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)

FACEBOOK

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

INSTAGRAM

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.