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Purdue SLHS Telehealth Webinar Series Fall 2020 Webinar 3: Telehealth Adapta2ons for Adult Popula2ons Speakers: Bauer Malandraki, Gutmann, Huber, Hubertz, Malandraki, Wetzel 1 Presenters Jaime Bauer Malandraki, MS, CCC-SLP, BCS-S (she/her/hers) Michelle Gutmann, PhD, CCC-SLP (she/her/hers) Jessica E. Huber, PhD, CCC-SLP (she/her/hers) Jillian Hubertz, AuD, CCC-A (she/her/hers) Georgia A. Malandraki, PhD, CCC-SLP, BCS-S (she/her/hers) Dawn Wetzel, MAT, CCC-SLP (she/her/hers) Moderator Georgia A. Malandraki, PhD, CCC-SLP, BCS-S (she/her/hers) TELEHEALTH IN ADULT POPULATIONS DURING AND BEYOND COVID-19: THE PURDUE SLHS PERSPECTIVE CEU Requirements To receive ASHA CEUs, there are two things we will need you to do in order to collect the full .10 amount. Please note there will not be any parGal credit given for this course. 1. The first component is to aIend this webinar in its enGrety tonight. a. Your aIendance will be tracked through the system and only those who are present through the whole webinar, will be eligible for credit. b. The moderator will designate the end of the webinar. 2. Secondly, we will need you to fill out a Learning Outcome Assessment form. a. This electronic form/quesGonnaire will be emailed to you the day aOer the webinar event. b. You will need to submit your form quesGonnaire, within the soOware system, no later than 15 calendar days aOer this event which will be Friday December 18 . A confirmaGon email will be sent to you once we have verified your aIendance and received your form. If you have any quesGons about your CEU redempGon, please contact our administrator Teasha McKinley at [email protected] . 2
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Feb 27, 2023

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Page 1: Webinar_3_Handout.pdf - Purdue University

PurdueSLHSTelehealthWebinarSeriesFall2020

Webinar3:TelehealthAdapta2onsforAdultPopula2onsSpeakers:BauerMalandraki,Gutmann,Huber,Hubertz,Malandraki,Wetzel 1

Presenters Jaime Bauer Malandraki, MS, CCC-SLP, BCS-S (she/her/hers)

Michelle Gutmann, PhD, CCC-SLP (she/her/hers) Jessica E. Huber, PhD, CCC-SLP (she/her/hers)

Jillian Hubertz, AuD, CCC-A (she/her/hers) Georgia A. Malandraki, PhD, CCC-SLP, BCS-S (she/her/hers)

Dawn Wetzel, MAT, CCC-SLP (she/her/hers)

Moderator Georgia A. Malandraki, PhD, CCC-SLP, BCS-S (she/her/hers)

TELEHEALTH IN ADULT POPULATIONS DURING AND BEYOND COVID-19:

THE PURDUE SLHS PERSPECTIVE

CEU Requirements ToreceiveASHACEUs,therearetwothingswewillneedyoutodoinordertocollectthefull.10amount.PleasenotetherewillnotbeanyparGalcreditgivenforthiscourse.1.  ThefirstcomponentistoaIendthiswebinarinitsenGretytonight.

a.  YouraIendancewillbetrackedthroughthesystemandonlythosewhoarepresentthroughthewholewebinar,willbeeligibleforcredit.

b.  Themoderatorwilldesignatetheendofthewebinar.2.  Secondly,wewillneedyoutofilloutaLearningOutcomeAssessmentform.

a.  Thiselectronicform/quesGonnairewillbeemailedtoyouthedayaOerthewebinarevent.

b.  YouwillneedtosubmityourformquesGonnaire,withinthesoOwaresystem,nolaterthan15calendardaysaOerthiseventwhichwillbeFridayDecember18.

AconfirmaGonemailwillbesenttoyouoncewehaveverifiedyouraIendanceandreceivedyourform.IfyouhaveanyquesGonsaboutyourCEUredempGon,[email protected].

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Disclosures Financial

• Bauer Malandraki Purdue University: salary

• Gutmann Purdue University: salary

• Huber Purdue University: salary SpeechVive (CSO)

• Hubertz Purdue University: salary

• Malandraki Purdue University: salary NIH (NIBIB) Curasis, LLC (acting CEO)

• Wetzel Purdue University: salary

Non-Financial • Bauer Malandraki

ASHA, member • Gutmann

ASHA, member • Huber

ASHA, member • Hubertz

ASHA, member • Malandraki

Dysphagia Research Society, Board Member; ASHA, Member; ISHA, Co-Chair Telehealth Taskforce

• Wetzel ASHA, member

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Purdue SLHS Clinics and Research Labs

WEST LAFAYETTE, IN

Chicago, IL

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PURDUE SPEECH, LANGUAGE, & HEARING SCIENCES

https://www.purdue.edu/hhs/slhs/

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OUR SPEAKERS TODAY

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Bauer Malandraki Wetzel

Gutmann Huber

Hubertz

Malandraki

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• Telehealth screenings for adults • Telehealth for adult dysphagia services • Telehealth for adult transgender voice services • Telehealth for adult language and AAC services • Telehealth for adult audiology services • Principles for adult motor speech tele-services

Outline

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Image by Rachel Arkenberg - from Malandraki et al., accepted, AJSLP

Reminder: TELEHEALTH ROADMAP

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TELEHEALTH SCREENINGS FOR ADULTS

The Need Cancelled practica

Acute care

Medical outpatient

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The Goals Student clinical hours Community engagement Generate clinic caseload

TELEHEALTH SCREENINGS FOR ADULTS

CASE HISTORY •  General concerns •  Medical history •  Specific speech-language concerns •  Participation / functional impact

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SCREENING TOOL

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TELEHEALTH SCREENINGS FOR ADULTS

PATIENT REPORTED OUTCOME MEASURES •  The Reflux Symptom Index (Belafsky et al, 2002)

•  Eating Assessment Tool (Belafsky et al, 2008) •  The Communicative Participation Item Bank General Short Form (Baylor et al, 2013)

•  Functional Oral Intake Scale (Crary et al, 2005)

•  Glottal Function Index (Bach et al, 2005)

•  Mini-Addenbrooke’s Cognitive Examination American Version B (Hsieh et al, 2014)

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SCREENING TOOL

COGNITIVE SCREENER FOR DEMENTIA

TELEHEALTH SCREENINGS FOR ADULTS

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GOALS 1.  Clinical hours 2.  Community engagement 3.  Grow adult caseload

PRE-WORK

1. Coordinate workflow with clinic office •  Templates/script •  Referral flowchart •  Screening contact form

2. Advertise •  University contacts •  Local senior citizen groups •  Independent and assisted senior living

communities •  Support groups •  Rock Steady

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TELEHEALTH SCREENINGS FOR ADULTS

PRE-SCREENING 1. Student prep

•  Mock screenings via Webex

2. Patient Prep / Set-up •  Eligibility & Candidacy

•  Scheduling & Consent •  Technology

•  Info sheet & Visual Webex guide

•  Front desk support 13

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TELEHEALTH SCREENINGS FOR ADULTS

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TELEHEALTH SCREENINGS FOR ADULTS

DURING SCREENING •  Audio / visual check and troubleshooting

•  Camera positioning, distance from microphone, need for second audio connection

•  Screen sharing of assessment tool •  Questions and PROMs

•  Results and recommendation sharing •  Waiting room and student de-brief •  Screening Report Form

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TELEHEALTH SCREENINGS FOR ADULTS

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POST-SCREENING REFLECTIONS

• Expand knowledge and prep for using accessibility devices, e.g., CapTel

• Have staff set-up trial run to ensure adequate a/v connection prior to appointment to maximize appt. time

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• DysphagiaAssessment•  CasehistorycompleGon(Kantarcigil&Malandraki,2017)

•  Clinicaldysphagiaassessments•  Inadults(synchronous)(e.g.,Wardetal.,2007,2009;Sharmaetal.,2011;Wardetal.2012;Wardetal.,2013;Morrelletal.,2017)

•  Inchildren(e.g.,Kantarcigiletal.,2016;Raatzetal.,2019)

•  VFSSinadults(e.g.,Malandrakietal.,2011;Burnsetal.,2016;Malandrakietal.,2013)

Pre-COVID-19 research evidence

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Levels of evidence Ib to III •  DysphagiaTreatment

•  TreatmentinHNCpaGents(e.g.,Burnsetal.,2017;Collinsetal.,2017;Walletal.,2020)

•  TreatmentinacomplexpediatricpaGent(casereport)(Malandrakietal.,2014)

•  Compensatorytreatments–casereports(Casell,2016)

•  InternaGonaltele-consultaGon(Greece-US)(Malandrakietal.,2013);(India-US)(Mayadevietal.,2018)

•  AppsanddevicesfordysphagiarehabilitaGon(e.g.,Kimetal.,2019;Starmeretal.,2018;Walletal.,201;)

TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

•  Patient Safety •  “Can we provide telehealth for dysphagia services

safely?” •  “What if someone aspirates/chokes during the tele-

session?”

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(Burns, Malandraki, & Ward, 2020; Malandraki, 2020)

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TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

• Clinical Evaluations •  Case history and PRO measures

•  Synchronous or via secure forms •  Cranial nerve exams (OPSES) & oral

trials •  Camera and microphone placement •  Two cameras! •  Flexibility and adaptability & facilitator

support •  Some components: asynchronously •  Add standardized tools (Borders et al.,

accepted, AJSLP)

19 Image from: Malandraki et al., accepted, AJSLP

TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

• Treatment sessions • Which interventions?

• How to validate •  Pre-session emails and instruction

sheets •  Scripts and step-by-step instructions –

screen share • Cloud-based / portable devices

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Some examples

Tele-EaT (patent pending)

Inventors: Malandraki & Lee

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TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

• Examples

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TELEHEALTH FOR ADULT DYSPHAGIA SERVICES

Additional resources and training •  Purdue I-EaT Lab Guidelines:

•  https://www.purdue.edu/i-eatlab/telehealth-recommendations-for-dysphagia-management-during-covid-19/

•  Queensland Health e-Learning Program: •  https://speechpathologyaustralia.org.au/SPAweb/

Professional_Development/Telepractice/Queensland_Health_Program.aspx

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TELEHEALTH FOR ADULT TRANSGENDER VOICE SERVICES

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NEEDS / CHALLENGES •  Patients in need •  Need for high level audio

connection •  Baseline data, mapping tx

progress, providing feedback

•  Rapport building

SOLUTIONS •  Adaptation to telepractice •  Multiple audio/mic

connections •  Utilizing Voice Analyst App

on Webex connected smartphone/tablet

•  Home environment helped build good relationship

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Link: https://www.pearsonassessments.com/content/school/global/clinical/us/en/professional-assessments/digital-solutions/telepractice/telepractice-and-the-wab-r.html

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Link: https://praacticalaac.org/?s=telepractice+

Link for video: https://www.youtube.com/watch?v=Cq46qf39S_I&feature=emb_logo

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TELEHEALTH FOR ADULT AUDIOLOGY SERVICES

§ Wide range of application in the field of audiology from diagnostic to intervention services

§ Started by identifying what opportunities and limitations exist for providing services and clinical education via telehealth

§ Focus on intervention and patient education

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TELEHEALTH FOR ADULT AUDIOLOGY SERVICES

§  Planning/Set up §  Creating a protocol §  Technology

§  Secure Webex §  Clinician, graduate clinician, patient,

patient family member(s)? §  Additional Bluetooth device needed if remote

programming §  Front desk staff provided pre-appointment

assistance as needed §  Organized additional materials to send to patients

as needed

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Patient

Graduate Clinician

Clinician

Clinic computer with HA software

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ADULT AUDIOLOGY TELEHEALTH APPOINTMENTS

§ Technology §  Hearing aids and assistive

listening devices

§  Troubleshooting

§  Remote programming

§  Replacing lost devices

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§ Counseling & patient education §  Utilizing and/or optimizing technology to improve

communication

§  Consultation & orientation

§  Communication strategies

§  Device maintenance

§ Considerations with COVID-19 § Masking wearing impact on communication

§ Mask wearing and hearing aid retention

RESEARCH EVIDENCE AND PRACTICAL GUIDELINES FOR ADULT MOTOR

SPEECH DISORDERS

•  Thank you to Jordanna Sevitz, a doctoral student in Michelle Troche’s lab at Teachers College, Columbia University, and Brianna Kiefer, my doctoral student, for investigating the literature supporting the use of telemedicine in motor speech disorders and for testing the feasibility of objective measures via telemedicine – watch for the upcoming paper which is provisionally accepted in AJSLP (telemedicine special issue)

•  Most of the literature supporting the use of telemedicine in motor speech disorders was conducted under controlled research conditions with specialized equipment and custom software

•  The trick is to translate these studies to the real clinical environment

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RESEARCH EVIDENCE AND PRACTICAL GUIDELINES FOR ADULT MOTOR

SPEECH DISORDERS

•  Important to consider using both objective and perceptual measures – critical with telemedicine due to limitations of teleconferencing software

•  Difficult to reliably perceive vocal intensity, vocal quality, and potentially intelligibility

(mixed outcomes)1-3

•  Studies have shown perceptual ratings of overall speech severity and articulatory precision to be reliable1-2

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1Constantinescu, G., et al. (2010). Assessing disordered speech and voice in Parkinson’s disease: A telerehabilitation application. International Journal of Language & Communication Disorders, 45(6), 630–644. https://doi.org/10.3109/13682820903470569. 2Hill, A. J., Theodoros, D., G., ussell, T. G., RCahill, L. M., Ward, E. C., & Clark, K. M. (2006). An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. American Journal of Speech-Language Pathology. 3Utianski, R. L., Sandoval, S., Berisha, V., Lansford, K. L., & Liss, J. M. (2019). The effects of speech compression algorithms on the intelligibility of two individuals with dysarthric speech. American Journal of Speech-Language Pathology, 28(1), 195-203.

RESEARCH EVIDENCE AND PRACTICAL GUIDELINES FOR ADULT MOTOR

SPEECH DISORDERS •  What types of objective measures are possible?

•  Fundamental frequency (mean and range), speech rate, utterance length, pause patterns, DDK rates and regularity

•  Important to develop a simple protocol and to use the same protocol with all patients

•  Due to issues with teleconferencing software, measurements of vocal intensity are not valid in most interfaces •  However, SpeechVive, Inc. has a software that can be used with the SpeechVive

device that controls gain and can be used to obtain measures of vocal intensity – available for free right now and can be used with telemedicine

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www.speechvive.com

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RESEARCH EVIDENCE AND PRACTICAL GUIDELINES FOR ADULT MOTOR

SPEECH DISORDERS •  Do not forget about the value of devices in telepractice treatment •  Lots of options out there:

•  EMST-150 (and a lower threshold option, EMST-75): www.emst150.com

•  PowerBreathe (comes in three levels): www.powerbreathe.com

•  SpeechVive: www.speechvive.com

•  Voice amplifiers

•  Pacing boards

•  And others

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Thank you

Contact info: [email protected] [email protected]

[email protected] [email protected]

[email protected] [email protected]

https://www.purdue.edu/hhs/slhs/

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STAY TUNED FOR MORE SLHS WEBINARS AND

OPPORTUNITIES IN UPCOMING MONTHS!!

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@PurdueSLHS Purdue University Speech, Language, and

Hearing Sciences

@purdueslhs