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). LIFT has been shown to improve outcomes for people with aphasia. However, the majority of Australians cannot access LIFT. We propose to use telerehabilitation to delivery LIFT directly into the homes of people with aphasia.

LIFT-HOME: 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 evaluation showed statistically significant improvements. However, poor access to LIFT remains an issue for the majority of Australians living with aphasia. We now propose the use of telerehabilitation to deliver all components of LIFT directly into homes.

Project aims

Primary aim

To compare the language outcomes when delivering LIFT in-home via telerehabilitation (LIFT-HOME) against the standard in-clinic delivery of LIFT.

Secondary aims

1. Compare quality of life outcomes and costs between LIFT-HOME and LIFT.

2. Evaluate the costs associated with LIFT-HOME compared to LIFT from both service provider and participant perspectives.

3. Determine access, satisfaction, and implementation barriers and facilitators for LIFT-HOME.

Progress

Currently seeking funding.

The Aphasia App: Putting people with Aphasia back at the centre of their healthcare

Aphasia affects the speed, ease, and effectiveness of communication between patients and healthcare teams. Stroke patients with aphasia are more likely to experience preventable adverse events while in hospital. Technology offers a solution. Working with key end-users, Chief Investigators Rose has led the development of the Aphasia App, a new eHealth intervention tailored to support professionals and people with aphasia to engage in 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 and effects of the beta version are currently being tested in a pilot study with stroke patients (n=3) and staff (n=6) in acute and rehabilitation wards. The next step is a Phase IIa study of its effect on healthcare communication.

Project aims

Primary aim

To determine the effects on healthcare communication of using the Aphasia App, compared to standard (no App) care.

Secondary aim

To discover facilitators and barriers to implementation of the Aphasia App in acute stroke and rehabilitation settings.

Hypotheses

Our hypotheses are:

1. Healthcare interactions will be of higher quality following Aphasia App use than usual care.

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
  • confidence
  • attitudes.

eHealth CPT was feasible, flexible, free, and acceptable to trainees.

Project aim

To evaluate the effectiveness of an eHealth CPT program in helping professionals communicate in real-life aphasia settings.

Progress

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).

Project aim

To evaluate the validity and reliability of assessing aphasia via telerehabilitation using the aphasia research core outcome set.

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