PAMELA HADLEY: I'd like to welcome you all to today's Fall Lecture Series featuring faculty from the Department of Speech and Hearing Science. My name is Pamela Hadley. And I'm the new interim head.

And it's my absolute delight to bring our panelists to you today. They'll be sharing some very interesting and exciting new projects, featuring academic and clinical partnerships in both research and instruction. And they're representing the way we, as a department, are generating new knowledge and translating evidence-based practice into our teaching practices as well.

It's my pleasure to introduce the two pairs of speakers today. They feature two sets of academic clinical partnerships. Each partnership has prepared a 15-minute presentation.

And we'll follow each with this period for question and answers. And, as Danielle said, please submit your questions to that Q&A box. And I will moderate that discussion for us.

So our first partnership is made up of faculty in Hearing Science and in Audiology. Dr. Brian Monson joined our faculty as an assistant professor in 2017. His research interests focus on auditory neurodevelopment and the development of speech in voice perception. In his research, his goal is to understand how experience with the environment affects auditory neurodevelopment and perception.

He'll describe the goals of a recently funded R21 grant from the National Institute on deafness and other communication disorders that is designed to determine the difference in language exposures for preterm infants in the NICU and for full-term infants in the womb and the impact of these differences on auditory neurodevelopment.

He is joined today by Dr. Sadie Braun, a new visiting clinical assistant professor in the department. Dr. Braun has more than 10 years of experience providing clinical services to individuals across the lifespan. She currently supervises and instructs graduate students in audiology. She'll be conducting the hearing assessments for the infants in this study in our audiology clinic. Please join me in welcoming Doctors Monson and Braun for their presentation on auditory exposures and brain development for preterm infants. Dr. Monson?

BRIAN MONSON: OK, thank you. Let me move my slides back here. So I'm going to give an introduction to the project that's given rise to this collaboration. And then I'm going to turn it over to Dr. Braun to discuss some of the experiences of students in result of this collaboration.

I want to acknowledge upfront, as Dr. Hadley said, this is funded by the National Institute of Deafness and Communication Disorders. This is a project focusing on auditory exposures and brain development for preterm infants. Let me give you a little bit of context here.

Babies are hearing in the womb, OK? About the onset of the third trimester of pregnancy, fetuses in the womb start to hear and can hear what's going on in the extrauterine environment. Among other things that they're exposed to then are voices, speech and language exposure from the extrauterine environment, including their mother's voice, as well as people in the near vicinity. They're speaking to mom or speaking around mom.

How do we know this to be true? Well, there is a lot of evidence now. We can use different techniques to measure auditory learning that occurs in utero. And that is if you measure behavioral or neurophysiological responses for full-term newborns, you discover that there are auditory memories being made from intrauterine experience.

In particular, full-term newborns show auditory memory-- that is, behavioral or neurophysiological responses that distinguish between the mother's voice and a stranger's voice. They can recognize mom's voice and recognize mother's native language compared to foreign languages. They can recognize familiar melodies that they heard while in utero, OK, as well as frequently-heard speech passages, say from a story that mother read frequently, even down to more subtle phonemic speech features. They can distinguish between phonemes. So they're really gaining a lot of information in the womb.

So you might say that the intrauterine environment has a very unique sound profile. The brain is developing rapidly during this period. And the brain is learning about the sounds from the extrauterine environment, as well as the intrauterine environment.

So what happens if you take this rapidly-developing brain and this baby and prematurely remove it from this environment and put it, let's say, in a box in a hospital. OK, you make a rapid change in the acoustic environment, among other things. And this is the experience, of course, of the infants born premature, who can spend up to-- well, several months, the first months of life in the neonatal intensive care unit, exposed to a very different sound profile than what they might get if they were still in the womb. So this project is motivated by this scenario, and in particular, to try to optimize the NICU sound exposures to foster healthy developments later in infancy and childhood. And that is auditory, speech, and language developmental outcomes.

I'm going to play for you a couple of recordings that I think will highlight the differences in these environments. The first is a recording from the actual uterus of a pregnant woman. It's combined with the recording from the uterus of a pregnant sheep.

You're going to hear-- I want you to attend to what you hear in this recording. There's some static there. Try not to pay any attention to that.

If you have a set of headphones, or you may need to turn up your computer speaker if you don't to hear some of these things. But you should hear mother's heartbeat. You will hear mom talking. There's a stomach growling there somewhere. You'll get to get privileged access to hear what a stomach growl sounds like from inside the stomach. So here we go.

[VIDEO PLAYBACK]

[STATIC BUZZING]

- Say the word doing. Say the word done.

- [INAUDIBLE]

[STOMACH GROWLING]

- He wants to talk about the [INAUDIBLE]. They had a problem with the clip.

[END PLAYBACK]

BRIAN MONSON: So what I hope you heard is that this is a pretty rich environment, that that signal coming in from the outside is pretty rich, right? You can tell it's speech, clearly, when you hear the man talking or mom talking. Heartbeat is constantly on.

Let's hear now a recording from an actual NICU. And pay attention to what is different and what you do or don't hear. And, again, I'll prep you as saying you're going to hear a lot of silence in this recording. And that's something to think about.

[VIDEO PLAYBACK]

[BELL CHIMING]

[BABY CRYING]

[BEEPING]

[END PLAYBACK]

So hopefully, you're hearing the contrast between these two recordings. You can get an idea of the drastic differences here and what effect that might have on the developing brain. And that's really what we're interested in. So for this, let me give you some information about preterm infants and outcomes, communication disorder-related outcomes for preterm infants.

First off, infants born premature are at an increased risk for sensorineural hearing loss, about five times the typically developing population. Language and speech developmental delays are widely reported for children who were born premature. Auditory attention deficits have been reported, as well as increased risks for auditory processing disorder. And the question for us, really, is how much of that is related to this auditory experience?

So we've been trying to measure auditory experience, comparing the intrauterine environment and the neonatal intensive care unit. How are we doing that? We use this device. It's called a LENA device. It's a 24-hour audio recorder.

And basically, it makes this 24-hour recording. It has a software that comes with it that classifies the different types of sounds that are captured on the recording. OK, how much of that 24 hours was speech and language? How much of it was silent? How much of it was noise, et cetera?

You can see here, it's about the dimensions of a credit card. And it fits in the places that we need it to fit. Namely, we have moms wearing this recorder around their necks during pregnancy. OK, so we're making twice-a-week recordings with pregnant moms from the Champaign community.

We also use this same device in the neonatal intensive care unit, here using an unoccupied incubator with the device sitting inside. When the baby is there, the device sits with the baby. When baby comes out, the device comes with the baby, and just trying to capture everything that the baby's hearing. And here, you see a couple of my grad students, who were assisting and making some measurements there in the neonatal intensive care unit. I want to highlight for you that thus far, we collected over 15,000 hours of data for both our NCIU group, which this work is being conducted at Carle Hospital here in Champaign, and over 15,000 hours of data for our pregnant woman group, capturing the fetal sound exposures from the extrauterine environment.

Here's just a quick snapshot of differences we're seeing between the two groups, for this group or for this audience, I'd like to highlight. So this is your 24-hour period pie here. And on average, averaging across all of our subjects, we see that the fetal group is getting about seven hours of speech exposure per day, OK, speech or speech-like exposure, vocalizations. And our preterm group is only getting 4.5 hours per day. So you're looking at right around 50% more language exposure for the fetal group than the preterm group. And what are the long-term consequences of that.

To measure this, and this where the clinical collaboration with Dr. Braun and our audiology clinic has come in, we are bringing our babies back at age three months, corrected age. And they are undergoing an assessment using auditory brain stem responses. This is a standard audiology clinical assessment for infants.

You can see our setup here with this cute little baby here, again, one of my grad students, who was fortunate enough to be able to hold baby during this particular test. We've got electrodes on the scalp. And we're playing sound in baby's ear and measuring responses to those sounds that look like this. These are neural responses.

And the duration-- or excuse me, the latency, the time that it takes to-- for these responses to come after this sound is played gives us information about how mature the system is and how well it's developing. Preliminarily, we're seeing some relationship between daily speech exposure, average daily speech exposure, and latency. That is, for our fetal group, we have seen some relationship of increased daily speech exposure leading to lower latencies or faster responses, which would-- we presume to be beneficial. So that's really interesting. At this point, I'm going to turn it over to Dr. Braun.

SADIE BRAUN: Thank you, Dr. Monson. I'd really like to highlight for you today how Dr. Monson's research, through a collaboration with our Audiology Clinic on campus, really provides our students with a unique opportunity. And that is to gain a foundational knowledge of what an auditory brainstem response is very early on in their graduate studies. I'll start by talking a little bit about the timeline for our audiology students with regard to learning about evoked potentials. And then I'll share with you some feedback that we've gotten from students who have been participating in Dr. Monson's research and who have also completed their evoked potentials coursework.

A quick note about some terminology before I move on-- when I'm talking about evoked potentials, auditory brainstem response, ABR, or electrophysiology, for purposes of this presentation, I'm talking about the same thing. So our students are getting to participate in the data collection for Dr. Monson's research during their second and sometimes even their first years, prior to even having had the evoked potentials coursework. So during these sessions, students are gaining a basic foundational knowledge about what an ABR is and how to collect it. So, for example, students are seeing how you prepare a baby for an ABR test and how you place electrodes on patients.

It's not until their second semester second year where the students complete their evoked potentials coursework. And this is when they learn so much more about the underpinnings of an ABR. And, for example, they're learning how do ABR wave forms relate to the anatomy of the auditory pathway?

In their third and their fourth-year placements, students are seeing clinical ABRs with supervision. And they have the ability, really, to apply everything they've learned so far through observation, as well as through their coursework. When they become practicing professionals, this is when they are able to analyze and synthesize everything they've learned so far. And they can complete ABRs independently, and then also provide recommendations and guidelines for patients for how to proceed after an ABR is complete. So if you really look at this slide, you can see that the observation and basic participation in Dr. Monson's data collection really forms the foundation of knowledge that our students built upon with regard to evoke potentials throughout our AUD program.

Now, we move on to some feedback that we've gotten from our students. And one student in particular commented how helpful it was for her to have this initial clinical experience with ABRs prior to being enrolled in the ABR coursework. So I'll read a little bit about what she said here.

"Having this research ABR experience prior to my electrophysiology course was extremely beneficial, as I was able to gain hands-on experience with identifying waves one through five. Having this prior experience made the electrophysiology course far more interesting, engaging, and easier to understand. So, as you can probably all relate to, sometimes you really have to see something in-person or have a hands-on experience with it before you can have a true understanding of what it is.

And when I think back on my own graduate program, I did not have this initial clinical experience with ABRs before I completed my ABR coursework. So I think had I had a better understanding going into the course what evoked potentials were, I might have been able to get more out of the course itself. In addition to preparing our students for their ABR coursework, participation in this research really gives them a lot of pediatric experience, particularly with babies, that they wouldn't otherwise have, at least in our internal on-campus clinic.

So traditionally, we see adults in our clinic. And when we do see children, they tend to be school-aged children and not necessarily babies. So this research provides a very unique opportunity to see a population that students otherwise might not see until they're in their external placements. Another student commented about how she knows now what normative data looks like with ABRs. So through seeing normal babies, normal hearing babies being tested in our clinic, she has a better idea as to where to expect to see various waves so that when she is in her external clinical placements and she sees something abnormal, she is able to identify it as abnormal, which is really a useful skill to have.

This brings me to the final component, which is this IHS system, evoked potential system, that was purchased jointly between Dr. Monson's research grant and our audiology clinic, as well as the Speech and Hearing Science Department. And it really provides a multitude of educational, clinical, and research experiences for our students. We had a student in particular comment on how her experience with this IHS system really allowed her to develop her own tools to learn unfamiliar ABR systems in clinical placements. So to have more experience with a wider variety of equipment gave her skill she needed and she put to use when she was in her external placements.

So in summary, this research and clinical collaboration allows so many opportunities for our students that are both specifically related to evoked potentials, as well as skills that our students really need for audiology practice in the real world, to become the best possible, competent, practicing audiologists. Thank you. And now we can take any questions if you have them.

PAMELA HADLEY: Thank you both for that wonderful presentation. If there are questions, if people could please submit them to the question and answer box, I'll be happy to moderate. Dr. Monson, do you want to share any comments about where this research is going in the next couple of months, or anything else while we're waiting?

BRIAN MONSON: Yes. I would like to, actually. We thought one of the real strengths of this project is we're going to have-- we've amassed a large amount of data in infancy for these babies, including the auditory brain stem, the electrophysiological response data. And we will be well-positioned to see if these measures are predictive of later outcomes with these babies. So this is a longitudinal study.

And we have let our moms know that we'll be contacting them when their baby turns two years old, again five years old, sort of prep them to let them know we would really like to follow up later in life to assess language development at these ages, to assess auditory function at these later ages. And I think we'll have-- like I say, we'll be well-positioned to really test the predictive power of ABRs, of prenatal and perinatal and auditory exposures on later outcomes, including language function and auditory function. And the language function piece, in the spirit of collaboration, we're planning to do with Dr. Hadley and her team, and so I'm quite excited about that.

PAMELA HADLEY: Thanks. OK, we've got some questions coming in. So let me read the first one. Since heartbeat and mother's voices are very important, can recordings of this information be provided to NICU babies?

BRIAN MONSON: Yeah, so that is-- you're right on the right track. That's where we're thinking as well. And that's one of the interventions that I've actually worked on a project previously, where we were assessing the benefit of recording mom's voice, recording mom's heartbeat, and playing that in the incubator for the baby.

Unfortunately-- so this was a number of years ago-- and unfortunately, in that project, we didn't have any targets. We didn't know how much language exposure baby needed, because nobody had the answer to what is the average exposure if baby were still in the womb? Well, now we're getting that answer. And so now we can more properly, in my head, I guess, in an evidence-based way determine how to develop such an intervention, what target language exposure, how much of mom's voice should we play for the baby?

I think there is something there. I think that will be beneficial. Just it's clear to me that you have to do it in a clever way. You have to be smart about how you provide that kind of exposure.

PAMELA HADLEY: Great, thank you. We have a question about how many mothers and babies are involved in your study at this point.

BRIAN MONSON: So we have collected data from about 27 mother-baby pairs for our full-term group. And then for our preterm group, we have collected from about 10 more than that, about 37 mother-infant-- well, not quite-- so many of the NICU babies are twins and triplets, so it's not quite pairs. But you get the idea, so 37 infant subjects. We plan to enroll, I should say, our target enrollment is 100 babies per group.

PAMELA HADLEY: Thank you. I think you've already alluded to what your plans are for interventions in the NICUs. So that question, I think, has been answered. So let me ask this next one. Are there any opportunities for undergraduate students to get involved in this project?

BRIAN MONSON: Yes. Thank you for that question. We have a number of undergraduate students in our lab. And they are-- so we have to meet up with mom twice a week-- well, excuse me, once a week, to provide her a recording device and collect the recording device from the previous week. And so when you have 10 to 15 moms running simultaneously, that's a lot of running around you have to do, right?

And there's ample opportunity for our undergraduates to meet with mom, swap out the device, check on mom, see how things are going. The undergraduates work in the lab to record times and any time that the device may have been removed, that we're recording that as well. So yes, we've got a fleet of undergraduates and graduate students who are involved in this work. And the undergrads as well, some undergraduates have had the opportunity to observe the ABR data collection as well, gain some clinical experience there.

PAMELA HADLEY: OK. And so I'm going to give you the last question before we move on to our next set. And that is if infants in utero can hear music, are there any studies that show if infants are exposed to music during pregnancy, are they more musically inclined later in life?

BRIAN MONSON: That is a very intriguing question. And the jury is still out on that. There have been studies here and there who have-- where these researchers have thought they had demonstrated some improvements, not just musical talent, but intellectual improvement by being exposed to, say, Bach or classical music.

The evidence for that is not very strong, I think. As for whether increased exposure to music in utero might lead to music intellectual development, music intellectual growth, I don't know of any studies that have examined that specifically. Really, we haven't-- there is a small number of studies that have examined exposures in the womb. And those that have not been able to follow up long term with these babies still. So the long-term effects of intrauterine exposures are really just a big question mark. We really have no idea. But, like I say, hopefully we'll be in a position to start answering some of those important questions.

PAMELA HADLEY: Thank you. Thank you both for that wonderful presentation and for all of the great questions. We'll switch gears now. And I'd like to introduce our second partnership. This partnership is made up of faculty in speech science and speech language pathology.

Our first speaker, Dr. Keiko Ishikawa, also joined our faculty as an assistant professor in 2017. Dr. Ishikawa's clinical and translational research focuses on understanding how voice disorders affect speech intelligibility. The ultimate goal of her research is to generate knowledge that will guide clinical decision making for directly addressing patients' communicative ability. Dr. Ishikawa also has very strong interests in teaching innovations and the use of telepractice in speech language pathology.

She's joined today by Clarion Mendes, a clinical assistant professor who has been a full-time member of our clinical faculty since 2014. Ms. Mendes has over 11 years of clinical experience. And she has worked in multiple medical settings. She currently supervises and instructs our graduate clinicians in the area of voice and neurological conditions affecting communication.

The two of them have teamed up to develop a really innovative model of instruction as part of the graduate course in voice disorders that Dr. Ishikawa teaches. And this exciting innovation in teaching has been funded by a provost faculty return research-- retreat grant, excuse me. So please join me in welcoming them for their presentation, Caring in Distance-- Standard Patients Telepractice for Understanding the Perspective of Individuals with Communication Disorders.

KEIKO ISHIKAWA: Thank you, Pam, for such kind introductions. I'm going to share my screen here. And I'm making sure that I'm sharing the right screen. So please hold. OK. Clarion, are you able to see my screen? OK, excellent.

OK, well, again, thank you so much for inviting us to the whole lecture series today. So today, we present our work, Caring in Distance-- Telehealth Training for Future Speech Language Pathologists. This project has been carried out in collaboration with professors Yvonne Redman, Sarah Wigley, and Dr. Bridget Sweet at School of Music as well. And we would like to thank the Office of Provost and vice chancellor for academic affairs and the Center of Innovation in Teaching and Learning for providing us the grant that made this project possible.

So telehealth [INAUDIBLE] practice is a rapidly-growing area of healthcare, which has greatly improved patient access to care, clinical outcomes, and patients satisfaction. The current pandemic accentuated the importance of telehealth with the restriction of in-person encounter in the medical offices. And last spring, the pandemic also forced our speech language pathology and audiology clinics to quickly move their practice from in-person due to the practice so that our students can continue their professional training and our clients can continue receiving their care.

One of the challenges there was that the students needed to get into it at their practice without any formal training. So speech and language pathologists have been using telehealth for more than 20 years. And there continues to be a strong interest in developing telepractice. As in many other areas of medicine, speech and language pathologists treat patients in remote areas. And some of these patients are limited in their mobility, which severely restricts their access to care.

Another population that benefit from telepractice is children. Parents are not necessarily able to secure time to drive 45 minutes to their children's and speech therapy. Or home health services may not be necessarily available to some areas of their residence. So given the interest and the necessity, many telehealth training programs have been developed for speech and language pathologists.

But there are-- these are exclusively catered to licensed clinicians. There are only a couple training programs available for graduate students in speech language pathology. And I believe, actually, there is only one graduate-level certificate program in telepractice in speech and language pathology today.

As we all are learning, delivering our service via teleconferencing tool like this poses unique challenges. I believe we are all learning that as teachers. There are always technical issues. But also, not being in the same room with our communication partners limit us from using nonverbal communication strategies. So for clinicians, it affects their ability to convey a sense of empathy to their clients.

This is a problem. Research has shown that such communication is crucial for forming a strong therapeutic alliance with their patients, which ultimately affects the patient's adherence to the prescribed treatment and treatment outcomes. So student clinicians needed to learn fundamental, technical, and practical skills to deliver their service in a telehealth environment. And that was the motivation of our project.

So we decided to incorporate standardized patient training, which allows students to practice fundamental skills, such as interview-- patient interview and counseling with actors. And this is a safe, low-risk environment, which should be very good for developing their self-efficacy. So this collaboration became possible through the collaboration with the School of Music.

So we set up three aims for this project. And one is to provide the training to speech and language pathology students. And the second was to provide opportunities for students in the music and theater programs to learn about individuals with voice disorders, and then perform the role of such individuals. The third aim was to provide any students an opportunity to receive voice evaluation at the free of charge. And I'll pass this along to Clarion now.

CLARION MENDES: Thank you so much, Dr. Ishikawa. And thank you very much also for commandeering our slides for us. I don't have anything as exciting to offer as an in-utero stomach growl. But you might hear my cat snoring under my feet. So I apologize if you hear Pythagoras underneath my toes.

So I want to share with you a little bit about the steps that have been involved with the telepractice experience that we've been able to provide for our students. And so this is part of the SHS 511 Assessment in Management of Voice Disorders course. And so as we designed this for a module for our students, we began with a traditional didactic lecture about the technology, telepractice-- the technology that's required in implementing telepractice for our students, in particular, having to modify it for remote service. As many of you are aware, when we're looking at assessing and monitoring the voice, we need to make sure that we have high-quality, high-fidelity tools in order to manage speech signals, and so training the students to ensure that they're still able to do that despite not being in the same physical location as their patients.

We also discussed legal and regulatory issues, because since we're still providing a healthcare service, we're still bound by the rules of HIPAA and other privacy rules and regulations as well. And also as far as telehealth etiquette, so making sure that we're able to provide a safe and secure environment for the client, and also to create that rapport that may be a little bit more challenging when we're looking at a remote evaluation or assessment. And we'll also talk about how some of that didactic training is what we're going to use as part of our outcome measurements as far as determining the success of this particular project.

After the initial didactic practice, the students were given the opportunity to do peer practice. So they were able to incorporate all of the elements that we would use in a typical voice assessment and practice that with each other. And so the risk there was relatively small. And this included both developing a case history, which I think our students might share with us is kind of difficult to do remotely.

We developed the case history, as well as some questionnaires that are very commonly used in a voice assessment, such as the voice handicap index and the vocal fatigue index. And we also collected acoustic data, as well as the perceptual data that we use for a voice assessment. This really gave the students an opportunity to practice getting the flow of a voice assessment, and also probably get some of those jitters out.

I should mention that, as Dr. Ishikawa explained to us, telepractice has historically been somewhat rare in graduate education. COVID has changed this significantly for us. And telepractice is considered an advanced clinical skill by our certifying body, the American Speech, Language, and Hearing Association. And so this is one of the other reasons why we thought it was important to do some formalized training for our students regarding this.

Our standardized practice patients were students of acting or students of voice. And they were formally trained in acting as if they had a voice disorder. And they did a remarkably good job.

And the students were given the opportunity to assess the standardized patients. This gave students a tremendous amount of freedom, because legally, we are required to supervise 100% of the time with any sort of telepractice client. And so there is a clinician right there the entire time. And with the standardized patient practice, our certifying body allows the student to be a little bit more independent and not be there the entire time, even though it is via telepractice.

And then the exciting part, after building up this scaffolding, I love how Dr. Braun used Bloom's Taxonomy in exploring this. If we continue to build on Bloom's Taxonomy here, after that, we recruited students that are enrolled in vocal health classes to serve as our patients. And so our students are currently in the phase where they have the opportunity to assess these students using the voice assessment battery that Dr. Ishikawa and I developed.

And so as a result, after the students create and craft and complete their assessment, the patients are using a couple of outcome measurement tools to measure the effectiveness of the student's bedside manner. And so they're using something called the CARE Measure, which is a tool that's typically used amongst physicians. To my knowledge, and Dr. Ishikawa can answer this for us, it has very rarely been used in communication sciences and disorders. In fact, there's very little research to look at the empathetic skills of speech language pathologists and audiologists.

And the real patients, as well as the standardized patients, are also rating our students based on their telepractice etiquette skills. And so we'll be able to have some data for you within the near future about how our students did. And now, I'd like to pass it along to-- if you could advance the slides for us, Dr. Ishikawa, we have the great pleasure of having three of our students who are enrolled in SHS 511 today to talk a little bit about their experience today.

So we'll have Brianna Legner go first. She is also an alumna of our undergraduate program, as is Hannah. And we warmly will welcome Megan as well. So Brianna, if you'd like to go first?

BRIANNA LEGNER: Yeah, of course. So this training, I feel, really surrounded our learning and our understanding of how to conduct an evaluation more independently. As Dr. Ishikawa mentioned before, telehealth is becoming a critical service, especially during this COVID craziness. And I feel that the training really helped us to do the proper ways of conducting a telehealth session.

In my case, I had a client who was acoustically typical. And then our standardized patient scenario, we had a speaker who was a little bit more on the dysphonic side. So it was so nice to see the differences in the acoustic measurements and being able to analyze those, where we might be able to do that in the future. I feel I learned material better, in my opinion. Definitely more confident instructing a voice evaluation because of the multiple opportunities we had.

CLARION MENDES: Brianna, thank you very much. I also love how you-- I didn't even think about the benefits that you had by comparing the, quote unquote, within typical limits acoustic data versus the acoustic data that showed impairment. Thank you very much. Hannah, I'm going to pass it over to you now, if I may.

HANNAH LI: Hi. Yes, I would just echo everything Brianna said. So I think it was wonderful that we kind of were able to go step-by-step in being able to conduct these assessments and having them grow progressively more difficult. But having that practice was really amazing. So I'll just share.

For me, my standardized patient session went really smoothly. But then when I got to my real client, I had a technological glitch. And I was in the session early, but I got kicked out and I had to restart my computer twice. And so I ended up being a few minutes late to the session.

And so with telehealth, things like that are going to happen. So it's really important to be flexible in that regard. And so for me, being able to practice with a standardized patient, I think that helped a lot with keeping my cool, coming back into the session a few minutes late, and just being aware of OK, now I know what I have to do, because I had everything ready before, so I kind of had to pull everything last minute. But I think it really helped in keeping this-- helping me stay composed and very professional with the client.

CLARION MENDES: And I can say, just by my observation of Hannah-- and please, keep in mind, Brianna, Hannah, and Megan are in their very first clinical semester. So this is a tall order, giving them this level of independence with a telepractice experience. And you were completely unflappable. And so I'm very proud of you there. And last but not least, Megan, please?

MEGAN PLACKO: So I have many of the same comments that Brianna and Hannah do. But I'd say for me, the thing that was most valuable about this project was being able to incorporate feedback from our supervisors, but also feedback from the clients, and be able to apply that to the real clients that I saw in the clinic, because I've also completed a couple assessments-- teletherapy assessments of voice patients this semester in the clinic as well. So being able to take the feedback from class and incorporate it has really made me a stronger clinician.

CLARION MENDES: And I promise that we did not give them a script. This is their own independent thought regarding their experience. So thank you to all of our students, Dr. Ishikawa, to all of you today, as well as the Center for Innovation in Teaching and Learning and the Provost Office. And I'll pass it back to Dr. Hadley.

PAMELA HADLEY: Thank you both for that wonderful presentation. So just like with the last speakers, we are now open for any questions. You can also direct those to the students if you'd like. I really appreciate you joining us today.

OK, so we have our first question. Thanks for your talk. Does the effective listening through Zoom affect the accuracy of the voice assessments?

KEIKO ISHIKAWA: Yes, that is one of our major questions. So we actually have multiple recordings to assess this. And we are able to compare how the Zoom environment has affected our recording. And, obviously, that would affect our analysis, too, and in listening as well. So that is one of the things that after this project is over and data collected, we are scientifically able to evaluate this piece.

CLARION MENDES: It is definitely an additional challenge doing the assessments via Zoom because the perception is, of course, going to be different than in a live clinical environment. At the same time, right now, because of the aerosolization that is part of a standard, in-person voice assessment, I'd also make the argument that doing an in-person, it's hard to get the best data right now also. But one of the extra steps is training clients to securely record their own tokens and securely send them to us as well. And so that's an additional challenge that our students have been really, really fantastic with.

KEIKO ISHIKAWA: I must say that we encounter so many unexpected challenges from this recording environment. And I think we'll be able to describe what we did wrong and what we did right in many ways.

PAMELA HADLEY: So I have a question while we're waiting for some others to come into the chat box. Oh, here comes one now. In addition to clarity of voice sounds, are there other challenges facing telepractice?

KEIKO ISHIKAWA: Well, Clarion, would you like to start?

CLARION MENDES: Absolutely. So there are several challenges here. So telepractice, like any clinical tool, can be used for good or it can be used for evil. Telepractice is very, very beneficial in a lot of situations. But in some circumstances, there are additional challenges.

And so, for instance, building rapport can be a little bit more challenging over the remote sort of environment. It is not appropriate for all clients. I have also found during neurological assessments via telepractice, while not impossible, is significantly more difficult. So what I mean by that is not only is the sound slightly degradated, but also that the visuals are not as good as they are face-to-face. So, for instance, if I'm doing a cranial nerve examination, it's not ideal to do it over telepractice, because I can't get the light as good.

I would love the students to also chime in very quickly, too, if they have questions about-- if they have feedback about some of the challenges of telepractice also. From a educator standpoint, one of the pros and cons is that we have to be attached to the screen with the students 100% of the time, which can be probably a little bit nerve-racking for the students, too. Megan, Hannah, and Brianna, is there anything you'd like to add?

BRIANNA LEGNER: I've got to unmute myself. I know that--

CLARION MENDES: That's a challenge, remembering when to unmute and when to mute.

BRIANNA LEGNER: Right. I know with one of our clients, we were working on breathing exercises. And we typically tell them to put their hands on their diaphragm and feel the movement. But it's hard when we're also trying to make sure that they're doing that movement correctly, because they have to move farther away from the screen so we can see their diaphragm. But then they're too far where we can't really identify the movements. And so I would say that is a challenge that has recently come up with telepractice.

CLARION MENDES: Good point, Brianna. Hannah or Megan, any you would like to add?

HANNAH LI: Yeah. So for me, I think something that was challenging was when you're talking with a person, it's very easy to make a connection with them by looking at their face and looking at their eyes. But when you're doing telepractice, you're maybe looking at the screen as opposed to the camera. And so keeping my eyes on the camera so that the patient perceives that I'm looking into their face has been challenging.

But I would also say something that I really enjoy about the sessions is that-- or at least for the standardized patient sessions, because those are recorded. So I was able to have that to look back and reference. And, obviously, that can't always happen with real clients. But at least for that portion of the project, that was really helpful.

MEGAN PLACKO: I also run into some additional problems with making sure that the clients have a secure location to be able to conduct the assessment as well, because I know I can control things on my end. But something that I've had to alter in real time is trying to accommodate the client's situation as well, and if they're not in a confidential area where they can conduct the assessment.

PAMELA HADLEY: Thank you all. Can we move on to the next question? So you have a compliment, amazing presentation. And the question is I'm curious about how healthcare disparities relating to access to healthcare and digital devices affect the quality of remote services.

KEIKO ISHIKAWA: That is the most important question to ask, I believe. Internet connection is not the same everywhere. Device availability is not same for everybody. Although this is-- I mean, use of telehealth does help deliver the care to individuals who otherwise cannot. It also handicaps individuals who are not able to get these devices.

So I hope that my research, as well as the others, will point at some problematic issues that we need to solve. And absolutely, this is a big, big challenge today that we all need to be aware of and we need to be tackling. Clarion, is there anything you'd like to add?

CLARION MENDES: I have found that in some ways, it has actually been a bit of an equalizer. I personally believe it's the job of the clinician to help meet the client with whatever technological barriers they have, within reason, of course. But if I need to do a session over a cell phone, that is considered legal and appropriate, and so with a video, of course. And so it's our job as clinicians to make it as accessible as possible. And one of the positive things that has come out of this is the number of rural clients that I've been able to see that otherwise would not have access to high-quality services.

PAMELA HADLEY: Absolutely. Thanks. So we have another question. Were all of the standardized patients adult cases? And is it possible to include pediatric standardized cases?

KEIKO ISHIKAWA: I would love to develop that program. I really do. And maybe we can ask some children's theater actors and actresses to get involved, and because many of us see pediatric patients and they are not necessarily represented well in the standardized patient cases.

And I would also really like to expand to different types of disorders. We just focused on voice this time because that was the most accessible type of cases. But there are many others that we would like to incorporate.

PAMELA HADLEY: And that leads us to our next question. Is it challenging to work with children virtually, to maintain their attention, to keep them focused without being able to physically interact with them?

KEIKO ISHIKAWA: Clarion, I think you have many more experience than I do.

CLARION MENDES: Oh, goodness. So caveat to the audience-- almost all of my clinical work is with adults. So I'm not the best person to answer this question.

I would frame it in a way where, again, it's telepractice is not perfect for everybody. But at the same time, telepractice is a phenomenal opportunity, in my opinion, for the caregivers to be very, very involved in the process. And maybe Dr. Hadley can add a couple of things here, in the sense that when it's remote, a parent or caregiver or some older-- some adult involved in the child's care has to be there during the session.

And so what a great opportunity for education and really empowering the caregiver to help lead the way with the child's progress. Doesn't mean it's easy or simple. I'd love any additional thoughts there, Dr. Hadley.

PAMELA HADLEY: Well, thank you. So in projects that I'm involved with doing parent-implemented interventions, the way in which we're working with young children is that the clinicians are speaking through earbuds to the parents. So the children don't actually hear the coaching. And so it isn't about engaging the children with the screen. It's about using it so that the clinician can see what's happening between the parent-child interaction and coaching that parent.

And so there are many different ways in which we can use telehealth. And I just want to echo also how important the telehealth model is for reaching our rural communities in the states. So we had a lot of opportunity to expand our services this summer. And I think that's one of the most exciting developments in having to have shifted so rapidly to telehealth. It's also opening up these other opportunities.

We have one more comment here. I just wanted to add a compliment. I think that the use of telehealth is an amazing way to interact with clients, because not many people have access to transportation or cannot leave their houses for personal reasons. Wonderful presentation. I've learned so much from this. Thank you.

All right, well, thank you to everyone who joined us today. We have provided some different resources to the labs that were featured today and to our Audiology and Speech Language Pathology Clinic page. The website is there, as well as our email.

I know there are a number of alumni who have joined us. And if you are interested in serving as external supervisors for short-term or for longer-term kinds of placements, please reach out to that email, SHSclinic@illinois.edu. We would love to hear from you. And we'll have somebody contact you.

And I've also provided some resources for just taking a tour of our different faculty, faculty labs. And there is a virtual tour that we prepared for incoming graduate students last year that-- that is a really great way to be able to see our new renovations in the department and the clinic space. And it'll take you through our physical spaces, and also share more information about what's going on in the department.

So thanks so much for joining us. Thank you to the presenters. They were wonderful, wonderful talks. And we hope to be in touch with you again soon.