RecoverNow: Feasibility of a Mobile Tablet-Based Rehabilitation Intervention to Treat Post-Stroke Communication Deficits in the Acute Care Setting

Grant Stotts,Karen H. Mallet,Rany M. Shamloul,Simon Hatcher,Richard H. Swartz,Dar Dowlatshahi,Michel C. F. Shamy,Franco Momoli,Jim Lumsden,Christine Yang,Dale Corbett,Hillel M. Finestone,Terence J. Quinn

doi:10.1371/journal.pone.0167950

Abstract

BackgroundApproximately 40% of patients diagnosed with stroke experience some degree of aphasia. With limited health care resources, patients’ access to speech and language therapies is often delayed. We propose using mobile-platform technology to initiate early speech-language therapy in the acute care setting. For this pilot, our objective was to assess the feasibility of a tablet-based speech-language therapy for patients with communication deficits following acute stroke.MethodsWe enrolled consecutive patients admitted with a stroke and communication deficits with NIHSS score ≥1 on the best language and/or dysarthria parameters. We excluded patients with severe comprehension deficits where communication was not possible. Following baseline assessment by a speech-language pathologist (SLP), patients were provided with a mobile tablet programmed with individualized therapy applications based on the assessment, and instructed to use it for at least one hour per day. Our objective was to establish feasibility by measuring recruitment rate, adherence rate, retention rate, protocol deviations and acceptability.ResultsOver 6 months, 143 patients were admitted with a new diagnosis of stroke: 73 had communication deficits, 44 met inclusion criteria, and 30 were enrolled into RecoverNow (median age 62, 26.6% female) for a recruitment rate of 68% of eligible participants. Participants received mobile tablets at a mean 6.8 days from admission [SEM 1.6], and used them for a mean 149.8 minutes/day [SEM 19.1]. In-hospital retention rate was 97%, and 96% of patients scored the mobile tablet-based communication therapy as at least moderately convenient 3/5 or better with 5/5 being most “convenient”.ConclusionsIndividualized speech-language therapy delivered by mobile tablet technology is feasible in acute care.

Highlights

IntroductionIn Canada, access to speech and language therapy is often delayed due to unavailability of timely rehabilitation services: in 2014, only 16% of Canadians with stroke were able to access in-patient rehabilitation, and of those, only 50% accessed rehabilitation centers within two weeks of their stroke [9]
40% of patients diagnosed with a stroke will have aphasia [1]; intensive speech and language therapy is recommended in order to maximize the chances of recovery [2,3]
Patients were enrolled based on a waiver of consent process based on the speech-language therapy intervention fitting within the College of Audiologists and Speech-Language Pathologists of Ontario clinical standard-of-care [22], and consistent with the Tri-counsel Policy Statement 2 for Ethical Conduct for Research Involving Humans

Summary

Introduction

In Canada, access to speech and language therapy is often delayed due to unavailability of timely rehabilitation services: in 2014, only 16% of Canadians with stroke were able to access in-patient rehabilitation, and of those, only 50% accessed rehabilitation centers within two weeks of their stroke [9]. During these first two weeks of acute care, patients spend over 60% of their time inactive and alone [10]. We propose using mobile-platform technology to initiate early speech-language therapy in the acute care setting. Our objective was to assess the feasibility of a tablet-based speech-language therapy for patients with communication deficits following acute stroke

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Results

Conclusion