Neuro Reflections 2 – Telerehabilitation

Technology has come a long way since the olden days of the Commodore 64 or the Apple IIE. We now have more technological capability in our smart phones than the Apollo space rockets of the 1960s (which is pretty amazing). The growth of technology has meant speech-language pathologists can provide therapy to more people in more varied ways. I recently attended some training in Brisbane all about telerehabilitation. I learned more about what telerehabilitation is, and how to deliver assessment and therapy to people who have speech, language, cognitive and swallowing problems using Skype/Factime, secure videoconferencing, or through email, apps or video.

 

What is telerehabilitation?

Telerehabilitation is where speech, language, cognitive or swallowing assessment and/or treatment is delivered remotely via the internet, email, phone, or through apps on an iPad or tablet. Telerehabilitation can be very useful for people who find it hard to get to therapy sessions. This could be because they have no transport, or because they live many kilometres from the nearest therapist. Perhaps the individual needs specialist assessment or therapy and their local speech-language pathologist isn’t able to deliver the treatment they need. Maybe someone already attends face to face therapy but wants to increase the amount of therapy they receive by having extra therapy sessions or speech/language practice done over the computer with their therapist. Maybe the person is working full-time and despite wanting therapy, don’t have the time to travel to the clinician they really want to see.

Telerehabilitation can sometimes be slightly cheaper than face to face therapy. This is because the speech-language pathologist may usually include travel costs in their fees, but with telerehabilitation, there is no travel involved and this may mean fees are slightly lower.

There are three main types of telerehabilitation:

  1. Live (also known as “synchronous”) – this is where a speech-language pathologist and a client uses a platform like videoconferencing, Skype or FaceTime to do assessment or therapy. Phone calls and email consultations are other examples.
  2. Offline (also known as “asynchronous”) – this is where a speech therapist might make a video of a therapy task and send it to a client using a link, or record some therapy instructions and send them in an audio file as an email attachment. In other words, something is recorded and saved to be used later. Using a therapy app or computer program might also be considered an offline approach to therapy particularly if the app has the ability to email session results to the therapist, or if the app uses a “virtual therapist” or avatar to provide or assist with therapy.
  3. Combination of live and offline – some treatment sessions might be done live; some sessions and perhaps home practice might be done offline.

 

Is therapy or assessment delivered via telerehabilitation as effective as face to face assessment or therapy?

There is a growing amount of research into whether telerehabilitation is as effective as face to face therapy. There is now good evidence that telerehabilitation provides the same or similar results in speech, language and swallowing assessment and therapy as face to face sessions. There are some areas of speech-language therapy that need more research, and there are some things that speech-language therapists do that can’t be done over the internet or by phone, but for the majority of things, telerehabilitation has been shown to be as effective as face to face.

 

Is telerehabilitation for me?

There are some thing you need if you’re going to have your assessment or therapy using telerehabilitation:

  • A willingness to give it a go. Doing your speech/language/swallowing therapy using the computer may sound like an odd concept, but sometimes it’s best to try it and see how you find it. Then you can make an informed decision about it. Don’t let lack of confidence hold you back!
  • A computer or laptop with an internal or external webcam, or an iPad, iPhone or tablet (these usually come with apps like FaceTime, or you can download Skype).
  • A reliable internet connection.
  • Someone to help you, if you need help using your device.

You may also need a printer to print off therapy materials your clinician emails to you. If you don’t have a printer, don’t worry – materials can be posted instead.

A telerehabilitation approach is not for everyone. Some individuals aren’t connected to the internet, don’t have access to or don’t have money to buy a computer, iPad or tablet, have limited internet download capacity, or an unreliable or weak internet connection. Some people don’t feel confident using a computer or a tablet. Others feel confident with technology but need someone to help them access it and don’t currently have someone to help.

In the end telerehabilitation is something to seriously consider.

 

What about security?

A video connection over the internet can be secure or non-secure. Secure means the connection can’t be hacked by someone else. Non-secure means the connection may be hacked. Examples of non-secure connections are Skype and FaceTime. Secure connections usually involve a videoconferencing app or software such as NeoRehab or Coviu. You can discuss security with your speech-language pathologist.

 

How about funding?

The unfortunate thing is that telerehabilitation is not covered by Medicare, and is often not covered by private health funds (although it’s worth asking the question of your private health fund if you’re considering using telerehabilitation). This is personally and professionally frustrating because there is clear research evidence that telerehabilitation approaches often work as well as face to face sessions.

 

Where does Neuro SLP fit in?

Neuro SLP uses all of the above telerehabilitation methods to help people who have speech, language, cognitive and swallowing problems. If you or someone you know wants to talk about whether telerehabilitation might be for you, give me a call or contact me through my website contact page. I’m more than happy to talk about whether telerehabilitation – in one form or another – might be a good approach for your speech, language, cognitive or swallowing therapy.

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