Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review.

BACKGROUND: More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE: This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS: From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS: We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS: Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/20552076211035988

Features of iPad language applications for speech-language therapy with children

A dissertation submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree Master in Speech-Language PathologyBackground: Speech-Language Pathologists (SLPs) worldwide are using apps in their interventions. Despite this growing trend, there is limited literature on the use of apps for language intervention. Reports indicate that SLPs are selecting apps by word-of-mouth and popularity. One of the difficulties in evaluating apps is related to the lack of consensus about which features are important in an app when providing speech-language therapy to children. Aim: This study aimed to investigate the features of apps that SLPs regard as valuable for language intervention with children and how SLPs were using apps in their intervention. Method: The study employed an explanatory, sequential mixed-method approach using SLPs in 6 predominantly English-speaking countries. A self-developed online survey (N = 338) identifying the features of apps was distributed to SLPs who use apps. This was followed by a semi-structured interview with some participants (n = 16) in order to obtain further insights from the survey. Descriptive statistics were used to examine the survey results. Interview data were explored using thematic analysis. Findings: The findings show that SLPs view apps as an engaging and motivating tool for therapy to facilitate their intervention goals. The lack of guidelines to support SLPs in their selection of apps has contributed to the selection of apps based on popularity and word-of-mouth rather than feature matching. Findings showed that specific content and design features of apps may support effective intervention, however these features need to be carefully evaluated in terms of the underlying principles of language intervention, multimedia learning and learning. Features that may impede effective intervention must also be considered. In addition, the social and pragmatic aspects of communication must be contemplated when using apps. Conclusions: A feature-matching checklist was developed in order to assist SLPs select apps based on feature matching. The findings from the study highlight the need for SLPs to engage more deeply with the theory underlying multimedia learning so that this information can be used to contribute to evidence-based practice when using apps for intervention. This study, calls for SLPs to make a concerted effort to engage in research around apps and app use.MT201

Occupational Therapy Students’ Perceptions of OSCE: A Qualitative Descriptive Analysis

Objective Structured Clinical Examinations (OSCE) are commonly used across health professions educational programs to evaluate student clinical competencies. OSCE are multiple, brief stations representing common practice scenarios. The purpose of the study was to evaluate student perceptions of OSCE. The researchers implemented 17 OSCE stations with 40 second year occupational therapy students to assess clinical competencies prior to fieldwork. Applying a qualitative descriptive methodologic approach, researchers analyzed station rating data, Qualtrics survey Likert-type items, and Qualtrics survey open-ended responses. Number of station rating responses varied widely, due to perceived time press. Station rating responses confirmed the more robust 80% response to Qualtrics survey. Analysis of Likert-type items revealed perceptions of OSCE as comprehensive, mixed eustress and distress, confirming of competence, and supportive of growth. Four dimensions of learning emerged from analysis of open-ended items: temporal, real world, bottlenecks to learning, and being open to the process. Findings affirmed student perceptions of OSCE to be valuable as summative and formative assessment of clinical competence. Existing literature supports three of the four dimensions of learning. The researchers advocate additional research to examine bottlenecks to learning, psychometrics of OSCE, the use of OSCE in program evaluation, and longitudinal study of student performance related to OSCE

Examining the Learning of Students Participating in an Interactive Simulated Patient Experience

Simulated patients are becoming increasingly used in the educational program of future speech-language pathologists. The use of standardized patients provides the opportunity to teach students clinical skills in a controlled environment (Bradley, 2006; Zraick, 2012). Simucase, a speech-language pathology software program, allows clinicians to practice their assessment and treatment skills on virtual patients and is a valid method when teaching clinical skills. Thus, this project examined five undergraduate senior clinicians’ performance and reflection about the Simucase program and their own clinical knowledge. The undergraduate student clinicians engaged in controlled simulation experiences that shared similar characteristics to their current clients, and then reflected upon their experiences via self-report questionnaires. Students engaged in simulations in two different modes. When working in the learning mode, students were provided with feedback about their clinical decision-making. In the assessment mode, no feedback was provided. Results indicated that students spent significantly more time interacting with simulated cases, as well as significantly increased competency scores when utilizing in the assessment mode. Students’ reflections about their experience with Simucase indicated increased confidence in utilizing the program and when providing treatment. However, students’ confidence decreased in taking data and making an appropriate clinical decision likely because their experience with Simucase allowed them to reflect on deficits in their knowledge and skills. This study demonstrates the need for continued research within communication sciences and disorders fields as to the efficacy of the use of simulated patients with undergraduate students. Additionally, a further study is needed to better understand the strengths and weaknesses of different Simucase modes on student learning

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

Introduction and purpose: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa’s regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. Methodology: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. Results and Conclusions: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a “big win” (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model.  Few studies were conducted in LMICs, indicating a gap in such research. &nbsp