Evaluation of the SWAN Game-Based Approach to Re-Building Numeracy Skills in Aphasia: Feasibility and Preliminary...

Numeracy difficulties are common in individuals with post-stroke aphasia, yet assessments and therapies addressing these are limited. This study investigated the feasibility and effectiveness of SWAN, a game-based digital intervention targeting foundational number language skills: counting and transcoding.

(1) To explore rates of recruitment, retention and adherence to SWAN; (2) To assess whether SWAN improves numeracy skills.

Eighteen individuals with aphasia were given SWAN to play at home for 15 minutes per day over three weeks. Outcome measures included assessments of transcoding, counting, calculation and functional numeracy. Linear mixed-effects models evaluated intervention effects, with the Smallest Detectable Change (SDC) calculated to identify individuals who responded to the intervention.

SWAN was feasible to deliver remotely, with high adherence. Significant group-level improvements were observed for transcoding, counting and calculation, although counting was the only outcome where no improvement was observed at baseline. Twelve participants demonstrated meaningful gains in at least one outcome measure, exceeding their individual SDC. Functional numeracy did not improve, though participants reported increased confidence in skills.

The findings suggest that SWAN is effective in motivating users and providing intensive practice for number sequences. However, further research is required which explores individual response to intervention in order to determine those most likely to benefit.

What is already known on this subject Numeracy deficits are prevalent in aphasia, impacting daily living and independence. Limited previous research involving tailored intervention delivered individually suggests these difficulties may be responsive to intervention. However, intervention to address them clinically appears rare. What this paper adds to the existing knowledge This study demonstrates the feasibility and efficacy of a game-based intervention to improve foundational numeracy skills in aphasia, including counting, transcoding and simple arithmetic (addition and subtraction). However, further exploration of SWAN's effectiveness at individual level is required to determine those most likely to benefit from the intervention. What are the potential or actual clinical implications of this work? The findings highlight the importance of considering numeracy in aphasia assessment and intervention. Digital therapies like SWAN can offer accessible and engaging solutions for addressing this largely unmet need.