Telepractice, involves the use of telecommunications technology to deliver professional services at a distance, and since the Covid-19 pandemic in 2020 it has become an increasingly popular way of delivering certain health care services, including medical visits, counseling and speech-language therapy.
Payers such as CMS (Medicare) authorized payment for use of telepractice services during the pandemic, and while this authorization has temporarily continued even after the public health emergency authorization ended, for some disciplines, such as speech-language pathologist, teletherapy authorization is currently slated to end in 2024 unless CMS approves ongoing authorizes for mode of delivery.
The appeal of teletherapy for many patients is apparent as it ensures that patients receive the care they need regardless of where they physically reside, and eliminates many of the barriers to out-patient speech therapy, including: transportation and frequent visits, and also provides more patient autonomy and less dependence on caregivers/carepartners.
In 2016 Deborah Theodoros (School of Health and Rehabilitation Sciences, The University of Queensland St. Lucia, Australia and Lorraine Ramig, National Center for Voice and Speech, University of Colorado-Boulder Boulder, CO published an article outlining the essential features and underlying principles of Lee Silverman Voice Treatment (LSVT®LOUD) and explored the successful delivery of this treatment via telepractice. Other researchers have published similar articles discussing the use of telepractice for patients with speech and swallowing impairment following stroke, voice disorders from other causes, and various other conditions requiring treatment from a speech-language pathologist or audiologist, and most agree the teletherapy can serve as a viable mode of treatment for some patients but not all.
When employing telepractice, the SLP needs to use technology that replicates in-person treatment as closely as possible in order to maintain the integrity of the treatment.
But is Teletherapy appropriate for EVERY patient?
Current technology using HIPAA secure web-based platforms enable the synchronous (real-time) delivery of treatment across the Internet via videoconferencing. For this to be successful, both the therapist and patient must have a stable internet connection and the patient needs to be able to receive treatment in a quiet and private setting.
There are challenges, however to successful use of teletherapy with patients, and for that reason not all patients will be candidates. As stated in the Theodoros-Ramig article, individuals with Parkinson’s disease (PD), for example, have a number of characteristics associated with PD that may make them unlikely participants and include: significant dementia; marked impairment of processing speed, memory, and/or executive functioning; severe depression; severe dyskinesias; and significant hearing and/or visual impairment. Dyskinetic movements will result in increased pixilation of the visual image during videoconferencing and may make it difficult for the patient to remain within the camera view. Patients undertaking speech treatment via teletherapy need to organize and maintain a self-directed practice schedule and operate the technology comfortably, and carry out home practice independently.
Selecting the best behavioral intervention for a patient is no different then when providing face-to-face treatment and suitability of the patient for telepractice remains a clinical decision. Collecting reliable acoustic measurements of speech/voice can be challenging when using a web-based platform and hands-on treatment such as laryngeal massage or postural adjustments can only be demonstrated.
Despite some limitations, teletherapy for speech, voice and swallowing treatment will be an option many patients will desire, and technical advancements will no doubt help in overcoming some of the short-comings of this type of service delivery.
I have had several phone calls recently with individuals inquiring about teletherapy. In most instances, a spouse or adult child made the call. For me this is a red flag that the individual needing the treatment may not be motivated or computer savvy enough to independently engage in their treatment via telepractice. While I understand the convenience teletherapy represents for a spouse who must otherwise drive the patient back and forth to therapy, I still need to meet with the patient and determine what they desire from treatment and decide if they are a suitable candidate for teletherapy. If a patient is within a reasonable driving distant to my office, I will often request the first visit be face:face allowing me to obtain accurate acoustic and aerodynamic measures and have access to other assessment tools not as easily employed when with the patient over the computer. If a patient lives at a distance or in another state where I am a provider, I will suggest a web-based call to discuss their concerns and criteria for participating in teletherapy.
“Telepractice Supported Delivery of LSVT®LOUD,” Theodoros & Ramig. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders. SIG 2 Perspectives Vol. 21, No. 3, October 2011.
After Therapy Classes and Programs
Numerous online after-therapy classes have also become available since the pandemic and offer patients an opportunity for continued guided practice as well as peer support and feedback. Voice Aerobics® was the OG (original) of this type of after therapy program developed for people with Parkinson’s, and remains available as a download to rent or buy. Online coaching is also available whenever a person purchases a Voice Aerobics product, and there is never a cost for a 15 minute product coaching session or pre-treatment screening. So if you are interested in teletherapy or meeting with me for an online screening visit to discuss the teletherapy option, contact me via email: firstname.lastname@example.org or visit my website https://voiceaerobicsdvd.com/ and complete a contact form.
The office is closed for vacation August 8 thru15-2023 resuming treatment 8-16-23. Products ordered during that time will ship 8-16-2023. If calling to schedule an appointment, call after 8-16-2023
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
Voice Aerobics the heART and Science of Voice Practice