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UHN speech-language pathologists (SLPs) always look for ways to provide patient-centered, innovative care. Toronto Rehab Stroke Service provides intensive inpatient rehabilitation for patients from across Ontario but securing ongoing outpatient therapy for those outside Toronto can be challenging.
Recently, Toronto Rehab SLPs Marla Fogelman and Alyssa Bobkin saw an opportunity to use in-home video-conferencing to provide therapy to patients who might otherwise have had no access to intervention, despite having debilitating communication impairment as a result of stroke.
Marla and Alyssa were working with several stroke patients who had significant aphasia, a communication impairment resulting in difficulty comprehending and formulating language. It is one of the greatest negative impacts on quality of life post stroke.
The patients needed more therapy but had limited options once discharged home.
"The inpatient team decided to look into alternative service delivery methods and the idea of telehealth came up," explains Marla, adding they soon realized Toronto Rehab's Stroke Outpatient team could access secure in-home video-conferencing through the Ontario Telemedicine Network (OTN).
"We knew it was a perfect way to bridge the gap between us and the patient," Alyssa says. "It's a system that sees the clinician use a desktop computer with a webcam and the patient uses their own device at home."
Alyssa and Marla spoke to
UHN News as part of Speech & Hearing Month, the annual opportunity to take a moment to acknowledge the essential contributions that speech-language pathologists and audiologists make to the healthcare system. More information on the
contributions these professions play can be found here.
Neither Marla nor Alyssa had previous experience using the system and wondered if it would be effective, especially given that it meant trying to deliver speech therapy via computer to a patient who was essentially unable to speak.
A quick review of the literature and a few emails to the College of Audiologists and Speech-Language Pathologists of Ontario helped build their confidence. While not widely used to deliver SLP therapy, a 2009 review study suggested the results using telehealth were equivalent to – but not a complete replacement for – traditional face-to-face therapy.
"There were a few logistical issues to overcome before we could get started," says Alyssa. "For instance, you have to ensure the patient feels comfortable with the platform or has a caregiver who can assist."
Adds Marla: "You have to think about how to modify your materials in order to maximize patient participation. It's also important to think about where you are in the video frame to ensure the patient can see your gestures and facial cues – these are very important during communication therapy."
Both Marla and Alyssa commend the excellent support they had through UHN Telehealth, pointing to Carol Toenjes, Telehealth Program Coordinator at UHN, as "a great coach who was instrumental in helping us navigate the system."
Patient and caregiver feedback has been very positive. "They are grateful that they were given this option versus driving to Toronto or waiting for five months to start therapy elsewhere," says Alyssa.
Marla shares the comments from one caregiver who stated: "I found the progress made through the video-conferencing opportunity remarkable. I believe the availability of video-conferencing, along with your combined skills, had a profound impact on recovery."
Both Alyssa and Marla feel inspired to share their experiences with others. To this end, they will be presenting a poster at the GTA Rehab Network Best Practice Day in June.
"This is a really exciting and innovative way to deliver service," says Marla, underscoring their enthusiasm. "We could reduce wait times for patients, help patients and families avoid transportation costs and potentially provide therapy to individuals who physically are housebound."
Alyssa adds: "There are great research opportunities here as well – both to explore patient experience and efficacy of service delivery."