2017 2nd International Conference on Information Technology (INCIT)

Clinical Research on Therapeutic Effect of Virtual

Reality Technology on Broca Aphasia Patients
Yaowen Zhang
Rehabilitation Medicine Department
Third Affiliated Hospital
of Sun Yat-sen University
Guangdong, China
384382272@qq.com
Peirong Chen Xin Li
Rehabilitation Medicine Department Rehabilitation Medicine Department
Third Affiliated Hospital Third Affiliated Hospital
of Sun Yat-sen University of Sun Yat-sen University
Guangdong, China Guangdong, China
462100478@qq.com sumslixin@qq.com

Guifang Wan Chunqing Xie Xianjia Yu

Rehabilitation Medicine Department
Third Affiliated Hospital
of Sun Yat-sen University
Guangdong, China
wgf2379@163.com
Rehabilitation Medicine Department Shanghai Institute
Third Affiliated Hospital of Intelligence and Electronics and Systems
of Sun Yat-sen University Fudan University
Guangdong, China Shanghai, China
chunqingxie@126.com xjyu16@fudan.edu.cn

Abstract—Objective: To explore the therapeutic effect of vir-
tual reality technology on speech function of Broca Aphasia
patients after stroke.
Method: Eighteen patients with stroke were enrolled in the Re-
habilitation Medicine Department, the Third Affiliated Hospital
of Sun Yat-sen University from December 2016 to August 2017.
The patients were divided into observation group and control
group by random number table. Both groups were trained in
speech function. The observation group received regular speech
training for 20 minutes per day, Virtual Reality (VR) training
for 20 minutes per day; the control group was given conventional
speech training 40 minutes per day but the same training content
with the observation group. And both groups of patients were
treated for 5 days per week lasting for 4 weeks. CRRCAE was
used to evaluate the language ability before and after treatment.
The Boston Diagnostic Aphasia Examination, BDAE was used
to assess the severity of aphasia.Bucco-facial-apraxia and speech
apraxia Methods were used to assess the patient’s state of bucco
facial function and speech function.
Result: There was no significant difference (P > 0.5) between
the situations of two groups in general data, bucco- facial-apraxia
and speech apraxia. Before treatment, the difference in CRRCAE
and BDAE between the two groups is also not so big(P > 0.05).
After 4 weeks of treatment, the severity of aphasia was improved
in both groups (P < 0.05). Except computing ability, listening
comprehension, repetition, expression, readout, reading, tran-
scription, depiction and dictation were all improved (P < 0.01).
And in noun repetition(P = 0.03),sentence repetition (P = 0.01),
noun expression(P < 0.01), verb expression (P = 0.02), sentence
expression (P < 0.01), comic expression (P = 0.01), enumeration
(P = 0.03),verb readout(P = 0.04),verb reading(P < 0.01),
sentence reading (P = 0.04), noun transcription (P = 0.02),
sentence transcription (P = 0.048), verb depiction (P = 0.01)
and so on, language ability of the observation group is signifi-
cantly better than the control group.
Conclusion: Virtual reality technology combined with speech
function training can improve the language ability of patients
with Broca Aphasia, and its improvement is better than the
simple speech function training.
978-1-5386-1431-0/17/$31.00 ©2017 IEEE
Index Terms—Virtual Reality, Broca Aphasia, Speech function
training.
I. I NTRODUCTION
At present, there are about 7 million patients after stroke
in China [1]. According to the different parts of the disease,
about 25% of patients is with varying degrees of aphasia
[2]. Those patients who mainly have difficulty in expression
can be classified as Broca Aphasia, BA [3]. These patients’
listening comprehension function is well kept and the ex-
pression disorder becomes the biggest problem that affects
its daily communication. Usually the way of speech function
rehabilitation treatment is to help patients to restore their
ability to express, but the traditional treatment progress is
relatively slow [4] and a large number of staff will be involved
since one-on-one or one-to-many is often the way of treatment.
Virtual reality (VR) is also known as spiritual environment
or artificial environment belonging to a new virtual user
interface with a three-dimensional space created by computer
[5]. It can make users be placed in the pre-made three-
dimensional environment through the visual, listening, touch,
smell, taste and other aspects of the simulation so that users
seem to be placed to the environment [6]. In this study,
we selected patients with Broca Aphasia as the research
object, tried to explore the therapeutic effect of virtual reality
technology on patients with Broca Aphasia by introducing pre-
recorded nouns, verbs, phrases and sentence reading videos
into VR equipment for patients and found a more scientific
and effective way to treat aphasia.
 2017 2nd International Conference on Information Technology (INCIT)
TABLE I
C OMPARISON OF TWO GROUPS OF PATIENTS ??? GENERAL INFORMATION
II. M ATERIALS AND M ETHODS
A. Research subjects
18 patients with stroke in the Rehabilitation Department,
the Third Affiliated Hospital of Sun Yat-sen University, were
selected as the research subjects. There were no significant
differences in general information, see Table 1.
Inclusion criteria:
1. Meet diagnostic criteria for stroke made by the Fourth
Cerebrovascular Disease Conference in 1995,
2. Vital signs are stable,
3. Age from 18 to 80 years old,
4. Courses of disease from 1 month to 6 months,
5. There are no significant differences in cognitive function
and Mini-mental state examination (MMSE) score ≥ 24,
6. Both patients and their families signed an informed
consent.
Exclusion criteria:
1. Patients with subarachnoid hemorrhage, venous sinus
thrombosis, transient ischemic attack, progressive stroke,
2. Lesions located in the bilateral cerebral hemisphere,
cerebellum or brainstem,
3. Severe sensory dysfunction,
4. ombined with heart, lung, liver, kidney and other serious
diseases,
5. There are no significant differences in cognitive function
and Mini-mental state examination (MMSE) score ≥ 24,
6. Attack history of epilepsy after stroke.
B. Assessment method
All patients were assessed by Chinese Rehabilitation Re-
search Center Standard Aphasia Examination (CRRCAE),
which had good reliability and was in line with the Chinese
language. Language ability of patients was assessed by 30
items including listening comprehension (nouns, verbs, sen-
tences, orders, out of 60 points for each one), repetition (nouns,
verbs, sentences, out of 60 points for each one), expression
(nouns, verbs, sentences, comic, out of 60 points for nouns,
verbs and sentences but comic out of 6 points), numeration
(out of 15 points), readout (nouns, verbs, sentences, out of 60
points for each one), reading (nouns, verbs, sentences, orders,
out of 60 points for each one), transcription (nouns, verbs,
sentences, out of 30 points for each one), depiction (nouns,
verbs, sentences, comic, out of 60 points for nouns, verbs and
sentences but comic out of 6 points), dictation (nouns, verbs,
sentences, out of 30 points for each one), computing (out of
20 points) and so on.
The severity of aphasia was assessed by Boston Diagnostic
Aphasia Examination (BDAE), 0-1 level for the severe, 2-
3 to moderate, 4-5 for the mild. Using bucco-facial-apraxia,
dominant hand assessment, speech apraxia and other methods
to assess the situation of the patient’s facial function, dominant
hand and speech function. All 18 patients were evaluated for
speech function before and after 4 weeks treatment.
C. Experimental Methods
Two groups of patients were treated with speech function
training, the treatment lasted 4 weeks, 5 days per week, 40
minutes per day. The control group was treated with con-
ventional speech function training for 40 minutes, including
pronunciation training, breathing training, picture illustration,
picture depiction and so on. The observation group was treated
with conventional speech function for 20 minutes and same
training content with control group. After 20 minutes, the
observation group was required to wear VR equipment. The
training contents including nouns listening and reading, verb
listening and reading, phrase listening and reading, sentence
listening and reading, etc. The contents above each would be
repeated 5 times, each time could be a group which contains
physical pictures, lib-rounding video, voice, and text. New
materials would be provided according to the abilities of
patients.
VR equipment was offered by Suzhou MingSite Medical
Technology Co. Ltd. It is a mirror neuron rehabilitation
training system (MNST1.0(6TD)) which consists of a control
unit, 4-channel virtual reality panoramic helmet+2 channel in-
dependent training equipment and mirror neuron rehabilitation
training software.
D. Statistical methods
SPSS 21.0 software for statistical analysis, measurement
data with the mean ?? standard deviation and use t for test,
measurement data comparison using χ2 test and P < 0.05
means the results are significant different.
III. R ESULTS
A. BDAE
There was no significant difference in the severity of aphasia
between the two groups before treatment (P > 0.05). After
treatment, the severity of aphasia was improved (P < 0.05),
and the improvement of the observation group was better than
that of the control group (P < 0.05), see Table 2.
B. CRRCAE
There was no significant difference between the two groups
before treatment (P > 0.05). After treatment, except com-
puting, every other assessment item has been improved(P <
0.05). And in nouns repetition, sentences repetition, nouns
 2017 2nd International Conference on Information Technology (INCIT)
TABLE II
C OMPARISON OF BADE BEFORE AND AFTER TREATMENT
TABLE III
C OMPARISON OF CRRCAE BEFORE AND AFTER TREATMENT
expression, verbs expression, sentences expression, comic ex-
pression, enumeration, verb readout, verb reading, sentences
reading, noun transcription, sentences transcription, verb de-
piction and so on, Observation group has shown more im-
provement than control group(P < 0.05), see Table 3.
IV. D ISCUSSION
A. The Theoretical Basis of VR Technique for BA Treatment
Patients with speech dysfunction after stroke are of high
incidence of depression [7] which will cause these patients
to be less engaged in training. At this time, the primary
purpose of carrying out the speech rehabilitation is to allow
patients to participate in training initiatively. One of the basic
characteristics of virtual reality technology is immersion, the
designers create another world for the experiencer through the
works of art, from the real world into the virtual world, to
view, to know and to understand immersion. When the patients
using VR for speech function training, there will be a certain
stimulation in visual experience, hearing sense and other
sensory levels and this will make them be immersive in the
training. It can be called ???physiological immersion??? [8],
which is people can completely ignore the speed of the media,
achieve the fastest and minimize the chance of feeling the real
event through the efficient extension of the human sensory
function. In a higher level, if the patients are more concentrated
during the training process, they can use their pure imagination
to perceive the virtual story. This immersion is a cognitive
level of immersion which can be called ???psychological
immersion??? [9]. Strengthening the physiological immersion
can help patients to achieve psychological immersion status
better and faster. A strong sense of immersion will increase
the interest of treatment process and the enthusiasm of patients
so that passive treatment can be turned into active treatment
[10].
The application of VR in speech training among patients
will provide more stimulation and feedbacks. In addition,
because of its unique and innovative way, patients will be more
easily attracted and more concentrated. Keller proposes that
behavioral input has a very strong connection to final results,
and the higher the degree of behavioral input means the higher
the level of behavioral results. It is also clear from the results
of this trial that the level of language proficiency in patients
treated with VR has been significantly and comprehensively
improved.
B. Analysis of the efficacy of VR in the treatment of BA
At present, VR technique is gradually applied to the rehabil-
itation of patients’ hand movement function after stroke [11].
[12]. This study is to explore the role of VR in the treatment
of BA patients, try to find a more suitable speech therapy
program for BA patients and verify the difference between the
treatment effects of the application of existing VR equipment
and traditional speech therapy. According to previous studies
[13]., intensive speech rehabilitation treatment can achieve
better efficacy. This study has also verified the opinion through
5 times treatment during 4 weeks. But this study found the
observation group can get a better improvement than control
group in noun repetition, sentence repetition, noun expression,
verb expression, sentence expression, comic expression, enu-
meration, verb readout, verb reading, sentence reading, noun
transcription, sentence transcription, verb depiction and so on
 2017 2nd International Conference on Information Technology (INCIT)
and there are statistical differences which have not yet been
clearly reported in the previous literature.
The application of VR technology in the early stages of
treatment can fully mobilize the enthusiasm of patients so
that patients are willing to speak. At the same time, since the
VR system almost completely shields the interference from
the outside world, so that patients can put more attention
on speech repetition. But at present, the treatment plan only
includes listening and repetition of nouns, verbs, phases and
sentences. In addition, the content of video is single. The
patients will get tired after a period of treatment. How to
reduce or even avoid this boredom during intensive treatment
requires a more scientific set of VR software training materials.
When it comes to how to set the VR training program to
achieve the best therapeutic effect, according to VR technology
in the application of language competence assessment in
western aphasia patients [14], it can be seen that patients
are more sensitive to voice and video signal input, so this
experiment also chose three methods including voice, video
and text input to stimulate the patients.
C. Shortcomings
At present, VR equipment used is still products of the
primary stage. Multi-sensory communication system also can’t
reach the degree that let users mix the spurious with the
genuine and patient can’t get the stimulation from sense of
touch, smell and so on except vision and hearing. In addition,
virtual rendering technology needs to be mature enough to
present the advantages of VR therapy. As for the current virtual
rendering technology, there are the following problems:
(1) Because of the refresh rate of the headset and the
lower resolution (virtual reality in the application of education:
advantages and challenges, Ding Nan), users often can clearly
feel the visual stagnation phenomenon, which often leads to a
strong sense of vertigo.
(2) Patients with BA, often accompanied by varying degrees
of limb motor dysfunction, and the current VR devices gener-
ally come to wearing glasses sitting on the terminal [15]. For
these patients, the use of 20 minutes is also a huge burden
and some of the patients even need their families in the side
to assist in glasses so that they can be treated. At the same
time, the use of VR equipment for the treatment needs patients
to have a certain listening comprehension ability to meet the
treatment, so patients with poor comprehension ability will
easily lead to emotional instability, which also means that the
clinical application needs more convenient and more portable
devices [16].
(3) The headset VR device still needs to link a large fixed
host to solve the problem of power supply and data transmis-
sion [17]. That is to say, in the process of the future application
of VR technology for carrying out centralized treatment, the
patient cannot stay too far from the host. This is bound to
make the treatment of patients with mutual interference and
influence the treatment.
In addition, the current treatment software is mainly about
words and sentences listening and repetition. In the case
of patients wearing headset equipment and headphones, the
therapist cannot make timely feedback and correction of the
patient’s voice and intonation, so that the patient would form
a solidified speech error mode. At the same time, since VR
training material is difficult to be changed, patients can repeat
the follow-up training only relying on the inherent material,
which makes it easy for patients to produce fatigue and affect
the final treatment effects. The subjects included in this study
are relatively simple, the number of the subjects is small and
VR materials are more single. In the future, more patients with
pathological and multiple types of aphasia should be collected
and analyzed in clinical work.
V. C ONCLUSION
There is a large amount of patients with speech dysfunction
after stroke, especially those patients with Broca Aphasia and
their desire to resume normal speech communication is much
stronger. In the traditional speech rehabilitation treatment, one-
on-one or one-to-many treatment through the therapist can
improve communication skills of patients, but it often requires
a quiet enough environment and enough manpower. The use
of virtual reality technology compared with traditional speech
rehabilitation in some areas can get a better therapeutic effect
and it is possible to help therapist to achieve a one-to-many
treatment.
In this study, through treatment effect comparison between
the application of VR in speech function therapy and tradi-
tional speech therapy, we found the application of VR makes
the treatment effects much better which may benefit from a
good sense of immersion and a wide variety of sensory inputs.
But what kind of choices of training content, which way of
image presentation and voice presentation in order to achieve
the best therapeutic effect and virtual reality technology on the
impact of advanced brain function mechanism are still not yet
clear, so these will be further explored in the future research so
that virtual reality technology can be better applied to patients
with aphasia.
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