Community Stroke Hub: Resources

Getting Started

Our approach

To help get started, we have identified sources of training and guidance to support professionals providing stroke rehabilitation remotely. With regard to use of social media (e.g. whatsapp, skype) and online platforms listed (e.g. accuRX) to contact patients, we recommend staff follow their NHS Trust and NHS X Information governance advice. Where necessary, request lifting of regulations to enable use of video with the range of options available.

We have then highlighted software/apps organised by rehabilitation focus that include features that help promote patient engagement in self-managed rehabilitation. Others are available and can be found in the repositories presented.

In addition to telerehabilitation resources, we have also included links to sources of remote support for patient participation and information for patients and their families.

The evidence

Telerehabilitation has been defined as the use of technologies such as the telephone or the Internet to help people communicate with healthcare professionals without having to leave their home. A Cochrane review suggested that outcomes using telerehabilitation appropriately are similar to those with face-to-face rehabilitation with no adverse effects (Laver et al 2020).

Synchronous telerehabilitation uses videoconferencing facilities for the therapist and patient to communicate in real time.

Asynchronous telerehabilitation uses computer-based interventions to remotely monitor and adapt exercises. This allows for self-management of rehabilitation exercises without the need for a scheduled meeting with a therapist at each exercise session, providing opportunities for efficient delivery of intensive/high dose rehabilitation (Hill et al 2016).

Software/app features that maximise engagement in self-managed computer-based in speech and language therapy include (Harrison et al 2020):

  • Personalisation/tailoring of the content
  • Provision of feedback
  • Ongoing support and monitoring by a therapist

Other things to consider in choosing software/apps for self-managed rehabilitation include:

  • Platform/device needed for the software/app
  • Price and whether this is for patient or clinician
  • Patient capability

We hope the resources featured help you to connect with stroke survivors, maximising the opportunities for delivery of stroke rehabilitation at this time.

References

Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. (2020) Telerehabilitation services for stroke. Cochrane Library. https://www.cochrane.org/CD010255/STROKE_telerehabilitation-services-stroke

Harrison et al 2020, PhD thesis on fidelity to treatment in Big CACTUS RCT of computer-based aphasia therapy.

Hill AJ, Breslin HM (2016) Refining an Asynchronous Telerehabilitation Platform for Speech-Language Pathology: Engaging End-Users in the Process. Front Hum Neurosci. 20;10:640

https://www.ncbi.nlm.nih.gov/pubmed/28066211

General Advice & Training

Advice and training on using telerehabilitation technologies

NHS info Governance Advice Re Covid-19
NHS England COVID-19 Information

Video Consultation Guide
Trisha Greenhalgh, Academic GP

Remote Consultations
Chartered Society of Physiotherapy guide to remote consultations

Advice for Neuropsychology services delivering therapy online
Neuropsychology focus

RCSLT guidelines for delivering service using Telehealth

Royal College of Speech and Language Therapist's comprehensive guidelines on delivering services using telehealth. Includes: key considerations, consent, information governance, selecting a platform (useful comparison of platforms), carrying out a telehealth session, remote assessment, the evidence (reference list), implementation, FAQs.

Telemedicine guide SLT
Steph Burgess, NHS Speech and Language therapist experienced in use of telerehab via videoconfencing. Briefly outlines NHS guidance and demonstrates use of Whereby videoconferencing platform.

Group Aphasia Therapy - Remote Guidance

Resource and Guidance for delivering group Aphasia therapy remotely (Download Doc - Excel Line 94)

Webinar - Dr Rachelle Pitt

Webinar on delivering group aphasia therapy remotely by Dr Rachelle Pitt

RCSLT advice on remote Dysphagia procedure

RCSLT advice on things to consider when completing a remote dysphagia procedure (under remote service delivery tab)

RCSLT resources for Telehealth

Resources section of RCSLT telehealth guidelines: contains consent forms and useful guidance on telehealth dysphagia set up and risk assessment

ASTUTE Telestroke implementation resources

Telestroke implementation resources developed in a UK National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) project called ASTUTE (Acute Stroke Telemedicine: Utility, Training and Evaluation).

Blog Post - Anna Volkmer

Blog post with guidance on conducting communication partner training remotely (Anna Volkmer)

https://toolkit.citcen.org/
Toolkit to support the use of technology with people with aphasia. Advice on where to find funding, useful considerations. Solutions to problems including purchasing apps, downloading apps in NHS, confidentiality and security, wifi/internet access (useful for all client groups)

HCPC Advice
Advice from the Health and Care Professions Council to providing online services

GMSODN Info
Digital Health and Technology for stroke services multiple pages available within the website relating to info on Covid-19

BPS strategies for online delivery of care
British Psychological Society - applicable to other disciplines

https://www.latrobe.edu.au/research/centres/health/aphasia/resources
Aphasia Centre for Research Excellence Australia, Resources for Healthcare communication support - contains advice for how to do videoconferencing/telerehab sessions with people with aphasia. Also comprehensive resource for telerehab assessment and treatment of aphasia, advice on using telehealth for dysphagia. Also source of patient information.

General remote consultation platforms (for synchronous telerehabilitation/videoconferencing)

AccuRx
NHS approved e-consultation system

Cisco
Webex Platform to deliver remote rehab

Doxy.me
Free teleconsultation via video and text

Vidyo
Video conferencing/meetings platform

Visionable
Video consultation platform

NHS near Me
Secure video calling app - NHS Scotland

Whereby
https://whereby.com  Video calling

Attend anywhere
https://www.attendanywhere.com/ video calling

RCSLT Comparison of different platforms 

https://www.rcslt.org/members/delivering-quality-services/telehealth/telehealth-guidance#section-5

 

Understanding of stroke and its treatment

BASP resource hub
Covid clinical guidance and evidence. Contains up-to-date advice on management of stroke during COVID-19

Speciality Guide for patient management - Covid-19
Clinical guide for management of stroke patients during Covid-19

https://www.stroketraining.org/
General Stroke Training - useful as a refresher for staff returning to stroke

Stroke Foundation Australia
Services for Stroke. Quite comprehensive

Bridges Self-Management 

Self-management tools and guidance for community teams for use during Covid-19

Stroke Association - advice, information and support

 

Guidance on remote cognitive assessment

Remote MOCA Testing
Guidance on remote administration of MOCA

OCS administration
Guidance on remote administration of the Oxford Screening Assessment

 

 

Telerehab Resources

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: Giraffe

Description: Web based physiotherapy platform for delivery and remote monitoring of physio for long term conditions. Not stroke specific but has neurological elements.

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes - by therapist from library of exercises

Provision of feedback?: Yes - from therapist

Enables ongoing remote support from therapist?: Yes

Platforms it is available on: web based via internet on any device with connectivity

Cost (if known): Currently free for NHS providers, charitities and third sector organisations during COVID outbreak, with 30% discount for private practice

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: Otago Exercise Programme

Description: App containing Otago exercise programme targetting balance. Suitable for older adults

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes - patient selected exercises

Provision of feedback?: Yes- from app (tracking exercise and uses emojis to reflect achievement)

Enables ongoing remote support from therapist?: No

Platforms it is available on: Android

Cost (if known): Free

Other: Available in English and Swedish

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: GRASP

Description: Canadian upper limb rehab programme. GRASP website includes therapist instruction manuals and training videos to guide upper upper limb rehabilitation in hospital and home settings.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?:Yes - by therapist informed by GRASP instruction manual.

Provision of feedback?: No - Would require additional video link into the patient's home setting

Enables ongoing remote support from therapist?: No - Would require additional video link into the patient's home setting

Platforms it is available on: Web based - usable on any device with internet connectivity

Cost (if known): Free

Other:

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: Hand Therapy App

Description: Hand Therapy App is primarily designed to support hand injury rehabilitation, but includes exercises that may be helpful for some stroke survivors. Information included in this App is intended to be used in conjunction with treatment that you receive from a qualified therapist and must only be used under the guidance of a qualified occupational therapist or physiotherapist.

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes – exercises can be personalised by choosing from a suite of exercises with supporting videos and leaflets

Provision of feedback?: No

Enables ongoing remote support from therapist?: No

Platforms it is available on:Requires iOS 10.0 or later. Compatible with iPhone, iPad, and iPod touch.

Cost (if known): Free

Other:

Rehabilitation Focus: Cognitive rehabilitation

Hyperlink & Additional Info: Canplan app

Description: CanPlan promotes independence and builds confidence by helping people with cognitive challenges complete tasks successfully. Activities are broken into a sequence of easy-to-follow steps, illustrated by photos and reinforced with optional text and audio.

Stroke Specific: No

Can be personalised/tailored to individual patients?:Yes - Any task can be broken down into steps and supported by pictures/ text

Provision of feedback?: No feedback provided via the App. Would require additional video link into the patient's home setting.

Enables ongoing remote support from therapist?: Does not enable remote support from therapist - would require additional video link into the patient's home setting.

Platforms it is available on: Compatible with iPhone, iPad and iPod touch.

Cost (if known): Free

Other:

Rehabilitation Focus: Communication rehabilitation

Hyperlink & Additional Info: Aphasia software finder

Description: The Tavistock Trust for Aphasia provides the Aphasia Software Finder, a resource for SLTs and stroke survivors/carers to find both specialist and general software and apps that may be suitable to address the specific communication difficulty identified. It contains options suitable for dyspraxia and dysarthria as well as aphasia. Currently 115 software packages and apps are described on the software finder. The comparison table helps clinicians to see at a glance whether the software/App can be personalised/customised, and if it is possible to remotely monitor and update exercises and view results along with details of the devices it can be used on and price guide/free trial availability. The software finder provides a detailed description of each piece of software/app from a specialist SLT. Software apps are categorised into those that work on talking, spelling and writing, reading, listening, following instructions, number and money, time concepts, word meanings/categories, conversation. There is an advanced search function for professionals to use where client needs can be selected and the relevant software/Apps are suggested accordingly. Options that enable personalisation/customisation, feedback, and remote monitoring and support have been highlighted below.

Stroke Specific: Suitable for communication difficulties aquired from stroke

Can be personalised/tailored to individual patients?: N/A

Provision of feedback?: N/A

Enables ongoing remote support from therapist?: N/A

Platforms it is available on: N/A

Cost (if known): Free

Other:

Rehabilitation Focus: Communication rehabilitation

Hyperlink & Additional Info: Aphasia Software

Description:StepbyStep v5 encourages word retrieval in single words and sentences and works on sets of words identified as important by the patient/family. Also helps with spelling and memory. Steps in exercise sequences promote errorless learning. Level of difficulty is automatically adjusted as the patient improves. Speech recognition is used to provide feedback on word finding attempts. Provision for assessment of treated and untreated words within the software.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: Yes

Provision of feedback?: Yes

Enables ongoing remote support from therapist?: If used in combination with Teamviewer remote control software (freely available) www.teamviewer.com

Platforms it is available on: Windows 10 on tablet, Windows 7,8,10 on PC and laptop

Cost (if known): Free 30 day trial, £20 per month for patient version (or £250 for life). Contact Steps Consulting Ltd for clinician/community team licenses and bundles. sales@aphasia-software.com or call 01454218436

Other:

Rehabilitation Focus: Communication and swallowing rehabilitation

Hyperlink & Additional Info: TACTUS

Description: TACTUS apps - single, relatively low priced, easy to use selection of apps that can be purchased according to the specific communication skills to be focussed on, and according to the level of difficulty required. Apps available for naming, conversation, auditory comprehension, reading, writing, dysarthria, cognition, dysphagia, visual attention. See app brochure https://tactustherapy.com/brochures/tactus-therapy-speech-therapy-adults-app-brochure-gbp.pdf. App finder to help find right app for your patient also easy to use on TACTUS website. Although no remote monitoring/support built in to these apps, TACTUS have provided advice on how to use the apps in conjunction with videoconferencing during COVID-19. Videoconferencing in conjunction with other apps selected from the aphasia software finder could also assist in providing important monitoring and support.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: Yes

Provision of feedback?: Yes

Enables ongoing remote support from therapist?: No, but see videoconferencing advice to enable this

Platforms it is available on: iOS and Android

Cost (if known): Range - most expensive is one-off payment of £23.99

Other:

General app repositories

Hyperlink & Additional Info: NHS apps

Description: NHS generic apps

Stroke Specific: No

Can be personalised/tailored to individual patients?: N/A

Provision of feedback?: N/A

Enables ongoing remote support from therapist?: N/A

Platforms it is available on: iOS and Android

Cost (if known): 

Other:

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: Physitrack

Description: US based Web based platform for delivery of rehab, remote monitoring and secure video calls. Largely MSK focussed but does have some neurological elements.

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes - by therapist from library of exercises; largely MSK focus

Provision of feedback?: Yes - from therapist

Enables ongoing remote support from therapist?: Yes

Platforms it is available on: iOS and Android

Cost (if known): NHS price not known - currently starts at £9.99/month for private providers

 

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: Strocit

Description: Basic exercise programme. Choice of two programmes, one for less affected and one for more severely affected.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: No

Provision of feedback?: No

Enables ongoing remote support from therapist?: No

Platforms it is available on: Android

Cost (if known): Free

Other: Available in 11 languages

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: REPS recovery exercises

Description: This App supports post-stroke exercise programs at home, guided by videos. TASK programme encourages repetitive practice of everyday tasks e.g. sitting, standing, stepping and standing up. PUSH programme includes repetitive practice of arm movements.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?:Yes - by therapist

Provision of feedback?: No - Would require additional video link into the patient's home setting

Enables ongoing remote support from therapist?: No - Would require additional video link into the patient's home setting

Platforms it is available on: Compatible with iPhone, iPad and iPod touch.

Cost (if known): Free

Other: Use of this App requires some basic equipment that can be purchased from an Australian company. TASK is also available as a web based resource: https://www.mq.edu.au/about/about-the-university/faculties-and-departments/medicine-and-health-sciences/departments-and-centres/department-of-health-professions/our-research/task-program.

Rehabilitation Focus: Physical rehabilitation

Hyperlink & Additional Info: iprescribe

Description: Developed by Physiotherapists; General activity and fitness app where individuals add in basic physical data and it develops a programme to increase fitness

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes app tailors progression and starting point

Provision of feedback?: Yes- from app (tracking exercise)

Enables ongoing remote support from therapist?: No

Platforms it is available on: Available on Apple Store and Google Play

Cost (if known): Free

Other:

Rehabilitation Focus: Cognitive rehabilitation

Hyperlink & Additional Info: HappyNeuron

Description: HappyNeuron Pro is an online resource that includes a variety of digital cognitive therapy tools to target cognitive functions including: executive funtion, verbal memory, visual memory, spatial memory, visio-spatial abilities, visual attention and cognitive processing

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: Yes, specific tasks can be assigned to individual patients that target cognitive functions impacted by stroke.

Provision of feedback?: Graphic feedback provided to patients after completion of each exercise

Enables ongoing remote support from therapist?: Therapists can view patient's progress to inform feedback and identify areas that need further input.

Platforms it is available on: 

Cost (if known): Free 7 day trial. Various pricing options ranging from $99-$249 per month

Other:

Rehabilitation Focus: Communication rehabilitation

Hyperlink & Additional Info: REACT2

Description: REACT 2 covers a range of communication skills. There are 9000+ exercises on listening, understanding, reading, remembering, improving. These are at different levels. A selection of exercises appropriate to the clients needs in terms of type and level of difficulty can be selected, reviewed and updated remotely by the therapist.

Stroke Specific: No

Can be personalised/tailored to individual patients?: Yes, can customise type and level of exercises selected for practice

Provision of feedback?: Yes

Enables ongoing remote support from therapist?: Yes, can be remotely monitored, adjusted and messages of support sent to client

Platforms it is available on: Any device with internet connectivity

Cost (if known): £20 per month for client, REACT2Pro for teams of therapists - discuss exact needs with supplier. Contact on 01721725875 or info@REACT2.com

Other: NHS governance and GDPR compliant. No patient identifiable data used.

Rehabilitation Focus: Communication rehabilitation

Hyperlink & Additional Info: Constant Therapy

Description: Constant therapy is a software package designed in the US and has a large bank of exercises covering reading, attention, problem solving, visual memory, spelling, memory, auditory comprehension, money/numbers, everyday language skills. Provides feedback and automatically adapts level of exercise difficulty.

Stroke Specific: Neuro specific

Can be personalised/tailored to individual patients?: Yes

Provision of feedback?: Yes

Enables ongoing remote support from therapist?: Yes

Platforms it is available on: iOS and Android

Cost (if known): $24.99 per month for patient ($10.50 per month during COVID-19) Clinician version is free

Other:

General app repositories

Hyperlink & Additional Info: My therappy

Description: NHS Database of rehabilitation Apps - search function for stroke Apps possible

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: N/A

Provision of feedback?: N/A

Enables ongoing remote support from therapist?: N/A

Platforms it is available on: iOS and Android mobile devices

Cost (if known): Ranges - most are free

Other:

General app repositories

Hyperlink & Additional Info: ORCHA

Description: Tested and approved Apps - can search for condition, see reviews and overall rating.

Stroke Specific: Yes

Can be personalised/tailored to individual patients?: N/A

Provision of feedback?: N/A

Enables ongoing remote support from therapist?: N/A

Platforms it is available on: iOS and Android

Cost (if known): 

Other:

Video Resources

Rehabilitation Focus: Physiotherapy

Hyperlink & Additional Info: Post Stroke Exercises

Description: Videos of 29 simple exercises - from the American Stroke Association. Each video lasts beween 1 to 2 minutes

Stroke Specific: Yes

Personalised/Tailor?: No

Provision of feedback?: No

Enables ongoing support from therapist: No

Platforms it is available on: Youtube

Cost (if known): Free

Rehabilitation Focus: Physiotherapy

Hyperlink & Additional Info: Chair Exercises

Description: 12 minute video of chair based exercises from team at Rotherham NHS Trust

Stroke Specific: Yes

Personalised/Tailor?: No

Provision of feedback?: No

Enables ongoing support from therapist: No

Platforms it is available on: Youtube

Cost (if known): Free

Rehabilitation Focus: Psychology

Hyperlink & Additional Info: Mindfulness

Description: The Rotherham NHS Trust Mindfulness exercises

Stroke Specific: No

Personalised/Tailor?: No

Provision of feedback?: No

Enables ongoing support from therapist: No

Platforms it is available on: Youtube

Cost (if known): Free

Rehabilitation Focus: Facial Exercises

Hyperlink & Additional Info: Facial muscles exercises

Description: The Rotherham NHS Foundation Trust Facial exercises

Stroke Specific: Yes

Personalised/Tailor?: No

Provision of feedback?: No

Enables ongoing support from therapist: No

Platforms it is available on: Youtube

Cost (if known): Free

Rehabilitation Focus: Physiotherapy

Hyperlink & Additional Info: General Exercises

Description: Seated exercises and basic neuro exercises - Active with Emma

Stroke Specific: No

Personalised/Tailor?: No

Provision of feedback?: No

Enables ongoing support from therapist: No

Platforms it is available on: Youtube

Cost (if known): Free

Patient Info & Remote Support

Patient and carer information and support

Facebook Group Different Strokes
Charity support group for stroke survivors

Ability net
Provide free remote IT support for patients using technology at home. Freephone 0800269545 email: mailto:enquiries@abilitynet.org.uk

Stroke Association
My Stroke Guide

Self Help 4 Stroke
Self help website

Aphasia friendly COVID-19
Speakeasy information sheet about COVID for people with aphasia

https://www.chss.org.uk/coronavirus/coronavirus-advice/?ref=popup
Chest Heart and Stroke Scotland: Coronavirus information and support for stroke survivors and carers

https://www.stroke.org.uk/finding-support/coronavirus-covid-19-and-stroke
The Stroke Assocation: Information and advice on Coronavirus for people affected by stroke

https://www.stroke4carers.org/
Stroke4carers: website containing information about stroke tailored to carers

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