Just as Covid-19 forced schools and businesses to rapidly substitute technology for in-person education and office work, the pandemic also led to dramatic changes in how healthcare providers care for their patients. Clinicians wanted to maintain their patient's health, without increasing the risk of spreading the deadly illness.
This was especially true for speech-language pathologists who treat people with speech and swallowing disorders, who get very close to their patients, many of whom are prone to coughing during evaluations.
“Most practitioners, if they wanted to continue to meet with their patients, had to do it via telehealth,” says Michelle Troche, Associate Professor of Speech and Language Pathology. “And even though telehealth had been growing in popularity and uptake, the pandemic dropped us all in the deep end in many ways.”
When the pandemic started, some of Troche's colleagues in neurology asked if she and her team would continue their research evaluating speech, swallowing and coughs disorders, particularly in movement-disordered patients — but now via telehealth.
“There was certainly literature to suggest we should be able to do this. But we're not talking about laboratory-type conditions here. We wouldn't be able to go to the patient's house, set up their computer or camera and generally walk them through the technical process,” Troche explains.
“Practitioners also questioned whether this would work for patients who have trouble using their arms and legs, or who have cognitive deficits, let alone unreliable internet. And so we embarked on research, trying to understand how reliable our assessments for swallowing, cough, and speech would be in these circumstances.”
In a pair of articles in the American Journal of Speech-Language Pathology, Troche and her colleagues at TC and Purdue University report that it is indeed possible to evaluate swallowing disorders via telehealth, in real-world, pandemic conditions; and created a tutorial for objective speech measures to be completed via telehealth in people with movement disorders.
“The reality is,” Troche says, “there were a lot of challenges to doing this work during the pandemic, but in many ways, that may make this work more immediately translatable to actual clinical practice. We were able to control fewer factors than you would in the lab, but those are the conditions clinicians encounter.”
While this virtual format certainly presented new challenges, Troche says that imperfect experiences with patients actually more closely resemble the real world. For example, when examining how patients can effectively drink, Troche and her fellow researchers’ visibility was sometimes limited in the virtual setting. However, “even among patients with more severe cognitive deficits, even when they did cover their mouths a bit, we were still generally able to be quite reliable with those assessments.”
With increased Covid vaccinations and subsiding case numbers, is there still a role for tele-health in these cases? Troche points to a recent survey of speech and language pathologists who'd used telehealth during the pandemic.
“They wanted to continue. They were concerned that the literature wasn't available to guide their practice, which is why we're interested in expanding that. And they were nervous about not having had formal training on telehealth,” explains Troche, who is the director and principal investigator of the College’s Laboratory for the Study of Upper Airway Dysfunction. However, after the pandemic thrust clinicians into virtual practice, many were “surprised that they could do much more than they expected, and their patients could do much more than they expected via tele-health.”
For Troche, who earlier this year published findings on Progressive Supranuclear Palsy with Lisa Edmonds, telehealth evaluation and treatment of swallowing and communication disorders is not going away.
“I think there's going to be a lot more uptake of a hybrid model, using both in person and tele-health care for both evaluation and treatment of these types of disorders,” Troche says. “Certainly there are some limitations. We wouldn't want to end up creating greater health disparities because we leave behind folks that don't have adequate access to broadband, for example. But when you think about the burdens for patients in New York City who have movement disorders, for example, getting in a cab or getting public transit and trying to come to appointments, and waiting for 45 minutes in a waiting room, as opposed to just walking to your computer, turning it on, and you're set. I think a lot of patients are going ‘Whoa, I would much prefer that.’”
— Margie Holt