A within-subjects experimental evaluation of the Television Assisted Prompting (TAP) system to maximize completion of home-delivered swallow strengthening exercises among individuals with co-occurring acquired swallowing and cognitive impairments
Lemoncello, Richard R.
Each year, over 65,000 brain injury survivors are discharged home from hospitals with ongoing rehabilitation needs due to acquired impairments, such as dysphagia. Emerging empirical evidence supports the benefits of intensive swallowing exercise programs when dysphagia results from muscle weakness. However, many of these survivors cannot complete intensive home exercise programs due to co-occurring cognitive impairments in memory or initiation. This project investigated the potential benefits of a new experimental assistive technology device, the Television Assisted Prompting (TAP) system to increase completion of home swallowing exercises. The TAP system was designed as a treatment package to provide both automated prompts and multimedia motivational instructional exercise videos via a person's home television. Three participants were recruited, all of whom had survived a hemispheric stroke and presented with neurogenic dysphagia and co-occurring cognitive impairments. Two home program delivery conditions were alternately presented on randomized days in a single-case experimental alternating treatment design: TAP delivery (e.g., TV prompting with motivational videos) or typical practice (TYP) delivery (e.g., care provider prompting as needed to follow assigned written home programs). The same exercises were presented in each condition. Measures included feasibility (e.g., reliability of the TAP system), efficacy (e.g., number of exercises completed per session), and satisfaction. Results revealed that two of three participants showed dramatic benefits from the TAP system. Participant 1 was 17 times more likely to complete exercises when prompted by the TAP system; participant 2 was six times more likely. Participant 3 completed exercises with equal likelihood on TAP or TYP days. All three participants reported preference for TAP system delivery and requested to increase the frequency of TAP delivery to every day. Care providers unanimously reported preference for the TAP system to prompt patients and reduce their burden of care. The TAP system malfunctioned during 21.70% (23/106) of scheduled sessions; two participants needed clarifications, instruction to use the system, or customized modifications in order to interact independently with the device. Recommendations for system improvements and applications to the field of assistive technology are provided.