Technology brings new speech therapy services to rural areasJune 30, 2016
Using video conferencing, UMaine clinicians help people recover after disabling strokes.
Kathy and Bob Jackson like to tease each other. The South Gardiner couple have been married nearly 50 years and their banter is still loving and sarcastic.
The banter came to a halt nearly three and a half years ago when Kathy had an aneurism and a stroke. Though she was unable to talk or swallow after the stroke, an Internet-based speech therapy program pioneered by the University of Maine has helped the Jacksons get their banter back.
“It’s been a godsend because Kathy has come so far in her ability to talk. I sometimes tell her she’s out of her mind,” Bob said as Kathy laughed, “but she hasn’t lost anything. She understands everything that’s going on around her, but she just can’t bring the words out sometimes.”
Kathy went through a rehabilitation clinic in Portland to get some of her speech back, but she still needed help. That brought her to Judy Walker, an associate professor at UMaine who founded the Speech Therapy Telepractice Program five years ago.
“It has helped me a lot,” Kathy said. “I couldn’t say anything and they helped me to speak and now I can talk. She gave me a check the other day and I got a 93 on it, so I’m almost normal.”
The program connects people who need speech therapy with professional therapists through online video conferencing technology. A therapist leads an individual or a group through a series of exercises and assesses their performance. Though it’s different from an in-person visit, the ease of the video interaction gives clients easier access to therapy and helps therapists see more people because they don’t have to travel to appointments.
The Jacksons’ story is a typical one for the telepractice program. In her former role as the chairperson of UMaine’s Department of Communication Sciences, Walker was regularly getting calls from schools asking for help with speech therapy. The schools had students with autism and other special needs that required specialized help. In a rural state like Maine, it can be prohibitively expensive for schools to provide that kind of support for students, Walker said.
“It’s very clear no matter how fast we produce bodies, we’re never going to keep up with demographic trends of both aging and incidents of childhood disabilities and so on,” Walker said, noting the program has a waiting list of patients. “We had to think about a way we could deliver speech therapy in a very efficient way.”
Walker’s observation mirrors federal projections, which show an increasing demand for speech pathologists and therapists. The Bureau of Labor Statistics expects jobs in that field to grow 21 percent from 2014 to 2024, compared with the national average of 7 percent growth in jobs overall.
“As the large baby-boom population grows older, there will be more instances of health conditions that cause speech or language impairments, such as strokes and hearing loss,” said the BLS in its analysis.
ADVANCES IN TECHNOLOGY
Walker spent years developing a pilot program, building a training manual and coming up with a business plan. The program got a critical $174,000 grant from Next Generation Foundation of Maine, paid over the course of three years, that has supported the nonprofit to this point.
That money has helped the program grow to serve 40 clients who work with four or five UMaine students and a supervisor. Some of those clients are schoolchildren – the program has a working agreement with RSU 10 and Good Will-Hinckley – and some of the clients are adults.
The program is in its final year of foundation grant money and Walker is working to expand it. The University of Maine has an age-in-place initiative that aims to help seniors stay in their homes, such as Bob and Kathy, whose stroke left her with aphasia, a term for brain damage that affects the ability to communicate.
“People with aphasia, because of the communication problems, already feel isolated, so you couple that with Maine’s geography and weather and folks with aphasia are even more isolated,” Walker said. “And definitely, that can lead to depression. We had long conversations about this in the group. It’s so critically important to bring people together to talk about it and to just talk about what everybody’s doing. It’s critically important to continue this program.”
The program is simple enough to use. Even with a finicky WiFi connection and a six-year-old laptop such as the Jacksons’, it only takes a couple of minutes to download an app and connect to a video conference. A group leader can run a group or an individual through exercises that include answering trivia questions about the state of Maine.
The experience pays off for college students as well.
Sarah Hunt is a UMaine graduate student working with the program for this spring semester. She works primarily with schoolchildren, and said her challenge was translating her “three-dimensional skillset” into a computer program.
“It’s two different experiences,” Hunt said. “The reward for me working in person is the understanding of that child’s scope or their reality and you’re an integral part of it. …
“The telepractice piece has a higher focus (that) comes back to innovative problem-solving and engaging a child in a different way.”
Federal estimates say between 5 and 8 percent of U.S. school children need some form of speech therapy when they’re young. But a lot of new attention is being trained on older populations, especially around insurance issues.
Lynn Covert, a speech pathologist and coordinator of a telepractice affiliate of the American Speech and Hearing Association, said insurance programs need to keep pace with technology advances. One of the biggest barriers to telepractice speech therapy for older people is that Medicare doesn’t pay for it.
“We have a legislative effort to change that,” said Covert. “Many insurances do cover (the service) as does Medicaid in many states, so people are able to get reimbursed.”
She said there needs to be additional support for elderly people, especially ones who live in rural areas and are challenged getting to appointments. Sometimes they need to tap family members to drive them – who then lose time from work or have to pay for childcare, said Covert.
“If you can treat someone at home, you can alleviate a lot of the financial burden for this service,” she said.
The Jacksons said they have had their share of medical scares and Kathy’s recovery was at times frustrating.
But Walker smiled broadly over a video conference as Bob talked about what the program meant to his family.
“You go to bed one night and everything’s fine and you wake up the next morning and the whole world’s changed,” he said of his wife’s stroke. “It’s limited some things we’re able or capable of doing. We’ve been married 50 years come July and we wouldn’t have it any different.”
The program has helped restore a sense of normalcy for the Jacksons, including the teasing.
“My husband, he said he wasn’t going to have a wife that couldn’t talk,” Kathy said. “He is sorry he said that, because I pick on him a lot.”
And then, over the video conference, everybody started laughing.