Successful remote delivery of a treatment for phonological alexia via telerehab

Telehealth Assessments and Interventions for Individuals With Poststroke Aphasia: A Scoping Review

PURPOSE

There are increasing demands for aphasia assessment and intervention services to be delivered remotely. The purpose of this scoping review was to address what is known about the delivery of assessments and interventions using telehealth for people with poststroke aphasia. Specifically, the review sought to (a) identify which telehealth assessment protocols have been used, (b) identify which telehealth intervention protocols have been used, and (c) describe evidence on the effectiveness and feasibility of telehealth for people with poststroke aphasia.

METHOD

A scoping review of the literature published in English since 2013 was conducted by searching MEDLINE, Embase, PsycINFO, CINAHL, and Scopus databases to identify relevant studies. A total of 869 articles were identified. Two reviewers screened records independently, finding 25 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer.

RESULTS

Two of the included studies examined telehealth assessment protocols, whereas the remaining studies focused on the delivery of telehealth interventions. The results of the included studies illustrated both effectiveness and feasibility regarding telehealth for people with poststroke aphasia. However, a lack of procedural variation among the studies was found.

CONCLUSIONS

Overall, this scoping review yielded continued support for the use of telehealth practices as an alternate mode of delivering both assessment and intervention services to people with poststroke aphasia. However, further research is needed to investigate the range of aphasia assessment and intervention protocols that can be offered via telehealth, such as assessments or interventions that use patient-reported measures or address extralinguistic cognitive abilities.

How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.

Motivation Theory and Practice in Aphasia Rehabilitation: A Scoping Review

PURPOSE

In the aphasia literature, motivation has been described as potentially influencing rehabilitation outcomes, and there are reports that researchers and clinicians have acted to promote it. However, studies directly investigating the range of beliefs and practices surrounding motivation do not exist currently. The purpose of this scoping review is to develop themes related to the beliefs and practices appearing in the recent aphasia literature.

METHOD

Four databases (CINAHL, PsycINFO, PubMed, and Google Scholar) were searched using keywords aphasia and motivation (including derivatives such as motiv*) for articles published between 2009 and 2020. Searches returned 19,731 articles; after deleting duplicates and applying inclusionary criteria, 365 articles remained. In each article, text surrounding the term motivation was highlighted and thematic analysis was applied to these quotations.

RESULTS

Sixteen themes were developed through thematic analysis and placed into two groups. The first group contained five themes suggesting that researchers believed that motivation should be studied and recognized the value of motivation in person(s) with aphasia when participating in research or clinical activities. The second group contained 11 themes reporting diverse beliefs and practices in how motivation is incorporated in research and clinical activities.

CONCLUSIONS

Results from this scoping review suggest that aphasia researchers, clinicians, and persons with aphasia hold beliefs about motivation that can influence clinical and research decisions. In general, beliefs and decisions related to motivation appeared to be guided by intuition rather than theories of motivation. These themes are discussed within the context of three psychological needs proposed by self-determination theory: competency, autonomy, and relatedness. Applying theories of motivation to future study in aphasia rehabilitation will guide work that can provide empirical support for these beliefs.

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

BACKGROUND

More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions.

OBJECTIVE

This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success.

METHODS

From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool.

RESULTS

We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses.

CONCLUSIONS

Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1177/20552076211035988.

Communication Bridge™-2 (CB2): an NIH Stage 2 randomized control trial of a speech-language intervention for communication impairments in individuals with mild to moderate primary progressive aphasia

BACKGROUND

Primary progressive aphasia (PPA) is a clinical dementia syndrome. Impairments in language (speaking, reading, writing, and understanding) are the primary and persistent symptoms. These impairments progress insidiously and devastate communication confidence, participation, and quality of life for persons living with PPA. Currently, there are no effective disease modifying treatments for PPA. Speech-language interventions hold promise for mitigating communication challenges and language symptoms. However, evidence regarding their efficacy in PPA is of low quality and there are currently no rigorous randomized trials.

METHOD

Communication Bridge™-2 (CB2) is a Stage 2, superiority, single-blind, randomized, parallel group, active-control, behavioral clinical trial delivered virtually within a telehealth service delivery model to individuals with PPA. Ninety carefully characterized participants with clinically confirmed PPA will be randomized to one of two speech-language intervention arms: (1) Communication Bridge™ a dyadic intervention based in communication participation therapy models that incorporates salient training stimuli or (2) the control intervention a non-dyadic intervention based in impairment therapy models addressing word retrieval and language production that incorporates fixed stimuli. The superiority of Communication Bridge™ over the Control arm will be evaluated using primary outcomes of communication confidence and participation. Other outcomes include accuracy for trained words and scripts. Participants complete two therapy blocks over a 12-month period. Outcomes will be measured at baseline, at each therapy block, and at 12 months post enrollment.

DISCUSSION

The CB2 trial will supply Level 2 evidence regarding the efficacy of the Communication Bridge™ intervention delivered in a telehealth service delivery model for individuals with mild to moderate PPA. An important by-product of the CB2 trial is that these data can be used to evaluate the efficacy of speech-language interventions delivered in both trial arms for persons with PPA. The impact of these data should not be overlooked as they will yield important insights examining why interventions work and for whom, which will advance effectiveness trials for speech-language interventions in PPA.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03371706 . Registered prospectively on December 13, 2017.

Social and Cognitive Interactions Through an Interactive School Service for RTT Patients at the COVID-19 Time

Background: The closure of all educational institutions and most rehabilitation centres represents a precautionary measure to face the COVID-19 pandemic, but the isolation and social distancing may be particularly challenging for children with special needs and disabilities (SEND), such as Rett Syndrome (RTT). The main aim of this study was to promote cognitive and social interactions among children with RTT through an interactive school program. Methods: The Interactive School palimpsest was composed of moments in which a teacher spoke directly to children with RTT and expected a response through eye gaze, and moments in which storeys-cartoon were presented while tracking the eye gaze of children. We investigated behavioural, social and cognitive parameters. Results: Children participated in both social and cognitive tasks with the spontaneous reduction of stereotypies and with increase in attention. They recalled more significant indexes when music or a song was presented together with a cartoon or a cognitive task. Conclusions: This study provides initial insights in promoting cognitive and social interactions and in the support needs of families with a child with RTT during the COVID-19 pandemic.

Social and Cognitive Interactions Through an Interactive School Service for RTT Patients at the COVID-19 Time

Background: The closure of all educational institutions and most rehabilitation centres represents a precautionary measure to face the COVID-19 pandemic, but the isolation and social distancing may be particularly challenging for children with special needs and disabilities (SEND), such as Rett Syndrome (RTT). The main aim of this study was to promote cognitive and social interactions among children with RTT through an interactive school program. Methods: The Interactive School palimpsest was composed of moments in which a teacher spoke directly to children with RTT and expected a response through eye gaze, and moments in which storeys-cartoon were presented while tracking the eye gaze of children. We investigated behavioural, social and cognitive parameters. Results: Children participated in both social and cognitive tasks with the spontaneous reduction of stereotypies and with increase in attention. They recalled more significant indexes when music or a song was presented together with a cartoon or a cognitive task. Conclusions: This study provides initial insights in promoting cognitive and social interactions and in the support needs of families with a child with RTT during the COVID-19 pandemic.

Technical Features, Feasibility, and Acceptability of Augmented Telerehabilitation in Post-stroke Aphasia-Experiences From a Randomized Controlled Trial

Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation. Trial Registration: ClinicalTrials.gov, ID: NCT02768922.

The TCTRS Project: A Holistic Approach for Telerehabilitation in Rett Syndrome

Telerehabilitation (TR) has been proven to be an effective tool in improving the adaptive skills of children and young adults with Multiple Disabilities (MDs). The application of a comprehensive set of new technologies reveals new opportunities for both physical and cognitive telerehabilitation, but there is no holistic approach in the case of genetic syndromes. In this paper we present reflections and early results of the TCTRS project that aims at implementing a telerehabilitation system capable of offering complete coverage of rehabilitation needs for people with Rett Syndrome, from both the physical and cognitive points of view. Moreover, the data acquired through the system can also represent a basis for machine learning applications to remotely support therapists and physicians. Our first tests on the system application show the great potential of our approach, in terms of feasibility and applicability, for both rehabilitation centers and families.

Telemedicine: A valuable tool in neurodegenerative diseases

Purpose of Review

The prevalence of neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), is rising as the global population ages. Access to specialist care, which improves outcomes, is insufficient and disease-related disability makes in-person physician visits burdensome. Telehealth is one potential means for improving access to care. The purpose of this manuscript is to review recent publications on telemedicine in AD and PD.

Recent Findings

Telemedicine is feasible in AD and PD and acceptable to patients and their caregivers. Compared with in-person visits, telemedicine reduces visit-associated travel and time. Telemedicine can be used for rehabilitative therapies, to administer cognitive tests, and to support caregivers. Access to telemedicine results in changes in patient care including medication adjustments and referrals for therapies and supports.

Summary

The use of telemedicine in AD and PD stands to decrease burden on patients and increase access to specialty care. Barriers to the expansion of telemedicine care include lack of widespread broadband access, state licensure requirements, and inconsistent reimbursement. More outcomes-based prospective telemedicine studies are needed.

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

Purpose

We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019.

Method

Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported.

Results

Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research.

Conclusion

Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

The development and feasibility of an online aphasia group intervention and networking program - TeleGAIN

PURPOSE

Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability.

METHOD

The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia.

RESULT

TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life.

CONCLUSION

TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.

Telerehabilitation of Anomia in Primary Progressive Aphasia

BACKGROUND

The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness.

AIMS

The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA).

METHODS & PROCEDURES

Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of six months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA.

OUTCOMES & RESULTS

All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items in both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items in the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected.

CONCLUSIONS

Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.