Preparedness, Training, and Support for Augmentative and Alternative Communication Telepractice During the COVID-19 Pandemic

From acceptance to implementation: student speech-language pathologists' perspectives on using digital technologies in practice

This qualitative study explores the perceptions of digital technologies among student speech-language pathologists (SLPs) at the bachelor's and master's levels, focusing on key factors influencing their acceptance and conditions fostering their intention to use these technologies in future speech-language pathology services. A total of 16 student SLPs, all currently enrolled in undergraduate and graduate programs, participated in this study. Their views on using digital technologies were gathered through in-depth semi-structured interviews. The data were analyzed using thematic analysis, guided by the Unified Theory of Acceptance and Use of Technology (UTAUT), which examines how factors such as performance expectancy, effort expectancy, social influence, and facilitating conditions affect their acceptance and use of digital technology. The findings revealed that these students generally have optimistic views on digital technologies, recognizing their role in sustaining speech-language pathology services during emergencies. Findings indicate that performance expectancy, effort expectancy, social influence, and facilitating conditions significantly shape student SLPs' intentions to use digital technologies. Themes beyond the UTAUT framework discovered in the study, such as confidence in one's digital skills and the impact of societal context, particularly the ongoing war in Ukraine, further emphasize the need for comprehensive strategies addressing both the psychological and practical dimensions of technology adoption. These strategies should ensure that student SLPs are equipped with the necessary skills, confidence, and support to integrate digital tools effectively in their professional practice. Participants emphasized the critical importance of institutional support, comprehensive training, and access to adequate resources to facilitate successful digital technology integration.

A Systematic Literature Review on School-Based Speech-Language Pathology Collaboration Research

PURPOSE

School-based teams are called to be collaborative in order to appropriately and effectively serve students. Speech-language pathologists play crucial roles on school-based teams. This systematic review sought to synthesize existing empirical evidence on collaborative perceptions and experiences in research that included school-based speech-language pathologists (SLPs).

METHOD

A systematic literature review was conducted, which included Boolean search methods of the Science Citation Index Expanded, Social Sciences Citation Index, Education Resources Information Center, Academic Search Complete, Education Research Complete, and PubMed databases. Through an abstract, text screening, and progeny search process, 26 articles met the study's inclusion criteria. Relevant data were extracted from each article, analyzed, synthesized, and organized into themes to answer the research questions.

RESULTS

The main findings from the systematic review were organized into (a) study design and participants; (b) purpose, definitions, and collaborative activities; (c) perceptions of collaboration; (d) engagement in collaboration; (e) facilitators and barriers; (f) collaboration and telepractice; and (g) differing findings based on demographic factors.

CONCLUSIONS

Underscoring the complexity of school-based collaboration, researchers have utilized varied designs and frameworks to explore collaborative perceptions and experiences in research including school-based SLPs. While SLPs generally view school-based collaboration as valuable, engagement in collaboration is not as clear-cut. The number of facilitators and barriers described, variability in frameworks and definitions, and limited disaggregation across demographic factors underlie the need for continued research and have implications for policy and practice.

Remote collection of language samples from three-year-olds

We characterised language samples collected remotely from typically developing three-year-olds by comparing them against independent language samples collected in person from age-matched peers with and without language delays. Forty-eight typically developing, English-learning three-year-olds were administered a picture description task via Zoom. The in-person comparison groups were two sets of independent language samples from age-matched typically developing as well as language-delayed children available on the Child Language Data Exchange System. The findings show that although language samples collected remotely from three-year-olds yield numerically dissimilar lexical and grammatical measures compared to samples collected in person, they still consistently distinguish toddlers with and without language delays.

A Preliminary Examination of a Novel Telepractice Screening Protocol for Poststroke Aphasia

BACKGROUND

The delivery of telepractice interventions for people with poststroke aphasia has been found effective and feasible compared to traditional, in-person interventions; however, telepractice assessments, particularly screening protocols, which may foster convenient access to aphasia diagnostic services, have received limited examination within the aphasia literature. Therefore, the purpose of this study was to examine a novel telepractice screening protocol for people with poststroke aphasia that assesses both language and extralinguistic cognitive abilities via both performance-based and patient-reported measures.

METHOD

Twenty-one participants with previously diagnosed poststroke aphasia completed the telepractice administration of the Frenchay Aphasia Screening Test (FAST), the Aphasia Impact Questionnaire-21 (AIQ-21), the Oxford Cognitive Screen (OCS), and the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI). Care partners of the participants completed the Communicative Effectiveness Index (CETI). After the telepractice session, each participant completed a feasibility questionnaire to rate their overall experience.

RESULTS

All participants screened as having aphasia. Pearson correlation analyses yielded a strong positive relationship between OCS and FAST scores (r = .74), a strong relationship between OCS and CCCABI scores (r = -.71), and a moderate relationship between FAST and AIQ-21 scores (r = -.35). Moderate relationships were noted between the performance-based measures and the CETI (r = .30). The overall feasibility of telepractice administration was rated positively by each participant. No significant relationships were found between the feasibility responses and participant characteristics.

CONCLUSIONS

Overall, the telepractice screening protocol yielded an effective and feasible way to identify poststroke aphasia. Similar to in-person administration of screening measures, it was more difficult to identify milder levels of aphasia severity. Future research should examine whether this telescreening protocol can identify poststroke aphasia within the broader stroke population.

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

Children's communication repair strategies: Online versus face-to-face interaction

INTRODUCTION

One's ability to repair communication breakdown is an important pragmatic language skill. The present study examined children's communication repair strategies between online and face-to-face interactions using a reading comprehension task designed to probe for persistent clarification requests.

METHODS

4-6-year-old typically developing children (Age: M = 5.5years) completed a communication repair task. Online group (n = 17) completed the task online, face-to-face group(n = 22) met researchers in person. Children's responses were then categorized into verbal strategies, supplementary strategies, and nonresponses.

RESULTS

Our results showed that children can effectively employ repair strategies when a communication breakdown occurs, regardless of the communication setting in response to a series of clarification requests. However, types and patterns of communication repair strategies varied between online and face-to-face interactions. Children in online interaction showed higher use of repetition and suprasegmental strategies than did their face-to-face peers. In contrast, children in face-to-face interaction demonstrated more frequent use of revision and addition. Also, we examined the relationship between repair strategy and children's language skills. The results showed that children with better language skills used more addition, which is a more complex strategy than suprasegmental and nonresponse, and tried to use repair strategies effectively in an attempt to repair their statements as clarification requests proceeded.

CONCLUSION

It is important to understand different trends of pragmatic skills of children across online and face-to-face interaction. Guidance on the effective strategy to repair communication breakdowns depending on the different contexts needs to be considered for the successful use of online learning and telepractice.

Rapid transition to telepractice across the lifespan in speech-language pathology: Insight from a survey of clinicians in Canada

PURPOSE

This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic.

METHOD

The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis.

RESULT

SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication).

CONCLUSION

The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

Experiences of South African speech-language therapists providing telepractice during the COVID-19 pandemic: A qualitative survey

BACKGROUND

The COVID-19 pandemic necessitated that speech-language therapists (SLTs) make a radical change to provide services to their clients safely via telepractice. For many practitioners, telepractice was an unfamiliar mode of practice that had to be implemented under emergency conditions. Limited literature on SLTs' experiences of implementing telepractice in the Global South during this time is available.

AIMS

To explore the experiences of South African SLTs (N = 45) who implemented telepractice services during the COVID-19 pandemic.

METHODS & PROCEDURES

SLTs across the country were invited via professional bodies to participate in an online qualitative survey distributed in 2021. Data were analysed using thematic analysis principles.

OUTCOMES & RESULTS

We describe participants' reports of their current telepractices, discuss their perspectives on accessibility to telepractice for SLTs, clients and caregivers, and working with specific diagnoses, and consider the support needs of SLTs to enhance telepractice services. Most participants work in private practice or school settings with primarily paediatric caseloads. They reported telepractice as a positive experience and felt it was effective, although they judged that some clients were not well served by telepractice. SLTs felt underprepared for the rapid switch to telepractice and the flexibility required, especially given the limited availability of guidelines given the pandemic crisis. Greater preparation is required for telepractice sessions and more attention needs to be paid to supporting caregiver involvement online.

CONCLUSIONS & IMPLICATIONS

Telepractice involves various barriers and facilitators, many of which seem common across Global North and South contexts. Support is required to enhance current telepractices in terms of computer literacy, technical education, different telepractice methods and caregiver coaching. Our findings have the potential to enable the development of support, training and guidelines to improve SLTs' confidence in providing telepractice whilst delivering quality services in an accessible and safe manner.

WHAT THIS PAPER ADDS

What is already known on the subject Many SLTs had to transition quickly to telepractice service provision during COVID-19, with limited existing guidelines and support. Although there is some literature available on SLTs' experiences of implementing telepractice in the Global North, perspectives from the Global South during this time are limited. It is important to understand experiences, barriers and facilitators to telepractice provision to provide tailored support to practitioners. What this paper adds to existing knowledge Telepractice provides a viable alternative to in-person therapy for specific clients and contexts. Telepractice presents both benefits and barriers for effective clinical practice across Global North and South contexts. Greater preparation is required for telepractice sessions and more attention needs to be paid to enhancing caregiver involvement online, especially since many practitioners are likely to continue offering telepractice services post-pandemic. What are the potential or actual clinical implications of this work? Clinicians felt underprepared for the rapid switch from service delivery mode to telepractice. Greater support, training and guidelines for students and practitioners are required to enhance current practices and ensure practitioners are equipped to provide effective telepractice in the future. In particular, support should cover technological aspects, caregiver coaching and online assessment options, especially for paediatric clients.

Comparison of Voice Therapy Outcomes: Clinic vs Telehealth

BACKGROUND

Voice therapy provides patients with valuable exercises and techniques to optimize vocal behaviors and improve their ability to communicate effectively and efficiently. These sessions were typically held by speech-language pathologists (SLPs) in clinic. During the COVID-19 pandemic, SLPs were provisionally able to provide billable voice therapy services in telehealth format. There is a lack of existing research studies comparing outcomes based on the format of voice therapy.

METHODS

A retrospective chart review was performed on 101 patients who underwent voice therapy at a large academic institution in order to compare outcomes between clinic, telehealth, and mixed voice therapy formats. Demographics, dysphonia etiology, duration of symptoms, number of therapy sessions, and pre- and postvoice therapy scores using reflux symptom index (RSI), voice handicap index (VHI-10), consensus auditory-perceptual evaluation of voice (CAPE-V), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scoring were collected. Statistical comparisons were performed using Fisher's exact test and analysis of covariance.

RESULTS

There were no statistically significant differences in pre- to postvoice therapy RSI, VHI-10, CAPE-V, or GRBAS scores based on format of voice therapy, after adjustment for number of therapy sessions received. There were no differences in these outcomes when comparing voice therapy by etiology of dysphonia.

CONCLUSIONS

Overall, these data support the effectiveness of the telehealth voice therapy format. It is a promising platform for greater patient access to therapy. All formats of voice therapy were effective in improving key measures of voice perception.

Views of Speech-Language Pathologists on Telepractice for Children Who Use Augmentative and Alternative Communication

Telepractice has become increasingly utilized in disability services, particularly with recent and ongoing measures to slow the spread of the novel coronavirus (COVID-19). In this study, 361 speech-language pathologists (SLPs) responded to a national, web-based survey about their views on utilizing telepractice with children aged 3 to 21 who used aided augmentative and alternative communication (AAC), such as picture symbols or speech-generating devices. The views of SLPs varied, and SLPs who received training on AAC telepractice within the last 12 months had more positive views about telepractice than those who did not. Several factors were associated with when and how SLPs thought telepractice was beneficial to serve children who use aided AAC, including SLPs' foundational perspectives about telepractice, service delivery options, considerations related to the child and family, and broader resources and constraints.

Augmentative and alternative communication services during the COVID-19 pandemic: impact on children, their families and service providers

The closure of schools and healthcare facilities across the United States due to COVID-19 has dramatically changed the way that services are provided to children with disabilities. Little is known about how children who use augmentative and alternative communication (AAC), their families and their service providers have been impacted by these changes. This qualitative study sought to understand the perspectives of parents and speech-language pathologists (SLPs) on how COVID-19 has affected children, families, services providers and the delivery of AAC-related communication services. For the study, 25 parents and 25 SLPs of children who used aided AAC participated in semi-structured interviews, with data analyzed using qualitative thematic analysis. Parents and SLPs highlighted wide disparities in how children have been impacted, ranging from views of children making more progress with communication and language than before the pandemic to worries about regression. A complex system of factors and processes may explain these differences. COVID-19 will have lasting impacts on the lives of children with complex communication needs. This research highlights the crucial role of family-service provider partnerships and access to quality AAC services for children during the pandemic and into the future.

Can You See My Screen? Virtual Assessment in Speech and Language

PURPOSE

This introduction presents the LSHSS Forum: Can You See My Screen? Virtual Assessment in Speech and Language. The goals of the forum are to document reliability and validity of assessment results conducted virtually, identify characteristics of measures that are suitable for online assessment, and provide clinical and research guidance for interpreting diagnostic results obtained in virtual settings.

METHOD

In this introduction, we provide an overview of the research completed by nine teams, who submitted research articles and notes on a variety of topics pertinent to the theme of telehealth assessments. Of these, seven teams investigated the validity and reliability of 14 different assessment tools, while two teams described training and experience issues.

CONCLUSION

The nine studies presented in this forum will provide speech-language pathologists with insight into a range of issues regarding telehealth assessment, including the breadth of suitable assessment tools; practical strategies for assessing children with a diverse range of ages, languages, skills, and abilities; and the unexpected challenges and opportunities of conducting clinical work and research during a global pandemic.