M-MAT Tele: Maximising Aphasia Treatment and Recovery across Australia through Innovative Group Telerehabilitation

M-MAT Tele is a new telehealth version of M-MAT. Telerehabilitation reduces clinician and client travel and need for treatment space while addressing geographical inequity amongst people who have experience a stroke. -The naming battery items from the COMPARE trial (ACTRN12615000618550) are used within custom made software (see doi: 10.1080/17483107.2024.2366423) which also contains sentence frames and exemplar multimodal cues (recorded gestures, drawings and spelling). -Games Used in M-MAT Tele All games require the participant to verbally direct the clinician for their turn using target words, phrases and sentences. Four games are used: 1. Memory - Participants find matching shapes hidden beneath naming pictures. 2. Bingo - Participants verbally claim shapes on their card (e.g., "I have a green salad"). 3. Guess the Card - Participants place tokens on pictures using target sentences. Random selection determines points. 4. Snap - Participants identify cards turned over and claim matching pairs. This task focuses on rapid verbal retrieval and interaction. Games are alternated based on group engagement, with changes recommended every hour. Cueing Hierarchy On failure of word retrieval, the clinician initiates a multi-modal cueing hierarchy: 1. Independent Gesture: Participants are prompted to produce a gesture of the target to support word retrieval. If this is unsuccessful, the remained of the hierarchy is completed in full. 2. Gesture: Therapist models the gesture and has the participant repeat the word verbally while gesturing. 3. Drawing: Participants create simple sketches to depict target words and repeat the word verbally. 4. Reading and Writing: Participants write and read the target aloud. 5. Sentence Repetition: Repetition of the full sentence three times to reinforce learning. Other participants practice the multimodal cueing steps as well to maintain engagement and inclusivity. Linguistic Levels 1. Single Words (Level 1): e.g., "Couch." 2. Carrier Phrases (Levels 2–4): e.g., "I’d like the red couch." 3. Full Sentences (Levels 5–7): e.g., "The girl is sitting lazily on the large red couch, but she should be at school." Participants progress to higher levels upon achieving 80% accuracy without cues. Adjustments are made to ensure challenge and engagement, with modifications for non-standard sentence structures (e.g., verbs lacking direct objects). -Paid, trained speech pathologists -Online via Zoom and using custom made software (10.1080/17483107.2024.2366423) -Thirty hours over five weeks. Three therapy days each week, with 2 hours of M-MAT Tele each day. Each session involves one hour of treatment followed by a 15-minute break and another hour of treatment -Home practice/transfer tasks provided during the five weeks of intervention, plus 12 weeks of self directed maintenance activities during the follow up phase. -Attendance logs are kept by therapists, as are detailed therapy records including start and stop times, number of utterances produced and percentage correct, linguistic levels targeted and the duration of any interruptions. Participants report back on their home practice and this is logged by therapists. Treatment fidelity is ensured through review of recordings of the first and midpoint sessions with feedback within 48 hours.