Telerehabilitation treatment of aphasia across the World Health Organisation International Classification of Functioning Disability and Health (WHO-ICF)

People with aphasia will receive any combination of three aphasia treatments via telerehabilitation including 1) Constraint Induced Language Therapy (CILT) 2) Group aphasia therapy 3) Communication partner training. The type of treatment received will be determined collaboratively with the client by the treating clinician according to the language difficulties they are experiencing, ability to commit to the time periods required and their support networks. Telerehabilitation is the delivery of medical rehabilitation services at a distance using electronic information and communication technologies. Telerehabilitation technology allows patients to access assessment and treatment services remotely. In this study, the treatment will be provided via multi-point videoconferencing over the internet using computer based software downloaded onto the participant and clinicians computers. The first treatment, Constraint Induced Language Therapy (CILT) has been demonstrated to have substantial and stable improvements of language function in people with chronic aphasia with evidence of successful carryover of improved language function to everyday life. Participants will receive 3 hours of therapy a day, 5 days a week for two weeks. Two participants are treated concurrently by one clinician. The primary therapy activity is a dual card game between participants where the objective is to collect matches until the participant has no cards remaining- similar to “Go Fish”. Each participant takes turns verbally requesting a card from the other who must provide a response. The requests are constrained to verbal output only with other forms of communication such as gesture or writing not permitted. The therapy will be delivered online using a web based version of the Go Fish card game developed by the research team and multi-point videoconferencing software to connect video and audio. In the second treatment, Group Therapy, participants will participate in tasks that incorporate activity and participation level treatment goals. Participants will attend one 1.5 hour treatment session per week for 12 weeks and will be engaged in activities that are functionally relevant and require spoken language to be the main route of communication. Clinician to patient ratios for groups will be one speech pathologist to four patients. The clinician and participants will be connected to each other using web-based videoconferencing software with video and audio. The clinician will use this software to also display electronic treatment materials such as maps, photos and videos. For the third treatment, Communication Partner Training, participants with aphasia may identify 1 -3 communication partners to be involved in communication partner. The participant and their communication partner will be involved in five 2 hour training sessions, fortnightly over 10 weeks, via the Internet in which they are: provided with education regarding the role of the communication partner in successful communication interactions; recorded participating in a conversation and then provided with feedback; trained in communication strategies and re-recorded and provided with feedback on implementation of the strategies. The strategies that are most relevant and successful with the person with aphasia will be identified and the clinician will provide support to problem solve any difficulties. The clinician will be connected to the participant with aphasia and their communication partner over the internet using web based videoconferencing software.