Capturing Teachable Moments

How one university uses network video to train next-generation speech and language pathologists

• By John Bartolac
• May 01, 2015

When you’re conducting a therapy session, it’s virtually impossible to be fully engaged with the client and be an objective observer of your own interactions at the same time. Yet both modes are essential to honing a student’s clinical skills. That’s why the professors in the Department of Communication Sciences & Disorders at the University of Wisconsin River Falls campus began taping therapy sessions to provide students with immediate, constructive feedback on their performance.

Sarah Smits, associate clinical professor in the Department of Communication Sciences & Disorders, gave an example of how the process works. There was a case where a speech and language pathology graduate student was given the assignment to evaluate a young child with delayed speech development. The network video camera in the therapy room allowed Smits to monitor the session from her office computer. As Smits watched the session unfold she noticed that the child’s mother, who was also in the room, was becoming increasingly upset about the task the student clinician was giving the child to do. The student, being so focused on the child, was completely unaware of the mother’s agitation.

“Immediately after the evaluation I brought the student into my office, cued up the recording of the session, and showed her what I had seen,” Smits said. “The mother’s facial expression said it all. The student instantly understood that she should have spent time at the beginning of the session putting the mother at ease by explaining the testing process and involving her in the task. It was a teachable moment that we might never have had with our old analog system because the VHS tapes were so inconvenient to deal with.”

Making a Good Idea Better

The Community Speech, Language and Hearing Clinic run by the Department of Communication Sciences & Disorders provides an important training ground for undergraduate and graduate students in its speech pathology program. Graduate students work with real clients who come to the practical learning lab with a host of speech and language disorders— from stuttering and aphasia to Asperger’s syndrome.

Supervising professors watch each student-led therapy session either from an observation room with one-way glass or remotely over the network from their office elsewhere in the building. In addition, video cameras in the therapy rooms stream the sessions over the network so that they can be viewed remotely in real time on more than one professor’s desktop and simultaneously archived for later review and evaluation of students’ clinical skills.

When the department introduced analog VCRbased cameras into the clinical curriculum years ago, it was considered quite an advanced teaching tool. But because it was so cumbersome to operate, it wasn’t being used to its fullest potential. As it aged, breakdowns become more frequent. And because the system was too complex for instructors to troubleshoot themselves, the equipment would be out of commission for days until a service call could be scheduled.

Even when the system was operational, “recording and reviewing stacks of VHS tapes, finding the exact sessions you wanted to use, queuing them up, and then taking them up to the classroom to show was pretty time consuming,” said Smits. “And even after all that effort you just crossed your fingers that the tapes worked on the classroom VCR.” Consequently, many teaching opportunities were lost.

So, when the system reached its end of life, the department looked for a replacement that was more user-friendly and would provide higher quality audio and video recordings of student-led therapy sessions. They felt that adopting a network video model would make it much easier for students and faculty to review and analyze the sessions on demand. It would also allow faculty to remotely observe students live during client sessions.

Revamping the Clinic Therapy Rooms

The department chose a turnkey solution from PDS, Inc. similar to the system installed in its sister campus in Eau Claire. CompView, an audio-visual systems integrator, installed the intuitive intelligent stream recorder (ISR) software and HDTVquality fixed and PTZ network cameras from Axis Communications to capture therapy sessions at the clinic and stream recordings to the ISR server in the campus data center.

CompView replaced the old standard- definition analog cameras in the four pediatric therapy rooms with HDTV-quality PTZ dome network cameras with two-way audio capability. The cameras were mounted on vertical bars so that clinicians could manually move them up and down from 18 to 48 inches from the floor.

“This was critical for capturing close-ups of children’s faces and their verbalizations whether they were sitting in a chair or playing on the floor with the therapist,” Smits said.

Because adults tend to move around less than children during therapy, the department chose three-megapixel Axis network cameras with two-way audio for the adult therapy rooms. Smits said the department is considering swapping out one or two of those cameras for Axis PTZ models at some point for more observational flexibility.

Given that students and supervisors would be listening closely to affected speech, Smits chose both camera models because their visual clarity was matched by equally exceptional audio quality. The two-way audio allows supervisors to monitor therapy sessions remotely and jump in with a vocal comment as needed.

“It’s amazing how much simpler the network camera system is,” said Erin Shannon, system designer for CompView. “The old analog system needed two full racks of audio/video gear plus countless feet of cabling to support it. And then each TV monitor needed its own associated VCR. The new IP-based system plugs directly into the building’s existing network with a network switch and streams the video to the main server several buildings away.

“Professors just log onto the network from their desktops to turn on the cameras, control the PTZ features, adjust volume levels and retrieve stored video,” Shannon said. “Groups of students can sit in front of large screen high-definition monitors in the computer lab and watch live sessions or pull up recorded sessions from the archives as part of their coursework.”

The Intelligent Stream Recorder software lets clinical students use free text or drop-down menus to classify the type of session being recorded, such as a client with a hearing loss, a stutter or a lisp. Because the video is catalogued using searchable descriptive tags, it also makes it fast and easy for a professor teaching a class about a particular speech or language disorder to search the database for therapy sessions that illustrate that specific disorder or intervention technique.

Making Teachable Moments More Sharable

“Since network video can be cued up with a simple click of the mouse, professors are now incorporating clips in their weekly classes on a regular basis,” Smits said. “They couldn’t have hoped to match that frequency in the past because it was just too cumbersome and time-consuming to find the segments they needed.”

Reviewing VCR tapes twice a semester for student assessments was also problematic, Smits said, because there were no standards for labeling the VCR tapes. With multiple sessions recorded on a single tape there was no quick way to queue to the exact spot you wanted to watch. Since supervisors and instructors carry an average caseload of 10 student/ client pairs a semester, they spent an inordinate amount of time searching for footage, time they would have rather spent evaluating performance. All that changed when the new system was installed. Since video is archived by descriptive, searchable tags, Smits reports that “finding” time has been cut to 15 to 20 minutes per semester.

Students also felt stymied by the old analog technology. Since it took nearly 30 minutes to program the system to record a client session, students typically recorded only two therapy sessions per client per semester. Now, with less than five minutes of programming time, students can set up the new system to automatically record all their sessions for an entire semester. With more frequent opportunities to monitor clinical progress and receive feedback, supervisors are able to offer more timely encouragement and praise for appropriate interactions and suggest different ways of cuing and behavioral management to improve clinical outcomes.

“The new Axis high-definition cameras give students and supervisors the audio and video clarity they need to catch the nuanced interaction between patients and clinicians,” Smits said. “And because it is so easy to use, it delivers an endless supply of teachable moments.”

The department finds the recorded therapy sessions so valuable that they’re contemplating sharing them with receptive parents to teach them how better interact with their children when practicing speech and language skills at home.

This article originally appeared in the May 2015 issue of Security Today.