Possible benefits of Fast ForWord® for stroke

In 1997, experts in aphasia started a trial to see whether the Fast ForWord® computer games could help people suffering from aphasia after a stroke. Researchers from VA Northern California Health Care System and the University of California at Davis tested twelve aphasic adults ‘in a subject-as-control study’.⁵ They found that those who used Fast ForWord® improved more than those who did not:

‘The investigators reported that on the comprehension subtests of the Western Aphasia Battery20 the patients improved an average of 4% after Fast ForWord® Language but showed no improvement (-1.5%) after traditional one-on-one treatment for the same amount of time.’⁶

Martha Burns also describes other cases where the Fast ForWord® reading programme was used to help stroke survivors improve their aphasia. In one case, a test subject called L.C. had been able to read a newspaper after his stroke but this ability had deteriorated to the point where he could no longer understand what he was reading. L.C. started to use computer games originally designed to help senior school children improve their ability to read. He did the exercises for 90 minutes a day, five days a week, and had one hour of speech therapy. After ten weeks, Burns noted a series of improvements:

‘…in number of spontaneous utterances during 15 minutes of conversation from 7 utterances to 11 utterances. He showed a 26% increase in comprehension of details and main ideas from independently read newspaper articles and a 25% increase in correct completion of 6th grade [USA] level analogies.’⁷

Another trial in 1999 tested 12 people suffering from aphasia after a stroke. They were aged between 40 and 78 years. The majority of participants had experienced a stroke more than one year previously.⁸ All participants underwent a battery of tests and evaluations before receiving Fast ForWord® treatment for eight weeks.⁹

‘All patients received Fast ForWord training for 1.5 h[ours] per day for a period of 8 weeks, for a total of 60 hours. They also received intensive one-on-one speech therapy with a speech language pathologist for exactly the same amount of time in the 8 weeks either before or after their Fast ForWord training. Order of treatment type was determined by random assignment.’¹⁰

When the researchers re-tested all the participants at the end of the trial, they found that some of them had made significant improvements, while others had made no improvement. They concluded that the site of the brain injury determined whether Fast ForWord® exercises could help people to make progress using this treatment. They explained that the

‘…lesion site (as evaluated in Dronkers, 1996) was an excellent predictor of improvement in auditory comprehension with Fast ForWord. Severe-to-moderately impaired patients with lesions restricted to the superior temporal and inferior parietal cortex were seen to improve by 5 to 18% while those with larger lesions that also encompassed perisylvian frontal lobe structures did not improve.’ ¹¹

Arguments against using Fast ForWord® for stroke

Despite being used extensively in schools around the world, there have been some questions about the value of the Fast ForWord® programme. For example, in 2009, there was a ‘randomized field trial in eight urban schools’.¹² It concluded that ‘the Fast ForWord Language program did not, in general, help students in these eight schools improve their language and reading comprehension test scores.' However, the research results are mixed and some of the results seem to be unclear due to the inclusion of a significant percentage of children for whom English was not their first language.¹³

Case histories

1. 'Willy Arbor is a seven-year-old from West Virginia. He’s got red hair and freckles, belongs to Cub Scouts, likes going to the mall, and, though barely over four feet tall, loves wrestling. He’s just gone through Fast ForWord and has been transformed.^{' 14}
2. Dr Paula Tallal talks about Temporal Processing Deficit - Reading at the Speed of Speech. Children of the Code website. This website contains fantastic resources.
3. 'Computer helps kids read -- and more' by Janet Steffenhagen, Postmedia News. The Gazette (montrealgazette.com) September 21, 2010

Notes and references

1. ‘Language comprehension in language-learning impaired children improved with acoustically modified speech’ by P. Tallal, SL Miller, et al. In Science 1996 Jan 5;271(5245):81-4.
2. ‘Lesion site as a predictor of improvement after Fast ForWord treatment in adult aphasic patients’ by Dronkers, N.F., Husted, D.A., et al. In Brain and Language, 1999, 9(3):450-452
3. ‘Retraining your brain’. In Time Magazine July 5, 1999
4. ‘Language comprehension in language-learning impaired children improved with acoustically modified speech’ by P. Tallal, SL Miller, et al. In Science 1996 Jan 5;271(5245):81-4.
5. ‘Application of Neuroscience to Technology in Stroke Rehabilitation’ by Martha S. Burns. In Stroke Rehabilitation 1074-9357: Volume 15, Number 6 / Nov-Dec 2008
6. ‘Application of Neuroscience to Technology in Stroke Rehabilitation’ by Martha S. Burns. In Stroke Rehabilitation 1074-9357: Volume 15, Number 6 / Nov-Dec 2008

   'The investigators also reported that mildly to moderately impaired individuals with lesions restricted to inferior parietal and superior temporal cortex showed the greatest improvement (5%–18%), whereas those with larger lesions did not improve.’

7. ‘Application of Neuroscience to Technology in Stroke Rehabilitation’ by Martha S. Burns. In Stroke Rehabilitation 1074-9357: Volume 15, Number 6 / Nov-Dec 2008
8. ‘Lesion site as a predictor of improvement after Fast ForWord treatment in adult aphasic patients’ by Dronkers, N.F., Husted, D.A., et al. In Brain and Language, 1999, 9(3):450-452
9. The tests included the WAB (Western Aphasia Battery), which is a standard test to assess the language function of adults and can determine the presence, degree and type of aphasia. They also used the Boston Diagnostic Aphasia Examination.
10. ‘Lesion site as a predictor of improvement after Fast ForWord treatment in adult aphasic patients’ by Dronkers, N.F., Husted, D.A., et al. In Brain and Language, 1999, 9(3):450-452
11. ‘Lesion site as a predictor of improvement after Fast ForWord treatment in adult aphasic patients’ by Dronkers, N.F., Husted, D.A., et al. In Brain and Language, 1999, 9(3):450-452
12. ‘A Randomized Field Trial of the Fast ForWord Language Computer-Based Training Program’ by G.D. Borman, J.G. Benson, L. Overman. In Educational Evaluation and Policy Analysis March 2009 vol. 31 no. 1 82-106
13. ‘A Randomized Field Trial of the Fast ForWord Language Computer-Based Training Program’ by G.D. Borman, J.G. Benson, L. Overman. In Educational Evaluation and Policy Analysis March 2009 vol. 31 no. 1 82-106
14. Norman Doidge, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books) (2007)