For people with aphasia who continue to have difficulty speaking in sentences, SimpTell offers a solution: after suffering brain injury, they can once again quickly make something clear. Not in full sentences as before, but still: communication becomes somewhat more natural again. Through a collaboration between science and industry, SimpTell provides people with aphasia and speech and language therapists with more possibilities
Marina Ruiter worked at the rehabilitation center of the Sint Maartenskliniek for nearly twenty years before becoming a researcher at Radboud University. There, Ruiter diagnosed and treated people with aphasia. "Aphasia is a language disorder caused by brain injury," Ruiter explains. "Some people with aphasia mainly have problems speaking in sentences. You can compare it to going on vacation to France but not mastering the French language well. When you want to say something, you can often find the individual words, but you can’t put them into the correct sentence order
In the Netherlands, about 40,000 people have aphasia, Ruiter estimates. "I know this target group quite well from my time at the Sint Maartenskliniek. About 30% of people with acquired brain injury have some form of aphasia. People with aphasia may have had, for example, a car accident or a stroke. When people with aphasia undergo rehabilitation, a neuropsychologist is always involved. Learning to live with lasting aphasia goes beyond language alone."
Jan Pons is co-founder of Logoclicks , a company that offers online therapy under the guidance of professional speech and language therapists for people with aphasia. He recognizes the situation Ruiter describes: "When a friend of mine suffered a brain hemorrhage, he suddenly could no longer speak. I looked at him in complete disbelief: how is this possible?"
A phase of grief
Ruiter nods in agreement: "You have to see it as a phase of grief. Speaking for myself, the way I use language is part of my identity. By communicating with words, I can do the work that gives me satisfaction: doing research and teaching. Language is so intertwined with my personality. Many people with aphasia say they feel they lose a part of their personality."
Some people with aphasia enter a ’fight mode’ after the brain injury occurs. They strongly believe they will overcome aphasia and that they will be able to speak again in no time. "Unfortunately, in practice that often doesn’t work because aphasia is chronic in many cases," Ruiter explains. "And then the grief returns. Just like when someone has died and you can’t immediately believe it. Some people with aphasia repeatedly get stuck when forming sentences. Since communication moves quickly, conversation partners may drop out. That makes them sad again. Only then is there often room to find a way to adapt to permanent aphasia. In cases of persistent problems producing sentences, that can mean speaking in ’telegram style.’"
She explains: "It’s comparable to children who are learning to talk and speak in twoor three-word expressions: functional, but less elegant. Actually, we all speak in telegram style sometimes. Do you ever say: ’Nice weekend’’ or ’Pretty busy day today’- Those are also examples of telegram style: a shorter, simplified message."
Telegram style
People with chronic sentence-production problems due to aphasia are often referred to a speech and language therapist. "They need to learn a different way of speaking. Research shows that changing behavior requires a lot of repetition. When you’re one year old, you start speaking. Producing sentences runs on autopilot throughout your life. If that automatic process is suddenly disrupted by aphasia, it doesn’t mean you can immediately stop it. To speak in telegram style, you have to build a new speaking routine, which can be very complicated. Especially with brain injury. Intensive and repetitive practice is required, but that type of therapy is relatively expensive."
A digital form
SimpTell is a web-based aphasia therapy consisting of telegram-style exercises that people with aphasia can partly practice themselves at home, allowing them to practice at any time of day. The speech and language therapist can then spend therapy time more effectively on learning how to apply this speaking style in daily life.
Pons: "Think of it as the speech and language therapist in a digital form. And that’s badly needed, because speech therapy services are under pressure. Waiting lists are growing everywhere to unacceptable levels. Something has to change. Making speech therapists work harder isn’t the solution but helping them work smarter is."
Pons adds: "We hear it from speech therapists: with little effort, SimpTell can achieve a lot of impact."
Win-win
The interaction between industry and research is a win-win situation.
Ruiter: "Because of my background, I tend to focus on research that can be applied in clinical practice. The development of SimpTell is an example of that."
That’s why she believes it is important that applications like this become and remain available for clinical practice. "For that, collaboration with a commercial partner such as Logoclicks is necessary. With a grant from Stitpro and support from the Radboud Fund and crowdfunding, we were able to realize this. The data that SimpTell currently generates can also be used for further research."
Pons is also proud of the collaboration with researchers from Radboud University: "Marina and her colleagues Ardi Roelofs and Vitória Piai provide a valuable product based on solid scientific research. We bring it to the right people. That’s a strong combination."
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