To provide definitive evidence of the clinical and cost-effectiveness of self-managed computerised therapy for post-stroke aphasia through a randomised controlled trial (RCT).
Speech and language therapy is frequently available only for the first few months after stroke. During this time many people are medically unwell, tired and concentrating on competing demands of recovering physical skills. Many do not meet their potential for recovery over this time period. Persisting aphasia impact on the ability to participate in everyday activities, communicate with family/friends or work, often leading to depression. Evidence suggests that aphasia can improve if therapy is provided intensively in the longer term. Opportunities for therapy in the later stages after stroke would enable people to access therapy when their health has improved, and as communication needs change over time. Providing intensive face to face therapy in the long term is costly and difficult to achieve with competing demands on limited therapy resources. The Big CACTUS trial will evaluate the clinical and cost-effectiveness of self-managed computerised therapy exercise practice for persistent aphasia, tailored by speech and language therapists and supported by volunteers. The Big CACTUS trial is informed by our pilot study (n=34) which randomised people with persistent aphasia to using available computer software designed for treating aphasia, or usual long-term care (most frequently this was social support). On average people with aphasia practised their speech exercises on the computer independently for 25 hours over 5 months (20 minutes, 3 times a week). The findings indicated that self-managed computer therapy supported by volunteers could help people with aphasia to continue to practice, improving their vocabulary and their confidence talking. Patients and carers found it an acceptable alternative to face to face therapy. Self-managed computer therapy could improve the quality of life of people with persistent aphasia, reducing costs to the NHS and society.
Big CACTUS is a large randomised controlled trial to compare the clinical and cost-effectiveness of aphasia computer therapy with usual care in the long term post stroke. Working with 20 speech and language therapy departments across the UK we have identified potential participants from speech and language therapy records and from voluntary support groups.