Feasibility and Acceptability of a Real-Time Telerehabilitation Intervention for Children and Young Adults with Acquired Brain Injury During the COVID-19 Pandemic: An Experience Report

Keywords: Acceptability, Acquired brain injury, Developmental age, Feasibility, Neuropsychology, Real-time, Speech therapy, Telerehabilitation

Abstract

This study examined the feasibility and acceptability of a telerehabilitation intervention during the COVID-19 pandemic in a sample of children and young adults with Acquired Brain Injury (ABI). Thirteen patients and/or their families agreed to participate in the speech and neuropsychological telerehabilitation sessions. The treatment was synchronous, patient centered and aimed at improving specific abilities. Sessions were held twice a week over a 10-week period. Two questionnaires were completed both by parents and therapists to assess feasibility and acceptability. Neither technical issues nor clinical obstacles were found. The quality of the therapeutic relationship played a key role in the intervention. Synchronous telerehabilitation provided several advantages both for patients and therapists. Moreover, the patient centered intervention eased the burden of the caregivers at a time of high stress. The real-time telerehabilitation treatments were deemed suitable for children and young adults with ABI. Further studies are needed to support the use of telerehabilitation as an integral part of their standard care.

  

Author Biographies

Maria Chiara Oprandi, IRCCS E. Medea La Nostra Famiglia

Maria Chiara Oprandi, PsyD. She is a Psychologist and Psychotherapist. In 2012 she obtained a master’s degree at the University of Milan-Bicocca in Clinical psychology, Neuropsychology and Developmental Psychology. In 2019 she completed the specialization school/course in cognitive and behavioral psychotherapy. She is currently working for the Neuro-oncological and Neuropsychological Rehabilitation Unit at the Scientific Institute Eugenio Medea, La Nostra Famiglia (Bosisio Parini, Lecco, Italy). Between 2014 and 2017 she was a researcher for the “Retrospective and prospective study of late radiation damages after focal radiotherapy for childhood brain tumors” and is currently working on its continuation (since 2018), the “Prospective study of late radiation damages after focal radiotherapy for childhood brain tumors”, founded by the Italian Association for Cancer Research (AIRC) and in collaboration with the National Tumor Institute in Milan. She has published articles about pediatric brain tumor and acquired brain injury patients.

Alessandra Bardoni, Scientific Institute, IRCCS E. Medea

Bardoni Alessandra, MD. She has been a Neurologist since 1996 and Head of the Departmental Outpatient Complex Macro Activity (It sounds strange but I realise this might be the actual name of the department …)  at the Scientific Institute Eugenio Medea, La Nostra Famiglia (Bosisio Parini, Lecco, Italy). She received her PhD in Neuroscience in 1999. She carried out basic research (gene therapy) from 1992 to 2000. She is the author of numerous publications on pediatric brain tumor and acquired brain injury patients. She collaborates with the Cincinnati Children's Hospital Medical Center for the Italian translation of the “Teen Online Problem Solving” (TOPS), a remote behavioral rehabilitation platform for adolescents with acquired brain injury, with the aim of stimulating problem-solving skills and psychological adaptation. She is the Co-PI for the Scientific Institute Eugenio Medea in the research “Coping with diffuse midline gliomas: non-invasive biomarkers, treatment and rehabilitation through Artificial Intelligence adoption”, which is about to begin, in collaboration with the National Tumor Institute in Milan.

Geraldina Poggi, Scientific Institute, IRCCS E. Medea

Geraldina Poggi, MD. She is a Child Neuropsychiatrist and the Head of the Neuro-oncological and Neuropsychological Rehabilitation Unit at the Scientific Institute Eugenio Medea, La Nostra Famiglia (Bosisio Parini, Lecco, Italy). She is the author of more than 100 publications on pediatric brain tumor and acquired brain injury patients. She graduated in 1997 from the university of Genova and then from the Child Neuropsychiatry Board in 2002. Between 2014 and 2017 she was the reference person/contact person/spokesperson for the Scientific Institute Eugenio Medea in the “Retrospective and prospective study of late radiation damages after focal radiotherapy for childhood brain tumors” and is currently working on its continuation the “Prospective study of late radiation damages after focal radiotherapy for childhood brain tumors”, founded by the Italian Association for Cancer Research (AIRC) and in collaboration with the National Tumor Institute in Milan.

References

Alexander M. (2020). Let's conquer COVID-19 and sustain our abilities. Spinal Cord Series and Cases, 6(1), 19. https://doi.org/10.1038/s41394-020-0271-z

American Psychiatric Association. (2014). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Raffaello Cortina Editore. ISBN 9788860306616

American Psychiatric Association. (2018). Best practices in videoconferencing-based telemental health. (2018). [Online]. [updated April 2018, cited October 14th 2021]. Available from: https://static1.squarespace.com/static/50a3e393e4b07025e1a4f0d0/t/5e77f55d188aa82a0aa44890/1584919902112/APA-ATA-Best-Practices-in-Videoconferencing-Based-Telemental-Health.pdf

American Psychological Association. (2020). Office and technology checklist for telepsychological services. [Online]. [updated March 2020, cited October 14th 2021]. Available from: https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist

American Speech-Language-Hearing Association. (ASHA). (2021).Telepractice (Practice Portal). [Online] [cited October 14th 2021]. Available from: http://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/

American Telemedicine Association. (2017). [Online]. [updated April 2017, cited October 14th 2021]. Available from: https://www.matrc.org/wp-content/uploads/2020/04/ATA-Telerehabilition-Services.Final_.revised.6.7.17.pdf

American Telemedicine Association. (2021). ATA quick-start guide to telehealth during health crisis [Online]. [updated March 2020, cited October 14th 2021]. Available from: https://www.americantelemed.org/COVID-19/ (Download with registration).

Brennan, D., Tindall, L, Theodoros, D., Brown, J., Campbell, M., Christiana, D., Smith. D., Cason, J., & Lee A. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31-34. https://doi.org/10.5195/ijt.2010.6063. PMID: 25945175; PMCID: PMC4296793.

Camden, C., Pratte, G., Fallon, F., Couture, M., Berbari, J., & Tousignant, M. (2019). Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: Results from a systematic review. Disability and Rehabilitation, 1–13. https://doi.org/10.1080/09638288.2019.1595750

Cherney, L., & van Vuuren, S. (2012). Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders. Seminars in Speech and Language, 33(3), 243-257. https://doi.org/10.1055/s-0032-1320044

Coleman, J. J., Frymark, T., Franceschini, N. M., & Theodoros, D. G. (2015). Assessment and treatment of cognition and communication skills in adults with acquired brain injury via telepractice: A systematic review. American Journal of Speech-Language Pathology, 24(2), 295-315. https://doi.org/10.1044/2015_ajslp-14-0028

Corti C., Oldrati V., Oprandi, M.C., Ferrari, E., Poggi, G., Borgatti, R., Urgesi, C., & Bardoni A. (2019). Remote technology-based training program for children with acquired brain injury: A systematic review and a meta-analytic exploration. Behavioural Neurology,1346987. https://doi.org/10.1155/2019/1346987

Corti, C., Urgesi, C., Poggi, G., Strazzer, S., Borgatti, R., & Bardoni, A. (2020). Home-based cognitive training in pediatric patients with acquired brain injury: Preliminary results on efficacy of a randomized clinical trial. Scientific Reports. 10(1),1391. https://doi.org/10.1038/s41598-020-57952-5

Dhiman, S., Sahu, P.K., Reed, W.R., Ganesh, G.S., Goyal, R.K., & Jain, S. (2020). Impact of COVID-19 outbreak on mental health and perceived strain among caregivers tending children with special needs. Research in Developmental Disabilities, 107, 103790. https://doi.org/10.1016/j.ridd.2020.103790

Fazzi, E., & Galli, J. (2020). New clinical needs and strategies for care in 4 children with neurodisability during COVID-19. Developmental Medicine & Child Neurology. 62(7), 879-880. https://doi.org/10.1111/dmcn.14557

Ferreira Meireles, A.L, & Ferreira de Meireles, L.C. (2020). Impact of social isolation due to the COVID-19 pandemic in patients with pediatric disorders: Rehabilitation perspectives from a developing country. Physical Therapy, 100(11), 1910-1912. https://doi.org/10.1093/ptj/pzaa152

Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N.J. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134-139. https://doi.org/10.1258/jtt.2009.090608

Hendry, K., Ownsworth, T., Waters, A.M., Jackson, M., & Lloyd, O. (2020). Investigation of children and adolescents’ mood and self-concept after acquired brain injury. Child Neuropsychology, 1–21. https://doi.org/10.1080/09297049.2020.1750577

Inter Organizational Practice Committee. (2020). Remote neuropsychological assessment models. [Online]. Available from: https://iopc.online/remote-neuropsychological-assessment-models

Italian Society of Child and Adolescent Neuropsychiatry (SINPIA). (2020). Clinical assistance activities during the COVID emergency: Operational indications for childhood and adolescent neuropsychiatric services and for developmental rehabilitation services. [Attività clinico-assistenziali durante l’emergenza COVID: indicazioni operative per i servizi di neuropsichiatria dell’infanzia e dell’adolescenza e per i servizi di riabilitazione dell’età evolutiva]. [Online]. [updated March 29th 2020, cited October 14th 2021]. Available from: https://www.sinpia.eu/wp-content/uploads/2020/03/COVID-indicazioni-operative-per-i-servizi-NPIA.pdf

Italian Society of Physical and Rehabilitation Medicine (SIMFER). (2020).The positions and actions of Italian physiatrists in the face of the COVID-19 phenomenon [Le posizioni e le azioni dei fisiatri italiani di fronte al fenomeno COVID-19]. [Online]. [updated March 3rd 2020, cited October 14th 2021]. Available from: https://www.simfer.it/le-posizioni-e-le-azioni-dei-fisiatri-italiani-di-fronte-al-fenomeno-COVID-19/

Johansson, B., & Tornmalm, M. (2012). Working memory training for patients with acquired brain injury: Effects in daily life. Scandinavian Journal of Occupational Therapy, 19(2),176-83. https://doi.org/10.3109/11038128.2011.603352

Kloek, C.J.J., Janssen, J., & Veenhof, C. (2019). Development of a checklist to assist physiotherapists in determination of patients’ suitability for a blended treatment. Telemedicine and e-Health, 26(8), 1051-1065. https://doi.org/10.1089/tmj.2019.0143

Koppenaal, T., Arensman, R.M., & van Dongen, J.M., et al. (2020). Effectiveness and cost-effectiveness of stratified blended physiotherapy in patients with non-specific low back pain: Study protocol of a cluster randomized controlled trial. BMC Musculoskeletal Disorders, 21, 265 (2020). https://doi.org/10.1186/s12891-020-3174-z

Koterba, C.H., Baum, K.T., Hamner, T., Busch, T.A., Davis, K.C., Tlustos-Carter, S., Howarth, R., Fournier-Goodnight, A., Kramer, M., Landry, A., O'Neill, J., Cass, J., Wilson, C., & Slomine, B.S. (2020). COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation - challenges to usual care and solutions during the pandemic. Clinical Neuropsychologist. 34(7-8), 1380-1394. https://doi.org/10.1080/13854046.2020.1811892

Linden, M., Hawley, C., Blackwood, B., Evans, J., Anderson, V., & O'Rourke, C. (2016). Technological aids for the rehabilitation of memory and executive functioning in children and adolescents with acquired brain injury. Cochrane Database of Systematic Reviews, 7, CD011020. https://doi.org/10.1002/14651858.CD011020.pub2

Linden, M.A., Glang, A.E, McKinlay, A. (2018). A systematic review and meta-analysis of educational interventions for children and adolescents with acquired brain injury. NeuroRehabilitation, 42(3), 311–323. https://doi.org/10.3233/NRE-172357

Lindsay, S., Hartman, L.R., Reed, N., Gan, C., Thomson, N., & Solomon, B. (2015). A systematic review of hospital-to-school reintegration interventions for children and youth with acquired brain injury. PLoS One, 10(4), e0124679. https://doi.org/10.1371/journal.pone.0124679

López-Cabarcos, M.Á., López-Carballeira, A., & Ferro-Soto, C. (2020). New ways of working and public healthcare professionals’ well-being: The response to face the COVID-19 pandemic. Sustainability, 19(8087). https://doi.org/10.3390/su12198087

Macoir, J., Sauvageau, M., Boissy, P., Tousignant, M., & Tousignant, M. (2017). In-home synchronous telespeech therapy to improve functional communication in chronic poststroke aphasia: Results from a quasi-experimental study. Telemedicine Journal and e-Health, 23(8), 630-639. https://doi.org/10.1089/tmj.2016.0235

Negrini, S., Grabljevec, K., Boldrini, P., Kiekens, C., Moslavac, S., Zampolin, J.M., & Christodoulou, N. (2020a). Up to 2.2 million people experiencing disability suffer collateral damage each day of COVID-19 lockdown in Europe. European Journal of Physical and Rehabilitation Medicine, 56(3), 361-365. https://doi.org/10.23736/S1973-9087.20.06361-3

Negrini, S., Kiekens, C., Bernetti, A., Capecci, M., Ceravolo, M.G., Lavezzi, S., Zampolini, M., & Boldrini, P. (2020b). Telemedicine from research to practice during the pandemic. Instant paper from the field on rehabilitation answers to the COVID-19 emergency. European Journal of Physical and Rehabilitation Medicine, 56(3), 327-330. https://doi.org/10.23736/S1973-9087.20.06331-5

Official Journal of the Italian Republic. (2020). Decree-law of February 23rd 2020, no. 6. [Online] [updated February 23rd 2020; cited October 14th 2021]. Available from: https://www.gazzettaufficiale.it/eli/id/2020/02/23/20A01228/sg

Øra, HP., Kirmess, M., Brady, M.C., Sørli, H., Becker, F. (2020). Technical features, feasibility, and acceptability of augmented telerehabilitation in post-stroke aphasia-experiences from a randomized controlled trial. Frontiers in Neurology, 11, 671. https://doi.org/10.3389/fneur.2020.00671

Palisano, RJ, & Murr, S. (2009). Intensity of therapy services: what are the considerations? Physical & Occupational Therapy in Pediatrics, 29, 109–114. https://doi: 10.1080/01942630902805186

Piovesana, A, Ross, S, Lloyd, O., Whittingham, K., Ziviani J., Ware, R.S., McKinlay, L, & Boyd, R.N. (2017). A randomized controlled trial of a web-based multi-modal therapy program to improve executive functioning in children and adolescents with acquired brain injury. Clinical Rehabilitation, 31(10), 1351-1363. https://doi.org/10.1177/0269215517695373

Ren, J., Li, X., Chen, S, Chen, S, & Nie, Y. (2020). The influence of factors such as parenting stress and social support on the state anxiety in parents of special needs children during the COVID-19 Epidemic. Frontiers in Psychology,11, 565393. https://doi.org/10.3389/fpsyg.2020.565393

Resch, C,, Rosema, S., Hurks, P, de Kloet A, & van Heugten C (2018).Searching for effective components of cognitive rehabilitation for children and adolescents with acquired brain injury: A systematic review. Brain Injury, 32(6), 679–692. https://doi.org/10.1080/02699052.2018.1458335

Sekhon, M, Cartwright, M, & Francis, J.J.(2017). Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Services Research. 17(1), 88. https://doi.org/10.1186/s12913-017-2031-8

Sicotte, C.1., Lehoux, P., Fortier-Blanc, J., & Leblanc, Y. (2003). Feasibility and outcome evaluation of a telemedicine application in speech-language pathology. Journal of Telemedicine and Telecare, 9(5), 253-258.

https://doi: 10.1258/135763303769211256

Sucala, M, Schnur, J.B,, Constantino, M.J., Miller, S.J., Brackman, E.H., & Montgomery, G.H. (2012). The therapeutic relationship in e-therapy for mental health: A systematic review. Journal of Medical Internet Research,14(4), e110. https://doi.org/10.2196/jmir.2084

Tanner, K., Bican, R., Boster, J., Christensen, C., Coffman, C., Fallieras, K., Long, R., Mansfield, C., O'Rourke, S., Pauline, L, Sagester, G., & Marrie, J. (2020). Feasibility and acceptability of clinical pediatric telerehabilitation services. International Journal of Telerehabilitation. 12(2), 43-52. https://doi.org/10.5195/ijt.2020.6336

Theodoros, D.G. (2008). Telerehabilitation for service delivery in speech-language pathology. Journal of Telemedicine and Telecare, 14(5), 221-4. https://doi.org/10.1258/jtt.2007.007044

Trabacca, A., & Russo, L. (2020). COVID-19 and child disabilities: Whom to protect and how. European Journal of Physical and Rehabilitation Medicine, 56(3), 372-373. https://doi.org/10.23736/S1973-9087.20.06309-1

United Nations. (2020). Policy Brief: The impact of COVID-19 on children. [Online]. [updated April 15th 2020, cited October 14th 2021]. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/WFP-0000114560.pdf

van der Valk, J.C., van den Oord, E.J., Verhulst, F.C., & Boomsma, D. (2001). Using parental ratings to study the etiology of 3-year-old twins' problem behaviors: Different views or rater bias? Journal of Child Psychology and Psychiatry. 42(7), 921-31. https://doi.org/10.1111/1469-7610.00788. PMID: 11693587

Wade, S.L., Narad, M.E., Shultz, E.L., Kurowski, B.G., Miley, A.E., Aguilar, J.M., & Adlam, A.L.R. (2018). Technology assisted rehabilitation interventions following pediatric brain injury, Journal of Neurosurgical Sciences, 62(2),187–202, https://doi.org/10.23736/S0390-5616.17.04277-1

Wechsler, D. (1997). Wechsler Adult Intelligence Scale Revised (WAIS-IV). Italian translation. Firenze: Organizzazioni Speciali

Wechsler, D. (2008). Wechsler Preschool and Primary Scale of Intelligence – Third Edition (WPPSI-III). Italian translation. Firenze: Organizzazioni Speciali

Wechsler, D. (2012). Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Italian translation. Firenze: Organizzazioni Speciali

WHO. (2020). Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19) (2020). [Online]. [updated February 16th-24th 2020; cited October 14th 2021]. Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-COVID-19---final-report-1100hr-28feb2020-11mar-update.pdf

Wong, A., Bhyat, R., Srivastava, S., Boissé Lomax, L., & Appireddy, R. (2021). Patient care during the COVID-19 pandemic: Use of virtual care. Journal of Medical Internet Research, 23(1), e20621. https://doi.org/10.2196/20621

Published
2021-12-01
How to Cite
Oprandi, M. C., Bardoni, A., Corno, L., Marchetti Guerrini, A., Molatore, L., Negri, L. ., Beretta, E., Locatelli, F., Strazzer, S., & Poggi, G. (2021). Feasibility and Acceptability of a Real-Time Telerehabilitation Intervention for Children and Young Adults with Acquired Brain Injury During the COVID-19 Pandemic: An Experience Report. International Journal of Telerehabilitation, 13(2). https://doi.org/10.5195/ijt.2021.6423
Section
Clinical Practice -COVID 19