July 15, 2025

Episode 130: A tool for sneaky good interprofessional learning and collaboration: In Conversation with Hillary Sample and Dr. Steven Richman

54 minutes

Take aways:

Learn about Hilary and Steve’s journey to enhance care for people with aphasia.
Learn about communication access as a health equity issue.
Identify systematic gaps and the disconnect between training and real world needs of people with aphasia.
Learn about the development of the MedConcerns app.
Get sneaky! Learn how the MedConcerns app can serve four functions simultaneously: 1) meeting the needs of someone with aphasia 2) serving as a tool that providers can use to communicate with people with aphasia 3) providing education to providers who learn about aphasia as they use the app 4) bringing SLPs and other providers together to meet the needs of people with aphasia

Welcome to the Aphasia Access Conversations Podcast. I'm Jerry Hoepner. I'm a professor at the University of Wisconsin – Eau Claire and co-facilitator of the Chippewa Valley Aphasia Camp, Blugold Brain Injury Group, Mayo Brain Injury Group, Young Person’s Brain Injury Group, and Thursday Night Poets.

I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources.

I’m today’s host for an episode that will feature Hilary Sample and Dr. Steven Richman to discuss their app, MedConcerns. We’re really excited to share this with you, so I’ll jump into introducing them.

Hilary G. Sample, MA, CCC-SLP

Hilary is a speech-language pathologist, educator, and co-creator of MedConcerns, a communication support app that helps people with aphasia express medical concerns and participate more fully in their care. The app was born out of her work in inpatient rehabilitation, where she saw firsthand how often individuals with communication challenges struggled to share urgent medical needs. Recognizing that most providers lacked the tools to support these conversations, she partnered with physician Dr. Steven Richman to create a practical, accessible solution. Hilary also serves as an adjunct instructor at Cleveland State University.

Steven Leeds Richman, MD

Dr. Steven Richman is a hospitalist physician and co-creator of MedConcerns, a communication support app that helps people with aphasia express medical concerns and participate more fully in their care. With nearly two decades of experience in inpatient rehabilitation, he saw how often communication barriers prevented patients from being heard.

In partnership with speech-language pathologist Hilary Sample, he helped translate core medical assessments into an accessible tool that supports clearer, more effective provider-patient communication.

Transcript:

(Please note that this conversation has been auto-transcribed. While we do our best to review the text for accuracy, there may be some minor errors. Thanks for your understanding.)

Jerry Hoepner: Well, Hello, Hillary and Steve. Really happy to have you on this aphasia access conversations podcast. With me, I'm really looking forward to this conversation. It's maybe a year or 2 in the making, because I think this was at the previous Aphasia Access Leadership Summit in North Carolina. That we initially had some discussions about this work. And then life happens right? So really glad to be having this conversation today.

Hilary Sample: And we’re really glad to be here.

Jerry Hoepner: Absolutely. Maybe I'll start out just asking a little bit about your background, Hillary, in terms of how you connected with the life participation approach and aphasia access and how that relates to your personal story.

Hilary Sample: Sure, so I haven't been in the field long. I graduated in 2019 and began my career immediately in inpatient rehab. I have to remember. It's talk slow day, and I'm going to make sure that I apply that as I speak, both for me and for listeners. So I began on the stroke unit, primarily in an inpatient rehab setting, and I've worked there for the majority of my career. I came in as many, probably in our field do, trained and educated in more of an impairment based approach but quickly when you work with people, and they let you know who they are and what they need. The people that I worked with on the stroke unit, the people with aphasia let me know that they needed more of a life participation approach. You know I learned how vital it was to support communication and to help him, you know, help them access their lives, because most of the time I entered the room. They had something they wanted to communicate, and they had been waiting for someone who had those skills to support communication in order to get that message across. So it wasn't about drills it was about. It was about helping them to communicate with the world, so that I spent more and more time just trying to develop my own skills so that I could be that professional for them and that support. And then that took me. You know that it just became my passion, and I have a lot of room to improve still today, but it's definitely where my interest lies and at the same time I noticed that in general in our hospital there was a lack of communication supports used, and so I thought that in investing in my own education and training, I could help others as well. And so I started doing some program development to that end as well with training and education for healthcare staff.

Jerry Hoepner: I just love the fact. And actually, our listeners will love the fact that it was patients who connected with you, people with aphasia, who connected with you and encouraged you to move towards the life participation approach, and how you learn together and how that's become your passion. That's just a really great outcome when people can advocate for themselves in that way. That's fantastic.

Hilary Sample: Yeah, it really meant a lot to me to be able to receive that guidance and know that, you know there's an interest in helping them to let you know what they want from therapy, and that was there. But a lot of times the selections were impairment based, and then we. But there was something wrong, and we needed to uncover that. And that was, you know, that was the push I needed to be able to better support them.

Jerry Hoepner: Yeah, that's really great, Steve. I'm interested in your story, too. And also how you came to connect with Hillary.

Steve: I started as a trained as a family physician, had a regular outpatient office for a number of years, and then transitioned into inpatient rehab. That's where I really started to meet some people with aphasia. For the 1st time. Hilary and I have talked a few times about my training and education about aphasia before we met each other, and it was really minimal in Med school. They had lectures about stroke and brain injury, and some of the adverse effects you might get from that. And they, I'm sure, mentioned aphasia. But I really don't recall any details, and if they did teach us more, it would just nothing that I grasped at the time. So I would walk into these patient rooms, and what I would normally do for my trainings. I would ask people all these open, ended questions to start with, and then try to narrow down, to figure out what their problems are, and with people with aphasia, especially when they have minimal or no language skills. They couldn't. I was not successful at getting useful information out, and I remember walking out of those patient rooms and just being frustrated with myself that I'm not able to help these people, and the way I can help everyone else, because if I don't know what's going on. you know. How can I? It was really challenging and I really didn't know where to go. I talked to a few other doctors, and there didn't seem to be much in the way of good information about how to move forward. Eventually I met Hillary, and we would have these interesting episodes where I would talk or try to talk with the patients and get minimal, useful information. And Hillary would come back and say, they're having this problem and this concern. And with this medicine change. And how do you do that? How and that kind of started our us on the pathway that we've taken that recognition from my end that there's a lot that can be done. And the yeah.

Jerry Hoepner: Yeah, I love that story, and it's a really good reminder to all of us that sometimes we forget about those conversations, the conversations with physicians, with other providers who might not know as much about aphasia. I'll just tell a really quick story. My wife used to work in intensive care, and of course she had been around me for years, and they would have someone with aphasia, and her colleagues would be like, how do you even communicate with them, and she would be coming up like you, said Steve, with all of this information about the patient, and they're like, where are you getting this information. The person doesn't talk.

Hilary Sample: Yes.

Jerry Hoepner: And that just emphasizes why it's so important for us to have those conversations, so that our all of our colleagues are giving the best care that they can possibly provide.

Hilary Sample: That's a great story. That was very much like almost verbatim of some of the conversations that we initially had like, where is this coming from? They don't talk, or you know they don't have. Maybe they don't have something to say, and that's the assumptions that we make when somebody doesn't use verbal communication. You know, we quickly think that maybe there's not something beneath it, you know. I have a story as well. So what led to a little bit more toward where we are today. sitting in those rooms with people with aphasia and apraxia and people with difficulty communicating. There's 1 that stuck out so much. She was very upset, and that it was. And I we had just really developed a very nice relationship, a very supportive relationship she kind of. She would let me have it if she was upset about something. We had really honest conversations and it and it was earlier on to where I was stretching my skills in in using communication supports, and she really helped me grow. But I remember being in her room one day, and she had something to share. And this is a moment that repeated itself frequently, that the thing that needed to be shared was medical in nature, you know, in inpatient rehab. That's a frequent. That's a frequent situation that you run into. And we sat there for maybe 15 min, maybe more. And we're working on getting this out. We're narrowing it down. We're getting clarity. We're not quite there yet, as I said, I'm still new, and but the physician walks in and we pause. You know I'm always welcoming physicians into the into therapy, because I really see that we have a role there. But and talk slow. Hilary, the physician, asked an open-ended question like Steve was talking about asking those open-ended questions as they're trained to do, and it was a question that the person with aphasia didn't have the vocabulary available to answer, and before I would jump in, that person shrugged her shoulders and shook her head that she didn't have anything to share with them, and I was like, but we had just been talking. You know, there's definitely something, and I think I just sat there a little bit stunned and just observing more. And you know the physician finished their assessment mostly outside of verbal communication, and left the room, and then I spoke to her, and we. We tracked down what the rest of her concern was, and clarified it, and then I found the physician who was not Dr. Richman, and I shared all the things that they had told me that she had told me, and I remember her saying I was just in there. She didn't have anything wrong. and I and I was, you know, I told her, like the communication supports that I used, and you know we got that. We moved forward with the conversation. But there were a few things that stuck out to me in that, and one was the way that the physician was communicating wasn't using. They weren't using supports. For whatever reason, I didn't have that knowledge yet. We dove into the literature to learn more later on. The second thing was that the person with aphasia seemed to give up on the provider, knowing that since supports weren't being used. It wasn't going to be a successful communication attempt. So why even bother, and that definitely fits her personality. She's like I give up on you. And the 3rd thing was that the education about that somebody has something to share the education about. Aphasia was lacking, so you know that the person's still in there. They still have their intellect, their identity, their opinions, beliefs. But they didn't have the ability to communicate that piece seemed to be missing on the part of the provider, because they were saying they didn't have anything to share. So, it was like, I said that situation happened repeatedly, and very much. Sounds just like yours, but it hit me how much there was to do. And so, hearing, you know Steve's experiences that are on the other side of that. Such a caring, the one thing that led me to want to speak to Steve is that he's a very compassionate caring physician, so it's not a lack of care and compassion. But what else was going on what led to this, and we started learning that together. It was really interesting for me to learn how Hillary's 1st assumption is. Why aren't these physicians using communicative supports or other things that we were never taught about? The assumption that the docs know all this, and there's plenty we don't know. Unfortunately, there's, you know there's so much out there.

Steve Richman: The other thing Hillary touched on that was so true in my experience, is here. I'm meeting people that had a significant event, a traumatic brain injury, a bad stroke. And we're so used to judging people's intelligence through their speech. And they're not speaking. And it's so easy to start thinking there's just not much going on up there, and I didn't have the education or information or training to know for a long time. That wasn't the case until my dad had a stroke with aphasia. And so yeah, there's still plenty going on there just hard to get it out. And even as a medical provider, I really wasn't fully aware of that. And it took personal experience and learning from Hillary to really get that. it's still there just need to find out how to help them get it out.

Jerry Hoepner: Yeah, I think that's a rather common story, especially for people with aphasia. But even for people without aphasia, that sense that the doctor is coming in, and things have to happen. And I know I'm sitting here with Steve, who is very compassionate and wants to ensure that communication. But I think there's a little bit of fear like, oh, I can't get it out in this context, and just bringing awareness to that, and also tools. So, tools in education. So those physicians can do the work that they need to do and get that knowledge that they may have never been exposed to, and probably in many cases have never had that training to communicate with someone so like you, said Steve. How are you supposed to know when they didn't train us in this? And I guess that brings us back around to that idea that that's part of the role of the speech language pathologist and also kind of a vacancy in tools. Right? We're. We're just missing some of the tools to make that happen consistently across facilities and across people. So, I'm really interested in hearing a little bit about the tools you've created, and kind of the story leading up to that if you if you don't mind sharing.

Hilary Sample: Absolutely. 1st I'll share. There's a quote, and I'm not going to remember who said it. Unfortunately, I'll come up with it later, and I'll make sure to share with you. But that healthcare is the medium by or I'm sorry. Communication is the medium by which healthcare is provided, or something to that extent. We need communication in order to ensure equal access to health care. And like you said that gap, it's really big, and it's a systemic issue. So, leading up to us, coming together, we had those experiences on both of our ends. I realized that I wasn't a physician. I already knew this, but I also I was trying to provide communication support to enable them to communicate something on a topic that I'm not trained in. In order to really give what it's due right? I don't know what questions that Steve is going to ask next, you know I tried, but I and I tried to listen, but I didn't always have, you know. Of course, I don't have that training, so know your limits right. But I did. The general overarching method that I was using was we'd have concerns to choose from, including the question mark that enabled them to tell. Tell me that you're way off, or you didn't guess it, or it's not on here. And then narrow choices that I try to come up with, and we'd move on like that. And anytime somebody appeared to have a medical concern. There's those general topics that you would try to see if it's 1 of these things. One of these concerns, and then those would generally take you to a series of sub questions, and so on, and so forth. So, I recognize that this was repeatable. I also, at the same time as I shared, was recognizing that communication supports weren't being used. And that doesn't. That doesn't end with, you know, a physician that's also nurses nursing aides. That's therapists, including SLPs, and you know, so I'm doing a thing that can be repeated. Why not stop recreating it every time I enter the room and make it into something that I can bring with me a prepared material that I can bring with me and ideally share it with others. So, I again, knowing my limitations, know what I have to bring to that equation. But I knew that I needed to partner with someone that cared just as much but had the medical knowledge to inform that tool. So at 1st it was a print little framework that I brought, and what happened is, I came up to Steve, and I let him know what I was thinking, and he was open and willing to work together on this, and Hillary showed me these pictures that were kind of showing some general medical concerns, and brought up the whole concept and we initially were going for this pamphlet booklet idea, you know. If you have this concern, you go to this page to follow it up with further questions, and then you go to this other page to finalize the subs. We realized there was a lot of pages turning involved to make that work, and we eventually turned it into an app where you could take your concern, and we start with a general Hello! How are you? You know? Kind of what's the overall mood in the room today. And then what medical concerns do you have? And then from those concerns, appropriate sub questions and sub questions and timeframes, and the stuff that you would want to know medically, to help figure out the problem. And then go ahead. I'm sorry.

Jerry Hoepner: Oh, oh, sorry! No, that's terrific. I appreciate that that process and kind of talking through the process because it's so hard to develop something like this that really provides as much access as is possible. And I think that's really key, because there's so many different permutations. But the more that you get into those the more complex it gets. So, making it easy to access, I think, is part of that key right?

Hilary Sample: One thing that I'm sorry. Did you want to say? Yeah, I'll say, okay, 1. 1 part of it. Yes, the accessibility issue. Every provider has a tablet or a phone on them, and many of our patients and their families also do so. It made it clear that it's something that could be easier to use if that's the method somebody would like to use, but also having a moment where my mind is going blank. This is gonna be one of those where we added a little bit. This is what you call a mother moment.

Jerry Hoepner: Okay.

Steve Richman: The one thing that was fascinating for me as we were developing this tool is I kept asking why? And Hillary kept explaining why, we're doing different parts of it. And at this point it seems much more obvious. But my biggest stumble at the beginning was, why are these Confirmation pages. Why do we have to keep checking, you know? Do they mean to say yes? Do they mean to go ahead? And that education about how people with language difficulties can't always use language to self-correct. We need to add that opportunity now makes so much sense. But I remember that was a stumbling block for me to acknowledge that and be good with that to realize. Oh, that's really important. The other thing that Hillary said a lot, and I think is so true is in developing this tool. We're kind of developing a tool that helps people that know nothing about communication supports like myself how to use them, because this tool is just communication supports. You know, I hear these repeatedly taught me about the importance of layering the clear pictures and words, and the verbal, and put that all the well, the verbalizing, the app is saying the word in our case, so that could all be shared and between all that layering hopefully, the idea gets across right and then giving time for responses.

Jerry Hoepner: It sounds like the tool itself. Kind of serves as an implicit training or education to those providers. Right?

Hilary Sample: And there's the idea that I was missing when I had a little bit of. So yes, all of those strategies. They take training right? And it takes those conversations. And it takes practice and repetition. And there's amazing, amazing things happening in our field where people are actually undertaking that that transformation, transforming the system from above right.

Jerry Hoepner: Right.

Hilary Sample: But one thing that a big part of this work was trying to fill the gap immediately. I know you and I had previously talked about Dr. Megan Morris's article about health equity, and she talks a lot about people with communication disorders, including aphasia. And you know there's and she mentions that people cannot wait. The next person pretty much cannot wait for that work to be done, though that'll be amazing for the people that come down the line, the next person, what can we do for them? So we also need to be doing that. And that's where we thought we could jump in. And so I think the biggest you know. The most unique aspect of MedConcerns is that, or of the tool we created is that it kind of guides the clinician, the healthcare provider, through using communication supports. So you know, when I go in the room I offer broad options, and then I follow up with more narrow choices, always confirming, making sure I'm verifying the responses like Steve talked about, and or giving an opportunity to repair and go back and then that I summarize at the end, ensuring that what we have at the end still is valid, and what they meant to say. And so that's how the app flows, too. It enables the person to provide a very detailed, you know, detailed message about what's bothering them to a provider that has maybe no training in communication supports, but the app has them in there, so they can. It fills the gap for them.

Jerry Hoepner: Absolutely. It's kind of a sneaky way of getting that education in there which I really like, but also a feasible way. So, it's very pragmatic, very practical in terms of getting a tool in the hands of providers. It would be really interesting actually, to see how that changes their skill sets over time but yeah, but there's definitely room for that in the future. I think.

Hilary Sample: We could do a case study on Dr. Richman.

Steve Richman: whereas I used to walk out of those patient rooms that have communication difficulties with great frustration. My part frustration that I feel like I'm not doing my job. Well, now you walk out much more proudly, thinking, hey, I able to interact in a more effective way I can now do in visit what I could never accomplish before. Not always, but at least sometimes I'm getting somewhere, and that is so much better to know I'm actively able to help them participate, help people participate. I love writing my notes, you know. Communication difficulties due to blank. Many concerns app used to assist, and just like I write, you know, French interpreter used to assist kind of thing and it does assist. It's it makes it more effective for me and more effective for the person I'm working with. It's been really neat to watch you know, go from our initial conversations to seeing the other day we were having a conversation kind of prepping for this discussion with you and he got a call that he needed to go see a patient and I'll let you tell the story. So we're prepping for this. A couple of days ago. I think it was this Friday, probably, or Thursday, anyways, was last week and I'm at my office of work and again knock on the door. Someone's having chest pain. I gotta go check that out. So I start to walk out of the room. Realize? Oh, that room! Someone was aphasia. I come back and grab my phone because I got that for my phone and go back to the room. And it's interesting people as with anything. People don't always want to use a device. And he's been this patient, sometimes happy to interact with the device, sometimes wanting to use what words he has. And so I could confirm with words. He's having chest pain. But he we weren't able to confirm. What's it feel like? When did it start? What makes it better. What makes it worse? But using the app, I can make some progress here to get the reassurance that this is really musculoskeletal pain, not cardiac chest pain. Yes, we did an EKG to double check, but having that reassurance that his story fits with something musculoskeletal and a normal EKG. Is so much better than just guessing they get an EKG, I mean, that's not fair. So, it would have been before I had this tool. It would have been sending them to the er so they can get Stat labs plus an EKG, because it's not safe just to guess in that kind of situation. So, for me, it's really saved some send outs. It's really stopped from sending people to the acute care hospital er for quick evaluations. If I if I know from the get go my patient has diplopia. They have a double vision, because that's part of what communicated. When we were talking about things with help from MedConcerns. Yeah, when I find out 4 days later, when their language is perhaps returning, they're expressing diplopia. It's not a new concern. It's not a new problem. I know it's been a problem since the stroke, whereas I know of other doctors who said, Yeah, this person had aphasia, and all of a sudden they have these bad headaches that they're able to tell me about. This sounds new. I got to send them for new, you know whereas I may have the information that they've been having those headaches. We could start dealing with those headaches from the day one instead of when they progress enough to be able to express that interesting.

Jerry Hoepner: Yeah, definitely sounds like, I'm getting the story of, you know the improvement in the communication between you and the client. How powerful that is, but also from an assessment standpoint. This gives you a lot more tools to be able to learn about that person just as you would with someone without aphasia. And I think that's so important right to just be able to level that playing field you get the information you need. I can imagine as well that it would have a big impact on medication, prescriptions, whatever use? But also, maybe even counseling and educating that patient in the moment. Can you speak to those pieces a little bit.

Steve Richman: You know, one of my favorite parts of the app, Hillary insisted on, and I'm so glad she did. It's an education piece. So many people walk into the hospital, into our inpatient rehab hospital where I now work, and they don't recall or don't understand their diagnosis, or what aphasia is, or what happened to them. And there's a well aphasia, friendly information piece which you should probably talk about. You designed it, but it's so useful people are as with any diagnosis that's not understood. And then explained, people get such a sense of relief and understanding like, okay, I got a better handle of this. Now it's really calming for people to understand more what's going on with them.

Hilary Sample: This is, I think you know, that counseling piece and education, that early education. That's some of the stuff that could bring tears to my eyes just talking about it, because it's; oh, and it might just now. So many people enter, and they may have gotten. They may have received education, but it may not have. They may have been given education, but it may not have been received because supports weren't used, or there's many reasons why, you know, even if it had been given, it wasn't something that was understood, but so many people that I worked with aphasia. That one of the 1st things that I would do is using supports. Tell them what's going on or give them. This is likely what you might be experiencing and see their response to that. And that's you know what aphasia is, how it can manifest. Why it happens, what happened to you, what tools might be useful? How many people with aphasia have reported feeling? And you might be feeling this way as well, and these things can help. And it's very simple, very, you know. There's so much more to add to that. But it's enough in that moment to make someone feel seen and you know, like a lot of my friends, or one of my friends and former colleagues, uses this, and she says that's her favorite page, too, because the people that she's working with are just like, yes, yes, that's it, that's it. And the point and point and point to what she's showing them on the app. It's a patient education page, and then they'll look at their, you know, family member, and be like this. This is what's going on this, you know, it's all of a sudden we're connecting on that piece of information that was vital for them to share. And it was. It was just a simple thing that I kept repeating doing. I was reinventing the wheel every time I entered the room, but it was. It stood out as one of the most important things I did. And so that's why Steve and I connected on it, and like it needed to be in the app. And there's more where that came from in the future planning. But we added to that A on that broad, you know, kind of that page that has all the different icons with various concerns, we added a feelings, concern emotions, and feelings so that someone could also communicate what's going on emotionally. We know that this is such a traumatic experience, both in the stroke itself, but also in the fact that you lost the thing that might help you to walk through it a little easier which is communicating about it and hearing education learning about it. But so those 2 tools combined have really meant a lot to me to be able to share with people, with aphasia and their families, and also another sneaky way to educate providers.

Jerry Hoepner: Yeah, absolutely.

Hilary Sample: Because that's the simple education that I found to be missing when we talked about training was missing, and this and that, but the like when Steve and I talked recently, we you know, I said, what did you really learn about aphasia? And you kind of said how speech issues? Right?

Steve Richman: The speech diagnoses that we see are kind of lumped in as general like the names and general disorders that you might see, but weren't really clearly communicated as far as the their differential diagnoses being trained as a generalist, we would learn about, you know, neurology unit stroke and traumatic brain injury. And somewhere in there would be throwing in these tumors, which are huge aphasia and apraxia and whatnot, and I don't think I recall any details about that from Med school. They probably taught more than I'm recalling, but it certainly wasn't as much as I wish it was.

Hilary Sample: and so that education can just be a simple way to bring us all together on the same page as they're showing this to the person that they're working with. It's also helping them to better understand the supports that are needed.

Jerry Hoepner: Sneaky part.

Steve Richman: Yeah, speaking of the sneaky part, I don't think I told Hilary this yet, but I'm sure we've all had the experience or seen the experience where a physician asked him, What does that feel like? And the person might not have the words even with the regular communication, without a communication disorder. and last week I was working with a patient that just was having terrible pain and just could not describe it. and using the icons of words on that he had a much better sense of. You know it's just this and not that, and those descriptors of pain have been really useful for people now without more with communication difficulties that I just started doing that last week. And it was really interesting.

Hilary Sample: You mentioned about how those interactions with physicians are can be. Well, it's not nothing about you guys.

Jerry Hoepner: It's the rest of the physicians.

Hilary Sample: No, it's the, you know. There's a time. It's the shift in how our whole system operates that it's, you know I go in and I'm like, I just need notes if I need to speak about something important to my physician, because, like, I know that one reason I connect so deeply with people with communication disorders is that my anxiety sometimes gets in the way of my ability to communicate like I want to, especially in, you know, those kind of situations. And so, you know, it can help in many ways just having something to point to. But we also saw that with people with hearing loss, which, of course, many of the people that we run into in many of the patients that we work with are going to have some sort of hearing loss. People that speak a little different, you know. Native language. You know English as a second language.

Jerry Hoepner: Absolutely.

Hilary Sample: There and then. Cognitive communication disorders, developmental disorders, anybody that might benefit with a little bit more support which might include you and me. You know it can help.

Jerry Hoepner: And I think you know the physician and other providers having the tools to do that education to use the multimodal supports, to get the message in and then to get responses back out again. I think it's really important. And then that process of verifying to just see if they're understanding it. Are you? Are you tracking with me? And to get that feedback of, I'm getting this because I think sometimes education happens so quickly or at a level that doesn't match, and they might not understand it. Or sometimes it's just a matter of timing. I know we joke about Tom Sather and I joke about this. We've had people come to our aphasia group before who traveled out to a place in the community and they're sitting next to you. And they say, what is this aphasia stuff everyone's talking about? And I'm like, you literally just passed a sign that said Aphasia group. Right? But it's so hard to ensure that the message does go in, and that they truly understand that until you get that Aha moment where you describe like, yes, that's me, that's it. And that's just so crucial.

Hilary Sample: yeah, it's 1 of the most important pieces, I think to name it doesn't for anything that anybody is dealing with that's heavy, you know, to have to have it named can really provide relief just because that unknown, you know, at least at least you can have one thing that you know. I know what it is, and then I can learn more about it. Once I know what it is, I can learn more about it, and I can have some sort of acceptance, and I can start that grieving process around it, too, a little bit better. But when it goes unnamed, and the other part of it is if you don't tell me that, you know like that, you can see and understand what I might be experiencing, I might not think that you know what it is either, and I might not feel seen. So just the fact that we're both on board that we know I have this thing. I think it can take a lot of the weight off. At least, that's what I've seen when it's been presented.

Jerry Hoepner: No or care, right?

Hilary Sample: Yeah. Yes. Exactly.

Jerry Hoepner: Yep, and that's a good a good chance to segue into we I know we picked on Steve a little bit as a physician but the system really kind of constrains the amount of time that people have to spend with someone, and they have to be efficient. I'll go back to that sneaky idea. This seems like a sneaky way to help change the system from within. Can you talk about that a little bit like how it might move care forward by.

Hilary Sample: Showing what's possible. Yeah, I'm sorry, sure. In part time. Constraints, unfortunately, are very real, and without the knowledge of training how to communicate or support communication. It's challenging for us to move us physicians to move forward, but with something like our app or other useful tools in a short amount of time you could make some progress. And then, if you could document, this is worthwhile time worthwhile that I'm accomplishing something with my patient. I'm helping to understand what their issues are, and helping to explain what we want to do. That all of a sudden makes the time worthwhile, although time is a real constraint. I think, is general. Doctors are happy to spend extra time. If it's worthwhile that's helping our patient. That's the whole reason we go into this is help our people. We help the people we're working with, you know. No one wants to go in there and spend time. That's not helping anybody. But if you could justify the time, because I'm making progress. I'm really helping them great go for it. It's worth doing, and the part about efficiency. So there's so many ways that this focus on. And it's not even efficiency, because efficiency sounds like some success was achieved, you know. But this, this we only have this amount of time. One of the one of the things that's kind of interesting to me is that it an assumption? I've seen a lot, or I've heard a lot is that using communication supports takes time. More time and I have watched plenty, an encounter where the physician is trying, and it takes forever. I've experienced my own encounters as I was growing and deepening my own skills, and where it took me forever. And that's because we're trying. We care, but we don't have something prepared. So when you have a prepared material, it not only helps you to effectively and successfully you know, meet that communication need and find out what is actually bothering the person that you're working with. But it enables you to move at a pace that you wouldn't be able to otherwise, you know. So if Steve and I have this kind of running joke that I'll let you tell it because you have fun telling it.

Steve Richman: With the MedConcerns app. I could do in a little while what I can never do before, and with the med concerns App Hillary could do in 5 min. What used to take a session? It's really.

Jerry Hoepner: Yeah.

Hilary Sample: Makes huge impacts in what we could accomplish, so less of a joke and more of just.

Jerry Hoepner: Yes, but having the right tools really is sounds like that's what makes the difference. And then that gives you time and tools to dedicate to these conversations that are so important as a person who's really passionate about counseling. One of the things we were always taught is spending time now saves time later, and this seems very much like one of those kind of tools.

Hilary Sample: Yeah. Well, we had one of the 1st times that we brought the prototype to a friend of ours who has aphasia. And it kind of speaks to the exactly what you just said. Spending time now saves time later, or saves money. Saves, you know, all the other things right is our friend Bob, and he doesn't mind us using his name. But I'll let you tell this story a little bit, because you know more from the doctor. Bob was no longer a patient of ours, but we had spent time with him and his wife, and they were happy to maintain the relationship, and we showed him that after he had this experience but he was describing experience to us, he was having hip pain. He had a prior stroke hemiplegic and having pain in that hemiplegic side. So the assumption, medically, is, he probably has neuropathy. He probably has, you know, pain related to the stroke, and they were treating with some gabapentin which makes sense. But he kept having pain severe. 10 out of 10. Pain severe. Yeah. And just. We went back day after day, and not on the 3rd day back at the er they did an X-ray, and found he had a hip fracture and look at our app. He was like pointing all over to the things that show the descriptors that show not neuropathic pain, but again, musculoskeletal pain and that ability to, you know, without words we could point to where it hurts. But then, describing that pain is a makes a huge difference. And he knew he very clearly. Once he saw those pictures he like emphatically, yes, yes, yes, like this is this, we could have, you know, if we could have just found out this stuff, we wouldn't have had to go back to the er 3 times and go through all that wrong treatment and this severe amount of pain that really took him backwards in his recovery to physically being able to walk. And things like that, you know, it's just finding out. Getting more clarity at the beginning saves from those kind of experiences from the pain of those experiences. But also, you know, we talked about earlier. If you have to sort of make an assumption, and you have to make sure that you're thinking worst case scenario. So in other situations where you send out with a chest pain and things like that, there's a lot that's lost for the person with aphasia because they might have to start their whole rehab journey over. They have to incur the costs of that experience. And you know they might come back with, you know, having to start completely over, maybe even new therapists like it's. And then just the emotional side of that. So, it not only saves time, but it. It saves money. It saves emotional. Yeah, the emotional consequences, too.

Jerry Hoepner: Yeah. Therapeutic Alliance trust all of those different things. Yeah, sure. Yeah. I mean, I just think that alone is such an important reason to put this tool in the hands of people that can use it. We've been kind of talking around, or a little bit indirectly, about the med concerns app. But can you talk a little bit about what you created, and how it's different than what's out there.

Hilary Sample: Yeah, may I dive in, please? Okay, so we yeah, we indirectly kind of talked about it. But I'll speak about it just very specifically. So it starts with an introduction, just like a physician would enter the room and introduce themselves. This is a multimodal introduction. There's the audio. You can use emojis. What have you then, the General? How are you? Just as Steve would ask, how I'm doing this is, how are you with the multimodal supports and then it gets to kind of the main part of our app, which is, it starts with broad concerns. Some of those concerns, pain, breathing issues, bowel bladder illness. Something happened that I need to report like a fall or something else and the list continues. But you start with those broad concerns, and then every selection takes you to a confirmation screen where you either, you know, say, yes, that's what I was meaning to say, or you go back and revise your selection. It follows with narrow choices under that umbrella concern, the location type of pain, description, severity, exacerbating factors. If you've hit that concern so narrow choices to really get a full description of the problem, and including, like, I said, timing and onset. And then we end with a summary screen that shows every selection that was made and you can go to a Yes, no board to make sure that that is again verified for accuracy. So, it's a really a framework guiding the user, the therapist healthcare provider person with aphasia caregiver whomever through a supported approach to evaluating medical concerns. So generally, that's the way it functions. And then there are some extras. Did you want me to go into those? A little bit too sure.

Jerry Hoepner: Sure. Yeah, that would be great.

Hilary Sample: Right? So 1 1. It's not an extra, but one part of it that's very important to us as we just talked about our friend Bob, is that pain? Assessment is, is very in depth, and includes a scale description, locations, the triggers, the timing, the onset, so that we can get the correct pathway to receiving intervention. This app does not diagnose it just, it helps support the verbal expression or the expression. Excuse me of what's wrong. So, it has that general aphasia, friendly design the keywords, simple icons that lack anything distracting, clear visuals simple, a simple layout. It also has the audio that goes with the icon, and then adjustable settings, and these include, if you know, people have different visual and sensory needs for icons per screen, so the Max would be 6 icons on a screen, although, as you scroll down where there's more and more 6 icons per screen. But you can go down to one and just have it. Be kind of a yes, no thing. If that's what you need for various reasons, you can hide specific icons. So, if you're in a setting where you don't see trachs and pegs. You can hide those so that irrelevant options don't complicate the screen. There's a needs board. So we see a lot of communication boards put on people's tray tables in in the healthcare setting, and those are often they often go unused because a lot of times they're too complex, or they're not trained, or they, for whatever reason, there's a million reasons why they're not used. But this one has as many options as we could possibly think might need to be on there which any of those options can be hidden if they need to be. If they're not, if they're irrelevant to the user language it's in. You can choose between English and Spanish as it is right now, with more to come as we as we move along, and then gender options for the audio. What voice you'd like to hear? That's more representative. And the body image for the pain to indicate pain location. There's some interactive tools that we like to use with people outside of that framework. There's the whiteboard for typing drawing. You can use emojis. You can grab any of the icons that are within the app. So, if you know we if it's not there and you want to detail more, you can use the whiteboard again. That needs board the Yes, no board. And then there's also a topic board for quick messages. We wanted to support people in guiding conversations with their health care providers. So, I want to talk to Steve about how am I going to return to being a parent? Once I get home, what's work life going to be. I want to ask him about the financial side of things. I want to ask him about therapy. I want to report to him that I'm having trouble with communication. I want to talk on a certain topic. There's a topic board where you select it. It'll verify the response. It has a confirmation page, but from there the physician will start to do their magic with whatever that topic is. And then, of course, there's those summary screens that I already detailed, but those have been very useful for both, making sure at the end of the day we verify those responses but then, also that we have something that's easy to kind of screenshot. Come back to show the physician. So show the nurse as like a clear message that gets conveyed versus trying to translate it to a verbal message at the end from us, and maybe missing something so straightforward, simple to address very complex needs, because we know that people with aphasia would benefit from simple supports, but not they don't need to stay on simple topics. They have very complex ideas and information to share. So we wanted to support that. That's what it is in a nutshell that took a nutshell. I love that. It's on my phone, or it could be on your.

Jerry Hoepner: Oh, yeah.

Hilary Sample: Or on your or on your apple computer. If you wanted that, it's on the app store. But I love this on my phone. So, I just pull in my pockets and use it. Or if you happen to have an another device that works also.

Jerry Hoepner: Sure.

Hilary Sample: We're in the. We're in the process of having it available in different ways. There's a fully developed android app as well. But we're very much learners when it comes to the business side of things. And so there's a process for us in that, and so any. Any guidance from anybody is always welcome. But we have an android that's developed. And then we're working on the web based app so that we could have enterprise bulk users for enterprise, licensing so that that can be downloaded straight from the web. So that's all. Our vision, really, from the onset was like you said, shifting the culture in the system like if there's a tool that from the top, they're saying, everybody has this on their device and on the device that they bring in a patient's room, and there's training on how to use it, and that we would provide. And it wouldn't need to be much, just simple training on how to use it. And then you see that they are. They get that little bit more education. And then it's a consistent. We know. We expect that it'll be used. The culture can shift from within. And that's really the vision. How we've started is more direct to consumer putting it on the app store. But that's more representative of our learning process when it comes to app development than it is what our overall vision was, I want to say that equally as important to getting this into systems is having it be on a person's device when they go to a person with aphasia's device when they go to an appointment. I always, when we've been asked like, Who is this? For we generally just kind of say, anybody that that is willing to bring it to the appointment, so that communication supports are used, and maybe that'll be the SLP. Maybe it's the caregiver. Maybe it's care partner or communication partner, maybe a person with aphasia. Maybe it's the healthcare staff. So, whoever is ready to start implementing an easier solution. That's for you.

Jerry Hoepner: Yeah, absolutely. And that brings up a really interesting kind of topic, like, what is the learning curve or uptake kind of time for those different users for a provider on one hand, for a person with aphasia. On the other hand, what's a typical turnaround time.

Hilary Sample: We've tried to make it really intuitive, and I think well, I'm biased. I think it is

Hilary Sample: I for a provider. I think it's very easy to show them the flow and it, and it becomes very quickly apparent. Oh, it's an introduction. This is putting my name here. What my position is next is a how are you that's already walk in the room, anyways. And that's that. What are your concerns? Okay, that that all. Okay. I got that I think with time and familiarity you could use the tool in different ways. You don't have to go through the set up there you could jump to whatever page you want from a dropdown menu, and I find that at times helpful. But that's you. Don't have to start there. You just start with following the flow, and it's set up right there for you. The, as we all know people with the page I have as all of us have different kind of levels, that some people, they, they see it, they get it, they take the app, and they just start punching away because they're the age where they're comfortable with electronic devices. And they understand the concept. And it takes 5 seconds for them to get the concept and they'll find what they want. Some of our older patients. It's not as quick. But that's okay. My experience with it's been funny to show to use it with people with aphasia versus in another communication disorders, and using it with or showing it to people in the field or in healthcare in general, or you're just your average person most of the time that I showed this to a person with aphasia or who needed communication supports. It's been pretty quick, even if they didn't use technology that much, because it is it is using. It's the same as what we do on with pen and paper. It's just as long as we can show them at the onset that we're asking you to point or show me right. And so once we do that and kind of show that we want you to select your answer, and some people need more support to do that than others. Then we can move forward pretty easily. So people with aphasia a lot of times seem to be waiting for communication supports to arrive, and then you show them it, and they're like, Oh, thanks, you know, here we go. This is what's going on. Of course, that's there are varying levels of severity that would change that. But that's been my experience with people with aphasia. When I show people that do not have aphasia. I see some overthinking, because you know. So I have to kind of tell people like, just them you want them to point and hand it over, you know, because when I've seen people try to move through it, they're overthinking their what do you want me to do? I'm used to doing a lot with an app, I'm used to, you know, and the app moves you. You don't move it. So the real training is in stepping back and allowing the communication supports to do what you're thinking. I need you to do right. Step back and just let the person use the communication supports to tell you their message. And you, you provide those supports like we tend to provide more training on how to help somebody initiate that pointing or maybe problem solving the field of responses or field of icons that's on the page, or, you know, troubleshooting a little bit. But the training more is to kind of have a more hands off. Approach versus you know, trying to move the app forward since the apps focus, really, on describing what's going on with somebody and not trying to diagnose once someone gathers. Oh, I'm just trying to get out what I'm experiencing, it becomes very intuitive. Yeah, that's the issue. And this is, yeah, that's how describes it more. And yeah, this is about when it started that

Jerry Hoepner: That makes sense. And it's in line with what we know about learning use of other technologies, too, right? Usually that implicit kind of learning by doing kind of helps more than here's the 722, you know, pieces of instruction. So yeah, that kind of makes sense.

Hilary Sample: Simple training. I just to throw in one more thought I you know a little bit of training on what communication supports are, and then you show them. And it really, the app shows you how to use communication supports. And so it, you know instead of having to train on that you can just use the app to show them, and then and then they sort of start to have that awareness on how to use it and know how to move forward from there. Generally, there's some training that needs to be to be had on just where things are maybe like the dropdown menu, or you know what's possible with the app, like changes, changes, and settings and the adjustments that we talked about earlier but usually it's a little bit of a tool that I use to train people how to use communication support. So, it's sort of like the training is embedded. So we're doing both at the same time. You're getting to know the app, and you're learning more about how to support communication in general.

Jerry Hoepner: I think that's a really great takeaway in terms of kind of that double value. Right? So get the value to the person with aphasia from the standpoint of multimodal communication and self-advocacy and agency, those kinds of things, and then the value to the providers, which is, you learn how to do it right by doing it.

Hilary Sample: Which is great. Yeah.

Jerry Hoepner: Really like that.

Hilary Sample: Some of the most meaningful experiences I've had are with nurses like, you know, some of those incredible nurses that, like they see the person with aphasia. They know they know what to say, they want to. They know that the person knows what they want to say, but has difficulty saying it. We have one person I won't mention her name, but she's just incredible, and you know the go to nurse that you always want to be in the room she pretty much was like, give me this as soon as we told her about it, and I did, you know, and she goes. She's like, see, you know she uses it as a tool to help her other nurses to know what's possible for these. She's such an advocate but if it can be used like that to show what's possible like to show, to reveal the competency, and to let other nurses know, and other physicians, and so on, to help them to truly see the people that they're working with. It's like that's my favorite part. But the it's not only like a relief for her to be able to have a tool, but it's exciting, because she cares so much, and that like Oh, I'll take that all day long. That's wonderful.

Jerry Hoepner: Absolutely well, it's been really fun having a conversation with you, and I've learned a lot more than I knew already about the app. Are there any other things that we want to share with our listeners before we close down this fun conversation.

Hilary Sample: I think maybe our hope is to find people that are ready to help kind of reach that vision of a culture shift from this perspective from this angle. Anybody that's willing to kind of have that conversation with us and see how we can support that. That's what we're looking for just to see some system change and to see what we can do to do that together, to collaborate. So if anybody is interested in in discussing how we might do that, that's a big goal of ours, too, is just to find partners in in aphasia advocacy from this angle.

Jerry Hoepner: That's great!

Hilary Sample: Perfect. I totally agree. We're very grateful for this conversation, too. Thank you so much, Jerry.

Jerry Hoepner: Grateful to have the conversation with both of you and just appreciate the dialogue. Can't wait to connect with you in future conferences and so forth. So, thank you both very much.

Hilary Sample: Thank you.

Jerry Hoepner: On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at [email protected]. Thanks again for your ongoing support of Aphasia Access.

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