Tuesday, 17 September 2019
The World Health Organization is preparing a Global Report on Assistive Technology, to be published in 2021. In order to prepare this report a large international consultation meeting was organised in Geneva on August 22-23. Here, about 300 people from across the world gathered to discuss topics that would need to be addressed in the global report. Colleagues from CATCH were involved in 4 of the 70 presentation during these days. The contributions from Sheffield were about a generic quality framework for Assistive Technology service delivery, models for AT provision in low resource settings, a tool to assess environmental factors affecting the use of assistive devices in very low resource settings and so-called 'frugal innovation' and do-it-yourself assistive technology solutions. In the next months the outline of the world report will be defined. The topics addressed by CATCH researchers will certainly get a place in the report. For more information about the WHO GREAT Consultation click here
Thursday, 12 September 2019
Big CACTUS Paper Published in The Lancet Neurology
'Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial' the paper reports findings from our 5 year RCT into self managed computer therapy for people with aphasia post stroke.
Post-stroke aphasia might improve over many years with speech and language therapy; however speech and language therapy is often less readily available beyond a few months after stroke. We assessed self-managed computerised speech and language therapy (CSLT) as a means of providing more therapy than patients can access through usual care alone.
In this pragmatic, superiority, three-arm, individually randomised, single-blind, parallel group trial, patients were recruited from 21 speech and language therapy departments in the UK. Participants were aged 18 years or older and had been diagnosed with aphasia post-stroke at least 4 months before randomisation; they were excluded if they had another premorbid speech and language disorder caused by a neurological deficit other than stroke, required treatment in a language other than English, or if they were currently using computer-based word-finding speech therapy. Participants were randomly assigned (1:1:1) to either 6 months of usual care (usual care group), daily self-managed CSLT plus usual care (CSLT group), or attention control plus usual care (attention control group) with the use of computer-generated stratified blocked randomisation (randomly ordered blocks of sizes three and six, stratified by site and severity of word finding at baseline based on CAT Naming Objects test scores). Only the outcome assessors and trial statistician were masked to the treatment allocation. The speech and language therapists who were doing the outcome assessments were different from those informing participants about which group they were assigned to and from those delivering all interventions. The statistician responsible for generating the randomisation schedule was separate from those doing the analysis. Co-primary outcomes were the change in ability to retrieve personally relevant words in a picture naming test (with 10% mean difference in change considered a priori as clinically meaningful) and the change in functional communication ability measured by masked ratings of video-recorded conversations, with the use of Therapy Outcome Measures (TOMs), between baseline and 6 months after randomisation (with a standardised mean difference in change of 0·45 considered a priori as clinically meaningful). Primary analysis was based on the modified intention-to-treat (mITT) population, which included randomly assigned patients who gave informed consent and excluded those without 6-month outcome measures. Safety analysis included all participants. This trial has been completed and was registered with the ISRCTN, number ISRCTN68798818.
From Oct 20, 2014, to Aug 18, 2016, 818 patients were assessed for eligibility, of which 278 (34%) participants were randomly assigned (101 [36%] to the usual care group; 97 [35%] to the CSLT group; 80 [29%] to the attention control group). 86 patients in the usual care group, 83 in the CSLT group, and 71 in the attention control group contributed to the mITT. Mean word finding improvements were 1·1% (SD 11·2) in the usual care group, 16·4% (15·3) in the CSLT group, and 2·4% (8·8) in the attention control group. Word finding improvement was 16·2% (95% CI 12·7 to 19·6; p<0·0001) higher in the CSLT group than in the usual care group and was 14·4% (10·8 to 18·1) higher than in the attention control group. Mean changes in TOMs were 0·05 (SD 0·59) in the usual care group (n=84), 0·04 (0·58) in the CSLT group (n=81), and 0·10 (0·61) in the attention control group (n=68); the mean difference in change between the CSLT and usual care groups was –0·03 (–0·21 to 0·14; p=0·709) and between the CSLT and attention control groups was –0·01 (–0·20 to 0·18). The incidence of serious adverse events per year were rare with 0·23 events in the usual care group, 0·11 in the CSLT group, and 0·16 in the attention control group. 40 (89%) of 45 serious adverse events were unrelated to trial activity and the remaining five (11%) of 45 serious adverse events were classified as unlikely to be related to trial activity.
CSLT plus usual care resulted in a clinically significant improvement in personally relevant word finding but did not result in an improvement in conversation. Future studies should explore ways to generalise new vocabulary to conversation for patients with chronic aphasia post-stroke.
National Institute for Health Research, Tavistock Trust for Aphasia.
Read the full article published by the Lancet.
Monday, 2 September 2019
Understanding the care and support needs of older people:
a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF)
One of our PhD students Sarah Abdi published an article recently in BMC Geriatrics. Read the abstract and more below.
AbstractBackground: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people.
Methods: A scoping review was conducted, using the Arksey and O’Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings.
Results: Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers.
Conclusions: The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people.
Read the full article here: https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-019-1189-9
Tuesday, 27 August 2019
Our colleagues Lauren Powell and Jack Parker have recently had an article published entitled 'Using Recurrent Neural Networks to Compare Movement Patterns in ADHD and Normally Developing Children Based on Acceleration Signals from the Wrist and Ankle'.
Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects, among other things, the movement patterns of children suffering it. Inattention, hyperactivity and impulsive behaviors, major symptoms characterizing ADHD, result not only in differences in the activity levels but also in the activity patterns themselves. This paper proposes and trains a Recurrent Neural Network (RNN) to characterize the moment patterns for normally developing children and uses the trained RNN in order to assess differences in the movement patterns from children with ADHD. Each child is monitored for 24 consecutive hours, in a normal school day, wearing 4 tri-axial accelerometers (one at each wrist and ankle). The results for both medicated and non-medicated children with ADHD, and for different activity levels are presented. While the movement patterns for non-medicated ADHD diagnosed participants showed higher differences as compared to those of normally developing participants, those differences were only statistically significant for medium intensity movements. On the other hand, the medicated ADHD participants showed statistically different behavior for low intensity movements.
Read the full article here: https://www.mdpi.com/1424-8220/19/13/2935/htm
Monday, 12 August 2019
New York, New York! Professor Luc de Witte attends the United Nations Convention on the Rights of Persons with Disabilities
Our colleague Luc de Witte participated in the COSP12 conference at the United Nations Headquarters in New York. COSP is the annual conference of States Parties to the CRPD, the Convention on the Rights of Persons with Disabilities. Here is a short report of his experiences at the conferences.
More than 400 people from all over the world, representing the 177 countries that have ratified the Convention on the Rights of Persons with Disabilities, gather in the main building of the United Nations to discuss the progress of implementing the CRPD. I was invited to speak during a session about “Artificial Intelligence and the potential to increase inclusion, participation and independence for people with disabilities”. Other speakers were from EDF (European Disability Forum), ITU (International Telecommunication Union), Microsoft, the European Commission, the Essl foundation and the Austrian Association in Support of the Blind and Visually Impaired.
Walking around amidst this large international group you wonder why we still have problems with the position of people with disabilities in the world. So many active and highly motivated people, so many great solutions readily available, so many great ideas about how policy should develop, and yet people with disabilities are still marginalised and do not have equal opportunities in education, work and independence in many parts of the world. It is motivating and frustrating at the same time. What this event also clearly shows is the need for research and development in this field, as CATCH tries to do. There is so much more that needs to be done…..
In the above mentioned session about AI we had a very interesting discussion about the great potential of Artificial Intelligence to support people with disabilities on the one hand, and huge risks of exclusion and violation of human rights on the other hand. Positive examples were the use of an avatar for sign language translation, an app that translates texts into easy readable text, virtual reality applications for people with dyslexia to help them focus and several others. Negative examples were AI systems used in the selection process of job candidates that are intrinsically biased towards the ‘ideal’ and ‘normal’ person and widely used speech recognition that does not properly recognise ‘abnormal’ speech. These examples show that AI can be a fantastic friend but also a dangerous enemy. This clearly is a field that requires much research to make sure that we steer applications in the right direction.
The rest of the conference I immersed myself in a range of meetings about very different topics related to technology and disability. There was a lot of attention for inclusive education and inclusion in sports, leisure and culture. However, whilst there are many solutions and approaches that can make a difference, there are also many challenges to make these solutions work in reality. I can only recommend everyone in this field to do this at least once. Participating in this event offers a strong compass and motivation for everyone who works in this field.
Luc de Witte
Wednesday, 7 August 2019
This week we are sharing the final instalment on the success of the THAW project and those who gained their PhD through their excellent work on the project.
The Second THAW PhD project focused on loneliness and social isolation of older people and was undertaken by myself. When the THAW project began, little did I know how loneliness and social isolation would race up the policy agenda in the UK. Loneliness and social isolation have become a ‘hot topic’. Although research into loneliness had been on-going since the 1940s in the UK, the death of MP Jo Cox in June 2016, who campaigned to end loneliness, saw cross-party agreement in the UK Parliament to tackle the issue in honour of her memory. In October 2018, the UK Government published its first loneliness strategy A connected society: A strategy for tackling loneliness – laying the foundations for change.
Dr David Clayton discusses his experience of the project and completing his PhD here at CATCH Sheffield:
Within this strategy is an aim to harness the power of digital tools to connect people. The research I undertook directly addressed the issues faced by older people in this respect. It started with a central concern of a ‘loneliness paradox’ where despite the greater opportunities that exist for social contact using new digital technologies, loneliness appears to persist among older people. In order to address this concerned, I decided to undertake a multi-method study which explored how older people used new technologies to help with loneliness, how they felt about using the technology, what difference it made to them, and what their experience of loneliness was in the context of increasing use of new technology. Older people were defined as those 65 and over and new technologies were defined as computers, laptops, smartphones and tablets that combine both personal and mass broadcast communication.
The fieldwork was undertaken between November 2015 and May 2016 using a purposive sampling procedure and older people were recruited by working with local charities, peer groups and social care organisations in the East Midlands of the UK. This included both urban and rural areas. I undertook visits to day services, lunch clubs, social groups and residential care homes to speak to older people about their experiences of using new technologies. My multi-methods approach involved a self-completion survey (both paper or online) and semi-structured interviews. The study found that new technologies were used by older people in new and positive ways to make social contact, but this technological contact did not always help with loneliness. Further exploration of the experiences of loneliness highlighted understanding loneliness and the use of new technologies in a multidimensional way through the idea of four loneliness modes (existential, comparison, loss and alienation) and three strategies for utilising new technologies based on social contact, distraction and therapeutic use.
I finished the project in August 2018 and successfully defended my PhD thesis in February 2019. I am currently working to publish some of the findings. The impact of this study has however gone beyond the academic world. I presented some of my findings to one of the charities who supported his work; Enrych: Looking Beyond Disability, at an event to celebrate their 30th Anniversary. The charity has recently won funding from the National Lottery Community Fund to run a support service which can help older and disabled people get online and connect with family and friends (www.enrych.org.uk). Their bid included data taken from my PhD thesis. I am pleased that my research has been able to support this bid and as a result will make an impact on the lives of older people in this area.
Tuesday, 30 July 2019
This week we will be continuing to reflect on the success of the THAW project and those who gained their PhD through their excellent work on the project.
My project concerned the delivery of psychotherapeutic interventions for mild to moderate stress,
Dr Matthew Bennion discusses his experience of the project and completing his PhD here at CATCH Sheffield:
anxiety and depression via digital platforms known as e-therapies. More specifically, it concerned
the use of e-therapies by older adults, a sector of the population hitherto neglected both in the
design of e-therapies and in research of this nature. The primary aim of the work was to explore
ways in which the user interface of an e-therapy could be enhanced to improve usability for and
promote acceptability by older adults, and hence improve access to this mode of therapy for this
particular service user group. Secondary aims were to examine whether perceived usability is
associated with other factors that influence the delivery of therapy such as credibility, pre-
expectancy and the therapeutic relationship. Phase one, comprising two surveys and a meta-
analysis, mapped the landscape of contemporary e-therapy use within NHS England in order to
determine: what e-therapies are used; what evidence exists for them; and whether they are suitable
for older adults. Findings indicated that e-therapies used in the NHS are broadly effective, but they
are less effective with age, and there is a dearth of research on their use in older adults. Following
on from this, phase two, comprising three empirical studies, investigated: the relationship between
usability and expectancies and acceptability of e-therapies, in older adults. Findings indicated that
the perceived therapeutic relationship older adults formed with the e-therapy was related to the e-
therapy’s usability, suggesting that usability is an important factor in e-therapy design that requires
further research attention.
My PhD research has enabled me to influence or participate in a number of projects relating to the
NHS’s digital implementation strategy such as:
- Being part of NHS England’s Digital Innovation and Adoption in Psychological Therapies Expert Reference Group.
- Contributing towards the Topol review through an NHS Topol review Workshop
- Helping the NICE IAPT assessment programme to gain a better understanding of the currentdigital therapy landscape in IAPT and the NHS through publication.
- Assessing a number of the health apps for the NHS App library via Our Mobile Health’s evaluation framework.
“ AVACHAT ” an artificially intelligent virtual agent developed using co-design to support the self-
management in individuals with complex physical comorbidities. It has also given me the
opportunity to be involved in a winning NewMinds funding bid to develop an AI Empathy Agent .
Finally working as part of THAW has equipped me with an array of additional skills that will assist me in future projects.
I'm extremely proud to have passed my PhD. As a Dyslexic I found the process of writing difficult but never gave up. I hope my success will inspire others with learning difficulties to do the same. It's
also been fantastic to see my work aiding decision making regarding digital mental health therapies
at both NICE and NHS England. I am currently working a twelve-month contract at University
Hospitals Birmingham working on their health data system. In the near future I hope to bridge my
work within the hospital with innovation and research to build digital interventions that I believe
could be potential game changers within the NHS.
Thursday, 25 July 2019
THAW Project Success: Dr Jacob Andrews
Over the next few weeks we will be looking back on the success of the THAW project and those who gained their PhD through their excellent work on the project.
Dr Jacob Andrews discusses his experience of the project and completing his PhD here at CATCH Sheffield:
In 2014, I was selected to be one of three new PhD students in an interdisciplinary network entitled ‘THAW’ (Technology for Health Ageing and Wellbeing). The network was designed to explore technology and mental health in older adults from a number of different angles.
My project involved exploring how machine learning might be used in digital technologies to predict the likelihood of a user developing a mental health condition. To do so, I began by using existing data to train a machine learning algorithm to predict depression based on mood reports made by older adults using digital devices. This work was published in the Journal of Affective Disorders, where it available to read via Open Access (read the article here). I also explored how and why older adults might interact with technologies for the purpose of supporting mental health, and this work has also been published in an open access publication. Lastly, I interviewed healthcare staff across secondary care to look at the potential for implementing predictive technologies in care pathways. This gave me an appreciation of some of the complexity involved in implementing technology in healthcare pathways.
Working as one member of an interdisciplinary network within THAW allowed me to have frank and interesting discussions with students from other disciplines, permitting me to gain a greater understanding of different ontological positions, and helped me to appreciate how approaches taken in different disciplines can complement each other to address a wider problem. Together, we organised and conducted two very successful events at which we engaged key stakeholders in the field of older adults’ mental health (healthcare professionals, older adults, and representatives from charities and industry), to open conversations around how technology might help or hinder late life mental health. We listened to the views of representatives at these events and allowed their input to guide the research we conducted during our PhDs.
Being a member of CATCH during my PhD granted me many exciting opportunities to get involved in projects and experiences in peripheral areas of interest. This included a visit to Sheffield University’s Medical Advanced Manufacturing Research Centre (AMRC), where I was shown the state-of the-art machinery used to prototype new forms of medical implant. Through CATCH’s connection to ScHARR, I was able to take part in the PhD Intensive Clinical Experience, where I met with patients who had lived experience of a variety of conditions, including mental health conditions. I was also able to study modules from ScHARR’s renowned masters programmes, and thereby hone important research skills. I also took the opportunity to contribute to postgraduate life in ScHARR, by standing as departmental and faculty student representative, and by setting up a short series of peer-led seminars for postgraduate students to share skills they had gained with other students.
Following on from my PhD, my close connections with staff members in CATCH led to my involvement in an interesting project relating to the Internet of Things, as well as involvement on a project with a local mental health charity. It also allowed me to be a key member of the TechnoTherapies Special Interest Group.
The THAW experience has provided me with a wide range of skills and experiences which will undoubtedly be of benefit in my future career. Currently I am working on a postdoc position in the Department of Sociological Studies relating to self-tracking. I am certain that moving forward my experience of interdisciplinary working as part of THAW will allow me to approach healthcare problems with a deeper understanding of the issues at hand, and a good knowledge of the different approaches that could be used to solve them.
Tuesday, 18 June 2019
New Publication: e-Therapies in England for stress, anxiety or depression: how are apps developed? A survey of NHS e-therapy developers
One of our recent PhD graduates Matthew Bennion has recently had this paper published, read the abstract and more below!
Objective To document the quality of web and smartphone apps used and recommended for stress, anxiety or depression by examining the manner in which they were developed.
Design The study was conducted using a survey sent to developers of National Health Service (NHS) e-therapies.
Data sources Data were collected via a survey sent out to NHS e-therapy developers during October 2015 and review of development company websites during October 2015.
Data collection/extraction methods Data were compiled from responses to the survey and development company websites of the NHS e-therapies developers.
Results A total of 36 (76.6%) out of the 48 app developers responded. One app was excluded due to its contact details and developer website being unidentifiable. Data from the missing 10 was determined from the app developer’s website. The results were that 12 out of 13 web apps and 20 out of 34 smartphone apps had clinical involvement in their development. Nine out of 13 web apps and nine out of 34 smartphone apps indicated academic involvement in their development. Twelve out of 13 web apps and nine out of 34 smartphone apps indicated published research evidence relating to their app. Ten out of 13 web apps and 10 out of 34 smartphone apps indicated having other evidence relating to their app. Nine out of 13 web apps and 19 out of 34 smartphone apps indicated having a psychological approach or theory behind their app.
Conclusions As an increasing number of developers are looking to produce e-therapies for the NHS it is essential they apply clinical and academic best practices to ensure the creation of safe and effective apps.
Read the article in full here: https://informatics.bmj.com/content/26/1/e100027
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/