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Kariveda RR, Tran A, Velu PS, Jabbour N, Pisegna JM, Tracy LF. Impact of Patient Factors on Attendance at Remote Telehealth Swallow Therapy. Dysphagia 2024; 39:735-745. [PMID: 38273158 DOI: 10.1007/s00455-023-10654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
In-person swallow therapy is a primary and effective treatment for dysphagia. However, remote telehealth is now a widely utilized component of healthcare delivery for therapeutic interventions. This study evaluates potential factors influencing attendance at telehealth swallow therapy. Retrospective review of 308 patients referred for telehealth swallow therapy from April 2020-November 2021 included patient referral diagnosis, diagnostic swallowing evaluations, and sociodemographic information including age, race, health insurance, interpreter use, and socioeconomic status. Univariable and multivariable analyses compared patient and appointment factors for those who attended telehealth swallow therapy with those who did not attend. Overall, 71.8% of patients attended at least one telehealth swallow therapy appointment while 28.2% did not attend any. The most common referral diagnoses were "Cancer" (19.2%) and "Dysphagia Unspecified" (19.2%). Patients diagnosed with "Cancer" and "Muscle Tension" were significantly less likely to attend telehealth swallow therapy compared to those with "Dysphagia Unspecified," "Globus," and "Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux" after adjusting for covariates. Lower socioeconomic status (p = 0.023), no interpreter use (p < 0.001), and more diagnostic evaluations (p = 0.001) correlated with higher telehealth swallow therapy attendance. Race and sex did not correlate with attendance. Most patients referred to telehealth swallow therapy attended at least one appointment. Patients with dysphagia associated with cancer and muscle tension, those with higher socioeconomic status, interpreter use, and fewer diagnostic swallowing evaluations were less likely to attend telehealth swallow therapy. Future research should investigate and compare attendance and efficacy of telehealth swallow therapy with in-person therapy.
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Affiliation(s)
- Rohith R Kariveda
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Audrey Tran
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Jessica M Pisegna
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Lauren F Tracy
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
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Ramkumar V, Neethi J, Kumar S. Needs and readiness to use tele-practice for identification and rehabilitation of children with hearing and speech-language disorders: perceptions of public sector care providers in South India. EARLY CHILD DEVELOPMENT AND CARE 2024; 194:39-57. [PMID: 38681940 PMCID: PMC7615870 DOI: 10.1080/03004430.2023.2276660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/24/2023] [Indexed: 05/01/2024]
Abstract
The current study was a first step towards planning the implementation of tele-practice in a South Indian state's public-sector services for childhood hearing and speech, language disorders. The aim was to understand the perceptions of public-sector health care providers (HCPs) regarding their need and readiness to accept and implement tele-practice-based diagnostics and rehabilitation services. A cross-sectional study design was used, which included focus group discussions (FGDs), semi-structured interviews (SSIs) and geo-spatial analysis. Participants in the qualitative component included various cadres of health HCPs in public-sector services. Theoretical saturation and cross-case variance were used to assess the data's sufficiency. A hybrid deductive-inductive thematic analytical approach was used to analyse the data. Geo-tags and geo-locations of addresses of all children with disabilities and all the public-sector service providers were used to generate geospatial maps. The HCPs considered the currently available services for childhood hearing and speech-language disorders to be insufficient and reported shortage of professionals to meet current demands. There was inconsistent availability of suitable equipment and professionals in the existing district-level facilities. HCPs were comfortable using technology, and were willing to investigate tele-practice, but they required training in tele-practice [Q2].
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Affiliation(s)
- Vidya Ramkumar
- Department of Audiology, Sri Ramachandra, Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
| | - J Neethi
- Department of Audiology, Sri Ramachandra, Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
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De Taeye R, Van Lierde K, Alighieri C. Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists. Int J Pediatr Otorhinolaryngol 2023; 169:111560. [PMID: 37116275 DOI: 10.1016/j.ijporl.2023.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE This prospective cross-sectional study aimed to investigate the opinions and experiences with telepractice (TP) of Dutch-speaking speech-language pathologists (SLPs) living in the Dutch-speaking part of Belgium (Flanders). This study will help to optimize care for children with speech-language disorders as we will gain more insight into the experienced barriers and facilitators while using TP for assessing and treating these disorders. METHOD Twenty-nine Dutch-speaking speech-language pathologists living in Flanders (age category 20-30 years: n = 16/29, 55.2%, 31-40 years: n = 10/29, 34.2%, 41-50 years: n = 2/29, 6.9%, 51-60 years: n = 1/29, 3.4%) were recruited through the social media. An online questionnaire was developed based on the available literature and administered to the SLPs. To compare the opinions and experiences of SLPs with TP, χ2 tests or Fisher's exact tests were used. RESULTS The study showed a statistically significant association between years of clinical experience of SLPs and their opinion that TP does not provide more options in a clinical setting compared to face-to-face contact. SLPs who had expertise in multiple domains experienced significantly more added value of TP during the corona pandemic than SLPs who had expertise in only one specific domain. Additionally, SLPs who worked in a private practice indicated significantly more difficulties in developing a therapeutic relationship due to a lack of personal contact than SLPs who worked in other settings. 51.7% (15/29) of the SLPs experienced technical barriers using TP. CONCLUSION Expertise in multiple domains of pediatric speech-language therapy resulted in experiencing more added value of TP during the corona pandemic, possibly because of the experience of multiple different and simultaneous advantages of TP in several domains. Additionally, SLPs in a private practice experienced more difficulties in developing a therapeutic relationship due to a lack of personal contact with their clients. This is in contrast to hospitals where children are often seen for a shorter period. Hence, there may be less chance of a negative perception of relationships with clients. Another conclusion is that treatment drop-out was not larger using TP compared to face-to-face therapy. However, SLPs experienced that the use of TP was not promoted/encouraged by their employer possibly because of technical barriers. It is hoped that the findings of this study will help SLPs and policymakers overthrow existing barriers and make telepractice a substantial, effective, and efficient service delivery model.
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Affiliation(s)
- Robin De Taeye
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium.
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Karlsson F, Lovric L, Matthelié J, Brage L, Hägglund P. A Within-Subject Comparison of Face-to-Face and Telemedicine Screening Using the Timed Water Swallow Test (TWST) and the Test of Mastication and Swallowing of Solids (TOMASS). Dysphagia 2023; 38:483-490. [PMID: 35809097 PMCID: PMC9873209 DOI: 10.1007/s00455-022-10490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/20/2022] [Indexed: 01/29/2023]
Abstract
The Timed Water Swallow Test (TWST) and the Test of Mastication of Solids (TOMASS) are dysphagia screening procedures that have been shown to be reliably assessed from video. The reliability of the procedures performed over telemedicine has not previously been assessed. TWST and TOMASS outcomes in two situations (both face-to-face and over telemedicine) were compared for 48 participants (aged 60-90; 27 with clinical conditions and 21 older persons). Both testing situation and test performed order were randomized, and all assessment procedures were performed within 3 h of each other. The results indicated a high level of agreement between face-to-face and telemedicine screening outcomes for TWST and TOMASS, respectively. The assessments indicated an 83% and 76% agreement in classifications of individual participants as within or outside normal limits for the TWST and TOMASS for the two test situations. The TWST showed a balanced distribution in differing classification in telemedicine (0.16-0.19 error rates). The TOMASS procedure classified more participants as outside normal limits over telemedicine compared to face-to-face administration. Agreement in the observed number of swallows was substantially lower than other outcome measures, which is attributed to increased difficulty in observing this property over video. Most participants (60%) reported that they would prefer telemedicine over face-to-face assessments, and 90% viewed the procedure as more accessible than expected. All participants were satisfied with the telemedicine procedures. The results suggest that clinical assessment of dysphagia over telemedicine using the TWST and TOMASS are viable alternatives to face-to-face administration of the procedures.
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Affiliation(s)
- Fredrik Karlsson
- Department of Clinical Sciences, Speech-Language Pathology, Umea University, 90187, Umea, Sweden.
| | - Leo Lovric
- Department of Clinical Sciences, Speech-Language Pathology, Umea University, 90187, Umea, Sweden
| | - Josephine Matthelié
- Department of Clinical Sciences, Speech-Language Pathology, Umea University, 90187, Umea, Sweden
| | - Louise Brage
- Department of Clinical Sciences, Speech-Language Pathology, Umea University, 90187, Umea, Sweden
| | - Patricia Hägglund
- Department of Clinical Sciences, Speech-Language Pathology, Umea University, 90187, Umea, Sweden
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Malandraki GA, Kantarcigil Ç, Craig BA, Zhang Y, Gordon AM. Day-to-Day Variability of Clinical Feeding and Swallowing Performance in School-Age Self-Feeding Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:190-200. [PMID: 36492292 DOI: 10.1044/2022_ajslp-22-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE We aimed to examine the day-to-day variability of feeding and swallowing performance and mealtime duration in school-age self-feeding children with spastic cerebral palsy (SCP) across 15 days. METHOD Thirteen children with SCP (ages 5;10 [years;months]-17;6) participated. Children were divided into unilateral (UCP, n = 6) and bilateral (BCP, n = 7) SCP groups. Feeding/swallowing assessments using the Dysphagia Disorder Survey (DDS) were conducted and total mealtime durations (TMDs) were calculated for all days. DDS Part 1 (factors related to feeding) and DDS Part 2 (signs of oropharyngeal difficulties) components were rated. Mixed-effects models were used to compare group means and estimate between- and within-subject variances in each group. Likelihood ratio tests were used to determine best covariance structure and compare variance types across groups. RESULTS Within-subject variance for all three variables, DDS Part 1, 2, and TMD, across days was larger in the BCP group than the UCP group (Part 1: p = .0036, Part 2: p = .0002, and TMD: p = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (p = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: p = .0160; Part 2: p = .0141) and shorter TMD (p = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (p < .0001). CONCLUSION These preliminary results emphasize the need to account for day-to-day variability when evaluating swallowing especially in children with BCP and provide preliminary ranges of performance that could be useful for clinical prognosis and future treatment research. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21669611.
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Affiliation(s)
- Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Çagla Kantarcigil
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Bruce A Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Yumin Zhang
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Telehealth Management of Dysphagia in Adults: A Survey of Speech Language Pathologists' Experiences and Perceptions. Dysphagia 2022:10.1007/s00455-022-10544-z. [PMID: 36515730 PMCID: PMC9749630 DOI: 10.1007/s00455-022-10544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
The goal of this study was to explore telehealth use for dysphagia management in response to COVID-19 to understand variables associated with clinician confidence and perceived effectiveness of this service delivery model and determine clinician-perceived benefits and challenges of managing dysphagia via telehealth. Speech-language pathologists (SLPs, n = 235) completed a web-based survey, providing information on demographics, telehealth use during the pandemic, and perspectives on current and future tele-management of dysphagia. Analyses included descriptive statistics to examine usage patterns; logistic regression to determine which variables were associated with telehealth use, clinician confidence, and perceived-effectiveness; and conventional content analysis to analyze responses to open-ended questions. Results revealed a sharp increase in the tele-management of dysphagia during the pandemic. Years of experience with dysphagia management (p = .031) and pre-pandemic use of telehealth (p < .001) were significantly associated with current use patterns. Working in the outpatient setting was associated with greater clinician confidence (p = .003) and perceived effectiveness (p = .007), and use of guidelines (p = .042) was also associated with greater clinician confidence. Key challenges identified included inadequate technological infrastructure, inadequate patient digital literacy, and reimbursement restrictions. Key benefits were treatment continuity, improving access to care, and time savings. The majority (67%) of respondents reported that they would use telehealth in the future. These findings demonstrate SLPs' abilities and desire to expand their practice patterns to include telehealth for dysphagia management. Therefore, clinician training and more research on best practices for assessment and treatment of dysphagia via telehealth is warranted to refine models of care for dysphagia tele-management.
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Omori F, Fujiu-Kurachi M, Wada K, Yamano T. Development of a Remote Examination of Deglutition Based on Consensus Surveys of Clinicians (Part II): Reliability and Validity in Healthy Elderly Individuals and Oral Cancer Patients. Dysphagia 2022; 38:896-911. [PMID: 36167837 PMCID: PMC9514714 DOI: 10.1007/s00455-022-10514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
In our prior published study, we extracted evaluation items suitable for remote administration, and made a relatively simple Remote Examination of Deglutition (RED). This study aimed at verifying the reliability and validity of RED. The participants were 21 healthy elderly individuals and 72 postoperative oral cancer (OC) patients. OC patients underwent videofluoroscopic dysphagia examination, and severity was judged on the dysphagia severity scale (DSS). Reliability and validity of RED were examined in all participants under face-to-face conditions, in comparison with the Mann Assessment of Swallowing Ability (MASA). Reliability and validity of remote administration of RED were examined in 40 participants. ROC curves were used to find cut-off RED scores to predict aspiration and deglutition disorders. The Cronbach's alpha coefficient for the items was 0.882. There was a high correlation between the total score of RED and MASA in the face-to-face condition. When RED score was compared among different severity groups (DSS1-4, DSS5-6, and DSS7), the total and oral preparatory stage scores revealed significant group differences. The area under the curve (AUC) for aspiration based on the ROC curve was 0.913, with a sensitivity/specificity of 0.80/0.98. The AUC for deglutition disorders was 0.819, with a sensitivity/specificity of 0.74/0.67. In both face-to-face and remote conditions, the reliability of RED was good.The reliability and validity of RED were confirmed. RED has shown the potential to assess the likelihood of aspiration and deglutition disorders in OC patients remotely as an initial assessment tool.
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Affiliation(s)
- Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan. .,Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, 4-3 Kouzunomori, Narita-shi, Tsiba, 286-8686, Japan.
| | - Masako Fujiu-Kurachi
- Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, 4-3 Kouzunomori, Narita-shi, Tsiba, 286-8686, Japan
| | - Kaori Wada
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Takafumi Yamano
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
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Shankar V, Ramkumar V, Kumar S. Understanding the implementation of telepractice in speech and language services using a mixed-methods approach. Wellcome Open Res 2022; 7:46. [PMID: 36158869 PMCID: PMC9490278 DOI: 10.12688/wellcomeopenres.17622.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Telepractice emerged as a solution to overcome the challenges of access issues in the delivery of healthcare. Telepractice in speech language pathology (SLP) has existed for nearly a decade yet there is a significant knowledge gap with respect to the factors influencing the implementation of telepractice as a routine or long-term, sustained effort. This mixed-methods study aimed to identify implementation factors that influence the provision of telepractice in SLP services. Method: A mixed-methods study consisting of a scoping review and semi-structured interviews (SSI) was carried out. Articles that described telepractice in SLP were included based on an operational definition of implementation and a set of inclusion criteria. Results: Data was extracted from 11 studies that were mapped to nine projects in telepractice in SLP. The broad focus areas identified included diagnostics and evaluation, therapeutics and comprehensive assessment, management and follow-up care services. Synchronous/ real-time telepractice methods were always used for the provision of diagnostic testing or when providing therapy services using video conferencing. The ‘
professional-facilitator-patient’ model was used most commonly followed by the ‘
professional-patient’ model. Barriers for long-term sustainability included inadequate initial capital investment, lack of reimbursement and payment options, low internet speed and bandwidth, resistance and hesitancy to use telepractice from the patient’s end, lack of organizational policies and uniform regulations. Sustainable source of funding, having a dedicated team of professionals and technicians with clear roles and responsibilities, and inclusion of systematic planning facilitated implementation. Conclusion: In general, telepractice in SLP was not explicitly guided by implementation science or framework. The use of implementation frameworks ensures systematic planning and feasibility assessment to inform the scale-up of implementation. Therefore, it would be worthwhile for program implementers to consider these aspects when exploring telepractice services.
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Affiliation(s)
- Varsha Shankar
- Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, 600116, India
| | - Vidya Ramkumar
- Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, 600116, India
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Shankar V, Ramkumar V, Kumar S. Understanding the implementation of telepractice in speech and language services for children and adults using a mixed-methods approach. Wellcome Open Res 2022; 7:46. [DOI: 10.12688/wellcomeopenres.17622.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Telepractice emerged as a solution to overcome the challenges of access issues in the delivery of healthcare. Telepractice in speech language pathology (SLP) has existed for nearly a decade yet there is a significant knowledge gap with respect to the factors influencing the implementation of telepractice as a routine or long-term, sustained effort. This mixed-methods study aimed to identify implementation factors that influence the provision of telepractice in SLP services. Method: A mixed-methods study consisting of a scoping review and semi-structured interviews (SSI) was carried out. Articles that described telepractice in SLP were included based on an operational definition of implementation and a set of inclusion criteria. Results: Data was extracted from 11 studies that were mapped to nine projects in telepractice in SLP. The broad focus areas identified included diagnostics and evaluation, therapeutics and comprehensive assessment, management and follow-up care services. Synchronous/ real-time telepractice methods were always used for the provision of diagnostic testing or when providing therapy services using video conferencing. The ‘professional-facilitator-patient’ model was used most commonly followed by the ‘professional-patient’ model. Barriers for long-term sustainability included inadequate initial capital investment, lack of reimbursement and payment options, low internet speed and bandwidth, resistance and hesitancy to use telepractice from the patient’s end, lack of organizational policies and uniform regulations. Sustainable source of funding, having a dedicated team of professionals and technicians with clear roles and responsibilities, and inclusion of systematic planning facilitated implementation. Conclusion: In general, telepractice in SLP was not explicitly guided by implementation science or framework. The use of implementation frameworks ensures systematic planning and feasibility assessment to inform the scale-up of implementation. Therefore, it would be worthwhile for program implementers to consider these aspects when exploring telepractice services.
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Ward EC, Raatz M, Marshall J, Wishart LR, Burns CL. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia 2022; 37:1386-1399. [PMID: 35428923 PMCID: PMC9012247 DOI: 10.1007/s00455-022-10444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.
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Affiliation(s)
- Elizabeth C. Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Madeline Raatz
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Jeanne Marshall
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Laurelie R. Wishart
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Clare L. Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Brisbane, QLD Australia
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Omori F, Fujiu-Kurachi M, Iiboshi K, Yamano T. Development of a Remote Examination of Deglutition Based on Consensus Surveys of Clinicians (Part I): Selection of Examination Items. Dysphagia 2021; 37:954-965. [PMID: 34435239 PMCID: PMC8386680 DOI: 10.1007/s00455-021-10357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022]
Abstract
In order to ensure appropriateness and feasibility of examination items for remote evaluation for deglutition disorders, a questionnaire based on the Delphi method was administered to 122 speech–language–hearing therapists (STs), and a set of examination items was selected. The participants were instructed to view a video recording of a remote assessment situation and answer a 30-item questionnaire. Of 19 items ensuring the appropriateness for deglutition disorders detection, 13 items ultimately met the consensus criteria for remote feasibility. Factor analysis extracted three factors: ‘oral observation,’ ‘overall evaluation,’ and ‘perceptual voice judgment.’ In free-text responses, “quality and stability of the voice that may be heard through the device” were the most common concerns, followed by “the need to correct of the camera angle, magnification, and targets that should be projected,” “concerns about the technical aspects of the assistants and their role in relation with the examiner/ST,” and “the need for palpation as well as visual confirmation.” The proposed 13-item examination is considered to capture the characteristics of deglutition disorders, while items that appeared difficult to implement remotely were excluded. The fact that some items could be influenced by the video calling experience when judging the feasibility of remote implementation, the acceptability of such items, is likely to increase in the future.
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Affiliation(s)
- Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan. .,Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, 4-3 Kouzunomori, Narita-shi, Tsiba, 286-8686, Japan.
| | - Masako Fujiu-Kurachi
- Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, 4-3 Kouzunomori, Narita-shi, Tsiba, 286-8686, Japan
| | - Kiyoko Iiboshi
- Department of Clinical Psychology, Shigakukan University, 59-1 Murasakibaru, Kagoshima-shi, Kagoshima, 890-8504, Japan
| | - Takafumi Yamano
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
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Theodoros D. Telerehabilitation for Communication and Swallowing Disorders in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:S65-S70. [PMID: 33896848 PMCID: PMC8385517 DOI: 10.3233/jpd-202414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). The negative impact of these disorders on the quality of life of the person with PD and their families cannot be underestimated. Despite a demand for speech-language pathology services to support people with PD, many barriers to services exist. Telerehabilitation provides an alternate and complementary approach to in-person therapy that is patient-centered, enables timely assessment and intervention, and facilitates continuity of care throughout the course of the disease. This review explores the telerehabilitation applications designed for the management of the communication and swallowing disorders in PD, addresses the benefits and challenges of telerehabilitation, identifies future research directions, and highlights the potential of new technologies to enhance the management of communication and swallowing disorders and quality of life for people with PD.
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Affiliation(s)
- Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Borders JC, Sevitz JS, Malandraki JB, Malandraki GA, Troche MS. Objective and Subjective Clinical Swallowing Outcomes via Telehealth: Reliability in Outpatient Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:598-608. [PMID: 33555954 DOI: 10.1044/2020_ajslp-20-00234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training). Method Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability. Results Forty-four trials were included for reliability analyses. All rater dyads demonstrated "good" to "excellent" interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated "good" to "excellent" interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43-.99) and swallows (ICCs = .21-.85). Immediate and delayed intrarater reliability were "excellent" for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient's mouth during tasks. Conclusions Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond. Supplemental Material https://doi.org/10.23641/asha.13661378.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jaime Bauer Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Georgia A Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Malandraki GA, Arkenberg RH, Mitchell SS, Malandraki JB. Telehealth for Dysphagia Across the Life Span: Using Contemporary Evidence and Expertise to Guide Clinical Practice During and After COVID-19. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:532-550. [PMID: 33555933 PMCID: PMC8740558 DOI: 10.1044/2020_ajslp-20-00252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/15/2020] [Accepted: 11/22/2020] [Indexed: 05/19/2023]
Abstract
Purpose Our aim was to critically review recent literature on the use of telehealth for dysphagia during the COVID-19 pandemic and enhance this information in order to provide evidence- and practice-based clinical guidance during and after the pandemic. Method We conducted a rapid systematized review to identify telehealth adaptations during COVID-19, according to peer-reviewed articles published from January to August 2020. Of the 40 articles identified, 11 met the inclusion criteria. Full-text reviews were completed by three raters, followed by qualitative synthesis of the results and description of practical recommendations for the use of telehealth for dysphagia. Results Seven articles were guidelines articles, three were editorials, and one was a narrative review. One article focused on telehealth and dysphagia during COVID-19. The remaining 10 mentioned telehealth in varying degrees while focusing on dysphagia management during the pandemic. No articles discussed pediatrics in depth. The most common procedure for which telehealth was recommended was the clinical swallowing assessment (8/11), followed by therapy (7/11). Six articles characterized telehealth as a second-tier service delivery option. Only one article included brief guidance on telehealth-specific factors, such as legal safeguards, safety, privacy, infrastructure, and facilitators. Conclusions Literature published during the pandemic on telehealth for dysphagia is extremely limited and guarded in endorsing telehealth as an equivalent service delivery model. We have presented prepandemic and emerging current evidence for the safety and reliability of dysphagia telemanagement, in combination with practical guidelines to facilitate the safe adoption of telehealth during and after the pandemic.
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Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Rachel Hahn Arkenberg
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Samantha S. Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Jaime Bauer Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
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Burns CL, Taubert ST, Ward EC, McCarthy KA, Graham N. Speech-language therapists' perceptions of an eLearning program to support training in videofluoroscopic swallow studies. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:257-270. [PMID: 33459451 DOI: 10.1111/1460-6984.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Speech-language therapists (SLTs) seek a range of educational opportunities for training in adult videofluoroscopic swallow studies (VFSS). However, variable training methods and/or unequal access to training can influence VFSS practice. AIMS To document current SLT needs and barriers to VFSS training and to determine if a new beginner-level VFSS eLearning program would assist to meet their training needs. The program incorporated multimedia modules on preparing, conducting, interpreting and reporting VFSS. METHODS & PROCEDURES SLTs with limited experience in adult VFSS completed surveys relating to VFSS training experience and barriers, and perceived changes in knowledge, skills and confidence on core VFSS module topics pre- (n = 36) and post- (n = 32) eLearning training. OUTCOMES & RESULTS Inconsistent access to VFSS training opportunities and time-related work pressures were reported as the greatest training barriers. SLTs viewed the eLearning program as a suitable option for VFSS training. Post-training, participants perceived they gained confidence, as well as improved knowledge and skills in all VFSS aspects along with generalised benefits for dysphagia management. SLTs indicated that key benefits of the eLearning program were its comprehensive content and self-directed learning with multimedia tools, which afforded theoretical and practical learning opportunities. CONCLUSIONS & IMPLICATIONS The eLearning program offered SLTs free access to beginner-level adult VFSS training, meeting many identified training needs and providing a foundation from which to develop further practical knowledge and skills within a VFSS clinic setting. What this paper adds What is already known on the subject SLTs demonstrate variable knowledge and skill in conducting and interpreting VFSS, which can impact dysphagia diagnosis and management. While access to VFSS training can be challenging, the barriers to training for SLTs have not been clearly documented. Research has confirmed that eLearning can be used effectively in healthcare education, and in some aspects of VFSS training; however, it is yet to be applied to address the broad range of VFSS training needs. What this paper adds to existing knowledge This study describes the SLT reported barriers to VFSS training which include limited access to formal and practical training, workload-related time pressures and the complexity of learning the VFSS skill set. The findings highlight that an eLearning program, was an accepted mode of learning for VFSS training. SLTs reported the online program met their learning needs by improving access to training, the multimedia program features supported their understanding of complex anatomical and physiological concepts, and training frameworks assisted their clinical reasoning and VFSS interpretation. What are the potential or actual clinical implications of this work? eLearning can assist in overcoming many VFSS training barriers identified by SLTs and the multimedia aspects of eLearning can effectively support VFSS beginner-level education to complement and expedite in-clinic practical training. Given that VFSS results inform decisions regarding commencement and progression of oral intake and swallow rehabilitation, enhanced VFSS training has the potential to positively influence dysphagia outcomes and quality of life.
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Affiliation(s)
- Clare L Burns
- Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Brisbane, QLD, Australia
| | - Shana T Taubert
- Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Kellie A McCarthy
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Nicola Graham
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
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Miles A, Connor NP, Desai RV, Jadcherla S, Allen J, Brodsky M, Garand KL, Malandraki GA, McCulloch TM, Moss M, Murray J, Pulia M, Riquelme LF, Langmore SE. Dysphagia Care Across the Continuum: A Multidisciplinary Dysphagia Research Society Taskforce Report of Service-Delivery During the COVID-19 Global Pandemic. Dysphagia 2020; 36:170-182. [PMID: 32654059 PMCID: PMC7353832 DOI: 10.1007/s00455-020-10153-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
At the time of writing this paper, there are over 11 million reported cases of COVID-19 worldwide. Health professionals involved in dysphagia care are impacted by the COVID-19 pandemic in their day-to-day practices. Otolaryngologists, gastroenterologists, rehabilitation specialists, and speech-language pathologists are subject to virus exposure due to their proximity to the aerodigestive tract and reliance on aerosol-generating procedures in swallow assessments and interventions. Across the globe, professional societies and specialty associations are issuing recommendations about which procedures to use, when to use them, and how to reduce the risk of COVID-19 transmission during their use. Balancing safety for self, patients, and the public while maintaining adequate evidence-based dysphagia practices has become a significant challenge. This paper provides current evidence on COVID-19 transmission during commonly used dysphagia practices and provides recommendations for protection while conducting these procedures. The paper summarizes current understanding of dysphagia in patients with COVID-19 and draws on evidence for dysphagia interventions that can be provided without in-person consults and close proximity procedures including dysphagia screening and telehealth.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand. .,Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Nadine P Connor
- Communication Sciences & Disorders; Otolaryngology, Head and Neck Surgery, University of Wisconsin-Madison, Madison, USA
| | - Rinki Varindani Desai
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sudarshan Jadcherla
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jacqui Allen
- The University of Auckland, Auckland, New Zealand
| | - Martin Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Kendrea L Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Georgia A Malandraki
- Speech, Language, and Hearing Sciences, and Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Timothy M McCulloch
- Otolaryngology, Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph Murray
- Audiology Speech Pathology Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Michael Pulia
- Emergency Care for Infectious Diseases (ECID) Research Program, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Luis F Riquelme
- New York Medical College, Valhalla, NY, USA.,Barrique Speech-Language Pathology, PC, Brooklyn, NY, USA
| | - Susan E Langmore
- Otolaryngology Head/Neck Surgery, Boston University School of Medicine, Boston, USA
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Brodsky MB, Gilbert RJ. The Long-Term Effects of COVID-19 on Dysphagia Evaluation and Treatment. Arch Phys Med Rehabil 2020; 101:1662-1664. [PMID: 32534801 PMCID: PMC7286637 DOI: 10.1016/j.apmr.2020.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Richard J Gilbert
- Laboratory for Biological Architecture, Research Service, Providence VAMC, Warren Alpert Medical School, Brown University, Providence, RI
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Raatz M, Ward EC, Marshall J, Burns CL. Developing the system architecture for conducting synchronous paediatric feeding assessments via telepractice. J Telemed Telecare 2019; 25:552-558. [DOI: 10.1177/1357633x19872091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Telepractice systems should be acceptable to users and meet end-user needs. Whilst the system requirements to conduct adult dysphagia assessments via telepractice are established, key differences exist between adult and paediatric swallowing assessments. This study was conducted to develop the system architecture required to conduct paediatric feeding assessments in patient homes via telepractice. Methods The study used a four-phase iterative design, informed by human-centred design principles. In Phase 1, two telepractice researchers and two paediatric feeding clinicians identified assessment tasks and explored potential system design solutions. Initial system testing was completed using clinical simulations (Phase 2). Live trials with 10 typically developing children were then conducted (Phase 3). Phase 4 involved user-centred feedback from clinicians and parents. Feedback from the development team, clinicians and parents was used to continuously refine the model. Results A combination of synchronous and asynchronous methods enabled all assessment components to be successfully completed. Clinician and parent feedback established the optimal technology (e.g. phone, tablet) and key camera positions necessary to optimise visual/auditory information for the online clinician. End-user feedback identified greater time efficiencies could be achieved through collecting some data (e.g. intra-oral pictures) via asynchronous methods prior to the session. Information sheets were deemed necessary to enhance the user experience. Clinicians and parents responded positively to the final system design. Discussion Modifications to standard videoconferencing were necessary to develop a clinically viable process for conducting paediatric feeding assessments in the home via telepractice. End-user feedback was integral to the design of the final model.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children’s Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children’s Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology & Audiology Department, Royal Brisbane and Women’s Hospital, Queensland, Australia
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Nordio S, Innocenti T, Agostini M, Meneghello F, Battel I. The efficacy of telerehabilitation in dysphagic patients: a systematic review. ACTA ACUST UNITED AC 2019; 38:79-85. [PMID: 29967554 DOI: 10.14639/0392-100x-1816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY Telerehabilitation is the use of telecommunications technology for rehabilitation. Recently, some studies have shown positive effects of telerehabilitation of swallowing disorders, yet there are no systematic reviews verifying the evidence. The aim of this review is to assess the effects of telerehabilitation in the field of dysphagia as an alternative to face-to-face patient care, considering swallowing recovery and/or quality of life in different patient populations. We searched the Cochrane Library, MEDLINE, EMBASE, Google Scholar, Google Search and the grey literature from inception until December 2016 for publications written in English (keywords: telerehabilitation, telemedicine, dysphagia, swallowing disorders), which resulted in 330 records. Abstract screening and data extraction was carried out independently by two reviewers. Four papers were selected to read in full, and the methodological quality of the studies included was evaluated using Cochrane Collaboration's tool for assessing risk of bias. One study met our inclusion criteria (Wall et al. 2016), which showed that telerehabilitation improves adherence to treatment compared to patient-directed intervention. Although adherence is an important factor that influences the treatment outcome, clinical outcomes have to be examined in randomised controlled trials in order to reach evidence in this field. Lastly, this systematic review did not demonstrate the efficacy of telerehabilitation compared with face-to face therapy.
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Affiliation(s)
- S Nordio
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - T Innocenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy
| | - M Agostini
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - F Meneghello
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - I Battel
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
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Malandraki GA, Kantarcigil C. Telehealth for Dysphagia Rehabilitation: The Present and the Future. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig18.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dysphagia affects about nine million adults and half a million children annually in the United States alone, and its prevalence is only projected to increase as the baby boomer generation grows older. For many individuals who live in rural or underserved areas, accessing a speech-language pathologist (SLP) with expertise in dysphagia can be challenging. Telehealth appears to be a viable solution to address the needs of individuals living in these areas, and for patients and clinicians with mobility/access limitations. This article provides an overview of the current research evidence in dysphagia telehealth and identifies research and clinical practice gaps as well as potential solutions. Our aim is to provide foundational knowledge for dysphagia clinicians who are interested in entering the telehealth arena.
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Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University West Lafayette, IN
| | - Cagla Kantarcigil
- Department of Speech, Language, and Hearing Sciences, Purdue University West Lafayette, IN
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Abstract
The diagnosis of dysphagia, defined as swallowing dysfunction or difficulty, is estimated to affect 40–60% of the institutionalized geriatric population, and is the leading cause of aspiration pneumonia, one of the primary contributors of geriatric mortality. In the United States, statistics suggest that at least 50% of these individuals have limited access to treatment due to mobility, distance, and socioeconomic constraints. While “tele-dysphagia intervention” – the delivery of dysphagia therapy services via telecommunications technology – may provide a solution, there is limited research investigating its validity or reliability. The following three case reports of individuals successfully participating in trial tele-dysphagia therapy sessions lend credibility to this service delivery approach, and highlight the need for future research.
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Fairweather GC, Lincoln MA, Ramsden R. Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:592-602. [PMID: 27063692 DOI: 10.3109/17549507.2016.1143973] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The objectives of this study were to investigate the efficacy of a speech-language pathology teletherapy program for children attending schools and early childcare settings in rural New South Wales, Australia, and their parents' views on the program's feasibility and acceptability. METHOD Nineteen children received speech-language pathology sessions delivered via Adobe Connect®, Facetime© or Skype© web-conferencing software. During semi-structured interviews, parents (n = 5) described factors that promoted or threatened the program's feasibility and acceptability. RESULT Participation in a speech-language pathology teletherapy program using low-bandwidth videoconferencing improved the speech and language skills of children in both early childhood settings and primary school. Emergent themes related to (a) practicality and convenience, (b) learning, (c) difficulties and (d) communication. CONCLUSION Treatment outcome data and parental reports verified that the teletherapy service delivery was feasible and acceptable. However, it was also evident that regular discussion and communication between the various stakeholders involved in teletherapy programs may promote increased parental engagement and acceptability.
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Affiliation(s)
- Glenn Craig Fairweather
- a Royal Far West, Speech Pathology , Manly , Australia
- b Faculty of Health Sciences , University of Sydney , Lidcombe , Australia
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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Greenwood R, Caine D, Hammerbeck U, Leff A, Playford D, Stevenson V, Ward N. Restorative Neurology, Rehabilitation and Brain Injury. Neurology 2016. [DOI: 10.1002/9781118486160.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Diana Caine
- National Hospital for Neurology & Neurosurgery
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Kantarcigil C, Sheppard JJ, Gordon AM, Friel KM, Malandraki GA. A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:207-217. [PMID: 27132060 DOI: 10.1016/j.ridd.2016.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. AIM To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. METHODS AND PROCEDURES Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. OUTCOMES AND RESULTS Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76). CONCLUSIONS AND IMPLICATIONS Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.
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Affiliation(s)
- Cagla Kantarcigil
- Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Justine Joan Sheppard
- Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Andrew M Gordon
- Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Kathleen M Friel
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Georgia A Malandraki
- Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
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Malandraki GA, Markaki V, Georgopoulos VC, Psychogios L, Nanas S. Postextubation Dysphagia in Critical Patients: A First Report From the Largest Step-Down Intensive Care Unit in Greece. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:150-156. [PMID: 27115679 DOI: 10.1044/2015_ajslp-14-0069] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/03/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study provided preliminary data on the occurrence and impact of postextubation dysphagia in the largest Greek step-down intensive care unit (ICU) over 2 years. METHOD A retrospective observational cohort study of patients referred for swallowing assessment postextubation was conducted from November, 2011, to August, 2013. RESULTS Of the 357 patients admitted to the unit during this period, 87, aged 55.8 ± 18.1 years (61 male, 26 female), were referred and evaluated. Of these, 2.3% were found to have no dysphagia, and 21.8% and 75.9% were diagnosed with mild and moderate/severe dysphagia, respectively. Across severity levels, 23% of patients in the unit were found to have dysphagia. Patients with moderate/severe dysphagia were more likely to have had prolonged intubation (> 48 hr; p = .02) and exhibit signs of aspiration (p = .002) than those with no or mild dysphagia. Prolonged intubation was associated with increased likelihood of moderate/severe dysphagia by a factor of 12 (p = .042, odds ratio = 12.355) compared to short intubation. Moderate/severe dysphagia was correlated with pneumonia (p = .02), feeding tube placement (p = .004) and in-hospital mortality (p = .034). CONCLUSION In this sample, moderate/severe dysphagia was correlated with prolonged intubation, and was found to increase the risk for pneumonia and in-hospital mortality. Our results suggest the importance of early dysphagia management in critical patients in Greece and globally.
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Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
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Burns CL, Ward EC, Hill AJ, Phillips N, Porter L. Conducting Real-Time Videofluoroscopic Swallow Study via Telepractice: A Preliminary Feasibility and Reliability Study. Dysphagia 2016; 31:473-83. [DOI: 10.1007/s00455-016-9701-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/25/2016] [Indexed: 12/01/2022]
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Rangarathnam B, McCullough GH. Utility of a Clinical Swallowing Exam for Understanding Swallowing Physiology. Dysphagia 2016; 31:491-7. [DOI: 10.1007/s00455-016-9702-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 11/29/2022]
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Beswick DM, Vashi A, Song Y, Pham R, Holsinger FC, Rayl JD, Walker B, Chardos J, Yuan A, Benadam-Lenrow E, Davis D, Sung CK, Divi V, Sirjani DB. Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population. Head Neck 2016; 38:925-9. [PMID: 26899939 DOI: 10.1002/hed.24386] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/26/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit. METHODS Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference. RESULTS Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs. CONCLUSION A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anita Vashi
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Yohan Song
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Rosemary Pham
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - F Chris Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - James D Rayl
- Department of Otolaryngology - Head and Neck Surgery, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
| | - Beth Walker
- Ambulatory Care Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - John Chardos
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Annie Yuan
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Ella Benadam-Lenrow
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Dolores Davis
- Department of Surgery, Central California Veterans Affairs Health Care System, Fresno, California
| | - C Kwang Sung
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Davud B Sirjani
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Isaki E, Farrell CF. Provision of Speech-Language Pathology Telepractice Services Using Apple iPads. Telemed J E Health 2015; 21:538-49. [DOI: 10.1089/tmj.2014.0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emi Isaki
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, Arizona
| | - Cynthia Fangman Farrell
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, Arizona
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Regina Molini-Avejonas D, Rondon-Melo S, de La Higuera Amato CA, Samelli AG. A systematic review of the use of telehealth in speech, language and hearing sciences. J Telemed Telecare 2015; 21:367-76. [DOI: 10.1177/1357633x15583215] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/24/2015] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Daniela Regina Molini-Avejonas
- Department of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Silmara Rondon-Melo
- Department of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Cibelle Albuquerque de La Higuera Amato
- Department of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Alessandra Giannella Samelli
- Department of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
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Burns CL, Keir B, Ward EC, Hill AJ, Farrell A, Phillips N, Porter L. A Dynamic Image Quality Evaluation of Videofluoroscopy Images: Considerations for Telepractice Applications. Dysphagia 2015; 30:473-81. [PMID: 26014137 DOI: 10.1007/s00455-015-9626-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
High-quality fluoroscopy images are required for accurate interpretation of videofluoroscopic swallow studies (VFSS) by speech pathologists and radiologists. Consequently, integral to developing any system to conduct VFSS remotely via telepractice is ensuring that the quality of the VFSS images transferred via the telepractice system is optimized. This study evaluates the extent of change observed in image quality when videofluoroscopic images are transmitted from a digital fluoroscopy system to (a) current clinical equipment (KayPentax Digital Swallowing Workstation, and b) four different telepractice system configurations. The telepractice system configurations consisted of either a local C20 or C60 Cisco TelePresence System (codec unit) connected to the digital fluoroscopy system and linked to a second remote C20 or C60 Cisco TelePresence System via a network running at speeds of either 2, 4 or 6 megabits per second (Mbit/s). Image quality was tested using the NEMA XR 21 Phantom, and results demonstrated some loss in spatial resolution, low contrast detectability and temporal resolution for all transferred images when compared to the fluoroscopy source. When using higher capacity codec units and/or the highest bandwidths to support data transmission, image quality transmitted through the telepractice system was found to be comparable if not better than the current clinical system. This study confirms that telepractice systems can be designed to support fluoroscopy image transfer and highlights important considerations when developing telepractice systems for VFSS analysis to ensure high-quality radiological image reproduction.
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Affiliation(s)
- Clare L Burns
- Speech Pathology & Audiology Department, Royal Brisbane & Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia,
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Hubert GJ, Müller-Barna P, Audebert HJ. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries. Int J Stroke 2014; 9:968-73. [PMID: 25381687 DOI: 10.1111/ijs.12394] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/08/2014] [Indexed: 01/23/2023]
Abstract
TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries.
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Affiliation(s)
- Gordian J Hubert
- Gordian Hubert, Städtisches Klinikum München GmbH, Klinikum Harlaching, Neurology - TEMPiS, Munich, Germany
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Abstract
A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger's Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia.
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Affiliation(s)
- Georgia A Malandraki
- Department Of Biobehavioral Sciences, Program of Speech and Language Pathology, Teachers College, Columbia University, New York, NY, USA ; Dysphagia Research Clinic, Edward D. Mysak Clinic for Communication Disorders, Teachers College, Columbia University, New York, NY, USA
| | - Melissa Roth
- Department Of Biobehavioral Sciences, Program of Speech and Language Pathology, Teachers College, Columbia University, New York, NY, USA
| | - Justine Joan Sheppard
- Department Of Biobehavioral Sciences, Program of Speech and Language Pathology, Teachers College, Columbia University, New York, NY, USA ; Dysphagia Research Clinic, Edward D. Mysak Clinic for Communication Disorders, Teachers College, Columbia University, New York, NY, USA
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Keck CS, Doarn CR. Telehealth Technology Applications in Speech-Language Pathology. Telemed J E Health 2014; 20:653-9. [DOI: 10.1089/tmj.2013.0295] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Casey Stewart Keck
- Department of Communication Sciences and Disorders, College of Allied Health, University of Cincinnati, Cincinnati, Ohio
| | - Charles R. Doarn
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Ward EC, Burns CL, Theodoros DG, Russell TG. Impact of dysphagia severity on clinical decision making via telerehabilitation. Telemed J E Health 2014; 20:296-303. [PMID: 24443927 DOI: 10.1089/tmj.2013.0198] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Recent research supports the proposal that valid and reliable clinical swallow examinations (CSEs) can be conducted via telerehabilitation. However, no studies have explored whether dysphagia severity has an impact on the success of the session or its outcomes. The current study examined how dysphagia severity impacted on either (a) clinical decision making for safety of oral intake or (b) clinician perceptions of CSEs conducted via telerehabilitation. SUBJECTS AND METHODS One hundred patients (25 nondysphagics and 25 mild, 25 moderate, and 25 severe dysphagics) were assessed using a telehealth system and methodology reported in prior research. For each assessment, the online and face-to-face (FTF) clinicians simultaneously completed a structured CSE. On session completion, the online clinician indicated level of agreement with two statements regarding the level of rapport and ability to competently assess the patient. RESULTS In each of the four groups, acceptable levels of agreement were observed between raters for the three primary outcomes (decisions regarding oral/nonoral intake and safe food and fluids) as well as over 90% of the CSE items. Clinicians agreed they could develop good rapport with the majority of patients in all groups. However, for a small but significant (p<0.5) proportion of patents in the severe dysphagic group, clinicians disagreed they were able to satisfactorily and competently assess to the best of their abilities using the telerehabilitation system. CONCLUSIONS Clinical decisions made during and as an outcome of the total CSE were found to be comparable to those made in the FTF environment regardless of dysphagia severity. Clinicians noted some difficulty assessing patients with greater complexity, which occurred in greater numbers in the group with severe dysphagia.
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Affiliation(s)
- Elizabeth C Ward
- 1 School of Health & Rehabilitation Sciences, The University of Queensland , Brisbane, Queensland, Australia
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Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation. Int J Telemed Appl 2013; 2013:918526. [PMID: 24381589 PMCID: PMC3870655 DOI: 10.1155/2013/918526] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/23/2013] [Indexed: 11/18/2022] Open
Abstract
Emerging research supports the feasibility and viability of conducting clinical swallow examinations (CSE) for patients with dysphagia via telerehabilitation. However, minimal data has been reported to date regarding the implementation of such services within the clinical setting or the user perceptions of this type of clinical service. A mixed methods study design was
employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management.
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Malandraki GA, Markaki V, Georgopoulos VC, Bauer JL, Kalogeropoulos I, Nanas S. An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia. J Telemed Telecare 2013; 19:75-9. [DOI: 10.1177/1357633x12474963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.
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Affiliation(s)
- Georgia A Malandraki
- Program of Speech and Language Pathology, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
- Step-down Intensive Care Unit, University Hospital Evangelismos, Athens, Greece
| | - Vasiliki Markaki
- Step-down Intensive Care Unit, University Hospital Evangelismos, Athens, Greece
| | - Voula C Georgopoulos
- Department of Speech and Language Therapy, Technological Educational Institute of Patras, Greece
| | - Jaime L Bauer
- Hamilton Plaza Nursing and Rehabilitation Center, New Jersey, USA
| | | | - Serafim Nanas
- Athens Medical School, National and Kapodistrian University of Athens, Greece and Evangelismos Hospital, Athens, Greece
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Coyle J. Tele-Dysphagia management: an opportunity for prevention, cost-savings and advanced training. Int J Telerehabil 2012; 4:37-40. [PMID: 25945196 PMCID: PMC4296812 DOI: 10.5195/ijt.2012.6093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Many patients survive severe stroke because of aggressive management in intensive care units. However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP), a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians. Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas. Tele-dysphagia management has the potential to increase patients’ survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year. Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.
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Affiliation(s)
- James Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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