Speech, Language and Hearing

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Uptake of telepractice among speech-language

therapists following COVID-19 pandemic in India

Komal Aggarwal, Ravi Patel & Rohit Ravi

To cite this article: Komal Aggarwal, Ravi Patel & Rohit Ravi (2020): Uptake of telepractice
among speech-language therapists following COVID-19 pandemic in India, Speech, Language and
Hearing, DOI: 10.1080/2050571X.2020.1812034

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Published online: 06 Oct 2020.

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SPEECH, LANGUAGE AND HEARING
https://doi.org/10.1080/2050571X.2020.1812034

Uptake of telepractice among speech-language therapists following COVID-19

pandemic in India
a b,c d
Komal Aggarwal , Ravi Patel and Rohit Ravi
a
Continua Kids, New Delhi, India; bMom’s Belief, Gurugram, India; cApollo Home Health Care, New Delhi, India; dDepartment of Audiology &
SLP, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

ABSTRACT ARTICLE HISTORY

Uptake of telepractice has drastically increased among speech-language therapists (SLTs) Received 29 July 2020
following the COVID-19 pandemic. This study aimed to explore the sudden uptake of Accepted 9 August 2020
telepractice in India among SLTs. An online survey consisting of 20 questions was carried out
KEYWORDS
between 4 and 17 May 2020 using Google form. The participants comprised of SLTs who Telepractice; speech-
indicated that they had shifted their services to telepractice during the COVID-19 pandemic. language therapists; COVID-
Descriptive analysis was used to summarize the findings. Eighty-four SLTs participated in the 19; pandemic; teletherapy
study, working across different work settings and from 21 to 53 years of age. Forty-nine
percent of SLTs had conducted more than 11 telepractice sessions, 89% conducted only
individual sessions. Further, 85% had a mostly paediatric caseload with 75% working with
child language disorders. They learnt about telepractice in a range of ways including from
colleagues (19%), social media and the internet (18%), formal education (24%), reading (8%)
and experience (8%). Overall, SLTs exhibited a positive attitude towards the use of
telepractice. The most common platform used was WhatsApp video calling feature (82%),
although more than one platform was being used. The greatest challenges faced were
dealing with network issues (38%) and lack of cooperation from the child during sessions
(27%). The findings highlight an acceptance and uptake towards telepractice. This might
pave the path for serious consideration for telepractice in the field of speech-language
therapy in India in the future.

Introduction
The declaration of a pandemic due to the spread of
Coronavirus disease 2019 (COVID-19) has led to
drastic changes in service delivery by healthcare pro-
fessionals. Various professionals have adapted to chan-
ging times and are providing their services via
telepractice during this pandemic (Arneson, Tucker,
Mercier, & Singh, 2020; Chua et al., 2020; Moccia
et al., 2020). The Government and Professional Associ-
ations have also stepped forward by updating guide-
lines or relaxation of licensing for telepractice
(American Speech-Language and Hearing Association
(ASHA), 2020a; Facher, 2020; Ministry of Health and
Family Welfare (MoHFW) 2020). Facher (2020) states
that despite being in the early stages, this world
health crisis has advanced even the United States of
America’s telemedicine by about 10 years. This shift
from in-person consultations to remote consultations
has become the need of an hour for speech-language
therapists (SLTs) across the wide range of disorders
they deal with (ASHA, 2020b, 2020c). Social distancing
is being implemented globally and using telepractice
has been adopted as the most viable alternative. It
ensures that essential healthcare can be provided
without compromising patient or clinician safety. The
MoHFW has provided guidelines for the application
of telepractice for healthcare providers focusing on
several issues such as patient privacy, professional
and ethical norms, referrals, counselling and overall
healthcare management (MoHFW, 2020).
Keck and Doarn (2014) reviewed the application of
telepractice technology applications in speech-
language therapy. It found the application of teleprac-
tice for various clinical specialities such as child speech
and language disorders, voice disorders, cranio-facial
anomalies, neurogenic communication and dysphagia.
It was also found that the majority of services used a
hybrid model combining synchronous and asynchro-
nous technologies to have optimal decision-making
and to overcome any infrastructural barriers. Synchro-
nous means the use of real-time technologies with
audio and video connections using internet-based
videoconferencing for consultation, assessment, coun-
selling and treatment. Asynchronous methods use
store and forward methods for information that can
be accessed by the clinician and/or the client separ-
ately at any point of time. These include audio/video
recordings of patient complaints for viewing and ana-
lysing at a later point of time. It also includes audio/
video recordings of techniques/therapy that are

CONTACT Rohit Ravi rohitravi94@gmail.com

© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 K. AGGARWAL ET AL.
available for viewing later (Anne, Kelly, & Todd
Houston, 2013; Keck & Doarn, 2014; Krumm & Syms,
2011). Studies have highlighted the need for educating
SLTs on technical advances and implementation for tel-
epractice to overcome challenges faced (Cohn & Cason,
2016; Keck & Doarn, 2014; Tucker, 2012). SLTs work in
different settings such as private consultancy clinics,
academic institutions, hospitals, Non-Government
Organizations, schools, and home visits. They provide
assessment and rehabilitation services for a wide
range of conditions such as child language disorders,
neurogenic language disorder, neurogenic speech dis-
orders, fluency disorders, and voice disorders (ASHA,
2016). Early identification and intervention is always
the key to providing adequate care for people with
speech and language difficulties. The cessation of all
non-essential activities to curb the spread of COVID-
19 has made it difficult for people to reach speech
and hearing professionals. Thus, it was the need of
the hour to adopt alternative means of consultation
to cater to the needs of maximum patients. Teleprac-
tice was thus viewed as a solution to this problem. Tel-
epractice over in-person face-to-face interaction for
dysphagia screening and intervention has been rec-
ommended to avoid the risk of COVID-19 transmission
(Fritz et al., 2020; Miles et al., 2020; Soldatova, Williams,
Postma, Falk, & Mirza, 2020).
In recent years, there have been attempts in India to
provide services via telepractice in Speech-language
Therapy and Audiology mainly with respect to audiolo-
gical services (Ramkumar, Rajendran, Nagarajan, Bala-
subramaniyan, & Suresh, 2018; 2019) and language
screening (Raman et al., 2019). However, most of
these studies have been single centre studies or
confined to a single geographical location of the
state of Tamil Nadu in India. These studies conclude
that it can be an effective method to provide care to
individuals with speech and hearing problems. Until
now, in India, the uptake of this model of service delivery
has been relatively slow. However, due to the COVID-19
pandemic and the subsequent nationwide lockdown in
India, all non-essential medical services and outpatient
services were stopped. In the current situation, many
clinicians were forced to rapidly change their method
of services from in-person to remote telepractice.
Many clinicians have had to adapt their assessment
and therapy programs to suit their patient needs
without prior experience in this mode. To the best of
our knowledge, there have been no attempts to study
the uptake of telepractice by SLTs after a drastic
change of mode of service delivery from face-to-face
to telepractice. This study was aimed at exploring the
sudden uptake of telepractice in India among SLTs.
The study’s objectives were: (a) to identify the uptake
and application of telepractice among SLTs in India,
and (b) to explore the attitude of SLTs on the use of tele-
practice for the Indian population.
Method
The study followed the Helsinki declaration guidelines
(World Medical Association, 2009). The use of online
survey research received global permission by the Con-
tinua Kids Institutional Ethics Committee during the
lockdown period.
Survey
Survey questions were framed after an online-brain-
storming session among three experienced SLTs practi-
cing in India and using telepractice. The survey
included closed questions and Likert scale questions
on demographic details, practice aspect of telepractice
(sessions taken, sessions taken per day, type of case-
load, duration of session, individual/group therapy)
and attitudes towards telepractice. These were fol-
lowed by open questions about preferred platforms
and challenges faced. This was provided to five other
SLTs with experience in clinical and research aspects.
These SLTs were asked to rate the questions as rel-
evant, quite relevant, somewhat relevant, and not rel-
evant. Only the items rated to be relevant and quite
relevant were retained in the final version. Scale-
Content validity index (S-CVI) calculation was applied
(Polit & Beck, 2006), and a score of 0.85 was obtained
indicative of excellent content validity. The final 20-
item survey consisted of questions requiring both
closed as well as open set responses. This was pilot
tested on five SLTs with over 3 years of clinical experi-
ence and presently using teletherapy. The final survey
was created online using Google forms.
Participants
The online survey was conducted using a convenient
sampling method. The Google form was shared using
email, social media platforms, and WhatsApp. The
inclusion criteria for participants were; SLTs currently
working in India who had shifted their services to
online/telepractice during the COVID-19 pandemic.
Before their participation, information related to the
study was provided, followed by the inclusion criteria.
The participants who fulfilled the inclusion criteria,
and volunteered to participate in the study were
required to fill the consent form and only then
proceed to the form.
Data collection
The online survey collected data during the third stage
of the national lockdown in India from 4 to 17 May
2020. The link was made available from 4 to 16 May
2020. The survey link was sent to 500 SLTs randomly
chosen from Indian Speech and Hearing Association

database. The participants required approximately 10
min to answer the survey questions.
Data analysis
Descriptive statistics were used to summarize continu-
ous variables, while discrete variables were summar-
ized using frequency and percentage. For open-
ended questions, common themes were tallied. The
responses obtained in the study were analysed using
SPSS 20.
Results
Ninety-seven SLTs responded to the survey, of whom
84 consented and met the criteria to participate. The
remaining 13 were not practising telepractice. All the
respondents were SLTs working across a range of set-
tings and had needed to shift their practice to teleprac-
tice due to national lockdown.
The mean age of the participants was 27 years,
range between 21 and 53 years. The number of
female professionals was almost double male pro-
fessionals (Table 1).
Practice aspect of telepractice
The total number of sessions taken per day varied
between 1 and 7 per day (mean 2.9 ± 1.6), while
the assessments conducted varied between 1 and 3
(mean 1.3 ± 0.5). The maximum number of sessions
taken by the SLTs at the time of this study were
more than 11 sessions (48.8%). Twenty-nine (34.5%)
SLTs took 1–5 sessions, 14 (16.7%) took 6–10 ses-
sions. Seventy-five (89.3%) gave individual sessions,
while nine (10.7%) SLTs gave group therapy. SLTs
were asked to report how often they saw a variety
of cases; only 9.0% said always, 61.9% reported some-
times, while 32.0% reported no variety in caseload.
The majority of caseload was paediatric (85.0%) fol-
lowed by adult (15.0%) and then geriatric (19.0%).
In terms of the distribution of the disorders, the
majority reported treating child language disorders
(75.0%); followed by fluency disorder (45.2%); voice
disorders (31.0%); neurogenic language disorder
(29.8%) and neurogenic speech disorders (25.0%). A
Table 1. Demographic details of participants.
Mean ± SD Range
Age (in years) 27.14 ± 5.6 21–53
Number (percentage)
Gender Male 25 (29.8)
Female 59 (70.2)
Work setting Clinic 45 (53.6)
Academic institutions 14 (16.7)
Hospital 14 (16.6)
NGO 04 (4.8)
Schools 04 (4.8)
Home visit 03 (3.6)
SPEECH, LANGUAGE AND HEARING 3
facilitator with the therapy client was always required
by 44.0% of participants, not required by 38.0% and
occasionally required by 18.0%.
The participants were asked their source for learning
about telepractice. Sources ranged from their faculty/
colleague/friends, social media, scientific papers and
the internet, with only 10.0% reporting receiving
formal education on telepractice (Figure 1).
Attitudes towards telepractice
SLTs were asked, ‘Do you feel online sessions are more
stressful than face-to-face sessions?’ 52.0% responded
as stressful, 31.0% as not stressful, while 9.0% were
unsure. Forty-nine percent of participants responded
that they would prefer to use telepractice even after
the lockdown was over, 34% responded that they
would use it sometimes and 17.0% did not prefer to
use it. The SLTs were asked about their attitude
towards telepractice using a five-point rating scale;
strongly disagree, disagree neutral, agree, strongly
agree. The details have been tabulated in Table 2.
There was a mixed opinion on whether telepractice
can compensate for in-person sessions; 35.5% agreed
that telepractice could compensate; while 33.4% dis-
agreed and 31.7% were unsure. More than 69.0% of
participants believed that telepractice would help in
the better prognosis of their cases. Eighty-one
percent of participants felt the need for promotion of
telepractice. Over 90.0% of participants felt that edu-
cational institutes should impart training at the
college level as a part of the curriculum, while 79.0%
felt the need for a standard operating protocol for tele-
practice in India.
The last two questions were open-ended questions
to identify the most preferred platforms used for tele-
practice and the challenges faced. In terms of the
most preferred platforms used for telepractice, multiple
platforms were being used. The most commonly used
platform was WhatsApp video call (82.0%), followed
by Zoom (58.0%) and Skype (36.0%) (Figure 2).
The final question in the survey, was the challenges
faced during telepractice. Most clinicians faced mul-
tiple challenges, with the most common being
network issues (38.0%) followed by lack of cooperation
or difficulty to make the child sit during teletherapy
(Figure 3).
Discussion
The fast spread of the global pandemic of COVID-19 led
to changes in the health sector to prioritize not just
public health but also healthcare professionals’ assess-
ment and interventions. The potential for telepractice
to be used in disaster and public health emergencies
has been established previously (Lurie & Carr, 2018).
The present COVID-19 pandemic has encouraged and
4 K. AGGARWAL ET AL.

Figure 1. Different platforms used by participants for telepractice.

increased non-traditional modes of healthcare, such as
e-visits, remote visits, virtual healthcare, and tele-moni-
toring (Tahan, 2020). Likewise, SLTs have also faced a
major challenge while providing healthcare using tra-
ditional face-to-face therapy. SLTs’ prolonged, direct
contact and close proximity to the airway has put
them at risk of contracting and spreading the virus
(Gunjawate, Ravi, Yerraguntla, Rajashekhar, & Verma,
2020). This has led to a shift to telepractice. Professional
bodies for SLTs have encouraged the adoption of tele-
practice services to improve services’ availability and
reduce patient contact. Several relevant educational
materials and guidelines for professional practices
have been made easily accessible (ASHA, 2020b,
2020c).
In an attempt to curb the spread of COVID-19 in
2020, a nation-wide lockdown was implemented in
India. This led to considerable disruption of traditional
face-to-face therapy services. A previous survey among
Indian SLTs and Audiologists in 2017 highlighted both
an acute shortage of these professionals and the need
for better access to telepractice in improve service
accessibility. In 2017, only 12% of the respondents
were involved in telepractice (Mohan, Anjum, & Rao,
2017). In the current survey, 84 out of 97 SLTs reported
that they currently used telepractice, reflecting a rapid
adoption of this method of practice. In the present
survey more than half of participants were private
therapists, allowing for the possibility that such clini-
cians may have had a greater uptake in use of
telepractice due to the potential reduction of income
they would face during the nation-wide lockdown
where face- to-face therapy sessions were not possible.
In the present study, the major caseload of these
professionals was paediatric populations, followed by
adult and geriatric. The same distribution was noted
in the 2017 survey where almost 46% provided services
to the paediatric population, followed by adults and
geriatrics (Mohan et al., 2017). However, it was not
possible to ascertain whether there was an overall of
the participants in both these surveys. In addition,
with respect to the distribution of caseload, child
language disorders were most prevalent as compared
to speech sound disorders being most common pre-
viously (Mohan et al., 2017). This draws attention to
the popularity of use of telepractice services for paedia-
tric population among the SLTs.
There was a mixed opinion among the SLTs about
whether telepractice could compensate for the lack
of in-person care. This could be due to the uncertainty
about the outcomes, efficacy, and monetary gains with
the shift in practice. Over 69% agreed that online
speech-language therapy sessions would help in the
prognosis of cases. This is very closely related to the
findings of the previous study, where 90% respondents
considered tele-practice as a viable option for service
delivery (Mohan et al., 2017). More than half of the par-
ticipants reported online sessions to be more stressful
than face-to-face sessions. This could be attributed to
the sudden uptake and shift to online platforms after

Table 2. Attitude aspect of telepractice by ASLPs.

Strongly Neutral/ Strongly
disagree Disagree Unsure Agree agree
Do you think telepractice can compensate for face-to-face sessions? 04 (4.8%) 24 (28.6%) 26 (31.0%) 26 (31.0%) 04 (4.8%)
Do you think online speech-language therapy sessions will help in prognosis 0 (0.0%) 03 (3.6%) 23 (27.4%) 22 (51.2%) 15 (17.9%)
of your cases?
Do you think tele sessions should be promoted? 0 (0.0%) 05 (6.0%) 11 (13.1%) 43 (51.2%) 25 (29.8%)
Do you think institutions should train their students for telepractice? 01 (1.2%) 0 (0.0%) 06 (7.1%) 39 (46.4%) 38 (45.2%)
Do you think we should make some standard operating protocols for 0 (0.0%) 02 (2.4%) 03 (3.6%) 36 (42.9%) 43 (51.2%)
telepractice?

Figure 2. Source for Learning About Telepractice.
the in-person services closure due to the lockdown. A
facilitator was always required for 44% of the partici-
pants, likely due to the predominance of child clients.
A facilitator in this context is a person who helps the
client while attending an online session. The facilitator
is usually a parent or caregiver, who may not be trained
to perform the assigned task, or be proficient enough
to use technology, which could be challenging. At
the same time, the presence of a facilitator might
ensure that therapy is smoothly conducted.
The most frequent sources for learning about tele-
practice were faculty/colleague/friends and social
media and internet. Only 10% referred to their curricu-
lum for learning about telepractice, which can be
related to the lack of emphasis on telepractice in the
curriculum (Rao & Yashaswini, 2018). Closely related
to the need for inclusion of telepractice training in
the curriculum, more than 90% SLTs agreed to the
need for institutions to train their students for teleprac-
tice. More than 92% expressed the need to make stan-
dard operating protocols for telepractice as compared
to 72% in previously (Mohan et al., 2017). This could
be due to hands-on usage of the telepractice in the
present study that has made the SLTs realize this
need. Training in the use of synchronous and asynchro-
nous telepractice by SLTs with respect to platforms
used, availability of resources, hands-on training, regu-
lations, data privacy issues and how to overcome the
challenges.
The most commonly used platform for telepractice
was WhatsApp video call, followed by Zoom and
Skype. Most SLTs were using multiple platforms based
on the need and comfort of the patients. WhatsApp
has emerged as one of the more conventional of com-
munications in India since it is both freely available
and easy to use (Indian Express, 2019). Also, WhatsApp
has been increasingly used in healthcare as a communi-
cation tool between public and healthcare professionals.
SPEECH, LANGUAGE AND HEARING 5
It has gained popularity due to ease of access, not
requiring extensive infrastructure, and being economical
(De Benedictis et al., 2019; Giordano et al., 2017). Zoom
was the second preferred option adopted by the clini-
cian for service delivery as it gives free 40 min video
call. Facebook messenger was the least preferred
because of the need to use personal accounts or
create a new account. At the time of this study, there
was a lack of any legislation or guidelines available on
telepractice using phone, video on internet-based appli-
cation in India (MoHFW, 2020). There is a need for having
further legislations or guidelines that ensure the use of
secure networks, data privacy, and professionals norms
while using telepractice.
Regina Molini-Avejonas, Rondon-Melo, De La
Higuera Amato, and Samelli (2015) systematically
reviewed 103 papers in audiology and speech-
language sciences in telehealth to conclude that tele-
health does pose an advantage over non-telehealth.
However, certain barriers, such as technology, lack of
training, acceptance, regulations, and recognition,
need to be resolved. In the present study, the most
common problem reported was network issues. This
can be attributed to network issues that are being
faced in India due to the overconsumption of data cur-
rently (Hindustan Times, 2020). Many parents and care-
givers are still sceptical of the new mode of therapy,
which might account for why so many participants
reported that they had difficulty cooperating and con-
vincing parents. In addition, the majority of the case-
load in the present study was child language
disorders leading to another difficulty that the partici-
pants reported was in demonstration.
The findings of the present study shed light on the
uptake of telepractice by SLTs in India following the
COVID-19 pandemic. This pandemic has led to a
global influence and is likely to continue for a while.
It has become imperative that healthcare is shifted
6 K. AGGARWAL ET AL.
Figure 3. Challenges faced during telepractice
from in-person to telepractice. However, at the same
time, it is important to develop guidelines that would
benefit SLTs. Change is needed and this change can
be brought about by improving awareness, accessibil-
ity and further uptake of telepractice. This can be
achieved more effectively with the active participation
of the SLTs, professional bodies and other stakeholders.
Implications for practice and future research
A follow-up study can be planned examining changes
over a longer period. Further, replication of this study
in different countries would be of interest to examine
similarities and differences in attitudes, practices, and
response to different COVID-19 related restrictions on
traditional practice. With respect to implications,
there is a need for professional associations to make
resources on telepractice techniques freely and easily
accessible to members.
Conclusion
This is the first attempt to study the uptake of teleprac-
tice by speech-language therapists after a drastic
change of mode of service delivery from face-to-face
to telepractice. The findings highlight a better accep-
tance and uptake towards telepractice as was the
need of the hour. Although it seemed to be stressful
to adapt quickly to using telepractice, the SLTs were
quick in adapting and making use of the available tech-
nology for rendering services. Further work is war-
ranted to make use of more secure dedicated
platforms, broadening the coverage and accessibility
of telepractice services. Nevertheless, the present situ-
ation would pave the path for serious considerations
being given for telepractice in the field of speech-
language therapy in countries like India where it is
still at its nascent stages.
Disclosure statement
No potential conflict of interest was reported by the author(s).
ORCID
Komal Aggarwal http://orcid.org/0000-0003-1262-2870
Ravi Patel http://orcid.org/0000-0002-9615-2089
Rohit Ravi http://orcid.org/0000-0001-9585-2385
References
American Speech-Language and Hearing Association. (2016).
Scope of practice in speech-language pathology [scope of
practice]. Retrieved from www.asha.org/policy.
American Speech-Language and Hearing Association.
(2020a). Considerations for speech, language, and cognitive
assessment via telepractice. Retrieved from https://www.
asha.org/SLP/clinical/Considerations-for-Speech-
Language-and-Cognitive-Assessment-via-Telepractice/.
American Speech-Language and Hearing Association.
(2020b). Service delivery considerations in early intervention
during coronavirus. Retrieved from https://www.
asha.org/Practice/Audiology-and-SLP-Service-Delivery-
Considerations-in-Early-Intervention-During-Coronavirus/
#telepractice.
American Speech-Language and Hearing Association. (2020c).
Providing telehealth services under medicare during the
COVID-19 pandemic. Retrieved from https://www.asha.org/
Practice/reimbursement/medicare/Providing-Telehealth-
Services-Under-Medicare-During-the-COVID-19-Pandemic.
Anne, M. F., Kelly, J. B., & Todd Houston, K. (2013). Putting the
“tele-” in telepractice. Perspectives on Telepractice, 3(1), 9–15.
Arneson, S. L., Tucker, S. J., Mercier, M., & Singh, J. (2020).
Answering the call: Impact of tele-ICU nurses during the
COVID-19 pandemic. Critical Care Nurse, e1–e7. Advance
online publication. doi:10.4037/ccn2020126
Chua, M. L., Ma, D. J., Anderson, C. M., Karam, S. D., Margalit, D. N.,
& Kimple, R. J. (2020). Follow-up and management of patients
with head and neck cancer during the 2019 novel corona-
virus (SARS-Cov-2) disease pandemic. Advances in Radiation
Oncology, doi:10.1016/j.adro.2020.04.031
Cohn, E. R., & Cason, J. (2016). Telepractice, telehealth, and tel-
emedicine: Acquiring knowledge from other disciplines.

Perspectives of the ASHA Special Interest Groups, 1(18), 19–
29. doi:10.1044/persp1.SIG18.19
De Benedictis, A., Lettieri, E., Masella, C., Gastaldi, L., Macchini,
G., Santu, C., & Tartaglini, D. (2019). Whatsapp in hospital?
An empirical investigation of individual and organizational
determinants to use. PLOS ONE, 14(1), e0209873. doi:10.
1371/journal.pone.0209873
Facher, L. (2020). Trump administration loosens Telehealth
regulations to combat coronavirus. STAT. Retrieved from
https://www.statnews.com/2020/03/17/trump-telehealth-
restrictions/.
Fritz, M. A., Howell, R. J., Brodsky, M. B., Suiter, D. M., Dhar, S. I.,
Rameau, A., … Kuhn, M. A. (2020). Moving forward with
dysphagia care: Implementing strategies during the
COVID-19 pandemic and beyond. Dysphagia. doi:10.1007/
s00455-020-10144-9
Giordano, V., Koch, H., Godoy-Santos, A., Dias Belangero, W.,
Esteves Santos Pires, R., & Labronici, P. (2017). Whatsapp
messenger as an adjunctive tool for telemedicine: An over-
view. Interactive Journal of Medical Research, 6(2), e11.
doi:10.2196/ijmr.6214
Gunjawate, D. R., Ravi, R., Yerraguntla, K., Rajashekhar, B., &
Verma, A. (2020). Impact of coronavirus disease 2019 on
professional practices of audiologists and speech-
language pathologists in India: A knowledge, attitude
and practices survey. Clinical Epidemiology and Global
Health. doi:10.1016/j.cegh.2020.07.009
Hindustan Times. (2020). India’s Internet consumption up
during Covid-19 lockdown, shows data. Retrieved from
https://www.hindustantimes.com/india-news/india-s-
internet consumption-up-during-covid-19-lockdown-
shows-data/story-ALcov1bP8uWYO9N2TbpPlK.html.
Indian Express. (2019). WhatsApp now has 400 million active
users in India. Retrieved from https://indianexpress.com/
article/technology/social/whatsapp-now-has-400-million-
active-users-in-india-confirms-company-5854881/.
Keck, C. S., & Doarn, C. R. (2014). Telehealth technology appli-
cations in speech-language pathology. Telemedicine
Journal and e-Health: the Official Journal of the American
Telemedicine Association, 20(7), 653–659. doi:10.1089/tmj.
2013.0295
Krumm, M., & Syms, M. J. (2011). Teleaudiology.
Otolaryngology Clinics of North America, 44, 1297.
Lurie, N., & Carr, B. G. (2018). The role of telehealth in the
medical response to disasters. JAMA Internal Medicine,
178(6), 745. doi:10.1001/jamainternmed.2018.1314
Miles, A., Connor, N. P., Desai, R. V., Jadcherla, S., Allen, J.,
Brodsky, M., … Langmore, S. E. (2020). Dysphagia care
across the continuum: A multidisciplinary dysphagia
research society Taskforce report of service-delivery
during the COVID-19 global pandemic. Dysphagia, doi:10.
1007/s00455-020-10153-8
Ministry of Health and Family Welfare, Government of India.
(2020). Telemedicine practice guidelines enabling registered
medical practitioners to provide healthcare using telemedi-
cine. Retrieved from https://www.mohfw.gov.in/pdf/
Telemedicine.pdf.
Moccia, M., Lanzillo, R., Brescia Morra, V., Bonavita, S.,
Tedeschi, G., Leocani, L., … & Digital Technologies Web
SPEECH, LANGUAGE AND HEARING 7
and Social Media Study Group of the Italian Society of
Neurology. (2020). Assessing disability and relapses in mul-
tiple sclerosis on tele-neurology. Neurological Sciences:
Official Journal of the Italian Neurological Society and of
the Italian Society of Clinical Neurophysiology, 1–3.
Advance online publication. doi:10.1007/s10072-020-
04470-x
Mohan, H. S., Anjum, A., & Rao, P. (2017). A survey of teleprac-
tice in speech-language pathology and audiology in India.
International Journal of Telerehabilitation, 9(2), 69–80.
doi:10.5195/ijt.2017.6233
Polit, D. F., & Beck, C. T. (2006). The content validity index: Are
you sure you know what’s being reported? Critique and
Recommendations. Research in Nursing and Health, 29(5),
489–497. doi:10.1002/nur.20147
Raman, N., Nagarajan, R., Venkatesh, L., Monica, D. S.,
Ramkumar, V., & Krumm, M. (2019). School-based language
screening among primary school children using teleprac-
tice: A feasibility study from India. International Journal of
Speech-Language Pathology, 21(4), 425–434. doi:10.1080/
17549507.2018.1493142
Ramkumar, V., Nagarajan, R., Shankarnarayan, V. C.,
Kumaravelu, S., & Hall, J. W. (2019). Implementation and
evaluation of a rural community-based pediatric hearing
screening program integrating in-person and tele-diagnos-
tic auditory brainstem response (ABR). BMC Health Services
Research, 19(1), 1. doi:10.1186/s12913-018-3827-x
Ramkumar, V., Rajendran, A., Nagarajan, R.,
Balasubramaniyan, S., & Suresh, D. K. (2018). Identification
and management of middle ear disorders in a rural cleft
care program: A telemedicine approach. American Journal
of Audiology, 27(3S), 455–461. doi:10.1044/2018_AJA-
IMIA3-18-0015
Rao, P. K. S., & Yashaswini, R. (2018). Telepractice in speech-
language pathology and audiology: Prospects and chal-
lenges. Journal of Indian Speech Language & Hearing
Association, 32(2), 67.
Regina Molini-Avejonas, D., Rondon-Melo, S., De La Higuera
Amato, C. A., & Samelli, A. G. (2015). A systematic review
of the use of telehealth in speech, language and hearing
sciences. Journal of Telemedicine and Telecare, 21(7), 367–
376. doi:10.1177/1357633x15583215
Soldatova, L., Williams, C., Postma, G. N., Falk, G. W., & Mirza, N.
(2020). Virtual dysphagia evaluation: Practical guidelines
for dysphagia management in the context of the COVID-
19 pandemic. Otolaryngology–Head and Neck Surgery.
doi:10.1177/0194599820931791
Tahan, H. M. (2020). Essential case management practices
amidst the novel coronavirus disease 2019 (COVID-19)
crisis. Professional Case Management. Publish Ahead of
Print. doi:10.1097/ncm.0000000000000455
Tucker, J. K. (2012). Perspectives of speech-language pathol-
ogists on the use of telepractice in schools: The qualitative
view. International Journal of Telerehabilitation, 4(2), 47–60.
doi:10.5195/ijt.2012.6102
World Medical Association. (2009). Declaration of Helsinki.
Ethical principles for medical research involving human
subjects. Jahrbuch für Wissenschaft und Ethik, 14(1).
doi:10.1515/9783110208856.233