Technology for healthcare communication and aphasia rehabilitation
Rehabilitation is needed for the communication, cognitive, behavioural, and social issues that limit community participation for those with aphasia. While such treatment is available during the sub-acute phase (up to three months after stroke), services then decline and are non-existent in some parts of Australia. However, the trajectory of recovery continues beyond this sub-acute period, so new models of chronic-phase treatment are needed. Current trends suggest at least five years of exponential increase in use of eHealth treatments.
We aim to empower consumers and determine how eHealth can improve communication and access, and transform health outcomes. The product will be an innovative eHealth ecosystem of complementary programs, quality-certified apps, and e-tools aligned with the Australian Aphasia Rehabilitation Pathway and Stroke Guidelines.
The platform will enable:
- online intensive aphasia rehabilitation
- iPad technology for people with aphasia
- online communication training for health professionals.
Intensive Comprehensive Aphasia Programs (ICAPs) involve goal-based individual and group therapy, education, computer-based therapy and home practice. ICAPs span the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) in a holistic biopsychosocial manner and incorporate principles of neuroplasticity.
Our team developed Australia’s first ICAP – Language Intervention and Functional Therapy (LIFT) and refined it further into a Comprehensive High-Dose Aphasia Treatment (CHAT). CHAT has been shown to improve outcomes for people with aphasia. However, the majority of Australians cannot access CHAT. We propose to use telerehabilitation to deliver CHAT directly into the homes of people with aphasia.
TeleCHAT: Comprehensive aphasia rehabilitation through telerehabilitation
There is an international move toward intensive comprehensive aphasia programs (ICAPs). Spanning the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) in a holistic biopsychosocial manner and incorporating principles of neuroplasticity, ICAPs include a variety of therapy approaches (individual, group, education) delivered in clinics to a cohort at high intensity.
Our team developed Australia’s first ICAP – Language Intervention and Functional Therapy (LIFT) and then refine it to CHAT, and evaluation showed statistically significant improvements. However, poor access to CHAT remains an issue for the majority of Australians living with aphasia. We now propose the use of telerehabilitation to deliver all components of CHAT directly into homes.
To translate the in-person CHAT program for delivery via telerehabilitation (TeleCHAT) and to evaluate TeleCHAT in terms of usability, feasibility, acceptability and efficacy. Data collected will also be used to compare the language outcomes from TeleCHAT with the standard delivery of CHAT.
1. Compare quality of life outcomes and costs between TeleCHAT and CHAT.
2. Evaluate the costs associated with TeleCHAT compared to CHAT from both service provider and participant perspectives.
3. Determine access, satisfaction, and implementation barriers and facilitators for TeleCHAT
PhD student Genevieve Voung (UQ) has translated CHAT into TeleCHAT using the Human Centred Design Framework for development of interactive systems (ISO, 2010). The process resulted in the TeleCHAT protocol which delivers one-on-one impairment and functional therapy, group therapy and computer-based therapy for a total of 50 hours across 8 weeks straight into the participant’s home using videoconferencing. Geneveive has also developed and evaluated the clinician training package for TeleCHAT. She has gathered data on usability, feasibility and acceptability from the perspective of people with aphasia, their family and the treating clinicians. To date, 12 people with aphasia and 9 support people (usually family members) have participated in TeleCHAT. Two clinicians have been involved in the delivery of TeleCHAT, with another 15 clinicians undergoing training in TeleCHAT. Clinical outcome data is also being collected and we plan to compare the clinical language outcomes from TeleCHAT with outcomes from the in-person delivered CHAT program. TeleCHAT will continue to be delivered 2022/23 from the Queensland Aphasia Research Centre located at the Surgical, Treatment and Rehabilitation Service (STARS) in Brisbane, Queensland.
The Aphasia App: Putting people with Aphasia back at the centre of their healthcare
Aphasia affects how safe patients are in hospital and how they communicate with their healthcare teams. Stroke patients with aphasia are more likely to experience preventable adverse events while in hospital. Technology offers a solution. We collaborated with individuals with aphasia, their family and healthcare workers to develop the Aphasia App: a new mHealth intervention tailored to support effective healthcare communication.
The app accompanies the patient throughout transitions in their healthcare aiming to close potential communication gaps and improve patient safety and satisfaction.
The usability of the beta version are currently being tested in an observational study with stroke patients and staff in acute and rehabilitation wards. The next step is a study of its effect on healthcare communication under controlled conditions.
To discover facilitators and barriers to implementation of the Aphasia App in acute stroke and rehabilitation settings and to determine its effects on healthcare communication.
Our hypotheses are:
1. Healthcare interactions will be of higher quality with the Aphasia App .
2. Increased confidence, mood, and satisfaction and lower hospital adverse events following Aphasia App use compared to standard care.
Enabling multidisciplinary communication partner training through eHealth
Most health professionals interacting with patients with aphasia receive little or no specific training for the task. While communication partner training (CPT) is recommended as best practice, it is not routinely accessible for health professionals due to poor availability. Our pilot work found that CPT for student health practitioners delivered using eHealth improved their:
- relevant knowledge
eHealth CPT was feasible, flexible, free, and acceptable to trainees.
To evaluate the effectiveness of an eHealth CPT program in helping professionals communicate in real-life aphasia settings.
We have developed pilot training materials comprising of a 50-minute online training module which was as effective as a face-to-face lecture in improving knowledge about aphasia and strategies to use with a person with significant communication difficulties.
This program will be reviewed and trialed with a wider range of communication partners, including health professionals and other service providers, and will be available by the end of 2020.
The validation of the telerehabilitation delivery of the aphasia core outcome set
A key element of aphasia management is valid and reliable assessment of aphasia. To improve access to aphasia rehabilitation there needs to be more widespread use of telerehabilitation. We propose to validate the telerehabilitation delivery of the research aphasia core outcome set which has been proposed by Wallace et al. (2018).
To evaluate the validity and reliability of assessing aphasia via telerehabilitation using the aphasia research core outcome set.
Communication Connect is a program that will be co-designed with people living with communication disability and clinicians. Communication Connect will be a comprehensive, multicomponent, technology-enabled program of care providing rehabilitation, support and self-management. It will be underpinned by artificial intelligence-enabled data management and resources.
Phase I will identify key problems experienced by people with communication disability after discharge from inpatient care. People with communication disability from stroke or TBI, their family or close others, and speech pathologists, psychologists, health managers, IT staff and general practitioners will identify and prioritise issues and gaps concerning short- and long-term community needs after discharge from rehabilitation services.
Communication Connect will use a specific co-design approach, Experience Based Co-Design, to design possible solutions. Through cycles of Experience Based Co-Design workshops, a sample of staff and consumers from Phase will be lead through development of the Communication Connect technology solution and testing of emerging prototypes.
Communication Connect will be tested at three sub-acute rehabilitation and community rehabilitation services in three states, both urban and regional. Participants being discharged home with communication disability will pilot the Communication Connect platform, supported by speech pathology and psychology/neuropsychology staff as well as trained adult peers with mild or recovered communication disability at least 1 year post injury. Feasibility, acceptability and preliminary efficacy will be assessed. The decision about a future scaled up trial will be made on these results.
The Social Brain Toolkit
The Social Brain Toolkit is a project involving the development of a suite of online tools to support more positive communication after an acquired brain injury (ABI). This project is funded by icare NSW. The Social Brain Toolkit includes the following tools:
- convers-ABI-lity: A web-based program to improve conversations between people with an ABI and their communication partners, guided by a speech pathologist
- interact-ABI-lity: A short self-guided online course to improve confidence and knowledge about how to interact with someone with an ABI.
- social-ABI-lity: An online learning module about using social media safely and successfully after an ABI
All three tools were developed through a process of co-design and pilot testing prior to launch in 2022. For more information, visit the ABI Communication Lab at The University of Sydney.
Multi-Modality Aphasia Treatment (M-MAT) is a group-based aphasia intervention delivered face-to-face. Recently, a large, randomised controlled trial (n=216) conclusively demonstrated M-MAT’s effectiveness in improving communication-related quality of life, word retrieval, and everyday communication in chronic aphasia. We are adapting M-MAT to an online format (M-MAT Tele) with the input of people with aphasia and speech pathologists, and piloted for feasibility, acceptability, and preliminary efficacy.
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