A UCL-developed smart app, which improves the reading ability of people who have suffered a stroke, has been a ’godsend’ for patients asked to rehabilitate at home during the pandemic.
iReadMore, developed by the Neurotherapeutics Group at UCL’s Queen Square Institute of Neurology, provides mobile or tablet-based reading therapy using a gamified therapy involving written and spoken words and pictures, and aims to improve word-reading speed and accuracy.
Stroke patients typically need around 100 hours of Speech and Language Therapy (SaLT), to see a marked improvement, NHS therapy is already significantly less than this and due to the pandemic NHS provisions* have been limited further.
The iReadMore app has enabled stroke patients including those with Covid-induced strokes at the National Hospital for Neurology and Neuroscience (NHNN), Queen Square, London, to have limitless hours of SaLT at the hospital and while rehabilitating at home.
In addition, the app can be used by patients with other neurological diagnoses, which cause reading impairments, including certain types of dementia.
To give as many people access to the app as possible, UCL has now added iReadMore to the Apple App and Google Play stores, making it publicly available** for android and apple smartphone and tablet users.
Two patient case studies
Paul Mylrea, aged 64, had Covid in March 2020 and during his time in hospital he went on to have two post-covid strokes caused by the coronavirus infection and was transferred for specialist care at the NHNN.
The strokes have caused Paul to develop a reading impairment called alexia causing slow and effortful reading. While recovering at home, he has been using the iReadMore therapy app to improve his reading speed and accuracy.
"The iReadMore app has been a godsend for me. My illness has spanned the entire lockdown period after developing Covid in March last year, then followed by multiple strokes," he said.
"Without UCLH’s innovative approach to stroke rehabilitation, I would probably still be waiting for help."
"The iReadMore app has allowed me to work on my recuperation at home and at my own pace. The use of digital delivery makes it easy to use and entertaining."
"I believe iReadMore will help both reduce the burden on the NHS and lead to more people being helped."
Peter McGriskin, 70, had a stroke in June 2012, which affected his speech and he has been using the iReadMore app for five months.
His wife, Carol, has been supporting him through his rehabilitation and spoke about Peter using iReadMore independently at home during lockdown.
"I think iReadMore is good because it gives Peter something for himself, something he can complete and be in control of, and I think that gives a big boost to his confidence," she said.
"Especially during lockdown, there’s been a bit of collateral damage from it all and I know Peter’s confidence has dropped, but by doing the app, he’s getting positive feedback, and at the end of a level, I’d hear him go ’yay!’ when he’s got it all right."
"Even after doing speech therapy at home, almost every day for nine years, it’s good the app stimulates a positive response and a willingness to continue - it gives him hope."
iReadMore has been designed for and with people with acquired reading disorder (alexia) or aphasia due to a stroke, brain injury or dementia. Both conditions affect speech and comprehension.
The app helps train single word reading ability, improving both reading accuracy and speed and adapts the difficulty of the therapy to each user’s reading abilities to keep the therapy relevant and challenging without being so difficult that it becomes frustrating. This also means that iReadMore can be used by people with different types or severity or reading impairment.
It also gives users immediate feedback on their performance and has regular reading tests with results fed back to users with easy-to-understand graphs so they can track their own progress and stay motivated.
In 2018, a large randomised clinical trial*** of iReadMore demonstrated significant improvements in word reading accuracy after four weeks of training and this treatment effect was still present 3 months after participants had stopped using the therapy.
Professor Alex Leff, (UCL Institute of Cognitive Neuroscience and UCL Queen Square Institute of Neurology), helped develop iReadMore.
"Reading ability is commonly affected in patients with strokes, brain injury or dementia that causes language loss. We know that the surviving brain networks can be retrained to improve reading ability, but it takes time and lots of specific practice. iReadMore provides this," he said.
"Because the current version of the app was developed by patients, it should enable many more patients to be able to rack up the necessary practice time at their own pace and without supervision."
Professor Nick Ward (UCL Queen Square Institute of Neurology) and Consultant Neurologist at NHNN is an expert in stroke rehabilitation and helped treat Paul Mylrea.
"We know that rehabilitation after stroke is important, but patients often don’t receive enough to keep their recovery going. Training without guidance or feedback can be difficult to maintain and sometimes counter-productive," he said.
"We should be striving to create stimulating and challenging ways for our patients to keep training for as long as they can and the iReadMore therapy app is a great way of doing this."
Tom Langford, PhD candidate working on iReadMore at the UCL Queen Square Institute of Neurology, said: "Since launching, the app has already been downloaded in every continent - except Antarctica!.
"By developing effective therapy apps that can be used at home, we are able to reach many more people around the world who may or may not have stroke rehabilitation services nearby."
"This has been particularly important during the pandemic when many rehabilitation and support services have been reduced or delayed."
* The NHS provides around 12 hours of SaLT with further face-to-face therapy available via some charities or privately.
** Via the app store iReadMore app is available for free to people with primary progressive aphasia (a dementia related condition), or for £5 a month for those with stroke related aphasia, following a 7-day free trial. T his cost helps cover software maintenance and user support to keep the app functioning. Any additional revenue will be reinvested into refining the iReadMore app and developing new aphasia therapy apps in the future.
*** UCL Press release , research published in Brain .