Interview with Bill Connors, Founder and Executive Director of the Aphasia Center of Innovative Treatment

Linda Schreiber: I'm visiting today with Bill Connors of the Aphasia Center of Innovative Treatment. Bill has founded this center as well as a website, to help individuals with aphasia. Bill, tell our readers a little about your background and how you came to found the Aphasia Center of Innovative T

Linda Schreiber: I'm visiting today with Bill Connors of the Aphasia Center of Innovative Treatment. Bill has founded this center as well as a website, to help individuals with aphasia. Bill, tell our readers a little about your background and how you came to found the Aphasia Center of Innovative Treatment.

Bill Connors: I left the University of Pittsburgh Medical Center in 2003 with a vision of founding a website where we could do some new things, some really, truly innovative and useful things for individuals with aphasia.

I received my Master's degree in 1975 from the University of Pittsburgh in speech-language pathology. I was fortunate to be around some really great teachers in several subjects but especially fortunate to learn from Audrey Holland and Albyn Davis, both of whom focused on aphasia. In 1976, I took a post-Master's course at RIT in computer-assisted instruction and that was when my vision was formulatedthat was 30 years ago. I knew then that I wanted to take the best of research and scienceclinical evidenceand combine it with what I knew about information technology to make aphasia treatment available and affordable.

In 1997, Dr. Malcolm McNeil from the University of Pittsburgh's graduate program, Dr. Patrick Doyle from the Pittsburgh VA Healthcare System, and I founded the Pittsburgh Aphasia Treatment Research and Education Center. It was an intense aphasia treatment program. Clients would fly in on a Sunday and we would do this intense therapy. Clients would have therapy six, seven, eight hours a day, five days a week. On Saturday, we would videotape instructions for the clients to take home. You had to think on your feet as things moved quickly. So the Pittsburgh Aphasia Treatment Research and Education Center was a big success. We had people from 27 different states and Canada come for treatment.

Linda: So there was a great need for this type of treatment for individuals with aphasia?

Bill: Yes, and so I thought there should be a way to help other speech-language pathologists (SLPs) do this same thing and that is how the website was founded and what the website is intended to accomplish. And not only does it help SLPs, it is a self-help site for families and individuals with aphasia.

Linda: And you're talking about the website: www.aphasiatoolbox.com. This website has the byline "The Future of Aphasia Treatment." Does the byline speak for where you think the future of aphasia treatment is headed: self-help for caregivers and individuals with aphasia?

Bill: That term is a spin-off from an article written by Dr. Steven Small of Chicago (convention.asha.org/2006/handouts/855_1436Small_Steven_091028_111206014350.pdf). What the term refers to is that there is so much we can do to use technology in treatment. Using technology doesn't mean taking traditional, routine, drill-and-practice, pen-and-paper tasks and automating them. It's not just taking printed material and putting it on the computer. And I know that there are a million people with aphasia in our country alone and most of those people have been discharged from treatment because the insurance money ran out, they can't afford the intervention, an SLP isn't available, or the client may have been told that he or she has reached a plateau in treatment and there can be no further progress. So yes, the term self-help in this context defines the future of aphasia treatment both in giving SLPs a valuable tool to use in continuing aphasia therapy and in giving aphasia patients and their caregivers a valuable way to both assist their SLPs and work on their own.

Linda: So what is www.aphasiatoolbox.com?

Bill: www.aphasiatoolbox.com is a website that offers support to SLPs, caregivers, and even individuals with aphasia in the area of intervention and treatment. It is a site that requires a subscription; however, we have a free sample, a free newsletter each month that we publish at the site, and, perhaps most important of all, a free Self-Help Guide that is a tool for SLPs and caregivers to use with aphasia patients in defining the specific communications problem and specific protocols and materials to use in treatment.

For subscribers, we have a collection of past issues of the newsletter, treatment protocols, intervention materials, videos, notes from the Pittsburgh Aphasia Information Technology Club meetings where using a variety of technological options (phones, GPS units, computers) are discussed, and a video.

The treatment protocols are the core of the site. All of the treatment protocols have been created by me with the assistance of caregivers and patients. Each protocol has two pages. The first page of a protocol is designed so anyonea caregiver, speech-language pathologist, student, or patient who's mildly impairedcan pick it up and follow the easy, step-by-step instructions. We've also included tips for making the task a little easier if needed or a little harder as the patient progresses. There are links on this page to other websites that give additional resources.

The second page of a protocol is more advanced and is intended for speech-language pathologists. We have what I call "horizontal tweaking" or "vertical stepping." In the old days, we conducted aphasia treatment vertically. You find out where the person is having trouble on a particular task and you try to move their performance accuracy up from where they are at, for example 60% accuracy to 90%. Well, I view aphasia treatment in a much more dynamic manner. I see it more like a sound engineer's board where there's not only a knob that moves vertically and up and down, but some that move horizontally and you turn and tweak them all. If a patient's stuck on that vertical knob, you don't need to say they have reached a plateau; you can work on some other things, especially the cognitive underpinnings like attention, working memory, mental resource allocation, etc.

You will also see performance objectives on that page so speech-language pathologists can easily collect data for each objective. And you will find the mental process targets for the activity, which to me is most important because aphasia treatment is really about what happens in the brainit's a cognitive issue and we're much more into how we're fixing that neural circuitry.

Linda: So how many treatment protocols will a subscriber have access to at the website?

Bill: We have 31 protocols to get started with. Plus, you can take a protocol and add vertical steps or massage it horizontally. You do that with stimulus management. I like to work with my university students on how to really use the dimensions of the stimulus to help people get better. And vertical stepping will show the speech-language pathologist or the advanced caregiver how to make that activity a little harder or to take a different but similar activity that's a little more difficult for horizontal tweaking. Each protocol can really become 30 or 40 protocols depending on how you use that concept.

Linda: Is there a way website visitors can view a protocol before subscribing to your site?

Bill: We have one treatment protocol available free (www.aphasiatoolbox.com/samples/sample_protocol.pdf) so people can see the concept and they will also have access to a demonstration videowhich is three or four minutes of the treatment being demonstrated (www.aphasiatoolbox.com/samples/sample_video.swf ).

Linda: You mentioned that this site is designed to be a self-help site. Tell us more about how the website achieves that.

Bill: Well, we have tried to make this website so easy to use that anyone can do the treatment. If a speech-language pathologist had to discharge a patient say, for example, for insurance coverage reasons, this is a great site to recommend to the caregivers to continue treatment. We have ways to help SLPs and caregivers make sure the treatment is usable and functional for the individual who has aphasia.

Linda: What are your future plans for the website?

Bill: We're going to be growing the site. I didn't want to put 100 or 200 protocols out there all at once; it would be overwhelming. But we'll be adding protocols and training videos for the advanced use of the protocols. Our website will also have a section specifically for SLPs that will save them time. We'll have some treatment plans for specific disordersespecially those disorders SLPs may not have experience with, like transcortical motor aphasia, pure alexia, the agraphiasand these protocols will show how to work on those cognitive underpinnings.
We have added the Aphasia Site Reader Programa program that effectively helps clients use their memory and own thoughts and ideas to perform tasks, drills, and retrieve words, as opposed to activities that depend on imitation, external cuing, or picture stimuli.

We do not want the website to be complex. We did a lot of research with focus groups and asked, "Can you pick this up and do this?" and developed the site based on their comments.

We're planning to add a new protocol and video every week, but for now our goal is to get this information technology useable and to help people feel comfortable using it.

Linda: Bill, tell us more about subscribing to the website.

Bill: To access everything, a person has to subscribe to the website. They can sign up for a yearwith a big discount for a yearor they can sign up month-by-month allowing them to stop after any month. Our pricing is very affordable and is explained fully on our website We also have an incentive program for SLPs who want to actively use our website as part of their therapy and need their patient(s) to subscribe in order to make the therapy more effective. I encourage people to contact me if they have any questions; we want people to subscribe because the website is really helpful for them.

Linda: This is a valuable site and your mission is to get services to the individual with aphasia, whether that is as self-help, through a caregiver, or via an SLP. The website address is www.aphasiatoolbox.com.

Bill: We are going to work at setting up self-help groups around the country. We're talking to some people in Ohio, Washington, DC, Canada, and Philadelphia. The Self-Help Guide is very useful; a caregiver can look at the Self-Help Guide for example and say, "Gee, my wife has trouble. She knows the words, but just can't get them out." The guide will suggest some protocols to try in order to get started traveling the pathway of aphasia recovery.

Linda: Bill, I appreciate learning about the website and know our readers will appreciate knowing about this site too

Bill: And I'm glad to talk to people so if they have questions, they can email me: bill@aphasiatoolbox.com

Linda: Bill, thanks for the interview.