With a Canadian Stroke Best Practices Standard of three hours per day of task specific therapy, hospitals and clinics are challenged with finding innovative and cost effective ways to hit this target. StrokeLink is a mobile application that allows therapists to build and modify therapy programs for patients to use independently to increase practice time. For more information visit www.strokelink.ca and check out our stroke rehab app.

1. Morgan Moe
Intensity Matters: Using the iPad
to Guide Independent Practice

2. 1. Why Intensity and practice
matters
2. How to streamline exercise
prescription, engage patients
and monitor adherence using
StrokeLink
3. Strategies to successfully
implement mobile
technology at your hospital
or clinic
Objectives

3. I am the founder and CIO of a private
company Talem Health Solutions which has
produced the StrokeLink software.
Conflict of Interest

4. • BSc Kinesiology ( U of C)
– Volunteered with Stroke & ABI
– Practicum involving GRASP
• Entrepreneurship (U of T)
– Crash course on business and
technology innovation
• Founded Talem Health
Solutions in 2012
Morgan Moe

5. Definition: Amount of therapy completed in a
specified time. Ex minutes/day, hours/week, etc.
According to the Canadian Stroke Best Practices
“Stroke patients should receive, through an
individualized treatment plan, a minimum of 3 hours
of direct task-specific therapy by the inter-professional
stroke team for a minimum of 5 days per week.”
Therapy Intensity

6. • Kalra and Langhorne (2007) suggest that “there is
evidence from neuroimaging studies showing that
increased intensity of rehabilitation therapies
results in greater activation of areas associated with
the function towards which this therapy is directed”.
• The greater the intensity of therapies the better the
outcomes (PT, OT, SLP, treadmill and U/E)
Why Intensity Matters

7. • Currently in Ontario there is an estimate of 1.5-2 hours of
direct patient-therapist time/day
Evidence Based Review of Stroke Rehabilitation
• De Wit et al. (2005) - Patients from Germany spent a larger
percentage of the day in therapy time (23.4%), while those
from the UK spent the least (10.1%). Therapy time ranged
from 1 hour per day in the UK to about 3 hours per day in
Switzerland.
• Bernhardrt et al. 2004, 2007 - A Very Early Rehabilitation Trial
(AVERT) which a cohort of 58 patients in 5 acute stroke units
in Australia were observed. Patients engaged in moderate or
high levels of activity for only 12.8% of their therapeutic day.
Status Quo

8. • Family facilitated
therapy
• Volunteer Facilitated
therapy
• Computer/Tablet
facilitated Therapy
Provision of evening and
weekend therapy ?
Strategies to Increase Intensity

9. Caregivers can assist in increasing the therapeutic
intensity of treatments
• Haris, Eng, et al. (2012) suggest that those who had
caregiver assistance with GRASP had better
outcomes (regardless of starting impairment) and
completed more hours of GRASP than those without
caregiver assistance.
Family Involvement

10. The Association for the Rehabilitation of the Brain
Injured (ARBI), Calgary AB
• Therapists assess patients and develop therapy
programs to be implemented by volunteers under
the supervision of therapy staff.
• Win-Win Model for therapy
Volunteer Involvement

11. Thousands of apps and computer programs are
available and have valuable therapeutic benefits.
• TOStroke.com
• TherapyApp411.com
• GeekSLP.com
• StrokeLink.ca
• ….Google is your friend 
Advantages of Technology

12. Why I Developed StrokeLink

13. StrokeLink
Our mission is to empower stroke survivors and their family members
throughout their care journey by providing knowledge and self-care
tools to help regain their independence.

17. StrokeLink Capture
Modify existing programs
Add/Remove Exercises
• Change instructions
• Add new media
Create programs from Scratch
Add/Remove Exercises
• Add Photos
• Add Videos
• Record Audio
• Write Instructions

20. Why Use StrokeLink Capture
1) Easy to use!
2) Enhanced understanding of exercises
3) Easily communicate patients specific modifications
4) Ability to modify over time

21. Alternatives: Force Therapeutics

22. Alternatives: Exercise Pro Live

23. Alternatives: PacPacs+

24. • Who should pay for it?
• What about theft protection?
• Is it sanitary to have people share iPads?
• What about access to internet?
• Is patient information secure?
• Are iPads for patients or are they for
therapists?
• What happens when patients leave the
hospital?
• How can we keep up with all the
changes?
• How can we prevent abuse?
• I don’t know how to use an iPad, how can
I possibly adopt it for patient use!?
Top Questions About Mobile

25. Do not be afraid of the technology!
Strategies for Success

26. Just like any medication you prescribe or therapy
technique you employ, you must know how it
works, when to use it and for whom it is
appropriate.
Strategies for Success

27. Involve all major stakeholders in making the decisions
on when and how technology should be
implemented.
Strategies for Success

28. Don’t rewrite the book. Steal strategies and tools
that have worked well for other organizations.
Strategies for Success

29. Recognize that you will have your own unique
challenges. Strategize with respect to your existing
environment and workflows to avoid unnecessary
behavior change.
Strategies for Success

30. Think Lean
Strategies for Success