered the basics. We certainly have plans for many more types of apps especially around cognitive issues like memory and reasoning. We draw off on a company aphasia even though they're not directly they're indirectly related to language. But these are we wanted to cover the basics first so... Yeah and with each one of those apps, there will be a number of different exercises to come at those fundamental skills from different angles. So in our, you know, our listening app because we think it's so important. There have actually six different types of exercises. Some will ask you questions, some will tell you about following directions, some will, you know, matching opposites of words and the same with speaking. We have some very we start at the word level, work up to phrases, reading same kind of thing where we start easy and then hard. Yeah, there's a lot of coverage there. You'll never know what's gonna work for a certain person and we also tend to target different types of skills within reading, writing, etc so that someone could spend their time what is really useful to them and not have to go to a lot of exercises that or of no interest.

19:22 Steve St. Clair

Now, you honestly didn't develop this just in sort of a way that was just you guys developed. You have a user group or some sort of, right?

19:33 Andrew Gomory

Yeah. We got a lot of help from the outside. You know, we have had therapy apps in our devices for about 20 years and of course, we got a lot of, you know, feedback and understanding to that. There was also a period of five years when the company actually ran therapy centers in conjunction with rehab hospitals, about 10 of them around the country. We got a lot of data gathering, testing of people, watching them use our exercise so we learned a lot there. But in our current formation, we have, you know, a few things or few people that really help us a lot. One that you mentioned is our user group. We have a very devoted group of about 10 people who we've been seeing now for several years. We try all of our software with them. They are really varied in the kinds of strokes and what kind of language problems they have. So that's a group that's just completely invaluable to us and like many people with aphasia, they're not afraid to give us very honest and very straightforward feedback. They don't like having their time wasted. Another group that we've assembled more recently that has been absolutely invaluable, what we call that clinical review board and we have a number of people, sort of prominent speech therapist once who are running aphasia centers. We have actually one from Canada who also does telemedicine. We really tried to put together a diverse group who work with different kinds of patients, some in private practice, some one-on-one, some in groups, some running centers and they help us with both very high-level design in terms of, for example just choosing the types of exercise, the kinds of skill to focus on, down to the very detailed level where we they'll help us design exactly how the software work, what interactions will be, and of course, what the content looks like.

21:27 Andrew Gomory

One of the things we've really worked very hard on just go around, is giving people a progression from easy to hard in an individual exercise and there are so many ways to do that. It really takes the guidance of some experienced clinicians to make that feel right and to really do that well for people. You know, they will give example that in one of our listening applications, if we're giving you instructions and you have to follow those instructions. Well, the first at the easy level, you might hear it, see it written and have a picture. You have three ways to understand what the questionnaires you're being asked to do. As you move to the medium level, we'll remove the pictures so it's just sound and text and then finally the hard level, it'll just be sound. So it really completely relying on your auditory comprehension. The other kinds of things it'll, you sort of might expect as we have multiple choice questions, the answers get more similar and trickier so, you know, if the answer is an apple, we'll have other kinds of fruit or other words that begin with "AP". There are all kinds of sort of tricky linguistic things you can do to throw people off, but that group was all the things are quite well understood. There's a lot of research behind it and that group brings that kind of understanding to us so that we can do a really effective job with that.

22:48 Steve St. Clair

Now, you're offering obviously four very important apps that are gonna help people re-engage with speaking and communicating with their communities. I imagine some caregivers out there might be asking themselves why four like you've got writing, speaking, reading and listening. Why not just speaking? What is it about, for instance, a writing app or a listening app that helps rebuild speech?

23:14 Andrew Gomory

Sure. Well, either to a certain extension, you know, all of languages are somewhat interrelated. But I think probably it will be better to say that our goals are to help people communicate and all four of those modes are ways to communicate. You have to understand what's being said to you to be able to respond to it and of course, being able to read and write are tremendously important to communication. So I think we'd look at it and say "Well, speech is always number one for us. The other modes of communication are both supportive and alternative and they're just critical to people being able to communicate well." So it's hard to attack any of these things in isolation so we just do them all.

23:57 Steve St. Clair

Okay. So what's your vision on how SLP should integrate these apps into their practice? How should they start using you apps?

24:07 Andrew Gomory

Sure. Yeah. Well, I guess "should" is always a dangerous word in these circumstances. You know, part of the magic of being an SLP is I think the rapport and the relationship with an individual patient. But the kind of things that we hope will happen is number one that we'll be providing a lot of clinical exercises that are varied and stimulating and that would really be hard for an SLP to produce. You know, they have workbooks. They have various things with their disposal. They also have no time during the day and we know very well that they spend a lot of their time running to the copy machine at the last minute pulling magazines to put materials in front of people that are stimulating and interesting and engaging and so what we're hoping is one of things we'll do is we'll simply say "You know, here's a lot of great stuff for you to use in whatever way you want and it's all at your disposal and there's a lot of it" and I think another would be that because we've got a very broad offering, they can teach their patients sort of one way of doing things. We have a very consistent approach so that if you learn one of our apps or even one of our exercises, you'll pretty much know how to do all of them. They all have a similar look and feel so then you can really minimize the training time and maximize the time spent actually doing the exercise. So our goal is always to make life easy for SLPs and make sure that the time that they spent with their patients is truly effective. And of course, the final piece is, you know, you get to go to a speech therapy if you're lucky three times a week for about 45 minutes. That goes on for a few months and then after that, most SLPs are really frustrated. They would love to go on longer, but you know, insurance won't pay for it. There are lot of impediments.

25:54 Andrew Gomory

Hopefully, if they find that what we're doing is effective, they'll feel good about saying "Well, I can give this person these apps that they can buy with a very reasonable price" and they could then go on doing self therapy or pick up a help from us and they can feel good about "Alright, I got this person trained on these apps and I know they'll continue to make progress even when they're out of my care."

26:18 Steve St. Clair

So what is developed with the basic idea that more talk test apps to focus on or enhance further skills that will offered down the road?

26:27 Andrew Gomory

Absolutely. We have plans for so many apps right now. We had to stop putting them up on whiteboards. The next one that will be out in the fall will be about will focus really on cognition so that we have one that will do basic memory and then the other one will be on reasoning. That will include things like Math, Logic, certain kinds of following directions, scrambling sentences. They're little more game like, but involved with enhance reasoning. After that, we've got part of the fun part of this is we do get to work with the top researchers and the people who are finding really effective ways to do things. We have plans for using scripting and it's very interesting area, things that had been uncovered right now about the influence of music on language and we have plans to get in all of those, but it will probably a little longer than the fall unfortunately.

27:31 Steve St. Clair

It takes awhile. ROM was not built in a day.

27:33 Andrew Gomory

Well, we keep reminding ourselves of that, but it's very frustrating.

27:37 Steve St. Clair

Well, the good news for people with aphasia and SLPs who want to help them is that these apps are gonna be available for the app tab in September, is that right?

27:46 Andrew Gomory

That's right. We will probably submit them to the app store in about a week or so. The app store, Apple turns, step around roughly in about a week so they should be ready very, very soon. We're very pleased about that.

28:00 Steve St. Clair

Congratulations. Its kind of hard work with your team and your user groups and every else.

28:05 Andrew Gomory

It's true, but it's a really fun work. It's addictive in its own way.

28:11 Steve St. Clair

Yeah. Well and folks can watch the app store or better yet, they can watch aphasia.com. It's www.aphasia.com to keep up with the progress and to keep up with your work.

28:25 Andrew Gomory


28:26 Steve St. Clair

So Andrew. Thank you for another great show. I know you're busy inventing new apps. New ways to get them out to people, so we'll let you get back to it.

28:34 Andrew Gomory

Alright, Steve. It's always a pleasure.

28:36 Steve St. Clair

Thanks a lot everybody for listening and again, that's www.aphasia.com to learn more about Lingraphica, the aphasia company. Bye bye!