"Gerald's" Story
Gerald is a retired mill worker who survived a right hemisphere stroke. He has a history of respiratory disease and has difficulty swallowing as a result of the stroke. He currently lives with his wife, who is legally blind, in an assisted living facility. His home care speech-language pathologist recommended a modified texture diet to compensate for swallowing challenges, as well as a series of strengthening exercises to improve swallowing function. Gerald was aware of his swallowing challenges and motivated to improve his safe swallowing abilities; however, his ability to recall, initiate, and follow-through with home swallowing exercises is limited due to cognitive challenges from the stroke. His wife reported feeling overwhelmed with managing Gerald’s medications and physical needs; she reported that Gerald did not always follow her suggestions to complete therapy exercises. Gerald and his wife left the assisted living facility occasionally for shopping, short outings, or medical appointments. They ate their meals in the dining room with other residents, and otherwise spent most of their time in their apartment.

Our solution was a TAP system. A customized home therapy program was designed in consultation with Gerald’s speech-language pathologist, who recommended a set of four swallow strengthening exercises to be completed three times each day. The TAP system automatically turned on the television at times selected by Gerald and his wife, to accommodate their schedules and TV watching habits. Gerald provided input on music choices (country-western music) that would motivate him to complete exercises. We further customized the system to provide longer pauses in which Gerald could complete each exercise, since his movements were slow and difficult to initiate; further, we provided periodic auditory and on-screen visual reminders to complete exercises since Gerald easily forgot what he was supposed to be doing. We compared adherence to the home swallowing therapy program between TAP days and “typical practice” days (i.e., Gerald’s wife would remind him to follow a written worksheet to complete exercises). Data showed that Gerald was six-times more likely to complete exercises when prompted by the TAP system compared to typical practice. In addition, he completed exercises with improved technique when provided multi-media instructions on the television compared to following his worksheet in typical practice. Gerald and his wife both highly endorsed the TAP system for providing motivating, individualized reminders that improved Gerald’s independence with his home therapy program and also helped decrease his wife's burden.

"Serena’s" Story
Serena is a young woman who survived an anoxic event due to cardiac disease. She lives with her husband in their own home, and they have family and paid support assistance on several weekdays. Serena has severe memory challenges, and relies on external prompts from her family and care providers to complete daily tasks. She participated in cognitive rehabilitation, where she learned to maintain a written planner and log book to track daily activities. She and her family are hopeful to improve Serena’s independence on daily tasks and engage her more in community activities. Serena maintains a fairly regular routine most days, and is attempting to learn this routine so it becomes automatic.

Our solution was a TAP system. Our staff met with Serena and her family to determine her unique needs and preferences. We mapped out her daily routine for weekdays; Serena assisted with generating wording and content for reminders that would be both clear and motivating. We created the customized reminders that included printed text on the screen, auditory content to assist with comprehension, and pictures to motivate her to complete various tasks. Although there were initial challenges with setting up the system due to the wireless Internet connection, our on-call helpdesk staff promptly remedied the problem. Serena quickly learned to interact with the TAP system using the four-button remote control. Another challenge that arose was to ensure Serena hears the morning wake-up prompt. The television is in the living room, and she does not hear the wake-up prompt in her bedroom. One solution has been to encourage her to sleep on the couch after her husband leaves earlier in the morning. Another solution would be to connect the TAP system to their home stereo system so that auditory content would be broadcast throughout the house. A third solution, which we are in the process of assessing, would be to train their newly acquired dog to wake-up Serena by having the TAP system prompt their dog (using the trainer's voice)! We are excited to attempt this solution. Currently, Serena is becoming much more independent with her use of the TAP system – she has been initiating, completing, and logging daily activities in her notebook without prompts from care providers. Serena endorses the TAP system as effective, and has provided additional feedback to help customize content to her personal preferences.