Moving toward the future: providing speech-language pathology services via telehealth

Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients

INTRODUCTION

Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients' experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality.

METHODS

A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code.

RESULTS

Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform.

DISCUSSION

Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.

Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia

PURPOSE

The aim of this study was to determine if a tablet-based home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia.

METHOD

In a pre-post group study of home practice outcomes, 21 individuals with chronic aphasia were examined before and after a 6-month home practice phase and again at follow-up 4 months later. The main outcome measure studied was change in naming previously treated or untreated, practiced or unpracticed pictures of objects and actions. Individualized home practice programs were created in iBooks Author with semantic, phonemic, and orthographic cueing in pictures, words, and videos in order to facilitate naming of previously treated or untreated pictures.

RESULTS

Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements.

CONCLUSION

Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.

Comparability of modern recording devices for speech analysis: smartphone, landline, laptop, and hard disc recorder

BACKGROUND

Large-scale multi-site experimental and clinical speech protocols require high-fidelity, easy-to-use speech recording technologies. However, little is known about the reliability and comparability of affordable, portable and commonly used technologies with traditional well-validated devices (e.g., a hard disc recorder with a high-quality microphone).

OBJECTIVE

To examine the comparability of speech and voice samples acquired from protocols involving high- and low-quality devices.

METHODS

Speech samples were acquired simultaneously from 15 healthy adults using four devices and analyzed acoustically for measures of timing and voice quality. For the purpose of making initial comparisons, methods were deemed comparable if the resultant acoustic data yielded root mean squared error values ≤10% and statistically significant Spearman's correlation coefficients.

RESULTS

The data suggest that there is significant and widespread variability in the quality and reliability between different acquisition methods for voice and speech recording. Not one method provided statistically similar data to the protocol using the benchmark device (i.e., a high-quality recorder coupled with a condenser microphone). Acoustic analysis cannot be assumed to be comparable if different recording methods are used to record speech.

CONCLUSIONS

Findings have implications for researchers and clinicians hoping to make comparisons between labs or, where lower-quality devices are suggested, to offer equal fidelity.

Perspectives of speech-language pathologists on the use of telepractice in schools: quantitative survey results

This research surveyed 170 school-based speech-language pathologists (SLPs) in one northeastern state, with only 1.8% reporting telepractice use in school-settings. These results were consistent with two ASHA surveys (2002; 2011) that reported limited use of telepractice for school-based speech-language pathology. In the present study, willingness to use telepractice was inversely related to age, perhaps because younger members of the profession are more accustomed to using technology. Overall, respondents were concerned about the validity of assessments administered via telepractice; whether clinicians can adequately establish rapport with clients via telepractice; and if therapy conducted via telepractice can be as effective as in-person speech-language therapy. Most respondents indicated the need to establish procedures and guidelines for school-based telepractice programs.

The Best of Both Worlds: Combining Synchronous and Asynchronous Telepractice in the Treatment of Aphasia

Telepractice is an appropriate model of service delivery for a person with aphasia (PWA). We define telepractice and its two modes of delivery (i.e., synchronous and asynchronous). We detail a technology, web-Oral Reading for Language in Aphasia (web-ORLA™), developed to provide aphasia treatment intensively from a distance and subsequently evaluated during a clinical trial. In this article, we describe our experiences using web-ORLA™, highlighting the role of the speech-language pathologist (SLP) and discussing the advantages and disadvantages of this unique combination of synchronous and asynchronous telepractice. Web-ORLA™ was delivered to PWAs in their homes by a digital agent, or “virtual therapist,” who served as a model and provided instructions similarly to a real therapist. An SLP at a distant geographical location monitored the sessions remotely, either synchronously or asynchronously, provided feedback, made appropriate adjustments to the difficulty level of the stimuli, and conducted weekly probe assessments of the participants' performance. Advantages of web-ORLA™ include increased practice, SLP oversight, guidance by the agent, program simplicity, and a level of autonomy and flexibility afforded to the PWA. Given the rapid advances in technology, current technological problems that were encountered are likely to be mitigated.