Telepractice Proves Effective for Those Living with Down Syndrome

co-authored by Maria Bernabe, M. S., CCC-SLP

Telepractice for those with Down syndrome has been a very effective service delivery model for some time. This presentation was given at the American Speech-Language and Hearing Association conference in 2019, prior to the coronavirus pandemic. Since that time, telepractice and teletherapy has grown and improved by leaps and bounds. Out of necessity, many SLPs have shared their knowledge, creativity, and innovation to ensure telepractice is successful and easy to access. As a result, some of the content of this presentation is now outdated less than a year after it was presented to SLPs across the country. Not to worry, much of the content remains insightful.

> PowerPoint presentation available here

1. Participants will be able to describe how and why telepractice can be successful for the Down syndrome population.
2. Learners will be able to make clinical recommendations based on the eligibility criteria for telepractice.
3. Attendees will have immediate access to resources for clinical practice.

Abstract

Telepractice is a valuable service delivery model for speech, language, cognitive, and feeding therapies. Populations, such as those with Down syndrome, benefit most from frequent and intense therapy sessions in authentic environments. The authors will address how and why individuals with Down syndrome benefit from telepractice by presenting case studies targeting a variety of goals.

Summary

Defining Telepractice:

Telepractice is therapy conducted remotely. Therapy sessions can take place in real-time, referred to as synchronous telepractice, or via pre-recorded sessions, referred to as asynchronous (Cason & Cohn, 2014) telepractice. Teletherapy has become more common for the treatment of speech, language, cognitive, and feeding disorders in recent years. Advances in technology have enabled those with disabilities to better exchange information, gain access to specialized services, and learn in authentic environments. Accessibility of services broadens when constraints like geographic location, socioeconomic barriers, and languages spoken, are removed.

Underserved and specialized populations:

This presentation will focus on the Down syndrome population but will provide applications for a broader range of needs and strengths. Despite being the most common genetic syndrome in the world, Down syndrome therapies for speech, language, feeding, and education have improved very little in the last 20 years. Medical research, however, has accelerated in the last decade and has nearly doubled the life expectancy of those living with Down syndrome. As we learn more about how an extra 21stchromosome affects cognition and physical abilities, we must also develop newer and better therapies that promote independence. Self-care, meaningful work, and social communication for relationship development and maintenance are critical to the long-term success of those with Down syndrome in a functioning society.

State regulations:

The American Speech-Language-Hearing Association (ASHA) has a State-by-State guide with information, if available, on telepractice regulations. At this time, therapists have to be licensed in their home state and the state in which their client is located (Cason & Brannon, 2011).

Technology requirements:

Due to the affordability of technology needed for telepractice, most people already have the basic tools they need. These include a computer with audio and video capabilities. As a practitioner, you will also need a secure, videoconferencing service. Numerous considerations should be taken when choosing a computer and external equipment (e.g. memory, processing speed, screen size, and headset).

Eligibility requirements:

Telepractice is an excellent choice for most individuals but there are eligibility requirements that should be considered. The technology used to provide telepractice is simple, but it does require individuals and/or their families to have basic computer knowledge or the ability to learn these basic skills for successful therapy sessions. A list of eligibility questions will be provided. Other considerations are physical abilities, cognitive abilities, and vision and hearing abilities when determining the mode of services. Cason & Cohn (2014) state that “The client selection process should consider these limitations, potential modifications necessary to maximize participation, the nature of the interventions to be provided, and the support available to the client to determine if the use of telepractice is appropriate” (Cason & Cohn, 2014, p.12).

Dispelling misconceptions:

Research has consistently shown similar benefits for traditional and telepractice outcomes. ASHA has recognized telepractice as an appropriate method of service delivery since 2005. Many studies have shown similar results for telepractice and traditional service delivery models with telepractice even surpassing traditional therapies in some outcome studies. A review conducted by Coufal, Parham, Jakubowitz, Howell & Reyes (2018) looked at speech production therapy outcomes for school-age children. They found no significant difference between the face-to-face cases and the telepractice cases they examined. Individuals with visual learning strengths, motor speech disorders, travel restrictions, special needs, and fragile medical status all benefit from telepractice.

Telepractice for individuals with Down syndrome: 

People with Down syndrome have unique learning styles and strengths making telepractice a highly effective option. Preferences for visual learning, dynamic modeling and practice, focused environments, predictable routines, and highly repetitive learning tasks (overlearning) make telepractice appealing to clients and their caregivers.

In addition to visual strengths, those with motor speech disorders, as often seen in those with Down syndrome, do particularly well using telepractice services that are highly repetitive, short in duration (intensity), and with frequent visits. Shorter and more frequent sessions for those with motor speech disorders is recommended, but rarely possible due to geographic location, cost, and time.

In order for those with Down syndrome to be valuable members of society and contribute to the world’s wellbeing, we must improve their communication skills. Speech is often neglected or delayed until after medical, gross motor, fine motor, and educational interventions are attained. As a result, many teens and adults with Down syndrome remain difficult to understand, have few friends, and limited functional independence skills. Lack of speech clarity and efficient digital communication will leave teens and adults out of social and vocational opportunities despite strong skills in other areas.

Functional communication and social independence:

Telepractice supports functional goals in authentic settings at home, school, and in the community. As those with Down syndrome get older, social communication and speech clarity become increasingly more important. We oftentimes assume speech therapy is effective when we practice and measure outcomes in clinical and academic settings; only to discover skills aren’t used in the functional settings as intended.

Functional communication must be taught within naturally occurring contexts to ensure long-term success and maintenance. Research in Experiential Learning suggests using “learning experience(s) that include the possibility to learn from natural consequences, mistakes, and successes” (Kolb, 1984). Teletherapy allows clinicians to move closer to the adherence of this recommendation by practicing most forms of communication in individual and group settings, using video chat technology, phone conversations, text messages, reading and writing emails, and social media. Most young adults communicate with family, friends, teachers, peers, and co-workers using non-face-to-face technologies. In a survey of 3,000 generation x-ers involved in the Longitudinal Study of American Youth, the average person reported about 75 face-to-face conversations a month, compared to 74 electronic interactions on Facebook, Twitter, email, and Skype (Miller, J.D., 2011). Therefore, it stands to reason that speech and language therapies should practice communication skills in those contexts as well. There are many opinions about screen time and the evolving modalities of new technologies. We hope to leave this to families and focus on skills that help our clients/patients communicate most effectively within the communities they live, work, and play.

References

According to the American Speech, Language, and Hearing Association, telepractice is being used in the assessment and treatment of a wide range of speech and language disorders (https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956&section=Key_Issues), including the following:

• Aphasia (Macoir, Martel Sauvageau, Boissy, Tousignant, & Tousignant, 2017).
• Articulation disorders (Crutchley, Dudley, & Campbell, 2010; Grogan-Johnson et al., 2013).
• Autism (Higgins, Luczynski, Carroll, Fisher, & Mudford, 2017; Iacono et al., 2016; Parmanto, Pulantara, Schutte, Saptono, & McCue, 2013).
• Cason, J., & Brannon, J. A. (2011). Telehealth Regulatory and Legal Considerations: Frequently Asked Questions. International Journal of Telerehabilitation,3(2), 15-18. doi:10.5195/ijt.2011.6077
• Cason, J., & Cohn, E. R. (2014). Telepractice: An Overview and Best Practices. Perspectives on Augmentative and Alternative Communication,23(1), 4. doi:10.1044/aac23.1.4
• Coufal, K., Parham, D., Jakubowitz, M., Howell, C., & Reyes, J. (2018). Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure. American Journal of Speech-Language Pathology,27(1), 82-90.
• Dysarthria (Hill et al., 2006).
• Dysphagia (Cassel, 2016; Malandraki, McCullough, He, McWeeny, & Perlman, 2011; Perlman & Witthawaskul, 2002.
• Fluency disorders (Carey, O’Brian, Lowe, & Onslow, 2014; Carey, O’Brian, Onslow, Packman, & Menzies, 2012; Lewis, Packman, Onslow, Simpson, & Jones, 2008).
• Kolb, D. A. (1984).  Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.
• Language and cognitive disorders (Brennan, Georgeadis, Baron, & Barker, 2004; Sutherland, Hodge, Trembath, Drevensek, & Roberts, 2016; Waite, Theodoros, Russell, & Cahill, 2010).
• Miller, Jon D. Longitudinal Study of American Youth, 1987-1994, 2007-2011. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2016-03-24. https://doi.org/10.3886/ICPSR30263.v6 
• Neurodevelopmental disabilities (Simacek, Dimian, & McComas, 2017).
• Voice disorders (Halpern et al., 2012; Mashima & Brown, 2011; Theodoros et al., 2006; Tindall, Huebner, Stemple, & Kleinert, 2008; Towey, 2012b).

Maria Bernabe is the founder of A+ Speech Therapy, a website dedicated to providing parent education about speech and language development and delays A Plus Speech Therapy and the co-founder of Telehealth Specialists which is dedicated to providing education to Speech and Language Pathologists seeking information about the field of telehealth.