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Expanding Use of Telepractice in Speech-Language Pathology and Audiology
Abstract
Recent advances in videoconferencing technology have resulted in a substantial increase in the use of live videoconferencing-referred to here as telepractice-to diagnose and treat speech, language, and hearing disorders. There is growing support from professional organizations for use of this service delivery model, as videoconferencing technology can alleviate the effects of distance on access to care. As telepractice becomes a standard mode of conducting diagnostic and treatment services in speech, language, and hearing disorders, it is essential to assure that research supports its application in the field. Search criteria were established to identify publications, primarily in peer-reviewed journals, from 1995 to 2011. These studies generally validate the delivery of diagnostic and therapeutic services through telepractice when compared to traditional services delivered in a face-to-face clinical setting. Most studies examined adults and school-age children. The search was then expanded to identify diagnostic and treatment services for infants, toddlers, and young children. The existing literature compels professionals to conduct more research related specifically to the effectiveness and efficacy of telepractice.
... Aided language input encourages and increases children's independent use of aided AAC (Dada & Alant, 2009;Lynch et al., 2018); however, its use via teletherapy has not been investigated. In fact, little research exists about the extent to which treatments, diagnoses, challenges, and benefits of teletherapy services extend to SLPs providing services for children with disabilities who use aided AAC (Anderson et al., 2015;Edwards et al., 2012). ...
... Outside of the field of AAC, the provision of teletherapy services was increasing pre-pandemic in part due to the combination of advancements in videoconferencing technologies and increased deployment of high-speed internet (Edwards et al., 2012). This combination improved access to therapy services for adults and children with speech and language disorders in remote or rural areas or who were physically unable to access in-person services (Anderson et al., 2015;Fleming et al., 2013). ...
... Evidence was building to suggest that teletherapy offered a feasible treatment modality for a variety of speech and language disorders. For example, one systematic review of studies comparing intervention delivered in person and via teletherapy (Edwards et al., 2012) pointed to teletherapy as an effective method for diagnosing and treating adults and children with a variety of speech and language disorders including aphasia, apraxia, dysarthria, voice disorders, articulation, and child language delays and disorders; however, there was limited research evaluating the feasibility and effectiveness of teletherapy for AAC-related service delivery before the pandemic (Hall & Boisvert, 2014). The research that did exist indicated positive outcomes for the use of teletherapy for initial AAC assessment, communication partner training, and AAC modeling (Anderson et al., 2015), but there was limited research into the use of teletherapy for direct service provision for children with disabilities who use aided AAC. ...
The COVID-19 pandemic required many speech-language pathologists (SLPs) to transition to teletherapy service delivery. This study was designed to explore the experiences and perceptions of SLPs who made this transition with children with disabilities who used aided augmentative and alternative communication (AAC). Semi-structured interviews were conducted virtually with 10 SLPs who provided regular teletherapy services to children who used AAC during but not before the pandemic. Interview transcripts were analyzed thematically using immersion, reduction, and constant comparison to understand SLP experiences and perceptions individually and across the group. Results reveal that despite the challenges faced transitioning to teletherapy, there were benefits. Furthermore, many of the participating SLPs developed successful strategies and solutions for the challenges they faced. Participants in this study highlighted the unique and important role that caregivers and parents played in the success of the teletherapy they provided. This study suggests that SLPs, caregivers, and children demonstrated resilience in the face of a large-scale, unforeseen change. SLPs consistently reported the ability to maintain continuity of care during a stressful transition period, while meeting the unique needs of the children who used AAC they served.
... telemedicinos paslaugų teikimo formą, pritaikytą logopedams, buvo paskelbti prieš dešimtmetį (ASHA, cit. Houston, 2014). Pasak Stone (2017), telekomu nikacijų ir sveikatos priežiūros naujausių technologijų prieinamumas ir po puliarumas atveria galimybes įvairiems specialistams teikti kokybiškas pas laugas virtualiai. ...
... (2015), didžioji dauguma nuotoliniu būdu dirbančių logo pedų taiko sinchroninę telepraktikos rūšį, trečdalis taiko hibridinę telepraktiką, likusieji -asinchroninę. Kaip teigia Houston (2014), telepraktika apibūdinama kaip paslaugų teikimo modelis, pritaikytas logopedams ir skirtas paslaugų fizi niam prieinamumui didinti. Telepraktika gali būti taikoma kaip vienintelis logo pedo paslaugų teikimo modelis arba tiesioginės, ne ugdymo / sveikatos priežiū ros įstaigos teikiamos, logopedo pagalbos tęsinys siekiant suteikti papildomą pagalbą namų aplinkoje. ...
... Pa sak Tucker (2012), telepraktika suteikia galimybę sumažinti logopedų trūkumą sveikatos priežiūros ir švietimo įstaigose. Telepraktikos paslaugas teikianti įs taiga dažnai laikoma patrauklesne klientams (Houston, 2014). Daugelio autorių (Ciccia, Whitford ir kt., 2011;Molini-Avejonas ir kt., 2015;Neely ir kt., 2017;Chisholm, Psarros, 2018) tyrimai atskleidžia, kad telepraktika yra ne tik efek tyvus mokymosi būdas, bet ir ekonomiškas, ypač laiko ir transporto sąnaudų požiūriu. ...
Straipsnyje analizuojamos logopedų nuomonė ir patirtys, teikiant logopedinę pagalbą telepraktikos būdu COVID-19 situacijos aplinkybėmis. Atlikta kiekybinė ir kokybinė tyrimo duomenų analizė atskleidė šalies logopedų sampratą, taikomas telepraktikos rūšis, šios praktikos taikymo privalumus ir ribotumus, galimybes teikti (ne)tiesioginę pagalbą vaikams, turintiems įvairių kalbėjimo, kalbos ir rijimo sutrikimų, galimybes kokybiškai atlikti profesines logopedo funkcijas per nuotolį. Tyrimas atskleidė, kad telepraktika logopedo darbe, nors kėlusi daug iššūkių dėl poreikio ją taikyti nenumatytomis aplinkybėmis ir tam tinkamai nepasirengus, turi daug privalumų ir gali būti sėkmingai taikoma derinant ją su įprasta, tradicine, fizinio kontakto būdu teikiama pagalba
... Nowadays, SLPs can use computerized methods, such as acoustic analysis, to support speech assessment [65]. SLPs can also deliver remote therapy sessions using conferencing software [24,28,35], and integrate digital therapy programs to supplement in-clinic sessions with on-demand and at-home care [13,29]. Among technology-mediated solutions for attending to speech disorders in children, games and gamification are emerging as promising avenues to deliver speech therapies that are both effective and engaging [25]. ...
... For example, telecommunication technologies and videoconferencing software are used to link therapists to their patients [74]. This enables SLPs to deliver consultations, assessments, and interventions remotely, thereby expanding access to therapy and reducing service inequities in rural areas [24,28]. However, the telepractice of speech therapy introduces its own set of challenges. ...
... According to the case and her family, the biggest advantage of teletherapy is accessibility and the biggest disadvantage is connection problems. Studies report that the use of teletherapy is feasible and effective in both adults and children, including different disorder groups (Edwards et al., 2012;Mashima & Doarn, 2008). In addition, it is claimed that teletherapy is as effective as face-to-face methods (Edwards et al., 2012). ...
... Studies report that the use of teletherapy is feasible and effective in both adults and children, including different disorder groups (Edwards et al., 2012;Mashima & Doarn, 2008). In addition, it is claimed that teletherapy is as effective as face-to-face methods (Edwards et al., 2012). Therefore, the use of telehealth services in speech and language therapy is supported (Speech Pathology Australia [SPA], 2014). ...
... There is promising evidence to support telepractice treatment of stuttering in preschool children through parent counseling. Direct therapy with telepractice has also been shown to be effective for children with fluency disorder (Edwards et al., 2012;Lowe et al., 2013;McGill et al., 2019). McGill et al. (2019) included seven studies that reported stuttering treatment via telepractice using the Lidcombe Program, Camperdown Program, and integrated treatment protocols into their review. ...
... There was no SLP who disagreed. Telepractice is frequently cited in the literature as a viable option for geographic and physical barriers, as well as providing benefits to patients (De Araújo Novaes, 2020; Edwards et al., 2012). When questioned about the benefits of telepractice, it was inevitable that COVID-19 would come up. ...
The purpose of this research was to investigate speech-language pathologists’ (SLPs) perspectives, attitudes, and experiences of using telepractice for preschoolers in Turkey. A mixed-method online survey was used with SLPs who implemented telepractice with preschool children. Frequency distribution and theme analysis were used to examine the data. Therapy was the most offered online service (98%). Further, 67% of SLPs worked with speech sound disorders. More than half of SLPs felt confident offering telepractice to preschoolers. Most respondents thought that telepractice was an appropriate and easily accessible approach for preschool children, with the applicability of telepractice connected to a child’s type of problem. The SLPs were motivated by the numerous advantages of telepractice. However, their opinions were divided when telepractice was compared to in-person treatment. The SLPs in Turkey must be better educated about telepractice, and clinical standards established. The findings point to areas of telepractice that might be improved for preschoolers, especially in Turkey.
... Speech-language therapists face a range of difficulties when providing services to children with ASD through telerehabilitation, from accessibility to resources that are required for telerehabilitation, adequate training of SLTs and caregivers, active involvement of the caregiver and the child and the appropriateness of the environment where the therapy is conducted (Edwards, Stredler-Brown, & Houston, 2012). ...
... Firstly, telerehabilitation requires the SLT and caregiver to have compatible devices to facilitate communication during therapy. Such devices may include laptops, computers, cell phones and telephones (Edwards et al., 2012), any of which can be used to support telehealth. Yet 5% of the South African population do not own or are not able to borrow a phone because of challenges such as theft, cost of the device and lack of sufficient literacy for the use of smartphones; high data costs and access to electricity also impact on access to telehealth services (McCrocklin, 2021). ...
Background: There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020.
Objectives: To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD.
Method: A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis.
Results: Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client’s and SLT’s travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits.
Conclusion: Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs’ knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included.
... Tele-audiology, a branch of telemedicine that facilitates audiological management at a distance (Edwards, Stredler-Brown, and Houston 2012;, may be a possible alternative to the temporary cessation of inperson services. This term was initially used by Dr. Gregg Givens in 1999 to explain the means by which a healthcare system could be accessible to different settings, including schools, hospitals, clinics, universities, homes, and medical facilities (Rushbrooke and Houston 2016). ...
... Constructive ways to overcome the complexities accompanying hearing technology use during the COVID-19imposed lockdown Remote provision of hearing and speech services is the key to solving most hearing aid-related issues that have arisen since the COVID-19 outbreak. Combining the application of information technology in hearing healthcare with computerisation could offer useful opportunities to enhance clinical care, provide extensive access to a variety of procedures and resources, and ensure cost-effective and maintainable hearing services (Edwards, Stredler-Brown, and Houston 2012;. Moreover, patients suggested the need for the education and training hearing healthcare professionals, paraprofessionals, parents (of children with hearing disorders), and adults with hearing disorders in the use of the internet in screening for auditory disorders, diagnosing hearing impairment, and intervention techniques. ...
Objectives:
To explore the difficulties and obstacles of hearing-technology users during the coronavirus disease 2019 (COVID-19) pandemic.
Design:
Descriptive, cross-sectional study.
Study sample:
Individuals with permanent hearing loss (n = 278) answered a questionnaire designed to identify potential obstacles caused by using hearing aids during the COVID-19 pandemic, along with the reasons and deleterious effects associated with the devices. Each category reflected challenges in communicating, learning, and working during the pandemic. Different response categories were compared using descriptive and inferential statistics.
Results:
The duration of daily device usage before the imposed lockdown was significantly higher than that during (Z = -2.01, p < 0.05), potentially attributable to the pandemic-induced difficulties faced by hearing-technology users. Such challenges include the shortage of batteries for hearing devices, limited access to repair or programming services of said devices and accessories, termination of speech therapy sessions, and obstacles to employment and education.
Conclusions:
Among audiologists, efficiency and professionalism are required to educate the public and private health sectors regarding the prevalent challenges and their harmful impact on hearing-technology users during the COVID-19 pandemic. To overcome these issues, awareness of telepractice and its importance in providing audiological services to hard of hearing individuals should be raised.
... Ongoing telehealth research is imperative for its continued acceptance, use, and growth. The prevailing literature in pediatric speechlanguage pathology has found high agreement among some assessments administered or scored in person and through videoconferencing, for example, the Goldman-Fristoe Test of Articulation-Third Edition (GFTA-3) and the Peabody Picture Vocabulary Test-Fourth Edition (PPVT-4;Campbell & Goldstein, 2022;Edwards et al., 2012;Lund & Werfel, 2022;Marcotte et al., 2022;McGill et al., 2021;Nelson & Plante, 2022;Schmitt et al., 2022). However, the list of assessments that have been validated to administer virtually is limited. ...
Purpose
Despite the speed with which telehealth use advanced during the COVID-19 pandemic, evidence is needed to support the remote delivery of standardized assessments. This study investigated the reliability and feasibility of administering a standardized language assessment administered in real-world telehealth scenarios compared to in-person administration.
Method
A total of 100 children between the ages of 3 and 12 years were administered one of three versions of the Clinical Evaluation of Language Fundamentals (CELF). Children were administered the CELF by the same licensed speech-language pathologists (SLPs) in person and using telehealth, with the order counterbalanced. Means for Core Language standard scores were compared between conditions and among devices. Descriptive statistics summarized the behavior and technology disruptions during administration as well as the results of parent and SLP telehealth perception surveys.
Results
In-person and telehealth mean scores on all three versions of the CELF revealed no systematic differences of one condition under- or overestimating another. The incidence of child behavior disruptions was similar for both test administration conditions. Adaptations compensated for the rare technology disruptions. Despite no significant language score and behavior differences between testing conditions, parents reported they continued to prefer in-person assessments. SLP participants viewed telehealth overall positively but identified conditions in which they continued to prefer in-person delivery.
Conclusions
This study provides evidence of minimal or no differences in scores and behavioral or technological disruptions between remote and in-person administration of the CELF core language assessments. SLP and parent participants' attitudes toward remote delivery of standardized tests appear to be evolving in a positive direction compared to previous studies.
Supplemental Material
https://doi.org/10.23641/asha.25292752
... Telepractice has been identified as an acceptable means of service delivery with benefits similar to in-person treatment (Edwards et al., 2012;Hall et al., 2014;Milman et al., 2020;Theodoros, 2008). ASHA suggests that audiologists and speech-language pathologists (SLPs) may use telepractice as a supplement to in-person services or as the primary means of service delivery across client needs and settings (Brown, 2011). ...
With advances in technology and the COVID-19 Public Health Emergency (2020–2023), telepractice has become a prominent service delivery model. This study explores the evolution of telepractice service delivery research published by the American Speech-Language-Hearing Association (ASHA) and the impact of the COVID-19 Public Health Emergency on ASHA publications through searches of the ASHAWire database using “telepractice OR telehealth OR virtual OR teletherapy” in February 2021, 2022, 2023 and April 2023. In February 2023, 1,683 records were identified and hand searched for relevance to the evolution of telepractice. In April 2023, 471 records published from 2020 to 2023 were systematically screened for relevance to reveal 148 articles that met inclusion criteria. ASHAWire is a reputable resource for articles on telepractice service delivery, especially after the COVID-19 Public Health Emergency. It is important, however, for researchers and clinicians to carefully examine methodology of studies as the use of technology may conflate search results.
... For instance, in a study on the effectiveness of online and presential versions of tele-neuropsychological intervention in pediatric demyelinating disorder patients, the Mann-Whitney U test showed no differences in effectivity between online and presential tests for language, memory, visual perception, visuomotor integration and math fluency (Harder et al., 2020). Lastly, it has been noted that there is a general lack of guidelines for cognitive assessment of children in terms of parameters of assessment, feasibility of cognitive functions that can be assessed, personnel requirements and so forth (Luciana and Nelson, 2002;Edwards et al., 2012), although the current article mapping shows that this situation is changing, with a steep rise in the publication of guidelines after 2020 (see Figure 2). ...
Cognitive tele-assessment (CTA) adoption has increased considerably recently, in parallel with the maturation of the digital technologies that enable it, and the push to move assessment to the online format during the COVID-19 pandemic in 2019. This mode of assessment stems from remote assessment applications that originated in general tele-medicine, where it was typically used for patient screening as part of an intervention. The development of remote tele-medicine was later adapted for CTA in adult populations in tele-neuropsychiatry and tele-psychology and is increasingly applied in experimental research in cognitive science research with adult and pediatric populations, and for remote academic assessment. Compared to in-person assessment, CTA offers advantages such as decreasing time and logistic costs and facilitating the assessment of remote or special needs populations. However, given the novelty of CTA, its technical, methodological, and ethical issues remain poorly understood, especially in cases where methods for assessment of adults are used in pediatric populations. In the current paper, we provide a scoping review on the evolution of remote tele-assessment from the years 2000 to 2021, to identify its main themes, methodologies, and applications, and then focus on the issues of assessment in pediatric populations. Finally, we present recommendations on how to address the challenges previously mentioned.
... Studies were often focused on particular groups of children with speech, language and communication needs (SLCN). These include telehealth interventions for children who stutter (Lowe et al., 2013;McGill et al., 2019), children with a hearing impairment (Edwards et al., 2012), childhood apraxia of speech (Thomas et al., 2016), speech-sound disorder (Grogan-Johnson et al., 2013) and increasingly for children with autism (Boisvert et al., 2010;Sutherland et al., 2018). Furthermore, although evidence reports comparable outcomes between telehealth approaches and face-to-face services, for both intervention (Grogan-Johnson et al., 2013;Speyer et al., 2018) and assessment (Hodge et al., 2014;Sutherland et al., 2017;Waite et al., 2010), a systematic review of the literature found that despite such promising evidence for the efficacy of telehealth, the evidence base remains limited (Wales et al., 2017). ...
Background
Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists’ (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective.
Methods
An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis.
Results
Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance.
Conclusions
Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow.
WHAT THIS PAPER ADDS
What is already known on this subject
The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear.
What this paper adds to existing knowledge
The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists’ (SLTs’) perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance.
What are the potential or actual clinical implications of this work?
UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance.
... Tele clinical services are an optimal solution for availing services by the users but the implementation of the delivery system is in its infancy. In Tele mode of audiological services such as assessment and management are provided from a distance [8][9][10] , which is an alternative to the direct or in person mode of services. This virtual mode of services can be offered in two ways: first, synchronously, with real-time videoconferencing, and second, utilizing the "store-and-forward" method, with information prerecorded, saved, and then transferred to a remote site 11,12 . ...
COVID-19 (Corona Virus Infectious Disease) situations reported in 2019, declared by World Health Organization (WHO) as a pandemic is still a prevailing global crisis. Common regulations were implemented such as lockdown, wearing face masks as mandatory, face shields, gloves and maintaining physical and social distance in public places to reduce the spread of the virus. These pandemic induced challenges affected social communication, technical and behavioral aspects in lifestyle of people with hearing impairment. Along with medical, paramedical services, the crisis had challenged hearing, speech language pathology and therapy services too. The study aimed to explore the challenges that adults with hearing impairment had experienced during the pandemic and to suggest some practical solutions that can be implemented by audiologists. It is a questionnaire-based study with purposive sampling method employed in data collection. The questionnaire was administered on adult hearing aid users (mean age: 18 years) recruited for participation from different parts/ clinical setups across India. The outcome of the questionnaire did support the assumption that availing audiological services was difficult or impossible for most of the hearing aid users. Accessing batteries was reported to be the most frequent issue. Adequate level of hearing though hearing aid was important to them and clinical services could not be availed for long period of time due to travel related issues and closure of audiological services. Also, social isolation impacted on their quality of life and effective communication. As a possible solution most of the users chose tele services as a better solution.
... 4 However, some children are not able to see SLPs regularly, especially if the limited visits are due to financial or geographic barriers (eg, patients who live in rural areas or in places where SLPs are not readily accessible). This approach both complements the trend toward telemedicine and home-based interventions in speech-language pathology [41][42][43] and provides a potential solution to the mismatch in provision of speech services that disproportionately affects vulnerable populations. 44 Speech intelligibility involves both the listener and speaker. ...
Introduction
This systematic review examines the use of machine learning (ML) algorithms to detect hypernasal speech in patients with cleft palate (CP), which can persist after primary repair surgery, and require revision. Due to a shortage of speech language pathologists (SLPs), automated detection tools could help improve access to care in underserved areas. The study compares the characteristics and accuracy of different types of machine learning algorithms.
Methods
On August 18, 2021, searches were conducted across 8 databases: PubMed, SCOPUS, Cochrane, IEEE, ACM, L&LB, PsychInfo, and CINAHL. Search terms used were: (Artificial Intelligence OR Machine Learning OR Neural networks AND Cleft lip OR Cleft palate OR Hypernasality OR Velopharyngeal Insufficiency). To be included, papers needed to describe ML algorithms for CP speech detection and report concordance to human professional speech clinicians.
Results
Database searches yielded 135 unique articles. Five articles met full inclusion criteria and 3 additional articles were identified by hand searching references of articles that passed initial screening. These algorithms were categorized as either Feature Dependent non-Deep learning (n = 5) or Feature Dependent deep learning (n = 2) algorithms or Feature Independent deep learning (n = 3) algorithms. Their pooled average concordance were 0.85, 0.93, and 0.91 respectively. Their average training database sizes were 3587, 3921, and 6306 speech samples respectively.
Conclusion
Machine learning algorithms have been shown to be an effective tool for the evaluation of hypernasal speech. This systematic review has shown that ML algorithms are able to detect hypernasality with high concordance, consistent with professional speech language clinicians in a rapid, and autonomous manner. ML algorithms can extend the reach of speech language pathologists and complement their gold standard, this long-term outcome monitoring has great potential to improve treatment outcomes.
... Estos elementos coinciden con lo descrito por Eyzaguirre et al., (2020) sobre las dificultades de los profesores en el contexto educativo en pandemia. Edwards et al. (2012) concluyen, en su revisión, que la telepráctica es útil y eficaz para la evaluación e intervención de niños y adultos con alteraciones de lenguaje y habla. Incluso informan que los resultados son similares al formato presencial. ...
Experiencias de fonoaudiólogos/as al realizar telerehabilitación a niños preescolares con trastorno del desarrollo del lenguaje en contexto de pandemia RESUMEN El confinamiento como medida sanitaria a causa del COVID-19 ha obligado la adopción de la modalidad virtual en los sistemas escolares del mundo. Los fonoaudiólogos/as que trabajan con niños/as preescolares que presentan alteraciones del lenguaje han debido modificar su metodología de trabajo usual para lograr los objetivos terapéuticos y educativos de los planes de intervención que aplican. En esta investigación se buscó describir la percepción que tienen los fonoaudiólogos/as acerca de la experiencia de realizar telerehabilitación a niños/as preescolares con trastorno del desarrollo del lenguaje en contexto de pandemia. Se diseñó un estudio cualitativo, con enfoque fenomenológico. A la muestra de 10 fonoaudiólogas, reclutadas por conveniencia, se les realizó entrevistas focalizadas semiestructuradas. El análisis fenomenológico de los datos obtenidos se realizó mediante la obtención de subcódigos, códigos y categorías, de forma manual. Del análisis surgen las siguientes categorías temáticas: valoración de la experiencia, efectividad de la intervención virtual, preparación de las sesiones y participación de los padres. Las vivencias expuestas en las entrevistas realizadas permiten señalar elementos críticos relacionados con el improvisado y repentino cambio de modalidad, la escasa formación y/o preparación de las terapeutas para implementar la telepráctica, la administración de recursos y la sensación de infectividad de la intervención. Si bien las intervenciones virtuales se han establecido como una alternativa a lo presencial, se concluye que esta fue poco aceptada entre las fonoaudiólogas entrevistadas, ya que se las considera demandantes y poco efectivas para niños/as tan pequeños/as. Se resalta que el compromiso de los padres, madres y/o cuidadores/as es fundamental para lograr un proceso exitoso. ABSTRACT Confinement as a sanitary measure due to the COVID-19 has forced the adoption of the virtual modality in school systems around the world. Speech pathologists who work with preschool children with language disorders have had to modify their usual work methodology to achieve therapeutic and educational aims of the intervention plans they apply This research sought to describe the perception that speech-language pathologists have about the experience of performing telerehabilitation for preschool children with language development disorders in the context of a pandemic. A qualitative study was designed, with a phenomenological approach. The sample of 10 speech therapists, recruited for convenience, underwent semi-structured interviews. The phenomenological analysis of the data obtained was carried out bymanually obtaining subcodes, codes and categories. The following thematic categories emerge from the analysis: evaluation of the experience, effectiveness of the virtual intervention, preparation of the sessions and participation of the parents. The experiences exposed in the interviews carried out allow us to point out critical elements related to the improvised and sudden change of modality, the lack of training and/or preparation of the therapists to implement telepractice, the administration of resources and the sensation of inefectivity of the intervention. Although virtual interventions have been established as an alternative to face-to-face intervention, it is concluded that this was not widely accepted among the speech therapists interviewed, considering it demanding and ineffective for such young children. It is emphasized that the commitment of parents and/or caregivers is essential to achieve a successful process.
... Telehealth is defined as the use of telecommunication services for the provision of various healthcare services over a distance, and focuses on the transmission of data rather than the moving of patients and healthcare professionals [5]. This mode of service delivery is currently being utilised in varying capacities within both allied health and medicine to provide services including general consultations, diagnostic assessments, rehabilitation, treatments, training, and education [6][7][8][9][10][11][12][13][14]. ...
Background
Thus far, the uptake of telehealth in Australia has been puzzlingly small in scale and sporadic in nature. This is particularly true of audiology. The current study aimed to investigate the satisfaction of clinicians and clients with audiology appointments in a trial of the telehealth mode.
Material and Methods
A mixed-methods study design was utilised involving surveys with all appointment participants and semi-structured post-appointment interviews with clients. Appointments were conducted with 11 individual clients; of these, 7 interviews were conducted. One audiologist and one allied health assistant were used for all appointments.
Results
High satisfaction ratings overall were given by both clients (87.3% excellent) and the allied health assistant (74.4% excellent), whereas the audiologist consistently provided slightly lower levels of satisfaction (72.7% good). It was also found that the audiologist believed that teleaudiology increased the quality of care offered.
Conclusions
By examining the perspectives of all key stakeholders, this study identifies a number of novel positive and negative aspects of a teleaudiology practice and offers suggestions for future implementation of such a program.
... U mnoha diagnóz se vědecky potvrdila efektivita telepraxe. Patří mezi ně například chronická afázie, dysartrie, hlasové poruchy nebo Alzheimerova demence (Edwards et al. 2012, Hall et al. 2013, Cherney, Van Vuuren, 2012, Jelcic et al., 2014. ...
Primary progressive aphasia is a neurodegenerative clinical syndrome with predominant speech and language dysfunction. There are currently no curative or symptomatic pharmacological treatments. Speech and Language Therapy represents the optimum treatment to maximise communication skills for patients withprimary progressive aphasia. There are multiple therapeutic strategies available for speech-language pathologists, which are aimed at concrete deficits, or which arefunctionally aimed strategies. This article summarises a review of the therapeutic strategies for primary progressive aphasia and the specifics of generalisation in therapy, in view of current research. Due to its promising conclusions pointing to the effectiveness of Speech Therapy, the necessity of referring patients diagnosed with primary progressive aphasia to the care of a Clinical Speech Therapist as soon as possible after diagnosis is emphasised.
... The evidence is, however, not strong often due to the lack of a control group, randomization, or description of the telepractice setting in the clinical studies. In another review, Edwards et al. (2012) described clinical studies for telepractice in adults and in children. They claimed that parent coaching and involvement is crucial for telepractice with young children. ...
Purpose
Speech-language pathologists (SLPs) and audiologists from around the world were forced to enter the world of telepractice at the start of the COVID-19 pandemic. This study investigated which types of applications SLPs and audiologists used most frequently at that time. It also examined what the main obstacles then were to provide speech, language, and hearing services through telepractice.
Method
A short electronic survey with 13 questions was distributed around the world. In total, 1,466 surveys from SLPs and audiologists from 40 countries were used for the analysis. Most of them (77.4%) delivered care through online real-time communication. A minority (40.1%) also delivered care through videos or exercises that they sent to their clients, 37.8% delivered through face-to-face intervention in the same room, 30.0% delivered through telephone without video, and 21.5% provided distant computer-based treatment.
Results
The most frequently used applications were those that establish synchronous video communication with the client (60.5%). SLPs and audiologists reported using applications to create exercises more frequently than applications that contain exercises or training (15.0% vs. 12.0%). The most reported obstacle (31.2%) referred to technical problems (poor Internet connection, poor quality, or poor access to resources). Other frequently reported obstacles included the difficulty to perform assessment or treatment procedures (13.8%), concentration issues during sessions (12.4%), and lack of interaction between professional and client or patient (10.9%).
Conclusions
Many SLPs and audiologists reported using telepractice technology, mainly in the form of real-time videoconferencing. However, existing barriers included technical problems such as poor Internet connection.
... Since caregivers have more interaction with their children, their involvement is crucial in their children's speech development (Washington et al., 2012). Furthermore, caregiver coaching ensures continued practice at home for children's sustained development (Edwards et al., 2012). ...
With the COVID-19 pandemic necessitating the adoption of telepractice for providing speech and language therapy services, this study investigated the factors affecting the perceptions and the implementation of telepractice for school-age children by speech language speech-language pathologists (SLPs) in the Philippines. Sixty-four SLPs completed a 36-item online survey assessing the adoption of telepractice, implementation concerns, student candidacy, continuous training in telepractice, and the SLPs’ demographics. The SLPs reported that they quickly adopted telepractice in their services for school-age students at the start of the pandemic. Multiple linear regression analyses revealed that SLPs’ perceptions of the effectiveness of telepractice were significantly affected by implementation difficulties while SLPs’ future use of telepractice was significantly predicted by training and resource availability. These results suggest that professional training and other therapeutic resources are needed to alleviate SLPs’ concerns about difficulties in implementing and continuing use of telepractice.
... Although there are some telepractice guidelines available in the speechlanguage pathology field -for example, Houston's (2013) edited book -rapid technology changes, particularly since the advent of the COVID-19 pandemic, necessitate more up to date perspectives. In addition, the emergency transition to online work during the pandemic is not an equivalent process to setting up and fully implementing telepractice outside of emergency circumstances (Grogan-Johnson, 2021), and many of the available guidelines do not take into account these differences. ...
Students and clinical educators have had to adapt to emergency telepractice during the COVID-19 pandemic without much preparation. We sought the experiences of clinical educators and students (n = 11) regarding a pediatric teletherapy practical at a university speech-language therapy clinic in South Africa, a Global South context, via qualitative surveys and a reflective focus group. Findings highlight several challenges experienced when engaging in telepractice, including allocating clients for telepractice, preparing for telepractice sessions, managing caregiver involvement in telepractice, promoting connection with clients online, and adapting supervision style for telepractice. We discuss several implications and considerations for student teletherapy practicals going forward.
... In traditional FTF assessments, the clinician generally scores the client's performance immediately and modifies the tasks according to the client's needs. It is argued that this is the same for TP, with clinicians able to monitor the clients, score their responses, and adjust the tasks as needed (Houston, 2013;Mashima & Doarn, 2008;Theodoros, 2008). Numerous studies have reported the feasibility of using TP to assess PWA using various types of assessments and technology (e.g. ...
Purpose
The outbreak of COVID-19 impacted the delivery of outpatient services by various healthcare systems, including speech and language therapy services for people with aphasia (PWA). One possible solution here is telepractice (TP). Previous studies have shown TP to be comparable to the traditional face-to-face (FTF) delivery method for the assessment of PWA. However, these studies have largely been conducted in Western, English-speaking countries. This study evaluates the feasibility of TP to assess PWA using the Short Aphasia Test for Gulf Arabic speakers (SATG).
Method
The feasibility study adopted a within-subject cross-over study design, involving 19 individuals with post-stroke aphasia aged 25–64. Each participant was assessed twice using the SATG, once with each delivery method (FTF and TP) and the scores were compared. We collected a number of feasibility measures, including a comparison of the scores for FTF and TP. Anecdotal cultural influences on participant preferences for TP were noted by researchers.
Results
The Wilcoxon rank-sum tests showed a non-significant difference between the two methods in the overall scores and the subsection scores, except for the auditory comprehension task which showed significantly lower scores for TP delivery. High satisfaction with TP was reported, and practical considerations for implementing TP are discussed.
Conclusion
This study provides evidence of the feasibility of adopting TP to assess PWA in Saudi Arabia and Kuwait and highlights the influence of cultural aspects on the use of videoconferencing. Participants reported a preference for some FTF contact to support setting up TP and prior to the first TP session.
... Ongoing telehealth research is imperative for its continued acceptance, use, and growth. The prevailing literature in pediatric speechlanguage pathology has found high agreement among some assessments administered or scored in person and through videoconferencing, for example, the Goldman-Fristoe Test of Articulation-Third Edition (GFTA-3) and the Peabody Picture Vocabulary Test-Fourth Edition (PPVT-4;Campbell & Goldstein, 2022;Edwards et al., 2012;Lund & Werfel, 2022;Marcotte et al., 2022;McGill et al., 2021;Nelson & Plante, 2022;Schmitt et al., 2022). However, the list of assessments that have been validated to administer virtually is limited. ...
Purpose:
COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology.
Method:
A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey.
Results:
All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment.
Conclusions:
This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use.
Supplemental material:
https://doi.org/10.23641/asha.19593367.
... As a result, there are only 25 qualified AV therapists (AVTs) across the United Kingdom (Auditory Verbal UK, 2020), meaning that local access to this EI is highly restricted. It was possible that telepractice would offer a means to overcome this restriction (Houston, 2014;Houston & Stredler-Brown, 2012). Existing research indicates that telepractice sessions are less likely to be canceled (Behl et al., 2017) and are ideal for children (or caregivers) with additional needs, which make it difficult or inconvenient to travel to appointments (Houston, 2020). ...
Purpose
The aim of this study was to explore parents' and therapists' views of the benefits and challenges of telepractice for early intervention for children who are deaf or hard of hearing during the COVID-19 pandemic.
Method
Surveys probed the views of (a) parents and (b) Listening and Spoken Language Specialist (LSLS) Certified Auditory Verbal Therapists (AVTs) in using telepractice to deliver auditory verbal (AV) sessions. The survey for parents covered technology, coaching, communication, learnings for the parent, learnings for the child, and parental preference. The survey for the therapists examined therapy style, technology, relationships with families, and coaching style. Using a convenience sample of 65 families and nine LSLS Certified AVTs, data were collected using Google Forms.
Results
A response rate of 42% was achieved for the parents' survey. Families were overwhelmingly confident in the subjective effectiveness of AV sessions delivered by telepractice with modal ratings of 8 and 9 on a 10-point rating scale for telepractice sessions and in-person sessions, respectively. On average, however, parents rated in-person sessions at a significantly higher level. Eighty-five percent opted to continue with either AV delivered solely via telepractice or a blend of telepractice and in-person sessions.
Changes in therapists' style included (a) increased interactions with the parent rather than the child and (b) an improvement in coaching techniques. Eight of nine therapists (89%) felt that sessions delivered via telepractice were equally effective as or more effective than in-person sessions.
Discussion
The necessary transfer of all AV sessions to telepractice from in-person sessions during the global pandemic of COVID-19 was enacted successfully for the majority of families. Both parents and therapists described benefits and challenges of telepractice for AV intervention. Going forward, the high proportion of families requested either a blended service delivery of telepractice and in-person sessions or therapy via telepractice alone, demonstrating the families' satisfaction with this approach.
... As in any new technology, determining the factors that make clinicians and clients accept this model is seen as an important issue regarding telepractice. For example, some socio-demographic characteristics such as education level, culture, age or gender were found to be effective in technology acceptance [22,23]. As another example, Tucker [24] concluded that telepractice is mostly preferred by young SLTs. ...
Objectives: With the COVID-19 pandemic, telepractice became a great option in speech-language therapy services, as in many healthcare utilities. However, the transition to this service model did not occur at a similar rate for every clinician. Therefore, this study aimed to determine the experiences, preferences and factors affecting the acceptance of speech-language therapists (SLT) regarding telepractice in Turkey.
Methods: Sixty-seven SLTs were presented with a questionnaire that addressed the professional tendencies, experiences and views on telepractice of them. Descriptive statistics regarding the preferences and experiences of SLTs were calculated. Moreover, factors that might be related to the number of sessions they held at the pandemic were examined with the Chi-squared test.
Results: The speech-language disorders that SLTs find the most suitable for telepractice were fluency disorders, voice disorders and speech sound disorders. Groups that SLTs deemed most suitable for receiving telepractice in terms of age were 12-21, 22-64 and 7-11, respectively. A significant relationship was found between the frequency of online meetings and telepractice sessions before the pandemic and the number of sessions during the pandemic. Furthermore, a significant relationship also was found between satisfaction with using clinician skills in telepractice and the number of telepractice sessions during the pandemic.
Conclusions: The importance of the first experiences of SLTs in the acceptance of the delivery method emerged. The necessity of in-service trainings and exemplary models to improve attitudes emerged. With these trainings, ensuring security, standardizing practices and increasing qualified services will be provided as well.
... Although digital technologies such as augmentative and alternative communication (AAC) devices, mathematical-linguistic language modeling, and cochlear implant or hearing aid technologies are well-established [25][26][27], evidence for digital therapy applications, game-based interventions, and digital screening tools is still emerging [28][29][30][31][32][33]. Telemedicine and teletherapy are building an evidence base and offer a useful means to deliver services in a patient's natural environment [34][35][36][37][38][39]. Despite the influx of new digital solutions, knowledge and implementation of such methods and their quality or efficacy as well as the extent to which these are explicitly incorporated into academic training programs remain unclear [40,41]. ...
Background
Advances in digital health and digital learning are transforming the lives of patients, health care providers, and health professional students. In the interdisciplinary field of communication sciences and disorders (CSD), digital uptake and incorporation of digital topics and technologies into clinical training programs has lagged behind other medical fields. There is a need to understand professional and student experiences, opinions, and needs regarding digital health and learning topics so that effective strategies for implementation can be optimized.
Objective
This cross-sectional survey study aims to interdisciplinarily investigate professional and student knowledge, use, attitudes, and preferences toward digital health and learning in the German-speaking population.
Methods
An open-ended, web-based survey was developed and conducted with professionals and students in CSD including phoniatricians and otolaryngologists, speech-language pathologists (German: Logopäd*innen), medical students, and speech-language pathology students. Differences in knowledge, use, attitudes, and preferences across profession, generation, and years of experience were analyzed.
ResultsA total of 170 participants completed the survey. Respondents demonstrated greater familiarity with digital learning as opposed to eHealth concepts. Significant differences were noted across profession (P
... WHO defines telehealth as "the delivery of health care services, where patients and providers are separated by distance…for the exchange of information for the diagnosis and treatment of diseases and injuries, research and evaluation, and the continuing education of health professionals" (WHO, 2019 Africa, the Americas, Europe, Southeast Asia, and Pacific regions, all of which indicated some degree of participation in telehealth. One conclusion of this survey is that telehealth programming is not limited to the minority world. 1 With easier access to broadband Internet and cheap smart devices, access to telehealth also has growth potential (Edwards et al., 2012). This growth is noted among general medical care and therapeutic services such as speech-language pathology and audiology (Weidner & Lowman, 2020). ...
Purpose
The following commentary outlines the principles of international telepractice with regard to speech-language pathology and audiology services. Additionally, this commentary provides critical caveats and concerns surrounding international telepractice as well as a summary of principles to follow as telepractice programs encourage access to care and bidirectional, sustainable, and ethical practice development.
Conclusions
Telepractice among communication disorders professionals has grown exponentially in recent years. With the rise in telepractice opportunities, easier access to digital practice platforms, and increased Internet access through mobile devices, telepractice is a popular therapeutic modality in the communication disorders field. Telepractice applications have extended beyond therapeutic services alone and into clinical education among speech-language pathologists (SLPs) and audiologists (AUDs). Telepractice has also extended beyond national borders called international telepractice. This practice has the potential to improve access to critical rehabilitative and therapeutic services, build capacity in allied rehabilitation systems, and encourage global bidirectional partnership among SLPs and AUDs. However, this practice should not proceed without caution, and the ethical implications should be carefully and critically considered.
... 14 in recent decades, the growing interest in the provision of social and health care services at a distance and the development in telecommunications have led to a significant increase in the application of telehealth on a global scale. a large number of studies have recently investigated the application of telemedicine reporting evidence of effectiveness, 15,16 but studies regarding the management of swallowing disorders remain limited. ...
Introduction:
Telerehabilitation is the provision of rehabilitation remotely through Information and Communication Technologies (ICT). Recently, there has been an increase of interest in its application thanks to increasing a new technology. The aim of this systematic review was to examine the evidence of the literature regarding the management of neurogenic dysphagia via telerehabilitation, compared to face-to-face rehabilitation treatment. The secondary aim was to create recommendations on telerehabilitation sessions for patients diagnosed with neurogenic dysphagia.
Evidence acquisition:
The databases were: Medline, Embase, Cinahl, Scopus. A total of 235 records emerged from bibliographic research, manual search of full text and from gray literature, published until January 2021. Two blinded authors carried out titles and abstract screening and followed by full-text analysis. 16 articles were included in the systematic review and assessed through critical appraisal tools.
Evidence synthesis:
The research shows that the majority of the studies on neurogenic dysphagia involved the Clinical Swallow Examination via telerehabilitation, compared with the inperson modality. Significant levels of agreement and high satisfaction from clinicians and patients are reported to support the use of telerehabilitation. Based on the results of this systematic review and qualitative analysis, the authors developed practical recommendations for the management of telerehabilitation sessions for patients with neurogenic dysphagia.
Conclusions:
Despite the presence of barriers, telerehabilitation allowed healthcare provision and increasing access to care and services with specialized professionals, remote rehabilitation can be a valid resource during the health emergency due to COVID-19.
... Also, 31% of the participants had faced technical difficulties often and had to troubleshoot. The audio and video quality majorly depend on the speed of the internet connection or the mobile network's strength that the client uses [22]. In the present study, most of the participants were from rural areas (64.8%) and among them, 51.1% of parents reported always /often faced technical difficulty, which required troubleshooting. ...
Background and Aim: Rehabilitation services to individuals with hearing impairment were on hold with widespread COVID-19. So, rehabilitation services were mandated mainly through telepractice for children with hearing loss. Evaluating the effectiveness of tele-practise compared to face-to-face therapy is of utmost importance for evidence-based approaches. Therefore, the present study aimed to evaluate the parent's satisfaction with tele-listening training for children with hearing impairment during COVID-19. Methods: Fifty-four parents of children with hearing loss participated in the study. The parents satisfaction on tele-listening training was evaluated through the Parent Satisfaction Questionnaire in terms of 1) the audio and video quality during teletherapy; 2) equipment use 3) general parent-therapist interaction and communication during teletherapy; 4) service delivery and convenience; and 5) overall satisfaction with the teletherapy. Results: The results showed a higher parent satisfaction rating to avail rehabilitation services through tele-modality during the pandemic. Tele-listening training sessions had helped parents continue training their children at home with the therapist's guidance online. However, parents were not satisfied with their child's
... Also, 31% of the participants had faced technical difficulties often and had to troubleshoot. The audio and video quality majorly depend on the speed of the internet connection or the mobile network's strength that the client uses [22]. In the present study, most of the participants were from rural areas (64.8%) and among them, 51.1% of parents reported always /often faced technical difficulty, which required troubleshooting. ...
Parent’s satisfaction on tele-listening training for children with hearing impairment during COVID-19"
... La distancia, el clima, el terreno geográfico y la escasez de especialistas son los grandes desafíos para asegurar un acceso a los servicios adecuado y equitativo. Edwards et al. (2012) sostienen que hay un apoyo creciente de organizaciones profesionales para el uso de este modelo de prestación de servicios, como la tecnología de videoconferencia, que puede aliviar los efectos de la distancia en el acceso a la atención médica, si bien la literatura existente obliga a los profesionales a realizar más estudios relacionados específicamente con la efectividad y la eficacia de la telepráctica en Atención Temprana. En relación con la muestra de los estudios, parece haber abundante evidencia sobre el uso de la teleintervención en niños con discapacidad auditiva de Behl y Houston (2012), siempre que se trate de un mecanismo de apoyo, no sustitutorio de la práctica en persona. ...
El equipo TRASCIENDE surge a partir de la necesidad de articular un proyecto de colaboración entre Plena inclusión-CLM y la UCLM para la transformación social, científica, académica y profesional en materia de discapacidad, inclusión y ciudadanía. A raíz de la situación sociosanitaria provocada por la COVID-19, el equipo TRASCIENDE se ha visto implicado en el cambio social que ha producido el confinamiento, desarrollando, necesariamente, un rol de observador del cambio. Esta situación global nos lleva a formularnos preguntas que pretenden iniciar procesos de investigación en la práctica: ¿de qué manera este confinamiento ha afectado a las prácticas en Atención Temprana? Para responder a esta pregunta se decide adoptar una perspectiva de investigación cualitativa para explorar las percepciones de familias y profesionales (logopedas, fisioterapeutas, estimuladoras y coordinadoras) de equipos de Atención Temprana, sus dificultades y sus fortalezas en esta situación de cambio. El trabajo describe un proceso de exploración de las prácticas durante los primeros meses del confinamiento, prácticas que se han dirigido, en muchos casos, hacia la teleintervención. Los datos han sido recogidos mediante entrevistas etnográficas (familias) y grupos focales (profesionales) y han sido tratados mediante análisis temático (Attride-Stirling, 2001). Los resultados muestran la percepción de las familias y los profesionales articulados en tres focos de redes temáticas: la reacción personal y colectiva a la nueva situación, lo que puede permanecer de la teleintervención (con sus matices) y lo que subyace a las prácticas en esta modalidad. El estudio abre, además, nuevas líneas de investigación futuras que evidencian la dificultad del proceso de transformación hacia modelos verdaderamente centrados en la familia.
... The LabConcept platform has unique and novel features compared to Doxy.me, eVisit, Vsee, Teladoc, TheraPlatform, Coviu and Chiron Health [30][31][32][33][34]. These examples of software are focused only on end-to-end video call consultations, except Teladoc and eVisit, which have also billing and electronic prescription capabilities. ...
The aim of this paper is to present a new original software platform, called LabConcept, that is designed for monitoring health activity in order to establish a more efficient treatment plan and provide a better lifestyle via telemedicine. It is fully designed by the authors and embeds all the patient’s healthcare information into a mobile software application, compatible with smartphones, laptops or other mobile devices. The novelty consists in standardizing the laboratory and the point-of-care results into a Quick Response (QR) code that is printed on every result bulletin issued and given to the patient after his routine blood assays are performed. Compared to the existing telemedicine software (VSee, Teladoc, TheraPlatform, Chiron Health), which have the basic videoconferencing role, LabConcept has a set of new important features that start from the concept of telemedicine, designed to load and create databases for all the assayed results in order to be sent to the doctor’s LabConcept application for professional interpretation. The software also analyzes the clinical evolution of an assay on a user-predefined period of time, automatically pre-diagnoses and alerts the user about a potential disorder from the stored results and records comments regarding the efficiency of the patient’s treatment plan. LabConcept is an easy and safe end-to-end real-time patient–doctor communication channel, conducive to improved monitoring and treatment procedures for the patient.
... Several studies have focused on tele-practice interventions for children who stammer (McGill et al. 2019, Lowe et al. 2014, children with a hearing impairment (Edwards et al. 2012), and increasingly so for children with autism spectrum disorders (Sutherland et al. 2018, Boisvert et al. 2010. Studies focusing on more general speech and language difficulties and speech and language therapy practice appear scarce. ...
Background
Many healthcare and educational services providers have undergone a rapid transition from a face‐to‐face to a tele‐practice mode of service delivery in the context of the COVID‐19 outbreak. This, in turn, has led to a need to understand better the evidence underpinning such moves. Based on a review of existing reviews, this paper critically analyses the relevant literature related to intervention with children with communication disabilities drawing on the COM‐B model.
Methods & Procedures
Ten reviews were identified following a systematic searching of electronic databases. These were then coded according to both PRISMA criteria and the components of the COM‐B model. Based on these findings, a critical analysis of the state of the tele‐practice intervention literature is discussed and fed into evidence‐based advice for practitioners transitioning to this mode of service delivery.
Outcomes & Results
The COM‐B mapping suggests that the existing literature has provided primary evidence for physical opportunity and reflective motivation (e.g., participants have the time to take part and the necessary materials, as well as a desire to do it). It has also focused on elements of social opportunity (e.g., having support and prompts from others to take part). However, there are significant gaps in the description and analysis of both physical and psychological capability components.
Conclusions & Implications
Whilst the evidence for tele‐practice interventions for children and young people with communication disabilities is growing, it is also lacking a comprehensive framework to support its implementation. In times of rapid transitions, researchers and practitioners alike need to understand how to evaluate comprehensively the impact of changing the mode of intervention delivery. The COM‐B model provides a powerful tool to reflect on the key elements for the successful design and implementation of tele‐practice interventions.
What this paper adds
What is already known on this subject
• Tele‐practice has been a feature of service delivery for speech and language therapists working with children and young people with speech and language disorders for many years, as it has in other areas of practice. This came into sharp focus during 2020 during the ‘lock‐down’ following the start of the COVID‐19 pandemic when most practice went online.
What this paper adds to existing knowledge
• This study set out to provide a framework for understanding service delivery, drawing on the COM‐B behaviour change model. This is applied using a rapid review methodology to 10 systematic and narrative reviews of the existing literature published since 2005. The findings suggest that while most studies demonstrated efficacy, there was a lack of information regarding specific aspects of the model which would affect their implementation.
What are the potential or actual clinical implications of this work?
• It is anticipated that the paper has the potential to have a direct bearing on how tele‐practice services for children and young people with speech and language disorders will be delivered in the future. The paper concludes with a series of recommendations for practice and research in terms of the application of the COM‐B model to tele‐practice in speech and language therapy.
... Telehealth care has been regarded as an alternative to face-to-face care in many countries [1,2]. Furthermore, speech-language pathologists have engaged in telepractice over the past 2 decades in various countries [3][4][5][6]. The efficacy of telepractice has been supported by scientific research on speech, language, voice, and fluency disorders across different age groups [7][8][9]. ...
Background:
The ongoing coronavirus (Covid-19) pandemic has resulted in face-to-face class suspensions and a boom in the use of telepractice in speech-language pathology. However, little is known about caregivers' and students' telepractice satisfaction and service delivery mode preferencesthat may affect therapy effectiveness and future adoption of telepractice.
Objective:
This study evaluated perceived telepractice efficacy and preference between onsite practice and telepractice as well as factors affecting service delivery mode preferences among caregivers and students during the Covid-19 pandemic.
Methods:
A 19-question survey on telepractice satisfaction and preference was administered to 41 Hong Kong Chinese students and 85 caregivers who received telepractice from school-based speech-language pathologists during the Covid-19 pandemic class suspension period. In addition to the demographic information and the implementation of telepractice in the survey, all participants were asked to rate their perceptions of the efficacy of telepractice and compare onsite practice and telepractice on a 5-point Likert scale (1 = strongly disagree/favoring the use of onsite speech-language therapy to 5 = strongly agree/favoring the use of telepractice).
Results:
Despite a high rating for telepractice efficacy from caregivers (95% CI 3.30-3.66) and students (95% CI 3.21-3.76), both groups rated that telepractice was less effective than onsite practice (caregivers: 95% CI 2.14-2.52; students: 95% CI 2.08-2.65). Moreover, the caregivers preferred onsite practice over telepractice (95% CI 2.04-2.43), whereas the students showed no preference for the mode of practice (95% CI 2.74-3.41). A significant association between telepractice efficacy and preference was found only among the students (τ = .43, P < .001), not the caregivers.
Conclusions:
Although telepractice can be considered as an acceptable alternative service delivery option for school-aged speech and language therapy services, it is necessary for speech-language therapists and caregivers to play a more proactive role in telepractice by facilitating effective communication between clinicians and caregivers.
Purpose
The COVID-19 pandemic thrust telepractice into the mainstream as a primary service delivery model. While some populations and providers were adversely impacted by this shift, there were some intervention approaches that became even more popular. Parent-mediated intervention (PMI) has been shown to be effective through both in-person and telepractice service delivery models. With PMI, caregivers learn language facilitation strategies and implement them with their child. Project SKILLS (Skills and Knowledge for Language Learning Success) is a PMI program for autistic children funded by a state-level autism grant program. The primary goal of SKILLS is training caregivers in language facilitation techniques to promote communication and language skills. It uses the Project ImPACT (Improving Parents as Communication Teachers) curriculum that is commercially available and supported by previous research. SKILLS also includes variations for neurodiversity-affirming practice and culturally and linguistically diverse families. Project SKILLS has offered both in-person and telepractice delivery since its inception in 2016, making it possible to compare results across the two modalities.
Conclusions
Project SKILLS has successfully implemented PMI for autistic children through both in-person and telepractice sessions. Clinically, children have made similar gains in social communication and language regardless of the modality. Caregivers also demonstrated similar progress with intervention fidelity, with some added advantages for families participating via telepractice. Telepractice may become a preferred service delivery model of PMI, especially for families living in geographically inaccessible locations with limited access to qualified providers.
Purpose
Many standardized assessments in speech-language pathology can be administered via telepractice. However, the literature is limited on reporting the equivalency of assessment administration between in-person and remote testing. The SCAN–3 for Adolescents and Adults: Tests for Auditory Processing Disorders (SCAN-3:A) is widely used by speech-language pathologists and audiologists to screen for auditory processing disorder (APD). The purpose of this study was to compare in-person and remote administration results on the screening subtests of the SCAN-3:A to determine test–retest consistency across the two settings.
Method
Eleven undergraduate and graduate students with normal hearing were administered the Gap Detection, Competing Words–Free Recall (CW-FR) and Auditory Figure Ground (AFG) screening subtests from the SCAN-3:A both in-person and via telepractice with the order counterbalanced across administrations. Specific modifications were made to accommodate remote assessment.
Results
Screening pass/fail decisions were above 80% agreement for each of the three subtests. Significant correlations ( p < .05) between in-person and remote scores were found for the CW-FR and AFG subtests. The mean score difference between administration type was not significant for the CW-FR subtest ( p = .921) but was significant for the AFG subtest ( p < .05).
Conclusions
These preliminary findings provide tentative, partial support for remote administration of the SCAN-3:A with adherence to specific recommendations. Some technical challenges were reported as well as other logistical limitations associated with remote administration. Recommendations to accommodate telepractice considerations for remote screening of APD are provided.
Supplemental Material
https://doi.org/10.23641/asha.25632135
Telepractica logopedică se referă la serviciile oferite de la distanță prin folosirea de platforme de videoconferință sau alte tehnologii similare. Potrivit American Speech Language Hearing Association (2020), există termeni sinonimi: teleaudiologie, teleterapie sau telereabilitare. Această terapie la distanță se realizează prin conectarea specialistului cu pacientul în vederea efectuării evaluării, intervenției și/sau consilierii.
Introduction. A newly discovered SARS-CoV-2 virus that causes an infectious disease called Coronavirus Disease 2019 (COVID-19) has spread around the world. Objectives. The study aims to explore the impact of the COVID-19 pandemic on speech-language pathologists (SLPs) clinical service delivery. Accordingly, this study aims to determine which modifications were used in the provision of speech-language pathology (SLP) services and which procedures were used by SLPs in their clinical practice in Bosnia and Herzegovina (B&H) during the third pandemic wave. The second aim of the study was to analyze how many SLPs from B&H used telepractice and what are the barriers to performing this type of work. Methods. The study included 107 SLPs, who voluntarily joined the survey, after sending the questionnaire directly to the e-mail or placing the questionnaire in online SLPs groups. The survey comprised questions to assess participants' demographics, personal protective equipment, procedures, provision of telepractice, and barriers and limitations to telepractice implementation. Results. Results showed that 93.4% of SLPs reported they use measures to prevent and control the COVID-19 pandemic. Only 28% of SLPs used telepractice in their work, which is a very low rate. The majority of SLPs (59.2%) reported that they did not receive the appropriate education about using telepractice. Conclusion. The COVID-19 pandemic led to a change in service delivery by SLPs requiring them to modify their work or to provide services through telepractice.
Objectives: The purpose of this paper is to review the recent literature and reflect on the studies conducted to investigate the efficacy of tele practice in speech-language therapy. This paper focuses more on the recent literature and the studies conducted during the coronavirus COVID-19 pandemic. Methodology: A review of the recent literature from 2012 to 2021 was studied on providing speech-language therapy intervention through tele practice. Key literature search sources included the Sci-hub, PubMed, HINARI (Health Inter Network Access to Research Initiative), and Google Scholar databases. Findings: The review of the literature provides evidence that telepractice delivery model for speech and language therapy services is an effective and useful way to cater to the needs of the patients. However, this paper also provides us with an insight that the hybrid model which is the combination of one-on-one and telepractice therapy session may be more effective and holistic way to provide therapy. There is a vital need for more investigative studies on the topic of telepractice. Unique Contribution to theory, practice, and policy: Speech and language therapist may opt for a hybrid therapeutic approach to achieve more functional outcomes. There is a need for in-depth and comprehensive investigative studies to fully understand the effectiveness of telepractice service delivery model when this model is utilized for variety of different speech and language disorder. Moreover, policies at professional institutes need to ensure that therapists undergo trainings on telepractice techniques and functionality to provide holistic treatment to patients and support care givers.
Purpose
During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed.
Method
Spoken discourse elicited through the picture description task of the Western Aphasia Battery–Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables.
Results
Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs.
Conclusions
These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies.
Supplemental Material
https://doi.org/10.23641/asha.21476961
Purpose
Plena Inclusión is the National Federation of Organisations of People with Disabilities in Spain providing services, defending rights, and being an agent of social change. Families who have children with early childhood intervention (ECI) support needs have experienced a changing situation during confinement due to the pandemic. Some of these changes have critically affected some families, whereas others have been able to rely on professional support that has allowed them to develop strengths and improve their functioning as a family. This objective is, precisely, one of the keys to the Family-Centered Practice (FCP) model in ECI. This study aims to explore the narratives of families who have received support in ECI practices during the lockdown in the region of Castilla–La Mancha (Spain) within the frame of Plena Inclusión services. These practices have been directed, in many cases, toward tele-intervention.
Method
Data have been collected through ethnographic interviews with families and have been processed through thematic analysis.
Results
The results show the perception of families articulated in two thematic network focuses: the personal and family emotions regarding the past and present moment (fear, loneliness, despair, nervousness, uncertainty, anguish, and frustration) and the emotions experienced also in the present but projected toward future (feeling of competence, hope, adaptation, tranquility as they felt supported by professionals, relief for not being alone, trust in their process, or empowerment, among others).
Conclusions
In parallel, focus groups with professionals who support these families were carried out, although the results of this analysis will be presented in future reports. The study opens new lines, which evidence the difficulty of the process of transformation toward actual FCPs.
Introduction: Pandemics affect people in a defeatist manner and become stressful for people with relatives which need specific forms of care and attention. The study was conducted to find out if anxiety prevails among caretakers during the Covid-19 Pandemic as according to the literature review caregivers experience burden and fears related to their care-recipients and telerehabilitation. Material and Methods: The study used cross sectional survey and quantitative research.50 care-givers participated in the research where they filled online questionnaires inspired and derived from care-giver burden scale and beck anxiety inventory. Anxiety was clearly evident as most of the care-givers agreed to have feelings of nervousness 19 (38%), feeling anxious 18 (36%), feeling distressed 22 (44%), complaints about emotional burden 23 (43%) and 23 (46%) constant immersion in duties towards care-recipients. Results: SPSS tables depict the analyzed results and their interpretation. The results show 36%of the care-givers agreed that they face anxiety when a situation gets out of control, 44% were distressed about not getting enough help from healthcare team and other family and friends, 55% are apprehensive about their present condition and 46% are emotionally challenged and constantly immersed in duties owing to their family members. Conclusions: Anxiety and depression as a result of caregiving burden is common among care-givers and needs to be addressed as soon as possible. This makes it essential that health professionals pay heed and attention to develop interventions for care-givers and provide them with pertinent knowledge. Keywords: anxiety, care burden, caregiver, covid 19, pandemic, telerehabilitation
This article discusses some aspects of online speech therapy, regarding the interaction, effectiveness and outcome, the discussion being based on studies conducted both in terms of language disorders and in accordance with the presence of disability. As a base for the research, I have used the survey method, with a questionnaire applied to a number of 51 parents whose children have conducted online speech therapy sessions, mainly synchronously. The advantages and disadvantages of using online therapy are debated from the point of view of both the parent and the speech therapist. The importance of choosing the right therapeutic form (online or classic) being an inherent conclusion.
Bu araştırmanın amacı, kekemelik terapisinin yüz yüze ve tele-terapi yoluyla sunumunun, kekemelik şiddeti, kekemeliğin bireyin yaşamına etkisi ve kekemeliğe ilişkin tutumlar üstünde etkisini incelemek ve katılımcıların tele-terapi deneyimlerini keşfetmektir. Araştırmanın katılımcıları kekemeliği olan 20 yetişkin bireydir. Katılımcılar tercihlerine ve koşullarına bağlı olarak tele-terapi ve yüz yüze terapi grubuna eşit sayıda atanmıştır. Tele-terapi grubu katılımcıları 8 farklı şehirden tele-terapi hizmeti almışlardır. Kekemelik terapisinde akıcılık biçimlendirme, kekemelik değiştirme ve danışmanlık yaklaşımları entegre şekilde kullanılmıştır. Araştırmanın deseni, nicel ve nitel verilerin kullanıldığı bir karma araştırma yöntemi olan eş zamanlı desendir. Nicel araştırma kapsamında, kontrol gruplu, eşitlenmiş, eşdeğer etkililik; öntest, sontest, izleme yarı-deneysel modeli kullanılmıştır. Nitel araştırmada ise fenomenoloji yaklaşımı kullanılmıştır. Araştırmanın birincil nicel verilerini üç durumda kekelenen hece oranları, kekemeliğin değerlendirilmesine ilişkin SSI-4 puanları ve katılımcıların özdeğerlendirmelerine ilişkin puanlar oluşturmaktadır. İkincil verileri ise algısal kekemelik şiddeti ve konuşma doğallığı puanları, tutumlara ilişkin OASES ve SL-ILP-S puanları oluşturmaktadır. Araştırmanın nitel verilerini yarı yapılandırılmış mülakatlardan elde edilen veriler ve klinisyen görüşleri oluşturmaktadır. Araştırmanın bulgularına göre tele-terapi ve yüz yüze terapi grupları, kekelenen hece oranlarını ve objektif klinik verilere ilişkin puanlarını anlamlı düzeyde düşürmüştür. Sontest ve/veya izleme evrelerinde iki gruptan elde edilen bu veriler arasında ise anlamlı bir farklılık bulunmamıştır (p>.05). Nitel analiz sonuçlarına göre katılımcıların %90'ı tele-terapiyi kendileri için uygun bulduklarını ve bu hizmetten yarar gördüklerini bildirmiştir. Nicel ve nitel bulguların üçgenlenmesi bu veri setlerinin genel anlamda uyumlu olduğunu ve birbirlerini doğruladıklarını göstermektedir. Bu araştırmada tele-terapinin, kekemeliği olan bireylere hizmet vermede uygun ve yüz yüze terapi kadar etkili bir hizmet sunum yöntemi olduğu görülmüştür.
Como consecuencia de la pandemia por covid-19 se ha debido implementar medidas como la suspensión de clases presenciales en las escuelas. La necesidad de adaptarse a esta emergencia global y la disponibilidad de herramientas tecnológicas ha permitido la activación de programas destinados a brindar opciones de atención terapéutica en contexto escolar, siendo la teleterapia uno de ellos. Este estudio busca describir el uso de teleterapia fonoaudiológica en educación regular durante la pandemia. Para esto se optó por un diseño tipo cuantitativo descriptivo, que permitió estudiar una muestra de 190 participantes de distintas regiones del país que cumplieron los criterios de elegibilidad, utilizando un cuestionario de Google para la recopilación de información. La información obtenida indica que la teleterapia se realizó con mayor frecuencia a través de sesiones sincrónicas y asincrónicas, de manera individual, una vez por semana y por 30 minutos. Asimismo, las dificultades relacionadas con la señal de internet y la prestación de insumos por parte del empleador fueron las principales barreras. Los resultados sugieren que la teleterapia puede ser una herramienta para dar continuidad a la intervención fonoaudiológica escolar, teniendo en cuenta que el covid-19 modificará radicalmente la prestación de servicios a mediano plazo.
Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children.
In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.
Purpose
Telehealth services experienced exponential growth during the COVID-19 pandemic. This survey examined the resulting evolution in the technology, connectivity, implementation of services, and attitudes of pediatric speech-language pathology clinicians using synchronous videoconferencing.
Method
The Telehealth Services: Pediatric Provider Survey participants were 259 speech-language clinicians in a variety of employment settings from across the country and abroad. Analyses identified telehealth barriers eliminated and those that persisted during the pandemic, advantages, and disadvantages of remote delivery of evaluation and treatment services, the most common telehealth technology used by clinicians and their clients to access care, and clinicians' predictions about the optimization and future of telehealth.
Results
Elimination of regulatory and insurance hurdles allowed children from varying socioeconomic backgrounds living in rural, suburban, and urban areas access to telehealth. Telehealth technology shifted from computers with external hardware and specialized software to commercially available equipment, such as handheld portable devices with built-in audiovisual components and publicly available videoconferencing platforms. However, connectivity of these devices continued to be problematic, and lack of technology prevented some children from accessing care. Judgments about the appropriateness and effectiveness of evaluations and treatments varied based on the age and communication disorder of a child. Although some participants expressed uncertainty about the effectiveness of telehealth compared with in-person care, telehealth was widely recognized as a viable delivery method.
Conclusions
Although clinicians reported many advantages of telehealth, some barriers identified reported prior to COVID-19 still persist. Clinicians anticipate that new developments have the potential to continue improving telehealth service delivery, bolstering the viability of telehealth long after the COVID-19 pandemic is gone.
Supplemental Material
https://doi.org/10.23641/asha.16959361
Purpose
The purpose of this study was to investigate the initial perceptions of speech-language pathology graduate student clinicians following implementation of telepractice using survey questions.
Method
The study used thematic analysis to answer three research questions: (a) How comfortable and confident are graduate student clinicians using telepractice? (b) What are the differences between in-person and telepractice service delivery? (c) What surprised graduate student clinicians about telepractice?
Results
Thirty first-year graduate student clinicians completed the survey following 5 weeks of telepractice service delivery. Findings revealed that, initially, graduate student clinicians felt nervous and uncertain about administering speech-language therapy through telepractice but eventually became more comfortable and confident with the new therapy delivery model. Differences between in-person and telepractice involved more attention to clinician's facial expressions, learning technology, managing environmental distractions at home, and the necessity for caregiver involvement. Graduate student clinicians expressed mixed perceptions of treatment effectiveness through telepractice, which may be associated with the client's attention, communication severity, and clinician's motivation. In the end, graduate student clinicians shared positive reflections of this learning experience.
Conclusions
As speech therapy through telepractice continues, students will require guidance about this service delivery model. This study described graduate students' perceptions of telepractice, which may be applied to academic clinical curriculum.
Purpose
The purpose of this survey research is to provide preliminary data regarding speech-language pathologists' (SLPs') perceptions of the role that social justice (SJ) plays in their work. As our professional organizations call us to advocate and communicate with regulatory agencies and legislative bodies to promote quality care for all individuals, this topic has become particularly important at this time. At present, there is a lack of data in peer-reviewed publications within the discipline of communication disorders on SJ and even less regarding the perceptions of SLPs on SJ.
Method
The survey was sent to American Speech-Language-Hearing Association (ASHA)-certified SLPs, identified by the ASHA ProFind database, across six U.S. geographic regions, including both urban and rural communities. Four themes were explored through the survey: (a) importance of SJ, (b) awareness of SJ, (c) current practices related to SJ, and (d) barriers to SJ implementation.
Results
The majority of respondents view SJ as important to the profession (91.2%) and value the work of creating equality among groups (96.0%). Many SLPs are actively involved in implementing SJ principles in their own practice by accepting Medicaid (40.7%), engaging in political outreach (55.0%), and providing transdisciplinary educational outreach (77.9%). Identified barriers to incorporating SJ include time (62.7%), resources (65.6%), and finances (70.0%).
Conclusions
Working for SJ is important to a majority of the respondents, and various efforts are implemented to create equal opportunities for service to clients. Barriers continue to exist that limit the degree to which SLPs can work toward SJ. A list of actions to be considered in order to promote SJ in the field is provided.
Supplemental Material
https://doi.org/10.23641/asha.16584044
Pediatric cochlear implantation has transformed the opportunity for children with severe to profound sensorineural hearing loss to acquire listening and spoken language. A multidisciplinary team effort, specialized skills, and timely coordination are critical to the successful achievement of these goals, starting from the determination of candidacy to the delivery of services, and transitions through various stages of language acquisition and educational settings. The candidacy process includes the characterization of auditory dysfunction and the evaluation of comorbidities and the peripheral auditory anatomy that may affect the feasibility and safety of the surgical intervention. The establishment of reasonable family goals and expectations provides an important roadmap for sustained commitment to the long habilitation process. The pediatric implant surgeon must have knowledge of the unique surgical challenges including inner ear malformations and the prevention and management of wound and device complications. The facility must be equipped to carry out play audiometry and the technical aspects of device programming to achieve a functional map in a young child. Consistent and frequent rehabilitation sessions and parent coaching after surgery are necessary to build a strong language scaffold. Close collaboration between surgeon, audiologist, auditory therapist, and educator is required to optimize sensory input and access to speech in the therapeutic and educational settings. In addition to age at implantation, parental sensitivity to the language learning needs of their child is an important determinant of language achievement in children with cochlear implants. Increased attention to the needs of families as the primary source of language input to an infant or toddler offers additional opportunity for enhancing outcomes.
Telepractice offers speech-language pathologists (SLPs) increased flexibility to support language development, including emergent literacy in clients with complex communication needs. However, clinicians may feel uncertain how to pair books with augmentative and alternative communication (AAC) over telepractice. Following an overview of telepractice, book sharing, and e-helpers, we describe four practical ways to combine storybooks with AAC online. These include: (a) using accessible books, (b) screen sharing e-books and communication aid, (c) adapting slide shows, and (d) creating asynchronous videos. Finally, we offer suggestions for modeling AAC, prioritizing emotions in storybooks, and tips for clinical supervisors. This topic can direct future researchers and is relevant to practicing clinicians who want to support language development for clients using aided communication systems.
School-based speech-language pathologists (SLPs) are implementing telecommunication technologies for service provision. Telepractice is one among an array of service delivery models that can be successfully implemented in the public-school setting. While many school-based SLPs have been plunged into telepractice with the recent pandemic, this temporary shift to emergency instruction is not the same as fully implementing a telepractice service delivery model. SLPs who recognize the potential application of telecommunications would profit from additional training and experience to take advantage of the benefits of this service delivery model. The purpose of this article is to explore the concept of telepractice as a service delivery model, and to answer the who, what, when, where, and why questions of school-based telepractice. Telepractice is one of several service delivery models that school-based SLPs can confidently utilize to provide effective speech and language therapy services to school-age students.
Published in the Australian Journal of Education of the Deaf; now known as Deafness & Education Internationl
We examined the current perspectives of service providers, administrators, and parents who are linked to the provision of special education and related services to learners with low-incidence disabilities in the United States. The purposes of the investigation were to gain information from the various respondents concerning the adequacy and availability of appropriate educational services for students with low-incidence disabilities and provide information regarding the need for additional services and supports. A detailed survey instrument that included a variety of open-ended response items was developed and mailed to the membership of two professional organizations with strong connections to rural special education. Responses indicated that the biggest areas of need were for highly qualified personnel with the necessary skills and knowledge to meet the needs of learners with low-incidence disabilities and for timely information that would support the education of these learners. Implications for how these concerns can be addressed are provided within the framework of four major functions including: information provision, teacher preparation, local school support, and research.
Abstr act Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation. This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention. Early intervention (EI) services for children from birth through two years of age are designed to promote development and improve the quality of life of infants and toddlers who have been identified as having a disability or developmental delay. A primary goal of EI services is to enhance the capacity of families to help their child learn, achieve developmental milestones, and participate in home and community activities. EI services for children from birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation is a service delivery model that demonstrates the potential to deliver EI services effectively and efficiently, thereby ameliorating the impact of provider shortages in underserved areas.
The shortages of special education personnel are nowhere more severe than in low incidence disabilities in rural schools. This article presents the results of a national study that identified shortage estimates, state certification patterns, personnel preparation programs, and distance delivery mechanisms and examined relationships among these data to assess the state of shortages of special educators in the areas of vision impairments, hearing impairments, severe disabilities, and early intervention. The authors outline current issues and future trends in preparing personnel in low incidence disabilities for rural areas.
Teleaudiology, the delivery of audiology services at a distance using telecommunications technologies, represents a growing area of opportunity for clinical practice. While audiology is a mature discipline whose development was fueled by World Wars I and II, advances in teleaudiology are relatively recent, having occurred over the past decade. Teleaudiology service delivery models include synchronous, asynchronous (i.e., store-and-forward) and hybrid approaches. As examples, computer-based teleaudiology technologies have been demonstrated to: perform puretone audiometry; measure otoacoustic emissions; program cochlear implants via neural response/telemetry assessment; and perform video-otoscopy. With further development of computer-based tympanometry, synchronous impedance testing via teleaudiology is soon to become a reality. Low technology teleaudiology applications are also developing. Teleaudiology appears very promising, as most of the teleaudiology applications reported upon thus far have demonstrated outcomes comparable to in-person interactions.
This paper presents results from a study conducted at the Rehabilitation Engineering Research Center (RERC) on Telerehabilitation at the National Rehabilitation Hospital. The study was designed to measure performance by brain-injured subjects, with medical diagnoses of stroke or traumatic brain injury, on a standardized Speech-Language Pathology evaluation conducted in both face-to-face and videoconference-based telerehabilitation settings. The Story Retelling Procedure (SRP), which measures connected language production and comprehension of spoken narratives, was administered to each subject in both settings. The primary objectives of this study were to: (1) compare communication as measured by the SRP between experimental settings, and (2) determine if subject variables (such as age, education, technology experience or gender) had an effect on performance differences between settings. The rationale was that any difference in this aspect of performance must be identified and characterized before this mode of intervention can be used clinically. Across all subjects (n=40), no significant difference (p>0.05) was found between SRP performance measured in the two settings. Additionally, variables including age, education, technology experience, and gender did not significantly affect the difference between performance in the two settings. Overall, subjects reported a high level of acceptance of videoconferencing with 34 subjects responding "yes," 4 responding "no," and 2 responding "maybe" when asked if they would use videoconferencing again to talk to a clinician. Results of this study confirm the potential for SLP treatment using videoconferencing and indicate a need for continued research in the field.
The subject of audiologists providing services over a distance via telepractice is attracting the attention of the profession. The new service delivery model will challenge us to exploit its potential without violating legal constraints or compromising our affirmative ethical responsibilities. This article provides an overview of the implications of current state licensure laws on telepractice and a look at the issues of competence, standard of care, privacy, informed consent, and the use of support personnel. Several principles are offered to guide the practitioner and additional resources are suggested.
Recent developments in deaf education are influencing teacher preparation programs, which are facing challenges in meeting the critical need for highly qualified teachers. Of approximately 65 teacher preparation programs in the United States, 11 programs focus primarily on preparing teachers to work with children who are deaf or hard of hearing and who use listening and spoken language, and 54 programs focus primarily on visual communication strategies. Advances in technology, changes in the population of children served, and shifts in educational placements and certification requirements are trends that impact teacher preparation programs. Challenges to these programs include issues related to faculty, university support, curriculum development, student recruitment, and recognition of the profession's value.
Determining the most effective methods and techniques to facilitate the spoken language development of individuals with hearing loss has been a focus of practitioners for centuries. Due to modern advances in hearing technology, earlier identification of hearing loss, and immediate enrollment in early intervention, children with hearing loss are experiencing greater success in their acquisition of spoken language, especially when they have access to well-trained professionals. Speech-language pathologists who have the necessary knowledge, experience, and skills can play a vital role in the communicative and educational development of young children with hearing loss. Fortunately, some university training programs are providing a needed focus on auditory learning and spoken language for preservice students in speech-language pathology. However, to meet an increasing need for these services, speech-language pathologists currently in the field should commit to ongoing professional development to ensure that all children with hearing loss have access to highly-qualified professionals who can foster listening and spoken language development.
This manuscript describes a pilot project in which infants in Guam who refer on newborn hearing screening receive diagnostic audiological evaluation conducted by audiologists in Colorado over the Internet (telepractice). The evaluation is completed in real time using commercially-available software and personal computers to control the diagnostic audiological equipment remotely, and videoconferencing with support personnel and the family. Test results for 9 infants, all of whom received complete diagnostic assessment by auditory-evoked potentials and otoacoustic emissions, are described. Further elaboration is provided on steps to establishing the project and how regulatory, privacy and confidentiality, and professional practice issues in telepractice are addressed.
A longstanding debate attempts to identify the best approach to language learning for children who are deaf or hard of hearing. Empirical evidence has not provided an answer. Each communication approach has been demonstrated to work with some children; it then becomes the responsibility of an early interventionist or educator to participate in the selection of an approach that supports the development of effective and age-appropriate communication and language for the individual child. This chapter describes the language approaches available to children with hearing loss. Historical approaches and recent adaptations are presented according to the modality or modes that are used. An extensive review of procedures, old and new, dedicated to the use of objective and prescriptive procedures to select an approach is discussed. A recent movement to use evidence-based practices (EBP) to document developmental outcomes of children is described, along with the challenges associated with implementing this practice.
The provision of consistent high quality home- and community-based services to children with disabilities living in rural and frontier areas is a challenge. Distance, weather, geographic terrain (mountains, canyons), and shortages of pediatric early interventionists are among the challenges to ensuring appropriate and equitable services. Videoconferencing offers a viable means to address these challenges and is becoming increasingly accepted due to the popular use and rapid advancement of voice-over-Internet protocol (VoIP) technology, Internet expansion, the growing "digital native" population, and coaching service models. This article offers a rationale for using a telepractice model for early intervention-virtual home visits (VHV) conducted via videoconferencing-and describes components of the service model, including equipment needs, costs, and training requirements. Additionally, the article summarizes evaluation results, including service provider and family satisfaction with the use of technology, and a comparison of interactions during home visits conducted face-to-face with those via VHV.
Children who are deaf and hard of hearing and their families need access to appropriate early intervention services that are delivered by professionals who are well trained and experienced using their chosen communication approach. Unfortunately, a lack of qualified practitioners, especially in remote and rural communities, and limited funding can affect the quality of services that are provided to some children. Advances in telecommunication and distance technology have led to models of telepractice that can provide access to appropriate services and reduce overall costs. While more efficacy research is needed, preliminary findings support the delivery of early intervention services through these distant service delivery models. Professionals who embrace models of telepractice can help to ensure that more children with hearing loss and their families receive the intervention to which they are entitled.
The authors surveyed 64 Listening and Spoken Language Specialist Certified Auditory-Verbal Therapists (LSLS Cert. AVTs) who mentor professionals seeking certification. Mentors answered questions regarding demographic characteristics, the organization and delivery of mentoring practice, and challenges and solutions faced by mentors. This group of mentors mirrored the larger population of LSLS Cert. AVTs in distribution of professions, work sites, and countries of origin. Respondents averaged more than 8 years of experience. Highest on the list of desirable goals for mentors was the development of mentee independence in the application of auditory-verbal principles, techniques, and case management. Mentors desired guidelines for practice and networking opportunities.
Telehealth is an emerging service delivery model for occupational therapy that uses information and communication technologies to deliver evaluative, consultative, preventative, and therapeutic services to clients who are in a different location than the practitioner. This article defines terminology related to telehealth, outlines benefits of implementing a telehealth service delivery model within occupational therapy, examines current evidence, and discusses considerations and resources for legal and ethical practice using telehealth technologies.
This paper presents the current status of telepractice as a service delivery model for persons with hearing loss. Telepractice can be broadly viewed as the delivery of preventative, habilitation, or rehabilitation services through telecommunications technology. Telemedicine and telehealth are closely aligned to telepractice, often with overlapping nomenclature, function, and common delivery systems. The technologies for telepractice are potentially but "a click away" for persons with hearing loss and their families. However, a full realization of this delivery model's benefits, barriers, and limitations is just beginning to emerge. On the professional side, challenges include the need for ethical, privacy, and other policy issues to keep pace with advances in technology; moreover, services provided via telepractice are not uniformly reimbursed. With the exception of federally-based practice settings, state licensure requirements do not efficiently engender interstate license portability and reciprocity. On the consumer-side, the challenges are to recognize the power of telepractice and acquire the knowledge to become informed consumers.
Many listening and spoken language specialists find themselves serving increasing numbers of children with hearing loss who come from families whose primary language is not English. This manuscript describes a variety of methods that can meet the needs of this ever-growing population by highlighting the dual-language support program at the Center for Hearing and Speech in Houston, Texas. The center uses videoconferencing technology and indirect methods of service delivery through remote consultations to serve this unique population.
As telecommunication technology continues to evolve, opportunities are emerging for telepractice to meet the communication needs of children with hearing loss. As well, documented shortages of well-trained speech-language pathologists and pediatric audiologists are leading some centers to augment their service delivery through telepractice as a means to meet a need for qualified providers. For families of young children with hearing loss, obtaining services that support auditory learning and spoken language can be a challenge in some communities. One form of telepractice, teleintervention, provides early intervention services to families of children with hearing loss using internet-based videoconferencing to model and coach parents in language facilitation techniques. Though it is a relatively new service delivery model, preliminary results are promising.
Today, children with hearing loss have more opportunities than ever before to use audition and to achieve age-appropriate spoken language and academic outcomes. Several factors are driving these new outcomes, including universal newborn hearing screening and earlier diagnosis of hearing loss, immediate fitting of advanced hearing technology, and enrollment in appropriate early intervention services. For speech-language pathologists and audiologists, these changes mean altering how these children and their families are served, including the types of diagnostic evaluations that are conducted. Specifically, if speech-language pathologists are to remain vital service providers, they must raise their professional expectations for what these children can ultimately achieve.
The Royal Institute for Deaf and Blind Children (RIDBC) provides specialist support to children with a sensory disability, e.g., a vision or hearing impairment. Recent developments in telecommunications technologies have enabled RIDBC to expand their services to better support families and children living in regional and remote areas of Australia. This paper outlines the challenges of accessing support in regional and remote areas, the innovative uses of telecommunications technologies, the specific technologies that have been trialled, the model of service delivery and the technologies currently in use.
The use of remote technology to provide cochlear implant services has gained popularity in recent years. This article contains a review of research evaluating the feasibility of remote service delivery for recipients of cochlear implants. To date, published studies have determined that speech-processor programming levels and other objective tests (electrode impedance and electrically evoked compound action potentials) are equivalent to those obtained in the face-to-face condition. Despite these promising findings, speech perception using remote technology has proven to be more challenging. Previous investigations have evaluated speech perception with recipients of cochlear implants using videoconference (Polycom) equipment in nonsound-treated rooms (due to lack of access to audiological sound booths in rural areas). Results have revealed poorer speech perception scores using remote technology compared to face-to-face results. Additionally, it has been shown that Polycom transmission of a speech stimulus does not cause significant compression for adequate evaluation; rather, poorer results are due to testing performed in nonsound-treated environments. Based on the literature, telepractice is a feasible option for cochlear implant service delivery. Barriers to the wide-spread use of remote services for recipients of cochlear implants include a uniform system for the evaluation of speech perception, validation of services for pediatric recipients and initial activations, license reciprocity, and reimbursement for services.
TeachSpeech [1] is an innovative project that is investigating the use of high-quality videoconferencing technologies to deliver remote speech and language therapy support services to school children with communication difficulties. This paper reports the progress of the project, from initial concept through to the trial and preliminary results. The telepresence trial encompasses both tele-health and tele-education issues. The videoconferencing application has the potential to reduce costs while simultaneously improving access to speech and language therapy services.
Many intervention programs use home visiting to target enhanced parent-child interactions; however, few studies have examined specific intervention strategies, limiting the potential utility of evaluation results to guide practice, research, or policy effectively. In this paper, we recommend that researchers and program evaluators open the "black box" of home visiting intervention strategies. We initiate this effort by exploring the overall intervention processes in two home visiting programs and describing specific strategies (e.g., coaching and modeling) interventionists used during triadic interactions with the parent and child together. One study included 28 families parenting a child with a disability and receiving Part C services, and the second study included 92 families receiving Early Head Start services. Interventions were not homogeneous across programs or families. Minimal time was focused on facilitating parent-child interactions; when these strategies were used, however, mothers were more likely to be engaged in the intervention activities.
The purpose of this study is to evaluate the impact of functional communication training on elopement when consultation support is delivered via desktop videoconferencing. An ABAB design was used to evaluate the effectiveness of functional communication training to reduce the elopement of a preschool student with autism. Intervention development, teacher training, and data collection were conducted at a distance using technology. Results show that the teaching staff was able to implement the intervention with a high degree of fidelity and that elopement was significantly reduced during intervention phases. The authors discuss the implications of using desktop videoconferencing to deliver consultation support, along with future applications in early childhood settings.
This article reviews the legislative history of P.L. 99–457, the Education of the Handicapped Act Amendments of 1986, which created a new program of early intervention services for infants and toddlers with disabilities. Legislative history research was undertaken to document the intent of Part H of P.L. 99–457. The concerns of policymakers are identified and provide a framework for considering the achievements of the law. The unique features of Part H and its status are discussed in the context of current uncertainty about its future.
Home visits are one mechanism for providing comprehensive services to young children with disabilities and their families, as required by Part H of the Individuals with Disabilities Education Act of 1990. This study reports observational data describing the content addressed and the processes employed by early childhood special educators during home visits with children with disabilities, birth to 3 years of age, and their families. The extent to which home visits were individualized was examined in terms of available family resources and level of child's caretaking demands. Findings revealed that a model of child-focused intervention was most frequently implemented. Some evidence was found to indicate that the content of home visits was more likely to focus on the child when family resources were adequate, and that the role of the interventionist was more likely to be that of an observer when children had greater care-taking demands.
