Abstract
Asynchronous telerehabilitation in which computer-based interventions are remotely monitored and adapted offline is an emerging service delivery model in the rehabilitation of communication disorders. The asynchronous nature of this model may hold a benefit over its synchronous counterpart by eliminating scheduling issues and thus improving efficiency in a healthcare landscape of constrained resource allocation. The design of asynchronous telerehabilitation platforms should therefore ensure efficiency and flexibility. The authors have been engaged in a program of research to develop and evaluate an asynchronous telerehabilitation platform for use in speech-language pathology. eSALT is a novel asynchronous telerehabilitation platform in which clinicians design and individualize therapy tasks for transfer to a client's mobile device. An inbuilt telerehabilitation module allows for remote monitoring and updating of tasks. This paper introduces eSALT and reports outcomes from an usability study that considered the needs of two end-user groups, people with aphasia and clinicians, in the on-going refinement of eSALT. In the study participants with aphasia were paired with clinicians who used eSALT to design and customize therapy tasks. After training on the mobile device the participants engaged in therapy at home for a period of 3 weeks, while clinicians remotely monitored and updated tasks. Following the home trial, participants, and clinicians engaged in semi-structured interviews and completed surveys on the usability of eSALT and their satisfaction with the platform. Content analysis of data involving five participants and three clinicians revealed a number of usability themes including ease of use, user support, satisfaction, limitations, and potential improvements. These findings were translated into a number of refinements of the eSALT platform including the development of a client interface for use on the Apple iPad®, greater variety in feedback options to both the participant and clinician, automatic transfer of results to the clinician, and expansion of the task template list. This research highlights the importance of including end-users in the process of technology refinement, in order to ensure effective and efficient use of the technology. Future directions for research are discussed including clinical trials in which the effectiveness of and adherence to intervention protocols using asynchronous telerehabilitation are examined.
Highlights
Aphasia is an acquired communication disorder that impedes to varying degrees an individual’s comprehension and expression of language, be it through their ability to read, understand spoken language, write, speak, and/or gesture (Code, 2010)
Full customization of aphasia rehabilitation protocols that are delivered in-person are improbable in a healthcare landscape of increasingly restricted resource allocation combined with growing demand
In keeping with the end-user design process, this paper explores the development of a novel asynchronous telerehabilitation platform, called eSALT and reports data from a usability study with two end-user groups and discusses how this data was used to further refine eSALT
Summary
Aphasia is an acquired communication disorder that impedes to varying degrees an individual’s comprehension and expression of language, be it through their ability to read, understand spoken language, write, speak, and/or gesture (Code, 2010). Aphasia becomes a chronic communication disorder for a significant proportion of people who experience stroke. Research has demonstrated that people with aphasia can continue to improve their language skills many years post-stroke when they have access to efficacious treatment regimens (Brady et al, 2012). Full customization of aphasia rehabilitation protocols that are delivered in-person are improbable in a healthcare landscape of increasingly restricted resource allocation combined with growing demand. Even when such tailored rehabilitation services are available, access by individuals with aphasia may be restricted due to decreased mobility and/or geographical isolation. A number of technology-based solutions, such as computerbased aphasia therapy (CBAT) and telerehabilitation, have been implemented in aphasia rehabilitation to overcome these issues of access, intensity, and limited resources
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