The MiNT Academy @ #RehabWeek2023

Until now the International Classification of Functioning, Disability and Health (ICF) is a framework, which is not as frequently used in therapeutic settings as it could be. As therapists, we attempt to utilize the ICF to support and evaluate assessments, goal setting and treatment processes for patients based on impairments to their activities of daily living.

In this workshop we will be interactively discussing the state-of-the-art initial assessments in a clinical setting nowadays and the advantages and disadvantages of integrating the ICF in a practical environment in neuro-rehabilitation. We will also discuss the importance of accurate assessments for individual treatment planning and how documenting a patient's journey with the right tools can improve the therapy process.

In this workshop, we will demonstrate how an app-integrated ICF core set supports the clinician's therapeutic anamnesis, physical assessments, selection and clinical reasoning for the choice of neurotechnology devices, and goal setting based on participation and activity through a detailed patient case study.

Participants will have the opportunity to follow and participate in this process of holistically describing our patient using the classification system provided by the ICF.

The ICF codes represent different activities, environmental factors, functions and structures which are necessary for reaching specific patient goals. The app is based on a core set for therapy in a neuro-rehabilitation setting. We will also discuss how the app can facilitate the monitoring and the communication of the therapeutic process, independent from professions or the usage of technologies, showing how it can be implemented in any clinical setting.

Rehabilitation is undergoing an accelerated transition from a predominantly in-person, single- timepoint intervention to a continuous and distributed, technologically enhanced process. The process is no longer confined to a rehabilitation clinic or regular outpatient appointments, but - as a true continuum-of-care - spans all locations including the home (Nuara et al., 2022).

With the introduction of new technologies that facilitate this process, such as robotics, wearables, mixed reality, and remote (tele-)therapy, there is a pressing need to enable practitioners to make the most of these new opportunities (Celian et al., 2021). Better understanding of the tools used and how to integrate these into existing and new rehabilitation pathways is paramount to successfully bringing a new standard of care to patients (Schopp et al., 2003).

Educational pathways must be tailored to clinical health professionals undergoing their initial training but must also be presented in digestible formats for the existing workforce. In the workshop we sample current and upcoming educational platforms that approach the space between science, rehabilitation, and technology with different perspectives. The RESC (ETH Zürich, CH), PNR (Lake Lucerne Institute, CH), and Rehabtech (Politecnico Milano, IT) target initial training with specialized Master of Science programs. MotusAcademy (CH) specializes in continuing education. C-STAR (Shirley Ryan AbilityLab, USA) and MiNT (UK) provide combinations of these approaches.

Through short presentations, panel discussions, and interactive group work, we will explore existing educational formats and brainstorm on refining these approaches to be even more inclusive and cross-cultural, while retaining socioeconomic viability. Goal of the workshop will be to position the different existing educational tools into a landscape that unveils underserved topics and populations. We will brainstorm on novel educational solutions that address these shortcomings.

As there is more and more requirement for shifting from generalized therapy approaches to therapy sessions and patient journeys customized to the individual’s impairments and treatment goals, there is also a growing need for valuable, objective and easily accessible outcome data and their interpretation.

We will be showing how the implementation of technology into clinical practice gives clinicians the possibility to use e.g. sensor data from these devices to customize a therapy session to the patient’s individual impairments and treatment goals and gather information for valuable reporting in neuro-rehabilitation.

In the first part of the workshop, we will be presenting a real patient case and shortly explain the clinical reasoning behind the chosen therapy approach. The attendees will be interactively discussing which information would be useful to see during and directly after a therapy session with this patient and if this information would be enough to interpret a therapy outcome.

We will then be performing a live gait therapy session in a robotic exoskeleton, demonstrating the use of a specially developed intra-session labelling system and additional wearable sensors. After the therapy session, we will demonstrate the near-time data reporting and talk through the interpretation of the data together with the attendees.

To evaluate the therapy-shaping process, we will conclude the workshop by discussing the advantages and disadvantages of this approach and gathering opinions on how to further develop the technology and data-driven reporting.

Current approaches used in evidence generation for rehabilitation technology interventions (RT) are based on evidence-based practice (EBP) with randomized controlled trials (RCTs) as criterion standards and on clinical trial practices developed for pharmaceutical research. Recommendations for intervention integration into practice consider systematic reviews and guidelines based on high-quality evidence. For RT, the availability of what is considered high-quality efficacy/effectiveness evidence, according to evidence grading schemes or hierarchies, is lacking. However, current approaches to generating evidence may be inappropriate or unfeasible, given complex user populations, and misaligned with the pace of technological change. Beneficial RT may not be commercialized or integrated into practice to benefit users. This workshop will engage the RT community to exchange knowledge and collaborate to re-envision evidence generation and appraisal and discuss new approaches for rigorous evidence generation. The workshop will involve the following content and activities: 1. Interactive lecture and surveys on EBP, research methods, study designs, and challenges of evidence generation for RT (30 min); 2. Breakout groups: Discuss experiences with RT development and evidence generation and opportunities for new approaches (30 min); 3. Large group: Discuss challenges and opportunities, and consolidate ideas for new approaches and future work (30 min). This workshop will be of interest to researchers, developers and clinicians across all RehabWeek societies who are involved in RT innovation, evidence generation and clinical application of RT.

The world of neurorehabilitation for Speech and Language Therapists (SLTs) is evolving, with neurotechnology entering our clinical work. For SLTs, neurotechnology has previously felt limited, and difficult to incorporate into clinical practice.

Hobbs Rehabilitation has a strong focus on interdisciplinary team collaboration and the use of neurotechnology to drive forward patient outcomes. The MiNT Academy is bringing SLT into the world of neurotechnology ensuring that researchers and developers are considering communication and swallowing impairments when creating their devices. SLTs can use some existing technology in innovative ways to treat patients with communication and swallowing impairments; however, there is an opportunity for significant development in this field, to improve access for all and allow the patient to increase their speech therapy dosage, in and out of clinic.

Our interactive workshop with facilitated breakout groups allows delegates to explore and critically assess existing neurotechnology when treating aphasia, dysarthria and dysphagia. The technology will be broadly categorised as ‘portable’, ‘clinic-based’ and ‘software’. An overview will be presented on how to use these with the SLT caseload with acquired neurological conditions, through a case-based discussion, at various stages of stroke recovery.

The workshop will guide delegates through the relevant evidence base to the clinical application of neurotechnology, allowing for a detailed appraisal of the advantages and disadvantages when using the technology. They will have opportunities to engage in clinical discussions encouraging them to challenge their own treatment approaches and to improve their confidence when incorporating technology into practice. The session will conclude with delegates having an appreciation of the often hidden interdisciplinary benefits of a device, as well as the need for future technology to be developed, to better serve this population.