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sadia_hussain
Online Speech and Language Therapy Assessments During Lockdown
  • Aug 25, 2020
  • Latest Journal

Just before the lockdown in March, I was instructed to undertake an assessment for a claimant living in the north of England, but with travel restrictions in place this became almost impossible. The only possible solution was to modify my clinical practice and follow the ‘online’ trend that was sweeping the nation.   

With experience of running online clinics for patients living in different countries, I was confident that using video conferencing and online platforms was a method I could adopt successfully in my medico-legal work. I have found that the outcomes have been positive. In fact, the outcomes have been better than I had expected, and I continue to use online methods as my main avenue of assessments during these sensitive times whilst the Covid-19 pandemic continues.

Nevertheless, I understood that this was a new way of working for experts and some solicitors had raised valid questions and concerns, including:
•  Will the findings of the expert assessment be compromised by video conferencing and online methods?

•  Are the outcomes of online assessments reliable?

•  Will the claimants have, and be able to use, the technology required for assessments?

•  How will the claimant’s respond to online assessments?

At Somek, as experts we came together to discuss ways to overcome these issues and find solutions to ensure expert assessments could continue with the same level of quality assurances. I would like to share my experience and top tips, which have helped me engage claimants, manage technology barriers, and ensure a smooth assessment with reliable findings to form a valid expert opinion.

Pre-assessment preparation has been key to all successful online assessments. The purpose of which has been to prepare the claimant and family prior to the online assessment.

In the case of NX (initials have been changed to protect the identity of the claimant), a claimant who had suffered a severe brain injury resulting in communication and swallowing difficulties, an online assessment was tailored to his specific needs. His wife was instrumental in supporting the assessment, which to me felt no different to when partners support during face-to-face home visits.

NX had never used online platforms, albeit, like most people, he owned a tablet device. With some basic instructions and help from NX’s teenage son, it was possible for NX’s wife to download Skype and set up a username. My reason for choosing Skype was based on it being one of the most familiar online platforms, which is simple to download, easy to navigate and has accessible symbols like those on a smart phone.

The pre-assessment phone call was also used to gauge NX’s clinical history and his current situation. From the information gathered, I was able to work out which assessments would be suitable and how NX was likely to respond. We also went through what would be needed from NX and what they would expect from me, to ensure that we met the instructions and the assessment went as smoothly as possible. To facilitate logistics and NX’s comfort, we went through factors such as the length of the assessment, lighting, positioning of the tablet, sound and toilet breaks.  

The most important element of the pre-assessment discussion was  to use it as an opportunity to gain the claimant’s  confidence and to reassure him that we would be able to complete an online assessment with the same, if not similar, outcomes as a face-to-face visit.
Environment factors had to be considered before the assessment took place and these included reducing background noise, using headsets for good sound, comfortable seating, good natural lighting, and access to a table or desk to position devices.

Equipment needs were also met on both sides of the screen to support the assessment. In NX’s case, his swallow and communication were examined, the latter required formal testing of his reading, writing and speaking skills. NX had a pen and paper available and different textured foods for the swallow assessment.

At my end, I had all paper assessment booklets within easy reach and used a document camera to be able to provide good ‘life-like’ images. It was important to ensure that NX had a full view of all the documents and that I could manipulate the images to make them larger/smaller where needed.

NX and the device positioning was imperative, as well as being prepared to alter this as necessary during examination. NX was, at times, required to prop up the tablet on a table near to him and during mouth and swallow inspection he moved it closer to his face.

The assessment commenced on time, with some general conversation, followed by a clinical interview, and then proceeded to an oral motor assessment and clinical swallow examination. A swallow analysis took place through observations of NX eating a biscuit and drinking juice. He had the option to wear a microphone to allow the swallow to be audible and to apply some tape to his throat to examine the lift of his throat during the swallow. This was followed by paper-based assessments to analyse his cognitive and communication skills. Using a document camera, I was able to  manipulate images and zoom in and highlight areas of the assessment that were most pertinent, which is something that is not possible when using a booklet in person.

As we got through the first part of the assessment, NX requested a 15-minute break as he was feeling fatigued, and this allowed me to regroup and prepare for the next half of the assessment. We resumed to complete the rest of the assessment and continued talking throughout with little interruption. By the end, I certainly felt that I had obtained reasonable data, which was no less valid than a face-to-face assessment.

Throughout the Skype call, there were occasional periods of low connectivity, but I prompted NX to give me continuous feedback on whether he heard the task instructions and whether he was able to access all the material when we shared screens, as well as how comfortable he was feeling.

Regardless of using an online platform, I felt I was able to build a rapport with NX, that his non-verbal expression was prevalent and that we conversed as we would have if we had met in person. If anything, I would say the assessment allowed me to attend to details, which sometimes are missed in the midst of a busy or rushed home visit. NX himself reported that he felt comfortable with me being on the screen as there was less pressure for him to perform and that he benefitted from having breaks in the comfort of his home.

In addition, NX and his wife reported that the experience had given him the confidence to  arrange much needed online therapy sessions, which had been stopped five weeks ago in response to the corona-virus  restrictions.

All in all, I found that using an online platform has had benefits, including keeping the claimant comfortable. In response to the concerns raised at the beginning of the article, I can confidently say that my online expert assessments have not been compromised by the use of video conferencing methods. I have found the outcomes of the assessment similar to face-to-face visits. And with regards to issues concerning technology, well most people have access to a smart device and wifi, and the accessibility of online platforms is growing for us all to be able to set them up and use with ease.

 

About the author
Sadia Hussain
has a BSc (Hons) Speech and Language Therapy. She works as a Consulting Clinical Lead Speech and Language Therapist at the Royal Buckinghamshire Hospital and is an Associate Trainer with Somek & Associates Ltd

Sadia is a specialist who works with swallow and communication difficulties arising from brain injury, stroke and spinal injuries. She is bilingual Urdu/Punjabi speaking and has an interest in treating individuals from culturally diverse backgrounds.

Somek & Associates is one of the largest providers of Expert Witness services in the UK, and has over two hundred experts, which include occupational therapists (care experts), nurses, midwives, physiotherapists, speech and language therapists, and other allied health professions.

For more information about Somek & Associates’ Speech and Language experts - and all their other healthcare professional experts please contact admin@somek.com or visit their website

 



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