2014/04/09

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Session Code: RSCH_19

Telepractice Post-Stroke: Present (500 camera hours)

and Future

Allison Baird

speechworks@shaw.ca

Andrew Gomory

agomory@lingraphica.com

February1, 9:20 Handouts are available at: www.atia.org/orlandohandouts

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Disclosure

Allison Baird is in private practice called Speechworks,

specializing in complex communication disorders and

telespeech. She is a paid consultant to Lingraphica.

Andrew Gomory is the CEO of Lingraphica.

People pictured in this presentation provided consent for

photographs.

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Problem

PWA need: A lifetime of continuous, affordable rehabilitation. PWA get: A small number of expensive therapy sessions.

2014/04/09

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Why?

Cost Access Low Incidence Convention Awareness

A Possible Solution

Telemedicine

Online Data & Analytics

Telemedicine

Cost - yes Access - yes Low Incidence - yes Convention - no Awareness – no Efficacy Equality

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Data & Analytics

Accountability Decision-making Free the SLP to interact with the patient Improvement through refinement

Kcumming 2007

SpeechWorks Inc.

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Thompson

Great Britain Manitoba Northern

Regional Health Authority

Population 60 million 1 million 72,000

Area 89,000 sq. miles 251,000 sq. miles 153,000 sq. miles

Population & Area

Stroke survivors living in remote communities are subject to feelings of isolation, dissatisfaction with care, and reduced quality of life. These feelings will compromise rehabilitation efforts and adjustment to stroke-related impairments and disabilities. Providing services via telehealth is one way to neutralize the impact of distance from expertise.

Rationale

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Nerves!

Benefits • Decrease travel • Continuity of care • Ease of use • Regional access • Low cost • Quick start up • For people with

communication disorders reduce impairment levels and for people with swallowing disorders reduce risk of aspiration pneumonia

Risks • Training required • Comfort level • Admin support • Coordinating with

client’s local support and Telehealth site

Risk / Benefit

• To provide speech, language, swallowing services to people post stroke.

• To provide services close to home. • To improve knowledge and coordination of

care. • To implement innovative treatment

protocols. • To document best practise policy and

procedure.

Program Objectives

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To provide speech-language and swallowing services to people post stroke.

Program Objectives

To provide services close to home.

Program Objectives

Telehealth Services Delivered to Northern Regional Health Authority

Program Objectives

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To improve knowledge and coordination of care.

Program Objectives

To implement innovative treatment protocols.

Program Objectives

To document best practice, policy and procedure.

Program Objectives

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• 400 hours of virtual care • 34 participants • 16 Northern Communities

• 66% aboriginal • 69% men

And we had some real life outcomes...

20% of a FTE

Back to Work – Four Years Post Stroke

Outcome

31%

25%

44%

Rehabilitation Stage of Stroke Patients Admitted to the Project

Acute Stroke (0-3 mo) Rehab Stroke (3-12 mo)

Chronic Stroke (>12mo)

Outcome

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Diagnosis Number

Aphasia 17

Dysarthria 9

Cognitive Linguistic Disorder 7

Swallowing Disorder 12

Outcome

0

2

4

6

8

10

12

14

Initial Assessments Deaths Quit the Program Re-stroked Unable to test on

camera

Patient Outcomes Associated with Non-Fluent Aphasia

Outcome

Patient #1 Patient #2 Patient #3 Patient#4

Pre-Therapy 88 12.8 0 84.7

Post-Therapy 95.9 27.2 8.2 90.5

0

20

40

60

80

100

120

Wes

tern

Ap

has

ia B

atte

ry S

core

Western Aphasia Battery Scores Pre- and Post-Therapy

Impairment Levels

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27%

27%

46%

Changes in Dysarthria Pre- and Post-Therapy

Resolved Without DirectIntervention

No Therapy, No Change

Intelligibility Increased25%-60%

Outcome

Right CVA 57%

Bilateral

43%

Impairment

Achieving positive treatment outcomes (Cognitive Linguistic Quick Test)

Before After

Outcome

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Completed

Assessments

PeopleSeen after

FailingTORBSST

Diet

Upgrades

Repeat

Assessments

Refusal tohave on

cameraassessment

Referral forvideo

fluroscopicstudy

PEG Tubes

required

PEG Tubes

Removed

Cases of

AspirationPneumonia

Series1 12 4 8 3 1 2 2 1 0

0

2

4

6

8

10

12

14

Nu

mb

er o

f P

atie

nts

Swallowing Assessment Outcomes

Outcome

0

1

2

3

4

5

6

7

8

Nu

mb

er o

f R

efer

rals

Mad

e

Referrals Made During the Course of the Project

Outcome

Client Resources

Increased access to care • All sites more than five hours from Winnipeg • 5 remote sites: winter roads for part of the year or by air/sled/snowmobile Client Travel Reduced • Over 411,000 km of travelling saved and that was to the shortest distance site Time saved • 160 hours of travel time

Cost Savings • Over $266,000 saved in out of client expenses

Savings

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Challenge What Happened

Using standardized tests Adobe Telemark-not! Buy several tests.

Teaching technology remotely Did therapy differently and learned the meaning of constraint induced therapy.

In 2011, finding applications for adults

Used Native Apps. Now there are some very good apps.

Communicating with people with attention and processing difficulties

Typed while talking. Learned to smile a lot.

Responding to client needs Stroke Checklist

Chronic impairments Group Telehealth

Neglect Resolves spontaneously

Dissatisfied Clients (only 2) Quit

Challenges

“It difficult to soar like an eagle when you’re surrounded by turkeys.”

Russell Illig

Melystu Flickr

“We can all fly as high as the dreams we dare to dream… unless we are a chicken.”

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WAB, Boston, SAC, NOMS,

Aphasia Bank

Group

Online Homework

1-on-1

SCALE Study

Online Tools

Online Tools