ASSBI 2020 Conference Bite Size!

Abstracts for

June 26th – Digital technologies in neuro assessment and rehabilitation – 90 mins

Elizabeth Beadle

Understanding the role of telehealth and implementation in to a community brain injury service
Beadle, Elizabeth1; Lucas, Karen1; Dawber, Jessica1; Page, Matthew2; Watter, Kerrin1,3; Murray, Alena1; Geraghty, Tim1,3 and Kennedy, Areti1,3
1
Metro South Health, Queensland Health, Australia
2
Clinical Excellence Queensland, Queensland Health, Australia
3
The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

Background and Objectives: Telehealth involves the use of telecommunication techniques to deliver health services over long distances e.g., video-conferencing. Telehealth has been shown to be a cost-effective, efficient means of delivering health services. However, there is currently a limited evidence base to support telehealth use within acquired brain injury rehabilitation. The objectives of the current project were to understand the role telehealth might play within a community-based interdisciplinary brain injury service and to integrate this service as required.

Method: A telehealth specific knowledge translation (Theodoros et al., 2016) approach was used to identify specific service requirements and staff and client training needs. The initial knowledge gathering phase (Phase 1) included reviewing literature, client considerations, equipment needs, and benchmarking. Clinician barriers/facilitators were also examined. The innovation phase (Phase 2) involved development of a local training package and development of service specific processes. The implementation and evaluation phase (Phase 3) involved the provision of training packages and embedding processes in to usual practice alongside various quantitative and qualitative measures of success (e.g., occasions of service, staff travel time saved, staff confidence).

Results: Staff feedback from focus groups identified common barriers, including: staff perceptions and confidence, client access, and practical support requirements for clients and clinicians. A 3-month snapshot of client resources revealed reasonable access to personal smartphones (88%) however reduced access to internet in home (69%). A local training package was developed and delivered to address clinician needs. Service processes developed included: an e-helper package to up-skill clients, suitability criteria, instructions, checklists, scripts, and troubleshooting documentation. Telehealth occasions of service increased, and clinician travel time significantly reduced. Clinician knowledge of telehealth significantly improved, along with confidence in usage.

Conclusions: Overall, telehealth was integrated into a community brain injury service, allowing greater access to rehabilitation. Ongoing staff and consumer feedback is essential to continue developing and maintaining the service.

Correspondence: Elizabeth Beadle; elizabeth.beadle@uqconnect.edu.au

Tamara Ownsworth

Use of a telehealth platform to provide psychological support to people with glioma: The Tele-MAST pilot study

Ownsworth, Tamara1,2; Cubis, Lee1,2; Foote, Matthew 3,4; Kendall, Melissa5; Oram, Joanne6; Lucas, Karen6; Prasad, Tali1,2 and Pinkham, Mark3,4
1
School of Applied Psychology, Griffith University, Mount Gravatt, Australia
2Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
3School of Medicine, University of Queensland, Brisbane, Australia
4Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Australia
5Acquired Brain Injury Outreach Service, The Hopkins Centre, Princess Alexandra Hospital, Brisbane, QLD, Australia
6Metro South Health, Brisbane, QLD, Australia

Background and objectives: Glioma is a life-limiting disease that can bring neurocognitive and psychosocial impairments. However, accessible psychological support addressing the unique needs of people with glioma is lacking. This study investigated feasibility, acceptability and preliminary efficacy of a telehealth (video-conferencing) format of the Making Sense of Brain Tumour (tele-MAST) intervention.
Method: Adults with glioma were recruited over 14-months from a hospital-based multidisciplinary brain tumour clinic. Participants were randomly allocated to the 10-session tele-MAST program or standard care (telephone follow-up), with the latter group offered tele-MAST after re-assessment. Mental health and quality of life measures were administered at pre-intervention and post-intervention. Semi-structured interviews explored participants’ experiences of receiving psychological support via the video-conferencing platform.
Results: Following 46 referrals, 14 adults with glioma (71% high-grade; aged 23-70 years) were eligible and consented to participate. Group-level analysis identified a significant reduction in depression and anxiety and improvement in quality of life between pre- and post-intervention for the tele-MAST group (n = 8); however, there were no significant changes for the standard care group (n = 6). Most participants (63%) demonstrated clinically reliable improvement after the tele-MAST intervention. Qualitative analysis revealed a core theme of valuing the tele-MAST program due to the ease of access, tailored support and sense of connection, despite some technological barriers.
Conclusions: Overall, delivery of the MAST program via video-conferencing was feasible and acceptable to people with glioma. These preliminary outcomes support the value of a larger-scale trial on the clinical efficacy of the telehealth MAST program.
Correspondence: Tamara Ownsworth; t.ownsworth@griffith.edu.au

Michelle Kelly

Telehealth-based assessment of cognition, social cognition, mood and functional independence in older adults
Kelly, Michelle1; Mierendorff, Simon1 and Wales, Kylie2

1
School of Psychology, University of Newcastle, Newcastle, Australia
2
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia

Background and Objectives: Telehealth technologies can provide important healthcare services for people in rural and remote areas. In older adults, cognition, social cognition, mood, and functional independence are key predictors of dementia, however, few assessment tools are validated for telehealth administration. Further, the question of whether older adults would accept this form of assessment undertaken remotely is unclear.
Method: 
This study examined the agreement between face-to-face and telehealth administration of five assessments: cognition (Addenbrooke’s Cognitive Examination-III; ACE-III), social cognition (Brief Assessment Social Skills-Dementia; BASS-D), mood (Hospital Anxiety and Depression Scale; HADS), and instrumental/activities of daily living (Assessment of Living Skills and Resources-revised; ALSAR-R2 and Modified Barthel Index; MBI)). We also examined the feasibility and acceptability of this mode of assessment. Thirty-nine healthy participants (18 male) over 50 years of age (M = 71.9, SD = 11.7) were randomized to face-to-face-first or telehealth-first test modality, followed by the alternate mode within five weeks. Telehealth administrations occurred via Skype and minor variations were made to the ACE-III and the BASS-D to allow for this remote form of assessment.
Results: 
Eligible participants completed all assessment items, and telehealth was well tolerated. There were no significant differences found for acceptability based on aged, gender, years of education, mood, vision or hearing impairments. High mean intra-class correlations (ICC = .913 to ICC = .995) were found for each assessment across formats. Relationships in performance between tools administered was consistent independent of mode of delivery.
Conclusions
Overall, this research provides preliminary evidence for the feasibility, acceptability and reliability of conducting a brief battery of assessment tools for older adults via telehealth. Further research should explore telehealth-based assessment with people diagnosed with mild cognitive impairment and dementia and their support person.

Correspondence: Michelle Kelly; Michelle.Kelly@newcastle.edu.au

Megan Topping

Training Sector Professionals to Support People with Disability to Develop Participant Led Videos: An Independent Evaluation
Topping, Megan1,2; Douglas, Jacinta1,2 and Winkler, Di1,2

1
Summer Foundation Ltd, Melbourne, Victoria, Australia
2
Living with Disability Research Centre, La Trobe University, Melbourne, Australia

Background and Objectives: Participant Led Videos (PLV) are an effective, innovative tool that give people with disability and complex needs the opportunity to direct and train their support workers based on their self described meaningful goals. PLV were codesigned, piloted and evaluated by La Trobe University and Summer Foundation with 5 National Disability Insurance Scheme (NDIS) participants in 2018. To extend the roll out of PLV, Summer Foundation conducted a training workshop with health and disability sector professionals in Australian Capital Territory to facilitate the development of PLV. This study independently evaluates the training workshop and subsequent PLV development from the perspective of trained sector professionals, people with disability and close others.

Method: A mixed-method research design utilizing quantitative and qualitative paradigms was used. Fifteen sector professionals completed a post-workshop online survey. Eight sector professionals participated in 1-month post-workshop telephone interviews and 5 sector professionals participated in 1-month post-PLV production telephone interviews. Additionally, 3 participants with disability and 3 close others were interviewed face-to-face. In total, 34 interview transcripts and survey data were thematically analysed.

Results: Sector professionals highly endorsed the usefulness of the PLV training workshop, and reported high levels of satisfaction and enjoyment, as well as confidence to support a participant to produce PLV. This was supported by a two-fold increase in excellent understanding ratings following the workshop. Interviews with sector professionals, people with disability and close others reinforced the findings from the pilot work that PLV provide a voice to people with disability to direct their own supports. PLV act as a mechanism to get to know the participant. Sector professionals, people with disability and close others recommended the PLV production process for others with an average rating exceeding 9 on a 10-point scale.

Conclusions: This evaluation demonstrates that production of PLV is not dependent on the innovative expertise at Summer Foundation. Following training, sector professionals successfully supported people with disability to produce videos. The findings support the use of PLV to improve the delivery of support and maximise outcomes by enabling people with disability to have choice and control, set their own goals and direct their supports.

Correspondence: Megan Topping; megan.topping@summerfoundation.org.au

Liss Brunner

How can we help people with traumatic brain injury to use social media during rehabilitation and beyond?
Brunner, Melissa1; Hemsley, Bronwyn2; Togher, Leanne1.2; Dann, Stephen3 and Palmer, Stuart4

1
University of Technology Sydney, Sydney, NSW, Australia
2
University of Newcastle, Newcastle, NSW, Australia
3
University of Sydney, Sydney, NSW, Australia
4
Australian National University, Canberra, ACT, Australia
5
University of Melbourne, Melbourne, VIC, Australia

Background and Objectives: Social media can support people with communication disability to access information, social participation, support, and their consumer rights. However, little is yet known about the use of social media by people who have a traumatic brain injury (TBI) during rehabilitation. The aim of this research was to investigate the experiences of people with TBI and rehabilitation professionals in relation to the use of social media by people with TBI.

Method: A mixed methods research design involved analysis and meta-synthesis of data collected from five sources: (a) evidence in the literature on use of social media and technology for communication and participation after TBI; (b) Twitter data and network analysis; (c) interviews with people with TBI; (d) focus groups with TBI rehabilitation professionals; and (e) national eSafety and social media safety research and guidance.

Results: In total, data from 13 people with TBI (7 males, 6 females), 11 rehabilitation professionals (4 males, 7 females), over 35,000 tweets, and 100 peer-reviewed articles were collected and analyzed. Results indicate that people with TBI use social media for connection through a process of trial-and-error in developing their skills, needing support and meaningful use to develop a sense of social media mastery. TBI rehabilitation professionals aspire to assist people with TBI to use social media for connection with their community. However, their concern regarding potential risks meant social media use was not proactively included as part of TBI rehabilitation.

Conclusions: Social media offers some adults with TBI opportunities to communicate and develop and strengthen social relationships. Considering their cognitive-communication disability and the risks associated with social media use, people with TBI are likely to require active integration of social media use into their rehabilitation. Further research is needed to examine the social media data and networks of people with TBI, to inform roles that family, friends, and clinicians may play in supporting rehabilitation goals for people with TBI. The clinical implications from this research will be presented, including a proposed social media rehabilitation protocol, showcasing how using mainstream social media platforms during rehabilitation could be woven into existing cognitive-communication programs addressing social communication and participation skills for people after their TBI.

Correspondence: Melissa Brunner; melissa.brunner@uts.edu.au

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