Please mute y0ur mic if you are not presenting. Thank you

Jaime Azios developed a wonderful Aphasia Friendly handout for zoom available on SIG 2 I think

An Informed consent form, does anyone have one that includes TELEHEALTH?

How can we get access to Jaime's handout if not a member of SIG 2? Will tonight's facilitators provide links to handouts, etc after webinar?

Yes we have an informed consent form for a college based clinic if you would like it emailed to you

Yes please, Heather!

I have read on ASHA that we should not be calling it telehealth, but telepractice of telespeech, can you address?

Please provide the “Aphasia Friendly” handout.

The national aphasia association has an aphasia friendly zoom handout.

I wouldn’t mind seeing the informed consent as well, thanks! :)

can the files shared in this chat with everyone?

UL Lafayette developed a consent for telepractice and I can upload/ send to the appropriate location.

Aphasia friendly instructions were created by Jody Morgan at Brookes in FLA

yes Heather, Im Melanieperkins5@gmail.com, will you send it INFORMED CONSENT WITH TELEHEALTH to me? M Perkins

Aphasia Access has a COVID19 resource page that has some excellent examples of aphasia-friendly Zoom supports. And the Aphasia Institute just shared an aphasia friendly telepractice consent form template available on their Participics link. Both great resources.

“Telehealth” is a legal and payment policy term. Most state licensure laws and payment policies reference telehealth rather than telepractice. ASHA uses the term telepractice as it encompasses the delivery of such services in both health care and education settings; however, the terms are interchangeable.

ty

Would love to have Brecken’s aphasia and dementia-friendly instructions for VVC!

SIG2 members, please consider posting your resources on the Community!

Resources will be posted to the SLP Health Care Community (open to all ASHA members) here: https://community.asha.org/viewdocument/sig-2-telepractice-considerations?CommunityKey=f1b028b3-5098-4091-b854-2bdee3dec2b7&tab=librarydocuments.

Thanks for the ideas on these links: https://www.aphasiaaccess.org/covid-19-resources/;https://www.aphasia.org/how-to-use-zoom-to-join-aphasia-cafe-chats/

talk about seeing pts. on COVID positive wards

Please also talk about pts at home (outpatient eval and treatment)

Just a comment, I had a new evaluation today for someone I wanted to do telehealth with, but who didn’t have supports at home to do so. Since they also needed an interpreter, I used my telehealth platform to have a VRI-based interpreter so that we could limit the number of people in person. I’m hopeful this exposure and incidental teaching can help this patient feel more open to doing telehealth as we progress, to ensure safety.

More detail about how you carry out swallow evals would be helpful as well.

Could you please talk a bit more about how you complete a BSSE via tele health?

Could someone speak about copyright issues for assessment materials used in telerehab? E.g. can we scan and screen share parts of an eval?

how to do cognitive eval for pt at home? this is my big question for my private practice (outpatient)

Michelle we use a document camera so we are not infringing on copyright. You can also use your phone as a camera.

Pearson Publishers has a form letter you can complete to give tele-versions of hardcopy tests you have purchased from them.

I would like to know copyright issues for telehealth assessment, too. I also like to know if it is allowed to modify assessment tools without violating copyright

agreed Sandy...need more info on conducting a language and cognitive ax for an outpatient at home

yes...or aphasia evaluation

how would you do an AAC assessment for someone who has lost their literacy skills and would be a symbol based communicator?

+1 for info on aphasia eval at home!

Aphasia Evaluation - great study on comparing WAB-R for in-person and telehealth by Dekhtyar ...Kiran.

How do you deal with timed written tasks if you send them in advance (e.g. FAVRES)?

Some publishers have letters with copyright permissions granted for use of their materials due to COVID - WAB and FAVRES at least.

Jennifer could you send the reference for that article pls?

timed tasks need to rely on an e-helper that you have provided some training.

https://asha.figshare.com/articles/Remote_WAB-R_administration_for_aphasia_Dekhtyar_et_al_2020_/11977857

WAB has been tested

The WAB

good question

KIran

WAB has been compared in person versus telehealth

thanks!

If not, it many cases I would believe that just getting any data would be better than no data, right?

Pearson is having a webinar in a week that may be helpful in this discussion. It will likely apply to outside of the neuro population but it may be helpful:https://www.pearsonassessments.com/professional-assessments/blog-webinars/webinars/2020/05/assessment-via-telepractice--office-hours-for-slps.html

reference for Lyn Turkstra's study please...

Details regarding dysphagia assessment and treatment via telepractice will not be discussed this evening. This past Monday, ASHA hosted a similar discussion on Dysphagia and Telepractice During COVID-19 and Beyond. The recording can be found here: https://asha.zoom.us/rec/play/vJEuJO_5rDg3S9ec4wSDV6QsW9S0f62s1CAW-vULxBzgAHEKZ1GlN-AbNuOOGI30Oniav1gTt7wfWIBl?startTime=1588633488000

Thank you!

How do you do a BDAE?

Could you give an example of a questionnaire to be used for cognition? (A name/location where to find one)

They can point to pictures through screen sharing

Can circle items

WAB Article: Videoconference Administrastion of the WAB- Revised: Feasibility and Validity in AJSLP - Dekhtyar et al 1-15 2020

Agreed on shared access to screen share for "annotate", if you train the client in how to do this.

wondering if possible to do Trails

NIH Toolbos has many self-reports freely available

Again - the article by Dekhtyar describes how to modify administration - but must view the article on line so you can click on Supplemental 1 and 2

Would love to have examples of questionnaires for cognition!

goal management training questionnaire for the patient

Would love to have the reference for the Self-Awareness of Deficits Interview that Don mentioned. :)

you can have a caregiver log in and use their camera to show what patient is doing in addition to seeing the face of the patient, with some telehealth programs

Health Measures have a lot of free questionnaires

http://www.healthmeasures.net/index.php

Assessment of Change in Communication Scale is good and has some cog questions

https://www.amazon.com/Brain-Injury-Workbook-Rehabilitation-Speechmark/dp/0863889786

Caveat that WebEx requires quite a bit of band width which may be problematic based on your internet provider.

I agree re groups, at NYU Langone we are doing several groups and it works ow and high level aphasia

We were forced to send our participants home mid-session for one of our PIRATE intensive residential aphasia treatment programs. We were able to finish the session via telehealth using most of our in-person goals.

Can you speak to the aspects of Webex that are especially helpful for aphasia groups as compared to Zoom?

did you have to get permission to use webex for groups at the VA?

I have used the Larobe Communication questionnaire for language skills and the Comprehensive Assessment of Prospective Memory for cognitive patients w/ complaints of memory specifically. I have used these as baseline and outcome measures. I also used them as Don recommended, selecting the ones that are most troublesome for the pt. and use them as goals.

Yes LaTrobe is another good one!

Treatment is much less of a challenge than standardized testing

Can anyone speak to the use of Zoom Chat and/or caption for multi-modal communication?

can we establish a new group for online collaboration? I'm a private practitioner and don't have colleagues readily available to consult

Also if you use closed captioning for written word supplementation

Treatment of auditory comprehension is very difficult! You really do need to think outside of the box!

treatments that work for aphasia SFA, VNeST, CAAST—-these all work

You can do the NYT mini crossword with an aphasic client using screen share

Great wordfinding treatment with reward built in

Zoom has accessibility feature so you can increase font size of the chat. WebEx font size in chat is very small and cannot be modified

Any resources for client's with visual deficits?

Screen sharing a word doc works better for supporting with written language

I read that there is better compliance with telerehab (NHS study)

less missed sessions for me

Will the recommendations posted through this group chat be available to attendees somewhere please?

The Famous Faces protocol develop by Dr. Holland, available on the Aphasia Bank website: https://aphasia.talkbank.org/famous/ might be a useful eval tool during telehealth evals.

Plus using the white board on Zoom works well as well as pulling up google and share screen

If attendees click the … to their right in the typing box, you can "save chat".

My clients are doing better with telerehab - less tired from travelling to the centre, comfortable in their environment, motivated to “show and tell” in natural context

With Zoom you can also allow the client to annotate or highlight text and type if you give them control of the mouse.

I think one of the reasons is because they are a captive audience at this point, not much else for them to do so are eager to be involved and have therapy

I am having a problem with younger PWAs who have very young children in the home. They find it stressful to manage tx and their kids.

I have found you can share the same document on google docs for reading and writing. You can edit their work and support their reading

Cognitive questionnaires/subjective assessments for TBI: LaTrobe, APT-II Attention Questionnaire, KBCI (Key Behaviors Change Inventory)

I was able to upgrade a 94 yr old pt on his bday and upgrade his diet so he could have his bday cake!

Thank you!

True - tx is a great leisure activity for our clients who are bored with isolating themselves.

Yay Stacey!

Also, the BADS Dysexecutive Questionnaire is useful for executive dysfunction

I think we have been hacked

hacked

Are we supposed to be seeing a video? I have the PP

Zoom bombing?

Are we being zoom bombed?

that was crazy

Well that was interesting. lol.

I agree, seeing patients on their lunch breaks is huge

has anyone done a telehealth eval for pt with more advanced dementia?

need to validate, the patients all talking about it

Great question!

listen intentionally and actively

start session with, how are you how is it going

facial expression is your best mode for expressing empathy

The one pt. I had a problem working with was a moderate to severe aphasia pt. w/ increasing cognitive decline. He was very confused by the situation, despite having his daughter there.

It’s interesting, I’m an interpreter and SLP, and doing a lot more work remotely right now for both, and while it’s weird to context switch (and do so much work within the same physical space), it also means less cognitive load for me in terms of driving and navigating my schedule. It’s an interesting “side effect” of our collective circumstance.

As an SLP and parent of a child with multiple health needs, there is truly zero available help.

stop eval/task, can document need to continue next session due to pt's emotional reactions to situation - same as in person

aphasia access has a pdf of great resources that are aphasia friendly

My biggest difficulty so far has been with a patient with PPA/dementia. I am having difficulty with the patient understanding how to interact through this format. It is hard for me to demonstrate to the patient/family how to use a communication book.

need to look at camera for them to feel your eye contact, looking at them may look like our eyes are closed if they are in lower part of our screen

Is there a way to use a sign language interpreter through a telehealth platformJ?

yes Ilana! Me too.

Yes re: ASL interpreter! I do that on telehealth

Some with mild cog impairment and more impaired hearing benefit from headphones with ambient noise.

Zoom has a special interpreter designated channel - user can select to mute original speaker’s voice and put interpreter’s voice as principal

you can invite an interpreter as a participant in the meeting, so you all see one another.

If the headphones have a mic built in even better.

I recently worked with an individual with hearing loss. Upgrading to ipad from phone made a huge difference. I used a dry erase board to write notes to support my comments.

a lot of the more severe cog work is with the family or nursing

great opportunity to collaborate with the interprofessional team!

definitely Elizabeth!

Are you all doing telehealth with patient in SNFs? Medicare patients?

If online platforms fail (like client has an internet failure), is it ever possible to do a session by phone?

yes, treatment/family/caregiver educ is less complicated for me - it's how to do a comprehensive standardized eval for reimbursement requirements

SNF staff are so swamped they don't have time

my thought too Lois. Not sure there is time for staff to assist.

Is it even allowed to provide telehealth in this setting? Especially when there are already therapists in most SNFs.

not the ones I work in!

maybe a PT if lucky

Is anyone doing an aphasia group? How are they managing conversation?

I facilitate a phone-only support group - our rule is that everyone counts to 2 before talking to decrease cross-talk; good for impulsivity control!

Yes, I’ve found that the clients at NYU Langone as outpatients who have sought telehealth have better attendance and appear motivated to participate…i find that sometimes attention is better with tele heath than in person!

My aunt is in a LTC facility and after they locked down 9 weeks ago, the director set up an online sign up for residents to FaceTime or Skype with families/friends. Staff they walk around with tablets to residents, set up headphones, etc. to start the sessions. It has been wildly popular, and residents are happier and more engaged with family and staff.

Do you have a list of the topics covered in the “preflight” session?

yes Jen

I am doing 14 aphasia groups per week

Nice Ann-Mari!

We can provide treatment in SNFs with the therapist onsite but not in the same room as the patient (ie therapist in the gym and patient in their room) via I pad. This is not considered telehealth though.

I am also interested in possible list of topics related to "preflight," if possible!

As of April 9, 2020 ASHA reported CMS has stated that therapists including SLPS may provide evaluation and treatment services to pt in SNF;s via audiovisual devices and that those services for billing would be considered in persons services.

We do interdisciplinary meetings with client, team, even family members out of province or country, works really well for goal setting and review

will there be another ASHA live webinar dealing with telehealth billing/reimbursement issues?

Thanks for this great session - would love to do additional sessions to go more in depth for some of these areas (e.g. standardized assessment, multimodal communication and interactive features that can be used in tx)

Yes Michelle!

Excellent suggestion, Trish!

Would be interested to hear more about billing/reimbursement with managed care insurance companies

I've done quite a few post-COVID webinars - Thank you! One of the better ones I've attended. I hope this will be made available later so I can share with colleagues.

yes I agree, thanks presenters for session, the group chat here great too

Thank you, everyone, for sharing your expertise and encouragement.

you are all great mentors - hope we can hear from you again!

Yes, what a thoughtful discussion, thank you all!

Set appropriate expectations.

I agree, Adam. And it will be available post live chat.

Lower your expectations may equal Grant yourself some grace!

thank you! this was great!

this was wonderful; thank you

Fantastic discussion.

Thank you! Very informative.

It is a great session! Thank you!

Thank you. Good night everyone.

Thank you!

Amen to Don!

This was such a helpful discussion! Thank you everyone for your excellent ideas and generosity with your time.

Thank you!

Thanks so much! :)

Very helpful. Thank you!!!

appreciate everyone! thanks

Thanks to Jessie and all the panelists!

thank you everyone!

Great information. Thank all presenters and participants.

This was wonderful! Learned both from the presenters and the zoom group chat! Thank you!!

Thanks to all for your time!

Thank you Don. That is very helpful!!!

Thanks very much for an excellent discussion.

Thank you all so much.

Thank you all for your encouragement and wisdom in this field.

Thank you!

Thank you so much!

Thank you!

Thank you to all of the presenters!

Thank you!

Jessica, great job as moderator! Hats off to everyone.

Thank you!

Thank you for sharing your expertise!

Thank you!

Thank you so much, this was wonderful!

Thank you to everyone!

thank you!!! really informative

Thank you so much. This was very helpful.

Thanks to all the presenters and to Jessie!

Thank you for this discussion.

Thank you all for sharing your expertise! I'm looking forward to starting my CF at the VA and adapting methods to fit the ever-changing state of our field.

Nite-nite!

Thank you so much! I learned a lot!

Thank you!