1. Although there is overall a growing body of positive research evidence for the use of telehealth for dysphagia management, what also must be kept in mind about these positive outcomes before “jumping into” implementation?
All of these published studies followed specific and strict procedural, training, and practical guidelines. Therefore, all the positive outcomes reported are specific to the methodologies used in these studies. Deviations from these protocols and methodologies may or may NOT yield similarly positive and safe results. Additionally, to our knowledge, no studies have examined the feasibility, safety, and reliability of swallowing tele-services provided when the clinician is at home. Therefore, clinicians that are delivering services from the home setting need to be extra careful and use their best clinical judgment when doing so.
2. True or False: Choosing a specific service or method to obtain legal documents’ signature needs to be approved by your legal counsel/risk management team.
True!
3. Multiple choice: Typical training guidelines for facilitators should include which of the following topics?
a. Clear delineation of the emergency plan |
b. Clear instructions/rules about when the facilitator may intervene and override the remote clinician |
c. Detailed instructions on how to prepare for the session |
d. A and C |
e. All of the above |
4. According to ATA guidelines, bandwidth should be at a minimum of ____________ for both upload and download, and should provide a minimum of 640 x 360 resolution at _______ frames/second.
384 Kbps; 30 frames/second. However, this should be considered the minimum and the higher the bandwidth on both the clinician and patient end, the better the connection will be.
5. List 3 adaptations you can make to create an environment as conducive to providing clinical services as possible?
- Make sure both the patient and client are in comfortable, quiet, and private rooms, free of clutter and distractions.
- Room lights should be adjusted to minimize shadows and windows should be closed. The computer/camera should face a wall, not a window.
6. Why is it important for both the clinician and patient to have all materials/tools during the sessions?
These items should be available at both ends of the connection (clinician and patient) so that the clinician can use these items to model targeted behaviors, and so that the patient can perform the different tasks, ideally with the help of a facilitator/caregiver.
7. Multiple choice: If established/published validated clinical swallowing assessments or screenings are used via telehealth, clinicians are strongly advised to:
a. Reach out to test developers to ask if they have online versions available |
b. Interpret results with extreme caution |
c. Use such tests only to supplement other aspects of the clinical assessment, not as stand alone evaluations |
d. Disclose the assessment or screening was given via telehealth and mention its limitations in documentation |
e. All of the above |
8. Describe the dysphagia-specific candidacy criteria we need to consider to determine if a patient is a good candidate for telehealth services?
- Ability of patient to understand and participate in dysphagia specific procedures (for example, patient is alert and can participate in activities)
- Patient is medically stable to participate in the session
- Adequate training of patient/family and e-helper/facilitator for all safety and emergency plan procedures in place (e.g., CPR training)
- Adequate training of family and e-helper/facilitator to ensure appropriate help/facilitation during sessions
- Availability of adequate bandwidth to allow for solid Internet connection during tele-evaluation and tele-treatments.
- Availability or adequate equipment/tools for dysphagia specific procedures
9. Multiple Choice: These are some of the actions recommended to be completed in every tele-session:
a. Identify all people in the room and ensure patient's permission for everyone's presence |
b. Test all technical aspects and have a protocol for when technical issues arrive |
c. Remind everyone of the emergency plan |
d. All of the above |
10. List 5 practical adaptations you would need to make to ensure the feasibility and validity of a tele-clinical swallowing evaluation
- Train your facilitators!
- Adjust camera and lighting to ensure you can view the specific parts you are examining very well (ideally use an external camera)
- Ensure CN exam kit items are available on both ends (clinician and patient)
- Script your directions and screen share them
- Use white tape on thyroid notch when examining swallows and examine some swallows in the front and some in the lateral view
- Use clear cups and utensils