The following is a guest article by Rob Chappell, Founder and Chief Science Officer, EyeTech Digital Systems.
Communication is what connects us all. The COVID-19 pandemic brought to light the tremendous impact that limited engagement can have on many aspects of life. Throughout the public health crisis, technology offered one of the few mechanisms that communities had to overcome physical distance barriers. Things like remote learning and telehealth were embraced as a new means to carry on.
In many ways, the isolation brought on by the pandemic mirrors the day-to-day experience of individuals with physical disabilities and communication impairments, who often rely on assistive technology as their lifeline to the outside world. The pandemic also brought newfound attention to the magnitude of health disparities among different patient populations. In the telehealth arena, many healthcare providers worked to integrate interpreter services into virtual care to support the needs of limited English proficient and hearing-impaired patients. As the healthcare industry continues its work to improve health equity and access for all patients, it’s important that we give equal consideration to the needs of the disabled community as well.
According to data released by the Centers for Medicare and Medicaid Services (CMS), 63% of disabled Medicare beneficiaries used telehealth services during the height of the pandemic (from March 1, 2020, to February 28, 2021). As care teams pivoted from in-person care to virtual patient engagement, speech language pathologists (SLPs) supporting individuals with complex communication needs followed suit. Prior to March 2020, Medicare paid for telehealth services under limited circumstances that were restricted to rural or health professional shortage areas, established patients, and certain types of providers. In response to the COVID-19 public health emergency, telemedicine services were expanded to increase access to care for patient populations.
This was a game changer for individuals with disabilities and their care teams. In the realm of communication impairments, distance between the patient and the nearest SLP or speech therapist clinic can be quite far. Transportation can be difficult for patients in need of these services, which often includes individuals with conditions such as cerebral palsy, ALS, muscular dystrophy, stroke, traumatic brain, spinal cord injuries, and Rett syndrome who struggle to move and communicate independently.
A study recently published by the American Journal of Speech Language Pathology found that telehealth was a viable means to support ALS patient evaluations for augmentative and alternative communication (AAC) and speech generating devices (SGDs). All ALS patients in the study who engaged with their clinician virtually were able to secure the SGDs they needed to communicate. “In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability.”
Another recent study published by the American Speech-Language-Hearing Association also evaluated SLP perceptions on the viability of telehealth as an alternative to in-person visits for communication evaluations and AAC device assessment appointments for individuals with disabilities. Roughly 60% of SLPs indicated that they felt telehealth was an appropriate substitute for in-person care and was equally as effective. 81% of respondents indicated that they anticipate telehealth use will continue or expand in their field going forward.
Accessibility, family involvement, safety, and convenience were most often cited as advantages to virtual engagement for individuals with disabilities. This echoes what has been reported in broader telehealth use cases within traditional care settings but has far greater implications for those with physical impairments. Increased incidence of immunocompromised and at-risk patient conditions among the disabled community made virtual clinical encounters one of the only safe options for engagement during the pandemic. Telehealth engagement also offers disabled individuals, who typically have difficulty commuting due to physical limitations, far more convenient access to care.
Barriers to virtual engagement with disabled patients included connectivity issues and diminished access to hardware device resources as patients evaluate communication aids. Greater funding within this sector could support enhanced connectivity initiatives as well as remote delivery of AAC devices to patients for evaluation. Some respondents also championed the creation of a HIPAA–compliant, speech pathology–specific telehealth platform to better support this unique use case.
As we seek to build a more inclusive health system, broader access to telehealth and assistive technology offerings for individuals with disabilities is imperative. Regulatory waivers around telehealth should be made permanent for the often-marginalized disabled patient cohort. The case for greater integration of assistive technologies such as AAC devices and eye-tracking enabled environmental controls within traditional healthcare settings can also be made. The world is a better place when everyone can participate.
About Robert Chappell
Robert Chappell is Chief Science Officer of EyeTech Digital Systems and a member of the company’s board of directors. He co-founded EyeTech in 1996 with a mission to advance innovation in health AI, eye-tracking intelligence, and assistive technology to deliver medical devices and research technologies that improve outcomes and enhance quality of life for healthcare patients, their caregivers and healthcare providers.
