Provision of Speech-Language Pathology Telepractice Services Using Apple iPads

Reliability and Feasibility of Administering a Child Language Assessment via Telehealth

PURPOSE

Despite the speed with which telehealth use advanced during the COVID-19 pandemic, evidence is needed to support the remote delivery of standardized assessments. This study investigated the reliability and feasibility of administering a standardized language assessment administered in real-world telehealth scenarios compared to in-person administration.

METHOD

A total of 100 children between the ages of 3 and 12 years were administered one of three versions of the Clinical Evaluation of Language Fundamentals (CELF). Children were administered the CELF by the same licensed speech-language pathologists (SLPs) in person and using telehealth, with the order counterbalanced. Means for Core Language standard scores were compared between conditions and among devices. Descriptive statistics summarized the behavior and technology disruptions during administration as well as the results of parent and SLP telehealth perception surveys.

RESULTS

In-person and telehealth mean scores on all three versions of the CELF revealed no systematic differences of one condition under- or overestimating another. The incidence of child behavior disruptions was similar for both test administration conditions. Adaptations compensated for the rare technology disruptions. Despite no significant language score and behavior differences between testing conditions, parents reported they continued to prefer in-person assessments. SLP participants viewed telehealth overall positively but identified conditions in which they continued to prefer in-person delivery.

CONCLUSIONS

This study provides evidence of minimal or no differences in scores and behavioral or technological disruptions between remote and in-person administration of the CELF core language assessments. SLP and parent participants' attitudes toward remote delivery of standardized tests appear to be evolving in a positive direction compared to previous studies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25292752.

Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review

Purpose

Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child.

Methods

A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy.

Results

A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology.

Conclusions

This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.

Evolution of Telehealth Technology, Evaluations, and Therapy: Effects of the COVID-19 Pandemic on Pediatric Speech-Language Pathology Services

PURPOSE

Telehealth services experienced exponential growth during the COVID-19 pandemic. This survey examined the resulting evolution in the technology, connectivity, implementation of services, and attitudes of pediatric speech-language pathology clinicians using synchronous videoconferencing.

METHOD

The Telehealth Services: Pediatric Provider Survey participants were 259 speech-language clinicians in a variety of employment settings from across the country and abroad. Analyses identified telehealth barriers eliminated and those that persisted during the pandemic, advantages, and disadvantages of remote delivery of evaluation and treatment services, the most common telehealth technology used by clinicians and their clients to access care, and clinicians' predictions about the optimization and future of telehealth.

RESULTS

Elimination of regulatory and insurance hurdles allowed children from varying socioeconomic backgrounds living in rural, suburban, and urban areas access to telehealth. Telehealth technology shifted from computers with external hardware and specialized software to commercially available equipment, such as handheld portable devices with built-in audiovisual components and publicly available videoconferencing platforms. However, connectivity of these devices continued to be problematic, and lack of technology prevented some children from accessing care. Judgments about the appropriateness and effectiveness of evaluations and treatments varied based on the age and communication disorder of a child. Although some participants expressed uncertainty about the effectiveness of telehealth compared with in-person care, telehealth was widely recognized as a viable delivery method.

CONCLUSIONS

Although clinicians reported many advantages of telehealth, some barriers identified reported prior to COVID-19 still persist. Clinicians anticipate that new developments have the potential to continue improving telehealth service delivery, bolstering the viability of telehealth long after the COVID-19 pandemic is gone.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.16959361.

Providing Telepractice in Schools During a Pandemic: The Experiences and Perspectives of Speech-Language Pathologists

PURPOSE

The main objective of this study was to gain insight into school-based speech-language pathologists' (SLPs') perspectives on and experiences with telepractice as a service delivery model at the onset of the COVID-19 global pandemic. A better understanding of the facilitating and challenging factors that belie telepractice-based services will guide the creation of training and resource development to further support remote speech-language services in schools.

METHOD

Four focus group sessions using a semistructured format were conducted with 22 school-based SLPs from 14 states in the United States. The focus groups provided an opportunity for SLPs to reflect on their telepractice experiences, including pros and cons, necessary knowledge and skills, factors impacting telepractice service delivery, and student and family participation. Inductive thematic analysis was used to describe the collective experiences and perspectives of the participants.

RESULTS

Three themes regarding telepractice emerged: technology use, locus of control for decision making, and student and family engagement. Participants reported experiencing a range of successes and challenges when attempting to meet students' needs and identified gaps in resources and school capacity for telepractice.

CONCLUSIONS

The findings revealed how school SLPs experienced telepractice service delivery during the remote learning portion of the 2019-2020 school year due to the onset of the COVID-19 pandemic. The study increases our understanding of factors that facilitated and challenged the effective delivery of speech-language services via telepractice. To assist SLPs in future telepractice efforts, implications for professional development and further research are provided.

Oral Narrative Intervention by Tele-Practice in a Case with Developmental Language Disorder

BACKGROUND

A narrative requires the integration and management of linguistic and cognitive skills. It has been observed that children with Developmental Language Disorder (DLD) have difficulties in narrating stories. This research proposes an intervention in a case of a child 9 years and 2 months old with DLD, with the aim of improving his oral narrative skills through a retelling task via telepractice.

METHODS

In the evaluation, standardized tests have been used and a 'remembering a story' task, with a story titled The Lost Backpack, elaborated by one of the authors. Narratives were elicited in two sessions, and were transcribed, coded, and analysed using the Child Language Data Exchange System CHILDES Project tool. The participant received a total of 10 sessions through the Skype platform, which included intervention-addressed explicit instruction about the narrative structure and the use of discourse markers to improve cohesion in story retelling.

RESULTS

Significant changes were observed in the retelling of the story at microstructure and macrostructure levels: an increase of the Mean Length of Utterance (MLU), Types and Tokens, specific vocabulary, discourse markers and the recall of events.

CONCLUSIONS

These results demonstrate the effectiveness of intervention in narrative skills through the oral retelling of a story with visual support via tele-practice.

A Pilot Study Comparing Teletherapy with the Conventional Face-to-Face Therapy for Speech-Language Disorders

Abstract

Speech-language therapists along with affected individuals face various challenges for accomplishing the rehabilitation services. In the current COVID19 pandemic scenario, telerehabilitation has emerged as a substitute to the traditional face-to-face therapy, and is the only option possible in some cases. To subjectively assess the feasibility & acceptability of telerehabilitation provided by speech-language pathologist to patients of speech and language disorders. This qualitative study includes 20 patients suffering from disorders of fluency, voice, swallowing and neurogenic disorders. The participants included were undergoing face-to-face therapy at our institute. After the completion of face-to-face session series, telerehabilitation services were provided through a video calling app. The outcomes of teletherapy were assessed subjectively using a structured questionnaire on 11 parameters using a Likert scale. Of the included 20 patients, after completion of teletherapy, four patients chose the physical interaction as the preferred mode of therapy while 16 chose teletherapy as the preferred mode. Except three clients who rated their overall satisfaction as ‘3’, others rated as ‘4’ or ‘5’.The therapists were satisfied with the outcomes in 17 cases, and were pleased with the overall progress of all the clients (rated 4 or 5). Telerehabilitation is a reliable method to deliver speech and language services at community level, on long-term basis, as is proven by the high satisfaction scores among the clients as well as the service providers.

Clinical Trial Registration

The trial has been registered in Clinical Trials Registry of India (CTRI) vide number CTRI/2018/04/ 012,922 (http://ctri.nic.in/Clinicaltrials/login.php) on 02/04/2018.

Telehealth in Pediatric Rehabilitation

Pediatric rehabilitation focuses on optimizing function and quality of life of children through a holistic and transdisciplinary patient-centered team approach. This article describes the incorporation of telehealth in pediatric rehabilitation and its growth over the past decade. It also reviews the experience of practitioners using telehealth by necessity during the 2020 COVID-19 pandemic. Evidence suggests many applications where telehealth can appropriately substitute for traditional in-person visits, and there are many potential applications of telehealth to be explored as a means to enhance connectivity of the interdisciplinary rehabilitation team and the outreach to patients in remote and underserved areas.

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

Purpose

We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019.

Method

Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported.

Results

Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research.

Conclusion

Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

Impact of school-based allied health therapy via telehealth on children’s speech and language, class participation and educational outcomes

Introduction

Access to telehealth services for children living in rural and remote areas of Australia is very limited. The delivery of allied health therapies to children in school via telehealth may help reduce inequality and improve academic outcomes over time.

Methods

A service delivering speech and language therapy (SLT) and occupational therapy (OT) via videoconferencing to children at five rural schools was prospectively evaluated. Each child’s teacher rated their speech and language, participation in class and educational outcomes at the beginning and end of semester. Change in the summative teacher-rating index over the first and subsequent semesters in which a child received therapy was examined. Independent predictors of change were identified using multivariable linear regression.

Results

Over two years, 1029 sessions of SLT and 531 sessions of OT were delivered to 98 children (67% male, 38% in Prep at commencement) via telehealth. In their first semester of therapy, 57 children received SLT, 37 OT and four both therapies. The mean teacher-rating index significantly improved from the beginning (35.05 ± 10.68) to end (40.02 ± 11.75) of the first semester of therapy ( p < 0.001). In multivariable linear regression, grade, school and baseline rating were significantly associated with the end-of-semester teacher-rating index.

Discussion

Delivering allied health therapy by videoconference may enable children to better engage with schooling. Differences in improvements by grade suggest improvements may be maximised by targeting therapy at certain year levels. This model may be useful in areas with limited access to allied health services.

Cognitive assessment using face-to-face and videoconferencing methods

BACKGROUND

Early and regular assessment is needed to identify cognitive impairment in older adults. The use of telehealth or telecognitive assessment is widely applied in some aspects of health services, but it is unclear if cognitive assessments conducted in this way are reliable.

AIM

To examine whether using a handheld device to complete a cognitive assessment in adults can provide reliable scores, whether participants would be satisfied to complete a cognitive assessment by videoconference and if they would prefer face-to-face or telehealth assessment, and what challenges might be associated with telecognitive assessment using a handheld device compared with using face-to-face methods.

METHOD

Participants ( n =27) were given a series of cognitive assessments face to face and using a handheld device. Results were examined for reliability, logistical and technical challenges, and participants were questioned about which they preferred.

RESULTS

Cognitive assessments made with the handheld device were effective and reliable, and produced results that were comparable to those made with face-to-face assessments. However, more participants preferred face-to-face assessments than handheld device assessments. Several technical limitations were also noted during the assessments made using the handheld devices.

CONCLUSION

Although scores made using the handheld device were reliable, preliminary evidence suggests there are some tangible barriers to integrating telehealth into all settings for all patients.

Tablet-Based Hearing Test Among Child Clinical Populations: Performance and Preference

Background and Introduction: Tablet-based automated audiometry applications are a recent alternative method to perform pure-tone hearing testing. Children, in particular, might benefit from such apps because of the game-like interface. However, how children perceive this alternative approach has not been well studied. This study examined children's preference of hearing test and a relationship between their test preference and hearing test results. Materials and Methods: Forty children 6-12 years of age completed a pure-tone hearing test in both the tablet-based automated (tablet) method and the conventional method. Hearing thresholds were measured at 0.5, 1, 2, 4, 6, and 8 kHz in each ear. An exit interview was conducted to obtain each child's test preference. Results: We found that 59% of the children preferred the tablet method when compared to the conventional method. Preference to the tablet method was stronger in the younger children (6 years) than older children (7-12 years). The linear regression analyses suggest that test preference does not affect the hearing test results in the conventional method, but does negatively affect the results in the tablet method. In addition, poor performance was found among children with a clinical diagnosis, in particular, in the tablet method. Discussion: These results suggest that hearing thresholds may be overestimated in children, especially those with clinical diagnosis such as attention or behavioral issues in the tablet method. Future work is needed to determine which clinical populations have potential benefit from a tablet method. Conclusions: Children's test preference is not a good index of hearing test accuracy.

The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review

The purpose of this article is to determine if telehealth-delivered speech-language pathology interventions are as effective as traditional in-person delivery for primary school-age children with speech and/or language difficulties. A systematic review was conducted (in accordance with PRISMA guidelines) using five databases, two journals and reference lists. Titles and abstracts were screened for inclusion, with relevant studies reviewed in full-text. Initial searches identified 132 articles. Following exclusion of non-relevant studies, seven articles remained for inclusion. Results revealed both telehealth and in-person participants made significant and similar improvements when treatment effects were measured through five of the six outcome measures. Findings showed there is limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children. Whilst this is encouraging, particularly for rural children where in-person services are limited, more rigorous study designs are required to support the efficacy of telehealth for this population.