Approximately 46 million Americans – roughly 14% of the population – experience some form of communication disorder, according to "School Programs in Speech-Language Pathology." Speech language pathologists (SLPs) help address many types of speech and communication difficulties for people of all ages, as explained by Avivit Ben-Aharon, founder and clinical director at Great Speech:

• Speech sounds – How we say sounds and put sounds together into words. Other words for these problems are articulation or phonological disorders, apraxia of speech or dysarthria.
• Language – How well we understand what we hear or read, and how we use words to tell others what we are thinking. In adults, this problem may be called aphasia.
• Literacy – How well we read and write. People with speech and language disorders may also have trouble reading, spelling and writing.
• Social communication – How well we follow rules, like taking turns, how to talk to different people, or how close to stand to someone when talking. This is also called pragmatics.
• Voice – How our voices sound. We may sound hoarse, lose our voices easily, talk too loudly or through our noses, or be unable to make sounds.
• Fluency – Also called stuttering, is how well speech flows. Someone who stutters may repeat sounds, like t-t-t-table, use "um" or "uh," or pause a lot when talking. Many young children will go through a time when they stutter, but most outgrow it.
• Cognitive-communication – How well our minds work. Problems may involve memory, attention, problem solving, organization and other thinking skills.

Speech and language therapy solutions are provided for those impacted by:

• Alzheimer's, dementia, Parkinson’s disease.
• Autism spectrum disorder.
• Cognitive communication disorder.
• Head and neck cancer.
• Hearing loss.
• Stroke and aphasia rehabilitation.
• Traumatic brain injury.
• Voice disorders.

More recently, progressive speech programs serve individuals seeking gender affirmation services to make their voice and/or other aspects of their communication congruent with their gender identity and/or gender expression. SLPs provide expertise in modifying the voice and other aspects of communication.

Ben-Aharon of Great Speech, a virtual speech therapy company, has a Master of Science in Education and a Master of Arts Certificate of Clinical Competence in Speech-Language Pathology.

She is recognized as a trailblazer for nationwide virtual access to speech therapy, allowing anyone who is committed to improving their communication to receive expert services, regardless of location or scheduling limitations.

We interviewed Ben-Aharon to talk about the convergence of speech therapy and telehealth.

Q. How is speech therapy delivered via telehealth? And how is it different from in-person care?

A. The pandemic introduced many people to the convenience of accessing multiple healthcare services via virtual care, also known as telemedicine or telehealth.

Now, speech therapy services can be accessed the same way. Virtual speech therapy is easy to engage, and people can learn new communication strategies in the comfort of their own homes.

This promotes consistency and routine, with regularly scheduled virtual therapy sessions leading to reduced anxiety about receiving assistance and creating a solid routine for speech therapy services in a familiar environment.

This approach eliminates transportation issues and waiting in unpredictable public waiting rooms for appointments – which often causes concern about exposure to COVID or other viruses, especially for vulnerable patients or those with mobility difficulties.

Virtual visits enable rapid access to care versus waiting weeks for an appointment at an office. These appointments also are easier to fit into a busy schedule and patients can avoid missing work or other activities.

Another key differentiator from in-person care, albeit reserved for more sophisticated virtual speech programs, is the utilization of patient-matching artificial intelligence technology that considers multiple data points to optimize pairing patients with the most qualified speech therapists for a patient’s specific condition.

With this technology, patients receive a personalized invitation to a private video session where they work one-to-one with a therapist who has specialized training. Conversely, during speech therapy conducted at a brick-and-mortar facility, the therapists treat all age groups and various conditions within the same day.

With focused speech therapy provided by a therapist who has specialized training and experience, the patient experiences faster results in a shorter time frame.

Additionally, select virtual programs may offer a hybrid care plan model that includes “synchronous” live one-to-one with a therapist and “asynchronous” access to an online practice portal: an opportunity for people to “complete homework assignments” that help extend the value of live sessions and to more rapidly attain their speech goals.

There is no one-size-fits-all plan for speech and communication improvement, although the average duration of virtual sessions (depending on frequency and diagnosis) ranges from three to six months (depending on diagnosis and severity).

After the established time period, the patient and therapist will review the plan of care, progress and goals, and together they will map out next steps. Consistent scheduling and active participation are the keys to success.

Q. How does the age of the patient matter in speech therapy? And how does that matter when care is being delivered via telehealth?

A. The chronological age of the patient is not the primary consideration for virtual speech therapy. However, treatment plans and approaches differ for specific age groups, with an essential goal to improve one’s ability to understand and express thoughts, ideas and feelings appropriate for one’s age.

Virtual speech therapy removes barriers that can limit access to care, specifically for children or older adults that face transportation issues and often prefer to improve their communication skills in a discreet, comfortable home setting.

For example, for young children under age 4, “parent coaching” is very important. Therapists work with the child’s main caregiver, usually the parent, offering coaching and assistance that empowers these relatives or caregivers to help the child until he or she turns four years of age. Once the child reaches a suitable stage, the therapist can work more closely with the child and offer meaningful support.

In fact, children over four years old often love the computer and find virtual speech therapy to be a fun activity – like a game they would play on their tablet. Furthermore, this approach addresses gaps in education when the school/pre-school system does not offer a specialized program like speech therapy for kids with Autism, articulation or stuttering.

At the other end of the age range, speech therapists can provide virtual care to seniors and Medicare Advantage enrollees nationwide. The therapist may pose questions such as, “Do you FaceTime with your grandchild?” or “Have you connected via Zoom in a family chat during the pandemic?”

If they answer “Yes,” they are likely good candidates for virtual speech therapy, because their response shows that they are comfortable with technology and have attached it to a positive experience.

What is particularly relevant to this discussion is that children with communication challenges can often benefit from therapeutic interventions or parent coaching that can improve their skills for a lifetime.

For older adults, improved communication skills enable better management of age-related conditions, helping seniors to adapt to the onset of changes, both physically and mentally, and optimize the skills they are able to maintain.

Q. How do social determinants of health play into virtual speech therapy?

A. Virtual speech therapy directly addresses social determinants of health by not only resolving transportation or financial issues but also assisting with another critical challenge – loneliness. Humans are social beings and the inability to effectively communicate with others can lead to anxiety, depression, social isolation and loneliness. Research also documents that people with communication disorders have poorer health and less than optimal healthcare outcomes.

Consistent therapeutic intervention can positively impact both social behavior and academic performance. When a child struggles to communicate, parents recognize how much this impacts all other aspects of their child’s life.

For older adults who may experience diminishing communicative abilities, the effects of these challenges can go far beyond the ability to communicate effectively.

Improved communications skills boost self-confidence, enhance interpersonal relationships and enable patients of all ages to express their wishes, articulate desires or describe pain or other problems. Speech therapy supports these improvements, providing the individual with the greatest possible chance for success.

The results literally speak volumes: reduced isolation and frustration, and stronger connections with family, educators and colleagues that are both gratifying and heartwarming for all.

The value of virtual care has now gained the attention of the nation’s payers, who increasingly understand its role in addressing SDOH. A growing number are adopting virtual speech therapy and regard it as an opportunity for easier access to therapists who can improve communication skills.

Health plans are interested in promoting member satisfaction with benefits and health plan member retention – and virtual speech therapy meets these goals by ensuring convenient access to care in the privacy of one’s own home; eliminating long wait times for appointments; avoiding travel to a brick-and-mortar facility; and removing time spent in a clinician waiting room.

Today, virtual speech therapy programs strengthen the health plan’s range and depth of services for members enrolled in both commercial and Medicare Advantage. It’s scalable, and accessible – serving members regardless of where they are located geographically, especially those living in rural areas.

Care barriers that previously prevented members from seeking speech therapy services, such as transportation concerns, mobility issues and other physical limitations, are eliminated when using a virtual care model. Additionally, flexible spending accounts and healthcare savings account dollars can be applied toward virtual speech therapy services to cover any early-year deductibles or co-pay requirements.

But health plans should be aware of the financial constraints of some members who are canceling speech therapy sessions over as little as a $7 co-pay. This should not come as a surprise, with U.S. and global inflation at a 40-year high.

However, patients and their families can offset – and sometimes cover – the cost of a co-pay by seeking virtual speech therapy as opposed to incurring the cost of travel (gas, tolls, etc.) to a brick-and-mortar facility or potentially losing time from work.

The financial advantages can also be measured in the time it takes for members to achieve results. On average, virtual speech therapy enables individuals to accomplish their goals faster and in fewer sessions than when they travel to a brick-and-mortar therapy clinic.

Experience shows that patients are less stressed in engaging in therapy when they are in a comfortable home setting, and caregivers are more closely involved to help support the client between sessions. Fewer sessions add up to savings for patients and families.

Q. How can virtual speech therapy be used to address long COVID conditions?

A. Researchers report that among the many challenges of long COVID, communication issues persist, including:

• Cognitive impairment: Mild to severe trouble remembering, learning new things, concentrating or making decisions that affect the person's everyday life.
• Brain fog: Diminished mental capacity marked by an inability to concentrate or to think or reason clearly.
• Speech and language issues: Difficulty forming specific words or sounds correctly, or making words or sentences flow smoothly, such as stuttering or stammering.

During recovery, individuals report that they have trouble remembering, using intended words or expressing ideas in coherent sentences. Left untreated these issues may worsen over time.

A long COVID patient who struggles with brain fog and other communication and voice issues should see a doctor for a formal diagnosis and ask for a virtual speech therapy referral to get help in the comfort and privacy of their home.

Fortunately, SLPs working in a virtual model and using specialized intervention plans can help long COVID patients to recover verbal skills, avoid further deterioration and more confidently return to work and academic activities:

• SLPs utilize a variety of approaches. For example, spaced retrieval helps patients practice recall and use of relevant information over increasing intervals of time. Patients who have difficulty speaking can sometimes utilize alternative modes of communication such as singing, allowing SLPs to introduce melodic intonation therapy as part of the treatment protocols.
• Script training enables patients to work with their therapists and develop common scripts for communication needs. These activities improve sentence formation, speech rate and overall confidence. SLPs can also focus on auditory and visual cueing strategies, as well as retrieval cueing approaches that aid patients in recalling the words they wish or intend to use.

One specialized approach leverages the advantages of virtual speech therapy to offer long COVID treatment that includes individual and group therapy. The program creates access to peer support and assures patients they are not alone in their journey to recovery.

In addition to individual therapy, virtual approaches that include speech and language group therapy can help patients who are affected by long COVID to confidently return to work, handle daily life and resume an active lifestyle. Virtual speech therapy provides the added benefits of allowing people to get help from their homes, eliminating travel to an office and minimizing opportunities for viral transmission.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email the writer: bsiwicki@himss.org
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