Telehealth and Speech-Language Pathologists

Telehealth is the application of telecommunications and teleprocessing to monitoring, assessing, maintaining, and promoting wellness. Current telehealth technologies include, among others: telephone, Internet video, voice over Internet, videoconferencing, podcasts, text messaging, and e-mail. These technologies are of increasing interest to persons involved in health-care service delivery for several reasons. First of all, they have the potential to bring down costs by increasing staff productivity, providing enhanced support, and automating records handling and processing. In addition, they can extend the geographic reach of medical personnel, permitting patient monitoring and service delivery in remote or difficult-to-reach areas. They may also support greater autonomy, dignity, and self-direction for patients as they master the use of standalone and self-guided applications and become more adept in using telehealth technologies to interact with others at a distance. Finally, they can promote long-distance connections for more effective networking as well as for wider group sharing of materials, methods, and demonstrations.

This article will introduce speech-language pathologists (SLPs) to telehealth. It touches on historical background, areas of opportunity, recent ASHA involvement, governmental policies at the national and state levels, and provides illustrative examples of promising work in academic, clinical, and commercial settings. For readers interested in more information on any of these topics, the References section at the end lists useful items for further reading.

Early Work and Reports

The idea of using telecommunications technologies to improve service delivery and extend the reach of health-care service delivery by speech-language pathologists is not new. A third of a century ago, Gwyneth Vaughn at the VA Medical Center in Birmingham, Alabama, headed work on ”tel-communicology,” which aimed to use then-available technologies in the diagnosis and treatment of neurogenic communicative disorders (Vaughn 1976a, 1976b). The intent was to supplement traditional treatment rather than replace it, and the earliest attempts involved using the telephone with a Dictaphone recorder, together with a beeper-box to comply with federal regulations about recording telephone conversations. A case report on one patient with moderate aphasia who used the system documented unexpected improvements, with verbal modality scores on the Porch Index of Communicative Ability improving from 55 to 90 percent (Sanders, 1977). Later acquisitions of more sophisticated equipment at the Birmingham facility permitted clinicians to focus on gestural and graphic modalities as well. While the equipment was primitive compared to today’s offerings, the responses of properly qualified patients were instructive: participants were generally actively engaged and enthusiastic, and their communication functions improved. This combination of more positive attitudes with improved performance in telehealth was first documented in this article, and it raised a question that still remains open: what is the role of non-linguistic factors such as motivation, positive self-image, and feelings of empowerment in a client’s improved outcomes? There is reason to think these psychological factors are among the contributors to improved outcomes often noted in clients involved.

Contemporary Telehealth - Applications for Speech-Language Pathologists

Much has changed since that early work in tel-communicology. Today the discussion is of telehealth, teletherapy, teleconferencing, and the like, and the available tools are far more powerful, flexible, and user-friendly than in the 1970s. The telephone is still one key element, but new components include personal computers with telecommunications applications such as Skype, faxes, and the Internet as well as specialized pieces of equipment. Studies show that these technologies support effective delivery of a variety of services by speech-language pathologists: assessment, treatment, home monitoring and follow-up, and the assessment of patient candidacy for tele-participation.

Assessment is an area where telecommunications equipment has proven its value. In neurogenic communication disorders, pilot studies have demonstrated the feasibility of remote assessment of motor-speech disorders (Hill et al., 2006). An extensive and carefully designed study carried out by Wertz and colleagues at the VA Medical Center in Martinez, California, compared remote to face-to-face conditions in the appraisal and diagnosis of aphasia, apraxia, dysarthria, and dementia, and it showed a 93 percent or better rate of agreement between diagnoses of the appraised clinical conditions by remote vis-a-vis face-to-face consultations. Such an agreement rate is a strong argument for exploitation of remote technologies that can save the costs of travel and hospitalization in treating distant clients (Wertz et al., 1992).