Participatory Development of a Speech-Language Telerehabilitation Intervention Combined With Home-Based Transcranial Direct Current Stimulation for Primary Progressive Aphasia: A Qualitative Study.

Purpose: Intensive speech-language therapy (SLT) delivered as telerehabilitation in combination with transcranial direct current stimulation (tDCS) may be an effective treatment option for people with primary progressive aphasia (pwPPA). However, such combined treatment approaches are technically challenging, and feasibility for pwPPA has not yet been established. We aimed to involve stakeholders in the development of a novel approach combining remotely supervised but independently self-administered home-based tDCS with an intensive aphasia telerehabilitation (naming and communicative-pragmatic therapy).

Method: Eight pwPPA (logopenic variant: n = 5, nonfluent agrammatic variant: n = 1, not specified variant: n = 2) and 16 caregivers participated in two semistructured interviews to identify the needs, preferences, and perceived barriers and challenges with regard to SLT, telerehabilitation, and tDCS and the combination of all components. Based on the results, a step-by-step manual was developed and tested by means of home-based usability tests and follow-up interviews involving four dyads (logopenic variant: n = 4). Interview data were transcribed and analyzed qualitatively and quantitatively. Competency checklists used in the usability tests were analyzed quantitatively.

Results: pwPPA and their caregivers provided valuable insights into all aspects of the planned treatment program. Overall, the findings suggest a high level of acceptance and perceived need for an intensive telerehabilitation SLT approach combined with tDCS. Using the developed step-by-step manual and training, pwPPA were able to independently perform more than half of the actions required for telerehabilitation but needed assistance with technically more demanding aspects of tDCS. To ensure feasibility, caregiver assistance is needed to support pwPPA during technically challenging interventions.

Conclusions: This mixed-methods study identified needs and preferences of pwPPA and their caregivers with regard to speech-language telerehabilitation, as well as barriers and challenges regarding telerehabilitation and home-based tDCS. We demonstrate high acceptability and initial feasibility of such combined programs. Our findings highlight the importance of stakeholder involvement in intervention development, which will inform future development and optimization of technologically demanding intervention programs.

Supplemental material: https://doi.org/10.23641/asha.29906063.