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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
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