Tonight, April 30, 2001, we are chatting with Richard Katz, Ph.D., BC-NCD, CCC-SLP
about neurogenic speech disorders and the clinical application of computer
technology and communication disorders.  Dr. Katz is Chair of the
Audiology and Speech Pathology Department at the Carl T. Hayden VA
Medical Center in Phoenix, Arizona. He is also an Adjunct Professor in
the Department of Speech and Hearing Science at the Arizona State
University in Tempe, President (2001-2002) of the Academy of
Neurologic Communication Disorders and Sciences (ANCDS), and
President-Elect of the Association of VA Speech-Language Pathologists
(AVASLP). Dr. Katz  is a graduate of the University of Massachusetts
and the University of Florida. He is a Fellow of the American
Speech-Language-Hearing Association (ASHA) and Board Certified in
Neurologic Communication Disorders in Adults (BC-NCD) by ANCDS. In
1991, Dr. Katz received the California Louis M. DiCarlo Award from the
California Speech-Language-Hearing Association and the Outstanding
Clinical Achievement Award from the American Speech-Language-Hearing
Foundation in recognition of his clinical accomplishments in the area
of computerized treatment of aphasic adults. Dr. Katz serves on the
editorial board for five journals, American Journal of Speech-Language
Pathology, Aphasiology, Journal of Cognitive Rehabilitation, Journal
of Medical Speech-Language Pathology, and Speech, Language and Hearing
Services in Schools. He served as chair on various national committees,
including the Clinical Aphasiology Conference (1990-1991), Computer
Applications Subcommittee for the ASHA Annual Convention (1993 and
1994), and ASHA Division 2 Clinical Issues Subcommittee (1999-2000).
Dr. Katz has lectured nationally and internationally on the
application of computers in speech-language pathology. In 1994, he
was the keynote speaker at the Sprache-Therapie-Computer
Internationaler Kongress in Graz, Austria, the first German-language
multi-disciplinary meeting devoted to recent advances in the clinical
application of computer technology and communication disorders. Dr.
Katz has written and published over 25 computer treatment programs and
has published a book, several book chapters and numerous articles
describing research in the area of computerized therapy

<Robin> Hello, we are chatting with Dr. Richard Katz about neurogenic speech
    disorders and the clinical application of computer technology.
<Robin> Dr. Katz, please tell us about the research and work you have been
    doing in regard to software for aphasia rehabilitation
<Dr. Richard Katz> I don't think I can type long enough to do that, but I'll try!
<Dr. Richard Katz> I began working with aphasic adults at the VA in Gainesville as a
    trainee for Dr. LaPointe in the mid-70d.
<Dr. Richard Katz> In the late 70s, I started working in an outpatient clinic in LA and
    thought that computers would be useful when treating chronic aphasic adults.
<Robin> you were ahead of your time
<Dr. Richard Katz> At first, I tried using slide projectors and film-strip projectors, but
    they were limited in the options you could provide patients.
<Adrienne> I was just about to ask... that wasn't very common in that time was it?
<Dr. Richard Katz> No, people were still riding the wave of behaviorism and operant
<Dr. Richard Katz> With a colleague, Vivian Nagy, a psychologist, we developed some
    rudimentary tx programs.
<Dr. Richard Katz> The patients loved it -- computers were still new -- it was kind of like
    playing language games with kids.
<Dr. Richard Katz> But then we got serious about the tx -- what makes tx work for
    different types of patients and different people with aphasia?
<Dr. Richard Katz> Computers can help us track down the salient elements of aphasia
    tx -- what works and what doesn't.
<Adrienne> that is what I find most intriguing..
<Dr. Richard Katz> I thought that, over the years, we could develop a body of knowledge
    about tx, aphasia, and aphasia treatment.
<Dr. Richard Katz> Clinicians should use everything available to make
    their treatment more effective.
<Robin> Do you currently have any software that is on the market?
<Dr. Richard Katz> No, my old software business, Sunset Software, is hybernating.
<Adrienne> Dr. Katz, what kind of empirical evidence has been collected for computer
<Dr. Richard Katz> Good question. Lots of little studies and a few big ones.
<Erika> why is your software business hibernating?
<Erika> I mean, was it not as successful as you'd hoped?
<Dr. Richard Katz> Well, Erika, it's tough to sell software on one hand and appear to
    be an impartial researcher on the other.
<Erika> interesting point
<Dr. Richard Katz> The money was good, though! ;;
<Adrienne> good point
<Erika> why is it tough?
<Robin> are there any programs out there now that you would recommend, and why or
    why not?
<Dr. Richard Katz> I made a "life decision" to try to improve treatment for folks with
    aphasia and not sell stuff -- I guess I'm a throw-back to the 60s.
<Dr. Richard Katz> When you are submitting for funding for research, your motive may
    be suspect if you stand to gain financially from your results. It's done all the time, but I
    am uncomfortable with it for myself.
<Dr. Richard Katz> Let me think about the software I am using in the clinic.
<Dr. Richard Katz> I use AphasiaMate from Australia.
<Dr. Richard Katz> It is a bit glossy and sort of comprehensive -- lots and lots of
    different tasks and colors and stuff.
<Robin> never heard of that one
<Dr. Richard Katz> But no real intervention, just a "stimulation" type of activity.
<Adrienne> what criteria do you use to determine what is "good" software?
<Dr. Richard Katz> Criteria?  What works for a starter.
<Dr. Richard Katz> More specifically...
<Dr. Richard Katz> does the program measure performance and chart it over time.
<Dr. Richard Katz> does the program provide an intervention for errors?
<Dr. Richard Katz> Is the intervention simply a cue or is it a strategy that the pt. can
    learn and take with him or her into real life?
<Dr. Richard Katz> Can the pt. run the program by him or her self, so they can practice
    on their own.
<Dr. Richard Katz> Is the interface -- style of interacting with the program -- intuitive and
<Adrienne> can you give an example of a task they would do that would generalize?
<Dr. Richard Katz> Good question, Adrienne.
<Adrienne> thanks
<Dr. Richard Katz> There is a program from Austria called, "Multicue"
<Dr. Richard Katz>  The author is presenting
    (something else) at CAC this year.
<Dr. Richard Katz> Multicue teaches pts.  how to use compensatory word-finding
<Adrienne> now that is one I definitely see using often
<Paula> I am here but I am learning from listening right now.  Don't have questions at
    this point.
<nan> is it expensive???
<Dr. Richard Katz> No, Multicue is free.
<Dr. Richard Katz> Another program I wrote for the old Apple II was Understanding
    Questions, which is being re-written by Bungalow for the PC.X
<Dr. Richard Katz> Understanding Questions taught pts. to discriminate between
    question words: who, what, where...
<Dr. Richard Katz> by providing a "tutorial" specific to the error item. It works,
<Dr. Richard Katz> Just like regular, face-to-face tx, computer tx needs to be modified
    to benefit pts. with aphasia more effectively, but that means extra work for the clinician
    or sophisticated programming.
<Adrienne> do clinicians usually do special training before using computer therapy?
<Dr. Richard Katz> Not anymore -- it's a good idea to practice using the software and
    become familiar with it before the patient sits down to use it.
<Dr. Richard Katz> The computer labs at ASHA are a terrific way to learn about
    software programs.
<Dr. Richard Katz> At FLASHA, I hope to bring lots of demo CD-ROMs from different
    software pubishers to distribute.
<Adrienne> I guess it is the booming thing right now!
<Dr. Richard Katz> That's why ASHA started charging to attend the labs. When we
    started them, it was free.
<Dr. Richard Katz> I've had the chance to study with folks from other countries, too, and
    learn about how they use computers with aphasic folks.
<Dr. Richard Katz> In Sweden, they use the internet a lot for aphasic adults to
    communicate and have "group tx".
<Adrienne> like in a chat room??
<Dr. Richard Katz> In Germany and Austria, the government has supported
    development of big programs to help adults communicate everyday activities.
<Dr. Richard Katz> Yes, like chat rooms.
<Erika> that is awesome
<Dr. Richard Katz> The German speaking programs are functionally oriented, not
<Dr. Richard Katz> "Pretend we are going skiing. What do you need to do first..."
<Dr. Richard Katz> That kind of thing.
<Adrienne> that's great!!
<Dr. Richard Katz> In Japan and China, computers aren't used much for aphasic
    patients, yet.
<Dr. Richard Katz> The language characters are too many for a conventional keyboard.
<Dr. Richard Katz> But as GUIs are developed, that will no longer be a barrier.
<Robin> what are GUIs?
<Dr. Richard Katz> GUIs is Graphic User Interface, like Windows, as opposed to
    straight text.
<Dr. Richard Katz> Sorry for the jargon...
<Robin> you are educating us!
<Robin> In your opinion, which country or countries is the most advanced in this
<Dr. Richard Katz> Well, many programs are developed in England and Europe, but
    the US is probably in the lead.
<Dr. Richard Katz> Bigger business and research funding opportunities.
<Dr. Richard Katz> It is great fun meeting these folks from all around the world.
<Dr. Richard Katz> We all speak differently, but aphasia affects people the same.
<Robin> what percentage of your patients use the computer as part of their tx
<Erika> I would love to learn more about that Swedish appraoch
<Dr. Richard Katz> These days, 65 % of our pts are seen for dysphagia.
<Dr. Richard Katz> Computers are used primarily with aphasic and motor speech
<Dr. Richard Katz> I use computers with the most chronic patients, as the goal of tx is
    to get them communicating again.
<Dr. Richard Katz> so time is valuable and acute folks need face-to-face tx.
<Dr. Richard Katz> For the acute, computers are secondary tx (supplementary).
<Dr. Richard Katz> For the chronic, computers are a means of stimulation and practice
    and sometimes, alternative ways to communicate and to be active.
<Robin> Do many of these patients have computers at home so they can use this
    approach after discharge?
<Dr. Richard Katz> Most people we see have computers at home these days.
<Dr. Richard Katz> Those that don't go to the libraries where they can use the
<Dr. Richard Katz> Erika -- I'll be talking a little about the program from Sweden at
<Erika> oh...I am no where near Florida
<Dr. Richard Katz> Computers can be helpful if we keep in mind our goal of improving
    communication... and that's between people, not a person and a machine.
<Dr. Richard Katz> Then email me for my handout and I'll attach it (after I write it, that
<Erika> that would be wonderful
<Adrienne> is machine interface a frequent barrier for people...
<Dr. Richard Katz> Yes, Adrienne.
<Dr. Richard Katz> I feel a lot of the benefit of tx in aphasia is something other than the
    specific content.
<Dr. Richard Katz> Now, I'm not proud of that -- I wish we could control all the important
    aspects of communication and tx.
<Dr. Richard Katz> but we can't. We don't even know all the important aspects.
<Adrienne> but we're closer!
<Dr. Richard Katz> So we therapists do the best we can with the various aspects we
    feel (and our literature shows to be) important.
<Dr. Richard Katz> Yes, every report in the literature brings us closer.
<Dr. Richard Katz> That's why I'm proud of my 1997 study in JSHR with Dr. Terry Wertz.
<Robin> tell us more about that study
<Dr. Richard Katz> We showed that for a large group of adults with aphasia, computer
    tx (language content) was more helpful that playing games on computers (stimulation)
    or doing nothing at all.
<Dr. Richard Katz> We had them in tx for 6 months, 3x/wk.
<Dr. Richard Katz> Tx was a hierarchy of 232 tasks in which the computer
    automatically moved the patients up and down the hierarchy, depending on their
<Dr. Richard Katz> It was soooo cooool....
<Robin> great!
<Dr. Richard Katz> The interesting thing was that pts didn't improve in reading (the tx
    was reading), but improved in their verbal and auditory skills.
<Robin> were the patients using software that you developed?
<Dr. Richard Katz> Yes, the software was developed by Terry and me and one of our
    research SLPs, Susan Lewis.
<Adrienne> any ideas on why that would happen Dr. Katz?
<Dr. Richard Katz> We figure that the pts. didn't improve in reading because the tx was
    stimulating reading (and language), but didn't provide any specific instruction to
    improve reading, e.g., reading strategies.
<Robin> is it available for purchase?
<Dr. Richard Katz> I wish it were, Robin, but it gets complicated...
<Adrienne> did it provide verbal/ auditory strategies?
<Robin> well, therapists and caregivers are always looking for something to help the
    patient, especially after their insurance coverage lapses for tx
<Dr. Richard Katz> The software was written for the Apple IIgs computer. It was
    re-written for the PC, but tied up now between the programmer and some software
<Robin> so many patients cannot continue therapy because their progress has
<Dr. Richard Katz> The software was visual only (nonlinguistc and linguistic) -- no
    verbal/auditory, but that would be easy now.
<Dr. Richard Katz> In the old days, I wrote dozens of programs for the Apple Ii and put
    them in the public domain. While I was at the
<Dr. Richard Katz> Lost Angeles VAOPC, we distributed over 1,000 disks to folks for
<Adrienne> how did you fund that?
<Robin> thats wonderful....I'm sure that the patients were very appreciative
<Dr. Richard Katz> Charitable contributions, Sunset Software, VA, etc.
<Adrienne> awesome
<Dr. Richard Katz> In 1990, I was given an award from CSHA (California SHA) for the
<Robin> having worked in just about every medical setting, I can tell you that many
    patients and their families are looking for something else when therapy is no longer
<Dr. Richard Katz> Absolutely.
<Adrienne> I'm sure 1,000 disks made quite a difference!!
<Dr. Richard Katz> Bruce Porch said...
<Dr. Richard Katz> "People with aphasia need to be in a reasonably stimulating
    language environment to improve."
<Dr. Richard Katz>  Computers can help do that, especially for those who no longer can afford tx.
<Dr. Richard Katz> Here's some other ideas for software sources:
<Dr. Richard Katz> I do like Clay and Terri's Bungalow software. It's getting better every
<Robin> they are very nice folks...Terri did a chat for us...we had clinicians and
    caregivers chatting together
<Dr. Richard Katz> Parrot software has lots of titles, but some of them don't work on my
    system -- we use Windows NT -- and in my opinion some don't deliver what they
    seem to promise.
<Robin> there are software programs for stuttering too
<Dr. Richard Katz> Lauret Learning writes for kids, but has several titles appropriate for
    adults. Their My House and My Town are good for aphasic adults working on auditory
<Dr. Richard Katz> What programs are available for stuttering that you like?
<Robin> thats good to know
<Robin> I haven't used them myself....Dr. Fluency comes to mind
<Dr. Richard Katz> I know an Australian author with  a great motor speech program.
<Dr. Richard Katz> She's an experienced SLP who wrote two nice CD-ROMs with video
    to help pts. produce initial sounds in words.
<Robin> these are wonderful resources
<Adrienne> You have been so informative tonight Dr. Katz!
<Erika> yes
<Erika> very interesting
<Adrienne> I hope to have more opportunities to use computer therapy
<Dr. Richard Katz> There are lots and lots of sources on the web for SLP and tx, too.
<Dr. Richard Katz> I'm going to add this one to my list to share with others!
<Dr. Richard Katz> Back to TX: We also issue lots of augmentative devices, some to
    aphasic folks.
<Dr. Richard Katz> Mostly to motor speech adults, Parkinsons, ALS, etc.
<Dr. Richard Katz> The VA is very generous in that area.
<Dr. Richard Katz> The little Palm Pilot types of computers have lots of potential.
<Robin> We had a wonderful chat about that with Joanne you offer your
    patients vocal amplifiers?
<Dr. Richard Katz> Not much -- amplifiers for weak voices tend to distort speech and
<Dr. Richard Katz> so we issue them rarely. Text-to-speech type devices more
<Robin> Dr. Katz,  we thank you so mcuh for taking time out of your busy schedule to join us.
    Good luck with all of your endeavors
<Adrienne> Thank you so much for everything Dr. Katz!
<Dr. Richard Katz> Thanks for inviting me to chat with you all!