Stroke survivors residing in rural areas experience significant difficulties obtaining much needed rehabilitation care despite having insurance and a usual source of care. In rural eastern NC specifically, access to rehabilitation care is significantly impacted by a lack of qualified and experienced service providers in the region. Telemedicine is an approach that has been used successfully to treat acute stroke in rural NC by matching patients who seek care in small rural hospital with stroke specialists at distant facilities. Substantial efforts have emerged to address access to and utilization of traditional primary care for chronic disease via telemedicine approaches. Unfortunately, less progress has been made in utilizing this approach for rehabilitation care. For stroke specifically, telemedicine has been used to treat acute stroke events among patients in rural communities by matching them with stroke specialists with patients in distant rural facilities. To date, the same approaches have not been used to improve access to post-stroke rehabilitation care for these same patients. This project has been designed to address the need for post-stroke rehabilitation that exists in access to and utilization of post-stroke rehabilitation among stroke survivors in rural communities. The objectives of this project will be achieved by the completion of the following specific aims:
Aim 1 : To evaluate the feasibility of using a telerehabilitation approach in rural eastern NC to treat aphasia among stroke survivors. Procedures:
For Aim 1 : Measures of recruitment success, advancement from training to telerehabilitation treatment, patient adherence and retention will be completed to determine feasibility a speech telerehabilitation treatment designed for stroke survivors residing in rural areas.
Aim 2 : To evaluate the acceptability, credibility and satisfaction of using a telerehabilitation approach in rural eastern NC to treat aphasia among stroke survivors. Procedures:
For Aim 2 : Measures of acceptability, credibility and satisfaction scales will be completed following a speech telerehabilitation treatment designed for stroke survivors residing in rural areas. It is expected that this project will provide critical information about: 1) the feasibility, acceptability, credibility and satisfaction with a telerehabilitation therapy approach for aphasia treatment administered to rural residents of eastern NC. The long-term goals of this project are to develop a therapeutic protocol for this stroke population who suffer from the availability of qualified Speech-Language Pathologists in the region. Lastly, this proposal will provide preliminary data to use for larger scale studies of telerehabilitation for aphasia to provide a bridge between rural residents and the treatments they need.
Understanding the feasibility of a speech telerehabilitation program for stroke patients with aphasia residing in rural areas is a critical first step in identifying the necessary advances to improve access to care for rural residing patients. The information that will be obtained from this study will serve as a basis for understanding novel approaches to speech-language pathology service provision for patients in rural areas.
