Communication aids and computer-based therapy after stroke

Stroke Helpline: 0303 3033 100
Website: stroke.org.uk

Communication aids and
computer-based therapy after stroke

Many people have communication problems after a stroke. Speech
and language therapists use a variety of approaches to help,
including aids and computer-based therapy. This resource sheet
offers guidance for family members and carers of people with
communication problems. It also lists sources of further information
and advice, including suppliers.

Communication problems affect about a third tiredness may make following instructions on
of all people who have a stroke. Although a computer too challenging. Physical effects
many people recover, about half of people with of stroke can cause problems with holding
aphasia (difficulty speaking or understanding an aid or using the computer mouse, and
what is said), are likely to have some visual problems can make it harder to read the
communication problems in the long term. screen.

Anyone with communication problems However, there are a number of adaptations
should have a thorough assessment available to help people with disabilities use
from a speech and language therapist. a computer or communication aid. These
The therapist will work with them to include adapted keyboards, specialised
improve their skills and find alternative switches, pointing devices and scanning
ways of communicating. This might involve technologies. They can allow someone to
face-to-face therapy sessions, using a use a computer or communication aid using
communication aid, or computer-based any movement they are able to control, such
therapy. You may also like to read our as their eye. Some communication aids can
factsheets F3, Communication problems after also be mounted onto a bed or wheelchair.
stroke and F14, Speech and language therapy
after stroke. In this resource sheet, you’ll find
information about:
Everyone is different and so different tools
and techniques may be used depending • communication aids
on how severe someone’s communication
problems are, how much recovery they have • computer-based therapy
made, and their individual needs.
• where to go for a specialist assessment
Communication aids and computer-based
therapy are not suitable for everyone. • contact details of useful organisations.
After a stroke, confusion, memory loss or

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Communication aids and computer-based therapy after stroke

Communication aids VOCAs use a computer-generated voice to
play messages aloud. Some can be operated
A communication aid can be anything that simply with one finger to select pre-recorded
makes communicating quicker and easier. messages. Others have a keyboard so typed
They range from simple charts with words text can be converted into speech. This may
and pictures to portable electronic devices. help if someone has difficulty speaking, but
can still write or type.
Simple communication aids include alphabet
boards, communication charts and books. Symbol sets
These aids display large letters or words,
as well as sets of colour pictures, photos or If someone has difficulty reading or
symbols. For example, an aid might have a spelling after a stroke, there are a number
grid of pictures to represent feelings and of symbol sets available. Sets of picture
moods such as ‘hungry’, ‘thirsty’, ‘happy’ symbols represent a range of vocabulary
and ‘sad.’ Each picture is usually labelled with and subject matter. There are different sets
the word, too. The person can then point to for different communication needs and
an image on the board to indicate what they abilities. Someone can select and group the
want to say. Our communication chart is a symbols to form personalised messages
good example – see page 6 for details. and communicate with others. One example
of a symbol set is Talking Mats (see Useful
An E-Tran Frame is a specialised chart that organisations).
can be used when someone cannot use their
hands to point, for example if they have Apps
locked-in syndrome and can only move their
eyes. They can use their eye gaze to indicate Apps are software applications for
a letter, word or symbol that is attached smartphones, hand-held computers or other
to this large frame, which is held in front of mobile devices. Once they are downloaded
them by a trained carer. to the device, apps provide specific
functions – for example there are apps for
A communication passport is used as a games and music. Some apps are available
record to communicate with health and free, but you need to pay for others.
social care providers so that the stroke
survivor’s needs, likes and dislikes can be Apps for communication work in a variety
properly heard and taken into account. of ways. Many of them allow you to pick
A ready-made medical passport is available symbols, and add text and sound to them.
from Speakability, and templates to create Some will let you choose a pre-recorded
your own are available on many websites. voice or record your own voice saying the
See the Useful organisations section. words. See page 9 for a list of apps (Useful
organisations).
Electronic aids

Specially designed electronic devices to aid
communication are available, such as Voice
Output Communication Aids (VOCAs).

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Communication aids and computer-based therapy after stroke

How do electronic aids and apps help? These alternatives may help the stroke
survivor to communicate more easily and
Electronic aids and apps allow the user to may be used alongside ongoing therapy to
communicate in a variety of ways. Many help them to recover.
allow the user to combine different forms of
media such as symbol sets, personal photos, People with dysarthria or dyspraxia have
video and audio voice recordings. problems co-ordinating the correct muscles
in their mouth and throat to speak. If these
They can include functions to: problems continue in the long term, a
communication aid may be suitable.
•• group words, pictures or symbols
together on a screen to represent Assessments for
meaningful phrases or messages communication aids

•• store standard messages or responses to If someone has not been assessed for
access later by pressing a single key communication aids in hospital, their GP can
refer them to a local speech and language
•• upload personal photos, videos or voice therapist. The therapist can then refer them
recordings to include as part of a message on to a specialist communication aid centre
if necessary.
•• flash messages to the screen or play them
aloud through the device’s speakers. The NHS has a small number of specialist
centres where someone can be assessed
There are also specialised electronic for a communication aid. At these centres,
communication aids that are larger than they will see a speech and language therapist
hand-held devices. These may offer other and other professionals who have specialist
computer functions such as access to the knowledge and training in technologies for
internet and email. communication. They will aim to identify
the most helpful aids for someone. Carers
If someone has aphasia and their speech and family members can all be involved in
continues to improve, there is no reason why the assessment. If someone’s needs are
they can’t keep using communication aids more complex, they may need to see other
for additional support. professionals, such as a physiotherapist or a
vision specialist.
When are communication aids
used after stroke? People usually need to be referred to a
communication aid centre by an NHS or
If someone has not significantly recovered private speech and language therapist, but
from aphasia two weeks after their stroke, this can vary. Ask the speech and language
then a speech and language therapist should therapist for advice and see the Useful
assess them for all alternative means of organisations section for contact details of
communication possible. This can involve the main centres. Communication Matters
using gestures and facial expressions, is a charity that has a full list of these
drawing, writing, or communication aids. services.

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Communication aids and computer-based therapy after stroke

The assessment services may also offer Computer-based therapy
general advice on the communication aids
available from independent suppliers, as well This type of therapy involves doing
as on related technology, including apps. practical exercises using a computer. It
Many NHS assessment services provide trial includes specific exercises for the different
loans of equipment, as well as training and communication problems someone may
support. experience after stroke. These programmes
are designed to be user-friendly, interesting
Training and interactive to encourage people to use
them regularly.
Using a communication aid can help
improve someone’s quality of life after a Computer-based therapy programmes may
stroke. When considering what type of have:
aid may be helpful, it is essential to think
about the needs of everyone involved, •• pictures or symbols next to words on
including family members and carers. Using a screen, to help with reading difficulties
communication aid can be a big adjustment
for families and carers to make and training •• visual or spoken cues to prompt the user
and support should be offered. The whole to answer questions by typing or speaking
family may need ideas to help them to bring into a microphone
alternative ways of communicating into
everyday situations. They may also need to •• spoken commentary to give feedback
adapt how they hold conversations. Ask the
speech and language therapist for advice. •• videos, with a speech and language
therapist showing mouth movements,
Buying communication aids to help the user form different sounds or
words
If you are considering buying a
communication aid privately from a •• different levels of difficulty depending on
specialised supplier for someone with the answers that have already been given.
aphasia, speak to a speech and language
therapist first. You can request a free trial The exercises focus on particular types of
of any equipment, and many commercial skills. For example, someone with aphasia
suppliers offer an initial assessment, advice, may need to practise saying single sounds or
training and ongoing support. Ask about what words.
backup systems are needed if the electronic
device malfunctions or loses power. Here are some examples of exercises for
people with aphasia:
Electronic aids may have many features that
can be personalised according to someone’s •• matching pictures with words displayed
needs. For example they could be on the computer screen
multilingual. Making sure an aid is personal
and providing training and support are great •• saying aloud the names of objects shown
ways to make it a success. when prompted

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Communication aids and computer-based therapy after stroke

•• repeating aloud syllables, words, phrases How do you access computer-based
or sentences displayed on screen, or therapy?
heard through earphones.
Computer-based therapy works best
There are also specific exercises designed with the support and guidance of a speech
to help with writing, using numbers and for and language therapist who can assess
people with dysarthria or dyspraxia. the person’s strengths and weaknesses.
The exercises can then be tailored to their
How useful is computer-based therapy? specific needs.

Research shows that this type of therapy The therapy may be given as part of face-to-
can help improve a person’s communication face sessions with the therapist, or carers
skills after stroke if it is tailored to their and family members can be trained to use
specific needs. How useful this approach the software so that therapy can continue at
is will differ from person to person. The home between sessions.
specific nature of their speech and language
difficulties, their overall health, their You can also buy software packages from
motivation to persist at the exercises, and commercial suppliers. It is a good idea to
how much therapist support is available will ask a speech and language therapist for
all have an effect. advice first though. Some NHS assessment
centres for communication aids can make
People with aphasia often feel they benefit recommendations or support someone with
from using computer-based therapy. Even computer-based therapy. They can also
if it doesn’t guarantee improvement in assess whether someone needs computer
everyday conversation, computer-based adaptations.
therapy can help improve a number of
language skills. For example, exercises Commercial suppliers usually offer free
designed to help someone find words can trials of their programmes. They may be
also help them understand their meanings. available on CD, DVD, or as free downloads
Information linking words and their from websites. Costs can be high, but some
meanings is stored in the same areas of the suppliers offer an option to subscribe and
brain. Similarly, exercises designed to help pay on a monthly basis.
someone say whole sentences can also
help them understand sentences heard in See below for details of assessment centres
conversation. This type of therapy may also and commercial suppliers.
help someone feel more confident about
their overall communication. Useful organisations

Some people find that having both All organisations are UK wide unless
computer-based therapy and face-to- otherwise stated.
face therapy sessions helps them to
recover more quickly. It also provides more Please note that technology in this area
intensive treatment. Research shows that, advances quickly, particularly with apps, and
in general, this can result in better recovery. so this list may not be exhaustive.

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Communication aids and computer-based therapy after stroke

Stroke Association Hollinwood Business Centre, Albert Street,
Stroke Helpline: 0303 3033 100 Hollinwood, Oldham OL8 3QL
Email: [email protected] Tel: 0161 358 0151
Website: stroke.org.uk Website: www.acecentre.org.uk
Contact us for information about stroke, This charity can assess children’s and
emotional support and details of local adults’ needs for communication aids.
services and support groups. Our They also provide training and ongoing
Communication Support Services are support. People can refer themselves to
available in some areas of England, Northern this service. Their website provides clear
Ireland and Wales. explanations, useful links and resources on
communications aids. The Oxford centre
Our resources takes referrals from the south of England
and Wales. The Oldham centre covers the
Communication card: states “I have had a north of England. They have a separate
stroke and find it difficult to speak, read or website with a list and information about the
write. Please give me time to communicate. apps available for the iPod, iPhone and iPad:
Speak clearly, taking your time and write www.appsforaac.net
down key words. Your help and patience
would be appreciated.” Also has room for Communication Aid Centre and Computer
name, address and emergency contact Assessment Training
details. (credit card size) Speech and Language Therapy Department,
Communication chart: An aid to Frenchay Hospital, Bristol BS16 1LE
communication consisting of four sides of Tel: 0117 340 3946
A4 with the alphabet, numbers, a clock and Website: www.cacfrenchay.nhs.uk
pictures for common words such as ‘hungry’, Leading NHS centre serving the south west
‘thirsty’, ‘hot’ and ‘cold’. (Price £1) of England. Offers specialist assessments
for communication aids, computer
Assessment services for adaptations and for mounting of equipment
communication aids on wheelchairs. Provides training, equipment
on loan and follow-up reviews.
The following organisations are key NHS
services and charities which provide Royal Hospital for Neuro-disability
information and assessments for West Hill, Wandsworth, London SW15 3SW
communication aids. There are many more Tel: 020 8780 4513
regional services. Communication Matters Website: www.rhn.org.uk
(see page 8) has a list of all NHS and private Specialist centre for people with
communication aid centres in the UK. neurological conditions including stroke.
Offers assessments for severely disabled
England people who are, for example, minimally-
conscious or who have locked-in syndrome.
ACE Centre
92 Windmill Road, Headington, Oxford Communication, Learning and Technology
OX3 7DR Service
Tel: 01865 759 800 Wolfson Neurodisability Service, Level 10,

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Communication aids and computer-based therapy after stroke

Main Nurses Home, Great Ormond Street Wales
Hospital, Great Ormond St,
London WC1N 3JH ACE Centre
Tel: 020 7405 9200, Ext 1144 92 Windmill Road, Headington, Oxford
Service for children only. OX3 7DR
Tel: 01865 759 800
Northern Ireland Website: www.acecentre.org.uk
This charity can assess children’s and
Communication Advice Centre adults’ needs for communications aids.
Belfast Health and Social Care Trust They also provide training and ongoing
Musgrove Park Hospital, RDS Building, support. People can refer themselves to
Stockman’s Lane, Belfast BT9 7JB this service. The website provides clear
Tel: 028 9090 2905 explanation and useful links and resources
Website: www.belfasttrust.hscni.net on communications aids. The Oxford centre
takes referrals from Wales. They have a
Scotland separate website with a list and information
about the apps available for the iPod, iPhone
AAC Resource and iPad: www.appsforaac.net
NHS Ayrshire and Arran, Ayrshire Central
Hospital, Room 156, Admin Block, Kilwinning Charities offering resources
Road, Irvine KA12 8SS or information and advice
Tel: 01294 274 191
Some of the following charities refer
Call Scotland to ‘augmentative and alternative
University of Edinburgh, Moray House, communication’ (AAC). This terms covers all
Paterson’s Land, Holyrood Road, forms of communication (other than speech)
Edinburgh EH8 8AQ that are used to express thoughts, needs,
Tel: 0131 651 6235 / 6236 wants, and ideas. Examples include writing
Website: www.callscotland.org.uk or using symbols, pictures, or electronic aids.
Website has a list of communication apps for
iPhone, iPod Touch and iPad. The term assistive technology means any
device that helps someone to perform a
Technological Assessment and Support task. It includes communication aids.
Service for Children and the Curriculum
(TASSCC) 1Voice: Communicating together
Aberdeen Exhibition & Conference Centre, Website: www.1voice.info
Balgownie One, Conference Way, Bridge of This organisation supports children and
Don, Aberdeen AB23 8AQ teenagers using AAC and their families to
Tel: 01224 814 775 overcome the isolation that being unable
Website: to speak can cause. Provides regular
www.aberdeen-education.org.uk/tasscc events and has an online support group and
For children and young people only. discussion forum.

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Communication aids and computer-based therapy after stroke

Aidis Trust Augmentative Communication in Practice:
Helpline: 0808 800 0009 Scotland
Website: www.aidis.org Website: www.acipscotland.org.uk
This charity provides advice on This working group represents professionals,
communication aids and computers to help users and carers involved with AAC in
people with disabilities to communicate. Scotland. The website provides links to
They can arrange assessments and they communication aid centres in Scotland.
provide a technical support helpline for all They hold regular events and have a range
sorts of computer queries. of publications.

Aphasia Corner Communication Matters
Website: http://aphasiacorner.com/blog Tel: 0845 456 8211
This is a blog for people with communication Website: www.communicationmatters.org.uk
difficulties after stroke, their carers and This charity supports people who find
others concerned for the needs of this communication difficult. Provides
community. publications and online information on AAC
and lists NHS and private communication
Aphasia Now aids centres in the UK. Runs regular events,
Website: www.aphasianow.org including some where AAC products are
Website maintained by the charity demonstrated.
Connect and run by and for people with
aphasia. Explore their resources section Connect
for information on aphasia therapy. This Tel: 020 7367 0840
includes reviews by a speech and language Website: www.ukconnect.org
therapist of well known computer-based This charity provides services and support
therapy, including Revivo, React2 and to people with aphasia in London and Bristol.
StepbyStep, as well as Co-Writer for Publishes a wide range of tools, resources
predicting words when typing. and publications to aid communication.

Aphasia Software Finder Disability Action – Northern Ireland
Website: www.aphasiasoftwarefinder.org Tel: 028 9029 7880
Independent resource from the Tavistock Website: www.disabilityaction.org
Trust for Aphasia. Provides a database of Works with people who have disabilities and
computer-based therapy. aims to improve their quality of life. Provides
information, employment and training
AppsForAAC support, mobility assessments and help with
Website: www.appsforaac.net transport. Their Digital Inclusion service has
Independent resource from the ACE Centre assistive technology available to try.
charity. Provides a database of apps for AAC
for the iPod, iPhone and iPad. Explains each Empowering Technology
app and has a tool for comparing features. Website: www.emptech.info
An independent online database of
products, manufacturers, suppliers and

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Communication aids and computer-based therapy after stroke

services for assistive technology, Talking Point
including communication aids. Website: www.talkingpoint.org.uk
This website from the charity ICAN
I CAN provides information and resources for
Tel: 0845 225 4073 children and young people with speech,
Website: www.ican.org.uk language and communication needs. Has
This charity provides independent information for young people, parents and
assessments of special educational professionals.
needs for children with communication
difficulties and runs two specialist Apps for communication
schools. Offers training to professionals problems caused by stroke
and an expert enquiry service for parents
and professionals. There are over 100 different apps for
communication problems available for the
Personal Communication Passports iPhone, iPod or iPad. The website www.
Website: www.communicationpassports. appsforaac.net from the ACE Centre
org.uk charity has a list of the apps available with
Provides templates for producing a an easy comparison tool so you can see
personalised communication passport. which device they can be used on, the
symbols they use and their prices. Apps
Speakability can be downloaded to your device from
Helpline: 0808 808 9572 itunes.apple.com.
Website: www.speakability.org.uk
This charity supports and campaigns for Fewer apps are available for android
people affected by aphasia. Publishes devices. The following is a list of apps
a wide range of aids, resources and available. Some have their own websites
publications to help communication, with more information. They can be
including Medical Communication downloaded from play.google.com.
Passports.
•• Box of words
Speechbubble •• DAF
Website: www.speechbubble.org.uk •• Droidspeaker
This website from the ACE Centre •• Communication helper
charity is an independent resource with •• Mobile 112
a database of voice communication aids •• My voice
including information on software, symbol •• Small Talk Website: www.aphasia.com
set vocabularies, the devices they run on •• Speech assistant
and commercial suppliers. Gives detailed •• Speak it Website: www.future-apps.net
descriptions of individual products and •• Taptotalk Website: www.taptotalk.com
how they work. •• Voice4u Website: http://voice4uaac.com

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Communication aids and computer-based therapy after stroke

Suppliers of communication aids They can arrange assessments, evaluate
products, and give training and support.
This list includes many commercial suppliers Products available include the ChatPC range
of well-known communication aids. of text-to-speech devices and
E-Tran Frames.
Ability World Ltd
Tel: 0845 47 47 245 Malvern Scientific
Website: www.ability-world.com Tel: 01886 884 741
Sells a wide range of communication aids, Website: www.malvernscientific.com
from simple aids like alphabet boards, to Provides computer-based assistive
specialist electronic aids. technology for people with disabilities.

Dynavox Mayer-Johnson MegaBee
Tel: 01926 516 250 Tel: 01600 714 856
Website: www.dynavox.co.uk Website: www.megabee.net
A leading provider of communication aids Produces and sells the MegaBee portable,
providing specialist advice, training, loans writing tablet for people who are unable
and support. Their website has a guide to to speak and to write clearly. The tablet
its communication solutions for aphasia responds to eye movements and blinking as
and guidance on UK statutory funding the user selects letters that are displayed
sources. Electronic aids to support people on a screen, or relayed to a computer screen
with aphasia include Maestro, Xpress and using a wireless connection.
Dynawrite 2.0.
Possum
Inclusive Technology Ltd Tel: 01296 461 000
Tel: 01457 819 790 Website: www.possum.co.uk
Website: www.inclusive.co.uk Manufactures, sells and distributes a range
Supplier of software and hardware for special of electronic assistive technology, including
educational needs, including a range of communication aids such as the Jive! hand-
communication aids and communication held text-to-speech device and the Sero
software. They produce Boardmaker, a phone with communication aid functions.
software package used to personalise and Provides product servicing and a range of
print your own communication boards other specialist services.
based on Picture Communication Symbols
and other pictures and graphics. Provides QED – Quality Enabling Devices Ltd
online and telephone technical support. Tel: 023 9258 0600
There are also helpful articles on choosing Website: www.qedltd.com
communication aids on their website. Sells and distributes a range of products
for people with special needs, including
Liberator communication software and simpler
Tel: 01733 370 470 electronic communication aids, like the
Website: www.liberator.co.uk AMDi range which can play back recorded
Provides a range of communication aids and messages.
assistive technology products and services.

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Communication aids and computer-based therapy after stroke

Smartbox Assistive Technology Aphasia Tutor programs, with ‘Out Loud’
Tel: 01684 578 868 versions available that speak cues and
Website: www.smartboxat.com answers. Can be used independently or
Supplier of communication aids, eye gaze tailored by a speech and language therapist
systems, and communication software according to someone’s needs and progress.
such as Sensory Software’s Grid 2 for both Their UK distributor is Propeller Multimedia
communication and computer accessibility. Ltd (see page 13).
Advice, assessment, loans, training and
ongoing support are provided. Communication Partner
Website: www.communicationpartner.com
Talking Mats Centre Sells a series of six DVDs for aphasia
Tel: 01786 479 511 therapy. They are designed to help someone
Website: www.talkingmats.com with aphasia find single words and put words
Talking Mats is a communication aid that together to form phrases. Video samples of
uses a mat with picture symbols attached as the therapy exercises are available online.
an aid to expressing thoughts and feelings. Please note this is a US website, so check
Talking Mats and Aphasia package available. you would be able to play the DVDs on your
player. They offer a 30-day money back
TechReady guarantee.
Tel: 0208 532 6138
Website: www.techready.co.uk Parrot Software
Sells and distributes assistive Website: www.parrotsoftware.com
technology products, including a range of Develops and sells over 100 software
communication aids and communication programmes that provide computer-
software and the Dragon Naturally supported therapy for speech and language
Speaking voice recognition software range. problems, memory loss and other cognitive
problems after stroke or brain injury. They
Toby Churchill Ltd are available to buy individually on CD, or
Tel: 01223 281 210 by monthly subscription for use online on
Website: www.toby-churchill.com their website. Their website offers free trial
Manufactures, develops, sells and services versions of their programmes.
digital recording aids, voice amplifiers and
the Lightwriter range of text-to-speech Propeller Multimedia Ltd
communication aids. Tel: 01721 725 875
Website: www.propeller.net
Suppliers of computer-based Sells a wide range of speech and language
therapy software software. Includes React2 for aphasia,
Bungalow’s suite of Aphasia Tutor software,
Bungalow Software Lexion, Speech Sounds on Cue, and Sword
Website: www.bungalowsoftware.com for people with dyspraxia and aphasia. You
Develops and sells a range of interactive can buy them on CD-ROM or take out a
therapy software for people with monthly subscription to use on the internet.
communication or cognitive disabilities Low cost demonstration CDs are available,
due to stroke or brain injury. Includes the or you can download free trials of full

Stroke Association – January 2013 11

Communication aids and computer-based therapy after stroke

packages for a limited number of days. Sequel Trust
Tel: 01691 624 222
Steps Consulting Ltd Website: www.thesequaltrust.org.uk
Tel: 01454 218 436 National charity that aims to provide help to
Website: www.aphasia-software.com children and adults who are severely disabled
Sells the StepByStep Aphasia Therapy and depend on electronic communication
computer-based programme designed to aids and adaptations.
help people with aphasia after stroke who
have difficulties finding words. It is designed The Tavistock Trust for Aphasia
to be used independently, tailored to the Tel: 01525 290 002
individual’s needs by a speech and language Website: www.aphasiatavistocktrust.org
therapist. A free 30-day trial is available. Grant-making trust that focuses solely on
There is also an option on the website for aphasia. They work towards making effective
tutorials to be set up that allow a speech and therapy available to all who have aphasia.
language therapist to monitor a person’s
progress remotely over the internet. Disclaimer: The Stroke Association provides
the details of other organisations for
Financial assistance information only. Inclusion in this factsheet
does not constitute a recommendation or
Full or part funding for communication aids endorsement.
may be provided by:

•• local health and social services
•• the Access to Work programme available

through JobcentrePlus
•• the Disabled Students’ Allowances for

higher educational needs
•• the Access to Learning Fund for those in

further education.

Talk to the speech and language therapist for
more information.

Produced by the Stroke Association’s Information Service.
For sources used, visit stroke.org.uk
© Stroke Association
Resource sheet 5, version 1 published
January 2013 (next review due March 2015).

Item code: A01R05

The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789). Also registered in
Northern Ireland (XT33805) Isle of Man (No 945)and Jersey (NPO 369).

12 Stroke Association – January 2013