A feasibility randomized controlled trial of ReaDySpeech for people with dysarthria after stroke

Mitchell, Claire; Bowen, Audrey; Tyson, Sarah; Conroy, Paul

doi:10.1177/0269215517748453

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…The main premise in pursuing technology-assisted therapy is to facilitate access (by reducing costs and/or logistical barriers like location/ transportation) and/or increase the amount of practice an individual can complete, given the large number of hours needed to facilitate learning. Good compliance, ease-of-use, and satisfaction have been reported with these studies [101,102,103], which is encouraging given a primary motivation of increasing total amount of practice time. Results from VR, telerehabilitation, and computer-/tablet-based treatment studies are overwhelmingly positive, but lack of comparison studies and/or adequate control groups/tasks makes it difficult to identify superior protocols or attribute outcomes to the technological component of the treatment [104,105].…”

Section: Language Speech and Communicationsupporting

confidence: 61%

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

Stockbridge

Bunker

Hillis

2022

Curr Neurol Neurosci Rep

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Purpose of Review Stroke is a common cause of disability in aging adults. A given individual’s needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains. Recent Findings Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients’ recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Summary Recent and ongoing trials have increasingly adopted a multidisciplinary nature — augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.

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Section: Language Speech and Communicationsupporting

confidence: 61%

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

Stockbridge

Bunker

Hillis

2022

Curr Neurol Neurosci Rep

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“…The number of studies in this field has rapidly increased over time ( Figure 2 ), from a single study in 2004 to 8 in 2022, with a peak of 15 in 2021. The majority (86/103, 83%) [ 47 - 51 , 53 - 56 , 58 , 59 , 61 , 63 - 68 , 71 - 86 , 89 - 95 , 97 - 105 , 107 , 109 , 111 , 112 , 114 , 115 , 117 - 126 , 128 - 136 , 138 - 148 ] were published in the past 10 years. Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , …”

Section: Resultsmentioning

confidence: 99%

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Gooch,

Jarvis,

Stockley

2024

J Med Internet Res

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Background Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. Objective This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). Results From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. Conclusions Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.

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“…Several interventions, such as circuit classes or group exercise, independent and semisupervised practice, and use of technology, have been found to be feasible and acceptable and are potential candidate interventions for further testing. 16,37,[96][97][98][99][100][101] The results regarding the association between the amount of PT per day of stay and outcome in terms of disability on discharge and the proportion of patients discharged home were unexpected. Our additional analysis using cubic splines indicated that increasing the average amount of PT per day of stay was associated with less disability and increased odds of being discharged home up to 5-10 minutes of PT per day of stay.…”

Section: Discussionmentioning

confidence: 99%

Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study

Gittins

Lugo-Palacios

Vail

et al. 2020

Health Serv Deliv Res

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Background Therapy is key to effective stroke care, but many patients receive little. Objectives To understand how stroke therapy is delivered in England, Wales and Northern Ireland, and which factors are associated with dose, outcome and resource use. Design Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics and multilevel mixed-effects regression models, while adjusting for all known and measured confounders. Setting Stroke services in England, Wales and Northern Ireland. Participants A total of 94,905 adults admitted with stroke, who remained an inpatient for > 72 hours. Results Routes through stroke services were highly varied (> 800), but four common stroke pathways emerged. Seven distinct impairment-based patient subgroups were characterised. The average amount of therapy was very low. Modifiable factors associated with the average amount of inpatient therapy were type of stroke team, timely therapy assessments, staffing levels and model of therapy provision. More (of any type of) therapy was associated with shorter length of stay, less resource use and lower mortality. More occupational therapy, speech therapy and psychology were also associated with less disability and institutionalisation. Large amounts of physiotherapy were associated with greater disability and institutionalisation. Limitations Use of observational data does not infer causation. All efforts were made to adjust for all known and measured confounding factors but some may remain. We categorised participants using the National Institutes of Health Stroke Scale, which measures a limited number of impairments relatively crudely, so mild or rare impairments may have been missed. Conclusions Stroke patients receive very little therapy. Modifiable organisational factors associated with greater amounts of therapy were identified, and positive associations between amount of therapy and outcome were confirmed. The reason for the unexpected associations between large amounts of physiotherapy, disability and institutionalisation is unknown. Prospective work is urgently needed to investigate further. Future work needs to investigate (1) prospectively, the association between physiotherapy and outcome; (2) the optimal amount of therapy to provide for different patient groups; (3) the most effective way of organising stroke therapy/rehabilitation services, including service configuration, staffing levels and working hours; and (4) how to reduce unexplained variation in resource use. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 17. See the NIHR Journals Library website for further project information.

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A feasibility randomized controlled trial of ReaDySpeech for people with dysarthria after stroke

Cited by 12 publications

References 32 publications

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study

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