An exploratory study of speech-language pathologists' clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19.

Purpose: To explore speech-language pathologists' (SLP) practice in literacy prior to, and during, COVID-19 to understand the practicalities, feasibility and sustainability of telepractice literacy services.Method: This exploratory study employed a cross-sectional survey comprising 46 questions covering participants' caseload profile and service delivery models, their assessment and intervention practices and telepractice delivery of literacy services.Result: Participants were 44 SLPs working primarily in private practice and education with children and adolescents. Students with literacy difficulties comprised a significant proportion of SLPs' caseloads. Individual and group sessions were the most common format of delivery prior to COVID-19. In a telepractice model during COVID-19, SLPs saw fewer students overall. Most provided individual sessions only and reported cancellation of group sessions. SLPs described their practice in literacy as being aligned with evidence-based principles. A range of resources were used for literacy assessment and intervention. For most, their usual practice changed for telepractice. Many felt underprepared to use telepractice and experienced numerous challenges mostly relating to technology and family engagement.Conclusion: Literacy has become a core area of practice for SLPs; however, continued advocacy towards consultative and collaborative services is needed within onsite and telepractice models. Telepractice required SLPs to develop additional skills and modify usual practice. Despite experiencing challenges, many indicated they would continue with telepractice given its perceived benefits.

Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists.

PURPOSE: This prospective cross-sectional study aimed to investigate the opinions and experiences with telepractice (TP) of Dutch-speaking speech-language pathologists (SLPs) living in the Dutch-speaking part of Belgium (Flanders). This study will help to optimize care for children with speech-language disorders as we will gain more insight into the experienced barriers and facilitators while using TP for assessing and treating these disorders. METHOD: Twenty-nine Dutch-speaking speech-language pathologists living in Flanders (age category 20-30 years: n = 16/29, 55.2%, 31-40 years: n = 10/29, 34.2%, 41-50 years: n = 2/29, 6.9%, 51-60 years: n = 1/29, 3.4%) were recruited through the social media. An online questionnaire was developed based on the available literature and administered to the SLPs. To compare the opinions and experiences of SLPs with TP, χ2 tests or Fisher's exact tests were used. RESULTS: The study showed a statistically significant association between years of clinical experience of SLPs and their opinion that TP does not provide more options in a clinical setting compared to face-to-face contact. SLPs who had expertise in multiple domains experienced significantly more added value of TP during the corona pandemic than SLPs who had expertise in only one specific domain. Additionally, SLPs who worked in a private practice indicated significantly more difficulties in developing a therapeutic relationship due to a lack of personal contact than SLPs who worked in other settings. 51.7% (15/29) of the SLPs experienced technical barriers using TP. CONCLUSION: Expertise in multiple domains of pediatric speech-language therapy resulted in experiencing more added value of TP during the corona pandemic, possibly because of the experience of multiple different and simultaneous advantages of TP in several domains. Additionally, SLPs in a private practice experienced more difficulties in developing a therapeutic relationship due to a lack of personal contact with their clients. This is in contrast to hospitals where children are often seen for a shorter period. Hence, there may be less chance of a negative perception of relationships with clients. Another conclusion is that treatment drop-out was not larger using TP compared to face-to-face therapy. However, SLPs experienced that the use of TP was not promoted/encouraged by their employer possibly because of technical barriers. It is hoped that the findings of this study will help SLPs and policymakers overthrow existing barriers and make telepractice a substantial, effective, and efficient service delivery model.

The Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk: A 2021 Follow-Up Study

Purpose: This study assessed changes in speech-language pathology practice 1 year following the onset of the COVID-19 pandemic. The specific focus was on speech-language pathologists (SLPs) engaged in evaluation and treatment activities that pose an increased risk of virus transmission, namely, aerosol-generating procedures. Method: SLPs from the United States and Canada (n = 609) who were engaged in clinical activities with an elevated risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included continuation, modification, or cessation of clinical services, personal protective equipment (PPE) use, COVID-19 infections and vaccinations among SLPs, and financial impacts. For comparison, the results from the 2020 survey are included, and the percentage change (2020% - 2021%) is reported. Results: A majority of SLPs (90%) who completed the current survey reported that they were not experiencing PPE shortages, a marked change from the 2020 survey. Over half of the SLPs (52%) reported changes in clinical duties in 2021, with in-person visits and endoscopy being the most impacted. Nearly half of the respondents (49%) reported conducting virtual/telehealth clinical activities during the pandemic, and of these, 78% had not done any virtual/telehealth work prior to COVID-19. A positive COVID-19 test was reported by 10% of the SLPs (5% higher than in 2020). Most SLPs (92%) indicated they were vaccinated at the time of this survey. Conclusions: The 2021 survey data indicated an overall increase in SLP clinical activities compared with 2020 but have not yet returned to prepandemic levels. These results highlight a notable uptake of virtual/telehealth practice by SLPs, including those who had not previously done so. SLP vaccination rates also exceeded that of the general population.

Professional Training and Therapeutic Resources Needed for the Adoption of Telepractice in the Philippines

With the COVID-19 pandemic necessitating the adoption of telepractice for providing speech and language therapy services, this study investigated the factors affecting the perceptions and the implementation of telepractice for school-age children by speech language speech-language pathologists (SLPs) in the Philippines. Sixty-four SLPs completed a 36-item online survey assessing the adoption of telepractice, implementation concerns, student candidacy, continuous training in telepractice, and the SLPs' demographics. The SLPs reported that they quickly adopted telepractice in their services for school-age students at the start of the pandemic. Multiple linear regression analyses revealed that SLPs' perceptions of the effectiveness of telepractice were significantly affected by implementation difficulties while SLPs' future use of telepractice was significantly predicted by training and resource availability. These results suggest that professional training and other therapeutic resources are needed to alleviate SLPs' concerns about difficulties in implementing and continuing use of telepractice.

Feeding practices in public hospitals' neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng.

BACKGROUND:  South Africa's healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU. OBJECTIVES:  This study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng. METHODS:  A qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis. RESULTS:  Although the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites. CONCLUSION:  COVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown.

Pragmatic impairment and COVID-19

The COVID-19 pandemic is the greatest global health threat in over 100 years. Its impact is seen in large numbers of premature deaths and the loss of economic stability for many millions of people. A significant number of people who contract the SARS-CoV-2 virus – the virus that causes COVID disease – experience symptoms many months after their acute illness. So-called Long COVID is now a recognized condition, with many affected individuals unable to return to work and engage in other daily activities. Among the complex symptoms of this condition is “brain fog”, a constellation of cognitive-linguistic problems that manifest as forgetfulness, word-finding difficulty, a lack of attention and concentration, and problems engaging in conversation. In this paper, I examine two women who had moderate COVID-19 infection during the first wave of the pandemic in Belgium and the UK. Both participants reported cognitive-linguistic difficulties several months after first becoming unwell. The UK participant is a native English speaker while the participant in Belgium speaks English as a second language. Case studies are used to examine their pre-morbid functioning and lifestyle, the onset and course of their COVID illness, and its impact on their language skills. It is argued that Long COVID has the potential to disrupt pragmatic and discourse skills even as structural language skills are intact. As such, this condition requires further systematic study by clinical linguists and speech-language pathologists.

Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Another Moment in Time: A Follow-Up Survey on Speech-Language Pathologists' Experiences With the COVID-19 Pandemic During the Fall of 2020

Purpose: Although the COVID-19 pandemic had been impacting K--12 education since spring 2020, educational professionals working in schools faced unique challenges at the beginning of the 2020-2021 school year. This study focused on gaining a deeper understanding of the experiences of school-based speech-language pathologists (SLPs) during the first half of the 2020-2021 school year and comparing these experiences to the previous spring. Method: This study involved a survey of 333 school-based SLPs working across the United States. The results of the survey were analyzed both qualitatively and quantitatively to identify key themes and trends related to communication, service delivery models, changes in job requirements, confidence levels, and personal challenges.

Understanding Clinician Perspectives and Actions to Address Caregiver Burden in Caregivers of Adults

Purpose: The purpose of this study was to determine how speech-language pathologists (SLPs) perceive and address caregiver burden. Method: A 29-question survey was distributed virtually via relevant Facebook pages and professional associations. Ninety-three responses from Englishspeaking SLPs working with adults in the United States or Canada were analyzed descriptively. Other analyses included one-way analysis of variance and chi-square tests to assess relationships between years of experiences, primary work setting, and other relevant variables, as well as a thematic analysis of one free-text response detailing how respondents defined caregiver burden. Results: Respondents associated caregiver burden with physical, psychological, financial, and social strain, loss of personal time, and the COVID-19 pandemic. The most described theme (80%) was physical strain. Almost all respondents (92%) believed that caregiver burden is a prominent issue and reported using strategies such as education and training to reduce burden. Most respondents (86%) would consider adopting a standardized tool to identify caregiver burden. Common barriers to addressing caregiver burden were lack of tools, time, and expertise. Additionally, less than half of respondents reported being confident in their ability to appropriately refer caregivers for support (45%). Conclusions: Most SLPs interacted with caregivers and used strategies such as education and training within their areas of expertise to try and address caregiver burden. Further research into the resources SLPs need to address caregiver burden is required. This study provides a preliminary understanding of current SLP perspectives and the strategies currently used to address caregiver burden in the United States and Canada.

TeleCPT: Delivery of a Better Conversations Approach to Communication Partner Training During a Global Pandemic and Beyond

Purpose: This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice. Method: We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies. Results: Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area. Conclusions: TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT.

COVID-19 Rehab Fright Management.

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords "Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words". Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.

Impact of coronavirus disease 2019 on professional practices of audiologists and speech-language pathologists in India: A knowledge, attitude and practices survey.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread throughout the world and become a global pandemic. This has hampered and led to drastic changes in the functioning of healthcare services, forcing the professionals to adapt and work efficiently. The present study aimed to explore the impact of COVID-19 on the professional practices of audiologists and speech-language pathologists in India using a cross-sectional knowledge, attitude and practices survey. MATERIAL AND METHODS: The study was conducted in two phases; phase one involved development and validation of the questionnaire, while phase II involved data collection. A cross-sectional self-reported internet-based study using convenience sampling was carried out. RESULTS: Two hundred and eleven audiologists and speech-language pathologists responded to the survey. Overall, the professionals exhibited good knowledge levels regarding the COVID-19 outbreak. However, there were differences in their attitudes towards service delivery in the midst of the pandemic. Further, poor practices towards infection control measures especially in terms of hand washing was noted. CONCLUSION: The findings of the present study are useful in highlighting the need to create better awareness among these professionals about appropriate and standard infection control measures. There is a need to have in place standard operating protocols for hand wash and infection control as well as inclusion in curriculum.