ICYMI: Closing the digital divide in aphasia, before COVID-19 and after

Read the third in our In Case You Missed It Series, where we review previously published scientific research about Constant Therapy and brain rehabilitation. ICYMI is written by The Learning Corp scientific advisor Paul Wicks, Ph.D., a neuropsychologist and expert in digital health, clinical trials, and patient centricity. Paul’s work has been profiled by the BBC, NPR, CNN, BBC Radio 4, the Wall Street Journal, and the New York Times. He was awarded MIT Technology Review’s TR35 “Humanitarian of the Year” award, recognized as a TED Fellow, and recently joined the inaugural FLIER Program at the Academy of Medical Sciences. He sits on the editorial boards of the BMJ, BMC Medicine, JMIR, Digital Biomarkers, and The Patient. You can read the first in our In Case You Missed It Series here.

In 1995, the respected scientist Clifford Stoll predicted, “Websites will never replace newspapers.” He could have been right; newspapers (as he thought of them then) had been in existence for hundreds of years, employed tens of thousands of people, and were a validated source of truth. But he was wrong, in part because the 24-hour news cycle was emerging, and most everyone, laggards included, embraced the transition to online, real-time news. Today we consume more news than ever, delivered not to our doorstep or mailbox but to our smartphones. 

Before the outbreak of COVID-19, traditional speech rehabilitation for aphasia was paper-based

Before the outbreak of COVID-19, traditional speech rehabilitation in aphasia was arguably in the same spot as newspapers in 1995; paper-based and reliable enough for the small proportion of people with the insurance to access it but inefficient in its reliance on face-to-face visits, and unevenly distributed due to the shortage of speech-language pathologists. In previous installments of “In case you missed it (ICYMI)” we’ve made the case that virtual therapy was the perfect post-discharge solution for patients with speech, language or cognitive issues and could even detect secondary strokes more quickly. 

The closure of many hospital outpatient services to prioritize COVID-19 patients means that those services are now scrambling to digitize their offerings

Federal and state governments and many private companies are stepping in to help, making changes to reimbursement guidelines far faster than our modern healthcare system has ever seen (see the latest updates here.)

Before this pandemic began, who was truly engaging with digital rehabilitation? Until now, we haven’t fully understood this digital divide – those who adopted digital therapeutics and those who did not. Were older patients less likely to get on board and stay with a digital program? What about those living in rural areas? And what does the future hold?

Until now, we haven’t fully understood the digital divide between those who adopted digital therapeutics and those who didn’t

A peer-reviewed study published by our team has just helped to answer some of these questions. Our researchers looked at data from 2,850 individuals with reported stroke and traumatic brain injury (TBI) using Constant Therapy between October 2016 and January 2019. To calculate how engaged users were, researchers examined three ‘activity metrics’: the number of active weeks of therapy, the average number of active therapy days per week, and the total number of therapeutic sessions over the first 20 weeks of use. 

Peer-reviewed study shows encouraging results around both patient age and physical location

So, what did they find? They quickly overturned the old cliches: older patients (aged 51-70) were more digitally engaged during the program – completing five more sessions than their younger counterparts (aged 50 and below). We already know that just two extra weeks of speech-language therapy can substantially contribute to the recovery of patients who develop chronic aphasia. So, a high level of motivation and engagement with virtual therapy is a promising step towards greater gains. 

Age is one factor, but what about where you live? While high-speed broadband has rolled out rapidly across the developed world, rural dwellers are often left behind. Here again, we were pleasantly surprised to find that rural patients using Constant Therapy were especially digitally active, completing 11.5 sessions more than urban users. That was the case even once age, gender, diagnosis, and chronicity were accounted for. Those who live remotely can face more significant barriers to accessing traditional face-to-face services such as distance, traffic, parking, and taking time off work – such that the barriers to digital rehabilitation seem much lower. 

This is all-important because patients describe recovery goals that stretch far beyond regaining the ability to just communicate basic needs. They strive for much more: greater independence, dignity, and respect; fulfilling engagement in their work and social lives, and the simple wish to help others. A mix of traditional and digital approaches could help patients realize those personal ambitions, stay motivated, bridge the digital divide, and offer more good news days to patients with aphasia. 

What does the future hold for the digitization of speech therapy? And how might it help close the digital divide?

One thing that had been holding back digitization of speech therapy for a long time was that “virtual visits” via Skype, Zoom, or other video conference services were not reimbursed. The situation is evolving rapidly, but governments and insurance companies are making it easier for professionals to use new digital tools to support patients at home. When the current pandemic has passed we might never go back to “the old normal” but instead, embrace a new world where digital therapy is the default option for supporting people on their path to recovery. We already know patients are ready to make the switch, now is the time to enable access for all. 

<TIME-LIMITED NOTE> As of March 30th, 2020, the Centers for Medicare & Medicaid Services has now agreed to pay for 80 additional services that can be supplied digitally.