By Meggin Nunamaker
Introduction
It is said, “Necessity is the mother of invention.” In this case, the global covid pandemic made “no contact” restrictions necessary, which was the catalyst for the surge of telepractice. “Telepractice is the delivery of services using telecommunication and internet technology to remotely connect clinicians to clients, other health care providers, and/or educational professionals for screening, assessment, intervention, consultation, and/or education.”, (American Speech-Language-Hearing Association, n.d.) While researching this topic, and asking colleagues opinions on social media, I found varying views, pointing out advantages and disadvantages of telepractice. It made me wonder, “What does this mean for people who use AAC?”
Advantages of Telepractice
A paramount advantage of telepractice is increased accessibility for several reasons. People who use AAC often will have coexisting motor disabilities and/or cognitive disabilities. Some clients have very complex disabilities. Not having to travel anywhere reduces the probability of AAC clients having fatigue, improves appointment time and scheduling of appointments. Another reason telepractice does not require AAC users to travel to hospitals, clinics, etc., therefore, reducing the risk if exposure to sickness (Erin Beneteau, Ann Paradiso, and Wanda Pratt, 2021) .
Telepractice allows clients who have disabilities, including clients who use AAC to utilize services they otherwise would not be able to. Also, they could have access to certain or multiple professionals that are difficult to get on their schedule.
Lastly, using tele-health allows AAC clients to use their preferred method of communication, when interacting with providers. Last night I “attended” a Zoom video meeting of the USSAAC Speaker Connection. The speakers were all AAC users. We all used different communication methods. I and others typed in the chat box. Some spoke with the voice on their SGD’s, etc. The meeting went well.
Disadvantages of Telepractice
Accessibility, or lack of can be an impactful disadvantage. Some obstacles fall under the category of “technical barriers”. People with disabilities, including AAC users may not have physical access to necessary equipment. For example, they cannot use a standard keyboard and mouse. Another obstacle is technical interference between AAC software and telepractice systems.
In research interviews, AAC users “… discussed how they had to balance their own technical needs with the needs of their healthcare provider…”, (Beneteau, Paradiso, and Pratt, 2021). For example, healthcare providers may only have one option of telepractice technology such as a phone call, that does not meet technology needs of the AAC user.
Another impediment is the ample time it takes to type an answer in an AAC device. Providers must wait for a response, and they have to be sure the silence is not interference of the technologies. I and other AAC Speakers experienced this at the aforementioned Zoom meeting. This problem cuts into the allotted time allowed for the appointment, (Beneteau,Paradiso, and Pratt, 2021).’ Another category of disadvantages is cognitive barriers. One challenge of telepractice for AAC users is when they have received a new AAC device, and are unfamiliar with how to use it. Some AAC users may not have the cognitive function to effectively use the telepractice systems, ( Beneteau, Paradiso, and Pratt, 2021). They just may not know how to use such equipment assimilated with their AAC technology, (Ayres et al., 2021).
Perhaps a most important obstacle is cost. A lot of people cannot afford such equipment, plus any assistive technology or AAC they need, let alone a good internet connection.
Many of those who need telepractice services are SSI (disability) recipients. I know from first-hand experience; there are laws and policies that limit their net worth. This makes out-of-pocket purchases of needed AT & AAC equipment very difficult.
Solutions
If an AAC client cannot independently use the telepractice system such as trouble physically accessing the system, or the AAC client has low cognitive function; This can be remedied by having someone such as a family member or caregiver sit in and participate in the tele-session. A good explanation for effective accessibility to telepractice for AAC users is to have multiple modes of telepractice systems, so they can use a system best fit for their AAC client. This leads to the issue of cost. Many providers have limited resources, and cannot afford multiple systems.
“We encourage designers of telehealth systems to include AAC users and clinicians in telehealth design and development, including individuals who use alternative access methods. We also encourage policymakers and administrators to consider broadening funding options to ensure that AAC users have equitable access to telehealth”, (Beneteau, Paradiso, and Pratt, 2021) .
A final issue is how are speech language therapists & other providers prepared to perform telepractice with clients who use AAC? One study found, “…the use of simulation in AAC through telepractice as a means of supporting masters level speech pathology students learning in this area of practice.”, (Howells et al., 2019). In the future, you most likely will see an increase in telepractice training as part of speech language pathologists’ curriculum.
Telepractice can be an effective way to administer services. However, it comes with a few bugs, and it should be incorporated into a multimodal approach to treatment plans. It is evident that telepractice is here to stay. As technology changes and advances, it will take telepractice services to the future and beyond.
References
American Speech-Language-Hearing Association. (n.d.). telepractice. https://www.asha.org/practice-portal/professional-issues/telepractice/
Ayres, L., Pelkowitz, L., Simon, P., & Thompson, S. C. (2021). Necessity as the Catalyst of Change: Exploring Client and Provider Perspectives of Accelerated Implementation of Telehealth by a Regional Australian Community Service Organisation during COVID-19 Restrictions. International Journal of Environmental Research and Public Health, 18(21), 11433. https://doi.org/10.3390/ijerph182111433
Cascio, C. J., Moore, D., & McGlone, F. (2019). Social touch and human development. Developmental Cognitive Neuroscience, 35, 5–11. https://doi.org/10.1016/j.dcn.2018.04.009
Howells, S., Cardell, E. A., Waite, M. C., Bialocerkowski, A., & Tuttle, N. (2019). A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students’ confidence and perceptions. Advances in Simulation, 4(S1). https://doi.org/10.1186/s41077-019-0113-x
Beneteau, E., Paradiso, A., and Pratt., W. (2021). Research and Applications Telehealth experiences of providers and patients who use augmentative and alternative communication. Journal of the American Medical Informatics Association, 29(3), 481–488. https://doi.org/10.1093/jamia/ocab273
Grant, C., Jones, A., & Land, H. (2022). What are the perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays? A systematic review of the literature. Australian Journal of Rural Health, 30(3), 321–336. https://doi.org/10.1111/ajr.12843
About the Author
Meggin Nunamaker has a bachelor’s degree and master’s degree in Communication Disorders from Murray State & Western Kentucky Universities. She has a congenital muscle myopathy that is progressive (described as similar to muscular dystrophy). She now has a tracheostomy (since 2012) and lives in a hospital on a ventilator (since 2013). She has been using AAC for about two or three years. After much trial & error, she finds that using a built-in function of an on-screen keyboard to “type” messages by clicking letters works best for her. She also uses a free text to speech app that she downloaded on her laptop from the Microsoft store. She was inducted into the vast world of AAC when she joined Patient Provider Communication network, and became a registered speaker for the United States Society of AAC. She’s written and published two books. This first book, A New Beginning, chronicles what it is like to live with a tracheostomy. The second book, Real Life is too Funny to Make Up (publication in process), contains funny and heartfelt stories from her life.
