Categories
Communication Disorders

What is Telepractice?

The internet has been a driving force in terms of bringing awareness to mental health issues. From Project SemiColon, which supports people battling depression, addiction, self-harm, and suicide, to R U OK? Day on the second Thursday of September, when Australians ask their friends and loved ones if they are okay, making room for open dialogue on their current emotional and mental health status. However, are we limiting the capacity to which the internet can serve mental health disorders, specifically social communication disorders?

Telepractice (also called teleaudiology, telespeech, and speech teletherapy) is the use of live-streaming to provide speech-language pathology and audiology to link clinicians with their clients. From assessments and diagnosis to interventions and consultations, telepractice is shown to be as effective as in-person consultation. The quality of telepractice is ensured because, in order to establish a credible telepractice, clinicians must follow the same Code of Ethics, Scope of Practice in Audiology, Scope of Practice in Speech-Language Pathology, as well as state and federal laws.

With the guaranteed quality of treatment, the question of the effectiveness of telepractice compared to traditional counseling methods is a non-issue. But in what areas can telepractice surpass them? When considering convenience for both client and counselor there are three versions of telepractice that one can participate in.

The first is Synchronous client interaction. This is a live interaction between the client and clinicians. Video chats, audio calls, screen-sharing, text chat between clients, one-on-one treatment, group therapy, and consultations with clinicians and specialists are some of the ways in which synchronous telepractice can be personalized to meet clients’ needs. The second is Asynchronous client interaction. This consists of either visual and/or audio data such as voice clips, audiology test results, video clips, etc. which can be saved and forwarded to clinicians for evaluation, in order to obtain a more in-depth analysis of clients’ patterns. The third type of telepractice is a hybrid of both asynchronous and synchronous that can be created around a schedule that best fits clients and clinicians. Regardless of one’s preferences for communicating via the internet, there is an outlet for them to feel comfortable with.

With all of these interactions happening and being recorded, the issue of client confidentiality is sure to come into question. Fortunately, the American Speech-Language Hearing Association states that clinicians are held to the confidentiality standards enforced by the Health Insurance Portability and Accountability Act of 1996, Health Information Technology for Economic and Clinical Health Act of 2009, and the Family Educational Rights and Privacy Act of 1974.

Additionally,  clinicians are required to have an understanding of state and federal regulations pertaining to the electronic storage of information, types of technologies with privacy protections, specific telepractice software with encryptions, applications of VPN software and firewalls, and breach notification policies.

Websites that offer telepractice services connect individuals to a specialist based on the responses they give to either automated bots like on 7 Cups of Tea or through a live text chat like on Talkspace. From there, clients are given access to a specialist, depending on the length of their subscription. Plans for these kinds of subscriptions are more cost-effective than traditional treatments (though most don’t take insurance currently). Also, telepractice uses the subscription-based method of payment that many online platforms are starting to adopt, which should help further encourage the longevity of telepractice when compared to a by-session payment method.

A review of Talkspace was published on Business Insider. Erin Brodwin gives positive feedback of the process from getting matched to the actual therapy. After connecting with her primary therapist Nicole, a licensed mental health counselor, she spent a week of texting Nicole at her own leisure; sometimes replying quickly within minutes and other times sparingly between hours. Nicole was always available to give “thoughtful, detailed, and insightful” replies to her texts, and she felt like “[Nicole] was really listening.”

Telepractice is a growing avenue for mental health counseling. Thanks to the internet, it’s just as easy getting help for mental health disease as it is getting a date for a Saturday night on Tinder. The accessibility it provides users, although relatively new, already shows benefits and continues to grow as an equally reliable source of speech pathology counseling as traditional practices.

 

References

Brodwin, Erin. “I Spent 7 Amazing Days With A Therapist Who Only Knew Me Via Text
Message”. Business Insider, 2019,
https://www.businessinsider.com/what-its-like-to-use-talkspace-text-therap
y-app-2015-3.  Accessed 2 Apr 2019.

 

Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study
comparing the effectiveness of speech language therapy provided by
telemedicine with conventional on-site therapy. Journal of Telemedicine and
Telecare, 16, 134–139.

 

Judy, Walker, and Jacques Katelyn. “Speech Therapy In A Virtual World: Building
Friendships In A Telepractice Aphasia Communication Group”. Frontiers In
Psychology, vol 7, 2016. Frontiers Media SA,
doi:10.3389/conf.fpsyg.2016.68.00013.

 

Novotney, A. “A Growing Wave Of Online Therapy”. Https://Www.Apa.Org, 2017,
https://www.apa.org/monitor/2017/02/online-therapy. Accessed 2 Apr 2019.

 

Rose, D. A. D., Furner, S., Hall, A., Montgomery, K., Datsavras, E., & Clarke, P. (2000).
Videoconferencing for speech and language therapy in schools. BT Technology
Journal, 18, 101–104.

 

“Talkspace | Online Therapy | Counseling Online | Marriage Counseling”.
Talkspace.Com, 2019, https://www.talkspace.com/.

“Telepractice: Key Issues”. Asha.Org, 2019,
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956&section=
Key_Issues#Telepractice_Technology.

Categories
Communication Disorders

Uncovering the Faces of Aphasia

While working in my office, I met a student who wanted directions to the other side of campus. He had a severe stutter and had a difficult time enunciating his words. It took him a while, but he managed to ask his question on his own time and I answered on mine. A couple of weeks later, I saw him around campus and decided to talk to him. He’s actually an honorably discharged veteran who was wounded in combat. Although grateful for the operation that saved his life, he said the impact of the shrapnel gave him a form of nonfluent aphasia.

Aphasia is an encompassing term of varying symptoms that affect social communication. The major difference between aphasia and social communication disorders is that aphasia is caused by damage to the parts of the brain dealing with language. Aphasia causes difficulties in four general areas of communicating: spoken language expression, spoken language comprehension, written language expression, and written language comprehension. The effects of aphasia are unique depending on the person’s experiences, brain development, and the size/cause of brain injury.

Like the student from earlier, spoken language expression impairments are expressed in many ways: slower recall of words, speaking in single words, speaking in short fragmented sentences, putting words in the wrong order, substituting words for sounds similar to the spelling of that word, and/or making up words. Spoken language expression impairments are also a form of nonfluent aphasia. This means that they interrupt a person’s ability to produce speech. Examples of nonfluent aphasia include: Broca’s and transcortical motor aphasia, which primarily cause an individual to repeat words or (at the very least) parts of words.

Individuals with spoken language comprehension impairments typically display the following: a lack of awareness of speech errors, taking literal meanings of figurative speech, difficulties in following quick speech, unrelatable answers to yes and no questions, errors in understanding complex grammar (Ex. There’s a round ball in the corner store across the street), all of which lead to a delayed understanding of spoken messages.

Written expression impairments follow patterns of spoken expression impairments that are similar to their spoken counterparts. Individuals with written language expression impairments typically spell words incorrectly, use non-words, and have a tendency of writing run-on sentences with incorrect grammar usage. Individuals with reading comprehension impairments have difficulties recognizing some words by sight, which prevents them from sounding out words by letters. Moreover, they have difficulties reading words like: to, the, from, etc.  

These impairments degrade a person’s ability to such an extent that they are unable to speak their native language on a fluent level. If you’ve ever taken an introductory language class, you would more or less be able to communicate on the same level as someone with aphasia. Spanish classes were always difficult for me, but I only had to speak Spanish during class. People affected by aphasia face this difficulty daily. If we are patient with them like our teachers were patient with us, we would realize that taking the time to communicate with individuals with aphasia is seldom different than talking to any other stranger you happen to meet on the street, in class, or even an office asking for directions to the nearest dining hall.

References:

American Speech-Language-Hearing Association. (2016a). Code of ethics [Ethics].
Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2016b). Scope of practice in
speech-language pathology [Scope of practice]. Available from
www.asha.org/policy.

Cherney, L. R., Merbitz, C., & Grip, J. (1986). Efficacy of oral reading in aphasia
treatment outcome. Rehabilitation Literature, 45, 112–119.

Darley, F. L., Aronson, A. E., & Brown, J. R. (1969). Differential diagnostic patterns of
dysarthria. Journal of Speech and Hearing Research, 12, 246–269.

Kagan, A., Black, S., Duchan, J., & Simmons-Mackie, N. (2001). Training volunteers as
conversation partners using “Supported Conversation for Adults With Aphasia”
(SCA): A controlled trial. Journal of Speech, Language, and Hearing Research,
44, 624–638.

Simmons-Mackie, N., & Kagan, A. (2007). Application of the ICF in aphasia. Seminars
in Speech and Language, 28, 244–253.

Categories
Communication Disorders

Social Communication Disorders: Making it Personal

Our measure of mental capabilities is held parallel to our ability to interact with and operate within our society; the same society that sets the social standards that medical journals and magazines derive from the relatively new science of psychology. For most of us, our social communication skills are attributed to our personalities, environments, experiences, and (some would even argue) astrological signs. However, all of these become overshadowed when our social communication becomes comorbid with other mental disabilities. We primarily associate a person’s social communication style and ability with their mental health. When they’ve been diagnosed with a mental disorder, it’s almost as if their mental health overshadows their personality.

It does not.

Social communication is the ability to vary your speech style, consider others’ perspectives, and effectively use and understand the verbal and nonverbal communications of a language. In a more practical sense, it is understanding a social situation and being able to participate in further developing it. We’ve all had frustrating conversations or arguments where someone is misunderstanding what we’re saying. Individuals with social communication disorders experience this on varying degrees. But what exactly are social communication disorders? Social communication disorders usually interfere with verbal and nonverbal communication and make understanding and participating in social settings difficult.

Some social communication disorders can be comorbid with aphasia, dementia, ADHD, intellectual disabilities, developmental disabilities, etc. Due to the fact that social communication issues are often a defining feature of autism spectrum disorder, social communication disorders and autism aren’t usually seen as being comorbid. Additionally, since the cause of social communication disorders as a distinct disorder isn’t known, it is almost always defined within the context of the disability.

The diagnosis process for social communication disorders varies depending on the aspect of the disorder that speech pathologists are trying to assess. However, typical social communication disorder diagnosis tests assess an individual’s use of verbal and nonverbal means of communication including natural gestures, speech signs, pictures, written words, etc. They also test to see if an individual can manipulate conversation topics to repair communication breakdowns and communicate using a range of social functions that can be reciprocated and used to promote the development of friendships and social networking. Treatment for individuals with social and communication disorders is developed using their scores on some of these assessments.

There are three treatment methods that are currently used by mental health professionals: Augmentative and Alternative Communication (AAC), which is replacing natural speech with symbols/objects so individuals can more effectively relate ideas in a less frustrating manner. Computer-Based Instruction is the use of technological programs to help teach language skills and social problem-solving. Video-Based Instruction is where videos of individuals are watched and recorded in order to track and help modify their progress.

With all this in mind, how a person communicates because of their ability shouldn’t be a description of their personality. To combat stigma and create a welcoming environment, we should operate within our ability to be socially aware and include consideration of mental health disorders as a part of our social settings.

References:

American Speech-Language-Hearing Association. (2016a). Code of ethics [Ethics].
Available from www.asha.org/policy.

Botting, N., Crutchley, A., & Conti-Ramsden, G. (1998). Educational transitions of 7-year
old children with SLI in language units: A longitudinal study. International Journal
of Language & Communication Disorders, 33, 177–197.

Gray, C., White, A. L., & McAndrew, S. (2002). My social stories book. London, United
Kingdom: Jessica Kingsley Publishers.

World Health Organization. (2001). International classification of functioning, disability
and health. Geneva, Switzerland: Author.

Categories
Communication Disorders

Reading the Signs of Illiteracy

I remember watching one of my friends trying to read in class and seeing the embarrassment grow on his face. Words he didn’t usually see, coupled with his insecurity in his shortcomings lead to an angry outburst of “[Screw] this class” and he walked out the room; leaving behind books, mocking laughter, and his confidence in being able to read. “It’s not that I don’t know how to read…” he later told me after class, “It’s just hard like the voice in my head takes time to start up for each word.” To this day, his reading hasn’t gotten much better. He had been in school his whole life so how did he make it this far and not develop the seemingly straightforward ability to read? Maybe it was the school system’s fault for letting him progress each grade? Was it his fault for not applying himself early on to read? Or is there something more unseen at play here?

“That’s what happens when you’re stupid.”

“He should’ve read more as a kid”

“He must be retarded lowkey”

Too many a times I’ve heard this about him and I know he’s sick of it as well. He’s an excellent math student and can play the trombone pretty well so his intellectual ability oblivious isn’t the problem here so what is?

Taking into consideration speech and sound disorders as a factor for literacy is very important. Speech and sound disorders is an umbrella phrase that includes numerous disorders that affect our ability to recognize, understand, and reproduce language. Some of these disorders are: functional speech (articulation) disorders, fluency(phonology) disorders, and voice disorders. In regards to literacy, functional speech and fluency disorders, or rather their symptoms, have major impacts on literacy. Fluency disorder symptoms include atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. Moreover, functional speech disorders cause certain consonant sounds: /s/ /l/ /z/ /r/ and “th” to be harder to form.

Stand alone, these don’t usually correlate with below average literacy, however, when compounded with each other they almost certainly are inhibitors of it. This is because functional speech disorders cause a delay in retrieving semantics, meaning of words, while fluency speech disorders cause a delay in syntax, complete sentence meaning. These delays can be manifested in many ways.

Currently, the best way to combat this, outside of a more curated curriculum, is with traditional articulation therapy. While it has no formal definition, traditional articulation implements behavioral techniques that familiarize and introduce certain sound patterns into a patient’s everyday life through new vocabulary and repetition with increasing complexity/difficulty. At young ages this causes them to lag behind indefinitely if not address and combated.

The causes for these disorders are widely unknown and still speculated. However, being “stupid” isn’t one of them. Reading, especially English, is a complex task we’ve categorize as a marker for basic intelligence. So whether it be really severe, mild, or slightly noticeable, people’s abilities to read should always be viewed below the surface of what we hear from them.

 

References

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper].

Bowen, C. (2011). Children’s speech sound disorders. Retrieved from http://www.speech-language-therapy.com/ on February 17, 2019

Bowen, C. (2011). Classification of children’s speech sound disorders. Retrieved from www.speech-language-therapy.com/index.php?option=com_content&view=article&id=45 on February 17th, 2019

Peterson, R., Pennington, B., Shriberg, L., & Boada, R. (2009). What Influences Literacy Outcome in Children With Speech Sound Disorder?. Journal Of Speech, Language, And Hearing Research, 52(5), 1175-1188. doi: 10.1044/1092-4388(2009/08-0024)