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Research Request — Delivery of Speech Pathology Support via Telehealth

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Research Request — Delivery of Speech Pathology Support

via Telehealth

Can telehealth deliver effective outcomes for the delivery of Speech Pathology support for a participant using Augmentative and Alternative communication (AAC) — low tech (e.g.PODD) vs face to face SP supports plus travel?

Brief: Particularly interested in the AAC aspect, as the participant will have complex communication needs and is most likely non-verbal. Include info re communication partner training

Date: 20/07/2020

Requester Naomi (Naomi e TAAT Senior Technical Advisor)
Shannon Assistant Director — TAB)

| Researcher | Jane (Research Team Leader)

| Cleared by | Jane (Research Team Leader)

Contents

  • Summary
  • Speech Pathology Support Delivered via telehealth
  • Delivery of telehealth to those with Augmentative and Alternative communication
  • Communication Partner Training
  • Communication partner training using telehealth
  • Reference List

Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters

Summary

  • There is an immense amount of literature which investigates the effectiveness of speech-language pathology delivered via tele-health/tele-rehabilitation/tele-practice

    • All systematic reviews find it to be feasible and provide comparable results to in-person therapy

  • Empirical research utilizing tele-practice for consultation, supervision and fieldwork in AAC is limited (mainly cover high tech AAC)

    • Preliminary case studies have found it to be a valid and appropriate service delivery method for individuals in need of AAC intervention
    • High speed internet connect is vital to success
    • Some face-to-face sessions may still be required, especially during initial consults to determine appropriate AT devices

  • Communication partners that are well trained and understand the participant are critical for those who rely on AAC

    • Early research has shown training can be delivered remotely

Speech Pathology Support Delivered via telehealth

Telehealth delivered speech-language pathology (SLP) has previously been investigated in literature reviews across various practice areas and populations. Below is a summary of findings from these reviews.

Mashima and Doarn (2008) [1] conducted an extensive literature review on the application of telehealth in SLP with adults and a small number of studies with children.

  • Reviewed 40 studies investigating disorders relating to adult neurogenic communication, fluency, voice, dysphagia (n=35), and childhood speech and language (n=5).
  • Suggested that telehealth is a feasible and effective method for providing SLP services at a distance
  • Authors noted that the reviewed literature consisted primarily of pilot studies and anecdotal accounts of telehealth applications rather than large, well-controlled, randomised clinical trials

Reynolds, Vick, and Haak (2009) [2] conducted a narrative review of 29 studies which were analysed using a quality assessment checklist.

  • Articles focused on assessment and intervention with the adult (n=19) and paediatric (n=7) population as well as an unspecified population (n=3)
  • Authors concluded that the results achieved through the telehealth and in-person service delivery models were equivalent
  • Many of the studies noted that telehealth was not a complete replacement for in-person services but may be appropriate for combined practices.

Edwards, Stredler-Brown, and Houston (2012) [3] conducted a further review investigating 39 studies in the fields of audiology and SLP.

  • Majority of studies conducted on adult populations (n=27) with neurogenic communication, voice, dysphagia and fluency disorders
  • Review expanded to include a small number of studies (n=12) focusing on early intervention services.
  • Concluded that telehealth is an effective way to diagnose and treat both adults and children in the areas investigated, as services provided through telehealth or by conventional in-person means resulted in similar outcomes

A more recent review focusing on the efficacy of telehealth delivered SLP services compared to traditional in-person delivery for primary school aged children with speech and/or language difficulties was conducted by Wales, Skinner, Hayman (2017) [4].

  • 7 studies met inclusion criteria (2 RCT, 2 comparison studies, 3 pre- vs post intervention studies)
  • Number of sessions ranged from 6-12 (delivered fortnightly)
  • Convincing evidence that speech sound intervention delivered through telehealth to primary school age children was just as effective as in-person intervention
  • Overall, whilst the studies revealed that intervention delivered through telehealth is as effective as in-person intervention, this result seemed to be found more consistently with

Delivery of telehealth to those with Augmentative and Alternative communication

Empirical research utilizing tele-practice for consultation, supervision and fieldwork in AAC is limited. The current literature in this space is summarised below.

Study by LoPresti, Jinks, Simpson (2015)

LoPresti, Jinks, Simpson (2015) [5] investigated whether individuals could obtain appropriate prescriptions for computer-based assistive technology through the use of a tele-rehabilitation (TR) system.

  • Study utilised VISYTER which is a web-based TR portal and integrated videoconferencing system based on cost-effective, open-source software
    • It allows for one site to send multiple video streams. For example, it is possible to transmit a view of the consumer’s face and a second view of the consumer’s hands on a keyboard, or a view of the consumer’s posture and a second view of an AAC device screen
  • 66 AAC participants were recruited and split across 3 groups
    • Control = received all services with an assistive technology specialist physically present
    • Mixed = initial assessment with the assistive technology specialist physically present and all remaining services remotely
    • Remote = received all services remotely
  • Participants reported high satisfaction with TR services, and similar satisfaction with their overall AT service experience compared with consumers who received exclusively in-person services.
  • Limitations of TR = lack of consistent high-bandwidth Internet connections, need for equipment and staff resources at the client location (especially during an initial evaluation), and TR visual and multi-tasking demands on the clinician.
  • TR might be most practical for follow-up sessions after an initial, in-person evaluation, or
    • in situations when a support person with sufficient expertise can be physically present with the participant.

Study by Vaughan (2018)

A descriptive study as part of a Master’s Thesis by Vaughan (2018) [6] implemented low technology AAC boards to two children in Peru and conducted maintenance appointments using telehealth.

  • Implementation of AAC consisted of 4 days of intervention sessions with durations between 30 minutes to 1 hour.
  • Four maintenance sessions for each participant were conducted through tele-practice on Skype for Business
  • Participant 1: Progressed and surpassed, mastered, and had emerging communication skills.
  • Participant 2: Due to technological difficulties (i.e., poor Internet connection) it was uncertain if communication was improved
    • When the parent was questioned, it was noted that the participant was developing a more efficient and effective means to consistently say yes or no with familiar and unfamiliar communication partners.

Delivery of Speech Pathology Support via Telehealth

In conclusion, tele-practice were easy to use and overall outcomes were positive.

Fissel, Mitchell and Alvares (2015) [7] present a case study of a 6 year-old boy with neurological impairments and a limited range of communication behaviours including mostly unintelligible single-world verbalisations, vocalisations and occasional gestures. The authors adapted an assessment model to assess the literacy skills of the participant using telehealth as no AAC specialists were available in the area. Concluded that telehealth appears to be feasible with the potential to assess, intervene with, and meet the diverse needs of children with complex communication needs. Particularly those with limited access to ACC specialists.

A further case study presented by Hall, Boisvert and Jellison [8] utilised 4 participants using a single subject, multiple baseline design to monitor the progress of student participants and compare outcome data when services were provided on-site or via tele-practice. No significant difference between the number of unprompted and prompted targets generated by participants when receiving services onsite as compared to the matched participants receiving services through tele-AAC. Provides empirical evidence in support of tele-practice as a valid and appropriate service delivery method for individuals in need of AAC intervention.

Three case studies are presented by Curtis (2014) [9]. Case 1: 50 year old woman with cerebral palsy with experience using speech generating device. Participant was able to learn new program (E Z Keys) over tele-consultation to operate the mouse, open and close programs, browse the web, email, and text message. Case 2: Experienced speech generating device user who has been living with ALS for many years. Participant able to develop eye gaze skills with no assistance from carer or wife. Case 3: 50+ year old woman with cerebral palsy who had never had a formal communication system. After weekly sessions for 12 months the participant was able demonstrate for the first time the ability to communicate novel information of her own choosing. She became a context dependent communicator who can communicate some information in some settings with a familiar and supportive communication partner.

Communication Partner Training

It is important for communication partners (e.g., caregivers and educators) to receive training on how to provide interventions. Communication partners should be incorporated in intervention training to further improve the language and communication outcomes for individuals with complex communication needs [10].

Various systematic reviews investigating the effect of communication partner training have found similar results across various participants groups requiring AAC;

  • Communication partner interventions were found to be highly effective across a range of participants using AAC, intervention approaches, and outcome measure characteristics, with more evidence available for participants less than 12 years of age, most of whom had a diagnosis of autism spectrum disorder or intellectual/developmental disability [11].

  • 56 studies across 2 systematic reviews have reported positive outcomes from communication partner training in aphasia [12].

O partner training should be conducted to improve partner skill in facilitating the communication of people with chronic aphasia.

Delivery of Speech Pathology Support via Telehealth Page | 5 Page 77 of 153

Intervention research designed to support communication partners provides positive preliminary evidence for partners’ adoption of strategies to support children using AAC [13].

Communication partner training using telehealth

Quinn, Beukelman and Thiessen (2011) [14] evaluated the accuracy of an instructional strategy for potential AAC facilitators to operate and maintain high technology AAC device software using Remote Access Error-Free (RA-EF) instruction.

  • Participants in this study were graduate students in speech-language pathology
  • Following fewer than 30 minutes of instruction focusing on 11 operational skills, a group of 10 participants who were unfamiliar with the Visual Scenes Display for Aphasia application (Version 2) achieved post-instruction accuracy scores of 98.2%

Timpe, E., Kent-Walsh, J., Harrington, N., Lavadia, L., & Vazquez (2016) [15] designed and delivered the ‘iCan Communicate’ program which is a parent focused AAC intervention program. The program was delivered over 9 sessions via face-2-face and tele-practice services.

Results indicated:

  • High parent satisfaction with the service delivery model
  • Increased accuracy of parent application of the targeted interaction strategy
  • Increased frequency and diversity in the children’s multi-modal communicative turn taking

Reference List

  • Mashima PA, Doarn CR. Overview of telehealth activities in speech-language pathology. Telemedicine and e-Health. 2008 Dec 1;14(10):1101-17.
  • Reynolds AL, Vick JL, Haak NJ. Telehealth applications in speech-language pathology: A modified narrative review. Journal of Telemedicine and Telecare. 2009 Sep;15(6):310-6.
  • Edwards, M., Stredler-Brown, A., & Houston, K. T. (2012). Expanding use of telepractice in speech-language pathology and audiology. Volta Review, 112, 227-242.
  • Wales D, Skinner L, Hayman M. The efficacy of telehealth-delivered speech and language intervention for primary school-age children: a systematic review. International Journal of Telerehabilitation. 2017;9(1):55.
  • LoPresti EF, Jinks A, Simpson RC. Consumer satisfaction with telerehabilitation service provision of alternative computer access and augmentative and alternative communication. International journal of telerehabilitation. 2015;7(2):3.
  • Vaughan LE. The Development, Implementation, and Maintenance of Augmentative and Alternative Communication Through Telepractice in Peru (Doctoral dissertation, University of Kansas).
  • Fissel SN, Mitchell PR, Alvares RL. An Adapted Assessment Model for Emergent Literacy Conducted via Telepractice. Perspectives on Telepractice. 2015 Sep;5(2):48-56.
  • Hall N, Boisvert M, Jellison H. An Investigation of the Efficacy of Direct AAC Service Provision via Telepractice: A Case Study.
  • Curtis TR. Case studies for telepractice in AAC. Perspectives on Augmentative and Alternative Communication. 2014 Jan;23(1):42-54.
  • Kaiser, A. P., & Roberts, M. Y. (2013). Parents as communication partners: An evidence- based strategy for improving parent support for language and communication in everyday settings. SIG 1 Perspectives on Language Learning and Education, 20, 96-111. DOI:10.1044/lle20.3.96.
  • Kent-Walsh J, Murza KA, Malani MD, Binger C. Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis. Augmentative and Alternative Communication. 2015 Oct 2;31(4):271-84.
  • Simmons-Mackie N, Raymer A, Cherney LR. Communication partner training in aphasia: An updated systematic review. Archives of Physical Medicine and Rehabilitation. 2016 Dec 1;97(12):2202-21.
  • Shire SY, Jones N. Communication partners supporting children with complex communication needs who use AAC: A systematic review. Communication Disorders Quarterly. 2015 Nov;37(1):3-15.
  • Quinn E, Beukelman D, Thiessen A. Remote instruction of potential AAC support personnel. Perspectives on Augmentative and Alternative Communication. 2011 Sep;20(3):97-101.
  • Timpe, E., Kent-Walsh, J., Harrington, N., Lavadia, L., & Vazquez, J. (2016). I-Can Communicate: Expanding Service Delivery Models to Include Telepractice. [Conference Proceedings]. International Society for Augmentative and Alternative Communication, 1-4. AN:120720849