What is Sword?
A complete program of therapy designed to treat word production
problems in apraxia and aphasia. It has a vocabulary of 70 highly
functional words. Associated with each word are high quality images,
a sound file and a video of a speaker producing the word. In the
first stages of the intervention, the recognition of the target
words is trained. This ensures that the subsequent word production
therapy is based on a firm foundation of accurate word recognition
and comprehension. Once perception has been trained, the program
moves on to word production through a set of carefully structured
phases. First the user observes the video of another speaker fluently
and accurately producing the word. In order to ensure that the user
is not trained to make errors, they are then encouraged to imagine
saying the word in unison with the video. They then move to independent
production, first in repetition and then in word production unsupported
by prompts.
Does Sword only train word production at the single word
level?
No. A novel feature of Sword is that the transfer of word production
to use in connected speech and sentences is carefully trained. The
user practises saying the trained words in a range of sentence types.
How is Sword different from other therapies for apraxia?
Traditional therapies for apraxia often involve training the production
of isolated articulatory gestures (e.g. m), and then combining this
movement pattern with vowels to form a range of syllables (e.g.
ma, me etc.). Such segmental therapies can be effective in developing
a range of articulatory positions, but the evidence for the transfer
of this capacity to more spontaneous speech production is more limited.
By contrast, Sword is based on contemporary psycholinguistic approaches
that suggest that words that are used frequently are stored as whole
movement patterns. Saying a word such as ‘coffee’ does not involve
combining individual sound segments into a whole word. Sword only
works at the whole word level. It does not ask users to think about
individual articulatory gestures or where or what their tongue might
be doing.
Does Sword have any evidence as to its effectiveness?
We have been fortunate to have been funded by The Health Foundation
and The University of Sheffield to conduct a series of studies to
explore the effectiveness of Sword therapy. A new and large study
of 70 patients is now underway, funded by The BUPA Foundation. This
will explore the range of impairments that Sword can be used to
treat. It will also determine the individuals who benefit most from
the therapy.
What did the early effectiveness studies show?
Sword resulted in improvements in word production in patients with
apraxia (and most of the users also had some degree of aphasia).
This was shown by increases in word accuracy and fluency for the
trained words. These improvements were maintained at the final assessment
of the research study – up to 18 weeks after the therapy had ended.
What was also encouraging was that there was improvement in words
that had not been treated in the programme. This more general improvement
in word production was particularly strong for words which were
similar to the treated words. So for example, if Sword treated the
word ‘car’ then words such as ‘card’ also showed improved accuracy
and fluency.
How does Sword therapy work?
Sword therapy has an explicit rationale behind it, and it is informed
by neuroscientific principles such as the intimate interconnectedness
of sensory and motor systems in the brain. It also incorporates
principles such as errorless learning – basically if you allow a
patient to struggle, grope and make many errors in a learning task,
what they will learn is to struggle, grope and make lots of errors.
Instead, Sword tries to break out of errorful learning. Its substantial
perceptual training phase ensures that words are ‘warmed up’ before
production is attempted.
The production phase is also highly structured. The user begins
with just observing a video of a speaker saying the word accurately.
They then imagine saying the word, and then at the third level they
repeat the word out loud. Then the user can repeat the word and
listen to the recording that Sword has made of their speech. The
programme then moves to transferring word production to more natural
and independent communicative settings. The user practises inserting
the trained words into a range of sentence types. In a final stage,
the user attempts production of the words without any prompting.
The purpose of Sword is to say the word accurately, promptly and
fluently – so if you get stuck, there are a set of prompts which
can be called up.
What does Sword contain?
Sword comes in two versions – Professional and Home User. In both,
there is a preloaded vocabulary set of 70 words. These are highly
functional words and so if the user can produce them quickly and
accurately, it should provide an ability to signal key messages
to people around them. For some vocabulary items, there are two
different images, a recording of the word, and a video of a speaker
saying the word. These words can be selected and inserted into the
Sword therapy format. The programme will then take the user through
the highly structured training programme.
What is the Home User version?
The home user version allows the person with word production problems
such as apraxia/dyspraxia, to self-administer therapy for these
difficulties. They can do this at times and locations convenient
to themselves. This means that the therapist does not have to be
present. In this way, people living in locations remote from clinics
or areas where there is only limited therapy available can still
access high quality and intensive therapy.
Can somebody with little or no computing experience use
Sword?
The Home User version of Sword has been designed to be as simple
as possible. The user needs to have sufficient visual and hearing
ability to see the screen and hear the sound recordings, and the
ability to use a mouse to move through the programme. In our research
studies, we have assisted the user in getting started with the programme,
but after this, people with little or no computer experience have
been able to successfully interact with the program.
What is the Professional User version?
The professional user version is aimed at rehabilitation professionals
such as SLT’s. In addition to the core Sword therapy programme and
the 70 item vocabulary, the professional version includes an Administration
program that incorporates a number of other capabilities.
First, it allows detailed tracking of the user’s interactions with
the software. The therapist can examine frequency of use and length
of sessions. Information on accuracy levels and response times can
be inspected, as well as the recordings of the user’s speech. All
this information can be downloaded from Sword – for example, sound
files can be transferred onto the desktop and used in Powerpoint
presentations of before/after speech accuracy. Similarly, charts
can be printed out and inserted into patient notes.
It also allows the user to introduce new content into the Sword
therapy program. If for example, a user has mastered the 70 word
vocabulary set, then new words can be introduced into the therapy
programme. In addition, the user can alter the program default settings
and produce an individually tailored therapy program. For example,
the therapy word set might be reduced to a very small number of
items for somebody with a severe speech production difficulty. This
individually tailored program can then be transferred to a satellite
machine – for example, the user’s home pc or a laptop.
The Professional version can be purchased as a single user on CD-Rom
or supplied on a 1Gb pen drive. Multi-user versions are also available.
The Administration program can hold simultaneously the personal
information and settings for multiple users, so that their use of
SWORD can be managed centrally.
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