Impact of COVID-19 in relation to the outpatient pediatric feeding therapy experience: A speech-language pathologist's review of literature and professional experience.

It is well known in the medical and pediatric feeding community how parental stress affects outcomes of pediatric nutrition and feeding behaviors. There is growing literature suggesting the impact of the COVID-19 pandemic in relation to caregiver and child stress. It could be suggested that this increase in stress contributed to or exacerbated pediatric feeding difficulties. In addition, the COVID-19 pandemic resulted in pediatric rehabilitation therapists quickly transitioning from in-person to virtual evaluation and treatment models. The purpose of this article is to review current literature regarding the definition and prevalence of pediatric feeding disorder, the impact of the COVID-19 pandemic on parent/child stress and relationships surrounding feeding, and this speech-language pathologist's perception of both the positive and negative aspects of providing ongoing outpatient feeding evaluations and treatments in the context of the COVID-19 pandemic, as well as clinical considerations for ongoing feeding therapy after the COVID-19 pandemic.

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.

Parent/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born With Cleft Palate Delivered via Telemedicine During COVID-19.

PURPOSE: The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK). METHOD: Parents were asked whether they found this method of delivery "very effective," "somewhat effective," or "not at all effective." Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal-Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis. RESULTS: One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was "somewhat effective," 56 (26.4%) "very effective," and 16 (7.6%) "not at all effective." There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as "better than nothing." CONCLUSIONS: Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least "somewhat effective." It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision.

Providing Telepractice in Schools During a Pandemic: The Experiences and Perspectives of Speech-Language Pathologists.

PURPOSE: The main objective of this study was to gain insight into school-based speech-language pathologists' (SLPs') perspectives on and experiences with telepractice as a service delivery model at the onset of the COVID-19 global pandemic. A better understanding of the facilitating and challenging factors that belie telepractice-based services will guide the creation of training and resource development to further support remote speech-language services in schools. METHOD: Four focus group sessions using a semistructured format were conducted with 22 school-based SLPs from 14 states in the United States. The focus groups provided an opportunity for SLPs to reflect on their telepractice experiences, including pros and cons, necessary knowledge and skills, factors impacting telepractice service delivery, and student and family participation. Inductive thematic analysis was used to describe the collective experiences and perspectives of the participants. RESULTS: Three themes regarding telepractice emerged: technology use, locus of control for decision making, and student and family engagement. Participants reported experiencing a range of successes and challenges when attempting to meet students' needs and identified gaps in resources and school capacity for telepractice. CONCLUSIONS: The findings revealed how school SLPs experienced telepractice service delivery during the remote learning portion of the 2019-2020 school year due to the onset of the COVID-19 pandemic. The study increases our understanding of factors that facilitated and challenged the effective delivery of speech-language services via telepractice. To assist SLPs in future telepractice efforts, implications for professional development and further research are provided.

School-Based Speech-Language Pathologists' Stress and Burnout: A Cross-Sectional Survey at the Height of the COVID-19 Pandemic.

PURPOSE: Low retention of school-based speech-language pathologists (SLPs) is a growing problem that can have drastic consequences at the school and student levels. Factors contributing to this shortage include features of the work environment, role ambiguity, low salaries, and a demanding workload with higher caseloads, which can result in limited time for paperwork and lesson planning for optimal service delivery models. The purpose of this study was to determine the current levels and predictors of occupational stress and burnout SLPs are experiencing in the school setting. METHOD: Using a cross-sectional survey design, 453 school-based SLPs from across the United States reported their workload manageability, career intentions, access to social support, and their stress and burnout levels. Multiple linear regression was used to determine the relation between the variables of interest and the occupational stress and burnout scores. Data were collected in September to December of 2020, at the height of the COVID-19 pandemic. RESULTS: SLPs, on average, reported overall stress levels in the somewhat noticeable range, moderate access to social support, high levels of emotional exhaustion, low-to-moderate feelings of depersonalization, and moderate-to-high feelings of personal accomplishments. Based on a standardized burnout scale, SLPs in this sample are characterized as feeling ineffective and overextended. Results of linear regression models suggest that the perception of work manageability was the best predictor of Total Stress score, Emotional Exhaustion score, and Depersonalization score, in this sample. CONCLUSIONS: Data from this study offer the beginning steps to making an informed change for school-based SLPs' workplaces. Results indicated that SLPs in the school setting are feeling ineffective and overextended. The perception of their workload manageability was the most significant predictor for their reported stress and burnout levels. Suggestions for SLP supervisors, administrators, and other stakeholders are discussed.

Telehealth Management of Dysphagia in Adults: A Survey of Speech Language Pathologists' Experiences and Perceptions.

The goal of this study was to explore telehealth use for dysphagia management in response to COVID-19 to understand variables associated with clinician confidence and perceived effectiveness of this service delivery model and determine clinician-perceived benefits and challenges of managing dysphagia via telehealth. Speech-language pathologists (SLPs, n = 235) completed a web-based survey, providing information on demographics, telehealth use during the pandemic, and perspectives on current and future tele-management of dysphagia. Analyses included descriptive statistics to examine usage patterns; logistic regression to determine which variables were associated with telehealth use, clinician confidence, and perceived-effectiveness; and conventional content analysis to analyze responses to open-ended questions. Results revealed a sharp increase in the tele-management of dysphagia during the pandemic. Years of experience with dysphagia management (p = .031) and pre-pandemic use of telehealth (p < .001) were significantly associated with current use patterns. Working in the outpatient setting was associated with greater clinician confidence (p = .003) and perceived effectiveness (p = .007), and use of guidelines (p = .042) was also associated with greater clinician confidence. Key challenges identified included inadequate technological infrastructure, inadequate patient digital literacy, and reimbursement restrictions. Key benefits were treatment continuity, improving access to care, and time savings. The majority (67%) of respondents reported that they would use telehealth in the future. These findings demonstrate SLPs' abilities and desire to expand their practice patterns to include telehealth for dysphagia management. Therefore, clinician training and more research on best practices for assessment and treatment of dysphagia via telehealth is warranted to refine models of care for dysphagia tele-management.

Training School Professionals in a Global Pandemic: Insights From Elementary Education and Speech-Language Pathology.

PURPOSE: The purpose of this research was to explore the preparation of practitioners from two disciplines-speech-language pathology and elementary education-who often work together in a school setting to identify ways to best support future professionals in their educational practicum settings. The primary research questions guiding this investigation were as follows: Did the student teaching and supervision experiences of preservice K-6 teachers (PSTs) and their mentors and speech-language pathology graduate student clinicians and their supervisors differ during the COVID-19 pandemic, and if so, in what ways? METHOD: A total of 54 participants from one university participated in this study from four groups: 15 graduate student clinicians in a speech-language pathology program, 14 speech-language pathology supervisors, 14 PSTs, and 11 teacher mentors. Survey questions were designed to capture the perceptions of students and supervisors in the fields of speech-language pathology and elementary education who were in the school setting during the fall 2020 semester. Quantitative and qualitative questions were included to obtain information related to the following areas: planning, environment, supervision preferences, team experiences, professional development, and telepractice. RESULTS: Speech-language pathologists and teacher mentors reported being able to successfully mentor and supervise students in the school setting despite significant challenges presented by the global pandemic. Findings also identified several significant differences in the experiences of PSTs and speech-language pathology graduate student clinicians who were in the schools for field experiences. CONCLUSIONS: Overall, speech-language pathology graduate student clinicians and their supervisors as well as PSTs and their teacher mentors reported adequately navigating their field experiences during the COVID-19 pandemic. Implications for how these findings can inform professional preparation programs to optimize future educational and therapy outcomes for students are discussed.

Application of machine learning approaches to analyse student success for contact learning and emergency remote teaching and learning during the COVID-19 era in speech-language pathology and audiology.

BACKGROUND:  The onset of the COVID-19 pandemic across the globe resulted in countries taking several measures to curb the spread of the disease. One of the measures taken was the locking down of countries, which entailed restriction of movement both locally and internationally. To ensure continuation of the academic year, emergency remote teaching and learning (ERTL) was launched by several institutions of higher learning in South Africa, where the norm was previously face-to-face or contact teaching and learning. The impact of this change is not known for the speech-language pathology and audiology (SLPA) students. This motivated this study. OBJECTIVES:  This study aimed to evaluate the impact of the COVID-19 pandemic on SLPA undergraduate students during face-to-face teaching and learning, ERTL and transitioning towards hybrid teaching and learning. METHOD:  Using course marks for SLPA undergraduate students, K means clustering and Random Forest classification were used to analyse students' performance and to detect patterns between students' performance and the attributes that impact student performance. RESULTS:  Analysis of the data set indicated that funding is one of the main attributes that contributed significantly to students' performance; thus, it became one of the priority features in 2020 and 2021 during COVID-19. CONCLUSION:  The clusters of students obtained during the analysis and their attributes can be used in identification of students that are at risk of not completing their studies in the minimum required time and early interventions can be provided to the students.

Simulations as a mode of clinical training in healthcare professions: A scoping review to guide planning in speech-language pathology and audiology during the COVID-19 pandemic and beyond.

BACKGROUND:  Simulation plays an important role as an alternative method for training of students, particularly in health education. As a result of coronavirus disease 2019 (COVID-19) restrictions of face-to-face interactions, traditional teaching methods have been disrupted, increasing the need for alternative methods to supplement modes of student clinical training in healthcare programmes. OBJECTIVES:  The scoping review aimed to determine what has been documented about simulation as a mode of clinical training in healthcare professions (HCPs) in order to guide speech-language pathology and audiology (SLPA) professions during the COVID-19 pandemic and beyond. METHOD:  A scoping review was conducted. Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE, ProQuest, Google Scholar and WorldCat were searched to identify peer reviewed publications, published in English, between January 2011 and December 2021, and related to the use of simulation in HCPs clinical training programmes. RESULTS:  A total of 32 articles met the inclusion criteria for this scoping review. Three themes emerged when reviewing the studies: (1) face-to-face simulations as a mode of clinical training, (2) virtual reality simulation and telesimulation as modes of clinical training and (3) simulation as a complementary mode of clinical training. Evidence suggests that whilst simulations are cost-effective, accessible and efficacious as clinical training modes, they need to be combined with other modes of training such as the traditional clinical training to yield better learning outcomes. CONCLUSIONS:  Current findings highlight the role and value of simulation as a clinical training mode during COVID-19 and beyond. However, there are aspects that need to be considered to ensure that this mode of clinical training is effective, with endorsement and regulations by the SLPA Professional Board of the Health Professions Council of South Africa (HPCSA). Simulations need to be complemented with traditional clinical training methods. In the context of SLPA, particularly in low- and middle-income countries (LMICs), simulation can be used to better prepare students for their clinical placement where clinical training platforms are limited and where simulation combined with teletraining or telesupervision can be utilised to increase access to training.

The perspectives of speech-language pathologists: Providing teletherapy to patients with speech, language and swallowing difficulties during a COVID-19 context.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on every facet of life. This directly included the delivery of health care from allied health professionals such as speech-language pathologists (SLPs) in South Africa. Research has shown that there is limited research done locally on the impact of COVID-19 relating to stroke care. Consequently, this results in a lack of research on the provision of speech, language and swallowing intervention using teletherapy after a stroke from an SLP point of view. OBJECTIVES:  The aim of this study was to explore the experiences of SLPs with regard to their use of teletherapy in a COVID-19 context when providing speech, language and swallowing intervention for patients after a stroke. METHODS:  This study made use of a qualitative approach. An electronic questionnaire was sent to SLPs inviting them to participate in the study. Purposive sampling was used to recruit participants and thematic content analysis was used to analyse the open-ended qualitative questions. RESULTS:  The findings show that SLPs experienced a variety of facilitators and barriers to using teletherapy. Additionally, issues of access differ across the private and public sector SLPs for both the clients and the SLPs. CONCLUSION:  The current study provided research in the field of teletherapy, which is relatively new in the South African context. The study, whilst small in scale, provided some insight into the changes experienced from the shift to teletherapy.

Exploring the online learning experience of first-year speech-language pathology students in a Johannesburg-based university.

BACKGROUND:  Understanding the learning experiences of first-year speech-language pathology (SLP) students during the coronavirus disease 2019 (COVID-19) pandemic is essential to ensure that academic staff are able to support and enhance the transition from secondary to tertiary education. An understanding of the student experience could lead to improved support strategies that could be beneficial for the blended learning environment that the University of the Witwatersrand will be entering from 2022. OBJECTIVES:  This research explored the experiences of first-year SLP students in online learning during the COVID-19 pandemic. METHOD:  An exploratory mixed-method concurrent triangulation design was employed. Quantitative data were collected from likert scales. Qualitative data were collected from critical incident timelines. Themes were identified from both the Likert scales as well as the critical incident timelines using bottom-up thematic analysis. RESULTS:  The majority of participants reflected that their online learning through the pandemic in 2021 was successful. The themes that emerged from this year pertain to 2021 and the specific participants however, it provides an important insight that the students' needs change during a year. As a lecturer, one needs to consider these evolving needs to ensure students have the support that they require to be successful in their learning. CONCLUSION:  This research provided insights into the evolving nature of the support first-year SLP students require in the online learning space during the COVID-19 pandemic.

Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic.

PURPOSE: The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families. METHOD: Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods. RESULTS: Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement. CONCLUSION: These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20405673.

Conducting clinical research in the era of the COVID-19 pandemic: Challenges and lessons for Speech-Language Pathology and Audiology research.

BACKGROUND:  The novel coronavirus disease 2019 (COVID-19) presented new and unanticipated challenges to the academic training and performance of clinical research at undergraduate and postgraduate levels of training. This highlighted the need for reimagining research designs and methods to ensure continued generation of knowledge - a core function of a research-intensive university. Whilst adhering to government regulations geared towards protecting both the research participants and researchers, innovative research methods are required. OBJECTIVE:  The purpose of this scoping review is to explore published evidence on innovative clinical research methods and processes employed during COVID-19 and to document challenges encountered and lessons that the fields of Speech-Language Pathology and Audiology can learn. METHODS:  Electronic bibliographic databases including Science Direct, PubMed, Scopus, MEDLINE, ProQuest were searched to identify peer-reviewed publications, published in English, between 2019 and 2021, related to innovative clinical research methods and processes applied where in-person contact is regulated. RESULTS:  Significant challenges with conducting research in the COVID-19 era were identified, with important lessons learned and numerous opportunities that have relevance for this pandemic era and beyond. These findings are presented under 10 themes that emerged that highlight important considerations for research methods and processes during a pandemic and beyond. The findings of this study also raise implications for telehealth from which low- and middle-income countries (LMICs), where resource challenges exist, can benefit. CONCLUSION:  Challenges and opportunities identified in this review have relevance for the field of Speech-Language Pathology and Audiology as far as current and future (beyond COVID-19) clinical research planning is concerned.

Elizabeth Usher memorial lecture: Speech-language pathology in the transformative age - valuing connectivity.

Living in the transformative age is one of disruption, change, and infinite opportunity. However, living in a cloud-based world with self-driving cars, advanced robotics, artificial intelligence, e-health, 3-D printing, and COVID-19 can also be somewhat daunting, challenging, and even confronting. As speech-language pathologists, researchers, educators, and advocates, we need to be agile, more creative and connected to data, experiences, and people. Now more than ever, these connections will enable transformation and ensure the future of our profession.speech-language pathologists are now practising on a global scale, in multiple languages and unique contexts, and the education of our future workforce is critical. Over the past 10 years, there has been rapid growth in the number of speech-language pathology training programs delivered by universities in Australia, as well as a significant shift in the demand for services and changing employment opportunities. In Australia, the profession has been planning for the future; Making Futures Happen, Building a Future workforce, and re-developing our Professional Standards. But, are we really cognisant of the global challenges and opportunities for our profession? Do we really value global connectivity?In this discussion paper, authentic examples and plausible scenarios are being used to explore the global transformation of the speech-language pathology profession. Each will highlight some of the political, economic, societal, cultural, and technological influences on speech-language pathology research, teaching, and practices that are driving development, change, and innovation. Readers will be challenged to consider how thinking globally, with a focus on context, translation, and connection will enable them to rise to the challenges we face today and forge new paths for the future.

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic.

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

Reliability of Scoring Telehealth Speech Sound Assessments Administered in Real-World Scenarios.

PURPOSE: COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology. METHOD: A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey. RESULTS: All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment. CONCLUSIONS: This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19593367.

Knowledge, Attitudes, and Practices of Speech Language Pathologists in India about Telerehabilitation Services during the COVID-19 pandemic.

PURPOSE: The global impact of the COVID-19 pandemic has opened opportunities for service providers and patients to continue with clinical services in certain extraordinary settings and circumstances. Telerehabilitation in the field of speech language pathology in India is still at its infancy, with a majority of the Speech Language Pathologists (SLP) accustomed with the conventional face-to-face system of service delivery. The present study aims to gather the knowledge, attitudes, and practices (KAP) of SLPs in India regarding telerehabilitation services during the pandemic. METHODS: The study was conducted in three phases: phase I involved the development and validation of a questionnaire to explore the KAP of SLPs regarding telerehabilitation services. The items were framed based on a Likert rating scale (strongly agree, agree, neutral, disagree, and strongly disagree), yes-no-maybe format, open-ended, and multiple-choice format. Phase II involved data collection, while phase III involved data analysis. Descriptive statistics was done to derive the frequency and percentage for discrete variables and mean and SD for continuous variables. RESULTS: Many SLPs feel underprepared in their technical knowledge and skills needed for telerehabilitation. Furthermore, a majority of the SLPs also did report patients to be relatively lesser motivated and satisfied with tele practices due to issues that are discussed in the paper. CONCLUSION: This study is an initial attempt to touch upon the fabric of telerehabilitation services delivered by SLPs of India. Future studies are directed to study the technical, professional, and personal issues encountered during telerehabilitation services specifically pertaining to specific communication disabilities.

Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond.

The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.