Managing Patient Factors in the Assessment of Swallowing via Telerehabilitation

Abstract

Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities.

Impact of Dysphagia Severity on Clinical Decision Making via Telerehabilitation

“…These findings are consistent with prior research that demonstrated that certain patient factors, such as movement disorders, agitation, hearing impairment, and reduced vocal volume, can enhance the technical difficulty of conducting dysphagia assessments via telerehabilitation. 40 In the current study, additional issues of cognitive and/or language difficulties that complicated ability to follow instructions further limited the information the online clinician could independently collect. In these cases there was greater reliance on the assistant who helped relay information to the online clinician to assist his or her decision making.…”

“…However, it does highlight the importance of considering the extent of other patient factors prior to assessment and also planning how the issues could be overcome/minimized in the online environment. 40 In recent policy guidelines it is noted that patient suitability for telerehabilitation assessments should be determined on a case-by-case basis. 41 Policy statements also stress the importance of training to ensure clinicians are competent to deliver online services, particularly for more complex patients.…”

Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine (Preprint)

“…For example, in Australia, there is only one major facial nerve centre -the Sydney Facial Nerve Service. In addition to limited access to relevant health professionals, individuals with FNP face common challenges to healthcare access, which include the direct and indirect cost of care, distance, transportation, mobility, and time constraints [11][12][13][14][15].…”

“…Telemedicine is healthcare delivered via telecommunications technology over a distance [11,[15][16][17][18], allowing improved access to care in various physical and mental health conditions by overcoming geographical and temporal barriers [11,[13][14][15][16][17][18][19][20][21]. Telemedicine has also been associated with increased access and compliance to pulmonary rehabilitation [22], and reduced hospitalization rates, emergency department visits, and length of hospital stay for patients with chronic obstructive pulmonary disease (COPD) [23].…”

Expanding speech pathology delegation practices: engaging Allied Health Assistants (AHAs) in dysphagia management in the acute hospital setting

“…Systematic study of AHA utilisation within adult SLP practice, has been primarily discussed in relation to aphasia rehabilitation, which identified an increase in treatment intensity, however, also contributed to increased planning and training time for the SLP during initial implementation (Gunning et al, 2017;Wenke et al, 2014). In the clinical area of dysphagia, studies investigating the AHA role to facilitate dysphagia assessment has been limited to the area of telepractice (Sharma et al, 2012;Ward et al, 2012aWard et al, , 2012b and more recently mealtime observations (Schwarz, Ward, Cornwell, Coccetti, & Kalapac, 2018). Key barriers to implementing AHA delegation in SLP practice have been raised by several authors, including the need for pre-service training, changes in workplace processes and lack of validity and efficacy data related to assistant provided interventions (Goldberg et al, 2002a;Goldberg et al, 2002b).…”