The Upside of Screen Time

Are you one of the scores of people who moan about how much time we all spend staring at our smartphones and tablets? You won’t hear Wendy Damon among the complainers.

For Damon, with her spiky dark hair, wrist-full of silver bangles, and the word “Aphasia” tattooed on her right upper arm, her iPad has been an unqualified positive—and not just because she can use it to check email.

After a stroke at age 54, in June 2012, Damon emerged physically fine but suffering from cognitive issues and aphasia, a brain disorder that seriously inhibits language.

Now, an iPad is helping her recover what she lost: the ability to speak in full, quick sentences, to follow directions, to remember things, to do basic math. Using a specialized app, Damon practices rebuilding these skills on her iPad for about an hour a day, and she swears it’s helping her.

“If a couple days go by and I don’t do it, I feel like I’ve backslid a bit,” she says in measured, deliberate tones as she concentrates on assembling the sentence. Each year, an estimated 200,000 people acquire aphasia, which is usually the result of a stroke. After her stroke, Damon could repeat only single words, like “Door, door, door,” when she wanted to say, “Close the door.”

A combination of in-person therapy sessions and near-daily practice on the iPad has built her language skills back up. She’s not where she used to be—not by a long shot, she says, not yet—but it’s miles better than where she was.

And now a research study coauthored by Swathi Kiran, a Boston University Sargent College professor of speech, language, and hearing sciences, recently published in Frontiers in Human Neuroscience, shows that people like Damon really are improving, even years after the brain damage occurred. The research further supports the idea that the brain is far more plastic and moldable than previously imagined, and it presents a simple, relatively inexpensive way for people to improve their long-term health.

With funding from the Wallace H. Coulter Foundation, Sargent College gave 51 aphasia sufferers an iPad. The goal of the study was to determine how effective iPads could be in delivering personalized therapy to people with aphasia, and to determine whether a structured iPad-based software therapy program that includes homework leads to significant gains in overall communication.

Participants were split into two groups: a control group and an experimental group. All participants had a weekly one-hour session with a clinician using the iPad therapy. But the people in the experimental group were also asked to practice a set of personalized tasks at home using the iPad software. They showed significant improvements, ranging from 2 to 11 points on a range of standard tests for language, memory, executive function, and attention. The control group did not experience any significant changes on those tests.

The most encouraging sign? The people who were more severely affected showed more improvements after therapy than those who were less impaired, according to Kiran, director of BU’s Aphasia Research Laboratory. That’s significant, she says, because people who are worse off after brain damage are the most likely to be written off, and this study shows that they should not be. The study further found that even those participating in the control group, who used the iPad therapy only during their weekly meetings with a clinician, experienced some improvement.

All types of aphasia sufferers need better long-term care, Kiran says. When someone has a stroke or other aphasia-causing injury, insurance typically covers only a patient’s acute care and maybe a couple of months of rehabilitation. Unless you have fantastic insurance, she says, you’re on your own after that. The upshot is that there is a huge problem in providing the continued communication rehabilitation that those with aphasia require.

That’s exactly the situation Damon found herself in by November 2012, when she was discharged from outpatient therapy several months after her stroke. “According to them, I was better,” she says, a note of frustration creeping into her voice. Her insurance coverage ran out, and the rehabilitation center had taken her as far as she could go.

But as neuroscientists are realizing, the brain can be worked and improved even after years of decline or decreased ability. However, Kiran notes, it takes a bit of strategy and a whole lot of work to make progress. “In the context of what we know about neuroplasticity, the main thing is you have to have repeated practice, repeated exposure, and you need to do it in a very structured way,” she says.

Mobile devices loaded with specialized apps could make that crucial practice possible. That’s where Newton-based start-up Constant Therapy comes in. Constant Therapy, cofounded by Kiran and CEO Veera Anantha, provides personalized iPad-based therapy for people with traumatic brain injuries, stroke, aphasia, and learning disabilities. So while Kiran’s team designed the rehabilitation tasks, Constant Therapy, one of whose investors is BU, made them available for download.

The Constant Therapy system is flexible. Users can pick and choose the tasks they want to work on, they can rely on the app to provide tasks for them based on their scores, or a clinician can select tasks personalized to an individual’s needs.

Kiran and her colleagues focused on the latter approach for the study. The experimental group had one hour of therapy a week with a BU clinician, who assigned tasks based on the patient’s specific performance. Then the patient was free to go home and do the homework—or choose not to.

But overwhelmingly, Kiran says, those patients wanted to work. The average time they spent on the iPad was four hours and eight minutes a week, but a few did much more. Some aphasia sufferers worked a whopping 17 hours a week on the tasks.

With technology that allows them to work on their abilities anytime and anywhere, they’ll often take full advantage, Kiran says. “They’re superdetermined to get better.”

The study showed preliminary evidence that structured, tablet-based individualized therapy can be provided to aphasia patients. Kiran and Constant Therapy are now collaborating with other researchers in the area to apply the apps’ tasks to other types of patients, such as people with dementia, mild cognitive impairment, and epilepsy and children with language deficiencies. Many of the same tasks that helped the aphasia sufferers can be applied to other types of disorders. And as Kiran notes, patients of all types are eager to improve their skills—they just need the opportunity.

“When you empower patients to take control of their rehabilitation, they actually do it,” she says.