Telepractice for the Delivery of Pediatric Feeding Services: A Survey of Practice Investigating Clinician Perceptions and Current Service Models in Australia.

The provision of speech-language pathology (SLP) services via telepractice is expanding. However, little is known about the use of telepractice to deliver pediatric feeding services. The current study aimed to investigate SLPs perceptions, and current use of, telepractice in pediatric feeding. An electronic survey was distributed to SLPs with pediatric feeding experience within Australia. Questions pertained to general demographics, feeding experience, telepractice experience and perceptions of telepractice. Most questions were multiple choice, with some short response questions. Eighty-four complete responses were received. Overall, 41% of the cohort were interested in providing telepractice services but only 20% reported experience delivering pediatric feeding services via telepractice. Most telepractice users reported commencing telepractice services within the last 12 months. Most clinicians identified a range of age groups and feeding services that they believed could be offered via telepractice and a range of benefits to telepractice feeding services were identified. Benefits included natural environment, reduced distance and travel, opportunities to increase services and increased supervision and support. Although most respondents reported access to technology, most had difficulty accessing this on a daily basis to establish regular telepractice services. Clinician concerns regarding the safety and efficacy of conducting pediatric feeding assessments via telepractice were also identified. Overall, although the delivery of pediatric feeding services via telepractice remains limited, many clinicians were interested in using telepractice and had positive perceptions regarding its use. Continued efforts to enhance clinician access to technology and further evidence for the efficacy of this service delivery model for pediatric feeding will aid clinical implementation.

Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists.

BACKGROUND: Descriptions of community-based speech-language therapy (SLT) dysphagia practices and services are underrepresented in the research literature, despite the prevalence of dysphagia in the community. Owing to a globally ageing population and government drives to support people to remain living at home rather than in hospital or aged care, there is a growing need for SLT services to be responsive to the needs of clients living at home in the community, referred to in this study as 'community-based clients'. Exploration of current SLT services and dysphagia care practices for this population may identify ways services can be designed and enhanced to better meet the needs of clients and carers. AIMS: To explore the nature (i.e., characteristics) of dysphagia services and SLT clinical practices for adults with dysphagia living at home in the community. METHODS & PROCEDURES: Using a qualitative descriptive approach positioned within an explanatory sequential mixed methods design, this study explored SLT services and practices for adults with dysphagia living in the community to explain further and elaborate on findings from an earlier quantitative study. A total of 15 SLTs working with community-based clients with dysphagia were recruited using purposive representative sampling. Content analysis was used to explore the data. OUTCOMES & RESULTS: The overarching theme of community commands a different approach and was illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) skills and mindset require adaptation in the community context; (2) values and approaches are different in the community context; and (3) organizational influences impact service delivery in the community context. From the data, it is apparent that the work undertaken in the community setting differs from dysphagia care in other settings and requires adapted SLT skills, values and approaches that encompass holistic care, client autonomy and carer engagement. SLT practices are also informed by organizational influences such as policies and resourcing, which in some services were enablers, while for others these presented challenges. CONCLUSIONS & IMPLICATIONS: Community-based SLT services must continue to foster flexible, responsive practices by SLTs to ensure the needs of clients and carers are met now and in future.

Evaluation of a multisite telehealth group model for persistent pain management for rural/remote participants.

INTRODUCTION: Individuals living in rural/remote areas have recognised barriers to specialist services for persistent pain management. Although there is current evidence to support the use of telehealth to deliver individual pain management support, there is minimal evidence to support the use of pain management programs delivered within a group model, using telehealth. The aim of the present research was to perform a formative evaluation of a persistent pain management program implemented using a multisite telehealth group model, and to examine consumer perceptions. METHODS: The Manage Your Pain multisite telehealth group program was developed as a modified hub-and-spoke model. The model allowed participants from multiple rural/remote 'spoke' sites in Queensland, Australia to access four 2-hour specialist persistent pain management sessions from a metropolitan interdisciplinary persistent pain management centre ('hub' site, 491-1009 km from spoke sites), and simultaneously enable real-time access/interactions between participants at each of the spoke sites. Twenty-one individuals living with persistent pain participated in one of five multisite telehealth groups over the 10-month period. All participants completed standard pain scales before and after the pain management program, including Chronic Pain Acceptance Questionnaire 20 (CPAQ20), Brief Pain Inventory (BPI), Depression Anxiety Stress Scale (DASS 21), Pain Self Efficacy Questionnaire (PSEQ) and the Participant Reported Outcomes Measurement Information System (PROMIS). The Patient Impression of Change Scale (PICS), a telehealth perceptions survey, and a semi-structured telephone interview were completed post-program. RESULTS: Results revealed significant (p<0.05) improvements in the activity subscale and total score of the CPAQ, with 6 (30%) showing reliable improvement (90% confidence interval), indicating higher levels of activity engagement and pain acceptance after the program. Four (19%) participants made reliable improvement on the BPI interference. Post-program, the PICS revealed 65% of participants reported improvements in overall function, 61% indicated improved mood, 57% reported improved physical activity and 50% had some improvement in pain. Post-program, less than 10% of participants reported having technical (audio, visual) issues that had impacted on their sessions, and more than 90% found telehealth to be comfortable, convenient and would consider using it for their healthcare in the future. Post-program, most participants felt they had connected and were in a shared health experience with other group members through the multisite telehealth model. The interviews revealed three main themes: 'group experiences', which involved comments relating to the dynamics of the group and the shared experience; 'telehealth accessibility', which pertained to perceptions of the telehealth model for accessing specialist services; and 'limitations and concerns', where participants spoke of possible improvements to the program delivery model. CONCLUSIONS: Results confirmed that participants received benefit from the pain management program and that they had positive perceptions of receiving the service using a telehealth model. The present findings provide positive data to support using telehealth to deliver specialist persistent pain management for individuals who face accessibility issues in rural and remote communities. The model also demonstrated that positive elements of group treatment can be achieved through telehealth group models.

Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment.

Introduction Following (chemo)radiotherapy (C/RT) for head and neck cancer (HNC), patients return to hospital for regular outpatient reviews with speech pathology (SP) and nutrition and dietetics (ND) for acute symptom monitoring, nutritional management, and swallowing and communication rehabilitation. The aim of the current study was to determine the feasibility of a home-based telehealth model for delivering SP and ND reviews, to provide patients with more convenient access to these appointments. Methods Service outcomes, costs, and consumer satisfaction were examined across 30 matched participants: 15 supported via the standard model of care (SMOC), and 15 via the home-based telehealth model of care (TMOC). Results All patients were successfully managed via telehealth. The TMOC was more efficient, with a reduced number ( p < 0.003) and duration ( p < 0.01) of appointments required until discharge. Significant patient cost savings ( p = 0.002) were reported for the TMOC due to decreased travel requirements. While staff costs were reduced, additional telehealth equipment levies resulted in a lower but non-significant overall cost difference to the health service when using the TMOC. High satisfaction was reported by all participants attending the TMOC. Discussion The findings support the feasibility of a home-based telehealth model for conducting SP and ND reviews post C/RT for HNC.

Intensive versus traditional voice therapy for vocal nodules: perceptual, physiological, acoustic and aerodynamic changes.

OBJECTIVES: To investigate the perceptual, physiological, acoustic, and aerodynamic outcomes of patients with vocal nodules following intensive voice treatment compared with traditional voice treatment. STUDY DESIGN: Pragmatic randomized clinical trial. METHODS: Fifty-three women diagnosed with bilateral vocal nodules participated in the study. Voice recordings, stroboscopic recordings, acoustic, and aerodynamic assessments were made before voice treatment, after vocal hygiene education, and immediately postvoice treatment. All participants completed one session of vocal hygiene and eight sessions of direct voice therapy, however the delivery of the treatment between the two groups differed in treatment intensity. RESULTS: Physiological improvements were observed after vocal hygiene alone, whereas physiological, perceptual, and acoustic parameters all improved to some degree in both treatment groups immediately posttreatment. There were no differences in the extent of change observed between the two groups at any point following treatment. CONCLUSIONS: The investigation provided initial evidence that individuals with vocal nodules are able to recover voice function, vocal health, and vocal communication through intensive voice treatment. The results suggest comparable positive perceptual, physiological, and acoustic outcomes from intensive voice therapy compared with traditional voice therapy. Further investigation is required to determine the long-term effects of intensive treatment.

Application of the International Classification of Functioning, Disability and Health (ICF) to people with dysphagia following non-surgical head and neck cancer management.

The International Classification of Functioning, Disability, and Health (ICF) is an internationally recognized framework which allows its user to describe the consequences of a health condition on an individual in the context of their environment. With growing recognition that dysphagia can have broad ranging physical and psychosocial impacts, the aim of this paper was to identify the ICF domains and categories that describe the full functional impact of dysphagia following non-surgical head and neck cancer (HNC) management, from the perspective of the person with dysphagia. A secondary analysis was conducted on previously published qualitative study data which explored the lived experiences of dysphagia of 24 individuals with self-reported swallowing difficulties following HNC management. Categories and sub-categories identified by the qualitative analysis were subsequently mapped to the ICF using the established linking rules to develop a set of ICF codes relevant to the impact of dysphagia following HNC management. The 69 categories and sub-categories that had emerged from the qualitative analysis were successfully linked to 52 ICF codes. The distribution of these codes across the ICF framework revealed that the components of Body Functions, Activities and Participation, and Environmental Factors were almost equally represented. The findings confirm that the ICF is a valuable framework for representing the complexity and multifaceted impact of dysphagia following HNC. This list of ICF codes, which reflect the diverse impact of dysphagia associated with HNC on the individual, can be used to guide more holistic assessment and management for this population.

The lived experience of dysphagia following non-surgical treatment for head and neck cancer.

The prevalence and severity of dysphagia in people treated non-surgically for primary head and neck cancer (HNC) is well documented. However, few studies have looked beyond the physiological impairment to explore the lived experience of dysphagia in the post-treatment period of HNC. The current study adopted a person-centred, qualitative approach to describe the experiences of people living with dysphagia in the months and years following non-surgical treatment for HNC. Using maximum variation sampling, 24 participants who had undergone radiotherapy treatment for HNC were recruited. Individual interviews were conducted to explore the impact of dysphagia on participants' everyday lives. The themes identified included: (1) physical changes related to swallowing; (2) emotions evoked by living with dysphagia; (3) altered perceptions and changes in appreciation of food; and (4) personal and lifestyle impacts. The data revealed the breadth and significance of the impact of dysphagia on the lives of people treated curatively for HNC. Assessment and management in the post-treatment period must be sufficiently holistic to address both the changing physical states and the psychosocial needs of people with dysphagia following HNC. Rehabilitation services which focus only on impairment-based management will fail to fully meet the support needs of this clinical population.

Patterns and predictors of swallowing resolution following adult traumatic brain injury.

OBJECTIVE: To examine the patterns of swallowing resolution and outcomes of traumatic brain injury (TBI) patients in an acute care setting and document the risk factors or predictors of resolution of swallowing function. PARTICIPANTS: 117 consecutive TBI patients who had received speech pathology intervention for dysphagia during acute postinjury care. MAIN OUTCOME MEASURE: Temporal measures relating to pattern of resolution of dysphagia postinjury. RESULTS: 75% of patients were assessed by 2 weeks postinjury, commenced oral intake by 17 days, and ceased supplementation by 3 weeks. By an average of 22 days after admission, 47% had progressed to normal-consistency diet and fluids. Duration to the first swallowing assessment was a predictor for achieving total oral intake and returning to normal intake. There was some preliminary support for severity of CT data and presence/absence of a tracheostomy as predictors for return to normal intake. CONCLUSION: The current data document the natural history of swallowing resolution and proposes prognostic factors for patients with impaired swallowing following TBI. Establishing clinical parameters that can help predict patterns of swallowing resolution over the course of acute care admission may greatly assist inpatient management and discharge/rehabilitation planning.

The use of electropalatography in the assessment and treatment of acquired motor speech disorders in adults: current knowledge and future directions.

Electropalatography (EPG) has been employed to measure speech articulation since the mid-1970s. This technique has predominately been used in experimental phonetic research and in the diagnosis and treatment of articulation disorders in children. However, there is a growing body of research employing EPG to diagnose and treat articulatory impairment associated with acquired motor speech disorder (MSD) in adults. The purpose of this paper was to (1) review the findings of studies pertaining to the assessment and treatment of MSDs in adults using EPG, (2) highlight current methodologies employed, and (3) discuss the potential limitations of EPG in the assessment and treatment of MSDs and examine directions for future applied research and treatment studies.