Design Innovation for Engaging and Accessible Digital Aphasia Therapies: Framework Analysis of the iReadMore App Co-Design Process

Background: iReadMore is a digital therapy for people with acquired reading impairments (known as alexia) caused by brain injury or neurodegeneration. A phase II clinical trial demonstrated the efficacy of the digital therapy research prototype for improving reading speed and accuracy in people with poststroke aphasia (acquired language impairment) and alexia. However, it also highlighted the complexities and barriers to delivering self-managed therapies at home. Therefore, in order to translate the positive study results into real-world benefits, iReadMore required subsequent design innovation. Here, we present qualitative findings from the co-design process as well as the methodology. / Objective: We aimed to present a methodology for inclusive co-design in the redesign of a digital therapy prototype, focusing on elements of accessibility and user engagement. We used framework analysis to explore the themes of the communications and interactions from the co-design process. / Methods: This study included 2 stages. In the first stage, 5 in-person co-design sessions were held with participants living with poststroke aphasia (n=22) and their carers (n=3), and in the second stage, remote one-to-one beta-testing sessions were held with participants with aphasia (n=20) and their carers (n=5) to test and refine the final design. Data collection included video recordings of the co-design sessions in addition to participants’ written notes and drawings. Framework analysis was used to identify themes within the data relevant to the design of digital aphasia therapies in general. / Results: From a qualitative framework analysis of the data generated in the co-design process, 7 key areas of consideration for digital aphasia therapies have been proposed and discussed in context. The themes generated were agency, intuitive design, motivation, personal trajectory, recognizable and relatable content, social and sharing, and widening participation. This study enabled the deployment of the iReadMore app in an accessible and engaging format. Conclusions: Co-design is a valuable strategy for innovating beyond traditional therapy designs to utilize what is achievable with technology-based therapies in user-centered design. The co-designed iReadMore app has been publicly released for use in the rehabilitation of acquired reading impairments. This paper details the co-design process for the iReadMore therapy app and provides a methodology for how inclusive co-design can be conducted with people with aphasia. The findings of the framework analysis offer insights into design considerations for digital therapies that are important to people living with aphasia

Pre-Operative Education for Total Knee Replacement: A Pilot Survey

Purpose: The structure of preoperative education programs used nationally for patients prior to total knee replacement (TKR) surgery has not been identified previously, thus hospitals across the United States lack a common standard for this preoperative education to ensure best patient outcomes. The purpose of this pilot survey study was to describe the content, providers, and delivery methods currently utilized to deliver preoperative education for total knee replacement in the United States. Method: Data were collected using an online survey developed by the authors based on review of literature and 3 preoperative programs and was distributed through the Research Electronic Data Capture (REDCap). The survey consisted of 16 questions, including 12 closed-ended and 4 open-ended items. Participants were identified through convenience sampling using contacts of the first author and an Internet search of hospitals that provided preoperative education. Seven professional participants from nursing, physical therapy, and occupational therapy completed the survey. Descriptive statistics were used for data analysis of the 12 quantitative questions to determine frequency and percentages of responses. Responses on the 4 open- ended survey items as well as participant responses of “other” for question items were recorded and collated from individual survey responses. Results: Preoperative education provider teams for total knee replacements most frequently consisted of nursing, physical therapy, and occupational therapy staff. Most education programs were provided 2 weeks prior to surgery in a group format with the majority of programs being delivered in a single session, lasting between 1 and 1.5 hours. Verbal and written instruction were the most commonly utilized methods to deliver education. Individual patient programs included a variety of topics, ranging from the expectations while in the hospital, self-care, adaptive equipment, and home safety, being some of the most commonly included content. Conclusions: With this pilot study, we have provided a framework to describe the structure of preoperative total knee replacement education nationally, which can be used to guide a future large-scale survey to fully describe the content, providers, and delivery methods of preoperative education for this population across the United States, using a representative sample

Pre-Operative Education for Total Knee Replacement: A Pilot Survey

Purpose: The structure of preoperative education programs used nationally for patients prior to total knee replacement (TKR) surgery has not been identified previously, thus hospitals across the United States lack a common standard for this preoperative education to ensure best patient outcomes. The purpose of this pilot survey study was to describe the content, providers, and delivery methods currently utilized to deliver preoperative education for total knee replacement in the United States. Method: Data were collected using an online survey developed by the authors based on review of literature and 3 preoperative programs and was distributed through the Research Electronic Data Capture (REDCap). The survey consisted of 16 questions, including 12 closed-ended and 4 open-ended items. Participants were identified through convenience sampling using contacts of the first author and an Internet search of hospitals that provided preoperative education. Seven professional participants from nursing, physical therapy, and occupational therapy completed the survey. Descriptive statistics were used for data analysis of the 12 quantitative questions to determine frequency and percentages of responses. Responses on the 4 open- ended survey items as well as participant responses of “other” for question items were recorded and collated from individual survey responses. Results: Preoperative education provider teams for total knee replacements most frequently consisted of nursing, physical therapy, and occupational therapy staff. Most education programs were provided 2 weeks prior to surgery in a group format with the majority of programs being delivered in a single session, lasting between 1 and 1.5 hours. Verbal and written instruction were the most commonly utilized methods to deliver education. Individual patient programs included a variety of topics, ranging from the expectations while in the hospital, self-care, adaptive equipment, and home safety, being some of the most commonly included content. Conclusions: With this pilot study, we have provided a framework to describe the structure of preoperative total knee replacement education nationally, which can be used to guide a future large-scale survey to fully describe the content, providers, and delivery methods of preoperative education for this population across the United States, using a representative sample

Pre-operative Education for Total Knee Replacement: A Pilot Survey

Purpose: The structure of pre-operative education programs used nationally for patients prior to total knee replacement (TKR) surgery has not been identified previously, thus hospitals across the United States lack a common standard for this pre-operative education to ensure best patient outcomes. The purpose of this pilot survey study was to describe the content, providers, and delivery methods currently utilized to deliver pre-operative education for total knee replacement in the United States. Method: Data were collected using an online survey developed by the authors based on review of literature and three pre-operative programs, and was distributed through the Research Electronic Data Capture (REDCap). The survey consisted of 16 questions, including 12 closed-ended and four open-ended items. Participants were identified through convenience sampling using contacts of the first author and an internet search of hospitals that provide pre-operative education. Seven professional participants total from nursing, physical therapy, and occupational therapy completed the survey. Descriptive statistics were used for data analysis of the 12 quantitative questions to determine frequency and percentages of responses. Responses on the four open-ended survey items, as well as participant responses of “other” for question items, were recorded and collated from individual survey responses. Results: Pre-operative education provider teams for total knee replacements most frequently consisted of nursing, physical therapy, and occupational therapy staff. Most education programs were provided two weeks prior to surgery in a group format, with the majority of programs being delivered in a single session lasting between 1 and 1.5 hours. Verbal and written instruction were the most commonly utilized methods to deliver education. Individual patient programs included a variety of topics, ranging from what to expect while in the hospital, self-care, adaptive equipment, and home safety being some of the most commonly included content. Conclusions: This pilot study provides a framework to describe the structure of pre-operative total knee replacement education nationally, and can be used to guide a future large scale survey to fully describe the content, providers, and delivery methods of pre-operative education for this population across the United States using a representative sample

Comparative genomic analysis of the family Iridoviridae: re-annotating and defining the core set of iridovirus genes

BACKGROUND: Members of the family Iridoviridae can cause severe diseases resulting in significant economic and environmental losses. Very little is known about how iridoviruses cause disease in their host. In the present study, we describe the re-analysis of the Iridoviridae family of complex DNA viruses using a variety of comparative genomic tools to yield a greater consensus among the annotated sequences of its members. RESULTS: A series of genomic sequence comparisons were made among, and between the Ranavirus and Megalocytivirus genera in order to identify novel conserved ORFs. Of these two genera, the Megalocytivirus genomes required the greatest number of altered annotations. Prior to our re-analysis, the Megalocytivirus species orange-spotted grouper iridovirus and rock bream iridovirus shared 99% sequence identity, but only 82 out of 118 potential ORFs were annotated; in contrast, we predict that these species share an identical complement of genes. These annotation changes allowed the redefinition of the group of core genes shared by all iridoviruses. Seven new core genes were identified, bringing the total number to 26. CONCLUSION: Our re-analysis of genomes within the Iridoviridae family provides a unifying framework to understand the biology of these viruses. Further re-defining the core set of iridovirus genes will continue to lead us to a better understanding of the phylogenetic relationships between individual iridoviruses as well as giving us a much deeper understanding of iridovirus replication. In addition, this analysis will provide a better framework for characterizing and annotating currently unclassified iridoviruses

An Utterance Verification System for Word Naming Therapy in Aphasia

Anomia (word finding difficulties) is the hallmark of aphasia an acquired language disorder, most commonly caused by stroke. Assessment of speech performance using picture naming tasks is therefore a key method for identification of the disorder and monitoring patient’s response to treatment interventions. Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in ASR and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present an utterance verification system incorporating a deep learning element that classifies ‘correct’/‘incorrect’ naming attempts from aphasic stroke patients. When tested on 8 native British-English speaking aphasics the system’s performance accuracy ranged between 83.6% to 93.6%, with a 10 fold cross validation mean of 89.5%. This performance was not only significantly better than one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset

NUVA: A Naming Utterance Verifier for Aphasia Treatment

Anomia (word-finding difficulties) is the hallmark of aphasia, an acquired language disorder most commonly caused by stroke. Assessment of speech performance using picture naming tasks is a key method for both diagnosis and monitoring of responses to treatment interventions by people with aphasia (PWA). Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in automatic speech recognition (ASR) and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present NUVA, an utterance verification system incorporating a deep learning element that classifies 'correct' versus' incorrect' naming attempts from aphasic stroke patients. When tested on eight native British-English speaking PWA the system's performance accuracy ranged between 83.6% to 93.6%, with a 10-fold cross-validation mean of 89.5%. This performance was not only significantly better than a baseline created for this study using one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset

Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial

Background Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this ‘dosage’ problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy. Methods Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, ‘iTalkBetter’, which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of ‘trained’ and ‘untrained’ items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081). Findings iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA’s propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction. Interpretation Our findings suggested that iTalkBetter significantly improves PWAs’ naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT