Telehealth adaptation of the Lidcombe Program of Early Stuttering Intervention: five case studies

Two-sided perspective on tele-speech therapy: Experiences of stuttering patients, and their parents

The purpose of this study was to investigate the benefits and challenges of the tele-speech therapy from the perspective of patients who stutter, and their parents. Semi-structured interviews were conducted with 12 patients and three parents in two rehabilitation centers. Data were analyzed using a qualitative content analysis approach proposed by Graneheim and Lundman. Seven categories were determined: accessible treatment, motivation of comfort in tele-speech therapy, challenges of tele-therapy, satisfaction, virtual competency, lower quality compared to face-to-face therapy, and uncertainty about the effectiveness of tele-speech therapy. The participants had a two-sided perspective regarding tele-speech therapy. Positive experiences included benefitting from more qualified therapists at multiple locations, faster access to treatment, and saving cost and time. Negative experiences and challenges consisted of low-quality of technology infrastructure for rehabilitation including low quality of shared images and videos, ineffective communication, insufficient sympathy, indirect communication, and technology incompetency. Findings showed that the participants were interested in the application of tele-speech therapy, as this method could increase their accessibility and provide the opportunity to choose proper therapists. The determined benefits and challenges can provide the policy-makers with beneficial information to implement tele-speech therapy.

Implementation fidelity in parent-implemented interventions for stuttering

Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.

Stuttering interventions for children, adolescents, and adults: a systematic review as a part of clinical guidelines

INTRODUCTION

Stuttering may have a holistic effect on the quality of life of a person who stutters by limiting participation in social situations, resulting in feelings of isolation and frustration, leading to difficulties in education and employment and increasing the likelihood of mental health problems. Even young children who stutter may have negative experiences of speaking. Therefore, it is important to treat stuttering behavior effectively in both children and adults. The purpose of this paper was to systematically review group and case studies about the effectiveness of behavioral stuttering interventions to provide evidence-based guidelines for clinicians.

METHODS

Systematic data retrieval was conducted in four electronic databases (PsycINFO, CINAHL, PubMed, Cochrane). The assessment of search results was conducted according to predetermined inclusion and exclusion criteria by two independent judges. The methodological quality of each paper was assessed using strict criteria to include only high-quality research.

RESULTS

The search revealed 2293 results, and 38 papers (systematic reviews N=3, group design studies N=21 and case studies N=14) with acceptable methodological quality were included. The data show that there is most evidence about the treatment of early childhood stuttering, very little evidence about school-aged children and some evidence about adults. The most convincing evidence is about the Lidcombe Program in the treatment of young children who stutter, but also other methods have promising evidence. Our data imply that in the treatment of adults who stutter, holistic treatments may influence speech fluency and overall experience of stuttering behavior. Speech restructuring treatments may have a positive effect on overt characteristics of stuttering, but not on covert stuttering behavior.

CONCLUSIONS

The results of this review agree with earlier reviews about the treatment of young children. However, due to different inclusion criteria, this review also shows the benefits of holistic treatment approaches with adults and adolescents.

No other choice: Speech-Language Pathologists' attitudes toward using telepractice to administer the Lidcombe Program during a pandemic

PURPOSE

Telepractice has been shown to be a viable modality for the delivery of stuttering treatment. Since the advent of COVID-19, speech-language pathologists must adapt in-clinic treatments for online presentation. This research aimed to gather information from speech-language pathologists on their experiences of telepractice to deliver the Lidcombe Program to treat stuttering in young children.

METHODS

This paper presents the findings of an online survey that polled the clinical experiences of 106 speech-language pathologists who were delivering the Lidcombe Program via telepractice during COVID-19.

RESULTS

The majority of respondents were experienced clinicians from the United States and Canada who had attended a Lidcombe Program workshop. Prior to COVID-19, 80 % had provided some clinical services online (up to 10 % of the time), and at the start of COVID-19 public lockdown orders, 77 % viewed telepractice as both a necessity and an opportunity. Three months after the public lockdown orders, the large majority, 94 %, said that they would continue to use both telepractice and in-clinic treatment in the future. Technology issues, concerns about establishing the clinical relationship, and identification of mild stuttering featured as challenges of telepractice service delivery, while benefits included time efficiency, flexibility of scheduling, and improved clinical processes.

CONCLUSION

Respondents reported that the Lidcombe Program was easily translatable to telepractice and the majority intend to continue telepractice in the future.

Speech-Language Pathologist Perspectives of the Implementation of Telepractice-Delivered Stuttering Treatment for School-Age Children

PURPOSE

The impact of stuttering can be significant, and effective treatment is critical. Despite evidence supporting direct treatment approaches for school-age children who stutter, a complex set of barriers can prevent access at school. One potential solution is telepractice. To date, however, there is no published evidence regarding the use of telepractice to deliver the Lidcombe Program within a school setting.

METHOD

In this pilot study, a telepractice service was established and the perspectives of the five treating speech-language pathologists (SLPs) were evaluated before, during, and after the trial through focus groups and recorded telesupervision sessions.

RESULTS

An inductive and reflexive thematic analysis identified four main themes: (a) Understanding and managing technology is critical; (b) logistical considerations can be time-consuming and challenging; (c) preparation and support are essential; and (d) family engagement, acceptance, and independence with telepractice services can be facilitated by external support and coaching. Initially, the SLPs shared feelings of uncertainty, fear, and apprehension. Yet, despite this concern, the SLPs ultimately reported that telepractice can play an important role in their service.

CONCLUSIONS

In order to maximize the potential value of telepractice, SLPs require training and support to (a) manage the technology and troubleshoot problems that invariably arise, (b) have the opportunity to watch demonstrations of the technology, and (c) clearly explain the roles, responsibilities, and expectations of the parent engaging in treatment. These findings have particular relevance now, as schools and support services navigate a COVID-safe delivery model for the indefinite future.

Feasibility, Acceptability and Limitations of Speech and Language Telerehabilitation during COVID-19 Lockdown: A Qualitative Research Study on Clinicians' Perspectives

The COVID-19 pandemic brought out the need to deliver health care services at a distance in the form of telerehabilitation (TR). This study aimed to analyse the Italian speech and language therapists' (SLTs) opinions on the feasibility of the TR in the field of speech-language therapy during the COVID-19 pandemic. We developed an anonymous survey to determine the SLTs' opinions on feasibility of TR during lockdown caused by COVID-19. We analysed the survey's answers provided by 136 SLTs. Cronbach's alpha coefficient showed good reliability of the survey. The SLTs working previously with TR showed better judgements regarding this method. The comparison analysis between TR and face-to-face treatment delivery showed statistically significant differences as follows: "importance" (4.35 vs. 3.32, p = 0.001), "feasibility" (3.37 vs. 2.11, p < 0.001), "alternative form" (3.64 vs. 2.58, p = 0.001) and "comparison" (2.24 vs. 1.69, p < 0.001), but not with "familiarity" (p = 0.81). The survey showed that most of the Italian SLTs were not satisfied with TR systems. SLTs who used TR previously had a better opinion on this treatment modality. Experience and familiarity with TR systems were key factors for the use of this new rehabilitation modality.

Telerehabilitation for people with aphasia: A systematic review and meta-analysis

OBJECTIVES

To evaluate effectiveness or non-inferiority of telerehabilitation for people with aphasia when compared to conventional face-to-face speech and language therapy.

MATERIALS AND METHODS

Five electronic databases (PUBMED, EMBASE, WEB OF SCIENCE, SCOPUS and the Cochrane Library) were searched. We extrapolated data from the included studies and evaluated the methodological quality using the Revised Cochrane risk-of-bias tool for Randomized Trials (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). A meta-analysis compared effects of intervention, and it was conducted using the Review Manager 5.3 software. GRADE profile to assess overall quality of evidence was carried out.

RESULTS

Out of a total of 1157 records, five studies met the inclusion criteria and were eligible for meta-analysis with a total of 132 participants with post-stroke aphasia.

DISCUSSION

Results revealed that telerehabilitation and face-to-face speech and language treatment are comparable with respect to the gains achieved in auditory comprehension (SMD = -0.02; 95% CI -0.39, 0.35), naming accuracy (SMD = -0.09; 95% CI -0.44, 0.25), Aphasia Quotient (MD = -2.18; 95% CI -16.00, 11.64), generalization (SMD = 0.77; 95% IC -0.95, 2.49) and functional communication skills (SMD = -0.08; 95% IC -0.54, 0.38).

CONCLUSION

Although evidence is still insufficient to guide clinical decision making due to the relatively low quality of the evidence identified, the analysis of the results suggest that telerehabilitation training for aphasia seems to be as effective as the conventional face-to-face treatment.

Comprehensive Review of Factors Influencing the Use of Telepractice in Stuttering Treatment

OBJECTIVES

Stuttering is a speech disorder characterized by the repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech. Telepractice allows speech services to be delivered to patients regardless of their location. This review investigated factors influencing the use of telepractice in stuttering treatment.

METHODS

Articles related to the application of telepractice in stuttering were searched using the Scopus, Web of Science, PubMed, Cochrane, and ProQuest databases without consideration of any time limit. Initially, 79 articles were found and after application of the inclusion and exclusion criteria, 15 articles were selected for the review study. Data were analyzed by using the content analysis method and synthesized narratively.

RESULTS

Factors influencing the use of telepractice in stuttering treatment were categorized into individual, technical, clinical, and economic factors. Providing access to healthcare services, maintaining personal privacy, and allowing flexibility in arranging appointments were among individual factors. In terms of the technical factors, technical problems and Internet speed were addressed. Clinical factors were divided into positive and negative outcomes, and economic factors were mainly related to time and cost savings.

CONCLUSIONS

Although patients may benefit from using telepractice, the widespread adoption of this technology can be hindered by some technical and non-technical factors. Because telepractice can be employed as a complementary method to treat stuttering, more attention should be paid to the required infrastructure and factors that may negatively impact the use of this technology.

Predictors of Lidcombe Program treatment dropout and outcome for early stuttering

BACKGROUND

Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis.

AIMS

To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277).

METHODS & PROCEDURES

A total of 32 variables were used as predictors in regression analyses of short- and medium-term Lidcombe Program outcome, and of treatment dropout.

OUTCOMES & RESULTS

Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity.

CONCLUSIONS & IMPLICATIONS

Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop-out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper adds What is already known on the subject Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome. What this paper adds to existing knowledge There are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant. What are the potential or actual clinical implications of this work? Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children.

Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial

Purpose The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption. Method The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyond-clinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms. Results Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered. Conclusions The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed.

Three Lidcombe program clinic visit options: a phase II trial

PURPOSE

Weekly clinic visits are recommended in the Lidcombe Program Treatment Guide (Packman et al., 2015). That specification is based on traditional speech-language pathology practices rather than empirical research, and two studies have suggested that such a format does not always occur in clinical communities. This research was conducted to determine the relative efficacy of different Lidcombe Program models of clinic visits.

METHOD

Thirty-one children were randomized to three different service delivery models: twice-weekly, weekly and fortnightly (once every two weeks) clinic visits. All children were treated with the Lidcombe Program following manualised procedures. Measures of percentage syllables stuttered were obtained from beyond clinic audio recordings pre- and post-randomization.

RESULTS

Results showed that the twice-weekly and fortnightly treatment formats were not suitable for all families. However, the fortnightly outcomes at 9 months post-randomization were comparable with those attained during weekly clinic visits.

CONCLUSIONS

These results justify further, large-scale clinical trialling to compare weekly Lidcombe Program clinic visits with schedules involving less frequent clinic visits.

A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions

PURPOSE

To compare two experimental Westmead Program treatments with a control Lidcombe Program treatment for early stuttering.

METHOD

The design was a three-arm randomized controlled trial with blinded outcome assessments 9 months post-randomization. Participants were 91 pre-school children.

RESULTS

There was no evidence of difference in percentage syllables stuttered at 9 months among groups. Dropout rates were substantive and may have been connected with novel aspects of the trial design: the use of community clinicians, no exclusion criteria, and randomization of children younger than 3 years of age.

CONCLUSION

The substantive dropout rate for all three arms in this trial means that any conclusions about the 9-month stuttering outcomes must be regarded as tentative. However, continued development of the Westmead Program is warranted, and we are currently constructing an internet version.

An investigation into the relationship between parent satisfaction and child fluency in the Lidcombe Program: Clinic versus telehealth delivery

Purpose: Parents have a vital role in the delivery of the Lidcombe Program when treating stuttering in young children. Research into parent experiences and perceptions throughout the Lidcombe Program is currently limited. Qualitative literature indicates that parent experiences and child progress are closely linked with program duration. This preliminary quantitative study examined parent satisfaction with child fluency at three time points. Data from clinic and telehealth delivery of the Lidcombe Program were used to further explore between-group non-inferiority. Method: The data were drawn from a parallel, non-inferiority, randomised controlled trial. Forty-nine children were randomised to the clinic or telehealth group. Parent satisfaction ratings with child fluency, the percentage of syllables stuttered and parent reported severity ratings were measured pre-treatment, 9 months and 18 months post-commencement of treatment. Result: An increase in parent satisfaction paralleled a decrease in stuttering severity across the three time points universally, however, the relationship between parent satisfaction and stuttering severity was not found at every time point. Conclusion: Though a general increase in parent satisfaction was seen as severity decreased, a global assumption on satisfaction cannot be made based on stuttering severity when measured using an ordinal scale.

School-based language screening among primary school children using telepractice: A feasibility study from India

Purpose: This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India. Method: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory. Result: Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks. Conclusion: Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.

After the RESTART trial: six guidelines for clinical trials of early stuttering intervention

BACKGROUND

The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter.

AIMS

To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention.

METHOD

The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning.

MAIN CONTRIBUTION

We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development.

CONCLUSION

In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.

Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review

INTRODUCTION

Rural children are likely to benefit from the telehealth delivery of multidisciplinary allied healthcare. This study aimed to (a) identify the scope of literature describing the telehealth delivery of allied health services to children living in rural areas and (b) understand the extent to which implementation - that is, specific activities designed to put telehealth into practice - has been investigated in such literature.

METHODS

Systematic scoping review methodology was used to locate studies in which telehealth delivered allied health services to children aged 0-12 who lived rurally (January 1998-January 2018). Two reviewers screened the studies, extracted data and appraised quality with Critical Skills Appraisal Programme checklists. Databases searched were PubMed, MEDLINE, CINAHL, PsycINFO, ERIC and Cochrane Library.

RESULTS

Data were extracted from 23 papers (two randomised controlled trials, one pseudorandomised controlled trial, one non-randomised experimental trial, two interrupted time series without parallel control groups, 10 case series and seven studies of diagnostic yield). Most were level III (n = 4) or IV (n = 17) when classified according to National Health and Medical Research Council guidelines. One study met all Critical Skills Appraisal Programme quality criteria. Allied healthcare interventions were aimed at improving functioning in communication (n = 10), behaviour and socio-emotional domains (n = 8) and identifying hearing concerns (n = 5). Many studies (n = 12) identified implementation facilitators, largely training and equipment. Only one study referred to an explicit framework for telehealth implementation (user-centred design).

DISCUSSION

Future research should target occupational therapy, physiotherapy, dietetics and social work, and determine the implementation factors and models likely to create successful telehealth services for this population.

Telehealth and autism: A systematic search and review of the literature

PURPOSE

Research interest in telehealth and autism spectrum disorder (ASD) has grown. There is a need to review the literature to allow speech-language pathologists (SLPs) and other service providers to consider applicability to their settings. The aim of this review was to examine the nature and outcomes of studies examining telehealth assessment and/or intervention in ASD.

METHOD

A systematic search of the literature was undertaken, with 14 studies meeting inclusion criteria. The authors extracted information from each included article, including participant characteristics, technology used, measures and reported outcomes. Quality review of articles was undertaken.

RESULT

The 284 participants with ASD across the 14 included studies ranged in age from 19 months to adulthood. The quality of the studies varied. A range of services were provided via telehealth, including diagnostic assessments, early intervention and language therapy. Results suggested that services delivered via telehealth were equivalent to services delivered face to face, and superior to comparison groups without telehealth sessions.

CONCLUSION

The findings suggest there may be a range of benefits in using telehealth with individuals with ASD, their families, and teachers. Further research, however, is required particularly regarding the use of telehealth directly with children with ASD for assessment and intervention.

Comparison of Percentage of Syllables Stuttered With Parent-Reported Severity Ratings as a Primary Outcome Measure in Clinical Trials of Early Stuttering Treatment

PURPOSE

This report investigates whether parent-reported stuttering severity ratings (SRs) provide similar estimates of effect size as percentage of syllables stuttered (%SS) for randomized trials of early stuttering treatment with preschool children.

METHOD

Data sets from 3 randomized controlled trials of an early stuttering intervention were selected for analyses. Analyses included median changes and 95% confidence intervals per treatment group, Bland-Altman plots, analysis of covariance, and Spearman rho correlations.

RESULTS

Both SRs and %SS showed large effect sizes from pretreatment to follow-up, although correlations between the 2 measures were moderate at best. Absolute agreement between the 2 measures improved as percentage reduction of stuttering frequency and severity increased, probably due to innate measurement limitations for participants with low baseline severity. Analysis of covariance for the 3 trials showed consistent results.

CONCLUSION

There is no statistical reason to favor %SS over parent-reported stuttering SRs as primary outcomes for clinical trials of early stuttering treatment. However, there are logistical reasons to favor parent-reported stuttering SRs. We conclude that parent-reported rating of the child's typical stuttering severity for the week or month prior to each assessment is a justifiable alternative to %SS as a primary outcome measure in clinical trials of early stuttering treatment.

The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach

PURPOSE OF REVIEW

Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs.

RECENT FINDINGS

Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.

Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure

PURPOSE

Using American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) Functional Communication Measure (FCM) as a common metric, this investigation compared traditional service delivery and telepractice service delivery for children receiving therapy for the NOMS diagnostic category of "speech sound production."

METHOD

De-identified cases were secured from ASHA's NOMS database and a proprietary database from a private e-learning provider. Cases were included if they met 3 criteria: (a) children received treatment exclusively for speech sound production, (b) they were between 6.0 and 9.5 years old, and (c) they received therapy lasting between 4 and 9 months. A total of 1,331 ASHA NOMS cases and 428 telepractice cases were included. The 2 groups were matched by initial FCM scores. Mann-Whitney U tests were completed to compare differences in the median change scores (the difference between the initial and final FCM scores) between the 2 groups.

RESULTS

There were no significant differences in the median change scores between the traditional group and the telepractice group.

CONCLUSIONS

These results suggest comparable treatment outcomes between traditional service delivery and telepractice for treatment of children exhibiting speech sound disorders. The findings provide support for the use of telepractice for school-age children.

A pilot study of online assessment of childhood speech disorders

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.

A scoping review of Australian allied health research in ehealth

Background

Uptake of e-health, the use of information communication technologies (ICT) for health service delivery, in allied health appears to be lagging behind other health care areas, despite offering the potential to address problems with service access by rural and remote Australians. The aim of the study was to conduct a scoping review of studies into the application of or attitudes towards ehealth amongst allied health professionals conducted in Australia.

Methods

Studies meeting inclusion criteria published from January 2004 to June 2015 were reviewed. Professions included were audiology, dietetics, exercise physiology, occupational therapy, physiotherapy, podiatry, social work, and speech pathology. Terms for these professions and forms of ehealth were combined in databases of CINAHL (EBSCO), Cochrane Library, PsycINFO (1806 – Ovid), MEDLINE (Ovid) and AMED (Ovid).

Results

Forty-four studies meeting inclusion criteria were summarised. They were either trials of aspects of ehealth service delivery, or clinician and/or client use of and attitudes towards ehealth. Trials of ehealth were largely from two research groups located at the Universities of Sydney and Queensland; most involved speech pathology and physiotherapy. Assessments through ehealth and intervention outcomes through ehealth were comparable with face-to-face delivery. Clinicians used ICT mostly for managing their work and for professional development, but were reticent about its use in service delivery, which contrasted with the more positive attitudes and experiences of clients.

Conclusion

The potential of ehealth to address allied health needs of Australians living in rural and remote Australia appears unrealised. Clinicians may need to embrace ehealth as a means to radicalise practice, rather than replicate existing practices through a different mode of delivery.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1791-x) contains supplementary material, which is available to authorized users.

Lidcombe Program Webcam Treatment for Early Stuttering: A Randomized Controlled Trial

PURPOSE

Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early stuttering.

METHOD

The design was a parallel, open plan, noninferiority randomized controlled trial of the standard Lidcombe Program treatment and the experimental webcam Lidcombe Program treatment. Participants were 49 children aged 3 years 0 months to 5 years 11 months at the start of treatment. Primary outcomes were the percentage of syllables stuttered at 9 months postrandomization and the number of consultations to complete Stage 1 of the Lidcombe Program.

RESULTS

There was insufficient evidence of a posttreatment difference of the percentage of syllables stuttered between the standard and webcam Lidcombe Program treatments. There was insufficient evidence of a difference between the groups for typical stuttering severity measured by parents or the reported clinical relationship with the treating speech-language pathologist.

CONCLUSIONS

This trial confirmed the viability of the webcam Lidcombe Program intervention. It appears to be as efficacious and economically viable as the standard, clinic Lidcombe Program treatment.

The Lidcombe Program of early stuttering intervention for Malaysian families: Four case studies

PURPOSE

This study investigated the outcomes of implementing the Lidcombe Program, an evidence-based early intervention for stuttering, with four preschool children in Malaysia. Early stuttering intervention is currently underdeveloped in Malaysia, where stuttering treatment is often more assertion-based than evidence-based. Therefore, introducing an evidence-based early stuttering intervention is an important milestone for Malaysian preschoolers who stutter.

METHOD

The participants ranged from 3 years 3 months to 4 years 9 months at the start of the study. Beyond-clinic speech samples were obtained at 1 month and 1 week pretreatment and immediately post-Stage 1, and at 1 month, 3 months, 6 months and 12 months post-Stage 1.

RESULTS

Two participants, who were bilingual, achieved near-zero levels of stuttering at 12 months posttreatment. Near zero levels of stuttering were also present in their untreated languages. One participant withdrew due to reasons not connected with the research or treatment. The remaining participant, who presented with severe stuttering, completed Stage 1 but had some relapse in Stage 2 and demonstrated mild stuttering 12 months post-Stage 1.

CONCLUSIONS

The outcomes were achieved without the need to significantly adapt Lidcombe Program procedures to Malaysian culture. Further research to continue evaluation of the Lidcombe Program with Malaysian families and to estimate proportion of those who will respond is warranted.

Non-pharmacological treatments for stuttering in children and adults: a systematic review and evaluation of clinical effectiveness, and exploration of barriers to successful outcomes

BACKGROUND

Despite many years of research, there is no certainty regarding the cause of stuttering. Although numerous interventions have been developed, a broad-based systematic review across all forms of intervention for adults and children was needed including views and perceptions of people who stutter.

OBJECTIVE

The aims of the study were to report the clinical effectiveness of interventions for people who stutter (or clutter), to examine evidence regarding the views of people who stutter and the views of professionals regarding interventions.

DATA SOURCES

A systematic review of quantitative and qualitative literature was carried out between August 2013 and April 2014. The following electronic databases were searched: (1) MEDLINE, (2) EMBASE, (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database and NHS Economic Evaluations Database), (4) PsycINFO, (5) Science Citation Index, (6) Social Science Citation Index, (7) Cumulative Index to Nursing and Allied Health Literature, (8) ASSIA, (9) Linguistics and Language Behavior Abstracts, (10) Sociological Abstracts and (11) the EPPI Centre. Reference lists of included papers and other reviews were screened and also key journals in the subject area were hand-searched.

REVIEW METHODS

The searches aimed to identify (1) evidence of clinical effectiveness in populations of pre-school children, school-aged children, adolescents and adults, and (2) data relating to perceptions of barriers and facilitators to intervention clinical effectiveness among staff and people who stutter. A metasynthesis of the two linked elements via development of a conceptual model was also carried out to provide further interpretation of the review findings.

RESULTS

A systematic search of the literature identified a large number of potentially relevant studies. Of these, 111 studies examining the clinical effectiveness of interventions, 25 qualitative papers and one mixed-methods paper met the criteria for inclusion in this review. Review of the effectiveness literature indicated evidence of positive outcomes across all types of interventions. Virtually all evidence we identified reported at least some positive effect for some participants. However, there was evidence of considerable individual variation in outcome for study participants. The qualitative literature highlighted the need for programmes to be tailored to individual need with variation at the levels of the intervention, the individual and interpersonal/social elements. Metasynthesis of the data highlighted the complexity of elements that need to be considered in evaluation of long-term impacts following stuttering interventions.

LIMITATIONS

Around two-thirds of the studies were considered to be at higher risk of bias. The heterogeneous nature and variability in outcomes meant that we were unable to complete a meta-analysis.

CONCLUSIONS

Although much of the evidence we identified was from studies at risk of bias, it is suggested that most available interventions for stuttering may be of benefit to at least some people who stutter. There is a requirement for greater clarity regarding what the core outcomes following stuttering intervention should be and also enhanced understanding of the process whereby interventions effect change. Further analysis of those for whom interventions have not produced a significant benefit may provide additional insights into the complex intervention-outcomes pathway.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013004861.

Standalone Internet speech restructuring treatment for adults who stutter: A phase I study

PURPOSE

This Phase I trial reports the results of a clinician-free Internet speech restructuring treatment for adults who stutter. The program consists of nine phases with concepts loosely based on the Camperdown Program.

METHOD

Twenty adults who stutter were recruited. They were given unlimited access to the program for 6 months. Primary outcome measures were the percentage of syllables stuttered and self-reported severity ratings.

RESULT

Five participants accessed all phases of the program, while another five accessed more than half the phases. The remaining 10 accessed between one and four phases. Four of five participants who accessed all phases reduced their stuttering frequency by more than 50% and an additional two participants who accessed more than half the phases also achieved similar reductions. These results were confirmed by self-reports of stuttering severity. Stuttering reductions were largely commensurate with the amount of the program accessed.

CONCLUSION

As with other clinician-free programs in related health areas, maintaining adherence to the program's procedures was a significant issue. Nonetheless, this novel approach to treating stuttering has the potential to be a viable alternative for some clients and may help to address the significant access and relapse issues that affect treatment provision for adults who stutter.

Management options for pediatric patients who stutter: current challenges and future directions

Stuttering is a speech disorder, with onset often occurring in the preschool years. The prevalence of stuttering in young children is much higher than that in the general population, suggesting a high rate of recovery. However, we are unable to predict which children will recover without treatment, and it is widely acknowledged that stuttering therapy during childhood provides the best safeguard against chronic stuttering. This review reports on current evidence-based stuttering treatment options for preschoolers through to adolescents. We discuss the clinical challenges associated with treating pediatric clients who stutter at different stages of development and explore potential areas of treatment research that might serve to advance current clinical practice in the future.

Telerehabilitation of Anomia in Primary Progressive Aphasia

BACKGROUND

The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness.

AIMS

The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA).

METHODS & PROCEDURES

Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of six months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA.

OUTCOMES & RESULTS

All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items in both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items in the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected.

CONCLUSIONS

Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.

The state of the art in non-pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness

BACKGROUND

The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad-based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities.

AIMS

To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non-pharmacological interventions for the management of developmental stuttering.

METHODS & PROCEDURES

A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed.

MAIN CONTRIBUTION

The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions).

CONCLUSIONS

This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention.

A systematic review of the use of telehealth in speech, language and hearing sciences

Introduction

We conducted a systematic literature review to investigate the domain of speech-language and hearing sciences (SLHS) in telehealth.

Methods

The databases used for the literature search were Web of Knowledge, Pubmed, Scopus, Embase and Scielo. The inclusion criteria consisted of papers published up to August 2014. Papers without peer-review evaluation, and those without abstracts or available full texts were excluded.

Results

A total of 103 papers were selected. The selected studies have focused primarily on hearing (32.1%), followed by speech (19.4%), language (16.5%), voice (8.7%), swallowing (5.8%), multiple areas (13.6%) and others (3.9%). The majority of the studies focused on assessment (36.9%) or intervention (36.9%). The use of telehealth in SLHS has been increasing in many countries, especially in the last 5 years. The country with the largest number of published studies was the United States of America (32.03%), followed by Australia (29.12%). The remaining studies were distributed in lower numbers among other countries.

Discussion

The advancement of information and communication technologies provides more favourable conditions for providing distance care in several areas. Most of studies concluded that the telehealth procedure had advantages over the non-telehealth alternative approach (85.5%); however, 13.6% reported that it was unclear whether the telehealth procedure had advantages. Some barriers still need to be overcome, such as technology, training, regulation, acceptance and recognition of the benefits of this practice by the public and professionals. The need for speech-language pathologists and audiologists to adapt to this new health care modality is evident.

Feasibility of automated speech sample collection with stuttering children using interactive voice response (IVR) technology

PURPOSE

To investigate the feasibility of adopting automated interactive voice response (IVR) technology for remotely capturing standardized speech samples from stuttering children.

METHOD

Participants were 10 6-year-old stuttering children. Their parents called a toll-free number from their homes and were prompted to elicit speech from their children using a standard protocol involving conversation, picture description and games. The automated IVR system was implemented using an off-the-shelf telephony software program and delivered by a standard desktop computer. The software infrastructure utilizes voice over internet protocol. Speech samples were automatically recorded during the calls. Video recordings were simultaneously acquired in the home at the time of the call to evaluate the fidelity of the telephone collected samples. Key outcome measures included syllables spoken, percentage of syllables stuttered and an overall rating of stuttering severity using a 10-point scale.

RESULT

Data revealed a high level of relative reliability in terms of intra-class correlation between the video and telephone acquired samples on all outcome measures during the conversation task. Findings were less consistent for speech samples during picture description and games.

CONCLUSION

Results suggest that IVR technology can be used successfully to automate remote capture of child speech samples.

An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program

PURPOSE

The Lidcombe Program is a behavioural treatment for stuttering in children younger than 6 years that is supported by evidence of efficacy and effectiveness. The treatment incorporates parent verbal contingencies for stutter-free speech and for stuttering. However, the contribution of those contingencies to reductions in stuttering in the program is unclear.

METHOD

Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction.

RESULT

No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity.

CONCLUSION

This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.

Stuttering intervention in three service delivery models (direct, hybrid, and telepractice): two case studies

This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children's attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency.

Group lidcombe program treatment for early stuttering: a randomized controlled trial

PURPOSE

This study adds to the Lidcombe Program evidence base by comparing individual and group treatment of preschoolers who stutter.

METHOD

A randomized controlled trial of 54 preschoolers was designed to establish whether group delivery outcomes were not inferior to the individual model. The group arm used a rolling group model, in which a new member entered an existing group each time a vacancy became available. Assessments were conducted prerandomization and 9 months and 18 months postrandomization.

RESULTS

There was no evidence of a difference between treatment arms for measures of weeks or clinic visits required, percent syllables stuttered, or parent severity ratings. However, children in the group arm consumed around half the number of speech-language pathologist hours compared with children treated individually. In addition, children in the group progressed more quickly after the treating speech-language pathologist became more practiced with the group model, suggesting the group results are conservative estimates.

CONCLUSIONS

Group delivery of the Lidcombe Program is an efficacious alternative to the individual model. Parents responded favorably to the group model, and the treating speech-language pathologists found group treatment to be more taxing but clinically gratifying.

Parents' Perspectives on Tele-AAC Support for Families with a New Speech Generating Device: Results from an Australian Pilot Study

Telepractice is rapidly gaining popularity as a cost-effective and convenient alternative to in-person services for a range of speech-language pathology (SLP) applications. To date, there has been little research investigating the use of telepractice to support families with a new speech generating device (SGD). This paper reports on the outcomes of a novel online training and support program, trialed with 4 underserviced Australian families of children with a new SGD. The program consisted of 6 video-narrated lessons on SGD use, along with an online supervision and practice component conducted via videoconference. Semi-structured interviews were undertaken with parents following their completion of the program. Parents noted the telepractice support model offered a range of benefits, including convenient service access and flexible learning options. Challenges included technology limitations and increased pressure on parents to coordinate home practice. Overall, parents reported that the telepractice program was a positive experience for them and their children. Findings indicated that telepractice is a promising mode of service delivery for those learning to use a new SGD. Further research in this area is warranted.

Webcam delivery of the Lidcombe program for early stuttering: a phase I clinical trial

PURPOSE

The Lidcombe Program is an operant treatment for early stuttering shown with meta-analysis to have a favorable odds ratio. However, many clients are unable to access the treatment because of distance and lifestyle factors. In this Phase I trial, we explored the potential efficacy, practicality, and viability of an Internet webcam Lidcombe Program service delivery model.

METHOD

Participants were 3 preschool children who stuttered and their parents, all of whom received assessment and treatment using webcam in their homes with no clinic attendance.

RESULTS

At 6 months post-Stage 1 completion, all children were stuttering below 1.0% syllables stuttered. The webcam intervention was acceptable to the parents and appeared to be practical and viable, with only occasional audiovisual problems. At present, there is no reason to doubt that a webcam-delivered Lidcombe Program will be shown with clinical trials to have comparable efficacy with the clinic version.

CONCLUSION

Webcam-delivered Lidcombe Program intervention is potentially efficacious, is practical and viable, and requires further exploration with comparative clinical trials and a qualitative study of parent and caregiver experiences.

Effectiveness of the Lidcombe Program for early stuttering in Australian community clinics

This study explored the effectiveness of the Lidcombe Program for early stuttering in community clinics. Participants were 31 speech-language pathologists (SLPs) using the Lidcombe Program in clinics across Australia, and 57 of their young stuttering clients. Percentage of syllables stuttered (%SS) was collected 9 months after beginning treatment along with information about variables likely to influence outcomes. The mean %SS for the 57 children 9 months after starting treatment was 1.7. The most significant predictor of outcome was Lidcombe Program Trainers Consortium (LPTC) training. The children of trained SLPs (n = 19), compared to the children of untrained SLPs, took 76% more sessions to complete stage 1, but achieved 54% lower %SS scores, 9 months after starting treatment. Results suggest that outcomes for the Lidcombe Program in the general community may be comparable to those obtained in clinical trials when SLPs receive formal training and support.

The Use of Telepractice Technology To Provide Speech and Language Services to Persons Aging With Communication Disorders

Telepractice, providing speech and language services at a distance from clients, is becoming another tool clinicians can use to provide services. Relieving the burden of travel may help those aging with a communication disability to access beneficial services. I will present evidence from several studies using telepractice for assessment and treatment of communication disorders. Although researchers have published promising results, future researchers should determine which populations will receive the most benefit from telepractice.

A new era in speech-language pathology practice: innovation and diversification

A new era in speech-language pathology practice is pending, and one that impels us to innovate and diversify as we move forward into the 21(st) century. The impetus for this transformation will include the increasing cost and demand for healthcare services as the population ages, changes in Australian society, rapid developments in technology, and major advances in neuroscience. New models of service delivery will need to be considered in line with evidence-based treatment protocols, the concept of a continuum of care for chronic disorders, and the need to engage clients in self-management. Innovations in technology will provide the means by which these new models of service delivery might be achieved. The exponential increase in electronic therapy resources and devices will transform the therapeutic process and provide clinicians with engaging and flexible therapy options. Clinicians will be challenged by this paradigm shift in service delivery, and their long-held perceptions of their clients' capacity to respond to these changes. Other challenges will include the preparation of future speech-language pathologists, reimbursement for services, availability of appropriate technology, and widespread connectivity. The future of the profession is an exciting one as we move forward into an era of unprecedented change.

A phase II trial of the Westmead Program: syllable-timed speech treatment for pre-school children who stutter

This report presents a Phase II clinical trial of a syllable-timed speech treatment for early stuttering known as The Westmead Program. Of 17 children recruited, eight children aged between 3-4.5 years (mean 3 years 8 months) completed the treatment. The primary outcome measure was percentage syllables stuttered (%SS) measured from independent, blinded speech assessments of beyond-clinic audio recordings. Secondary outcomes were measures of treatment time, speech quality, and parent severity ratings. Dropouts occurred, but at a similar rate to other clinical trials of this nature. For the eight children who completed the treatment, mean pre-treatment stuttering was 6.0%SS and at 12-months post-Stage 2 entry stuttering had decreased to 0.2%SS, representing a mean stuttering reduction of 96%. A large effect size was obtained with a mean of 8.0 clinical hours required for these children to reach Stage 2. Independent listeners judged the everyday speech of all children to be not unnatural in any way. Stuttering reductions were attained with clinical efficiency and simplicity compared to other early stuttering interventions. Further clinical trials development of the treatment is warranted.

Reprint of: technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.

EDUCATIONAL OBJECTIVES

The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.

Telepractice in Speech-Language Pathology: The Evidence, the Challenges, and the Future

This article provides a review of the evidence base for telepractice in speech-language pathology, the challenges that exist, and the future directions for this field. It describes the benefits of telepractice for clients and their families and outlines the evidence currently available to support the validity and reliability of this mode of delivery in the management of adult neurogenic communication disorders (aphasia, dysarthria, apraxia of speech); voice disorders; stuttering; dysphagia; laryngectomy; and articulation, language, and literacy disorders in children. The challenges facing telepractice in speech-language pathology and the future directions for this field are discussed.

Telepractice is an emerging area of service delivery in speech-language pathology that is likely to become an integral part of mainstream practice in the future. In order to achieve this, it is imperative that the profession accelerates its program of research and clinical endeavor in this area.

Assessing swallowing disorders online: a pilot telerehabilitation study

OBJECTIVE

Dysphagia (a swallowing disorder) is known to occur in numerous clinical populations, but unfortunately because of issues accessing speech pathology services, not all patients are able to receive dysphagia intervention and rehabilitation services in a timely manner. Existing research supports the use of telehealth technology for providing various aspects of speech pathology service; however, to date there is limited evidence to support the utilization of telerehabilitation in the assessment and management of dysphagia. The aim of this research was to provide pilot information on the basic feasibility and validity of conducting dysphagia assessments via telerehabilitation.

MATERIALS AND METHODS

Ten simulated patients, actors portraying patients with a range of swallowing difficulties, were used rather than actual patients to minimize any potential patient risk from unidentified aspiration. Dysphagia was assessed simultaneously by a face-to-face (FTF) and telerehabilitation speech pathologist (T-SP). Each simulated patient was assessed using a Clinical Swallowing Examination (CSE) protocol that was modified to suit a telerehabilitation environment. The CSE was administered with the support of an assistant via an Internet-based videoconferencing telerehabilitation system using a bandwidth of 128 kilobits per second.

RESULTS

Results revealed high to excellent levels of agreement between the T-SP and the FTF-SP across all parameters of the CSE. Agreement for aspiration risk was excellent.

CONCLUSION

The pilot data indicate that the current model of administering a CSE via telerehabilitation has potential to be a feasible and valid method for the remote assessment of swallowing disorders.