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The Care is Virtual, the Commitment is Real

SLP Professor Michaela Medved says teletherapy can be a "wonderful" alternative, but it has its limitations.

While Dr. Michaela Medved’s approach to treating patients has been severely affected by the coronavirus, her job at its heart hasn’t changed. She still works in her clinical practice with children and adults to continue focusing on their therapy goals. In recent weeks, however, that has meant communicating with them over video as opposed to treating them at home or in the hospital.

“I’ve been able to maintain a working relationship with my older clients in virtual sessions,” said Dr. Medved, a clinical assistant professor in the Speech-Language Pathology program at Yeshiva University’s Katz School of Science and Health. “But for clients who have feeding or swallowing disorders and underlying medical conditions, I haven’t been able to treat them because it’s dangerous for them. That’s been really tough.”

A good share of the burden of care, said Dr. Medved, has shifted temporarily to the families of patients. But she maintains regular contact, guiding caregivers on how to administer treatments to her patients. For the past six months, she has been working with a 10-year-old girl, a pediatric stroke victim, in her home until the virus prevented her from visiting. To make sure, though, that the girl’s care continued uninterrupted, she gave the parents responsibility, albeit under her watchful eye, for improving the girl’s feeding skills.

Using FaceTime, Dr. Medved showed the parents how to use a Neuromuscular Electrical Stimulation device, which is half the size of a smart phone, to administer an intermittent electrical current to their child during a meal. The current, delivered by two electrodes under the girl’s chin for half an hour, four times a week, is meant to strengthen her tongue and swallowing muscles. Even with the loss of in-person contact, Dr. Medved, by checking in with the parents regularly, has ensured that the girl is making steady progress. She’s graduated from eating puree to normal breakfast foods, like waffles.

“We have remained in contact to discuss her progress as well as new foods and textures,” said Dr. Medved, “but I haven’t been charging anything because I don’t feel comfortable. I’m sensitive to the fact that these families have more than one child and are overburdened with home schooling.”

Dr. Medved said that though teletherapy is a “wonderful” alternative in many cases, she emphasized that it’s not a replacement for in-person care for every patient population. She has found that teletherapy is most successful when working with older school-age children, adolescents and adults with a variety of diagnoses, including expressive and receptive language delays, articulation disorders, cognitive dysfunction and fluency disorders.

“Though appropriate at times, teletherapy has been increasingly difficult to use with younger children—birth to three—older adults with compromised cognition, and patients with feeding and swallowing issues,” she said.

Dr. Medved said the current lockdown is teaching her how to be flexible. She said healthcare professionals are now beginning to work through online platforms regardless of where their settings once were, and though teletherapy will undoubtedly become increasingly popular and more readily used and accessible, in-person therapy will always remain the ideal modality for providing therapy services.

Since 2016, Dr. Medved has been with the Katz School and has taught courses in Clinical Speech-Language Pathology, Diagnostic Methods, Syndromes and Craniofacial Anomalies, Communicating with Patients and Families, and Stuttering and Related Fluency Disorders.

She holds a doctorate in Speech-Language Pathology from Rocky Mountain University of Health Professions, and a master’s degree in Speech-Language Pathology and bachelor’s degree in Speech Pathology and Audiology from Lehman College.

The Katz School’s master’s program in Speech-Language Pathology is one of the few in the country specializing in medical speech pathology, taking a multidisciplinary approach to diagnosing and treating speech, language and communication cases. Students graduate prepared to apply for certification from the American Speech-Language Hearing Association (ASHA) and for licensure in New York State.

Dr. Medved recently published the article, “Adapting to the New Normal: SLP Adjustments in the COVID-19 Era” on the website of the Rocky Mountain University of Health Professions.

She said she can foresee the important role that the medical speech-language pathologist will play in the rehabilitation of individuals globally. In order to serve those patients, she emphasized that it’s imperative that students be trained in the most up-to-date modalities for intervention, evidence-based practice and therapy options.

“Though we cannot foretell the extent of the needs that will be required, we can predict that as patients recover there will be a need for the restoration of swallowing, voice, motor speech disorders and respiratory de-conditioning,” she said.