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New tool to help people with aphasia communicate

A new therapy website is assisting people with aphasia to speak again by allowing them to customise words and phrases they wish to express.

Named after the first six keys on the keyboard, Project 'QWERTY' was a joint effort between two Monash University student groups and a duo of speech pathologists.

Aphasia is a neurological disorder that affects someone's ability to communicate including their understanding of reading, numeracy and writing.

The condition can result from a stroke, brain injury or tumour and impacts one in three stroke survivors in Australia.

Speech pathologist Grace Schofield says it can be devastating to lose your ability to communicate, so individualised rehabilitation is essential.

"We noticed many therapy websites don't have a personalised aspect to therapy," Schofield says.

"They tend to focus on touch typing phrases, such as 'the cat jumped over the mat'.

"So we wanted to create a customisable program where people can learn words that are meaningful to them in their lives - that's what sets it apart."

In the short time the website has been online, it has already positively influenced people's lives.

Schofield recalls a man in his 40s living with multiple sclerosis who had had a second stroke. 

"He was diagnosed with aphasia, which had a significant impact on his mood,” she shares.

"There was a big barrier for him to engage in therapy to such an extent that any attempt to verbalise or engage in a conversation would make him quite upset."

He and his wife ran an Airbnb, where he used to take bookings over the phone or send out email confirmations, but was now unable to perform these tasks.

In QWERTY, Schofield created a customised list for him with words related to answering the phone and emails.

"He practised that, and it was the first time that we could do therapy without him bursting into tears," she says.

"While it was still hard and challenging for him, he persevered, and it was a huge win for us."

During the website's design, the team focused on creating an aphasia-friendly interface that showed empathy and insight into the person.

Senior speech pathologist Jenny Walsh says they kept in mind that people before their stroke were often high-functioning individuals that could communicate like everybody else.

"The interface respects the fact that users could once write or spell without difficulty," she says.

"And we noticed that it was quite motivating for people to practise a specific number of words at a set amount of times in the way they wanted to.

"They can also adjust the level of assistance they need as they learn."

One challenge was to strike the right balance between teaching people something while also making it appropriate for adults to use. 

"Creating a tone of voice for QWERTY that was motivating and supportive and not patronising was quite difficult during the process," Walsh says.

"But we always strived to base our design on features that people with aphasia said they wanted to be able to control."

She says they've had a lot of laughs during the website design, where they had help from volunteer software engineering students.

"It started as a website that looked like a student project and became something we all feel very proud of," Walsh says.

"But finding the right noise played when you've answered a question correctly; that was a hilarious search.

"They may seem like simple decisions, but that's what makes the website appealing and useable for people."

Walsh says one man's dedication, in particular, stood out to her.

He used to be an engineer who could speak multiple languages but suffered a spontaneous bleed to the brain when he went for a 12km run.

As a result, he had severe apraxia and aphasia, which left him unable to speak or write for over 12 weeks. 

"He came in 4 days a week – he was a nine o'clock person and saw this as his job," Walsh shares.

"But after all that hard work, he's now gotten to the stage where the average person on the street would not realise he has aphasia.

"He's now up to the point where he's writing paragraphs and short stories, from someone unable to write his name.

"It's still taking him more energy to appear and speak as he does – he's described himself as a duck paddling underwater."

The website received funding from Monash University to ensure it can stay online for the next 10 years. 

Walsh and Schofield say the project has been done with a lot of love and hope it'll help people with aphasia regain their ability to communicate.

"We're going to continue to seek feedback from people with aphasia and speech pathologists and implement changes that we can," Walsh says.

"We're all quite motivated to continue and have in mind a version 2.0 where people have the option to practise phrases and not just single words.

"Overall, it's been a great learning experience for us."

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