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TECHNOLOGY-SUPPORTED SOCIAL COMMUNICATION INTERVENTIONS FOR INDIVIDUALS WITH APHASIA AND RELATED DISORDERSIowa Conference on Communicative Disorders
April 19th – 20th 2018
Jerry K. Hoepner, Ph.D., CCC-SLP
University of Wisconsin – Eau Claire
DISCLOSURES
Non-financial disclosure for contributions to the AphasiaWeb app
Everyday technologies chapter in Müller, D., Hayre, C. & Scherer, M. Eds.
Self Management chapter in Damico, J. & Ball, M. Eds.
Affiliations:
ACKNOWLEDGEMENTSHeather Buhr & our computer science collaborators –Hannah Miller & Chris Johnson
Carissa Baier
Sarah Olson
Tom Sather & Mary Beth Clark
Lyn Turkstra
Lauren Sell & Heather Kooiman
LEARNER OUTCOMES
Attendees will identify factors that contribute to social
isolation among people with aphasia and their close partners
Attendees will identify barriers to accessing social networking applications
Attendees will identify supports and features that foster access of social networking applications
Attendees will identify potential benefits of using social networking applications to connect individuals with aphasia to each other, as well as friends and family
AGENDA8:00 – 8:45 am Overview of social isolation and social intervention approaches
15 min social isolation, 30 min social approaches
8:45 – 9:45 am Research on technology-supported interventions10-15 minute increments address self-management, blogs, Facebook, AphasiaWeb, Snapchat, Instagram/Cluster, video self-modeling
10:00 – 11:00 am Applications of technology-supported interventions
15 minute increments address peer to peer, client to family/friends, partner training, and self-management
11:00 – 12:00 pm Implementation of technology-supported interventions
15 minute increments address hands-on practice, pitfalls to avoid, supports to include, and individualized considerations
SOCIAL ISOLATIONIncreased risk (Cruice et al., 2006; Parr, 2007; Simmons-Mackie, 2000)
Fewer friends and smaller social networks (Code, 2003; Cruice et al., 2006; Davidson et al., 2008; Hilari & Northcott, 2006; Vickers, 2010)
Need for quality over quantity and desire to contribute (Dalemans et al., 2010)
SOCIAL INTERVENTION FRAMEWORKLife Participation Approach to Aphasia interventions (LPAA; Chapey et al., 2001)
Person-centered
Authentic, meaningful
Self-directed
Includes everyday partners
PLASTICITY: KLEIM & JONES, 2008LUDLOW ET AL., 2008
Use it or lose it
Use it and improve it
Specificity – ecologically valid, authentic, environment matters
Repetition matters – errorless repetition = adaptive plasticity
Intensity matters – how much? Recovery continuum
Time matters – when is optimum time? Recovery continuum
Salience matters – person-centered, motivation, goal setting
Age matters – while young is better, change remains possible
Transference matters – generalization depends on authentic intervention
Interference - one experience affects others (can be constructive or deconstructive)
Increase participation
Participation matters
COMPREHENSIVE PARTNER TRAINING INGREDIENTS
• Provide information about the nature of the disorder, recovery or progression path, and interactional strategies through direct instruction, videos, and accessible written materials.
Education regarding the symptoms and path of the
disease process.
• Guided review of their own interactions (VSM), transcribed interactions of their own interactions, video recordings of other couple’s dyadic interactions (VOM), role plays, and return demonstrations.
Increase partner awareness of supportive techniques and
attitudes.
• These techniques include modifying the physical environment by reducing complexity and implementing external memory aids, along with modifications to the psychosocial (partner) environment
Environmental modifications.
• This includes a variety of training components such as direct, hands-on practice, information dissemination, and guided review-reflection. Address trouble-shooting in-the-moment!
Multiple, ecologically valid environments for partner learning & carryover.
•Ensuring a means of response, validating comprehension, wait-time, acknowledging competence through linguistic & non-linguistic behaviors, sharing of self to foster balance, & avoiding quizzing or demanding a specific response
Supported Conversation Techniques.
HOEPNER, 2018; HOEPNER, 2016; HOEPNER & OLSON, 2018; HOEPNER, SELL, & KOOIMAN, 2015
INCREASE PARTNER AWARENESS & METACOGNITION
VSM
VOM
DOM
Review of dyad’s transcripts
Role Plays
Return Demonstrations
HOEPNER & OLSON, 2018; HOEPNER, 2018; HOEPNER, 2016; HOEPNER, SELL, & LINDERT, 2015; SMALL & PERRY, 2012; WILKINSON ET AL., 2010; ROQUE ET AL., 2008; LOCK ET AL., 2010; ORANGE & COLTON-HUDSON, 1998
SELF-MANAGEMENT
HOEPNER & OLSON, 2018
Lots of potential ways to use “everyday” technologies to support participation and recovery
Figure 4. Quick reference for self-management in CSD
Assisted promptingpting
IMPLICATIONS & DIRECTIONS
TAP not commercially available
Limitations if not in home all day
Svoboda & Richards, 2009 examined
prompts through cell phones and other
portable devices
Programmable reminder apps already
exist (push technologies)
LEMONCELLO, SOHLBERG, FICKAS, & PRIDEAUX, 2011; LEMONCELLO, SOHLBERG, FICKAS, ALBIN, & HARN, 2011; SOHLBERG, LEMONCELLO, & LEE, 2011; WILSON, EMSLIE, QUIRK, & EVANS, 2001
ELEMENTS…1) Prompts for completion
of exercises
2) Reminders of benefits & goals
3) Provides clear instruction (reduces anxiety)
4) Video demonstrations (highly valued by client/family)
5) Exercise prompt & prepare environment
6) Reflect & feedback on completion
Example 1
We use the Nudge reminder app and ScreencastOmatic.com (www.screencast-o-matic.com).
FACETIMEWhat is the potential for connecting people with aphasia via Facetime?
HINTGEN, HOEPNER, & ALLEN, UNPUBLISHED
FACETIME2 people with aphasia
Used coaches to support persons with aphasia in their respective homes
Partners trained in SCA
Coaches cued persons with aphasia to use multimodal supports to communicate
Both were partner dependent
APHASIA BLOGSThese narratives generated by individuals with aphasia reveal a desire to discuss living with aphasia and other post-stroke challenges with peers
Relationships with friends and family were frequent points of discussion in this blog
Feeling connected to a wider support community was also identified as being important to individuals with aphasia
(Fotiadou, Northcott, Chatzidaki, & Hilari, 2014)
APHASIA-FRIENDLY ACCESS
BAIER, HOEPNER, & SATHER, 2017
AphasiaWeb
BUHR, HOEPNER, MILLER, & JOHNSON, 2017; HOEPNER & BUHR, 2016; MILLER, BUHR, JOHNSON, & HOEPNER, 2013
AphasiaWeb INTERFACE
BUHR, HOEPNER, MILLER, & JOHNSON, 2017; HOEPNER & BUHR, 2016; MILLER, BUHR, JOHNSON, & HOEPNER, 2013
AphasiaWeb TAKEWAYS
People with aphasia desire a forum to connect with other people with aphasia
Shared posts can foster a call to action
Posts identify social affiliation
Posts share mundane, everyday activities
They also value aphasia-friendly modifications to support access
Further, they want tools to allow communication with others without aphasia – they indicated a preference to use ubiquitous applications to connect with friends and family
BUHR, HOEPNER, MILLER, & JOHNSON, 2017; HOEPNER & BUHR, 2016; MILLER, BUHR, JOHNSON, & HOEPNER, 2013
DYNAMIC CAPTUREUses technology as a multi-modality communication & memory tool
Flexible and universal
Capture objects, people, actions, text, figures, photos
Photos and videos
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017; MCKELVEY ET AL, 2007; HUX ET AL. 2010; BEUKELMAN ET AL, 2005; DIETZ ET AL., 2009; FRIED-OKEN ET AL., 2012
aaaa aSNAPCHAT
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
SNAPCHAT
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
SNAPCHAT
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017 BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
SNAPCHAT
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
SNAPCHAT
BAIER, HOEPNER, & SATHER, 2018; HOEPNER, BAIER, SATHER, & CLARK, 2017
Take Aways:
People with aphasia desire to share their activity and identity
They are able to share images, text, drawings, and videos
Changes to app get in the way, as does restrictions on use
The 24 hour story was problematic – now less of an issue
WiFi access can be an issue – likely not a problem if on phone
SNAPCHAT
Create learning models on the spot!Students add their own learning snaps!
Creations can be posted to other class i
CLUSTER(HOMEROOM)
Students capture their own learning!
Instruct. Interns share best student examples
Students share their examples
CLUSTER(HOMEROOM)
Faculty capture and explain white board drawings
Students use Snapchat to draw, write, or add text to captured images!
Students capture in-class activities
Peers follow and like
INTERACTIONAL/CONVERSATIONAL ASSESSMENTS
Elicits perceptions of interactional behaviors by client and partner
Can be used retrospectively (traditional) or directly (video review)
Can highlight consensus and discrepancies
Can provide insight into partner knowledge & attitudes
HOEPNER & TURKSTRA, 2013; HOEPNER, 2010; TURNER & WHITWORTH, 2006; KAGAN ET AL., 2001; OLSWANG ET AL., 1998
KAGAN SCALES (MPC & MSC)Measure of participation in conversation (MPC) examines client contributions
Interaction – engagementTransaction – productivity
Measure of skill in supported conversation (MSC) examines partner support
Acknowledging competenceRevealing competence
Has been modified for use with TBI (Togher, 2010)
KAGAN, WINCKEL, BLACK, FELSON-DUCHAN, SIMMONS-MACKIE, & SQUARE, 2004
METACOGNITIVE STRATEGY INSTRUCTION
Uses direct instruction to train persons with TBI to
regulate their own behavior by breaking up complex tasks into steps, thinking strategically.
People with TBI must
set goals
predict performance
identify best solutions based on past performance
self-assess during the activity
change approach using a strategy
self-assess at the end of the activity – essentially OGPDRBURKE ET AL., 1991; CICERONE & GIACINO, 1992; CICERONE & WOOD, 1987; FASOTTI ET AL., 2000; LEVINE ET AL., 2000; TURKSTRA & FLORA, 2002; SOHLBERG, EHLARDT, & KENNEDY, 2005; VON CRAMON ET AL., 1991
mplex
TIME PRESSURE MANAGEMENT
First address awareness and acceptance of their injuries
Use a step-by-step approach to stay focused and avoid distracting thoughts
Rehearse this process with gradually increased levels of distraction
FASSOTI ET AL., 2000
PROBLEMS & POTENTIAL SOLUTIONS
Retrospection ≠ accurate
• Neither people with TBI nor their partners are good at making retrospective judgments (Hoepner & Turkstra, 2013)
Memory + emotional
bias ↓accuracy
• Everyone has difficulties making retrospective judgments (Fiske, 1980; Matt, Vazqez, & Campbell, 1992)
Direct review ↑ accuracy
• Strong consensus when people with TBI and their partners make direct judgments viewing videos (Hoepner & Turkstra, 2013)
Joint is better for
both• There is It’s effective to train interactional behaviors jointly (Togher et al., 2013)
INTERPERSONAL PROCESS RECALL
Authentic interpersonal interactions and footage is reviewed immediately afterwards, fostering identification of insights related directly to the interaction dynamics
IPR technique improved situational anxiety, overall self-concept, interpersonal communication skills, and specific behavior associated with effective interpersonal communication (Youse & Coelho, 2009)
VIDEO-SELF MODELING:THE GOOD OLE DAYS…
Act natural…
SEVERAL DECADES LATER…
HOEPNER & OLSON, 2018; HOEPNER, 2016; HOEPNER, SELL, & KOOIMAN, 2015; HOEPNER & TURKSTRA, 2013
TASKS CAN RANGE FROM PHYSICAL TO CONVERSATION
EVOLUTION OF VIDEO SELF-MODELING
Learning from every moment
Positive feedback from clinician
Self-feedback by client can be positive or constructive
Audio Self-
Modeling
Audio Other-Modeling
Video Other-
Modeling
Video Self-
Modeling
Direct Other-
ModelingEmulation
HOEPNER & OLSON, 2018; HOEPNER, 2016; HOEPNER, SELL, & KOOIMAN, 2015; YLVISAKER, 1998
BROAD TO NARROW; LEAST TO MOST CONSTRAINING
What did you think?
Let’s look at this shorter clip. What do
you think?
What would you say about this
specific thing?
Did you see problem X?
Notice how you go from little or no scaffolding to maximum scaffolding.
Recognize that in each case, the clinician merely prompts the assessment –doesn’t make a judgment themselves
METHODS (VSM – THE INTERVENTION…)
Videos were
generated at home
Coach controlled playback and prompted self-
assessments
Inverted hierarchy
for prompts
Metacognitive discussion
and validation
What did you think about that interaction?
So, with regards to your interactional goals, let’s look at this shorter clip of
video.
You identified reducing
interruptions as an
interactional goal. In this clip, what
would you say about your ability to
avoid interruptions?
In this brief
segment, did you
notice any interruptio
ns?
TO ELICIT JUDGMENTS: USE OARS
Open-ended questions
Affirmation
Reflection
Summary
What did you think about that interaction?
So, with regards to your interactional goals, let’s look at this shorter clip of
video.
You identified reducing
interruptions as an
interactional goal. In this clip, what
would you say about your ability to
avoid interruptions?
In this brief
segment, did you
notice any interruptio
ns?
Metacognitive discussion and validation
EXAMPLE VIDEO
Focus on goal/target before attempt
Review, starting broadly
PEP TALKS
https://youtu.be/tePwOSv9txghttps://youtu.be/JahINt8VooY
https://youtu.be/zXRtUvZ2mwg
CAPO & HOEPNER, IN PROCESS
PEP TALKS
Double dipping ☺ - clients benefit from the process and viewers benefit from the product
Triple dip – students benefit from the process
TAKE AWAYS!
Everyday technologies can be used as tools to support participation and recovery
Technologies are not a panacea and cannot replace training, partner support, or other therapy
Clients desire tools that are ubiquitous, universally accessible, and “aphasia/communication” friendly
Clients desire meaningful participation and would sacrifice quantity for quality
QUESTIONS?REFERENCES
Hoepner, J.K. (in preparation - 2019). Everyday technologies for communication and cognition. In Müller, D., Hayre, C. & Scherer, M. (Eds.), Everyday Technologies in Healthcare. CRC Press - Taylor & Francis Group.
Hoepner, J.K. & Olson, S.E. (2018). Self Management. In Damico, J. & Ball, M. (Eds.), The SAGE Encyclopedia of Communication
Sciences and Disorders. Thousand Oaks, CA: SAGE Publications Inc.
Hoepner, J.K., & Olson, S.E. (2018). Joint video self-modeling as a conversational intervention for an individual with
traumatic brain injury and his everyday partner: A pilot investigation. Clinical Archives of Communication Disorders
Baier, C.K., Hoepner, J.K., & Sather, T.W. (2017). Exploring Snapchat as a Dynamic Capture tool for social exchange among individuals with aphasia. Aphasiology. doi.org/10.1080/02687038.2017.1409870
Hoepner, J.K., Baier, C.K., Sather, T.W., & Clark, M.B. (2017). A pilot exploration of Snapchat as an aphasia-friendly social
exchange technology at an aphasia camp. Clinical Archives of Communication Disorders. 1(1). 1-13.
doi.org/10.21849/cacd.2016.00087
Buhr, H.R., Hoepner, J.K., Miller, H., & Johnson, C. (2017). Aphasia Web: Development and evaluation of an aphasia-friendly social networking application. Aphasiology. 31(9). 999-1020. doi: 10.1080/02687038.2016.1232361
Hoepner, J.K. (2016). Partners as environment: Coaching partners. In Johnson, P. (Eds.), A Clinician’s Guide to Successful
Evaluation and Treatment of Dementia, Gaylord, MI: Northern Speech Services Publishing.
Hoepner, J.K., Sell, L., & Kooiman, H. (2015). Case study of partner training in corticobasal degeneration. Journal of
Interactional Research in Communication Disorders. 6(2). 157-186. doi: 10.1558/jircd.v6i2.27178
Miller, H., Buhr, H., Johnson, C., & Hoepner, J.K. (2013). Aphasia Web: a social network for individuals with aphasia. Proceedings of the 15th International ACM SIGACCESS Conference on Computers and Accessibility; 4. doi:
10.1145/2513383.2513439
Hoepner, J.K., & Turkstra, L.S. (2013). Video-Based Administration of the La Trobe Communication Questionnaire for Adults
with Traumatic Brain Injury and Their Communication Partners. Brain Injury, April 27(4), 464-472.