Is Telehealth and Telepractice Effective?

Abstract Excerpt: "The article profiles the Children's Hearing and Speech Centre of British Columbia, which has provided a listening and spoken language option since 1963 for children who are deaf and hard of hearing. A discussion of a decision which the center made in 2006 to provide direct services via telepractice to families of children from birth to age five living outside of the greater Vancouver area, is presented. The features of the center's telepractice services, including the A Sound Move service and the Stepping Out service, are discussed."

Abstract Excerpt: The article profiles the Utah State University Sound Beginnings program, which originated in 2007 as a laboratory school for children with hearing loss and in 2012 offers an interdisciplinary listening and spoken language educational option for families with services which include toddler and preschool classrooms, individual therapy, home-based early intervention, and onsite pediatric audiology services. A discussion of telepractice technologies and telepractice sessions which are included in the Sound Beginnings program is presented.

Abstract Excerpt: The article profiles the Maine Educational Center for the Deaf and Hard of Hearing, which is located on a small island off the coast of rural Maine and provides services to children from birth through age 21 who are deaf and hard of hearing. An overview of the center's Providing Opportunities for Integrating New Technologies (POINT) project, which has implemented a telepractice, distance learning collaborative that uses Tandberg videoconferencing technology to provides services to clients in rural locations, is presented.

Abstract Excerpt: The article profiles Listen and Talk, an early intervention and preschool program in Seattle, Washington, that offers auditory-verbal education and therapy to children with hearing loss and their families and features staff members who provide consultations on education for students with hearing loss to public and private schools across the state. A discussion of a coaching model which the program uses to support the parents of children with hearing loss, and of a decision which the program made in 2011 to implement a telepractice service to provide its services to families in remote locations, is presented.

Abstract Excerpt: The article discusses various online therapy programs for counseling and treating college students with mental health issues. Topics covered include the Therapist Assisted Online (TAO) developed by former counseling center director Sherry Benton at the University of Florida, the WellTrack self-help program used in some colleges in the U.S., and the use of teletherapy in other U.S. colleges. It also discusses the SilverCloud online program used at the University of Minnesota-Twin Cities.

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

Abstract Excerpt: This investigation compared traditional service delivery and telepractice service delivery for children receiving therapy for the NOMS diagnostic category of “speech sound production.”...A total of 1,331 ASHA NOMS cases and 428 telepractice cases were included...Results: There were no significant differences in the median change scores between the traditional group and the telepractice group. Conclusions: These results suggest comparable treatment outcomes between traditional service delivery and telepractice for treatment of children exhibiting speech sound disorders.

Abstract Excerpt: Little is understood about factors that influence speech-language pathologists' (SLPs') acceptance of telepractice. The aim of this study was to investigate SLPs' perceptions and experiences of transitioning to a school-based telepractice service to identify factors that contributed to positive clinician attitudes...Results indicated that although SLPs reported initially having mixed feelings towards telepractice, they later evaluated telepractice positively and viewed it as a legitimate service delivery mode. The overarching theme was that positive beliefs about telepractice were associated with perceptions of its consistency with the underlying principles of face-to-face therapy. In evaluating telepractice, SLPs considered: (a) therapeutic relationships with children; (b) collaboration with parents and teachers; (c) adequacy of technology and resources; and (d) access to support for learning telepractice. Therapy assistants and specific clinician attributes emerged as key strategies used to manage threats to acceptability. Preparation of SLPs transitioning to telepractice should address factors that support positive experiences with, and attitudes towards, telepractice to ensure that training achieves the greatest, most sustained change.

Abstract Excerpt: The purpose of this study was to evaluate the use of telepractice to train interventionists to implement incidental teaching with preschool children with ASD. Three interventionists were taught to implement incidental teaching using a telepractice training package consisting of an online module, self-evaluation, and delayed performance feedback delivered via videoconferencing...Results showed that following the telepractice training program, interventionist implementation fidelity improved and child mands increased. Within six telepractice sessions, all interventionists reached the preset performance criteria of four consecutive sessions above 90 % fidelity....These results suggest that telepractice is a promising method of providing instruction in incidental teaching to interventionists of young children with ASD.

Abstract Excerpt: Purpose: The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD)...Results: Perceptual and quality-of-life measures were significantly better posttreatment and were statistically equivalent across groups...The results of this study indicate that flow phonation exercises can be successfully used for patients with MTD using telepractice."

Abstract Excerpt: The provision of consistent high quality home- and community-based services to children with disabilities living in rural and frontier areas is a challenge...Videoconferencing offers a viable means to address these challenges and is becoming increasingly accepted..This article offers a rationale for using a telepractice model for early intervention--virtual home visits (VHV) conducted via videoconferencing--and describes components of the service model, including equipment needs, costs, and training requirements.

Abstract Excerpt: The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders. Method: Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals-4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. Results: No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest....The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.

Abstract Excerpt: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment...Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. Conclusions: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Abstract Excerpt: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site...Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod...Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.

Abstract Excerpt: Tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model...The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.

Abstract Excerpt: 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...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.

Abstract Excerpt: The purpose of this study was to examine the effect of telerehabilitation on missed appointment rates in a rehabilitation clinic. Clients fail to attend scheduled appointments for a variety of reasons. Unmet appointments represent a loss of financial support as well as diminished efficiency and capacity to provide services. Speech therapy utilizing multiple appointments is most difficult to maintain during a treatment regimen. This may cause individuals to miss appointments and therefore not achieve desired results. For this study, researchers utilized an intense speech therapy technique, the Lee Silverman Voice Treatment (LSVT®) to measure compliance with scheduled appointments. Participants were randomized to either in-person treatment or telerehabilitation treatment at a site distant from the speech-language pathologist. Participants in the telerehabilitation (TR) condition completed significantly more appointments than participants in the in-person (IP) condition. When comparing results of treatment for each condition, there were no significant differences in outcome whether treated in the IP or TR condition of the study for monologue and picture description tasks, which are closely associated with conversational speech. There was a difference in the reading task with participants demonstrating significantly better post treatment results in the IP condition. The reason for this disparity is unclear and warrants further study. Full Article

Abstract Excerpt: The purpose of this article is to describe the characteristics and effectiveness of a telepractice speech-language therapy program for school-age children. Outcome data related to the caseload, type and amount of intervention, and student progress from a school-based telepractice therapy program were compared with the K-12 Schools National Outcomes Measurement System (NOMS) of the American Speech-Language-Hearing Association. NOMS provides data for students receiving intervention through direct, in-person service delivery models. The findings suggest many similarities between the characteristics of the telepractice and direct, in-person service delivery models. The telepractice service delivery model was effective for most students included in the study. Results of this study support the described telepractice service delivery model as a viable option for speech-language therapy services delivered to public school students with communication impairments..

Abstract Excerpt: We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months. The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.

Abstract Excerpt: Here we report the feasibility and acceptability of telehealth for direct intervention in children with Prader-Willi syndrome (PWS). Children with PWS have social-cognitive challenges that are similar to children with ASD. However, developing behavioral interventions for individuals with PWS is faced with the significant challenge of enrolling enough participants for local studies where multiple visits per week are indicated for effective intervention. This study delivered a 6-week play-based intervention via telehealth directly to eight children with PWS (6-12 years). Participants completed the program with minimal behavioral or technological difficulty (#sessions M = 11.875/12). Behavioral Intervention Rating Scale results indicate good acceptability (M = 5.54/6.00). These findings support using telehealth in rare disorders and delivering intervention directly to children with developmental delays through this modality.

Abstract Excerpt: Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families' homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee et al. Journal of Applied Behavior Analysis, ) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5 %. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation.

Abstract Excerpt: The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs. Full Article

Abstract Excerpt: The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face...To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology...Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people's intention to use videoconferencing. Self-efficacy appeared to play a role in both older people's intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people's effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people's capacities to make use of digital technology. Full Article