Providing speech therapy through telemedicine
Providing speech therapy through telemedicine
Rehab facility helps improve its speech outcomes
Telemedicine can be used as a way to expand a rehab facility’s continuum of care and services, but it’s also useful when a facility wishes to provide rehab therapy services to underserved communities.
For instance, INTEGRIS Jim Thorpe Rehabilitation Hospital at Southwest Medical Center in Oklahoma City developed a telemedicine program that provides speech therapy to rural students who otherwise would have to compete for the little time available from the area’s only speech/language pathologist.
The community of Hugo had one speech pathologist providing therapy to 60 students from pre-kindergarten through high school.
Initially, rehab hospital representatives approached the Hugo school district, asking its administrator if the district had any need for allied health services that the rehab hospital could provide. The administrator suggested the hospital check with Hugo Elementary School, whose officials expressed a need for a speech therapist. The hospital applied for and received a $900,000 three-year grant from the federal Health Resources and Services Administration.
Earlier in the process, however, the hospital sought buy-in from its own therapy staff. "What we did was develop stakeholders for telemedicine before getting the grant, and part of the stakeholders are therapists," says Pam Clark, PhD, director of research and development at the hospital. Staff buy-in is crucial to any new program’s success, Clark adds.
The next step was to engage the school staff and community into accepting and supporting the program. Toward that end, the hospital held a community open house to show teachers, nurses, and others how the telemedicine technology worked.
"We explained that we’d like to do a pilot program for five weeks, a research and development demonstration," Clark says. "We said, This is what it is, and do you want us to come and help the speech therapist?’"
School employees and the community agreed with the plan. They were aware that the speech therapist had too high of a caseload, and they were in danger of losing her due to burnout.
Pilot program involves five students
The pilot project involved five students at Hugo Elementary School. The rehab facility set up a two-way interaction television monitor with high-quality definition. "It’s like watching Dan Rather on the nightly news with less than a second delay," Clark says.
A speech pathologist based at Jim Thorpe Rehab Hospital met with students at the elementary school. The therapist assisted the students with their communication and articulation skills, meeting with each student twice a week for five weeks. Each session lasted 45 minutes.
The pilot program demonstrated patient satisfaction and student improvements in speech skills. The speech improvements were assessed based on pre-therapy functional improvement measurement scores based on what the parents, teachers, and the rural speech pathologist observed before and after the five-week program.
After the pilot program concluded, the school and hospital made a contract to continue the program for one school year for 11 students. "That significantly decreased the caseload of the speech pathologist in the rural community," Clark says.
The program also provided the 11 students with more intensive speech therapy. Some of those students had moderate to severe articulation deficits, and a few had developmental-delay retardation. Previously, some of them had received only 30 minutes of group speech therapy per week.
Before beginning the therapy via telecommunications, the speech pathologist drove to the Hugo school and explained to the students, their parents, and their teachers how the program would work.
The speech pathologist met with students via telecommunications a total of 450 times during a nine-month period. She also met weekly by teleconference with the Hugo speech pathologist. The outcomes proved effective: Of the 11 students, three no longer require any speech/language therapy, and the others have improved.
Also, the Hugo speech pathologist was able to spend more time with her remaining students, enabling them to receive more intensive therapy.
"We helped to enhance the quality of services the other students received, and we also helped with the morale of the speech/language pathologist in that community," Clark says.
The Jim Thorpe speech pathologist was designated to the telemedicine project but also spent some hours each week doing documentation and providing coverage for the hospital’s inpatient pediatric program.
Clark says the program is being expanded to 12 students for this school year. The school is being reimbursed for the speech therapy through the Oklahoma Health Care Authority, so some of the rehab speech therapists will be reimbursed.
The program’s success prompted some other rural schools to contact the rehab facility about occupational therapy, neuropsychology, and educational inservices for teachers. "We have gotten a call from other school systems asking if we have a psychologist who can work with a family or child, and we say, Yes, we have other allied health professionals who could do this,’" Clark says.
Telemedicine programs could include pharmacy and nursing consultations, as well as other therapies, she adds. "They took advantage of our speech therapy, but this year we hope we will be used for other specialty services as well, and we would like to set up contracts with other schools as well."
The rehab hospital could provide telemedicine services to rural communities and schools that are near Hugo Elementary by having those schools provide transportation to the school, where the dedicated equipment is in place.
Providing follow-up care
Another offshoot of the program is the hospital’s ability to use telerehabilitation to follow post-acute stroke or spinal cord injury patients who do not have access to community services, Clark says.
"We’ve done studies with a physical therapist who works with patients who were discharged to their home communities and who then go to a rural hospital to receive outpatient therapy," she explains. "The physical therapist at Jim Thorpe then provides guidance and counseling through telecommunications technology."
The hospital has been exploring the use of inexpensive home-based units that could work on analog phone lines. That way, a physical therapist can observe the caregiver making patient transfers and watch patients during exercise programs to assess how well they’re doing those activities.
"We have a research team currently evaluating different outcomes measures, and we’re basically just at the beginning of using this technology," Clark adds.
Need More Information?
Pamela Clark, PhD, Director of Research and Development, INTEGRIS Jim Thorpe Rehabilitation Hospital at Southwest Medical Center, 5219 South Western, Oklahoma City, OK 73109. Telephone: (405) 644-5343.
Al Moorad, MD, INTEGRIS Medical Director, and Sharon Smeltzer, MS, Director of Operations, can be reached at the same address. Telephone: (405) 644-5200.
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