Patient Co-Design Transforms Digital Therapy App for Stroke Survivors with Reading Impairments

Are Digital Therapies Reshaping Stroke Rehabilitation?

Redesigned iReadMore app launches following co-design with stroke patients to enhance engagement and accessibility. The digital therapy, which improves reading speed and accuracy in alexia patients, incorporates user-driven design changes based on extensive patient feedback. A mixed-methods trial (NCT04849091) is now underway to evaluate real-world effectiveness following the app's release on major app stores.

The iReadMore app represents a significant advancement in digital stroke rehabilitation, targeting the estimated 80 million stroke survivors globally, a third of whom develop aphasia with two-thirds of those experiencing alexia (acquired reading impairment). The therapy delivers personalized word-reading exercises that users can complete independently at home, addressing the substantial gap between recommended therapy hours (20-100+) and actual provision (average 12 hours in the NHS).

How Has Clinical Research Inspired Innovation?

Previous clinical trial data demonstrated iReadMore's effectiveness, with significant improvements in reading speed and accuracy following 34 hours of therapy using the prototype version. Neuroimaging studies confirmed the therapy strengthened neural connectivity within reading networks of stroke survivors. However, user feedback highlighted concerns about the repetitive nature and low user acceptability of the original design, prompting the development team to employ a co-design approach for the commercial version.

The co-design process involved 25 participants with varying degrees of alexia and aphasia, alongside partners and carers, in five structured sessions. Participants ranged in age from 29 to 78 years, with diverse technology experience levels. "I think iReadMore is good because it gives something for himself, something he can complete and be in control of, and I think that gives a big boost to his confidence," remarked the partner of one stroke survivor participating in the study.

Seven key themes emerged from the framework analysis: agency, intuitive design, motivation, personal trajectory, recognizable content, social sharing, and widening participation. Notably, participants strongly preferred functionality over visual appeal, with a simplified interface that maintained core therapy elements while enhancing user control. The redesign allows users to adjust therapy difficulty themselves, choose session duration, and access clear progress feedback without overwhelming complexity.

How Do Experts and Competitors View iReadMore?

Dr. Fiona Cormack, Chief Science Officer at Cambridge Cognition, who was not involved in the study, told Clinical Trials Arena: "This approach to digital therapy development addresses a critical gap in stroke rehabilitation. By incorporating user perspectives into the design process, we're likely to see higher engagement and potentially better outcomes than with traditional approaches."

Unlike similar digital therapies such as EVA Park and GeST, which utilize immersive virtual environments, iReadMore participants preferred simpler navigation and less overtly gamified approaches. The team implemented a travel-based concept with 10 destinations that users visit as they progress through therapy, providing visual novelty without distracting from the core therapeutic task. Progress-sharing capabilities were also added, enabling users to share achievements with family members and clinicians.

What Does the Future Hold for Stroke Rehabilitation?

The app has now been released on both the Apple App Store and Google Play Store following remote beta testing with an additional 25 participants. A mixed-methods evaluation trial has commenced to assess clinical effectiveness in real-world settings, with study registration and data collection conducted entirely through the app. Future research will explore adapting iReadMore for people with reading impairments resulting from primary progressive aphasia, a language-led dementia.

Industry Context: This development reflects the growing trend toward patient-centered digital health solutions, particularly for conditions with significant therapy gaps like stroke rehabilitation. As healthcare systems worldwide struggle with increasing caseloads and limited resources, digital therapies that can deliver evidence-based interventions at scale represent a promising market opportunity. The integration of user perspectives through co-design processes is increasingly recognized as essential for developing solutions that achieve both clinical efficacy and sustained user engagement.

Summary

The iReadMore app, a digital therapy for stroke survivors with alexia (acquired reading impairment), has been redesigned through extensive co-design with patients and launched on major app stores. Targeting an estimated 80 million stroke survivors globally—of whom approximately a third develop aphasia and two-thirds of those experience alexia—the app delivers personalized word-reading exercises that can be completed independently at home. Previous clinical trials demonstrated the prototype's effectiveness, with significant improvements in reading speed and accuracy after 34 hours of therapy, and neuroimaging studies confirmed strengthened neural connectivity in reading networks. However, user feedback revealed concerns about repetitive design and low acceptability, prompting a comprehensive co-design process involving 25 participants with alexia and aphasia, their partners, and carers. Seven key themes emerged from this process: agency, intuitive design, motivation, personal trajectory, recognizable content, social sharing, and widening participation. The redesigned app prioritizes functionality over visual appeal, featuring a simplified interface that gives users greater control over therapy difficulty, session duration, and progress tracking. Unlike competing therapies that use immersive virtual environments, iReadMore participants preferred simpler navigation with less overt gamification, leading to implementation of a travel-based concept with 10 destinations. Following remote beta testing with an additional 25 participants, the app is now available on Apple App Store and Google Play Store, and a mixed-methods evaluation trial is underway to assess real-world clinical effectiveness. The development addresses a critical gap in stroke rehabilitation, where recommended therapy hours range from 20 to over 100, yet actual provision averages only 12 hours in the NHS. Future research will explore adapting iReadMore for people with reading impairments from primary progressive aphasia, a language-led dementia.