Sheffield Investigators

Rebecca Palmer

Cindy Cooper

Pam Enderby

Steven Julious

Nick Latimer

Sheffield Researchers

Liz Cross

Madeleine Harrison

Ellen Bradley

Helen Witts


Glasgow Caledonian University

University of Manchester


National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme with additional support from the Tavistock Trust for Aphasia

Clinical and cost effectiveness of aphasia computer therapy compared with usual stimulation or attention control long term post stroke (Big CACTUS).

Aphasia is a communication disorder often caused by stroke. It affects the ability to understand, talk, read and write. People with aphasia rarely receive treatment from NHS speech and language therapists for more than 3 months. It has been established that people with aphasia can continue to improve their communication with prolonged treatment (beyond 12 months), but this is rarely available.

StepByStep is a computer program designed to help people to practise exercises to improve their ability to find the correct words when they are talking. Following a successful pilot study (CACTUS), Big CACTUS aims to compare computer therapy with attention control (puzzle books) and usual care to see if use of computer software with assistance from a volunteer/speech therapy assistant can improve the ability of people with aphasia to talk.

This research will establish whether people with aphasia can continue to improve their ability to talk after completion of traditional NHS therapy, and whether this can be achieved cost effectively by offering computer treatment at home. Potential benefits to patients include the opportunity for continued treatment and thus improved ability to talk. It could also give patients independence and control over their therapy. The NHS would benefit by being able to support a long term aphasia treatment service without increasing demand on therapy resources.

A total of 278 participants have been recruited to the trial from 20 UK centres between October 2014 and August 2016. The participants will be followed up for 12 months. The results of the study are now available via the link below where you will find a booklet and video. The big CACTUS project has also been published in The Lancet Neurology.