Post-stroke aphasia at the time of COVID-19 pandemic: a telerehabilitation perspective.

We report on our remote speech therapy experience in post-stroke aphasia. The aim was to test the feasibility and utility of telerehabilitation to support future randomized controlled trials. Post-stroke aphasia is a common and disabling speech disorder, which significantly affects patients' and caregivers' health and quality of life. Due to COVID-19 pandemic, most of the conventional speech therapy approaches had to stop or "switch" into telerehabilitation procedures to ensure the safety of patients and operators but, concomitantly, the best rehabilitation level possible. Here, we planned a 5-month telespeech therapy programme, twice per week, of a patient with non-fluent aphasia following an intracerebral haemorrhage. Overall, treatment adherence based on the operator's assessments was high, and incomplete adherence for technical problems occurred very rarely. In line with the patient's feedback, acceptability was also positive, since he was constantly motivated during the sessions and the exercises performed autonomously, as confirmed by the speech therapist and caregiver, respectively. Moreover, despite the sequelae from the cerebrovascular event, evident in some writing tests due to the motor deficits in his right arm and the disadvantages typical of all telepractices, more relevant results were achieved during the telerehabilitation period compared to those of the "face-to-face" therapy before the COVID-19 outbreak. The telespeech therapy performed can be considered successful and the patient was able to return to work. Concluding, we support it as a feasible approach offering patients and their families the opportunity to continue the speech and language rehabilitation pathway, even at the time of pandemic.

The impact of COVID-19 confinement on the neurobehavioral manifestations of people with Major Neurocognitive Disorder and on the level of burden of their caregivers

The long-term consequences of confinement at home due to the COVID-19 pandemic are not yet known;however, an exacerbation of the neurobehavioral symptoms of patients with dementia and an increase in their caregiver burden are conceivable. The aims of this study were to investigate any changes in the neuropsychiatric symptoms of patients with Major Neurocognitive Disorder as well as in the levels of burden and distress of their caregivers due to COVID-19 confinement, and to detect any relationship between the changes in patients and their caregivers. A "pre-post" study was carried out by means of a semi-structured telephone interview, which was administered to 128 caregivers of patients with dementia. The interview included patient and caregiver demographic information, the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the Caregiver Burden Inventory (CBI). Results showed an increased risk for burning out of caregivers by about 10%. Statistically significant differences were found between the conditions prior to lockdown (pre-lockdown) and during lockdown in both the CBI and the NPI-Q distress scale. Neuropsychiatric symptoms in patients with dementia significantly increased as well. Results have a practical implication for the organization of public and private support services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Telephone-Based Reality Orientation Therapy for Patients With Dementia: A Pilot Study During the COVID-19 Outbreak.

IMPORTANCE: When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. OBJECTIVE: To determine whether telephone-based reality orientation therapy (T-ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T-ROT can relieve the burden of distress among their caregivers. DESIGN: Nonrandomized interventional comparison study. SETTING: Individual telephone calls between practitioners and patients and their caregivers. PARTICIPANTS: Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. INTERVENTION: Ten T-ROT sessions and a pretest-posttest neuropsychological evaluation over 4 wk. OUTCOMES AND MEASURES: Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. RESULTS: T-ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. CONCLUSIONS AND RELEVANCE: T-ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. WHAT THIS ARTICLE ADDS: Occupational therapy practitioners can use T-ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.