Towards PWA in Healthcare

Nowadays there is a very large number of mobile applications that use the network to offer some functionality to users and because of this, applications are limited by the network conditions, such as network latency. These mobile applications usually are developed in a traditional approach, designated as a native approach and its goal is to develop the application to a specific operating system (iOS, Android). Applications used in a working environment are known to improve its process, but the network has the potential to decrease application performance and traditional mobile development is inefficient. Healthcare is a field with huge opportunities for application development because applications have the potential to improve work efficiency and quality of patient care. This paper consists of introducing the Progressive Web Application mobile development approach in the healthcare industry as an m-Health solution. It highlights successful cases of such an approach and key features, that allow establishing a reliable and resilient mobile application, that deals with most challenges involving the network nowadays and is a valid opportunity in the healthcare business. This document also presents a mobile health application for dietary evaluation, compares the PWA approach and other traditional approaches with a SWOT Analysis, PWA success cases, the INTCare system (an intelligent decision support system available in the Centro Ho spitalar do Porto) and the opportunity to use Progressive Web App in the INTCare's Electronic Nursing Record (ENR), which is a web interface that represents clinical patient information, integrated in a new proposed INTCare system architecture design. (C) 2019 The Authors. Published by Elsevier B.V.This work has been supported by national funds through FCT -Fundacao para a Ciencia e Tecnologia within the Project Scope: UID/CEC/00319/2019 and Deus ex Machina (DEM): Symbiotic technology for societal efficiency gains -NORTE-01-0145-FEDER-000026

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway

Supporting people with aphasia to ‘settle into a new way to be’: speech and language therapists’ views on providing psychosocial support

Background: People with aphasia are at risk of becoming depressed and isolated. On-line surveys have found that the majority of Speech and Language Therapists (SLTs) lack confidence in addressing the psychological needs of people with aphasia. Aims: To explore how SLTs conceptualise the scope of their role; barriers and facilitators to SLTs addressing psychosocial needs; and SLTs’ experiences of specialist training and support, and working with mental health professionals (MHPs). Methods and procedures: Focus groups conducted in stroke healthcare settings. Purposive sampling was used in selecting sites so as to capture a range of experiences. Results were analysed using Framework Analysis. Outcomes and Results: Twenty-three SLTs took part in six focus groups. Participants’ psychosocial work included counselling-type interactions, psychoeducation, working with families, facilitating peer support, and training other healthcare professionals. There was a lack of consensus on the scope of the SLT role. Many expressed a sense of conflict, both perceiving it as valuable to spend time addressing psychological well-being, while simultaneously feeling uneasy if they deviated from ‘direct SLT’ work. Barriers to addressing psychosocial wellbeing were: emotionally challenging nature of this work, particularly for those who felt unsupported; caseload and time pressures; attitude of senior managers and commissioners; difficulties measuring and documenting more ‘fluid’ psychosocial work; and the complexity of needs and backgrounds of some patients. Enabling factors were: specialist on-going support; peer support from colleagues; experience; support of management; and personal belief. Specialist training was valued. It changed how participants viewed the therapist-client relationship (more client-led); the assessment and goal setting process; and gave them more confidence to acknowledge client emotions. However, many felt that there was a need for on-going specialist advice, and to be able to see approaches modelled for this client group. In terms of mental health professionals (MHPs), a subset of stroke specialist clinical psychologists worked directly with people with marked aphasia and families, as well as supporting the multidisciplinary team to provide holistic care. However, a main theme was that participants perceived many MHPs did not consider people with aphasia as ‘appropriate candidates’ for psychological input. Conclusions and Implications: All participants cared about the emotional well-being of their clients; however, they identified a number of barriers to people with aphasia receiving appropriate psychological support. A cultural shift, whereby psychological care for people with aphasia is seen as valuable, feasible and necessary, delivered collaboratively by SLTs, MHPs and the wider team, may improve services

Preliminary Investigation of an Aphasia-Friendly Version of the Patient Health Questionnaire – 8 (PHQ-8) Compared to other Patient and Proxy Reported Outcome Measures of Depression

Persons with aphasia (PWA) experience post-stroke depression more frequently than stroke survivors who do not have aphasia. Currently, no patient reported outcome measures that screen for depression have been created specifically for PWA or modified to be aphasia friendly for PWA. The purpose of this preliminary study is to modify the Patient Health Questionnaire- 8 (PHQ-8) to an aphasia friendly format and to assess the feasibility of administering the modified assessment compared to other patient-reported and proxy-reported outcome measures used to screen depression. This retrospective analysis examined pre- and post-treatment outcome measures of depression for seven stroke-survivors with aphasia. The Patient Health Questionnaire -8 (PHQ-8) was modified to an aphasia friendly format through simplification of questions, increased font size, addition of a calendar representation of possible responses, and addition of pictures related to the question being asked. Prior to and immediately following an intensive comprehensive aphasia program (ICAP) lasting four weeks, stroke-survivors with aphasia were administered the modified PHQ-8 (mPHQ-8). Each stroke survivor also completed the Geriatric Depression Scale (GDS) and the Modified Perceived Stress Scale (mPSS); family caregivers completed a proxy measure, the Stroke Aphasia Depression Questionnaire -10 (SADQ-10). The GDS and SADQ-10 were administered in their original formats. The mPSS was administered in its designed format as an aphasia friendly version of the Perceived Stress Scale. The GDS, mPHQ-8, and SADQ-10 were scored immediately before and after the summer 2019 ICAP at the University of Montana. Undergraduate research assistants not involved in the data collection and blind to research procedures rescored all outcome measures for validity and reliability purposes. Means, standard deviation, and standard error of measurement are reported for each measure. Feedback about the feasibility and ease of administration of these measures was collected from speech-language pathology clinicians immediately following pre- and post-testing, and again approximately three months later. Clinicians report that the mPHQ-8 required less modifications than the GDS, and that responses to the mPHQ-8 were perceived to be more accurate than responses to the GDS. Data from this study provides preliminary support for the use of modified depression screening tools for use with PWA. Key words: aphasia, depression, patient-reported outcome measures, proxy outcome measures, aphasia-friendly modification, psychosocial well-bein

Aphasia simulation: A perspective from the student and standardized patient

The aim of the current study was to examine student ability, student and standardized patient perceptions of competency, and student perceptions of effectiveness of simulation methodology for conducting language screenings on individuals with aphasia. Graduate students enrolled in a mandatory course on acquired language disorders (n = 36) completed a variety of simulated learning experiences using videos, high-fidelity manikins, and standardized patients, in preparing them for clinical practice with persons with aphasia. 5-point Likert scales and open-ended survey questions relating to student and standardized patients’ perceptions were administered. Results demonstrated a strong positive perception that simulation promotes student understanding of assessment procedures and aids in the development of clinical judgment. Data also illuminate that certain skills may be slower to emerge and require greater experience and supervisory feedback, for example, problem-solving difficult moments. There was an overall positive response to the use of simulation methodology to build skills in screening patients with PWA. Students’ perceptions matched that of the standardized patients, and students excelled in the final summative skill activity. Keywords: aphasia; simulated learning; academic education; clinical educatio

Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA. Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs. Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs. Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former. Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff

Students\u27 Understanding of Self-Management in Aphasia Treatment

Aphasia is a neurogenic language disorder caused by damage to the language areas of the brain in the left hemisphere, resulting in speech and language impairments. People with aphasia (PWA) often receive services from speech-language pathologists (SLPs) who provide screening, assessment, diagnosis, and treatment to address communication deficits. Aphasia is a chronic condition and PWA experience symptoms throughout their lives. Healthcare costs related to aphasia account for $46 billion annually. Provider shortages, lack of transportation, insurance constraints, and travel expenses can leave PWA without adequate care. One possible solution to the costs and access issues is the implementation of self-management for chronic aphasia. Through self-management, PWA take responsibility for their care after being educated on how to manage their symptoms and make adaptive communication changes. However, clinicians have limited resources to guide them in implementing this approach. This study utilized a pre-test/post-test design to: 1) assess the knowledge and perceptions of SLP graduate students regarding self-management in aphasia rehabilitation before and after their participation in a training session on the topic, and 2) determine if participants have become more familiar with this concept and if they would consider implementing it in their future practice. Results suggested that participants were more likely to consider implementing self-management in their future practice and were more knowledgeable about this intervention after the training session. Therefore, introducing the concept of self-management to more SLPs can garner their support in building and implementing a formal intervention in their practice

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings.

Purpose: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in ten Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. Method: Ten rehabilitation centres took part in a multifaceted implementation of conversation partner training over thirteen months. Each centre selected two speech and language therapists to act as knowledge brokers whose role it was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans. Results: Successful implementation was described as 1) four dyads included during the intervention period, 2) two more dyads included after the intervention period, before the end of the study and 3) inclusion of Partners of Aphasic Clients Conversation Training (PACT) in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of 6 dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation of PACT study (ImPACT). Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for PACT within existing care routines. Conclusions: The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support