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A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy
Abstract
We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months. The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.
... To date, our knowledge about how teletherapy is implemented in routine settings for school-age children remains relatively limited. Although several studies indicate that speech-language therapy delivered via teletherapy can be effective for children with variable communication disorders (e.g., Constantinescu et al., 2014;Havenga, Swanepoel, Le Roux, & Schmid, 2017;Lee, Hall, & Sancibrian, 2017), these studies have largely focused on the use of specific intervention approaches or programs (Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010;Lee, 2018) and occur in tightly-controlled, technologically-supported environments, such as university clinics (e.g., Grogan-Johnson et al., 2013). As such, these studies may not be fully representative of current and day-to-day practice. ...
... Teletherapy for school-age children prior to Evidence concerning the use of teletherapy for school-age children prior to the COVID-19 school closures largely indicates that its effects are comparable to in-person therapy (Grogan-Johnson et al., 2010; see Wales, Skinner, & Hayman, 2017, for a review ) and that it can serve the critical purpose of reaching children in remote/rural areas and address issues of personnel shortages (e.g., Cason, 2009). Studies examining the effectiveness of teletherapy have varied considerably with respect to study design. ...
... Studies examining the effectiveness of teletherapy have varied considerably with respect to study design. For example, some work has sought to compare children's outcomes after receipt of speechlanguage therapy via teletherapy to outcomes after receipt of traditional face-to-face therapy (e.g., Grogan-Johnson et al., 2010, 2013. Grogan-Johnson et al. (2010) compared children's outcomes on a standardized test of articulation, as well as patient satisfaction ratings, between the two settings, and reported no significant differences between the two. ...
Purpose
Low retention of school-based speech-language pathologists (SLPs) is a growing problem that can have drastic consequences at the school and student levels. Factors contributing to this shortage include features of the work environment, role ambiguity, low salaries, and a demanding workload with higher caseloads, which can result in limited time for paperwork and lesson planning for optimal service delivery models. The purpose of this study was to determine the current levels and predictors of occupational stress and burnout SLPs are experiencing in the school setting.
Method
Using a cross-sectional survey design, 453 school-based SLPs from across the United States reported their workload manageability, career intentions, access to social support, and their stress and burnout levels. Multiple linear regression was used to determine the relation between the variables of interest and the occupational stress and burnout scores. Data were collected in September to December of 2020, at the height of the COVID-19 pandemic.
Results
SLPs, on average, reported overall stress levels in the somewhat noticeable range, moderate access to social support, high levels of emotional exhaustion, low-to-moderate feelings of depersonalization, and moderate-to-high feelings of personal accomplishments. Based on a standardized burnout scale, SLPs in this sample are characterized as feeling ineffective and overextended. Results of linear regression models suggest that the perception of work manageability was the best predictor of Total Stress score, Emotional Exhaustion score, and Depersonalization score, in this sample.
Conclusions
Data from this study offer the beginning steps to making an informed change for school-based SLPs' workplaces. Results indicated that SLPs in the school setting are feeling ineffective and overextended. The perception of their workload manageability was the most significant predictor for their reported stress and burnout levels. Suggestions for SLP supervisors, administrators, and other stakeholders are discussed.
... In parent-training programs, Microsoft PowerPoint was used to present intervention content to parents in real-time [33], and via printed copies of slides [34]. Other features included: (a) the use of 'e-helpers' (e.g., additional support staff on the videoconferencing call) to troubleshoot technology issues [35], (b) the use of screen recording software to provide families with the session information as a reference [36], and (c) the addition of a transcription service to increase accessibility by presenting captions in real-time during the intervention session [37]. All of these features were reported, but it should be noted that their effectiveness was not assessed. ...
... Many interventions were child-focused (n ¼ 9, 56%), but some were parent-focused (n ¼ 6, 38%), or both child-and ¼ 1, 6%). All 16 included studies which involved one-on-one interventions, however one reported combining individual and group-based sessions for children with articulation, language, and/or fluency disorders [35]. Across studies, most virtual interventions (n ¼ 14, 88%) were delivered by clinicians. ...
... Two studies reported a combination of parent-and clinician-administered intervention, with clinicians first teaching intervention techniques and then providing parents with feedback on their use of the techniques. Two studies [35,38] were conducted at remote sites set up to deliver telehealth services with pre-determined technology, while the rest were conducted from the client's home (see Table 3). Remote sites helped eliminate some of the challenging factors associated with conducting virtual therapy from the client's home (e.g., noise, other family members, etc.). ...
Purpose:
To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention.
Methods:
Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries.
Results:
Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement.
Conclusion:
This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.
... These two variables are necessary to maintain positive outcomes for children with ASD. 60 Parent led interventions were based on skills training in relation to young children with disabilities. Parents had the opportunity to be educated in this alternative way of communication by involving them in therapy. ...
... In education, telepractice, using distance technology is in its infancy. 60 This treatment strategy does not differ from face-to-face therapy but the means of administration and approach are changed. As in traditional approaches, the therapist plans the treatment to answer the child's needs, observes, and offers feedback on the treatment including new interventions based on observation and evidence-based practice. ...
... These strategies were presented in various therapy modules. 48,60 ...
Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.
... Telepractice was investigated as a viable means of providing services for children and youth in rural settings and an alternative to in-person services. Telepractice for the purpose of assessment, screening, and/or treatment was explored or examined for the disciplines, including speech-language pathology, occupational therapy, physiotherapy, and audiology [13,[38][39][40]42,51,54,58,60,62,[65][66][67][68][69][70][71][72][73]. ...
... In fifteen of the studies, researchers examined provision of treatment services, using telepractice [13,38,39,42,54,58,60,62,[65][66][67][68]70,71,73]. Little et al. [62] investigated the efficacy of occupationbased coaching delivered via telepractice for families of young children with autism spectrum disorder living in rural areas. ...
... In terms of telepractice treatment efficacy, results from comparison studies between in-person delivery and telepractice show similar progress made by both cohorts of children [39,67,68]. Additionally, a hybrid telepractice model that includes parent reports and behavioral measures of vocabulary can provide useful information in screening toddlers for language development [69]. ...
Purpose:
To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services.
Methods:
This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers.
Results:
Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described.
Conclusions:
Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.
... Ob pregledu literature ugotavljamo, da se logopedska telerehabilitacija uporablja predvsem pri otrocih s tipičnim razvojem s prisotnimi motnjami govorjenih glasov. V večini raziskav so bila izključitvena merila pridružene motnje, kot so duševna manjrazvitost, izguba sluha ali vida, motnje avtističnega spektra, nevrološke okvare ali cerebralna paraliza (17,(19)(20)(21)(22)(23)(24). Manjši delež raziskav je v telerehabilitacijo vključil specifično populacijo, in sicer otroke z otroško govorno apraksijo in/ali kognitivnim primanjkljajem (25), otroke s stanjem po zaprtju razcepa v orofacialnem področju (26), otroke z motnjo avtističnega spektra (18) ter otroke z motnjami hranjenja (27). ...
... Za merjenje učinkovitosti telerehabilitacije so avtorji uporabili različne formalne in neformalne diagnostične materiale. Najpogosteje uporabljen je bil test artikulacije Goldman-Fristoe (21,22,24,26). Dve raziskavi sta pri diagnostiki uporabili instrument CELF-4 za ocenjevanje jezikovnih sposobnosti (18,19). ...
... Raziskave, katerih cilj je bil ugotoviti učinkovitost telerehabilitacije pri izvajanju intenzivne logopedske terapije, kažejo primerljivost dosežkov s terapijo v živo. Tri študije s kontrolno skupino, ki je bila vključena v klasično terapijo, ugotavljajo podoben napredek otrok ne glede na način izvedbe (21)(22)(23). Tudi v preostalih raziskavah so ob zaključni ponovitvi ocenjevanja otroci dosegli pomembno višje rezultate ter večino individualno zastavljenih ciljev (24)(25)(26). Edina vključena študija s področja obravnave motenj hranjenja v otroštvu opaža napredek na vseh merjenih spremenljivkah (27). ...
Povzetek
Izhodišče: Epidemija COVID-19 je močno vplivala na izvajanje vseh zdravstvenih storitev, med drugim tudi na logopedske obravnave. Tuji avtorji ugotavljajo, da se je pogostost izvajanja telerehabilitacije na področju logopedije pomembno povečala. Potreba po izvajanju logopedske telerehabilitacije se je poja-vila tudi na Oddelku za (re)habilitacijo otrok v URI-Soča. V ta namen smo pregledali dostopno literaturo o učinkovitosti logopedske telerehabilitacije otrok. Metode: Raziskave smo poiskali v podatkovnih zbirkah Eric, PubMed in Apa PsycInfo s ključnimi besedami: logopedija, otroci, pediatrija, telerehabilitacija, teleterapija in internet. Sistematičen pregled literature je bil izveden po smernicah PRISMA. Rezultati: V končno analizo smo vključili 11 člankov, ki so ustrezali vsem merilom. Rezultati vključenih raziskav podpirajo uporabo telerehabilitacije v procesu logopedske diagnostike in terapije. Vsi otroci, vključeni v telerehabilitacijo, so pomembno napredovali. Način izvedbe rehabilitacije ni statistično značilno vplival na uspešnost. Zaključek: Uporaba logopedske telerehabilitacije se je izkazala za učinkovit in izvedljiv način ocenjevanja govorno-jezikovnega razvoja ter izvajanja terapije pri govorno-jezikovnih motnjah. Področje telerehabilitacije otrok z nevrološko okvaro bi bilo treba dodatno raziskati.
Abstract
Objective: The COVID-19 epidemic has greatly affected the delivery of all health services, including speech and language therapy. Foreign authors established that the use of telerehabilitation in speech and language pathology has increased significantly. Recently, the need for telerehabilitation has also appeared at our Department for the habilitation and rehabilitation of children. Our aim was to review the available literature about the effectiveness of telerehabilitation in pediatric speech and language pathology. Methods: The Eric, PubMed and Apa PsycInfo databases were searched, using key words: speech and language pathology, children, paediatric , telerehabilitation, telepractice and internet. A systematic review was conducted in accordance with PRISMA guidelines. Results: We included 11 papers that fulfilled the inclusion criteria. The results of the included studies support the use of telerehabili-tation in the process of speech and language assessment and intervention. All children included in the telerehabilitation showed progress. The service delivery method did not statistically significantly affect the effectiveness of therapy. Conclusion: The use of speech and language telerehabilitation has proved to be an effective and feasible method of assessing speech and langauge language development as well as delivering the treatment of speech and language disorders. There is a need for further research on the use of telerehabilitation in children with neu�rological disorders
... Studies have explored parent views and satisfaction of SLP delivered to different communication impaired populations of children via telemedicine through questionnaires, satisfaction rating scales, and semistructured interviews (Chen & Liu, 2017;Crutchley & Campbell, 2010;Fairweather et al., 2016;Grogan-Johnson et al., 2010). In their systematic review, Molini-Avejonas et al. (2015) stated that overall families were satisfied with telemedicine. ...
... In their systematic review, Molini-Avejonas et al. (2015) stated that overall families were satisfied with telemedicine. Studies have also reported that while parents supported the use of telemedicine, there were some difficulties in relation to Internet connectivity and technology (Chen & Liu, 2017;Crutchley & Campbell, 2010;Grogan-Johnson et al., 2010;Fairweather et al., 2016), although this did not necessarily put parents off telemedicine (Thomas et al., 2018). ...
... As identified in other work (Chen & Liu, 2017;Crutchley & Campbell, 2010;Grogan-Johnson et al., 2010;Fairweather et al., 2016;Filbay et al., 2021), issues regarding technological aspects of telemedicine were highlighted in the responses to the free text questions. This included connection problems and a perception that the speech-language pathologist at the other end of the call was not able to see or hear features of children's speech difficulties. ...
Purpose
The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK).
Method
Parents were asked whether they found this method of delivery “very effective,” “somewhat effective,” or “not at all effective.” Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal–Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis.
Results
One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was “somewhat effective,” 56 (26.4%) “very effective,” and 16 (7.6%) “not at all effective.” There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as “better than nothing.”
Conclusions
Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least “somewhat effective.” It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision.
... Studies involving school-aged children reported that telepractice services are effective, reliable, and efficient (Boisvert & Hall, 2019;Coufal et al., 2018;Grogan-Johnson et al., 2010;Grogan-Johnson et al., 2011;Short et al., 2016). Coufal and colleagues (2018) specifically looked at speech-sound production outcome measures between traditional speech-language pathology service delivery and telepractice. ...
... Recent studies refute these concerns. Telepractice service delivery modalities are implemented relatively easily and efficiently (Grogan-Johnson et al., 2010;Short et al., 2016). Boisvert and Hall (2019) reported that with appropriate introduction and training, stakeholders adopted telepractice modalities enthusiastically and with positive post-intervention perceptions. ...
... Additionally, Hines et al. (2015) found no negative effects of telepractice on clinicians' and pediatric clients' rapport. While these findings are encouraging, widespread implementation requires that research be expanded beyond the pilot and exploratory phases, include larger samples sizes (Coufal et al., 2018;Grogan-Johnson et al., 2010), and utilize objective outcome measures relevant to clinical translation (Coufal et al., 2018;Musaji et al., 2019). These needs are directly addressed by the NOMS system, which aggregates national outcomes data across FCM categories to enable research into the efficacy of various clinical programs. ...
The American Speech-Language-Hearing Association (ASHA) developed the National Outcomes Measurement System for aggregating standardized patient outcomes. Outcomes are standardized using Functional Communication Measures (FCM), scales designed to describe communicative function across specific areas of clinical need. This investigation compared in-person and telepractice service delivery for children in elementary school settings who received treatment targeting the FCM categories of either “spoken language production” or “spoken language comprehension.” De-identified cases were secured from ASHA’s NOMS database and the database of a private e-learning provider that implemented the NOMS format. There were minimal significant differences in the median change scores between the traditional and telepractice interventions. These results support comparable treatment outcomes between in-person service delivery and telepractice for treatment of children exhibiting impaired spoken language production or spoken language comprehension in an elementary school setting
... To date, our knowledge about how teletherapy is implemented in routine settings for school-age children remains relatively limited. Although several studies indicate that speech-language therapy delivered via teletherapy can be effective for children with variable communication disorders (e.g., Constantinescu et al., 2014;Havenga, Swanepoel, Le Roux, & Schmid, 2017;Lee, Hall, & Sancibrian, 2017), these studies have largely focused on the use of specific intervention approaches or programs (Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010;Lee, 2018) and occur in tightly-controlled, technologically-supported environments, such as university clinics (e.g., Grogan-Johnson et al., 2013). As such, these studies may not be fully representative of current and day-to-day practice. ...
... Teletherapy for school-age children prior to Evidence concerning the use of teletherapy for school-age children prior to the COVID-19 school closures largely indicates that its effects are comparable to in-person therapy (Grogan-Johnson et al., 2010; see Wales, Skinner, & Hayman, 2017, for a review ) and that it can serve the critical purpose of reaching children in remote/rural areas and address issues of personnel shortages (e.g., Cason, 2009). Studies examining the effectiveness of teletherapy have varied considerably with respect to study design. ...
... Studies examining the effectiveness of teletherapy have varied considerably with respect to study design. For example, some work has sought to compare children's outcomes after receipt of speechlanguage therapy via teletherapy to outcomes after receipt of traditional face-to-face therapy (e.g., Grogan-Johnson et al., 2010, 2013. Grogan-Johnson et al. (2010) compared children's outcomes on a standardized test of articulation, as well as patient satisfaction ratings, between the two settings, and reported no significant differences between the two. ...
The purpose of this study was to examine how school-based speech-language pathologists (SLPs) maintained clinical services via teletherapy during the COVID-19 pandemic closures. School-based SLPs in the United States were invited to participate in an anonymous online survey. Questions relevant to this study gathered information regarding a) provision of teletherapy following COVID-19 school closures, b) the types of technologies used to deliver teletherapy and supports offered from school districts, and c) challenges to providing consistent therapy. Descriptive results indicate that over 60% of responding SLPs with complete data (n = 1109) provided teletherapy to all or some students on their caseloads. A variety of virtual methods were used, but Zoom and Google hangouts were the most commonly used technologies. Although some SLPs received training to deliver teletherapy (16%), many received no support from their district to maintain service provision (25%). The most frequently noted barriers to providing therapy included poor attendance of online therapy sessions and parenting their own children simultaneously. School-based SLPs were largely successful in maintaining speech-language therapy services to children on their caseloads. Information regarding the types of technologies used and common challenges can inform future teletherapy training for SLPs should future school closures occur.
... The four included studies focused on asynchronous and synchronous telehealth service delivery models. Two of the studies utilized a pre-posttest study design (Hall, Gordon, Hulcombe, & Stephens, 2019;Levy, Silverman, Jia, Geiss, & Omura, 2015), one study used a two-group randomized study design (Grogan-Johnson et al., 2010), and the fourth study used a mixed-methods case study design (Sangelaji et al., 2017). ...
... The focused telehealth studies were in rural settings across the United States, Australia, and New Zealand. One study was completed within several schools across four school districts in Ohio (Grogan-Johnson et al., 2010). Another study took place in a general outpatient clinic in remote Queensland, Australia (Hall et al., 2019), while the other took place within the homes of patients in rural North Florida/South Georgia (Levy et al., 2015). ...
... The fourth study took place in rural New Zealand within patients' homes (Sangelaji et al., 2017). The studies varied on diagnoses treated and interventions provided; however, all studies utilized patient satisfaction as a primary outcome measure (Grogan-Johnson et al., 2010;Hall et al., 2019;Levy et al., 2015;Sangelaji et al., 2017). ...
Telehealth provides health care services to clients through telecommunications. Rehabilitation services such as occupational therapy, physical therapy, and speech-language therapy can be delivered via telehealth. The aim of this study was to evaluate patients’ reports of their satisfaction with telehealth compared to standard in-person therapy for patients living in rural areas. Four databases were utilized for this systematic review. The following words were searched: telehealth, rural, and patient satisfaction. Abstract searches identified 251 articles, and 55 were read in full text. Four articles met inclusion criteria. There was high satisfaction for patients in all studies regarding the use of telehealth. Findings showed that overall, telehealth supported increased rates of patient satisfaction for OT, PT, and SLP services delivered to rural communities.
... Sin embargo, los estudios analizados no se realizaron en un contexto pandémico, es decir, un contexto de confinamiento prolongado, en donde no solo las sesiones fonoaudiológicas eran virtuales sino que también todas las actividades escolares. Los hallazgos de esta investigación muestran resultados opuestos a los reportados por otras investigaciones (Coufal et al., 2018;Covert et al., 2018;Grogan-Johnson et al., 2010). De la evidencia obtenida se extrae ue la adaptación a la modalidad virtual requiere de ciertas condiciones para lograr los objetivos de la intervención, de lo contrario la terapia no logra su finalidad. ...
... También en la literatura se menciona que la telepráctica es más exitosa cuando es individual (Grogan-Johnson et al., 2010;San Martín & Gutiérrez, 2021), lo que no ocurrió en el contexto de las participantes de este estudio. Ello debido a que en la virtualidad todas las participantes mantuvieron la misma dinámica de atención que en la presencialidad. ...
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.
... management (Boisvert & Hall, 2019). The teletherapy studies involved children with a wide range of speech and language goals, and often the language interventions used were not specified (e.g., Fairweather et al., 2016;Gabel et al., 2013;Grogan-Johnson et al., 2010), combining various types of interventions, the duration of intervention, populations, settings, and measures of treatment outcomes even within studies (Wales et al., 2017). In addition, the children treated within these studies typically represented a very wide range of ages (e.g., Fairweather et al., 2016;Gabel et al., 2013;Grogan-Johnson et al., 2010). ...
... The teletherapy studies involved children with a wide range of speech and language goals, and often the language interventions used were not specified (e.g., Fairweather et al., 2016;Gabel et al., 2013;Grogan-Johnson et al., 2010), combining various types of interventions, the duration of intervention, populations, settings, and measures of treatment outcomes even within studies (Wales et al., 2017). In addition, the children treated within these studies typically represented a very wide range of ages (e.g., Fairweather et al., 2016;Gabel et al., 2013;Grogan-Johnson et al., 2010). It may well be that older, school-age children derived more benefit than preschool children simply due to their greater maturity and ability to comply with the demands of teletherapy. ...
Purpose:
This investigation adapted a well-studied language treatment method, Enhanced Conversational Recast, paired with auditory bombardment to a teletherapy format.
Method:
The study used a single case series approach (n = 7) to determine the feasibility of teletherapy with children ages 5 and 6 years of age. Treatment targeted grammatical errors in the context of dialogic reading and craft activities. Clinicians administered 24 doses in the form of focused conversational recasting, followed by 12 doses consisting of simple sentences containing the grammatical forms targeted for remediation. Children were treated for up to 26 sessions, with four children treated on consecutive weekdays and three treated twice a week. Treatment progress was operationalized as generalization of target grammatical forms to untreated linguistic contexts, as well as spontaneous use of the treated form. To control for nontreatment effects, generalization of an untreated form was also tracked throughout the treatment period.
Results:
Six of the seven children showed clinically meaningful gains in the use of the grammatical forms targeted for treatment within the treatment period. This was true for children enrolled in both treatment schedules. Learning for treated forms was retained after treatment was discontinued. In comparison, no change was seen for untreated forms for six of the seven children.
Conclusions:
The results suggest that this treatment method is feasible in a telepractice format, even with young children. The range of individual results is generally comparable to previous face-to-face versions of this treatment.
... On the other hand, speech therapy conducted via videoconferencing treatments appears to be better suited to the use of real-time telerehabilitation (Theodoros et al., 2008), especially for the improvement of stuttering (Sicotte et al., 2003), voice disorders, laryngectomy, swallowing dysfunction, and speech and language disorders (Grogan-Johnson et al., 2010;Theodoros et al., 2008) in children, or in the treatment of chronic post-stroke aphasia in adult patients (Macoir et al., 2017;Øra et al., 2020). ...
... The mean number of sessions for the speech telerehabilitation also ranged from 12 to 20 (Grogan-Johnson et al., 2010;Sicotte et al., 2003). It is of note that the relevant literature suggested that online scheduled encounters seemed to be more useful, than a needs-based approach (Camden et al., 2018). ...
This study examined the feasibility and acceptability of a telerehabilitation intervention during the COVID-19 pandemic in a sample of children and young adults with Acquired Brain Injury (ABI). Thirteen patients and/or their families agreed to participate in the speech and neuropsychological telerehabilitation sessions. The treatment was synchronous, patient centered and aimed at improving specific abilities. Sessions were held twice a week over a 10-week period. Two questionnaires were completed both by parents and therapists to assess feasibility and acceptability. Neither technical issues nor clinical obstacles were found. The quality of the therapeutic relationship played a key role in the intervention. Synchronous telerehabilitation provided several advantages both for patients and therapists. Moreover, the patient centered intervention eased the burden of the caregivers at a time of high stress. The real-time telerehabilitation treatments were deemed suitable for children and young adults with ABI. Further studies are needed to support the use of telerehabilitation as an integral part of their standard care.
... Telepractice has been used by SLPs working in school settings to address challenges with personnel shortages and to serve children in rural and geographically dispersed areas (Short et al. 2016). A few studies have compared the effectiveness of telepractice to in-person services in schools for children with speech sound disorders, suggesting that telepractice outcomes were equivalent to or, in some cases, better than services provided at school (Gabel et al., 2013;Grogan-Johnson et al., 2010). ...
... Although this study makes important contributions, it is just one step toward understanding how to capitalize on the promise of teletherapy to serve children who use AAC and their families. Because the survey focused only on SLPs' perceptions of effectiveness, it highlights the need for efficacy research in the area of AAC telepractice, including how these services compare to in-person services (see Gabel et al., 2013;Grogan-Johnson et al., 2010). ...
Purpose
The novel coronavirus (COVID-19) pandemic has led to sudden, widespread use of telepractice, including providing services to children who use aided augmentative and alternative communication (AAC). This exploratory study examined speech-language pathologists' (SLPs) experiences using telepractice to provide services to children and youth aged 3–21 years who used aided AAC during the earlier months of the pandemic (May–June 2020).
Method
Three hundred thirty-one SLPs responded to an online survey. Closed- and open-ended survey items were analyzed quantitatively and qualitatively and mixed at the point of interpretation to understand the experiences of SLPs related to the use of telepractice with children who use aided AAC, including how they perceived effectiveness.
Results
Most SLPs were using telepractice to provide both direct and consultation/coaching services to children who used aided AAC. There was fairly wide variation in perceptions of effectiveness of both types of services, but SLPs were more likely to rate consultation/coaching services as being more effective than direct services. SLPs identified factors impacting effectiveness across five dimensions: broader factors, practice-based factors (i.e., technology, the type of services), the child, parents and family members, and professionals. School-based SLPs perceived telepractice as being less effective than non–school-based SLPs.
Conclusions
The use of telepractice during the COVID-19 pandemic has unfolded quite differently for different SLPs and the children who use aided AAC that they serve. Although AAC telepractice offers promise for the future, particularly for partnering with families, further research is needed to know how to overcome challenges experienced by SLPs.
Supplemental Material
https://doi.org/10.23641/asha.17139434
... Second, the nature of Zoom could have differential effects on attention (McClure et al., 2018) and responsiveness (Strouse et al., 2018) compared to in-person testing. However, there is also evidence that using teletherapy in speech-language therapy is effective in some cases (Constantinescu et al., 2014, Grogan-Johnson et al., 2010. Although future research should examine teletherapy and its efficacy, children do seem to respond well to the modality, and it can have positive outcomes (Wales et al., 2017). ...
Purpose:
The goal of this study is to examine how shyness affects a child's performance on language assessments that vary in sociability. We hypothesized that accuracy on language tasks would be driven by shyness such that shyer children would perform better on nonsociable tasks compared to sociable tasks.
Method:
The procedures followed a quasi-experimental design. One hundred twenty-two participants, ages 17-42 months and varying in their temperament, each underwent a series of three language tasks. The order of tasks was randomized, and each task varied in the social interaction required: a looking task, a pointing task, and a production task. Data were collected via Zoom, and parents reported their child's shyness level via the Early Child Behavior Questionnaire.
Results:
Shyness was compared with participants' accuracy across the three tests while controlling for age and vocabulary percentile. There were significant differences in children's performance across the tasks, with respect to shyness. Shyer children performed worse on the production task compared to less shy children. All children did well on the pointing task regardless of shyness level, but performance was more nuanced on the looking task such that shyer children were at times more accurate but also less likely to respond in general.
Conclusions:
As shown by these results, shyer and less shy children respond differentially to methods of language assessment that vary in sociability. It is important for clinicians to acknowledge shyness when choosing an appropriate assessment of children's language. Future direction includes assessing performance on standardized assessments.
Supplemental material:
https://doi.org/10.23641/asha.23845521.
... This is in alignment with a family-centered treatment approach, which is considered best care for the early intervention population (Dunst et al., 1991;Pollard & Hogan, 2021). The literature has also supported the efficacy of telepractice as a method of speech-language pathology service delivery compared with in-person therapy (Coufal et al., 2018;Gabel et al., 2013;Grogan-Johnson et al., 2010. ...
Purpose
The aim of this study was to evaluate parent/guardian satisfaction with speech-language pathology telepractice services provided at a New York–based pediatric health care facility during the COVID-19 pandemic. Specifically, satisfaction with appointment maintenance, progress, acquisition of goals, and parent education was measured.
Method
Researchers identified patients from 0 to 21 years of age who received at least one speech-language pathology telepractice service from May 1 to May 29, 2020, for study inclusion. One hundred seven patients met the inclusion criteria. A qualitative survey with four Likert scale questions was e-mailed to a parent/guardian of these patients. Questions assessed interest in maintaining telepractice services following the COVID-19 pandemic in addition to rating satisfaction with appointment maintenance, parent/caregiver education, and patient progress. Thirty participants completed the survey, reflecting 28% completion rate.
Results
Parents/guardians indicated overall satisfaction with pediatric speech-language pathology telepractice services. Qualitative analyses revealed subthemes for advantages and disadvantages of the telepractice platform. Advantages included convenient scheduling and session maintenance, improved safety in the setting of COVID-19, opportunities for visual models that were not possible while masked, and increased opportunities for parent education and training in the child's natural environment. High-level clinician engagement, continuity of care, creativity, and a well-established clinical rapport improved the efficacy of telepractice sessions. Reported disadvantages included distractibility, patient age contingencies, technological difficulties, restricted treatment modalities, and virtual session structure. Results implied a preference for in-person speech-language pathology sessions versus telepractice at this facility.
Conclusions
The results of this survey study indicated parent satisfaction with speech-language pathology services via telepractice. Patients' return to in-person speech-language pathology sessions when available in subsequent months does imply a preference for in-person care. However, the notable advantages and disadvantages of telepractice expressed by parents/guardians at the researchers' facility during the early months of the COVID-19 pandemic offer valuable insights for current and future speech-language pathology telepractice providers.
... In this survey, SLT expressed reservations about the comparability of digital practice to face-to-face provision, a theme replicated in most COVID-19 SLT surveys (Aggarwal et al., 2020;Fong et al., 2021;Macoir et al., 2021;Rettinger et al., 2021;RCSLT, 2020bRCSLT, , 2020c. Interestingly, the research has demonstrated fidelity, validity and reliability of certain remote SLT management activities compared with in-person practice, including some non-standardized and standardized assessments and targeted interventions for speech, language and social skills (Grogan-Johnson et al., 2010;Shire et al., 2020;Stavropoulos et al., 2022;Taylor et al., 2014). This perhaps indicates a clinical disconnect with the empirical data and highlights the need for clinical-academic collaboration across all stages of research including design, implementation, analysis and dissemination. ...
Background:
The COVID-19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic-induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed.
Aims:
To survey the impact of COVID-19 remote working on UK paediatric SLTs' digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM-B) model.
Methods & procedures:
An online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open-response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM-B behaviour change model.
Outcomes & results:
A total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians' perception of their frequency, convenience and confidence with digital practice during COVID-19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service-specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school-based provisions.
Conclusions & implications:
During COVID-19, paediatric SLTs' recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long-term digital enhancement of SLT services.
What this paper adds:
What is already known on the subject The COVID-19 pandemic led to an unprecedented interest in the use of technology across SLT practice. Studies are emerging nationally and internationally to identify the digital priorities of the SLT workforce, the areas of digital SLT provision that are thriving or lacking, and the evidence to guide clinical practice and service development. What this study adds to existing knowledge This is the first UK-wide COVID-19 survey solely focusing on the digital practice of paediatric SLTs. The findings provide critical insights into SLT perception of how practice has been impacted in the early stages of the COVID-19 pandemic, including digital trends that are service, condition and demographic specific. Tools and channels required to support sustained beneficial change are also discussed. What are the potential or actual clinical implications of this work? This paper demonstrates the potential for digital solutions to enhance SLT practice, as long as implementation is guided by clinicians' experiences and perspectives. The findings lay groundwork for service development work, such as the creation of training packages, updating of clinical guidelines and care pathways, and development of processes to ensure equitable allocation of evidence-based resources.
... Onze artigos realizaram pesquisa de satisfação 11,12,13,15,19,20,21,24,27,31 e em quase a totalidade desses estudos, os pacientes e/ou responsáveis relataram moderada a alta satisfação nesta modalidade de intervenção, e indicaram disposição de participar novamente na avaliação e/ou terapia na configuração de telefonoaudiologia. Somente em um artigo 31 , os pais relataram preferência e melhor satisfação com o atendimento presencial fonoaudiológico. ...
Introdução: A pandemia do Coronavírus trouxe a necessidade do distanciamento social. A partir dessa nova realidade, o Conselho Federal de Fonoaudiologia (CFFa) recomendou o uso da telefonoaudiologia para permitir a continuidade do atendimento fonoaudiológico. Embora a telefonoaudiologia não seja uma prática inédita, dúvidas quanto à sua utilização e eficácia, quando comparada ao atendimento presencial, ainda permeia a prática clínica. Objetivo: realizar uma revisão integrativa da literatura sobre a eficácia da telefonoaudiologia comparada ao atendimento presencial. Métodos: foi realizada uma revisão integrativa da literatura cientifica, sem restrição de idioma e tempo, nas bases de dados: Pubmed, Web of Science, Science Direct, Cochrane e Google Scholar. Resultados: vinte e um artigos foram selecionados. A unanimidade dos artigos demostrou que não houve diferença estatística significante entre as configurações. Nos estudos com foco na avaliação, os métodos de teste (presencial X teleavaliação) foram altamente correlacionados e com alta confiabilidade inter examinador. Nos artigos com foco na terapia, em ambas as configurações de tratamento, houve melhora significativa dos parâmetros avaliados. Os artigos que realizaram pesquisa de satisfação na modalidade de telefonoaudiologia, em quase a totalidade dos estudos, os pacientes e/ou responsáveis relataram moderada a alta satisfação e indicaram disposição de participar novamente de avaliação e/ou terapia na configuração de atendimento remoto. Conclusão: a literatura atual em telefonoaudiologia sugere o uso do atendimento remoto e demonstra a não inferioridade deste quando comparado ao atendimento presencial. Porém, a maioria desses estudos apresenta baixa evidência cientifica.
... For children with communication difficulties or disorders, existing evidence suggests that telepractice is feasible (Gibson et al., 2010;Samadi et al., 2020;Sicotte et al., 2003), and may be as effective as in-person services for improving both child (Behl et al., 2017;Grogan-Johnson et al., 2010;Hao et al., 2021;McGill et al., 2019;Reynolds et al., 2009;Sicotte et al., 2003) and parent outcomes (Akemoglu et al., 2020;Behl et al., 2017;McCarthy et al., 2020). To fully ascertain the effectiveness of telepractice compared with in-person services; however, larger and better controlled studies are still needed (Akemoglu et al., 2020;Mashima & Doarn, 2008;McGill et al., 2019). ...
Background:
There has been a significant uptake in the use of telepractice during the coronavirus SARS-CoV-2 (COVID-19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID-19 pandemic.
Aims:
(1) To identify factors that influenced success of telepractice; and (2) to describe clinicians' and parents' preferences for the future mode of service delivery for preschoolers with communication disorders.
Methods & procedures:
The study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi-structured videoconference interviews.
Outcomes & results:
Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future.
Conclusions & implications:
The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families.
What this paper adds:
What is already known on the subject? Studies conducted before the COVID-19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in-person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID-19. What this paper adds to existing knowledge? Parents and clinicians shared factors that influenced the success of telepractice during semi-structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work? SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family.
... Telepractice is the use of technology to provide speech-language services to clients at a distance by connecting clinicians and clients. 1 Earlier studies comparing the effectiveness of tele practice to in-person services have found tele therapy services to be equally efficient and thus a promising method for speech and language therapeutic services for school age children. 2 Teletherapy has also been reported to be effective for parent-implemented intervention for children with autism spectrum disorder. 3 Parents on the other hand, play a crucial role in children's intervention, especially during the pandemic. ...
Background: COVID-19 pandemic has resulted in the reduction of in-person speech and language therapeutic services and a considerable increase in tele practice. Objective:The study aimed to understand the parents’ preferences, opinions, satisfactions and difficulties with regard to teletherapy for speech language pathology services. Method: A 19-item questionnaire on Teletherapy satisfaction and preferences was completed by 50 parents of individuals with disabilities. The individuals were receiving therapeutic services for a variety of communication disorders. The results obtained were analysed descriptively. Results: The majority of the parents were highly satisfied and reported tele practice to be very effective in improving the speech and language skills of their children. Majority of parents also reported to have better communication with clinician, and to have a better understanding of goals in Teletherapy. On the other hand, the responses were mixed when questioned about their preference and their child’s preference for in-person therapy services over Teletherapy. Major difficulties reported by parents were network connectivity, and holding the child’s attention. Marked differences were observed in parents’ perceptions with respect to the child’s age and disability. Conclusion: Though parents found Teletherapy to be effective, their preference for Teletherapy services over in-person speech and language therapeutic services were mixed. And parents perceived Teletherapy as a best service delivery model during the current COVID-19 pandemic. Keywords: Teletherapy, In-person Therapy, Speech Language therapy, Covid-19, Efficacy.
... Los investigadores concluyeron que el uso de la telepráctica para evaluar el lenguaje a través del CELF-4 es un método válido para realizar diagnóstico. Grogan-Johnson et al. (2010) exploraron, en las escuelas públicas rurales de Ohio, el uso de la telepráctica como modelo de prestación de servicio para estudiantes con trastornos de lenguaje y/o habla, en el que participaron treinta y cuatro estudiantes que recibieron la intervención, y por medio de un modelo directo aplicado en grupos pequeños y dirigido por un fonoaudiólogo. Los avances en el rendimiento se midieron mediante herramientas de seguimiento del progreso, incluidas las evaluaciones estandarizadas, la recopilación de datos y los informes trimestrales de avance que se suelen utilizar en el entorno de la escuela pública. ...
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.
... The temporal order of a child's engagement in telepractice or in-person therapy models does not seem to have an impact on their outcomes. Grogan-Johnson et al. (2010) alternated the order of telepractice versus in-person therapy for 38 children ages 4-12 years who had speech sound disorders. There were no significant differences on a test of articulation between the two groups. ...
Purpose
The main objective of this study was to gain insight into school-based speech-language pathologists' (SLPs') perspectives on and experiences with telepractice as a service delivery model at the onset of the COVID-19 global pandemic. A better understanding of the facilitating and challenging factors that belie telepractice-based services will guide the creation of training and resource development to further support remote speech-language services in schools.
Method
Four focus group sessions using a semistructured format were conducted with 22 school-based SLPs from 14 states in the United States. The focus groups provided an opportunity for SLPs to reflect on their telepractice experiences, including pros and cons, necessary knowledge and skills, factors impacting telepractice service delivery, and student and family participation. Inductive thematic analysis was used to describe the collective experiences and perspectives of the participants.
Results
Three themes regarding telepractice emerged: technology use, locus of control for decision making, and student and family engagement. Participants reported experiencing a range of successes and challenges when attempting to meet students' needs and identified gaps in resources and school capacity for telepractice.
Conclusions
The findings revealed how school SLPs experienced telepractice service delivery during the remote learning portion of the 2019–2020 school year due to the onset of the COVID-19 pandemic. The study increases our understanding of factors that facilitated and challenged the effective delivery of speech-language services via telepractice. To assist SLPs in future telepractice efforts, implications for professional development and further research are provided.
... The results of the study by Waite et al. [27] also confirmed the effectiveness of Internet-based remote health systems for assessing childhood language disorders. Participants in Johnson et al. 's study [28] strongly supported the treatment provided through videoconferencing and believed that videoconferencing was a promising way to render speech-language health services to schoolchildren. Crutchley and Campbell [29] stated that the distant speech-language treatment at a school in a remote North Carolina village was a satisfactory service model and suggested it to other schools in the district. ...
Background
Lack of proper and timely patients' access to speech pathologists can affect the treatment and follow-up process; therefore, patients do not achieve the expected therapeutic goals. The aim of this study was to determine the effect of tele-rehabilitation on the stuttering patients using the goal attainment scaling (GAS).
Methods
This interventional study was carried out on patients who visited the rehabilitation centers affiliated to the Jahrom Welfare Office. They underwent remote speech therapy using Skype. To evaluate the treatment outcomes of the stuttering patients, GAS was used.
Results
The participants' speech and lingual skills improved using videoconferencing. The mean score of total GAS for patients was 53.08. Of 112 health goals, patients reached the expected or higher than expected levels in 78 goals.
Conclusions
Rehabilitation through video conferencing was effective for patients with stuttering, improved their speech, and decreased their stuttering. Since, application of remote rehabilitation services can provide regular access to healthcare services, it can lead to improving patient treatment provide more frequent and faster treatment follow-up.
... In terms of the efficacy of intervention delivered through telehealth services, another systematic review has indicated that speech sound therapy delivered via telehealth may be as effective as in-person intervention (Wales et al., 2017). This review found that the outcomes measured via standardized testing (e.g., the standard scores derived from the Goldman-Fristoe Test of Articulation-2 (GFTA-2; Goldman & Fristoe, 2000)) were more consistently positive in telehealth settings, whereas outcomes measured via Functional Communication Measures (FCMs; Mullen & Schooling, 2010) demonstrated contradictory results across studies (Gabel, Grogan-Johnson, Alvares, Bechstein, & Taylor, 2013;Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010). In another study conducted by Gabel and colleagues (2013), the authors found that the number of participants whose speech sound productions and intelligibility improved for at least one level on the FCMs was greater in the telehealth in comparison to the in-person condition. ...
Background: In the wake of the COVID-19 outbreak, many speech-language pathologists have transitioned from in-person service delivery to online environments. As such, there is an urgent need to inform clinicians on the availability of efficacious and effective telehealth interventions for childhood apraxia of speech (CAS).
Objectives: This review was informed by the following clinical question: Is providing intervention remotely through telehealth as efficacious and effective as in-person therapy for treating CAS?
Methods, eligibility criteria, and sources of evidence: Eight databases and seven search engines were searched for articles to identify intervention studies that have investigated the efficacy and/or effectiveness of treating CAS remotely. Search criteria was restricted to papers with children under 18 years of age, published in the English language between 1993 and 2020.
Results: Two studies were found to meet our inclusion criteria. A phase I study employed a multiple baseline across participants design to investigate the efficacy of the Rapid Syllable Transition treatment via telehealth. The second study assessed the feasibility of adopting a novel system for the remote administration of the Nuffield Dyspraxia Program-Third Edition. Based on the Oxford hierarchy Centre for Evidence-Based Medicine, both studies are level IV (case-series/case-control), and therefore deemed low level evidence. Results showed limited but promising outcomes when CAS therapy is conducted remotely.
Conclusion: There is limited, low-level evidence indicating positive outcomes for the remote treatment of CAS via telehealth. The scarcity of data available warrants a need for large-scale randomized control trials and controlled clinical trials.
... Further a recent narrative review of therapeutic alliance in online psychotherapy concluded that therapeutic alliance, particularly from clients' points of view, was high and comparable with face-to-face services (Berger, 2016). Similarly, evidence suggests that allied health services delivered via telehealth may be as effective as in-person services (Grogan-Johnson et al., 2010;Speyer et al., 2018) and they have repeatedly been found to be highly acceptable to service users (Crutchley & Campbell, 2010;Graham et al., 2020;Hines et al., 2019). ...
This paper uses secondary analysis to understand how COVID-19 shaped people’s experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people’s experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People’s wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a ‘COVID-normal’ world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options.
... The current study shows that telerehabilitation is a dependable and effective mode of service provision. The participants and clinicians in our study have reported above average levels of satisfaction and progress with telepractice service, Grogan-Johnson et al. [5] in a pilot study on school-going children have reported excellent satisfaction and progress results from the therapists as well as the parents when teletherapy and face-to-face therapy were delivered in sessions of four months each. Scheideman-Miller et al. [6], reported improved problem-solving capacities, memory and social interaction skills among school children when teletherapy was provided over a 5-week period. ...
Speech-language therapists along with affected individuals face various challenges for accomplishing the rehabilitation services. In the current COVID19 pandemic scenario, telerehabilitation has emerged as a substitute to the traditional face-to-face therapy, and is the only option possible in some cases. To subjectively assess the feasibility & acceptability of telerehabilitation provided by speech-language pathologist to patients of speech and language disorders. This qualitative study includes 20 patients suffering from disorders of fluency, voice, swallowing and neurogenic disorders. The participants included were undergoing face-to-face therapy at our institute. After the completion of face-to-face session series, telerehabilitation services were provided through a video calling app. The outcomes of teletherapy were assessed subjectively using a structured questionnaire on 11 parameters using a Likert scale. Of the included 20 patients, after completion of teletherapy, four patients chose the physical interaction as the preferred mode of therapy while 16 chose teletherapy as the preferred mode. Except three clients who rated their overall satisfaction as '3', others rated as '4' or '5'.The therapists were satisfied with the outcomes in 17 cases, and were pleased with the overall progress of all the clients (rated 4 or 5). Telerehabilitation is a reliable method to deliver speech and language services at community level, on long-term basis, as is proven by the high satisfaction scores among the clients as well as the service providers.
Clinical trial registration:
The trial has been registered in Clinical Trials Registry of India (CTRI) vide number CTRI/2018/04/ 012,922 (http://ctri.nic.in/Clinicaltrials/login.php) on 02/04/2018.
... Ekeland et al. (6) evaluated all of the telemedicine implementations that had taken place by 2010, and it was concluded that 64% of implementations suggested that telemedicine, was well implemented in diseases, especially chronic diseases. It seems that telemedicine is an effective model for providing health services, including assessment and treatment (7)(8)(9)(10)(11)(12)(13)(14). Sue O'Brian et al. (14) performed the Lidcombe program using webcam (as distance training) on three children with stuttering without face-to-face visit. ...
... Ekeland et al. (6) evaluated all of the telemedicine implementations that had taken place by 2010, and it was concluded that 64% of implementations suggested that telemedicine, was well implemented in diseases, especially chronic diseases. It seems that telemedicine is an effective model for providing health services, including assessment and treatment (7)(8)(9)(10)(11)(12)(13)(14). Sue O'Brian et al. (14) performed the Lidcombe program using webcam (as distance training) on three children with stuttering without face-to-face visit. ...
Background: Stuttering as a communication disorder can lead to serious problems in interpersonal communication and affect the quality of life of the affected person. Objectives: The aim of this study was to investigate the effectiveness of telehealth in improving its treatment and its effect on maintenance phase of stuttering children. Methods: In this study, all 6 - 12 year-old stuttering children referred to the Speech Therapy Center of Shahid Beheshti Hospital in 2018 were selected by purposeful sampling method and divided into two groups of experiment and control. Children were healthy and without any disorder. All 12 children received a three-month course of treatment with a speech and language pathologist (SLP) weekly one session. Maintenance phase included 8 sessions of 30 minutes over a period of six months. Results: Six children in the experimental group received maintenance phase training exercises by the SLP in the form of audio and video files through the WhatsApp software. Average total satisfaction rating (4.22) the lowest satisfaction score (3.16) highest score (5). According to the total score of the questionnaire,17% of the parents were satisfied at a low rate, 33% of parents were satisfied with the average and 50% of parents were very satisfied. Conclusions: In this study, the efficacy of telehealth on the maintenance phase of stuttering children has been evaluated. Results showed that telemedicine, with its ability to completely remove distance and travel as barriers for both patients and health care professionals is one option. Telemedicine can be a viable alternative to traditional in-person physician-based care for stuttering.
... These ratings show that telepractice services not only improved students' speech and language abilities, but also increased students' engagement with speech-language therapy and their motivations for learning. These results extend the findings of client satisfaction studies that focused on the evaluation of telepractice treatment programs [16,26,27]. These results also suggest that telepractice services help with retaining user satisfaction in real-life school service settings. ...
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.
... . 구체적으로는 자폐스펙트럼장애, 언어발달장 애, 유창성장애, 말소리장애, 신경의사소통장애, 연하장애 등 다양 한 의사소통장애 유형에서 그 효과가 보고되었다 (Carey et al., 2010;Coufal, Parham, Jakubowitz, Howell, Reyes, 2018;Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010;Grogan-Johnson et al., 2011;Lewis, Packman, Onslow, Simpson, & Jones, 2008;Morrell et al., 2017;Pullins & Grogan-Johnson, 2017;Weidner & Lowman, 2020). ...
... Video therapy was found to be as effective as inperson therapy in the treatment of articulation disorders (Grogan-Johnson et al., 2010). More research is needed to evaluate the effectiveness of telehealth voice therapy in children compared to traditional in-person care, but especially during the pandemic, telehealth should be considered as a viable option. ...
Purpose
Evaluation and management of voice and upper airway disorders in adults and children, by speech-language pathologists worldwide, have been significantly altered by the COVID-19 pandemic. Secondary to the pathogenic nature of the virus in the respiratory tract and upper airway, it is essential that speech-language pathologists who specialize in these disorders are knowledgeable of current practices to provide evidence-based care while minimizing viral transmission. Understanding how and when SARS-CoV-2 spreads is critical to the development of effective infection prevention within clinical practices.
Method
We established an evidence-based clinical practice guide for clinicians working with voice and upper airway through a comprehensive evaluation of peer-reviewed journals, non–peer-reviewed manuscripts on preprint servers, national health guidelines, and published and online consensus statements and emerging data. Emphasis was placed on risk mitigation for viral transmission via safe clinical practices, including evaluative procedures, therapy including telehealth, personal protective equipment, room, staffing, and distancing considerations.
Results/Conclusions
While knowledge relevant to viral transmission of SARS-CoV-2 is rapidly evolving, there is a paucity of literature specific to the evaluation and treatment of voice and upper airway disorders. Within these confines and given the potentially significant high risk of infection secondary to the nature of COVID-19, we summarize current considerations and recommend best practices that maximize risk mitigation whereby ensuring patient and provider safety.
... These ratings show that telepractice services not only improved students' speech and language abilities, but also increased students' engagement with speech-language therapy and their motivations for learning. These results extend the findings of client satisfaction studies that focused on the evaluation of telepractice treatment programs [16,26,27]. These results also suggest that telepractice services help with retaining user satisfaction in real-life school service settings. ...
BACKGROUND
The coronavirus disease 2019 (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 preferences.
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 COVID-19.
METHODS
A 20-question survey on telepractice satisfaction and preference was administered to 41 Chinese students and 85 caregivers who received telepractice from school-based speech-language pathologists in Hong Kong during the COVID-19 pandemic class suspension period. They were asked to 1) report the implementation of telepractice, 2) rate their perceptions of the efficacy of telepractice on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), 3) compare the efficacy of telepractice to onsite practice, and 4) state their preference between telepractice and onsite practice.
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 perceived 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 an acceptable alternative service delivery option for school-aged speech and language therapy services, a more proactive role of speech-language therapists and caregivers in telepractice is needed to facilitate the engagement of caregivers and effective communication between clinicians and caregivers.
Purpose
There is a clear need for speech-language pathologists, audiologists, and related health care professionals to understand the barriers to hearing health care, so that we may propose possible solutions. Through interview, collaboration, and analysis, the objective was to identify opportunities to enhance support provided for these children.
Method
The authors conducted a review of available literature related to hearing health care disparities. Dr. Matthew Bush, an expert in hearing health care disparities and advocacy, was interviewed on October 12, 2022. Data were extracted and compiled from available literature and the interview including demographics, themes, and available interventions.
Results
The section “Entry Barriers” describes findings in the main categories of Steps, Proximity, Health Care Literacy, and Systemic Inequalities. The “Opportunities for Change” section describes topics from the interview for ongoing discussion in the field.
Conclusions
Ultimately, having this conversation led exactly in a direction that it should—toward further professional development, awareness, and a call to action. To facilitate meaningful change, we are tasked with active discussion, questioning, probing, and improvement. Only through evolution of existing systemic bias and harmful structures can we make meaningful change.
Introduction: The objective of this work was to investigate Speech-Language Pathologists' (SLPs) and audiologists' telehealth awareness, experience, and perception in terms of applicability, effectiveness, barriers, facilitators, and the influence of the coronavirus disease 2019 (COVID-19) pandemic on telehealth practice. Methods: A questionnaire was developed and validated based on relevant literature, authors' clinical expertise, and a published survey. Sample size was determined through power analysis, and participants were recruited using a snowball-sampling technique. Results: Ninety-five (n = 95) clinicians completed a survey. A majority (87.4%) reported awareness of and 68.4% reported experience with telehealth. The SLPs (86.4%) had more experience than audiologists (38.9%). Overall, 78.5% first used telehealth during the COVID-19 pandemic, with no significant difference in telehealth use during versus after the pandemic lockdown; 63.8% reported telehealth being less effective than in-person. However, there were differences in perceived telehealth effectiveness: Telehealth was significantly more effective for consultations and counseling, with adults aged 18-40 years; and clients with fluency and speech sound disorders. The highest significant barrier to telehealth delivery was network issues, and available workplace resources was the highest facilitator although this was not significant. Conclusions: Most clinicians were aware of telehealth, had a positive attitude toward it, and had experience using telehealth. More SLPs than audiologists used telehealth. The COVID-19 pandemic had a positive influence on telehealth service provision with an increase in use that was maintained after in-person services were re-initiated. Perceived effectiveness of telehealth services varied depending on the type of clinical service, the client's age, and diagnosis. These factors must be considered while planning telehealth services in Speech-Language Pathology and Audiology.
Purpose: Telehealth may be a solution to access barriers in speech-language pathology. Previous investigations of telehealth assessment have alluded to factors affecting children's engagement, though these factors have not been comprehensively described.Aim: This study aimed to develop a novel clinical tool to describe the factors affecting children's engagement in paediatric telehealth assessments.Method: The Factors Affecting Child Engagement in Telehealth Sessions (FACETS) tool was developed using a mixed methods approach. Iterative analysis was conducted through a qualitative evidence synthesis, followed by the application of the tool to seven children aged between 4;3 and 5;7 years old who participated in a speech and language assessment via telehealth. Descriptive data were obtained regarding engagement on both a child-by-child and task-by-task basis. Reliability of the FACETS was determined via percent agreement and Cohen's kappa between two independent raters.Result: Using a mixed methods design, the FACETS framework was developed and refined. Application of the tool to seven case studies revealed variability in engagement with acceptable inter-rater reliability.Conclusion: The FACETS may be a useful resource for describing the factors that influence children's engagement in telehealth during the assessment. The FACETS requires further testing with clinical populations.
The COVID-19 pandemic disproportionately affected the health and well-being of marginalized communities, and it brought greater awareness to disparities in health care access and utilization. Addressing these disparities is difficult because of their multidimensional nature. Predisposing factors (demographic information, social structure, and beliefs), enabling factors (family and community) and illness levels (perceived and evaluated illness) are thought to jointly contribute to such disparities. Research has demonstrated that disparities in access and utilization of speech-language pathology and laryngology services are the result of racial and ethnic differences, geographic factors, sex, gender, educational background, income level and insurance status. For example, persons from diverse racial and ethnic backgrounds have been found to be less likely to attend or adhere to voice rehabilitation, and they are more likely to delay health care due to language barriers, longer wait times, a lack of transportation and difficulties contacting their physician. The purpose of this paper is to summarize existing research on telehealth, discuss how telehealth offers the potential to eliminate some disparities in the access and utilization of voice care, review its limitations, and encourage continued research in this area. A clinical perspective from a large volume laryngology clinic in a major city in northeastern United States highlights the use of telehealth in the provision of voice care by a laryngologist and speech-language pathologist during and after the COVID19 pandemic.
บทนำ: การฝึกพูดออนไลน์เป็นระบบที่ยังไม่มีหน่วยงานใดในประเทศไทยศึกษามาก่อน ซึ่งการฝึกพูดจำเป็นต้องคำนึงถึงประสิทธิภาพการฝึกและความพึงพอใจของผู้ป่ วย เพื่อพัฒนาระบบฝึกพูดออนไลน์ให้มีประสิทธิผลและเป็นต้นแบบการบริการแก่ผู้ป่วยในสถานการณ์โรคระบาด วัตถุประสงค์: เพื่อศึกษาจำนวนผู้ป่วยใหม่ที่เข้าถึงบริการฝึกพูดออนไลน์จำนวนผู้ป่วยเก่าที่ติดตามการฝึกพูดได้อย่างต่อเนื่องผ่านการฝึกพูดออนไลน์ และระดับความพึงพอใจของผู้ป่วยต่อระบบฝึกพูดออนไลน์ วิธีการศึกษา: การศึกษาข้อมูลย้อนหลังในผู้ป่วยที่รับการฝึกพูดออนไลน์ คลินิกฝึกพูด โรงพยาบาลรามาธิบดี ในปี พ.ศ. 2564 เก็บข้อมูลจากการสืบค้นเวชระเบียนและตัวตามรอยทางคลินิกของระบบฝึกพูดออนไลน์ โดยวิเคราะห์ด้วยสถิติเชิงพรรณนา ผลการศึกษา: ผู้ป่วยจำนวนทั้งหมด 524 คน พบว่า ผู้ป่วยใหม่เข้าถึงบริการฝึกพูดออนไลน์และผู้ป่วยเก่าที่สามารถติดตามการฝึกพูดได้ต่อเนื่องผ่านระบบออนไลน์ คิดเป็นร้อยละ 29.19 และ 70.81 ตามลำดับ และผู้ป่วยมีความพึงพอใจต่อระบบฝึกพูดออนไลน์ในระดับพึงพอใจถึงพึงพอใจมาก คิดเป็นร้อยละ 97.52 ของผู้ป่วยที่รับบริการฝึกพูดออนไลน์ทั้งหมด สรุป: การฝึกพูดออนไลน์เป็นระบบที่สามารถใช้ได้ในผู้ป่วยรายใหม่และรายเก่า และผู้ป่วยมีความพึงพอใจในการรับบริการฝึกพูดผ่านระบบออนไลน
Objectives:
To examine the effect of telepractice on vocal turn-taking between one clinical provider and children with cochlear implants and their caregivers during child-centered auditory rehabilitation intervention.
Methods:
Seven dyads of children with cochlear implants (mean age 4:11 years) and their hearing mothers and one speech-language pathologist participated together in a telepractice session and an in-person intervention session. Dependent variables were vocalization rate, turn taking rate, rate of speech overlap per second, and between-speaker pause duration.
Results:
The speech-language pathologist and children had lower rates of vocalization in the telepractice session than the in-person session. However, maternal vocalization rate was higher in the telepractice than in-person session. The rate of turn-taking between the provider and children was lower in telepractice than in-person sessions but the rate of turn taking between mothers and children was higher in telepractice than in-person sessions. Between-speaker pause duration between children and the provider and between mothers and children was longer in telepractice than in-person sessions. Rate of speech overlap did not vary significantly by session type.
Discussion:
The quantity and temporal characteristics of vocal turn-taking were impacted by remote communication during tele-intervention suggesting a potential increase in the cognitive effort required of participants.
Aim
To determine the level of evidence for the effectiveness of telerehabilitation against comparison interventions in improving child- and parent-related outcomes in children and youth with developmental disabilities.
Method
A systematic approach, comprised of a comprehensive search; transparent study selection, data extraction, quality assessment by independent reviewers; and synthesis of sufficiently similar data (per diagnostic group, health profession, and overall level of evidence for each outcome) was undertaken.
Results
Fifty-five studies (29 randomized trials) were included across six diagnostic groups and ten health professions. Common telerehabilitation targets varied across diagnostic groups and included motor function, behavior, language, and parental self-efficacy. Telerehabilitation was found to be either more effective or as effective versus comparison intervention in improving 46.9% or 53.1% of outcomes, respectively. It was never found to be detrimental or less effective. Strong to moderate, limited, and insufficient levels of evidence were found for 36.5%, 24.5%, and 38.6% of the outcomes, respectively.
Conclusion
There is sufficient evidence suggesting that telerehabilitation is a promising alternative when face-to-face care is limited. It is comparable to usual care and is more effective than no treatment. Blending in-person and telerehabilitation approaches could be beneficial for the post-pandemic future of rehabilitation in pediatric care.
Over 50% of American Speech-Language-Hearing Association (ASHA)-certified speech–language pathologists (SLPs) are employed in schools (ASHA, n.d.). Speech–language pathologists increasingly provide services to students with speech and language disorders via telepractice. ASHA's Roles and Responsibilities of Speech-Language Pathologists in Schools document states that telepractice services must be comparable to in-person services (ASHA, 2010). This article presents the School-Based Telepractice Assessment (STA; Lundblom et al., 2021), comprising aspirational questions related to compliance with federal legislation; personnel; roles and responsibilities of school-based SLPs; and privacy and security issues. The STA is designed for use by SLPs, school administrators, and contracted providers. The guide comprehensively evaluates the range of school-based telepractice components such as diagnostic and therapeutic services, the use of support personnel consultation, preventative services, integration with the school culture and curricula, and compliance with federal regulations. The STA can guide both school-based SLPs and administrators as they prepare for telepractice service delivery and later appraise whether the telepractice services are comparable to in-person school-based practice.
Objectives: The Coronavirus Disease 2019 (COVID-19) led speech-language pathologists (SLPs) around the world to shift their service delivery methods from face-to-face service to telepractice. This study explored the implementation of telepractice by Malaysian SLPs and determined whether there was an association between the SLPs’ perceptions of the effectiveness of telepractice and the frequency of the telepractice services provided, as well as between the use of telepractice and prior training received.Methods: Eighty-nine SLPs responded to an 18-question online survey that inquired about demographics, telepractice during the pandemic, perceptions of telepractice and prior training received.Results: Seventy-five percent of SLPs reported providing services via telepractice during the pandemic compared to 19% before the pandemic. Most SLPs who used telepractice stated that services delivered via telepractice were comparable with face-to-face services; no association was found between the frequency of providing services via telepractice and the SLPs’ perceptions of its effectiveness. They had also received some training in telepractice, although no association was found between the type of training received and the provision of telepractice services. SLPs who did not provide services via telepractice reported awareness of telepractice but described a lack of knowledge, support, and training. All SLPs expressed interest to receive more training in telepractice to enable them to provide better services.Conclusion: Malaysian SLPs demonstrated great commitment towards service provision during the pandemic, similar to SLPs in other nations. It is hoped that Malaysian SLPs continue to have positive attitudes toward telepractice with increased familiarity, use, and training. Telepractice services, undoubtedly, are here to stay.
Disorders affecting speech, language, cognition, and swallowing are prevalent across the lifespan and require evaluation and intervention from a speech-language pathologist. Traditionally, these services have been provided within home, school, hospital, or clinic-based settings. With growing advances in technology, the use of teletherapy has increasingly become a viable option for speech-language pathologists and the individuals they serve. This chapter discusses the various service delivery models to consider when providing speech, language, and swallowing assessment or treatment via telehealth. Common features of online platforms, external tools, and web-based resources are described in the context of adapting speech and language treatment approaches for online use. Review of the current literature supports the use of teletherapy to evaluate and treat patients with a variety of diagnoses including aphasia, articulation disorders, autism, dysarthria, dysphagia, fluency disorders, language and cognitive disorders, and voice disorders (American Speech-Language-Hearing Association, 2020). Despite this, further research comparing outcomes following teletherapy and traditional therapy for specific diagnoses will be helpful for choosing service delivery models that are effective and patient-specific.
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.
Objective
To examine patient and physician satisfaction with telemedicine in otolaryngology during COVID-19 and identify associated factors.
Study Design
Prospective cohort study.
Setting
Tertiary care center.
Methods
Patient satisfaction was rated by patients (age ≥18 years) who had encounters from May to July 2020 (n = 407). Physician satisfaction was rated by 15 otolaryngologists for specific encounters delivered from May to June 2020 (n = 1011). Patient satisfaction was measured with a Press Ganey questionnaire and a Telemedicine Satisfaction Questionnaire. Mean Press Ganey satisfaction scores of telemedicine encounters during COVID-19 were compared with the pre−COVID-19 Press Ganey scores from in-person encounters (n = 3059) to test a noninferiority hypothesis. Physician satisfaction was measured with a Provider Satisfaction Questionnaire.
Results
The mean Press Ganey patient satisfaction score for telemedicine encounters was 94.5 (SD, 8.8), no worse than that for in-person encounters prior to COVID-19 at 93.7 (SD, 15.5; Δ = 0.8 [95% CI, −0.5 to 2.1, excluding the noninferiority margin of −1]). Encounters with videoconference (vs telephone) and patients reporting higher income were associated with higher Telemedicine Satisfaction Questionnaire scores. Physician satisfaction scores during COVID-19 with telemedicine encounters were overall high at 83.3 (95% CI, 77.5-89.1), slightly lower when compared with the scores with in-person encounters at 88.4 (95% CI, 82.5-94.3; Δ = −5.2 [95% CI, −6.6 to −3.8]). Encounters with videoconference (vs telephone) and patients with English as a preferred language and follow-up visits were associated with higher Provider Satisfaction Questionnaire scores.
Conclusions
Telemedicine is a feasible alternative format in otolaryngology during COVID-19 with overall high patient and physician satisfaction. Patient satisfaction with telemedicine encounters during COVID-19 was no worse than in-person encounters prior to the pandemic. Physician satisfaction with telemedicine was relatively lower in comparison with in-person encounters.
Students diagnosed with specific learning disabilities, autism, or emotional disturbance may also receive speech-language services as part of their individual education program. This article focuses on the use of telepractice for providing speech-language services in schools. The benefits of telepractice are described, including the accessibility, efficiency, and preference of telepractice in delivering effective speech-language services. In addition, the implementation of telepractice services is outlined, strategies for troubleshooting are described, and two implementation checklists are provided.
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.
For children with voice disorders, access to care has long been a challenge. Reasons for this include the challenge of qualifying children with isolated voice disorders for services within the public-school system as well as a family's geographic proximity to experienced clinicians who are in the healthcare system. Over the past decade, there have been both formal and informal investigations into the use of telepractice to deliver services to communicatively disordered children and adults, including those with voice disorders. Although barriers and obstacles existed, use of telepractice to deliver such services demonstrated both feasibility and, in some studies, effective outcomes. However, prior to spring of 2020, use of telepractice to deliver speech pathology services was not mainstream. This changed when the nation was forced to shut down many of its in-person healthcare and educational delivery due to the COVID-19 pandemic. This article summarizes select relevant literature pertaining to the use of telepractice in speech language pathology over the past decade and provides a case-based discussion of how it was and is currently being used to deliver pediatric voice care.
This evaluative study assessed the feasibility and outcome of delivering speech-language services from a distance to children and adolescents who stutter. All six patients who formed the first cohort seen in the telespeech programme were included in the study. The results demonstrated that interactive videoconferencing can provide a feasible and effective care delivery model. Patient attendance was maintained throughout the intervention. All participants showed improved fluency. Stuttering ranged from 13% to 36% before treatment and 2% to 26% after treatment. All participants maintained at least part of their improved fluency during the six-month follow-up, when stuttering ranged from 4% to 32%. The study demonstrates that full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine.
We investigated the feasibility of assessing childhood speech disorders via an Internet-based telehealth system (eREHAB). The equipment provided videoconferencing through a 128 kbit/s Internet link, and enabled the transfer of pre-recorded video and audio data from the participant to the online clinician. Six children (mean age = 5.3 years) with a speech disorder were studied. Assessments of single-word articulation, intelligibility in conversation, and oro-motor structure and function were conducted for each participant, with simultaneous scoring by a face to face and an online clinician. There were high levels of agreement between the two scoring environments for single-word articulation (92%), speech intelligibility (100%) and oro-motor tasks (91%). High levels of inter- and intra-rater agreement were achieved for the online ratings for most measures. The results suggest that an Internet-based assessment protocol has potential for assessing paediatric speech disorders.
This article describes and reports data-based outcomes of a low-tech telehealth adaptation of the Lidcombe Program of Early Stuttering Intervention. Participants were 5 children with early stuttering, ranging in age from 3;5 (years;months) to 5;7, and their families. All children met the speech criteria for completion of Stage 1 of the Lidcombe Program. Data suggested that the treatment method may be viable and that favorable outcomes may be achievable. Mean posttreatment stuttering rates in everyday speaking situations were available 12 months posttreatment for 4 children. Two children scored a mean percent syllables stuttered of less than 1.0 at that time, and 2 children scored a mean of below 2.0. As occurs often in standard delivery of the Lidcombe Progam, 1 child relapsed after Stage 1, apparently because of parental noncompliance, but this relapse was managed successfully. Follow up data were unavailable for 1 child. For 4 of the 5 cases, the number of consultations required exceeded established benchmarks for standard Lidcombe Program delivery, suggesting that telephone-based telehealth may be a less efficient version of the treatment. The implications of these preliminary data are discussed.
The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as "responders."
A speech-language pathologist provided telehealth delivery of the Lidcombe Program during telephone consultations with parents in their homes, remote from the clinic. The study design was an open plan, parallel group, randomized controlled trial with blinded outcome assessment. Children in the no-treatment control group who were still stuttering after 9 months then received the same treatment. The primary outcome measure was frequency of stuttering, gathered from audiotape recordings of participants' conversational speech in everyday, nontreatment situations, before and after treatment.
Analysis of covariance showed a 73% decrease in frequency of stuttering at 9 months after randomization in the treatment group, as compared with the control group (95% confidence interval = 25%-90%, p = .02). Measures of treatment time showed that telehealth delivery of the Lidcombe Program requires around 3 times more resources than standard presentation.
Telehealth delivery of the Lidcombe Program is an efficacious treatment for preschool children who cannot receive the standard, clinic-based Lidcombe Program. Avenues for improving efficiency are considered.