Background Noise levels on intensive care units (ICUs) are typically elevated. While many studies reported negative effects of ICU ambient sounds on patients, only few investigated noise as a factor to influence well-being or performance in healthcare professionals. Methods An online survey in the German-speaking part of Switzerland was conducted to assess how ICU soundscapes are subjectively perceived by healthcare professionals. The questionnaire was answered by 348 participants. Additionally, effects of noise on working memory performance were evaluated in an experimental noise exposure setting. Twenty-six healthcare professionals and 27 healthy controls performed a 2-back object-location task while being exposed to either ICU or pink noise. Results Survey results demonstrate that a majority of participants was aware of heightened noise levels. Participants reported that mostly well-being, performance, and attention could be reduced, along with subjective annoyance and fatigue by ICU ambient sounds. Although no significant effects of noise exposure on working memory performance was observed, self-assessments revealed significantly higher stress levels, increased annoyance and distraction ratings as well as decreased confidence in performance after ICU-noise exposure. Conclusion Subjective assessments indicate that heightened noise levels on ICUs induce annoyance, with heightened stress levels, impaired well-being, and reduced performance being potential consequences. Empirical evidence with objective and physiological measures is warranted.

Background Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer–based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists. Objective The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient’s progress as well as creation of new individual exercises. Methods The system consists of two main parts: (1) the patient’s interface, which allows the patient to exercise, and (2) the therapist’s interface, which allows the therapist to assign new exercises to the patient and supervise the patient’s progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory). Results A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z =–1.90; P =.03) and therapists rated the app as good (score >85; Z =–1.75; P =.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z =–1.66; P =.049). Conclusions Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer–based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy.

IntroductionAphasia is a common language disorder acquired after stroke that reduces the quality of life of affected patients. The impairment is frequently accompanied by a deficit in cognitive functions. The state-of-the-art therapy is speech and language therapy but recent findings highlight positive effects of high-frequency therapy. Telerehabilitation has the potential to enable high-frequency therapy for patients at home. This study investigates the effects of high-frequency telerehabilitation speech and language therapy (teleSLT) on language functions in outpatients with aphasia compared with telerehabilitative cognitive training. We hypothesise that patients training with high-frequency teleSLT will show higher improvement in language functions and quality of life compared with patients with high-frequency tele-rehabilitative cognitive training (teleCT).Methods and analysisThis study is a randomised controlled, evaluator-blinded multicentre superiority trial comparing the outcomes following either high-frequency teleSLT or teleCT. A total of 100 outpatients with aphasia will be recruited and assigned in a 1:1 ratio stratified by trial site and severity of impairment to one of two parallel groups. Both groups will train over a period of 4 weeks for 2 hours per day. Patients in the experimental condition will devote 80% of their training time to teleSLT and the remaining 20% (24 min/day) to teleCT, vice versa for patients in the control condition. The primary outcome measure is the understandability of verbal communication on the Amsterdam Nijmegen Everyday Language Test and secondary outcome measures are intelligibility of the verbal communication, impairment of receptive and expressive language functions, confrontation naming. Other outcomes measures are quality of life and acceptance (usability and subjective experience) of the teleSLT system.Ethics and disseminationThis study is approved by the Ethics Committee Bern (ID 2016-01577). Results will be submitted to a peer-reviewed journal.Trial registration numberNCT03228264.

In laboratory time-based prospective memory tasks, older adults typically perform worse than younger adults do. It has been suggested that less frequent clock checking due to problems with executive functions may be responsible. We aimed to investigate the role of clock checking in older adults’ time-based prospective memory and to clarify whether executive functions would be associated with clock checking and consequently, with time-based prospective memory. We included 62 healthy older adults (62-85 years of age) and applied tasks of time-based prospective memory as well as of executive functions (i.e., inhibition, fluency, and working memory). We used mediation analysis to test whether time-based prospective memory declined with advancing age due to less frequent clock checking. In addition, we tested whether there would be an association between executive functions and clock checking or time-based prospective memory. Time-based prospective memory declined with advancing age due to less frequent clock checking within 30s prior to intention completion. We only found a link between executive functions and clock checking (or time-based prospective memory) when not controlling for age. Our results support the importance of clock checking for time-based prospective memory and add to the current literature that older adults’ prospective memory declines because they are less able to adapt their clock checking. Yet, the reason why older adults are less able to adapt their clock checking still remains open. Our results do not indicate that executive function deficits play a central role.

BACKGROUND Aphasia is the loss or impairment of language functions and affects every day social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, the training must be adapted individually and dynamically to the patient needs. An important factor for a successful aphasia therapy is dose frequency. Computer-based applications allow patients to train independently with high intensity at home. But most of the newest tele-rehabilitation applications focus on one linguistic modality, whereas there is currently a lack of validated tele-rehabilitation systems that focus on multimodal linguistic modalities. OBJECTIVE The aim of this project was to develop a multimodal system that enables aphasic patients to train at home using language-related tasks autonomously and also allows therapists to remotely assign new tasks and track the patient’s progress as well as to create new individual exercises. METHODS The system consists of two main parts. First, the patient’s interface, which allows the patient to exercise. Second, the therapist’s interface, which allows the therapist to allocate new exercises to the patient and supervise the progress of the patient. The system has been evaluated by therapists and patients by validated questionnaires in terms of usability and motivation. RESULTS A total of 11 speech and language therapists (age, MD = 28, SD =7) and 15 patients (age, MD = 53, SD =10) with diagnosed aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale zero to hundred) as excellent (score above 70, 95% CI 85.9 to 100.0, t (14) = 2.16, P = .024) and therapists as good (score above 85, 95% CI 70.5 to 100.0, t (10) = 2.21, P = .026). Furthermore, patients highly enjoyed (scale zero to six) solving the exercises (score above 3, 95% CI 3.1 to 6.0, t (4) = 2.58, P = .031). CONCLUSIONS Based on the questionnaire scores, the developed system is well accepted and simple to use by patients and therapists. Furthermore, the new system allows patients with different types of aphasia to train with a high intensity independently at home. Thus, the novel system has potential for treatment of aphasic patients as a supplement to face-to-face therapy.