Upload
vothuy
View
220
Download
4
Embed Size (px)
Citation preview
Re-app-ilitation Smart use of Smart-Phones in Therapy
Colleen Kerr Optimal SP
Re-app-ilitation 2
Colleen Kerr
Emma Charters (RPA, Liverpool BIU)
Colleen Kerr
Systematic review
• Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review. 2015
– Dr. Grahame Simpson & Lauren Nguyen
• Evaluation:
– RCT: PEDRO
– Group: Downs & Black
– Single: SCED
Re-app-ilitation 4
Other systematic reviews out there…
• de Joode et al., 2010
• focused on the usability of assistive technology for patients with cognitive and memory deficits
• Morris & Reinson, 2010
• focused on the usability of assistive technology for patients with memory deficits only
• Gillespie, Best, and O’Neil (2012)
• Assistive devices that were and were not portable
Missing Communication!!
Variable methodological quality rating systems
Re-app-ilitation 5
Results • Participants: Mix of neurologically based brain injury
• Range of Devices
• Training:
• Range of clinicians
• Training time: 30-180 min
• Cueing method:
• Visual, auditory and/or tactile
• Errorless learning
• Measures:
• Participant
• Carer
• Clinician
• Outcomes:
Positive Neutral
PDAs
Neuropage
Smart phones
Voice memo
AAC
Mobile phone
Re-app-ilitation 6
Study Device Goal
Bo a Mobile Phone ADL Recall
Bo a PDA Exercise & ADL Recall
Culley & E a s Mobile Phone Goal Recall
Dowds PDA ADL Recall
E a s Neuro-page ADL Recall
Fish Mobile Phone Phone Call Recall
Gentry PDA ADL Recall
Hart Voice organiser Goal Recall
Kirsch Pager Information Recall
Kirs h PDA Navigation
Laffont Speech Synthesizer AAC 9
Study Device Goal
Sohlberg PDA Navigation
“tapleto Mobile Phone ADL Recall
“ o oda & ‘i hards Smart Phone ADL Recall
“ o oda & ‘i hards Smart Phone ADL & Phone call Recall
Thone-Otto & Walther PDA + Mobile phone Information & ADL Recall
Van Den Broek Voice organiser Information & ADL Recall
Van Hulle & Hux, 2006 Wrist alarm + voice recorder ADL Recall
Wade & Troy, 2001 Mobile phone ADL Recall
Wilson et al., 1997 Neuro-page ADL Recall
Wilson et al., 2001 Neuro-page ADL Recall
Wright et al., 2001 Pocket computer ADL Recall
Yasuda et al., 2002 Voice message recorder Diary writing and ADL Recall 10
Barriers
• Devices • Motivation • Prior knowledge + acceptance • Motor and sensory impairments • Apps available • Distractions • Cost • Accidental setting changes • Internet connection • Privacy • Infection control
Re-app-ilitation 11
For the future
• Statistical analysis
• Validated outcome measures
• Document the details
• Clinician’s background
• Teaching + cueing strategies
• Participant factors
• Goal/function
• Adverse events
• Larger participant numbers
• Control groups
• Randomisation + blinding strategies
• Independent assessors
Re-app-ilitation 12
Themes
• Majority of recent research is focused on:
– App choice
• Rapid rate of app development
– Institution description of their methods
– Single or small group case descriptions
• Broadening the EPAD scope:
– Clinicians
– Clinical populations
– Types of devices
– Functions and goals
– Measurement tools
Re-app-ilitation 13
Our role
Rehab clinicians have a role in helping to select:
Appropriate smartphone/tablet/mobile tech
Apps and accessories
AAC (augmentative and alternative communication)
(Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2013)
Evaluate appropriateness of app
(Wild, 2014)
Feature match Apps to the patient’s strength’s and needs
(Gosnell, 2011)
Re-app-ilitation 15
SELECTION
• Consider:
– Length of time in marketplace
– Frequency of updates
– Functioning after updates
• (Wild, 2014)
• Pre-injury familiarity with devices
– Although they may not have been using them in a way that will help them post injury
• (Wild, 2014)
• Consider limitations of a device i.e. trouble shooting if battery runs out
• (Gentry, 2014)
Re-app-ilitation 16
Study Device + Apps Outcome
Szabo &
Dittelman
2014
iPad, small talk aphasia, pictello and
story creator for script development,
photo editor, language therappy, dragon
dictation, awesome memory
iPad used in group context for people who pre-stroke had little exposure
to mobile technology
mobile and tablet devices can be used by people with aphasia as a daily
communication and organisational tool
Ramsberger
& Messamer
2014
iPad, dragon dictation, little story maker,
notepad pro
Incorporate smart phone and tablet technology in a step-wise fashion
incorporating client’s strengths/weaknesses and goals, considering the device, app and accessibility
Wong et al
2014
Smart phone Difficulty learning new technology (stroke), forgetting how to use
smartphone (TBI + stroke)
- entertainments apps associated with less anxiety
- therapy apps associated with more productivity
- communication apps associated with better productivity, social
integration and verbal learning
Kurland,
Wilkins &
Stokes 2014
iPad, iBooks + GoToMeeting iPads are a promising tool to maintain and progress treatment goals
attained in intensive aphasia therapy regardless of aphasia type and
familiarity with tablet technology.
Mehta et al
(2012)
Smart phone Monitors fundamental frequency, sound pressure level and model-based
glottal airflow. Piloted an ambulatory biofeedback tool which has the ability
to aid skill acquisition in voice therapy.
Hoover &
Carney 2014
iPad, proloquo2go, pictello, notes,
maps, calendar, camera, small talk &
skype
Preliminary evidence to support use of tablet technology in a range of
client centered goals with scope for generalisation across environments
Gurol-
Urganci et al
(2013)
Mobile phones Low-moderate quality evidence shows that SMS and MMS reminders do
improve attendance compared to no reminder or a postal reminder. 17
Study Clinical factors to consider in device and app selection
Ramsberger
& Messamer
(2014)
Assess then develop client centred goals
Assess motor, cognitive + sensory requirements of the device and apps under consideration
Assess the device + apps accessibility for the client
DeCurtis +
Ferrerr
(2011)
Participants: age and developmental appropriateness
Parameters: cost and environment
Purpose: what is the advertised purpose of the app
Positioning: ability to hold, position and use the device
Playtime (ADLs/leisure): how is the device incorporated into usual activities
Potential: how can it be used in more everyday activities
Dunham
(2011)
Apps can serve the same purpose as books, toys, games, stimulus cards and worksheets.
Smartphone and App technology can aid generalisation of treatment goals to more natural
environments
Care needs to be taken that treatment approach should not be dictated by the smartphone or app
Gosnell
(2011)
- Identify the person’s strengths + weaknesses and device access
- Clinician should be knowledgeable about apps and devices
- Clinician matches, compares and selects appropriate apps
- Functional assessment of appropriateness
18
Re-app-ilitation 19
Part 2 - Practical Considerations Objectives: 1. Offer thoughts on staying current in a
changing app landscape 2. Outline a case where app-based therapy
appears to have been integral to intervention. 3. Consider factors that may be important in
smartphone/technology uptake.
Re-app-ilitation 20
SLPs Talk Apps APPropriate Apps – SPA Member Group Tactus Therapy Solutions Jane Farral Consulting (AAC) iPhone, iPad, iTouch for Speech Therapy The Appy Ladies iTeach – Apps for the Classroom Appy therapy American OT Associaton (app repository – members)
Closer to home.... http://www.tbistafftraining.info/SmartPhones/SmartPhones1.html
Re-app-ilitation 21
For Patients TAVISTOCK Aphasia Software finder http://www.aphasiasoftwarefinder.org National Aphasia Association Aphasia Hope But definite potential for too much information.....
Re-app-ilitation 22
Case Study 2 – Kay – 21yo Motor vehicle accident 2010. GCS of 4 and required intubation at the scene of the accident. Traumatic brain injury characterised by left frontotemporal subdural haemorrhage with mass effect and intraventricular extension, bilateral frontal contusions, traumatic subarachnoid haemorrhage, left temporal contusions and midbrain haemorrhage. Bifrontal craniectomy, evacuation of the subdural haemorrhage and frontal haematoma and an extraventricular drain. Multiple left facial fractures, fracture of the right skull and a midclavicular fracture. PEG . History of depression and assault. Kay does not show functional communication skills for daily tasks.
She is unable to express her needs using talking/speech or gestures or to comprehend what is said to her. Kay’s daily needs are determined by her routine and what she is doing. Kay demonstrates ability to tolerate small amounts of puree however at this stage she
remains nil by mouth.
Re-app-ilitation 23
Observed Behaviours 12.12.11
Looks towards unseen speaker Looks outside in response to question about rain (novel response not repeated in other contexts) Selective (ie preferential) focus on TV channels objects/people on command No gaze response to questions about bedroom, toys, Xmas tree.
Raises head and smiles when asked for photo (but response repeated at other times) Lowers head/leans forward to disengage Looks up to her name (not others)
Indiscriminate reaching/pulling of objects in room. Intermittent response to offered hand – shakes gently (without grabbing) Allows cleaning of clothes/hands by unfamiliar
Indiscriminate reaching/grabbing for carers but not for directional purposes Leans body in chair to express interest about unseen speaker
Indiscriminate ripping of paper/fabric Carers report sustained interest in bubble wrap and shredding (and passing) tinsel Throws spoon in agitation Throws toy in agitation Holds lifter belt in place with verbal and context cue. Tucks blanket under legs. Attempts to self propel in wheelchair.
Removes and rips paper/pictures but no meaningful response possible due to behaviour
Perseverative no-no-no (not meaningful) Head nod/shake used in response to basic needs but no consistency for biographical or immediate environment Discernible “Yup” when asked about food (novel response not replicated)
‘would you like some yoghurt’ lifts head and looks at food on bench (novel response not replicated)
X Let’s go into your room (no gaze) X Let’s watch the TV (no gaze) X I can see you are ready for Xmas with the Xmas tree (no gaze) Can you get the belt for me – looks down and holds
belt
No verbal responses to questions. Carers report occasional obscenities. Responding to hand shake but not initiating Not able to assess use of remote/light switches/phone due to behaviour (throwing)
Re-app-ilitation 25
Eating – shaping Matching pictures, photos (VAT) Sorting socks Matching dinner plates Picture cards or object cues to accompany directions Increasing periods of shared activity
Re-app-ilitation 27
3.5 years post onset Echolalic and some obsessive behaviours. Some response to questions and cued naming just emerging prior to interstate transfer I Get It - Social stories trialled for continence training but not successful – had to remove iPad for a time Facebook – picture selection, news from outings Those Days Skype to group home residents/family interstate Clinical handover provided by video on iPad and Story Creator (stories about me) Ongoing improvement ??
Re-app-ilitation 28
Why did apps make a difference?
•High degree of carer interest/engagement – young ACWs •All carers using smart-phones themselves and modelling to client •Pre-injury behaviour of client •Acceptability even on low level matching tasks •Used in conjunction with real life activities and other therapy modalities •Flexibility for upgrade as client needs changed – combination of apps and in-built features of device
•In this case no prospect of independent use so structured clinical apps were not used
Re-app-ilitation 29
Practice Directions Technology in Supported Accomodaton Sloan Monash University (2015 ASSBI in press)
• 138 supported accommodation residents - house manager surveys • majority urban, ABI, tablet, often self-prescribed or self-provided • primary use social, recreation, communication, education
“build successful integration of technology into daily lives of people with focus on independence, autonomy, social connection and skill development” “deliver effective training, ongoing support structures and evaulation of technology over time to avoid abandonment”
Re-app-ilitation 30
References
(Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association, 2013)
Boman, I.L., Tham, K., Granqvist, A., Bartfai, A., & Hemmingsson, H. (2007). Using electronic aids to daily living after acquired brain injury: a study of the learning process and the usability. Disability and Rehabilitation: Assistive Technology, 2(1), 23-33.
Boman, I.L., Bartfai, A., Borell, L., Tham, K., & Hemmingsson, H. (2010). Support in everyday activities with a home-based electronic memory aid for persons with memory impairments. Disability and Rehabilitation: Assistive Technology, 5(5), 339-350.
Campling Review of iRecovery-iPhone/iPad application (2011) Sexual Addiction & Compulsivity. Vol.18(3), Jul 2011, pp. 188-190
Culley, C., & Evans, J.J. (2010). SMS text messaging as a means of increasing recall of therapy goals in brain injury rehabilitation: a single-blind within-subjects trial. Neuropsychological Rehabilitation: An International Journal, 20(1), 103-119.
DeCurtis, L. L. and Ferrer, D. (2011). Maximizing Mobile Technology with Toddlers and Preschoolers. Retrieved from http://pampclub.org/site/2011/07/01/maximizingmobile-technology-with-toddlers-preschoolers/
De Joode, E., van Heugten, C., Verhey, F., & van Boxtel, M. (2010). Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review. Clinical Rehabilitation, 24(8), 701-714.
Dowds, M.M., Lee, P.H., Sheer, J.B., O Niel-Pirozzi, T.M., Xenopoulos-Oddsson, A., Golstein, R., et al. (2011). Electronic reminding technology following traumatic brain injury: effects on timely task completion. Journal of Head Trauma Rehabilitation, 26(5), 339-347.
Evans, J.J., Emslie, H., & Wilson, B.A. (1998). External cueing systems in the rehabilitation of executive impairments of action. Journal of the International Neuropsychological Society, 4(4), 399-408.
Fish, J., Evans, J.J., Nimmo, M., Martin, E., Kersel, D., Bateman, A., et al. (2007). ‘eha ilitatio of e e uti e d sfu tio follo i g rai i jur : Co te t-free uei g improves everyday prospective memory performance. Neuropsychologia, 45(6), 1318-1330.
Fish, J., Manly, T., Emslie, H., Evans, J.J., & Wilson, BA. (2011). Compensatory strategies for acquired disorders of memory and planning: differential effects of a paging system for patients with brain injury of traumatic versus cerebrovascular aetiology. Journal of Neurology, Neurosurgery and Psychiatry, 79(8), 930-935.
Gentry, T., Wallace, J., Kvarfordt, C., & Bodisch Lynch, K. (2008). Personal digital assistants as cognitive aids for individuals with severe traumatic brain injury: a community-based trial. Brain Injury, 22(1), 19-24.
Gentry, T. (2014) Mobile Technologies as Cognitive-Behavioral Aids Perspectives on Augmentative and Alternative Communication pp 148 - 156
Giles, G.M. & Shore, M. (1989). The effectiveness of an electronic memory aid for a memory-impaired adult of normal intelligence. American Journal of Occupational Therapy, 43(6), 409-411.
Gorman, P., Dayle, R., Hood, C.A., & Rumrell, L. (2003). Effectiveness of the ISAAC cognitive prosthetic system for improving rehabilitation outcomes with neurofunctional impairment. NeuroRehabilitation, 18(1), 57-67.
Gosnell, J., Costello, J., and Shane, H. (2011). Using a Clinical Approach To Answer "What Communication Apps Should We Use?". Perspectives on Augmentative and Alternative Communication. 20(3), 87-96.
Gos ell, J., Costello, J., a d “ha e, H. . There Is t Al a s a App for That". Perspectives on Augmentative and Alternative Communication. 20(3), 7-8
Hart. T., Hawkey,. K., & Whyte, J. (2002). Use of a portable voice organiser to remember therapy goals in traumatic brain injury rehabilitation: a within-subjects trial. Journal of Head Trauma Rehabilitation, 17(6), 556-570.
Hoover. E.L. & Carney.A. (2014) Integratng the iPad into an Intensive Comprehensive Aphasia Program Seminars in Speech and Language vol 35 (1) pp 25-37
Kirsch, N., Shenton, M., & Rowan, J. (2004). A generic, 'in-house', alphanumeric paging system for prospective activity impairments after traumatic brain injury. Brain Injury, 18(7), 725-734.
Kirsch, N., Shenton, M., Spirl, E., Rowan, J., & Schreckenghost, D. (2004). Web-based assistive technology interventions for cognitive impairments after traumatic brain injury: a selective review and two case studies. Rehabilitation Psychology, 49(3), 200-212.
Kurland. J., Wilkins. A. & Stokes. P. (2014) iPractice: Piloting the Effectiveness of a Tablet-Based Home Practice Program in Aphasia Treatment Seminars in Speech and Language vol. 35(1) pp 51-63
Laffont, I., Dumas, C., Pozzi, D., Ruquet, M., Tissier, A., Lofaso, F., et al. (2007). Home trials of a speech synthesizer in severe dysarthria: patterns of use, satisfaction, and utility of word prediction. Journal of Rehabilitative Medicine, 39(5), 399-404.
Morris, K., & Reinson, C. (2010). A systematic review of the use of electronic memory aids by adults with brain injury. Special Interest Section of The American Occupational Therapy Association Inc, 20(1), 1-3.
Ramsberger.G. & Messamer. P. (2014) Best Practices for Incorporating Non-Aphasia-Specific Apps into Therapy Seminars in Speech and Language vol 35(1) pp 17-24
Sohlberg, M., Fickas, S., Hung, P., & Fortier, A. (2007). A comparison of four prompt modes for route finding for community travellers with severe cognitive impairments. Brain Injury, 21(5), 531-538.
Stapleton, S., Adams, M., & Atterton. L. (2007). A mobile phone as a memory aid for individuals with traumatic brain injury: a preliminary investigation. Brain Injury, 21(4), 401-411.
Svoboda, E., & Richards. B. (2009). Compensating for anterograde amnesia: a new training method that capitalizes on emerging smartphone technologies. Journal of the International Neuropsychological Society, 15(4), 629-638.
Svoboda, E., Richards, B., Polsinelli, A. & Guger, S. (2010). A theory-driven training programme in the use of emerging commercial technology: application to adolescent with severe memory impairment. Neuropsychological Rehabilitation: An International Journal, 20(4), 562-586.
Szabo. G. & Dittelman.J. (2014) Using Mobile Technology with Individuals with Aphasia: Native iPad Features and Everyday Apps Seminars in Speech and Language vol 35(1) pp 5-16
Wakefield, L. & Schaber, T. (2012, July 31). APP-titude: Use the Evidence to Choose a Treatment App: This evidence-based practice model provides strategies for selecting an app.. The ASHA Leader.
Wild, M.R. (2014) Principles of App Selection and Training After Brain Injury Perspectives on Augmentative and Alternative Communication