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Research Article
Delivery of Speech-Language Therapy and Audiology
Services Across the World at the Start of the
COVID-19 Pandemic: A Survey
Sabine Van Eerdenbrugh,
a
Kirsten Schraeyen,
a,b
Heleen Leysen,
a
Charlotte Mostaert,
a
Wendy D’haenens,
a
and Dorien Vandenborre
a
a
Department of Speech-Language Pathology & Audiology, Thomas More University of Applied Sciences, Antwerp, Belgium
b
Parenting and
Special Education Research Unit, Faculty of Psychology and Educational Sciences, Catholic University of Leuven, Belgium
ARTICLE INFO
Article History:
Received June 7, 2021
Revision received August 28, 2021
Accepted December 1, 2021
Editor-in-Chief: Patrick Finn
Editor: Geralyn M. Schulz
https://doi.org/10.1044/2021_PERSP-21-00134
ABSTRACT
Purpose: Speech-language pathologists (SLPs) and audiologists from around
the world were forced to enter the world of telepractice at the start of the
COVID-19 pandemic. This study investigated which types of applications SLPs
and audiologists used most frequently at that time. It also examined what the
main obstacles then were to provide speech, language, and hearing services
through telepractice.
Method: A short electronic survey with 13 questions was distributed around the
world. In total, 1,466 surveys from SLPs and audiologists from 40 countries
were used for the analysis. Most of them (77.4%) delivered care through online
real-time communication. A minority (40.1%) also delivered care through videos
or exercises that they sent to their clients, 37.8% delivered through face-to-face
intervention in the same room, 30.0% delivered through telephone without
video, and 21.5% provided distant computer-based treatment.
Results: The most frequently used applications were those that establish syn-
chronous video communication with the client (60.5%). SLPs and audiologists
reported using applications to create exercises more frequently than applica-
tions that contain exercises or training (15.0% vs. 12.0%). The most reported
obstacle (31.2%) referred to technical problems (poor Internet connection, poor
quality, or poor access to resources). Other frequently reported obstacles
included the difficulty to perform assessment or treatment procedures (13.8%),
concentration issues during sessions (12.4%), and lack of interaction between
professional and client or patient (10.9%).
Conclusions: Many SLPs and audiologists reported using telepractice technol-
ogy, mainly in the form of real-time videoconferencing. However, existing bar-
riers included technical problems such as poor Internet connection.
Telepractice is “the application of telecommunica-
tions technology to the delivery of speech language pathol-
ogy and audiology professional services at a distance by link-
ing clinician to client or clinician to clinician for assess-
ment, intervention, and/or consultation”(American Speech-
Language-Hearing Association [ASHA], 2020). ASHA pre-
fers the term telepractice as its use is not limited to health
care settings, as opposed to the terms telemedicine or tele-
health. A synonym of telepractice is telerehabilitation. In
certain countries, such as the United States, Australia,
Canada, and the Netherlands, telepractice has been
included in the legislation and health reimbursement
scheme for years. In other countries, such as Belgium, that
was not the case at the start of the COVID-19 pandemic.
Telepractice clearly has a clear value in the assess-
ment, intervention, and counseling of speech, language,
and hearing disorders (Rao & Yashaswini, 2018; Theodoros,
2011). Reviews have been conducted for persons with
SIG 18
Correspondence to Sabine Van Eerdenbrugh: sabine.vaneerdenbrugh@
thomasmore.be. Disclosure: The authors have declared that no competing
financial or nonfinancial interests existed at the time of publication.
Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022 •Copyright © 2022 American Speech-Language-Hearing Association 635
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dementia (Cotelli et al., 2019), dysphagia (Nordio et al.,
2018), and stuttering (McGill et al., 2019), and best prac-
tices were established for patients with hearing disorders
(Thai-Van et al., 2020). Weidner and Lowman (2020) state
that telepractice is an appropriate service model for speech-
language pathology for adults. In their review, most ser-
vices implied intervention for (chronic) aphasia, delivered
with synchronous videoconferencing. The evidence is, how-
ever, not strong often due to the lack of a control group,
randomization, or description of the telepractice setting in
the clinical studies. In another review, Edwards et al. (2012)
described clinical studies for telepractice in adults and in
children. They claimed that parent coaching and involve-
ment is crucial for telepractice with young children. They
mainly called for extending research in telepractice because
research evidence was limited at that time. Freckmann
et al. (2017) reported about the therapeutic alliance between
the speech-language pathologist (SLP) and client or patient.
They did not find a difference between face-to-face and tele-
practice sessions for the intervention of adults and children
with a range of speech-language pathology disorders.
Mohan et al. (2017) reported that telepractice in India
meets the need of the shortage of SLPs and overcomes the
barriers of distance. They also mentioned that technology
(mobile phones and Internet) is widely available in India.
Some countries incorporated telepractice as a service deliv-
ery format for speech-language pathology for several years,
supported by limited but promising evidence. However, until
recently, telepractice was merely an optional delivery method
for service delivery.
Before the COVID-19 pandemic, Rosling, professor
of International Health, predicted: “There are pressing
global risks we need to address”(Rosling, 2018, p. 237). He
listed five problems, with a global pandemic being number
one. It is terrifying how realistically he predicted a then not
yet existing flu-like disease. Rosling claimed that this type
of disease is the most dangerous threat to global health
because of its transmission route. The transmission route
refers to the droplets of saliva flying and spreading between
people even without touching. The spreading of these drop-
letscancauseahighlyaggressiveglobalepidemic.
The COVID-19 pandemic started its massive infec-
tion spread in Wuhan (China) during the last months of
2019. From there onwards, the virus spread out over the
entire world with infection peaks varying per region
(World Health Organization, 2021). The initial fear of
how the disease would affect the health of people resulted
in lockdown measures in many countries (e.g., European
Centre for Disease Prevention and Control, 2021). With
that, basic health services were limited to emergency inter-
ventions. Also, speech, language, and hearing services in
many countries were limited to the most urgent services.
During the first months of 2020, it was not clear how the
pandemic would evolve. However, it was clear that SLPs,
audiologists, and also clients and patients needed to find
their way to health care services (e. g., Richter et al., 2021).
Physical contact between SLPs or audiologists and clients or
patients to organize assessment and deliver intervention
was not an option. However, telepractice could address this
obstacle.
Because of the recent COVID-19 pandemic, more
studies about delivering care through telehealth were con-
ducted. For example, Tenforde et al. (2020) administered
an online satisfaction survey to understand client and phy-
sician’s satisfaction with telerehabilitation during the
COVID-19 pandemic. Based on 205 completed surveys,
they reported high satisfaction ratings for all patient-
centered outcome variables, such as addressing concerns,
developing a treatment plan, and convenience, as well as
value in future telehealth visits, with slightly higher ratings
provided by female than male participants. They also
identified both benefits (e.g., eliminating travel time) and
limitations (e.g., technology, elements of hands-on aspects
of care). Based on their outcomes, these authors conclude
that telepractice services should be considered in future
health care delivery models. It is however not clear whether
SLPs and audiologists around the world were ready for tele-
practice at the start of the COVID-19 pandemic.
This study aimed at gaining this insight in the imme-
diate impact of the COVID-19 pandemic on the circum-
stances in which SLPs and audiologists around the world
delivered care at the start of the pandemic. The research
questions were as follows: (a) How did SLPs and audiolo-
gists deliver their services at the beginning of the COVID-
19 pandemic? (b) Which digital applications did SLPs and
audiologists across the world use at that time? (c) What
were the obstacles for SLPs and audiologists to administer
telepractice at that time? To answer these questions, a
brief survey was created.
Method
Participants
An electronic survey was sent to SLPs and audiolo-
gists around the world between March 27 and June 29,
2020. The only inclusion criterion was that respondents
provided speech-language pathology or audiology services.
The survey was constructed in English.
The survey was conducted when the first lockdown
hit most countries in Europe and was distributed to two
international networks, the European Clinical Specialization
in Fluency (http://www.ecsf.eu), an international postgradu-
ate course for stuttering, and the Speech Language Pathol-
ogy International Network (http://www.thomasmore.be/slp),
which includes 19 SLP departments across the world. In
addition, the survey was distributed in Belgium by social
636 Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022
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media and throughout the personal international contacts of
all the authors. The respondents read about the purpose of
thesurveyandthetypeofdatathatwerecollected.Given
the fact that the survey did not collect identifiable personal
information such as name, age, or gender, responding to the
questions was considered as giving consent.
There was a loss of data integrity due to incomplete
surveys: 443 out of 1,909 participants were excluded as
they did not complete the survey. As a result, 1,466 com-
pleted surveys were included for further analysis. The
study was approved by the scientific advisory board of the
Thomas More University of Applied Sciences (Department of
Speech-Language Pathology and Audiology).
Procedure
The survey was constructed using the licensed ver-
sion of the software program Qualtrics by the authors. It
consisted of 13 questions: four general questions about
respondents’profession and type of provided intervention,
and nine questions about situational factors related to
delivered speech, language, and hearing services.
The authors deliberately limited the number of ques-
tions to maximize the response rate. Two questions were
open questions, whereas the others were multiple choice.
The survey is added in the Appendix.
Analysis
Excel was used for the analyses. For the analysis on
the description of providers and their services, descriptive
analysis of the multiple-choice questions was used. For
the analysis on digital application, broad themes were
sought in the answers to the open questions before con-
ducting a frequency analysis.
For the analysis on obstacles free listed by respon-
dents, fine-coded themes were listed and broad themes
were sought before conducting a frequency analysis. Most
multiple-choice questions included more than one answer,
and not all open questions contained valid answers.
Hence, the numbers of answers differed for each question
and are indicated in the heading of each table or figure.
Results
Nearly all respondents (n= 1,412, 96.3%) were
SLPs, 26 (1.8%) were audiologists, and 28 indicated both
professions (1.91%). In the community setting, SLPs man-
age a diverse caseload. Table 1 presents the caseload
details of the respondents.
Table 2 provides information on the number of
respondents per country and their situation. SLPs and audi-
ologists from Belgium, Portugal, and Finland comprised
68.0% of the respondents.
About half of the respondents (n= 698, 52.4%)
could continue providing care even though most of the
countries were in lockdown when the respondents com-
pleted the survey.
Many respondents provided care through real-time
communication applications (see Table 3) and could con-
tinue delivering their health care services as before the pan-
demic (see Table 4). The respondents who did not provide
health care services, mainly SLPs and audiologists from
Belgium, did not have a legal frame to provide the care at
that time, only provided emergency care, or were unfamiliar
with or not certified to deliver intervention other than face-
to-face intervention (see Table 5). Without the answers of
the Belgian SLPs and audiologists (n= 421), the most fre-
quently reported reasons for not providing services were
only delivering emergency intervention, needing to take
care of the family, or being assigned to other tasks.
The digital applications that were used are grouped in
five themes and presented in Figure 1. Only applications that
were reported by at least three respondents were added in
the figure except for the applications Tympanometer and
Voice Analytics (n= 2). The five themes are (a) instruments
for measurement, (b) applications to create exercises or train-
ing, (c) applications with exercises or training, (d) applications
for communication outside service delivery, and (e) applica-
tions for communication during service delivery.
The applications that were reported most frequently
and with the largest variety were related to communication
during service delivery (60.5%). Applications to create exer-
cises were reported frequently as well (15.0%), with many
respondents using the same applications. Respondents also
Table 1. Caseload details of the speech-language pathologists and audiologists who responded to the survey (N= 1,466).
Demographic
Speech Tx:
n(%)
Language
a
Tx:
n(%)
Fluency Tx:
n(%)
Swallowing Tx:
n(%)
Hearing Tx:
n(%)
Rehabilitative
audiology Tx:
n(%)
Other:
n(%)
Children 1,122 (76.5%) 1,141 (77.8%) 363 (24.8%) 337 (23.0%) 58 (4.0%) 69 (4.7%) 268 (18.3%)
Adults 542 (37.0%) 527 (35.9%) 186 (12.7%) 387 (26.4%) 46 (3.1%) 68 (4.6%)
Note. Tx = treatment.
a
Includes learning disorders, augmentative and alternative communication.
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reported using a wide variety of websites or games with
exercises (12.0%).
Table 6 provides an overview of obstacles that SLPs
and audiologists encountered during telepractice. Almost one
third of the reported obstacles were related to poor Internet
connection, poor video or audio quality, and lack of access
to digital resources (31.2%). Another frequently reported
obstacle was the inability to perform certain assessment or
intervention procedures through webcam service delivery
(13.8%). SLPs and audiologists also reported concentration
problems (12.4%), lack of interaction (10.9%), and compli-
ance issues (6.9%) as frequently encountered obstacles.
Discussion
COVID-19 did not have the same consequences for
SLPs and audiologists around the globe between March
and June 2020. Although common face-to-face health care
service delivery was disrupted in most countries, the
continuity of care was more challenging in some countries
than in other. Indeed, not all countries were ready for the
massive switch to telepractice. For instance, in Belgium, this
type of service was not yet included in the existing health
care delivery models and, hence, not regulated or reim-
bursed. In contrast, in countries where telepractice was
already regulated such as in Australia, the Netherlands, and
the United States, the continuity of care was less challenging.
About half of the SLPs and audiologists were able
to continue to provide care or initiate intervention with
new clients or patients thanks to telepractice. Over 60% of
the telepractice applications that were reported by the
respondents intend to establish synchronous videoconfer-
encing. This finding corroborates research findings on most
frequently used telepractice techniques (e. g., Mashima &
Doarn, 2008; Reynolds et al., 2009; Theodoros, 2011).
One possible reason is that this technique of synchronous
videoconferencing is to some extent similar to face-to-face
intervention (Hammersley et al., 2019). Another possible
reason, given the data generated in this study (see
Table 2. Speech-language pathologists (SLPs) and audiologists reporting about their lockdown situation (N= 1,466).
Country (N,%)
Providing care:
n(%)
Total (N) of SLPs and
audiologists who
answered this question
Lockdown:
n(%)
Total (N) of SLPs
and audiologists who
answered this question
The Netherlands (37, 2.5%) 30 (96.8%) 31 11 (31.4%) 35
Finland (151, 10,3.%) 133 (95.7%) 139 143 (95.3%) 150
Australia (31, 2.1%) 28 (93.3%) 30 16 (53.3%) 30
Sweden (68, 4.6%) 57 (91.9%) 62 8 (12.3%) 65
Germany (25, 1.7%) 19 (82.6%) 23 23 (92%) 25
Poland (10, 0.7%) 7 (77.8%) 9 9 (100%) 9
Austria (19, 1.3%) 11 (73.3%) 15 18 (94.7%) 19
United States (26, 1.8%) 18 (72%) 25 15 (57.7%) 26
Portugal (269, 18.3%) 177 (71.1%) 249 263 (99.2%) 265
Norway (54, 3.7%) 34 (66.7%) 51 51 (94.4%) 54
France (17, 1.2%) 11 (64.7%) 17 17 (100%) 17
Croatia (62, 4.2%) 34 (60.7%) 56 61 (100%) 61
Brazil (5, 0.3%) 2 (40.0%) 5 5 (100%) 5
Slovenia (9, 0.6%) 3 (37.5%) 8 9 (100%) 9
The Philippines (14, 1.0%) 3 (23.1%) 13 14 (100%) 14
Belgium (577, 39.4%) 121 (22.2%) 545 525 (91.9%) 571
India (16, 1.1%) 3 (20%) 15 16 (100%) 16
Turkey (41, 2.8%) 7 (18.4%) 38 33 (80.5%) 41
Total 698 (52.4%) 1,331 1,237 (87.6%) 1,412
Note. Only countries with ≥5 respondents are reported.
Table 3. Method for delivering speech-language pathological or audiological care during the initial months of the COVID-19 pandemic (N= 664).
Total number of SLPs and
audiologists responding
to the question: N
Face to face
in the same
room: n(%)
Through
telephone
(no video):
n(%)
Through online
real-time
communication:
n(%)
Through videos
or exercises sent
by the SLP: n(%)
Distant
computer-based
treatment: n(%) Other*
664 251 (37.8%) 199 (30.0%) 514 (77.4%) 266 (40.1%) 143 (21.5%) 29 (4.4%)
Note. SLP = speech-language pathologist.
*Includes compliance with specified hygiene measures, in discussion with physicians and nurses and with help from caregivers.
638 Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022
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Table 5), is that SLPs might lack knowledge and skills to
implement other applications (Mahajan et al., 2020).
Apart from the applications for videoconferencing,
SLPs and audiologists frequently reported using software
to create exercises. This might raise the question whether
applications that provide exercises are sufficiently accessi-
ble or exist for some speech, language, or hearing needs as
they do for other medical domains (Golinelli et al., 2020).
For exercises on clearly defined topics, such as training of
articulatory skills, applications that provide exercises with
feedback seem to be successful (e. g., Quia Games, Digital
Spinners, and Articulation Trials). To train more complex
skills, such as certain voice skills, or to involve partners or
parents in the intervention, such as partners of patients
with aphasia or parents of young children, such applica-
tions that provide pre-set exercises may not meet the
expectations for successfully training these skills (Castillo-
Allendes et al., 2020; Lam et al., 2021). Applications with
exercises provide means to train certain aspects but may
not suffice for the entire intervention. It is possible that
SLPs and audiologists do not know they exist and, hence,
did not report using them (Golinelli et al., 2020). SLPs
and audiologists tend to create their own resources, which
is reflected in the extra time some SLPs and audiologists
report because of telepractice.
In the beginning of the COVID-pandemic, SLPs and
audiologists were suddenly confronted with the impact of
COVID-19 on society in general and sessions were canceled,
postponed, or limited to emergency care only in the hopeful
perspective that COVID-19 would only impact service
delivery for some weeks. As time passed, it became clear
that the impact was more comprehensive. Therefore, SLPs
and audiologists considered alternatives to replace physi-
cal face-to-face contact. This predicament resulted in the
rapid adoption of telepractice methodologies (Krukowski &
Ross, 2020). Later in time, the focus moved to digital tools
for different purposes and patient needs, such as adherence,
surveillance, lifestyle, and patient engagement (Golinelli
et al., 2020).
Not surprisingly, SLPs and audiologists reported
obstacles associated with telepractice given the abrupt
switch that most of them had to make to telepractice.
They most frequently reported difficulty due to poor Inter-
net connection, poor audio quality, and poor access to
technical resources (lack of computer or a printer). This
obstacle was also reported in the review of Molini-
Avejonas et al. (2015) in one out of four telepractice stud-
ies. Telepractice, however, should improve access to health
care, for example, by including relaxed regulation and
increased reimbursement, and not increase the threshold,
knowing that equity of care is one of the important goals
of telepractice (e. g., Wilson et al., 2002).
Another frequently reported obstacle in our study
was that some assessment or intervention components are
not suited to be delivered through telepractice. This was
also previously reported and included components for dys-
phagia or oromotor assessment or intervention (Brodsky
& Gilbert, 2020; Hincapié et al., 2020), or intervention for
children with concentration difficulties such as attention-
deficit/hyperactivity disorder (McGrath, 2020). Also, in
specific aged populations, SLPs and audiologists encoun-
tered difficulties, such as service delivery to older clients
or patients (technology) and to very young children (lim-
ited attention span; Ienca & Vayena, 2020; Lam et al.,
2021). SLPs and audiologists reported to miss the level of
engagement and interaction that they usually have in face-
to-face encounters with their clients or patients. SLPs and
audiologists frequently reported compliance issues, espe-
cially in families of children who received speech-language
therapy or audiology services. This is possibly also due to
the COVID-19 situation in which parents had to work
from home and children received schooling from home.
Although some digital technologies have existed for
decades, they have had poor penetration into the market
because of heavy regulation and sparse supportive pay-
ment structures (Hincapié et al., 2020). Due to the sud-
den lockdown, health care providers were confronted
with the difficulty of treatment provision and continua-
tions without face-to-face contact (Krukowski & Ross,
2020). The urgent need for adaptation has allowed the
implementation of telepractice in a comprehensive man-
ner in different health services, which was translated into
multiple benefits for the community at large (Dimer et al.,
2020).
This study collected data from around the globe at
an extremely unique point in time. The strength of this
study is that it represents data from the situation in which
SLPs and audiologists forcefully entered the world of
Table 4. Content of speech-language pathological or audiological care during the initial months of the COVID-19 pandemic (N= 664).
Total number of SLPs and
audiologists responding to
the question: N
Same as
before: n(%)
Advice for
client/patient: n(%)
Advice for parents/
caretaker of
client/patient: n(%)
Mainly
follow-up: n(%) Other*
664 563 (80.7%) 283 (35.8%) 385 (58.0%) 160 (24.1%) 21 (3.2%)
Note. SLP = speech-language pathologist.
*Includes assessment, first meetings, only treatment aspects that are treatable from a distance.
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Table 5. Reason for not providing care (N= 603).
Country
(nwho
responded
to the
question, %)
No legal
frame in
your
country/
state to
provide
care
in a
“COVID-19
safe way”:
n(%)
a
Needed
to take
care of
the family
(children,
parents,
etc.) or
assigned
to other
tasks:
n(%)
a
Only
emergency
care/
treatment
at that
moment:
n(%)
b
SLPs are
unfamiliar
with
possibilities/
not certified:
n(%)
a
Policies and
procedures
are not yet
in place
(school
closed,
etc.):
n(%)
b
Not
possible to
guarantee
safety:
n(%)
b
Clients/
patients
have no
access to
necessary
resources/
poor
infrastructure:
n(%)
b
SLP is
a high
risk
person,
SLP
has
fear, or
SLP
is ill:
n(%)
b
Pathology
does not
allow
telecare
(e.g.,
dysphagia,
oromotor
difficulties,
etc.:
n(%)
b
Lack of
acceptance/
commitment
client/patient
or SLP:
n(%)
b
Digital
applications
are not
sufficient
(privacy,
options,
etc.):
n(%)
b
Belgium
(421, 68.2%)
362
(86.0%)
119
(28.3%)
186
(44.2%)
141 (33.5%) 8 (1.9%) 10 (2.4%) 2 (0.5%) 6
(1.4%)
1 (0.2%) 1 (0.2%) —
Portugal
(71, 11.5%)
16 (22.5%) 30
(42.2%)
35 (49.2%) 6 (8.4%) 1 (1.4%) 1 (1.4%) 1 (1.4%) 1
(1.4%)
3 (4.2%) 3 (4.2%) —
Turkey
(28. 4.5%)
13 (46.4%) 8 (28.6%) 17 (60.7%) 9 (32.1%) 2 (7.1%) —1 (3.6%) —— — —
Croatia
(22, 3.6%)
12 (5.4%) 3 (13.6%) 12 (5.4%) 6 (27.3%) 2 (9.1%) —1 (4.5%) ——1 (4.5%) —
Norway
(17, 2.8%)
8 (47.1%) 4 (23.5%) 12 (70.6%) 1 (5.9%) 3 (17.6%) —1 (5.9%) 1
(5.9%)
1 (5.9%) ——
India
(12, 1.9%)
2 (16.7%) —10 (83.3%) 1 (8.3%) —1 (8.3%) 4 (33.3%) ——1 (8.3%) —
Philippines
(10, 1.6%)
4 (40.0%) —5 (50.0%) 1 (10.0%) 1 (10.0%) —3 (30.0%) —— — —
US (7, 1.1%) —1 (14.2%) 1 (14.2%) 1 (14.2%) 4 (57.1%) ——————
Finland
(5, 0.8%)
2 (40.0%) 1 (20.0%) 2 (40.0%) 1 (20.0%) 1 (20.0%) ———1 (20.0%) ——
Slovenia
(5, 0.8%)
5 (100%) 1 (20.0%) 1 (20.0%)
France
(5, 0.8%)
1 (20.0%) 4 (80.0%) 1 (20.0%) 1 (20.0%) —1 (20.0%) ——— — —
Total (N= 603) 425
(70.5%)
171
(55.8%)
281
(46.6%)
169 (28.0%) 22 (3.6%) 13 (2.1%) 13 (2.1%) 8
(1.3%)
6 (1.0%) 6 (1.0%) 1 (0.2%)
Note. Only countries with ≥5 respondents are reported. Percentages are calculated on the number of respondents who answered the question with at least one answer (multiple
answers were possible). Em dashes indicate no one gave this answer. SLP = speech-language pathologist.
a
Indicates a given option.
b
Indicates a self-reported answer.
640 Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022
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Figure 1. Use of digital applications (number of responses = 869).
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telepractice. The findings made it clear that some countries
were already implementing telepractice as part of their ser-
vices whereas some did not have the necessary legal frames
in place. It would be interesting to conduct a similar survey
at this point in time, to assess the evolution of SLPs and
audiologists in the use of telepractice services. The overrepre-
sentation of the sample by SLPs and audiologists from Bel-
gium and Portugal is the study’s major limitation. This has
an impact on the findings of the study. For example, the
main reported reason for not providing care was the lack of
a legal frame. If the respondents of Belgium were excluded
from this question, the most reported reason would be that
only emergency care was provided. Because the purpose of
the study was to investigate the circumstances at the start
of the COVID-19 pandemic, the survey was only made
accessible for a limited period. It was therefore difficult to
establish a balance in the representation of the number of
respondents. Another limitation was that the survey did not
ask what the benefits were for the respondents. Therefore,
mainly the obstacles of telepractice were highlighted while
numerous benefits could have been reported.
The COVID-19 crisis forced SLPs and audiologists
to an immediate digital implementation. Digital solutions
that were developed during the last decades were imple-
mented by many during this crisis. Telepractice can be con-
solidated in the future and can contribute to defining and
adopting new digital models of care (e. g., video visit with
the use of wearable devices, chatbots, Artificial Intelligence
(AI)–powered tools [e. g,. augmented and virtual reality sys-
tems], voice interface systems, and mobile sensors; Keesara
et al., 2020). Telepractice is useful in delivering care during
social distancing and quarantine periods, but it can also
mitigate or even solve other challenges and so improve
health care delivery in general. For example, telepractice
offers promise for evidence-based treatment dissemination
in rural populations (Doraiswamy et al., 2020), for treat-
ment for individuals who frequently move to other places
to live, and for groups that have difficulty attending regu-
larly scheduled in-person appointments (e. g., shift workers;
Krukowski & Ross, 2020). Moreover, telepractice has led
to develop support platforms (Chevance et al., 2020) or dig-
ital solutions integrated with traditional methods, such as
AI-based diagnostic algorithms (Golinelli et al., 2020).
A legal framework is not yet designed to regulate
the use of telepractice in each country around the world.
It would be beneficial, however, to integrate digital tools
in international and national guidelines for public health
preparedness, alongside the definition of national regula-
tions and funding frameworks in the context of public
health emergencies (Chevance et al., 2020). The active
SLPs and audiologists in the field should dedicate efforts
to the proper provision of telepractice services. Mean-
while, the speech-language-hearing associations should
take solemn measures to train SLPs and audiologists to
provide telepractice services and increase the quality of
these services (Tohidast et al., 2021). Besides workforce
training, high-quality evidence, digital equity, and patient
adherence should be considered (Chevance et al., 2020).
There has been an ongoing quest to adopt digital technol-
ogies to improve the quality and reduce the cost of health
care services. It is also important to understand whether
these new approaches help to increase clinical efficiency
(Krukowski & Ross, 2020). It is recommended to keep track
of the ideas and solutions being proposed today to imple-
ment best practices and models of care tomorrow and to be
prepared for future national and international emergencies
Table 6. Reported obstacles in delivering treatment/care in a distant way (number of responses = 781).
Obstacle Number of responses: n(%)
Technical problems (poor Internet connection, poor quality, poor access to resources) 244 (31.2%)
Inability to perform assessment or treatment procedures 108 (13.8%)
Concentration issues during session 97 (12.4%)
Connection or interaction issues between SLP and client 85 (10.9%)
Compliance issues client or parents 54 (6.9%)
Lack of (variation of) activities 33 (4.2%)
Requires extra time for the SLP 24 (3.1%)
Cause of misunderstandings 24 (3.1%)
Motivation or collaboration issues with client during session 23 (2.9%)
Inexperienced SLP 20 (2.6%)
Treatment takes more time and was of less quality 14 (1.8%)
Difficult to supervise environment client 11 (1.4%)
Safety issues 9 (1.2%)
Difficult communication with multilingual clients 6 (0.8%)
Resistance of parents or clients 6 (0.8%)
Physical inconveniences of SLP 5 (0.6%)
Difficult for parents to implement treatment 4 (0.5%)
Other 14 (1.8%)
Total 781
Note. SLP = speech-language pathologist.
642 Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022
SIG 18 Telepractice
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(Keesara et al., 2020). Since telepractice is an evolving sub-
ject, training of medical professionals, clear guidelines, and
good quality Internet service systems will go a long way in
increasing the acceptability of telepractice (Mahajan et al.,
2020). Ongoing evaluation and research are necessary to
help develop telepractice service delivery in the field of
speech-language pathology and audiology.
Conclusions
The findings from this study made it clear that countries
were not ready for mass use of telepractice services at the
beginning of COVID-19 due to delays in changes to regula-
tion and reimbursement. Adaptations to those factors seem to
be key indicators to successfully implement telerehabilitation.
While many SLPs and audiologists reported using teleprac-
tice technology, mainly in the form of real-time videoconfer-
encing, barriers included technical problems, such as poor
Internet connection. A diverse set of digital applications was
reported for use, with video programs for real-time communi-
cation (e.g., Zoom) being the most widely used. Limited
applications for exercises or training were used and may be
related to a lack of knowledge. Future work should measure
again how SLPs and audiologists are doing since then.
Author Contributions
Sabine Van Eerdenbrugh: Conceptualization (Equal),
Methodology (Equal), Writing –review & editing (Equal).
Kirsten Schraeyen: Conceptualization (Equal), Methodology
(Equal), Writing –review & editing (Supporting). Heleen
Leysen: Formal analysis (Equal), Methodology (Supporting),
Writing –review & editing (Supporting). Charlotte Mostaert:
Data curation (Equal), Methodology (Supporting), Writing
–review & editing (Supporting). Wendy D’haenens: Con-
ceptualization (Supporting), Writing –review & editing
(Supporting). Dorien Vandenborre: Conceptualization (Equal),
Formal analysis (Supporting), Methodology (Equal),
Writing –review & editing (Supporting).
Acknowledgments
The authors would like to thank the colleagues
around the world for helping distribute this survey.
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Appendix (p. 1 of 2)
Survey: “The care of SLPs and audiologists at times of Corona”
Dear colleagues, at these extraordinary times we don’t want to miss the opportunity to know how you provide treatment/
care to your clients and patients at times of corona. In most countries there is a lockdown and face-to-face contact is pro-
hibited. Therefore, it is possible that you cannot deliver any care. It is also possible that you provide treatment/care in alter-
native ways, or maybe you are performing other duties (administrative duties, voluntary work, ...). Please, let us know!
We do not ask for personal information such as name, age, gender. The information that we collect is purely profes-
sional. After processing the data, we will delete them.
Best regards,
Researchers from Thomas More College of Applied Sciences (Belgium):
Charlotte Mostaert,
dr. Wendy D’haenens,
dr. Kirsten Schraeyen,
dr. Dorien Vandenborre and
dr. Sabine Van Eerdenbrugh
1. Country of working:
2. You are:
Speech-language pathologist (or similar, such as, speech therapist, ...)
Audiologist (or similar)
3. You usually provide (more than one can apply):
Speech treatment/care to children (such as speech sound disorders, child apraxia of speech, ...)
Speech treatment/care to adults (such as dysarthria, apraxia of speech, speech disorders in neurodegenerative
diseases)
Language treatment/care to children (reading, spelling, language, ...)
Language treatment/care to adults (aphasia, cognitive communicative disorders, language/communication disorders in
neurodegenerative diseases)
Stuttering or cluttering treatment/care to children
Stuttering or cluttering treatment/care to adults
Swallowing treatment/care to children
Swallowing treatment/care to adults
Hearing treatment/care to children: clinical audiology
Hearing treatment/care to children: rehabilitative audiology (hearing aids, cochlear implants)
Hearing treatment/care to adults: clinical audiology
Hearing treatment/care to adults: rehabilitative audiology (hearing aids, cochlear implants)
Other: ...
4. Is your country in lockdown due to the coronavirus?
Yes, since ...
No
5. Do you at this moment provide treatment/care to your clients/patients?
Yes ➔continue with the questionnaire
No ➔two extra questions, then stop:
6. Why?
There is no legal frame to provide treatment/care in your state/country in a corona-safe way (e.g., telepractice),
You are unfamiliar with possibilities
You have to take care of your family (children, parents, ...),
Your client/patients do not ask for treatment/care at the moment, `
Other, ...
7. Do you have time for other duties than taking care of your family (if that applies)?
Yes, which ones? ...
No
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8. Which treatment/care and to which clients/patients? (more than one can apply)
Speech treatment/care to children (speech sound disorders in (preschool age) children, ...)
Speech treatment/care to adults (dysarthria, ...)
Language treatment/care to children (reading, spelling, language, ...)
Language treatment/care to adults (aphasia, ...)
Stuttering or cluttering treatment/care to children
Stuttering or cluttering treatment/care to adults
Swallowing treatment/care to children
Swallowing treatment/care to adults
Hearing treatment/care to children: clinical audiology
Hearing treatment/care to children: rehabilitative audiology (hearing aids, cochlear implants)
Hearing treatment/care to adults: clinical audiology
Hearing treatment/care to adults: rehabilitative audiology (hearing aids, cochlear implants)
Other: ...
9. How do you provide treatment/care to your clients/patients? (more than one can apply)
Face-to-face in the same room with the client/patient
Through telephone (no video)
Through online real-time telecommunication (e.g., Skype, Face time, What’s app, Zoom, ...)
Through videos or exercises you send to your clients/patients
Distant computer-based treatment, website, exercises (e.g., exercises, generated by a computer program)
Other ....
10. How often do you provide treatment/care to your clients/patients? (more than one can apply)
Same as to usual (face-to-face) treatment/care
Less often than the usual (face-to-face) treatment/care
More often than the usual (face-to-face) treatment/care
11. What is the content of the treatment/care?
The same as treatment/care given before the corona-crisis
Advice for the client/patient
Advice for the parent(s) and/or carer of the client/patient
Mainly follow-up
Other...
12. Which applications/apps/software do you use most frequently? Please give the three that you use most and experience
as most successful (give indication what you are using them for).
1.
2.
3.
13. Which obstacles do you experience most frequently in delivering treatment/care in a distant way?
1.
2.
3.
Appendix (p. 2 of 2)
Survey: “The care of SLPs and audiologists at times of Corona”
646 Perspectives of the ASHA Special Interest Groups •Vol. 7 •635–646 •April 2022
SIG 18 Telepractice
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