From A to Z: How patients with Aphasia can recover speech and language thanks to neolexon

Where would we be today without digital gadgets, first and foremost our smartphone? At this point, digitization has also conquered the healthcare industry. Wearables are currently one of the biggest trends in this sector. Yet when it comes to speech therapy, we are not really up to date in Germany. Meanwhile, digital services and products that might assist patients with aphasia to effectively practice language at home could improve therapy success and support therapist efforts without replacing them. During their studies, two students of the Ludwig Maximilian University of Munich came to this conclusion and subsequently developed an app that offers personalized support for affected patients.

A figure of speech says that when something is so beautiful, surprising or even terrifying, it "puts you at a loss for words." But what if that’s something that really happens to you? This inability to speak, also known as aphasia, is often caused by a stroke though it can also be the result of an accident, such as a head injury after a fall. Regardless of the causes of aphasia, affected patients must learn to speak and understand the meaning of words again. Plus there are different types of aphasia. The disorder might involve anomia and affect a person’s ability to retrieve words, i.e., a mild type of speech disorder or it might cause more serious issues in terms of articulating thoughts. Oftentimes, affected patients know what they want to say, but are unable to form complete sentences or their words are twisted or scrambled. Meanwhile, the person’s general level of understanding speech is largely unaffected by the disorder. Having said that, individuals might lose their entire vocabulary, while also affecting their understanding of spoken or written words. It should be noted that aphasia is not a mental illness and is only affecting speech, meaning the understanding of language, reading and writing.

In a German blog post, Annette Schwindt describes what it is like to have aphasia and work with a person suffering from the disorder. The same blog post is also available on author Kai-Eric Fitzner’s blog, who has lived with Broca’s aphasia (also known as expressive aphasia) since suffering a stroke in 2015. Though he is presently still unable to write his own blog posts, Annette Schwindt has become his "blog voice". The two communicate via daily Skype calls and many actual visits. Fitzner also considers these conversations a type of therapy.

Learning to speak again is a lengthy and cumbersome process that can take months or even years. It is crucial for patients to receive an adequate number of speech therapy sessions. According to the guidelines set by the German Society of Neurology, five to ten hours per week would be commensurate to consider a therapy effective. But the reality is different. Typically, patients are prescribed only one hour per week. The increasingly limited financial and human resources in the healthcare sector make matters worse. While the skills shortage is increasingly pressing and budgets are getting tighter, the number of patients is growing, especially since older people are at an increased risk of stroke.

That being said, long waiting lists to be admitted for speech therapy are not the only problem. Added to the mix is the quality of services. In the majority of cases, therapists work analogously with photo cards and worksheets. The few available digital services and sources are barely adapted to meet the personal needs of patients. Meanwhile, mobile devices and apps for speech therapists and those affected would garner enormous advantages and benefits.

Two students of the Ludwig Maximilian University of Munich came to the same conclusion. Four years ago, Mona Späth and Hanna Jakob came up with the idea for neolexon. Since the start of 2017, the app has been online and already boasts several thousand registered users. The two founders have since expanded their team and added six more employees. At the outset, the two speech therapists were joined by Swaroop Nunna as the back-end developer and Jakob Pfab as media information scientist and app developer, who both helped with the development. Three speech therapists and one game engineer were since added to the mix and round off the neolexon team today.

But what can the app do? The neolexon app is available for Android and iOS devices in a therapist and a patient version. Therapy can be organized, carried out and adapted with the therapist app. Meanwhile, the patient app facilitates independent and unlimited training at home. The app’s database contains 7,800 words (nouns and verbs), 468 animals, 274 professions and 316 kitchen items. The scope of words ranges from "eel" to "cypress" (German: Aal bis Zypresse, referencing words from A to Z; editor's note). Patients can practice the words by looking at a picture of each word, while a video of lip and mouth movements is played at the same time to exercise one’s own pronunciation and articulation. Therapists can check the patient’s progress and up the intensity level or target specific areas of concern. In doing so, a gardener can practice explicit terms such as "tulip" or "lawn mower," while a soccer fan is able to train words like "jersey" and "goal."

 "We often get feedback from patients and their relatives who are grateful and happy about the chance to practice and exercise on their own," says Hanna Jakob. People point out the usability and the fun they have practicing, as well as the progress patients make thanks to the app. The neolexon team also conducted a small-scale evaluation study. The result: "Patients made significant progress in relearning words while using our app." Therapists also appreciate the digital service. "Speech therapists say it makes their work easier, while working with the tablet as a modern therapy method also proves motivating for therapists and breathes new life into therapy."

Needless to say, this type of service relies on user acceptance. Perhaps the biggest obstacle is data security considerations when it comes to sensitive patient information. "Data protection is a very important issue and our top priority," says Jakob and adds, "we are advised by data protection and privacy lawyers and collaborated to create a data protection concept that complies with all applicable German laws (General Data Protection Regulation, GDPR, the new BDSG- Federal Data Protection Act). The data of our users is absolutely safe with us."

Another obstacle on the way to becoming a successful digital speech therapy tool is its approval as a medical device. Respective products must be certified, that is, they must meet specific criteria to be approved for patient use. The team from Munich has already overcome this particular obstacle. At the moment, negotiations are underway to ensure that health insurance companies will reimburse the fees for the app in the future. That being said, the team says it is a long and arduous process "to obtain health insurance reimbursement for a new product. However, our long-term goal is for health insurance companies to pay for the patient’s self-directed learning and training expenses." Until now, neolexon was available free of charge. This is about to change on October 1st.

At the moment, the app is designed for adults with aphasia, but the Munich team is already working on a version for children with speech and language development disorders. "The developments are making great progress," says Hanna Jakob.

While we're on the subject, nearly 100,000 people in Germany suffer from aphasia. That’s why effective, personalized and modern outpatient treatment support with a professional speech therapist would help a lot of people, especially since an app’s advantage is that it points out mistakes to the patient and gives feedback on treatment progress to both the patient and the therapist. The ultimate goal is for patients to no longer be "at a loss for words" but to be able to say "I have found my voice again."