Increased Self-Managed Digital Application Use Results in Poststroke Benefits

Swathi Kiran, PhD, CCC-SLP

Using the Constant Therapy app, a self-managed and commercially available digital health platform, new findings showed that increased practice or dosage frequency was associated with greater therapeutic gains for individuals with poststroke speech, language, and/or cognitive disorders. The real-world study represented an important step toward the development of optimal dose recommendations for self-managed speech-language therapy.¹

The data, spanning over a 10-week treatment period, included therapy tasks spanning 13 different language and cognitive skill domains. Across all skill domains, linear mixed-effects model results showed that performance improvement was significantly greater for patients who practiced 2 days per week (ß = .001; t15,355 = 2.37; P = .02), 3 days per week (ß = .003; t9738 = 5.21; P <.001), 4 days per week (ß = .005; t9289 = 7.82; P <.001), or at least 5 days per week (ß = .005; t6343 = 8.14; P <.001) compared with those who only practiced for 1 day per week.²

"Access to this very large real-world data set from Constant Therapy illustrates the actual patient usage patterns outside of a research environment and underscores the real-world validity of the study results, thereby making findings more readily applicable to clinicians’ recommendations for therapy in clinical practice,” senior investigator Swathi Kiran, PhD, CCC-SLP, James and Cecilia Tse Ying Professor of Rehabilitation, Sargent College of Health and Rehabilitation Sciences, director, Aphasia Laboratory, Boston University, and co-founder of Constant Therapy, said in a statement.¹ "This study represents an important step toward the development of optimal dose recommendations for self-managed mobile speech, language, and cognitive therapy."

The efficacy of high-dose speech-language therapy for those with poststroke aphasia has been previously documented, but poorly translated to clinical practice. Patients who receive suboptimal amounts of the therapy may have negative consequences for their functional communication recovery. Constant Therapy, an award-winning mobile program, uses patented artificial intelligence technology to deliver over 244 personalized exercises that rebuild cognitive and speech function for those recovering from stroke or traumatic brain injury or living with aphasia, dementia, and other neurological conditions.

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Within each practice session, each task is practiced until accuracy reaches 90% or higher on at least 2 occasions, at which point a patient is advanced to the next level of difficulty or to a different task. If a user was not improving on a level or their accuracy was below 40%, a lower level of the task was assigned in addition to or in replacement of the original task. Generation of the domain score involved: identifying the highest task passed (accuracy ≥90%) or working (accuracy between 40% and 90%) and the lowest task working or failed (accuracy <40%) during a session; and taking the average progression order of the highest level passed or working and the lowest level working or failed, thereby providing an estimate of the given session’s difficulty level.²

In a cohort of 2249 patients with poststroke deficits, the average baseline domain score was 33%, indicating that patients were typically in the lower third of the domain’s task progression during their first week of therapy. In addition to seeing significant interactions between frequency and benefits, there were significant differences in means emerged for all group comparisons (ie, 1 day vs 2 days, 2 days vs 3 days, 3 days vs 4 days, and 4 days vs ≥5 days) except for the groups practicing 4 days vs at least 5 days per week. "This result indicates that the significant magnitude differences accrued over the course of treatment attributable to differences in slopes across the dosage groups as opposed to baseline differences in means,” the study investigators wrote.²

When analyzing individual skill domains, a significant interaction between time and frequency were found in 9 of the 13 included domains. These 9 domains included the arithmetic, auditory, comprehension, auditory memory, naming, quantitative, reading, visual memory, visuospatial, and writing domains. For most of these domains, model results revealed a trend similar to the overall model results, in which a significantly greater rate of change in domains was observed for higher vs lower practice frequencies.

"Constant Therapy has the world’s largest rehabilitation database for speech and cognition disorders among patients with different diagnoses and demographics and recently surpassed 200 million exercises completed by Constant Therapy users. We are excited to partner with Boston University and other leading research institutions to use this data to advance brain science and accelerate real-world-evidence to discover new clinical insights,” Veera Anantha, PhD, MS, chief executive officer, and cofounder, Constant Therapy, said in a statement.¹ "These study results demonstrate the benefits of providing digital therapy to patients at home so they can get the optimal dose of therapy to regain their cognitive skills."

REFERENCES
1. Constant Therapy announces publication of study demonstrating improved outcomes for post-stroke patients using its digital speech, language, and cognitive therapy. News release. Constant Therapy. July 20, 2022. Accessed July 20, 2022. https://www.globenewswire.com/news-release/2022/07/20/2482945/0/en/Constant-Therapy-Announces-Publication-of-Study-Demonstrating-Improved-Outcomes-for-Post-Stroke-Patients-Using-Its-Digital-Speech-Language-and-Cognitive-Therapy.html

2. Cordella C, Munsell M, Godlove J, Anatha V, Advani M, Kiran S. Dosage frequency effects on treatment outcomes following self-managed digital therapy: retrospective cohort study. J Med Internet Res. 2022;24(7):e36135. doi:10.2196/36135