Disclosures. Background. Equipment 2/4/2015

Transcription

1 Disclosures Telepractice and Technology: Innovative Aphasia Therapy in Clients Homes and Communities Judy P. Walker and Denise Connor University of Maine Speech Therapy Telepractice Program Dept. of Communication Sciences and Disorders Madelyn E. & Albert D. Conley Speech, Language and Hearing Center Judy Walker is a faculty member at the University of Maine. Denise Connor is a former graduate student. We do not have a financial relationship with any company whose product or service we may discuss in this presentation. Background Telerehabilitation effective Dx and Tx of patients with aphasia (e.g., Georgeadis et al., 2004; Hill et al., 2009) Technology advances change where and how we provide telepractice services (Towey, 2012) Describe some of the unique telepractice methods we use at the University of Maine for clients with aphasia Case example Services provided through the Dept. of CSD, Conley Speech Language and Hearing Center Team of CSD graduate students and supervisors Telepractice lab located on campus at the University of Maine University of Maine Speech Therapy Telepractice Program Equipment Use secure web based video conferencing system On existing computers Mac PC High definition audio and video High speed Internet access 1

2 Exciting interactive webbased approach Provided to clients in their homes, schools and communities Single and multiple users SLP and client manipulate custom digital materials simultaneously Share Audio Video E Tools Application Train e Helpers (see Towey, 2012) What is an e helper? Facilitates telepractice sessions and carry over of activities/strategies Who is the e helper? Family member, caregiver, school personnel Technical Skills Basic computer skills Facilitate sessions Troubleshoot Interpersonal Skills Can follow directions Has patience Good vision and hearing Telepractice Evaluations Face to face in clients environment Follow same procedures as face to face Technology checklist in person Hybrid approach Technology checklist first via telepractice Travel to patient s home for face to face evaluation Telepractice only Technology checklist via telepractice Telepractice evaluation Do our Homework Thorough speech language evaluation Functional evaluation of patients ADLs in home and community environments Physically walk around the patient s home and drive community Virtually Tour of homes Google earth of communities Websites of specific places patient frequents Individual Therapy Sessions Develop goals designed around individual ADLs Create authentic functional individualized digital materials and activities Microsoft PowerPoint Custom Digital Pictures Custom Videos Websites Incorporate Apps and Software Programs EXCELLENT EXTRA: Include family members and others in sessions from any where!! Incorporate Assistive Technology Use Different Devices Desktop Laptops Tablets Smart Phones 2

3 Telepractice Group Therapy Type of group communication theme based support Ideal size (4 6) Technology Thumbnails Large screen Voice activation The Digital Exchange Huge files Transfer to/from clients Clog e mail DropBox Share files Multiple users Either end CASE EXAMPLE CP 69 y.o. right handed female 8 mos. post onset L CVA Initial evaluation WAB aphasia quotient 48 Wernicke s aphasia Moderate deficits Auditory comprehension Verbal expression Reading and Writing History Medical Hx unremarkable Retired accountant Lived southern ME with 90 year old mother Daughter living nearby, another daughter in RI Driver s license reissued, ran own errands Daughters concerned about inability to communicate while performing ADLs Therapy Goals LTG: Improve linguistic abilities and functional communication to increase independence in ADLs. STG 1: Improve VE STG 2: Improve Reading STG 3: Improve Writing STG 4: Increase use of compensatory strategies STG 5: Improve communication partner strategies 3

4 Tx Approach and Strategies Selected a specific ADL Daughter and client took digital photos Inserted into custom PP presentations Develop linguistic skills Traditional approaches Used websites related to ADL incorporated linguistic strategies Conversations PACE (e.g., Davis & Wilcox, 1981) Scripts (e.g., Holland et al., 2002) Daughters involved in activities (e helper, RI) Carry over for homework Example Verbal Expression ADL > driving routes and describing directions/location Verbal expression Lexical access (nouns and verbs) Phonemic cue Grapheme cue Sentence level (nouns + verbs) Example Script Insert video clip confrontation naming task Practice in a script activity Using Google Earth Describe route from home to Wendys Using all strategies Outcomes Insert video clip sharing web browser WAB aphasia quotient > 48 to 59.9 Goals VE, reading, writing related to ADLs improved Compensatory strategies of meaningful gestures and writing improved Communication partners learned effective strategies Gained greater independence and confidence 4

5 Consumer Comments Consumer satisfaction survey Agreed or Strongly agreed Expectations Progress Availability Satisfaction Recommend This program is wonderful! The individualized sessions make all the difference. We are so thankful for this program. My mother s quality of life has improved so much! Discussion References Davis, G., & Wilcox, M. (1981). Incorporating parameters of natural conversation in aphasia treatment. In R. Chapey (Ed.), Language intervention strategies in adult aphasia. Baltimore, MD: Williams and Wilkins. Georgeadis, A., Brennan, D., Barker, L., & Baron, C., (2004). Telerehabilitation and its effect on story retelling by adults with neurogenic communication disorders. Aphasiology, 18 (5 7), Hill, A., Theodoros, D.G., Russell, T.G., Ward, E.C., & Wootton, R. (2009). The effects of aphasia severity on the ability to assess language disorders via telerehabilitation. Aphasiology, 23(5), Holland, A., Milman, L., Munoz, M. & Bays, G. (2002). Scripts in the management of aphasia. Paper presented at the World Federation of Neurology, Aphasia and Cognitive Disorders Section Meeting, Villefranche, France. Towey, M.P. (2012). Speech telepractice: Installing a speech therapy upgrade for the 21st century. International Journal of Telerehabilitation, 4(2),