Refining an Asynchronous Telerehabilitation Platform for Speech-Language Pathology: Engaging End-Users in the Process

Abstract

Asynchronous telerehabilitation in which computer-based interventions are remotely monitored and adapted offline is an emerging service delivery model in the rehabilitation of communication disorders. The asynchronous nature of this model may hold a benefit over its synchronous counterpart by eliminating scheduling issues and thus improving efficiency in a healthcare landscape of constrained resource allocation. The design of asynchronous telerehabilitation platforms should therefore ensure efficiency and flexibility. The authors have been engaged in a program of research to develop and evaluate an asynchronous telerehabilitation platform for use in speech-language pathology. eSALT is a novel asynchronous telerehabilitation platform in which clinicians design and individualize therapy tasks for transfer to a client's mobile device. An inbuilt telerehabilitation module allows for remote monitoring and updating of tasks. This paper introduces eSALT and reports outcomes from an usability study that considered the needs of two end-user groups, people with aphasia and clinicians, in the on-going refinement of eSALT. In the study participants with aphasia were paired with clinicians who used eSALT to design and customize therapy tasks. After training on the mobile device the participants engaged in therapy at home for a period of 3 weeks, while clinicians remotely monitored and updated tasks. Following the home trial, participants, and clinicians engaged in semi-structured interviews and completed surveys on the usability of eSALT and their satisfaction with the platform. Content analysis of data involving five participants and three clinicians revealed a number of usability themes including ease of use, user support, satisfaction, limitations, and potential improvements. These findings were translated into a number of refinements of the eSALT platform including the development of a client interface for use on the Apple iPad®, greater variety in feedback options to both the participant and clinician, automatic transfer of results to the clinician, and expansion of the task template list. This research highlights the importance of including end-users in the process of technology refinement, in order to ensure effective and efficient use of the technology. Future directions for research are discussed including clinical trials in which the effectiveness of and adherence to intervention protocols using asynchronous telerehabilitation are examined.

Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review

“…It is acknowledged that participatory design approaches rely heavily on effective communication between the participants and designers and thus may be challenging for people with poststroke aphasia [78]. However, there are numerous examples of people with poststroke aphasia successfully partaking in participatory design studies to enhance the usability of aphasia-specific programs [19,78-82].…”

Factors Associated With Adherence to Self-Managed Aphasia Therapy Practice on a Computer—A Mixed Methods Study Alongside a Randomized Controlled Trial

“…Computerized homebased therapy for aphasia has been delivered through software programs (e.g., AphasiaScripts TM ) (13), specifically designed apps (e.g., TACTUS Language therapy © ) (14), and generic apps (e.g., iBooks) (9). Asynchronous tele-rehabilitation is a service delivery model that enables patients to carry out independent practice of computer-based rehabilitation interventions in their own time, with monitoring and adaption of therapy exercises carried out asynchronously (15). The Big CACTUS trial was the first fully powered, randomized controlled trial to evaluate the clinical and cost-effectiveness of computer speech and language therapy for aphasia in the long-term post stroke (16,17).…”

The Application of Lexical Retrieval Training in Tablet-Based Speech-Language Intervention

“…Beyond circumventing these constraints, such therapies can be leveraged to increase the intensity of treatment as they are accessible from any setting at any time (1,(6)(7)(8)(9)(10)(11)(12). Furthermore, even when therapy is administered remotely, clinicians are able to monitor progress and tailor therapy to a client's unique needs (4,5,8,(13)(14)(15). Recent work by Kiran et al (16) demonstrated that utilizing tablet-based language rehabilitation can simultaneously increase the intensity of practice while also tailoring treatment to the individual participant's needs.…”