By the time most people reach kindergarten, speaking is second nature. But for some children in Maine, and a growing population of aging adults, verbal communication does not come easily.
Unable to verbalize needs or to greet loved ones as they enter the room, people with aphasia, an impairment of language frequently caused by a stroke, often live in a secluded world. Maine’s rural geography can compound this social isolation, and many small communities have limited treatment options, requiring caregivers and patients to travel long distances, or do without.
To help overcome these challenges, the Speech Therapy Telepractice Program was established in 2012 at the University of Maine’s Madelyn E. and Albert D. Conley Speech, Language and Hearing Center in collaboration with colleagues at Waldo County General Hospital in Belfast.
Using a secure web-hosted video conferencing system, graduate student clinicians provide speech therapy services to clients anywhere in the state through computers or other devices connected by high-speed internet. Instead of traveling to a speech and hearing center, clients are able to receive speech therapy while sitting at their computers in their homes, schools or any other setting.
“In a predominantly rural state, telepractice is an efficient, cost-effective way to provide speech therapy services that are beneficial to children and adults with communication disorders,” says Judy Walker, an associate professor in UMaine’s Department of Communication Sciences and Disorders, who developed the program.
The UMaine Speech Therapy Telepractice Program was one of the first of its kind in the nation to offer speech therapy telepractice training for graduate students and serves as a model for other academic institutions worldwide.
As part of their clinical training, graduate student clinicians provide speech therapy telepractice services to 36 children and adults from York to Aroostook counties. A client and his or her eHelper — the person who is assisting — log onto a password-protected site for the telepractice therapy session. Clients converse with graduate student clinicians through an interactive monitor, where they can jot their lessons on the computer screen so the therapist responds to what they are doing in real time. Family members from other remote locations and collaborators who assist and encourage the client between therapy sessions also can “attend” the session.
On the other side of the globe, four children with disabilities at the International School Suva in Fiji also are receiving speech therapy through UMaine’s telepractice program. The tropical archipelago does not have speech therapists, and like some children in Maine’s rural schools, without telepractice they would not receive consistent speech therapy.
In Maine, Buckfield Junior-Senior High School started using UMaine’s speech therapy telepractice services following the retirement of its speech pathologist almost two years ago. Principal George Reuter says the school adopted the new model to benefit students.
“For me and my position as principal, we really want a quality level of service provided on a consistent basis, and without telepractice, I don’t know that we would be able to provide such a consistent level of service,” Reuter says.
Special education technician Tina Hicks says the UMaine team is “accommodating and flexible with our schedule, and takes a lot of what we do daily and incorporate that into their lessons.”
“The kids love it. I think they prefer this,” Hicks says. “I never have any of them not want to go. The kids are really engaged and we have seen improvement.”
Telepractice also created new opportunities to improve the quality of clients’ lives, including helping senior citizens stay in their homes. Walker recently completed a research project that focused on reducing social isolation of people with aphasia through participation in a telepractice communication group.
Bob and Kathy Jackson of South Gardiner, Maine joined the group to connect with other people.
“It was great just having somebody new to talk to,” Kathy says.
Kathy lost the ability to speak following a stroke four years ago. Thanks, in part, to individual speech treatment through telepractice, she regained her speech.
Phone conversations, though, can still be a challenge, making it difficult to keep in touch with family and friends out of state. Following individual therapy, Kathy has participated in two telepractice aphasia communication groups.
“This support group helps make connections and friendships that you lose because people don’t know how to deal with you,” Bob says.
“I look forward to it,” says Kathy.
“They can talk together because they all understand each other,” says Bob.
“In a predominantly rural state, telepractice is an efficient, cost-effective way to provide speech therapy services that are beneficial to children and adults with communication disorders.” Judy Walker
Following the success of the telepractice aphasia communication groups, Walker also is focused on building telepractice caregiver support groups in future research projects.
In addition to the telepractice program, the Conley Center has expanded to meet the growing demands for speech therapy and audiology services, along with serving as the on-site training facility for graduate and undergraduate students.
UMaine’s Audiology Clinic and Speech-Language Clinic offer services for people across the lifespan. The Speech-Language Clinic includes comprehensive speech and language diagnostic evaluations, family-based approach to therapeutic services, and support services for children and adults who stutter.
“We have over 50 clients in our on-campus center — from 18 months to 93 years — all working with our students,” says Judith Stickles, the center’s director.
From 2014–24, the U.S. Bureau of Labor Statistics anticipates the speech pathology field will grow 21 percent — three times the national average for job growth overall.
In states with rapidly aging populations like Maine, the demand may become even more critical. Maine is the oldest state in the nation, with the population of citizens 65 years of age or older on track to increase by almost 90 percent over the next 15 years.
UMaine is home to the state’s only undergraduate major in speech-language pathology and Maine’s only accredited master’s program that leads to national certification in speech-language pathology.
“Our workforce development is critical for meeting current and future demands for speech-language pathologists, and the telepractice service delivery model will enhance the ability to reach those in need of services,” says Nancy Hall, chairwoman of UMaine’s Department of Communication Sciences and Disorders.
Experience with telepractice was essential for Anastasia Valcourt, a graduate of the Communication Sciences and Disorders master’s program, when she entered the workforce.
“UMaine is one of the few universities in the country that offers the telepractice program. From day one, we had opportunities to practice our skills working with a range of different age groups, from preschool to adult-age clients,” Valcourt says.
She now works for Mark R. Hammond Associates, Inc. in Portland, Maine, where she trains other speech language pathologists on telepractice.
For families like the Jacksons, more telepractice-savvy speech pathologists is great news.
“The whole telepractice program was a godsend for us,” Bob says.