Usingeverydayappstoassistrehabilitationandlifeafterbrain

injury

MichaelaEmm-Evans– HighlySpecialistSpeechandLanguageTherapist&HeatherBushell– HighlySpecialistOccupationalTherapist14th June2018

Overview

• ReasonsforusingApps• Apps• Casestudies• Links

Statistics2013- 2014

Source:Headwayhttps://www.headway.org.uk/media/2882/brain-injury-statistics-2015-infographic.pdf

ReasonsforusingApps

• Localservicescanbelimited• Shortagesofqualifiedorspecialistsupportstaffinunits

• Longerdurationbetweensessionsincommunity• Offersoptionforhighdosagetherapy (towards45minutesatleast5days)

• Canincreasemotivation• Reduceboredom

AppUsethroughouttheRehabilitationPathway

ClinicalGuidanceonuseoftechnology

G154G118

5.14.4.1.14.3.3.1

StandardphoneApps/features

NotesFindmyFriends

Speechtotext

Calendar Reminders

AccessibilitysettingsoniPhone

Therapy/rehabApps

Thereare1000’s!

Canplan Constanttherapy Tactustherapy Cuespeak SpeakupforParkinson's

CanPlan(OTmostused)

• Sequencetaskplanner• Canrecordvideos,takepicturesaddaudio.• Scheduleregularsessions• Cantailortoanyindividual• Builduparesourceonshareddeviceinaunit• UsefulforthosewhosefirstlanguageisnotEnglish.

AboutMyDay(OTmostused)

•Usedasretrospectivediary•Usedforthosewhodon’tlikepaperdiaries•Addpicturesorvideosofwhattheyhavedonethatday•Assistsindividualswithinsightandawarenessasprovidesvisualfeedbackofactivitiescompleted•Canbeenteredbyfamilyasadifferentauthor

Constanttherapy(OTandSLTmostused)

• Cognitiverehabacrossalldomains• Android/IOS– iPhoneandiPad• American• FreeforTherapiststousewithclients• Clientshavetopay$20permonth– 15dayfreetrial

• Recommendstasksbasedonimpairments

ConstantTherapy– taskareas

• Language*- especiallylikethereadingtasks• Attention*• Memory:auditory*,visual*• Visuospatial• Arithmetic• Reasoning• Everydayskills*e.g.Listeningtoavoicemail,functionalreading,functionalmaths,

• Assessments

TactusTherapyApps

• Cognitiverehabacrossdomains• Android/IOS– iPhoneandiPad• AmericanbutcanchangethevoicetoEnglishUK• LanguageAppsalsoinFrench,Spanish,Germanetc – goodforESLclients

• FreeLiteversionsofallAppswithinTactusrange• Payforfullversions– between£15-£25perApp• Used++bySLTashasarangeoflanguage,speechandswallowingApps

RangeofTactusApps

• LanguageTherapy*• AdvancedNamingTherapy• CategoryTherapy*• ApraxiaTherapy*• ConversationTherapy• NumberTherapy*• QuestionTherapy• AdvancedComprehensionTherapy

RangeofTactusApps

• AnsweringTherapy• VisualAttentionTherapy*• DysphagiaTherapy• AdvancedReadingTherapy• AlphaTopicsAAC• SpacedRetrievalTherapy– memorytraining• SpeechFlipBookStandard

CueSpeak• UKdeveloped– notforprofitproject• IOSandiPadonlyatpresent• CanbeusedwithandwithoutSLTpresent• Forpeoplewithaphasiaandapraxiaofspeech• CanbedownloadedforfreetoNHSservices• Homeusersandindependenttherapistsaskedtotakeoutavoluntarymonthlysubscription

• Veryuserfriendlyincludeshelpbuttons/tutorials

Tasks

Arangeoftasksincludedtotargetspeechandlanguagee.g.• wordfinding• comprehension• reading• writing• semantics

SpeakupforParkinson's• It’sfree!• IOSandiPadonly• NotjustusefulforpeoplewithPD• Audio/visualfeedbackasitvideorecordstheperson

• Cantargetwordandphraselevelandconversationallevel

• American/?Howfunctionalthephrasesare

AugmentativeandAlternativeCommunication(AAC)Apps

Proloqu02go–theAppusedbyLostVoiceGuyonBGT

Gridplayer*– freeApp,iPadandiPhoneGridforiPad– newApp,caneditandpersonalise

AlphaTopicsfreefromTactus,iPadoriPhone

**BeforepayingforanAACAppand/ordevicepleaseseeifyourclientiseligibleforanassessmentfromyourlocalSLTorAAChub**

100’s– SeetheAppwheelforextra

ImpairmentLevel- FineMotor

Dexteria– finemotorskills**

DexteriaDots2– MotorSkills(+Math)

YokeePiano–finemotorandbilateral**

ImpairmentLevel– Visual/PerceptualYokeePiano– visualscanning**

Matrix(Games1,2,3)– Visualperceptionskills**

DesteriaVMI– visualmotorskills**

P.O.V- Spatialreasoning

VisualAttentionTherapy

Client1- HypoxicBrainInjury

• 52yearoldmale,maindifficultieswithattention,memoryandexecfunctions

Impairment Retrospective Prospective

Client2– HypoxicBrainInjury

• 17yearoldmalewithhypoxicbraininjury.Significantcognitiveimpairment,sexualdisinhibitiondirectedtofemales.

StrategyTraining– tapedactionmessages

Client3- Stroke

• 76yearoldmale,rightsideneglect,severelyaphasic

Lefttorightscanningpracticetocomplementeverydayfunctionalscanningpractice.Patientmotivatedtoincreaseindependence.

Tactus – naming,comprehensionandwriting

Client4– spinalinjury

• 32yearoldfemale,Nocognitivedifficulties,tetraplegia,quietbutfunctionalvoice.

Wasusingastylusfortext/emails– fatiguewasimpacting++ShownhowtousespeechtotextoptionandSirioniPhonetotextandmakecalls

Client5- TBI• 30yearoldmale,severeaphasia,globalcognitiveimpairment

AbletolearnanddemonstrateabilitytouseiPhone/iPadvideoandpicturemessagingto‘checkin’withfamily/careteamtoreducelevelofsupportandincreaseindependentliving

Client6- TBI

• 52yearoldmale,severeAOS,globalaphasia,othercognitivedifficultiesextentunknown

NotappropriateforhightechAACdeviceonleavingrehabunit.UsedarangeofcomputerandtabletbasedspeechandlanguageApps.Languageskillsimproved++AOSmainbarriertofunctionalcommunication.3yearspostBInowusingGridforiPlayer

Client7– TBIanddyslexiaWhatApps/accessibilityfeaturesdoyoufinduseful?• Speechtotexttowritemessages,emails• Selecttoreadmessages(texttospeechoption)• FaceTime• Airdroptosharephotos• Swiftkeytohelpwithwritingmessages• Photomaths App• Googlecalendar• GoogleAssistant– hasthislinkeduptolightsinhouseetc• FindsthatGoogleassistantunderstandsspeechbetterthan

Siri+++!

Thanksforlistening

UsefulInfo• iPadAppsWheel- http://www.callscotland.org.uk/Common-

Assets/ckfinder/userfiles/files/iPad-Apps-for-Complex-Communication-Support-Needs.pdf

• CommunicationAccessFeaturesonAppledevices– www.aphasiafriendly.co• CanPlan- https://itunes.apple.com/us/app/canplan/id598687543?mt=8• Tactus– www.tactustherapy.com• CueSpeak– www.cuespeak.com• GridPlayer- https://itunes.apple.com/gb/app/grid-player/id456278671?mt=8• SpeakUpforParkinson's- https://itunes.apple.com/gb/app/speak-up-for-

parkinsons/id784117908?mt=8• ConstantTherapy- https://itunes.apple.com/gb/app/constant-

therapy/id575764424?mt=8• Dexteria Apps- http://www.dexteria.net/• PhysiotherapyExercises- (NolongercompatiblewithiOS11,althoughstillavailableas

websitefreenotasgoodasphysiotools.https://www.physiotherapyexercises.com/• Proloquo2Go- http://www.assistiveware.com/product/proloquo2go• ViaTherapy- http://www.viatherapy.org/

UsefulInfo• NICEandBNF- https://www.nice.org.uk/about/what-we-do/nice-apps-for-

smartphones-and-tablets• NeuropsychologicalRehabilitation,2016;ImprovedLanguageinchronicaphasiaafter

selfdeliveredipadspeechtherapy(Tactus)• JournalofSpeechLanguageandHearingresearch,2018:Effectsofatabletbasedhome

practiceprogramwithtelepracticeontreatmentoutcomesinchronicaphasia• www.tactustherapy.com/evidence-based-apps/• https://www.my-therappy.co.uk/• https://otswithapps.com/• https://www.asha.org/Events/convention/handouts/2012/1319-Mobile-Apps-for-

Managing-Memory-Impairments-After-Brain-Injury/• https://itunes.apple.com/gb/app/find-my-friends/id466122094?mt=8• https://citcentoolkit.wordpress.com/• RehabilitationfollowingacquiredbraininjuryNationalclinicalguidelines2003

(Availablefrom:https://www.headway.org.uk/media/3320/bsrm-rehabilitation-following-acquired-brain-injury.pdf)

• Nationalclinicalguidelineforstroke2016(Availablefrom:https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx)

• SocietyforCognitiveRehabilitationRecommendationsforBestPracticeinCognitiveRehabilitationTherapy:AcquiredBrainInjuryAvailablefrom:https://www.societyforcognitiverehab.org/membership-and-certification/documents/EditedRecsBestPrac.pdf

RehabilitationfollowingacquiredbraininjuryNationalclinicalguidelines20037.8ComputersandassistivetechnologyG154Rehabilitationteamsshould:RoutinelyconsidertheuseofcomputersasanadaptivesourceofmeaningfuloccupationforpeoplewithbrainInjury7.4CommunicationandLanguageInterventionsG118 considertheneedforcommunicationaidsincludinggesturedrawing,communicationchartsandcomputerisedsystems.Nationalclinicalguidelineforstroke2016Aphasia4.4.1.1Recommendations– D- Peoplewithcommunicationproblemsafterstrokeshouldbeconsideredforassistivetechnologyandcommunicationaidsbyanappropriatelytrained,experiencedclinicianCAfterthefirstfourmonths,peoplewithcommunicationproblemsafterstrokeshouldbereviewedtodeterminetheirsuitability forfurthertreatmentwiththeaimofincreasingparticipationincommunicationandsocialactivities.Thismayinvolveusinganassistantorvolunteer,familymemberorcommunicationpartnerguidedbythespeechandlanguagetherapist,computer-basedpracticeorotherimpairment-basedorfunctionaltreatment.AttentionandConcentration4.3.3.1Recommendations‒Cbeofferedanattentionalintervention(e.g.timepressuremanagement,attentionprocesstraining,environmentalmanipulation),ideallyinthecontextofaclinicaltrial;‒begivenasmanyopportunitiestopractisetheiractivitiesasreasonableundersupervision.Apraxiaofspeech4.4.3.1RecommendationsPeoplewithseverecommunicationdifficultiesbutgoodcognitiveandlanguagefunctionafterstrokeshouldbeassessedandprovidedwithalternativeoraugmentativecommunicationtechniquesoraidstosupplementorcompensateforlimitedspeech.SocietyforCognitiveRehabilitationRecommendationsforBestPracticeinCognitiveRehabilitationTherapy:AcquiredBrainInjury5.RestorationandCompensation• 5.1CRTtreatmentsshouldencompassattemptsatrestorationoflostfunctionatthesametimeasteachingcompensatory

strategiestominimisethecognitiveimpairments