Article

A pilot study of online assessment of childhood speech disorders

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Abstract

We investigated the feasibility of assessing childhood speech disorders via an Internet-based telehealth system (eREHAB). The equipment provided videoconferencing through a 128 kbit/s Internet link, and enabled the transfer of pre-recorded video and audio data from the participant to the online clinician. Six children (mean age = 5.3 years) with a speech disorder were studied. Assessments of single-word articulation, intelligibility in conversation, and oro-motor structure and function were conducted for each participant, with simultaneous scoring by a face to face and an online clinician. There were high levels of agreement between the two scoring environments for single-word articulation (92%), speech intelligibility (100%) and oro-motor tasks (91%). High levels of inter- and intra-rater agreement were achieved for the online ratings for most measures. The results suggest that an Internet-based assessment protocol has potential for assessing paediatric speech disorders.

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... It is generally accepted that telerehabilitation allows clinical consultation from a distance, improves access to services, and eases a patient's burden. Recent research has supported the use of telerehabilitation across a range of aspects of speech pathology practice, such as the assessment and/or treatment of aphasia [4,5], stuttering [6][7][8][9], motor-speech disorders [10][11][12][13], voice [8,[14][15][16], pediatric communication disorders [17,18], and post-discharge monitoring for head and neck cancer patients [19,20], but as yet published literature supporting the reliability of dysphagia assessment and management via an Internet-based service remains limited [19][20][21][22][23]. ...
... The other SLP served as the FTF-SLP and was located in the room with the patient. The FTF-SLP assessed the patient simultaneously but independently of the T-SLP during the CSE to establish the concurrent validity of the telerehabilitation assessment consistent with prior research [5,11,[17][18][19][20]. This simultaneous assessment methodology (as opposed to comparing separate, sequential, independent assessments by the T-SLP and the FTF clinician), was chosen in this study to control for data error which can be created by patient variability between assessments conducted sequentially [10]. ...
... An ad-hoc 802.11 g wireless network with a throttled bandwidth of 128 kbit/s was used for communications. As per previous research [6,11,12,15,17,20,23,25], this low bandwidth was purposefully chosen as it is the minimum bandwidth currently available across Australia's public health network. The system, as described in detail in the pilot study [23] and illustrated in Fig. 1, included (1) a stand-alone, portable, computer system at the patient end, which was placed on an adjustable mobile platform and configured such that the patient did not need to control any aspect of the technology; (2) a free-field combined echo-cancelling microphone and web conference speaker for general communication between sites; (3) a lapel microphone clipped to the patient's shirt/blouse collar for capturing and recording the patient's voice quality; (4) fixed and freestanding cameras with zoom capacity remotely controlled by the T-SLP for close viewing of the patient/oral cavity (Fig. 2); (5) split-screen displays to allow the patient to see both him/herself and the T-SLP at all times during the assessment session, and (6) custom-built software which enabled capture of high-quality audio and video (640 9 480 pixels) for ''store-and-forward'' recordings of the sessions. ...
Article
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To assess the validity of conducting clinical dysphagia assessments via telerehabilitation, 40 individuals with dysphagia from various etiologies were assessed simultaneously by a face-to-face speech-language pathologist (FTF-SLP) and a telerehabilitation SLP (T-SLP) via an Internet-based videoconferencing telerehabilitation system. Dysphagia status was assessed using a Clinical Swallowing Examination (CSE) protocol, delivered via a specialized telerehabilitation videoconferencing system and involving the use of an assistant at the patient's end of the consultation to facilitate the assessment. Levels of agreement between the FTF-SLP and T-SLP revealed that the majority of parameters reached set levels of clinically acceptable levels of agreement. Specifically, agreement between the T-SLP and FTF-SLP ratings for the oral, oromotor, and laryngeal function tasks revealed levels of exact agreement ranging from 75 to 100% (kappa = 0.36-1.0), while the parameters relating to food and fluid trials ranged in exact agreement from 79 to 100% (kappa = 0.61-1.0). Across the parameters related to aspiration risk and clinical management, exact agreement ranged between 79 and 100% (kappa = 0.49-1.0). The data show that a CSE conducted via telerehabilitation can provide valid and reliable outcomes comparable to clinical decisions made in the FTF environment.
... ASHA endorses telepractice as a valid service delivery model and, most importantly, research demonstrates its effectiveness as a viable and effective method for the assessment and treatment of communication disorders (Carey, O'Brian, Lowe, & Onslow, 2014;Crutchley, Dudley, & Campbell, 2010;Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010;Reese et al., 2013;Waite, Theodoras, Russell, & Cahill, 2010a). For assessment of children, telepractice has proven to be as reliable and valid as the in-person evaluation of language (Waite et al., 2010a), of speech (Waite, Cahill, Theodoras, Russell, & Busuttin, 2006), and of literacy (Waite, Theodoras, Russell, & Cahill, 2010b) for the administration of the Autism Diagnostic Observation Schedule (Reese et al., 2013;Schutte et al., 2015) and for conducting functional behavior analyses of children with autism spectrum disorder (ASD; Davis et al., 2009;Gibson, Pennington, Stenhoff, & Hopper, 2010;Machalicek et al., 2009a;Machalicek et al., 2009b). For example, Waite and colleagues (2006) reported high inter-and intrarater agreement on measures of single-word speech sound production, speech intelligibility, and oral-motor tasks in SLP services delivered through telepractice. ...
... In the area of treatment, telepractice has proven effective for increasing fluent speech in children and adolescents (Carey, O'Brian, Onslow, Packman, & Menzies, 2012;Lewis, Packman, Onslow, Simpson, & Jones, 2008;Sicotte, Lehoux, Fortier-Blanc, & Leblanc, 2003), for treating articulation errors, (Grogan-Johnson et al., 2010;Waite et al., 2006), for delivering auditory-verbal therapy to young children (Constantinescu et al., 2014), and for increasing desirable behaviors in children with ASD (Gibson et al., 2010;Machalicek et al., 2009a;Machalicek et al., 2010). ...
... Nearly one third of all responding districts (27%) expressed school district and or community concerns regarding the validity of telepractice, including 29% of school districts that indicated that they currently had unfilled SLP positions or that recurring vacancies were an ongoing problem. Yet, as we have already noted, empirical evidence supports telepractice for the assessment and treatment of speech and language disorders (Carey et al., 2012;Grogan-Johnson et al., 2010;Waite et al., 2006;Waite et al., 2010a;Waite et al., 2010b). And as we noted previously, parents have also reported positive perceptions of telepractice (Molini-Avejonas et al., 2015;Scheideman-Miller et al., 2002). ...
Article
Little information exists regarding the statewide adoption of telepractice, the delivery of speech-language services at a distance through telecommunications, for addressing the documented shortage of speech-language pathologists (SLPs) in rural communities. A statewide survey of directors of special education revealed that only two school districts out of 87 respondents had adopted telepractice as a means of addressing job vacancies, whereas 79% (n = 69) of the districts had never considered telepractice. A lack of knowledge about telepractice was not the primary barrier to adoption. Instead, concerns about the validity of telepractice, technology-related concerns, and inadequate support staff were noted as barriers to adoption.
... All of the identified studies were method comparison studies, 9,[18][19][20][21] and all investigated the validity of speech and/ or language assessment via telehealth, by comparing telehealth results with face-to-face (FTF) results. A further three studies [18][19][20] investigated the reliability of telehealth assessment, by measuring intra-and inter-rater reliability. ...
... All of the identified studies were method comparison studies, 9,[18][19][20][21] and all investigated the validity of speech and/ or language assessment via telehealth, by comparing telehealth results with face-to-face (FTF) results. A further three studies [18][19][20] investigated the reliability of telehealth assessment, by measuring intra-and inter-rater reliability. One paper included a parent satisfaction survey. ...
... Participants were randomly allocated to a telehealth-led or FTF-led assessment in two studies, 19,20 and the speech pathologist role was also randomly allocated in these studies. The remaining studies did not randomly allocate speech pathologist roles or participants, and all assessments were led by either the telehealth speech pathologist 18,21 or the FTF speech pathologist. 9 Studies also varied according to participants, speech/language assessment tools used and statistical analysis. ...
Article
We reviewed the literature relating to the use of telehealth for paediatric speech and language assessment. Four databases, and relevant reference lists, were searched for articles published between January 2004 and July 2014. A total of 180 articles were identified, of which only five were relevant. All studies assessed efficacy using method comparison techniques; no studies assessed effectiveness. The method comparison studies investigated the validity and/or reliability of speech and language assessment via telehealth, when compared with face-to-face assessment. Studies varied in terms of participant group, assessment tools, statistical analysis and telehealth equipment. The papers reviewed presented some evidence that telehealth can be used to make valid assessments of oromotor function, speech intelligibility and language. Articulation screening via telehealth was found to be valid, but there was conflicting evidence about full articulation assessment. Intra- and inter-rater reliability was good for all speech and language tasks, with the exception of oromotor assessment, which also had reduced reliability when assessed face-to-face. There were discrepancies between the two modalities for individual oromotor tasks, judgement of individual speech sounds, detection of pluralisation, and discriminating between similar sounding words; these have the potential to be clinically important. Evidence regarding satisfaction was extremely limited, with only one study reporting parental satisfaction, and no studies reporting child or clinician satisfaction. Although there is limited evidence to support the validity and reliability of speech and language assessment via telehealth, it is probably not yet sufficient to influence clinical practice or policy development.
... In a series of studies, Waite et al. reported the use of telepractice to assess different aspects of speech (Waite, Cahill, Theodoros, Busuttin, & Russell, 2006), language (Waite, Theodoros, Russell, & Cahill, 2010a) and literacy skills (Waite, Theodoros, Russell, & Cahill, 2010b). Waite et al. (2006) explored the feasibility of assessment of childhood speech disorders through an Internetbased telehealth system. Six children were tested and scored on single-word articulation, intelligibility and oro-motor structure and function, through in-person and telemethods. ...
... Results reflected high levels of agreement between scores obtained through in-person and telemethods of language screening among primary school children in the current study. These results agreed with research conducted in Australia and USA, which have established high levels of agreement between in-person and telemethods for speech-language assessments (Fairweather, Lincoln & Ramsden, 2016;Fairweather, Parkin, & Rozsa, 2004;Waite et al., 2006Waite et al., , 2010a. These results suggested that testing through the telemethod was conducive in local school environments with mobile hotspot/plugin dongles, which provided adequate bandwidth connectivity. ...
... These, in turn, led to increased or prolonged time for screening or resulted in the child losing interest and not cooperating for testing. These observations were similar to the challenges recorded by Waite et al. while assessing language among children, using telepractice (Waite et al., 2006(Waite et al., , 2010a. The role of the facilitator was particularly crucial in such times to ensure that the children were re-engaged in the process to complete testing. ...
Article
Purpose: This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India. Method: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory. Result: Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks. Conclusion: Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.
... As for the efficiency and satisfaction with the use of this type of practice, studies are scarce [44] and some are pilot studies [45,46]. Despite the scarcity of evidence, there are a few studies that show positive results in relation to this type of practice focused on both the patient and the caregivers [44,45,[47][48][49][50][51][52][53], and it appears to be a very promising method in the case of children with difficulties in speaking and language [53]. ...
... As for the efficiency and satisfaction with the use of this type of practice, studies are scarce [44] and some are pilot studies [45,46]. Despite the scarcity of evidence, there are a few studies that show positive results in relation to this type of practice focused on both the patient and the caregivers [44,45,[47][48][49][50][51][52][53], and it appears to be a very promising method in the case of children with difficulties in speaking and language [53]. ...
Article
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Background: A narrative requires the integration and management of linguistic and cognitive skills. It has been observed that children with Developmental Language Disorder (DLD) have difficulties in narrating stories. This research proposes an intervention in a case of a child 9 years and 2 months old with DLD, with the aim of improving his oral narrative skills through a retelling task via telepractice. Methods: In the evaluation, standardized tests have been used and a 'remembering a story' task, with a story titled The Lost Backpack, elaborated by one of the authors. Narratives were elicited in two sessions, and were transcribed, coded, and analysed using the Child Language Data Exchange System CHILDES Project tool. The participant received a total of 10 sessions through the Skype platform, which included intervention-addressed explicit instruction about the narrative structure and the use of discourse markers to improve cohesion in story retelling. Results: Significant changes were observed in the retelling of the story at microstructure and macrostructure levels: an increase of the Mean Length of Utterance (MLU), Types and Tokens, specific vocabulary, discourse markers and the recall of events. Conclusions: These results demonstrate the effectiveness of intervention in narrative skills through the oral retelling of a story with visual support via tele-practice.
... The results were obtained through pre-and postremote intervention assessments, questionnaires about user satisfaction and remote monitoring. 61 Three papers 68,69,71 analysed the effectiveness of speech assessment via telehealth; all of the items accessed via telehealth were considered viable and reliable by users and professionals. Three other studies 64,76,79 addressed the effectiveness of technologies for remote speech disorder assessment and telemonitoring. ...
... All of the studies reported user satisfaction with the results of the remote procedures. Sixteen studies 10,[61][62][63][64][65][67][68][69][70][71][72]73,75,78,79 reported therapist satisfaction with the results of assessments administered before and after the remote and FTF interventions. Finally, four other studies [74][75][76][77] included data regarding user evaluation and satisfaction with the use of telehealth resources related to treatment. ...
Article
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Introduction: We conducted a systematic literature review to investigate the domain of speech-language and hearing sciences (SLHS) in telehealth. Methods: The databases used for the literature search were Web of Knowledge, Pubmed, Scopus, Embase and Scielo. The inclusion criteria consisted of papers published up to August 2014. Papers without peer-review evaluation, and those without abstracts or available full texts were excluded. Results: A total of 103 papers were selected. The selected studies have focused primarily on hearing (32.1%), followed by speech (19.4%), language (16.5%), voice (8.7%), swallowing (5.8%), multiple areas (13.6%) and others (3.9%). The majority of the studies focused on assessment (36.9%) or intervention (36.9%). The use of telehealth in SLHS has been increasing in many countries, especially in the last 5 years. The country with the largest number of published studies was the United States of America (32.03%), followed by Australia (29.12%). The remaining studies were distributed in lower numbers among other countries. Discussion: The advancement of information and communication technologies provides more favourable conditions for providing distance care in several areas. Most of studies concluded that the telehealth procedure had advantages over the non-telehealth alternative approach (85.5%); however, 13.6% reported that it was unclear whether the telehealth procedure had advantages. Some barriers still need to be overcome, such as technology, training, regulation, acceptance and recognition of the benefits of this practice by the public and professionals. The need for speech-language pathologists and audiologists to adapt to this new health care modality is evident.
... The feasibility and validity of conducting diagnostic evaluations of speech and language disorders using telepractice were examined in three studies. Waite, Cahill, Theodoros, Russell, and Busuttin (2006) evaluated 6 children with speech disorders. Clinicians in both face-to-face and remote locations scored the same test protocols. ...
... Challenges include distance, inclement weather, hard-to-access communities, and shortages of trained pediatric providers ( . Two studies, one in the United States (Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010) and one in Australia ( Waite et al., 2006), reported on comparative studies between face-to-face therapy and telepractice for school-age children. ...
Article
Recent advances in videoconferencing technology have resulted in a substantial increase in the use of live videoconferencing-referred to here as telepractice-to diagnose and treat speech, language, and hearing disorders. There is growing support from professional organizations for use of this service delivery model, as videoconferencing technology can alleviate the effects of distance on access to care. As telepractice becomes a standard mode of conducting diagnostic and treatment services in speech, language, and hearing disorders, it is essential to assure that research supports its application in the field. Search criteria were established to identify publications, primarily in peer-reviewed journals, from 1995 to 2011. These studies generally validate the delivery of diagnostic and therapeutic services through telepractice when compared to traditional services delivered in a face-to-face clinical setting. Most studies examined adults and school-age children. The search was then expanded to identify diagnostic and treatment services for infants, toddlers, and young children. The existing literature compels professionals to conduct more research related specifically to the effectiveness and efficacy of telepractice.
... The feasibility and validity of conducting diagnostic evaluations of speech and language disorders using telepractice were examined in three studies. Waite, Cahill, Theodoros, Russell, and Busuttin (2006) evaluated 6 children with speech disorders. Clinicians in both face-to-face and remote locations scored the same test protocols. ...
... Challenges include distance, inclement weather, hard-to-access communities, and shortages of trained pediatric providers ( . Two studies, one in the United States (Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010) and one in Australia ( Waite et al., 2006), reported on comparative studies between face-to-face therapy and telepractice for school-age children. ...
Article
Telepractice is emerging as a viable alternative to traditional ‘‘face-to-face’’ service as practitioners seek to meet the diverse needs of children who are deaf or hard of hearing and their families. Telepractice provides the opportunity for many countries to expand their reach and viability within their own borders as well as the possibility of delivering some services internationally. The potential benefits of moving to telepractice models of service delivery are significant, but successful implementation requires that consideration be given to potential barriers. As one of the international ‘‘early adopters’’ of telepractice, the experiences of service providers in Australia offer insight into the factors that influence the development of telepractice services as well as some of the potential barriers to implementation.
... Several studies of speech sound/articulation abilities and oromotor function in children ages 4-9 years have been carried out and suggest that agreement between scoring in-person and telepractice recordings of speech ranges from fair to good (Eriks-Brophy et al., 2008;Waite et al., 2006Waite et al., , 2012. For detailed assessment at the phoneme level, very high-quality recordings may be needed, yet remote data collection still holds promise for speech-language assessment. ...
... Researchers and clinicians should be mindful that further validation of this measure is needed. Importantly, previous studies have shown that speech measures may be more difficult to assess using remote methods than language measures (Eriks-Brophy et al., 2008;Waite et al., 2006). A trend toward lower child speech intelligibility as calculated here was observed in the withinsubjects analysis. ...
Article
Full-text available
Purpose There has been increased interest in using telepractice for involving more diverse children in research and clinical services, as well as when in-person assessment is challenging, such as during COVID-19. Little is known, however, about the feasibility, reliability, and validity of language samples when conducted via telepractice. Method Child language samples from parent–child play were recorded either in person in the laboratory or via video chat at home, using parents' preferred commercially available software on their own device. Samples were transcribed and analyzed using Systematic Analysis of Language Transcripts software. Analyses compared measures between-subjects for 46 dyads who completed video chat language samples versus 16 who completed in-person samples; within-subjects analyses were conducted for a subset of 13 dyads who completed both types. Groups did not differ significantly on child age, sex, or socioeconomic status. Results The number of usable samples and percent of utterances with intelligible audio signal did not differ significantly for in-person versus video chat language samples. Child speech and language characteristics (including mean length of utterance, type–token ratio, number of different words, grammatical errors/omissions, and child speech intelligibility) did not differ significantly between in-person and video chat methods. This was the case for between-group analyses and within-child comparisons. Furthermore, transcription reliability (conducted on a subset of samples) was high and did not differ between in-person and video chat methods. Conclusions This study demonstrates that child language samples collected via video chat are largely comparable to in-person samples in terms of key speech and language measures. Best practices for maximizing data quality for using video chat language samples are provided.
... Video conferencing assessments produce equivalent results to face-to-face assessments in several speech and language areas, including paediatric speech-sound disorders (Eriks-Brophy et al. 2008, Waite et al. 2012. Despite the promising results from speech-pathology assessment of speech-sound disorders using video conferencing, poor inter-rater reliability has been shown between faceto-face and telehealth assessments for the identification of the presence or absence of voicing, accuracy of fricative phoneme perception, identification of phonemes without visible articulation (e.g., /tʃ/ and /l/) (Eriks-Brophy et al. 2008, Waite et al. 2006, and perception of abnormal nasal resonance in speech (Hill et al. 2006). ...
... Thomas et al. 2014). Based on previous research indicating difficulty perceiving high frequency sounds, clusters, and phonemes without visible articulation (Eriks-Brophy et al. 2008, Waite et al. 2006 we would not have been surprised to find poor reliability for the control items (/s/, /l/ clusters, /s/ clusters, and /r/), however the average intra-and inter-rater reliability for the control items was acceptable at 93.5% and 81.5% respectively. ...
Article
Background: Rapid Syllable Transitions (ReST) treatment uses pseudo-word targets with varying lexical stress to target simultaneously articulation, prosodic accuracy and coarticulatory transitions in childhood apraxia of speech (CAS). The treatment is efficacious for the acquisition of imitated pseudo-words, and generalization of skill to untreated pseudo-words and real words. Despite the growing popularity of telehealth as a method of service delivery, there is no research into the efficacy of telehealth treatments for CAS. Telehealth service delivery is associated with compromised audio and visual signal transmission that may affect the efficacy of treatment. Aims: To conduct a phase 1 efficacy study of telehealth delivery of ReST treatment for CAS, and to discuss the efficacy with reference to face-to-face ReST treatment. Methods & procedures: Using a multiple baseline across participants design, five children aged 5-11 years with CAS received ReST treatment four times a week for 3 weeks via video conferencing with Adobe Connect. The children's ability to imitate new pseudo-words, generalize the skills to untreated pseudo-words and real word items, and maintain the skills following treatment were assessed. Both visual and statistical analyses were utilized. Outcomes & results: All five children significantly improved with their production of the imitated treated pseudo-word items and significantly generalized to similar untreated pseudo-words and real words. Additionally, two of the children showed significant generalization to imitated phrases with the treatment items. Four of the children maintained their treatment gains up to 4 months post-treatment. Telehealth delivery produced similar acquisition of pseudo-words and generalization to untreated behaviours as face-to-face delivery; however, in the 4 months following treatment, the children showed stable rather than improving speech skills. The intra- and inter-judge reliability was similar in telehealth delivery for face-to-face delivery. Caregivers and clinicians were satisfied with the telehealth treatment. Conclusions & implications: This phase 1 study provides promising indications of the efficacy of ReST treatment when delivered four times per week via telehealth, and warrants further large-scale investigation.
... The USyd focus was on telehealth for evidence-based stuttering interventions for children [19][20][21], adolescents [22,23], and adults [24,25]. They reflected technology developments from telephone to the internet, beginning with phase 1 trials to demonstrate viability [19,21,22,24], then progressing to RCT [21,26]. Telehealth was found to be at least as effective as therapy delivered face-to-face, with both parent and client satisfaction reported [19][20][21][22][23]. ...
... The UQ studies addressed speech pathology assessment and treatment of a variety of disorders across child [26][27][28] and adult client groups using telerehabilitation: a computer with videoconferencing capability, and software designed for purpose, allowing real-time data capture, store and forward. Remote communication was simulated in most studies using dial-up or wireless internet to deliver low bandwidth videoconferencing to connect clinicians and clients located in the same building, argued to reflect the technology most available to rural and remote communities [37,41]. ...
Article
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Background Uptake of e-health, the use of information communication technologies (ICT) for health service delivery, in allied health appears to be lagging behind other health care areas, despite offering the potential to address problems with service access by rural and remote Australians. The aim of the study was to conduct a scoping review of studies into the application of or attitudes towards ehealth amongst allied health professionals conducted in Australia. Methods Studies meeting inclusion criteria published from January 2004 to June 2015 were reviewed. Professions included were audiology, dietetics, exercise physiology, occupational therapy, physiotherapy, podiatry, social work, and speech pathology. Terms for these professions and forms of ehealth were combined in databases of CINAHL (EBSCO), Cochrane Library, PsycINFO (1806 – Ovid), MEDLINE (Ovid) and AMED (Ovid). Results Forty-four studies meeting inclusion criteria were summarised. They were either trials of aspects of ehealth service delivery, or clinician and/or client use of and attitudes towards ehealth. Trials of ehealth were largely from two research groups located at the Universities of Sydney and Queensland; most involved speech pathology and physiotherapy. Assessments through ehealth and intervention outcomes through ehealth were comparable with face-to-face delivery. Clinicians used ICT mostly for managing their work and for professional development, but were reticent about its use in service delivery, which contrasted with the more positive attitudes and experiences of clients. Conclusion The potential of ehealth to address allied health needs of Australians living in rural and remote Australia appears unrealised. Clinicians may need to embrace ehealth as a means to radicalise practice, rather than replicate existing practices through a different mode of delivery.
... Two earlier telehealth studies of childhood speech sound and language disorders also showed promising results. A pilot study comparing the assessment of children with speech sound disorders side-by-side vs. videoconferencing resulted in high levels of agreement in scoring for single word articulation, speech intelligibility, and oral motor tasks between the online and the side-byside SLPs (Waite, Cahill, Theodoros, Busuttin, & Russell, 2006). Waite, Theodoros, Russell, and Cahill (2010) recently conducted an online assessment of children ages 5 years -9 years with suspected language impairment using a multimedia presentation of the four core subtests of the Clinical Evaluation of Language Fundamentals-4th edition (CELF-4) (Semel, Wiig, & Secord, 2004). ...
Article
Full-text available
This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth), or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002). Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP) goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting.
... Overall satisfaction was high with the majority of therapists and parents indicating that they were either 'satisfied' or 'very satisfied' with the service. Other factors shown to enhance user satisfaction with real-time remote online delivery are the clinician's interpersonal skills in maintaining a warm and empathetic approach when delivering sessions (Waite et al., 2006;Constantinescu et al., 2010). ...
Article
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The purpose of this systematic review was to examine whether online or computer-based technologies were effective in assisting the development of speech and language skills in children with hearing loss. Relevant studies of children with hearing loss were analysed with reference to (1) therapy outcomes, (2) factors affecting outcomes, and (3) publication and methodological quality. The study quality was assessed using the 11-point PEDro scale. The review identified ten studies of relevance to the question of interest. All studies had relatively low PEDro quality scores with only four studies scoring in the mid-range on the scale. For these four studies, computer-based training appeared favourable at the group level. However, the small number of studies found significantly limits the generalizations and indicates the usage of these technologies in this population as an area requiring further rigorous research.
... It allows for consistent and controlled presentation of stimuli, precise delivery of auditory information, and greater accuracy in performance measurement [Veale 1999]. Waite et al. [2006] investigated the feasibility of remote assessment of childhood SSDs by SLPs and compared it with face-to-face interaction. They found a high level of agreement between the two methods (singleword articulation: 92%; speech intelligibility: 100%; and oromotor tasks: 91%). ...
Article
We present a multitier system for the remote administration of speech therapy to children with apraxia of speech. The system uses a client-server architecture model and facilitates task-oriented remote therapeutic training in both in-home and clinical settings. The system allows a speech language pathologist (SLP) to remotely assign speech production exercises to each child through a web interface and the child to practice these exercises in the form of a game on a mobile device. The mobile app records the child's utterances and streams them to a back-end server for automated scoring by a speech-analysis engine. The SLP can then review the individual recordings and the automated scores through a web interface, provide feedback to the child, and adapt the training program as needed. We have validated the system through a pilot study with children diagnosed with apraxia of speech, their parents, and SLPs. Here, we describe the overall client-server architecture, middleware tools used to build the system, speech-analysis tools for automatic scoring of utterances, and present results from a clinical study. Our results support the feasibility of the system as a complement to traditional face-to-face therapy through the use of mobile tools and automated speech analysis algorithms.
... Very little research has been conducted on assessment utilizing a telepractice service delivery model. Crutchley, Dudley, and Campbell (2010) and Waite, Cahill, Theodoros, Busuttin, and Russell (2006) determined that it is feasible to deliver the Goldman-Fristoe Test of Articulation-2 (Goldman & Fristoe, 2000) by telepractice. Waite, Theodoros, Russell, and Cahill (2010) found no significant difference between the subtest scores of the Clinical Evaluation of Language Fundamentals-4th Edition (CELF-4; Semel, Wiig, & Secord, 2003) given by telepractice and those of the CELF-4 given in person. ...
Article
After being engaged in school-based telepractice programs for several years, the authors have learned many valuable lessons. Within the framework of an overview of how to implement a successful school-based telepractice program, the authors share many of those lessons. This article provides the basic foundation for what to consider and how to get started before implementing a telepractice program.
... Studies have shown that children with SSD/CAS have higher levels of engagement and reduced error response with computer-based intervention as compared to traditional therapy [16]. Waite et al. [29] investigated the feasibility of remote assessment of childhood SSDs by therapists and compared it with face-to-face interaction. They found a high level of agreement between the two methods (singleword articulation: 92%; speech intelligibility: 100%; and oromotor tasks: 91%). ...
Conference Paper
We present a multi-tier system for the remote administration of speech therapy to children with apraxia of speech. The system uses a client-server architecture model and facilitates task-oriented remote therapeutic training in both in-home and clinical settings. Namely, the system allows a speech therapist to remotely assign speech production exercises to each child through a web interface, and the child to practice these exercises on a mobile device. The mobile app records the child's utterances and streams them to a back-end server for automated scoring by a speech-analysis engine. The therapist can then review the individual recordings and the automated scores through a web interface, provide feedback to the child, and adapt the training program as needed. We validated the system through a pilot study with children diagnosed with apraxia of speech, and their parents and speech therapists. Here we describe the overall client-server architecture, middleware tools used to build the system, the speech-analysis tools for automatic scoring of recorded utterances, and results from the pilot study. Our results support the feasibility of the system as a complement to traditional face-to-face therapy through the use of mobile tools and automated speech analysis algorithms.
... Johnson & Pietranton, 2006 ). Des résultats suggèrent que la prestation de certains services d'orthophonie par télésanté donne des résultats équivalents à une rencontre face-à-face (Waite, 2006; Reynolds, 2009; Packman, 2012). duction de périodes d'évaluation intensives est remontée à près de dix mois. ...
Research
Full-text available
Cette synthèse identifie les données issues de la littérature scientifique et de l’expérience de CSSS du Québec concernant les modalités de prestation des soins favorisant l’accès des enfants âgés de 0 à 5 ans aux services d’orthophonie de première ligne.
... There is a growing body of evidence that paediatric speech-language pathology delivered via telepractice is feasible and highly acceptable to clients and carers (Lincoln, Hines, Fairweather, Ramsden, & Martinovich, 2014;Sicotte, Lehoux, Fortier-Blanc, & Leblanc, 2003;Theodoros, 2008Theodoros, , 2012Valentine, 2014;Waite, Cahill, Theodoros, Busuttin, & Russell, 2006;Waite, Theodoros, Russell, & Cahill, 2010a, 2010b. There is increasing evidence that telepractice is as effective as face-to-face service delivery for both assessment and intervention (Bridgman, 2014;Grogan-Johnson et al., 2013;Waite et al., 2010b). ...
Article
Purpose: To investigate the face validity of a measure of therapeutic alliance for paediatric speech-language pathology and to determine whether a difference exists in therapeutic alliance reported by speech-language pathologists (SLPs) conducting face-to-face sessions, compared with telepractice SLPs or in their ratings of confidence with technology. Method: SLPs conducting telepractice (n = 14) or face-to-face therapy (n = 18) completed an online survey which included the Therapeutic Alliance Scales for Children - Revised (TASC-r) (Therapist Form) to rate clinicians' perceptions of rapport with up to three clients. Participants also reported their overall perception of rapport with each client and their comfort with technology. Result: There was a strong correlation between TASC-r total scores and overall ratings of rapport, providing preliminary evidence of TASC-r face validity. There was no significant difference between TASC-r scores for telepractice and face-to-face therapy (p = 0.961), nor face-to-face and telepractice SLPs' confidence with familiar (p = 0.414) or unfamiliar technology (p = 0.780). Conclusion: The TASC-r may be a promising tool for measuring therapeutic alliance in speech-language pathology. Telepractice does not appear to have a negative effect on rapport between SLPs and paediatric clients. Future research is required to identify how SLPs develop rapport in telepractice.
... Vo vzťahu k online hodnoteniu jazykových a komunikačných schopností detí boli realizované viaceré štúdie. Niektoré sa dotýkajú použiteľnosti online diagnostiky v oblasti výslovnosti, zrozumiteľnosti reči či oromotoriky (Weite et al., 2006), iné štúdie zas sledujú použiteľnosť diagnostických nástrojov hodnotiacich čiastkové jazykové funkcie (Sutherland et al., 2017). Neevidujeme však štúdiu, ktorá by sa venovala problematike naratív a možného vplyvu online testovania na ich produkciu či porozumenie. ...
Article
Full-text available
The study describes the Slovak online version of the MAIN tool, which preserves the idea of non-shared knowledge during the storytelling between the administrator and the child. The study also compares the performance of two groups of children in pre-school age in narrative comprehension. One group of children (N = 24) was examined by the Slovak online version of the MAIN tool in online environment and the other group (N = 24) was examined face-to-face in personal contact. There were no significant differences in narrative comprehension scores between the groups. We did not find the difference between the groups in the answers to questions related to goals, internal state terms, and questions investigating the reasoning about those internal state terms. The online administration of the MAIN tool does not influence the performance of children, so we consider the Slovak online version of the MAIN tool as appropriate for assessment of narrative comprehension in online environment.
... Furthermore, the majority of the studies included in their review dealt with various types of adult populations. Only one study (Waite et al., 2006) was an experimental study with children. Reynolds et al. (2009) also conducted a systematic review of telepractice for speech-language pathology and found that out of a total of 62 studies, 28 articles were sufficiently detailed to be reviewed whereas the remaining studies were nonanalytic studies such as case-reports. ...
Article
Full-text available
The goals of the present study were to (1) examine the effects of the multiple opposition phonological approach on improving phoneme production accuracy in children with severe phonological disorders and (2) explore whether the multiple opposition approach is feasible for the telepractice service delivery model. A multiple-baseline, single-participant design replicated across two children, was implemented. Two male children who resided in rural areas of West Texas in the USA participated. One child was 4 years and 10 months old and the other child was 6 years old. Both of the children were diagnosed with phonological disorders without any sensory, motoric, or intellectual disabilities. The children’s articulation was tested using Goldman–Fristoe Articulation Test-2 and probes were administered across the period of the study. The children received a 30-minute phonological intervention via telepractice twice a week for 12 or 16 weeks. An increasing trend for production accuracy for target sounds was observed during intervention for both children. Maintenance also was observed at 2-week and 2-month follow-ups. Standard scores from a standardized articulation test increased during posttest compared to pretest. The multiple opposition phonological approach can lead to improved speech production accuracy in children with severe phonological disorders. Telepractice may be an effective context for a phonological intervention approach as has been found for other domains of speech and language intervention and a useful service delivery model to underserved children with speech disorders who are unable to access a speech pathologist due to various circumstances.
... The use of telepractice has the potential to address the need for high-quality services to all populations in the United States, while adhering to the scope of practice of speech-language pathology. Research on the efficacy of telepractice has demonstrated positive results including the assessment and treatment of articulation disorders (Waite, Cahill, Theodoros, Busuttin, & Russell, 2006), autism (Parmanto, Pulantara, Schutte, Saptono, & McCue, 2013), language disorders (Waite, Theodoros, Russell, & Cahill, 2010), and dysphagia (Malandraki, McCullough, He, McWeeny, & Perlman, 2011). However, research specifically related to the needs and experiences of SLPs to service diverse populations via telepractice is virtually nonexistent. ...
Article
Full-text available
Telepractice has the ability to connect speech-language pathologists (SLPs) to clients across geographical boundaries. Technological advances in the United States, including increased Internet access, could lead to potential increases in culturally and linguistically diverse clients for SLPs working via telepractice (telepractitioners). This article will introduce and explore cultural considerations for SLPs treating diverse populations via telepractice. Descriptions of professional resources, considerations, and guidelines related to treatment of diverse clients diagnosed with communication disorders are summarized.
... Some studies investigated the feasibility of remote assessment of childhood speech problems by therapists and compared it with face-toface interaction. They have shown that internet-based tele-rehabilitation sessions can be as effective as clinic-based sessions ( Waite et al., 2006 ;Constantinescu et al., 2010 ). More recently, projects integrate a separate module for automatic assessment and feedback ( Parnandi et al., 2013 ;Turk -Arslan 2004 ;Kirsching 2003 ;Danubianu -Tobolcea 2016 ;Resmi et al., 2011 ) . ...
Article
https://authors.elsevier.com/c/1Y6Ncc7UI18fQ In this paper we present a two-year-long speech training experiment in which we have studied the extent of improvement owing to multimodal visual support as compared to traditional methods. The hypothesis that children having more severe hearing impairment benefit more from visual assistance was also tested. 30 children had extracurricular lessons with the visual support of the Speech Assistant (SA) system providing complex services. The control group (CG) – that was comprised of another 30 children – got the same amount of extracurricular lessons and was improved with traditional methods, without the help of the SA. A subjective test was used to evaluate the speech samples of all children involved in the experiment recorded at the beginning and at the end of the two-year speech improvement period. The results of the two-year improvement clearly demonstrate that the SA helps in acquiring speech production in the examined age-group. The results also suggest that children having more severe hearing impairment benefit more from visual support. From the multimodal visual assistance including the talking head, the bar charts and the display of prosody, children gained valuable information that could be used in improving speech production. It is a question of further investigations to measure how much each of these facilities adds to the children's progress.
... Several studies of speech sound/articulation abilities and oromotor function in children age 4-9 years have been carried out and suggest that agreement between scoring in-person and telepractice recordings of speech ranges from fair to good (Eriks-Brophy et al., 2008;Waite et al., 2006;2012). For detailed assessment at the phoneme level, very high-quality recordings may be needed, yet remote data collection still holds promise. ...
Preprint
Full-text available
Purpose: Whereas telehealth is becoming more common in clinical practice and researchers are working to study more diverse participants, little is known about the feasibility, reliability, and validity of language samples, which are widely-used clinical and research assessments of speech and language, when conducted via telehealth. This analysis compared characteristics of language samples collected in person, face-to-face (FTF) in the lab versus remotely via video chat. Method: Language samples were collected as part of a larger longitudinal study. The study design included toddler-parent dyads who participated in either a mixed visit structure including both in-lab FTF and at-home video chat visits (n=16), or video-chat only visits (n=46). The two visit-type groups did not differ significantly on child age, sex, or socio-economic status. Parent-child play was recorded via video chat using the parent’s preferred commercially available software on their own device. Language samples were then transcribed and analyzed using SALT software.Results: Data quality (as indicated by percent intelligible audio signal) and usability were similar in FTF and video chat language samples. Child speech and language characteristics (including percent utterances with intelligible speech, MLU, TTR, and grammatical errors/omissions) did not differ significantly between FTF and video chat methods; this was the case for between-group analyses and within-child comparisons across timepoints. Further, transcription reliability (conducted on a subset of samples) was high and did not differ between methods. Conclusions: This study demonstrates feasibility of collecting child language samples via video chat for analysis of language measures. Best practices for maximizing data quality are provided. Employing telehealth or remote data collection via video chat may allow underserved and more diverse children and families to participate in clinical and research activities.
... According to the American Speech-Language-Hearing Association (ASHA), telepractice (or telehealth) is defined as "the application of telecommunications technology to the delivery of speech-language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation" (ASHA, n.d.). With the rapid growth in telecommunication technology, telepractice has been utilized in interventions for various communication disorders, including childhood speech and language disorders, as well as fluency, voice, and neurogenetic disorders (Machima & Doarn, 2008;Waite et al., 2006Waite et al., , 2010. Furthermore, telepractice is as effective as on-site service in the field of communication sciences and disorders (Grogan-Johnson et al., 2010;Keck & Doarn, 2014;McCullough, 2001). ...
Article
This study investigated factors prioritized by speech-language pathologists (SLPs) and caregivers for telehealth services involving speech-language assessments and interventions and determined whether the priorities differed between SLPs and caregivers in Korea. The survey data obtained from 23 SLPs and 50 caregivers were analyzed using analytic hierarchical process (AHP) methodology. The results showed that the “SLP” category was the most important high-level category and “building rapport with the child client” in the “SLP” category was of the highest priorities for both SLPs and caregivers across all factors. Furthermore, the rank-order of a few categories and the global priority between SLPs and caregivers varied slightly. These findings suggest that, in addition to important factors associated with SLPs and caregivers, the different expectations of service providers and clients using telepractice in Korea should be addressed.
... Several prior studies have been conducted regarding the assessment of speech and language skills of children via teleconferencing (C. Fairweather, Parkin, & Rozsa, 2004;Jessiman, 2002;Waite, Cahill, Theodoras, Busuttin, & Russell, 2006). Reading disability is the most common form of learning disability and is defined as a developmental language disorder of neurobiological basis characterized by difficulties with reading and spelling (Lyon, Shaywitz, & Shaywitz, 2003;Waite et al., 2010a). ...
Chapter
Speech-Language Pathologists/Therapists have been using a different service delivery model known for almost 40 years as telepractice, so they can meet the growing demand for assessment, intervention, consultancy and also distance learning in their scope of practice. As far as the authors could review the literature highlights a number of benefits for students, teachers, parents and stakeholders, as well as evidence for the delivery of professional services at a distance within the clinical and educational settings. There are few studies regarding the effectiveness of telepractice intervention in this field. To our knowledge, there are no European Portuguese studies. The chapter illustrates up to date international applications of telepractice and distance learning in speech-language therapy services. It has currently increased in order to respond to the world crisis related to COVID-19 in which social self-isolation and personal dislocations are being implemented, forcing this professional to adapt to this new reality.
... Full articulation assessments in children delivered via telehealth compared to face-to-face have shown high levels of agreement, although there are reported difficulties in detecting presence of voicing, high frequency sounds and consonant clusters. 41,42 One challenge telemedicine poses for care of VPD patients is the limited ability to visualize velopharyngeal anatomy for presurgical planning. Studies on remote nasopharyngoscopy have been limited to specialist teleconsultations to provide guidance for general practitioners in rural locations. ...
Article
Full-text available
Objective The COVID-19 pandemic has introduced a period of social isolation that has challenged the ability of providers to uphold in-person patient care. Although commonplace in pediatric otolaryngology, multidisciplinary clinics pose a unique challenge during this time due to increased infection risk from multiple patient-provider interactions. Guidance on the application of telemedicine for multidisciplinary clinics in pediatric otolaryngology is limited. Methods We provide comprehensive guidance on best practices for conducting telemedicine visits for a number of multidisciplinary otolaryngology clinics using our experiences at a single tertiary care children’s hospital. A review of literature to support the adoption of telemedicine in multidisciplinary pediatric otolaryngology is also incorporated. Results Telemedicine was successfully adopted for 7 multidisciplinary pediatric clinics with a variety of specialists: aerodigestive disorders, congenital hearing loss, microtia/aural atresia, orofacial clefting, sleep disorders, tracheostomy care, and velopharyngeal dysfunction. Conclusions Telemedicine is feasible for a variety of multidisciplinary clinics and its optimization is critical for providing care to complex pediatric otolaryngology patients during the COVID-19 pandemic and beyond.
... Studies of teleassessment with older adults have demonstrated consistent performance between video-based and FTF testing modalities, particularly for verbally mediated tasks such as verbal fluency, list learning, and digit span (Cullum & Grosch, 2013). Although teleassessment of children has been less wellstudied, tests of language skills including vocabulary, comprehension, verbal memory, literacy (Eriks-Brophy et al., 2008;Sutherland et al., 2017;Waite et al., 2010), intellectual ability (Hodge et al., 2019), and speech articulation/ intelligibility (Waite et al., 2006(Waite et al., , 2012 have been found to yield similar results when administered by teleassessment compared to FTF. One study of CI users found that speech perception performance was significantly poorer in remote assessment than in soundbooth administration (Hughes et al., 2012), while another study found comparable results across video versus FTF administration modalities (Fletcher et al., 2019). ...
Article
Purpose Youth with cochlear implants (CIs) are at risk for delays in verbal short-term memory (STM)/working memory (WM), which adversely affect language, neurocognitive, and behavioral outcomes. Assessment of verbal STM/WM is critical for identifying and addressing these delays, but standard assessment procedures require face-to-face (FTF) administration. The purpose of this study was to determine the feasibility and validity of remote testing methods (teleassessment) of verbal STM/WM in youth with CIs as a method of addressing COVID-19–related restrictions on FTF test administration. Method Tests of verbal STM/WM for nonwords, digit spans, letter–number sequences, sentences, and stories were individually administered by speech-language pathologists over a teleassessment platform to 28 youth (aged 9–22 years) with CIs and 36 same-aged normal-hearing peers. Examiners, parents, and participants completed quality and satisfaction ratings with the teleassessment procedure. Teleassessment scores were compared to results of tests obtained at FTF visits an average of 1.6 years earlier. Results Quality and satisfaction ratings for teleassessment were high and in almost all cases did not differ between the CI and normal-hearing samples. Youth with CIs scored lower than normal-hearing peers on measures of verbal STM/WM, and scores for digit span and letter–number sequencing did not differbetween teleassessment and FTF methods. Correlations across teleassessment and FTF visits were strong for digit span, letter–number sequencing, and sentence memory, but were more modest for nonword repetition. Conclusion With some caveats, teleassessment of verbal STM/WM was feasible and valid for youth with CIs.
... In contrast, fewer studies have examined the validity and feasibility of conducting assessments online. Previous studies focusing on assessments indicate high rates of agreement between online and in-person evaluation for standardized assessment of neurogenic communication disorders (Palsbo, 2007), nonstandardized evaluation of voice disorders (Ward et al., 2007) and standardized evaluation of speech sound disorders (Waite et al., 2006). There have been fewer studies that have evaluated validity of oral language and literacy assessments for virtual use. ...
Preprint
Full-text available
Objectives Previous virtual care literature within the field of speech-language pathology has focused primarily on validating the virtual use of intervention programs. There are fewer articles addressing the validity of conducting standardized paediatric oral language and literacy assessments virtually. Additionally, there is a lack of practical recommendations available on how best to conduct these assessment measures virtually. Given the rapid rise in virtual care as a result of the COVID-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently. Methods We identified six key themes for recommendations based on two sources (1) our lab meeting discussions and (2) the outcomes of a narrative review of the extant literature. We then conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings to generate recommendations within these themes. Subsequently, in line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-delphi consensus procedure was used to reach agreement on ratings for recommendations. Results We have developed recommendations for the use of standardized language and literacy assessments in virtual care, across six key themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations. Conclusions This paper is one of the first to share practical recommendations for virtual assessment in the domain of paediatric oral language and literacy assessment. We hope these recommendations will facilitate future clinical research and that as the body of research grows, that this paper will act as a basis for the development of formal Clinical Practice Guidelines.
... A growing body of literature has shown that telepractice is an efficient and effective SLP service delivery method (Molini-Avejonas et al., 2015). Telepractice has been used for the assessment of language in neurodegenerative diseases (Adams et al., 2020), intelligibility in dysarthria (Ziegler & Zierdt, 2008), dysphagia from various aetiologies (Ward et al., 2012) and childhood speech disorders (Waite et al., 2006). ...
Article
Background The coronavirus disease2019 (COVID-19) pandemic has led to important challenges in health and education service delivery. Aims The present study aimed to document: (i) changes in the use of telepractice by speech-language pathology (SLP) professionals in Quebec since the start of the COVID-19 outbreak; (ii) perceptions of the feasibility of telepractice by SLPs; (iii) barriers to the use of telepractice; and (iv) the perceptions of SLP professionals regarding the main issues of telepractice. Methods & Procedures An online survey with closed and open, Likert scale and demographic questions was completed by 83 SLPs in Quebec in June and July 2020. Outcomes & Results The survey responses showed that within the cohort responding, telepractice use has increased significantly as a response to the COVID-19 pandemic. Most respondents planned to continue using telepractice after the pandemic ends. In addition, the respondents considered telepractice to be adequate for many clinical practices but less so for others (e.g., swallowing disorders, hearing impairment). Most of the reported barriers to the use of telepractice concerned technological problems and a lack of clinical materials for online use. Confidentiality and privacy issues were also raised. Conclusions & Implications SLP professionals rapidly took advantage of existing technologies in their clinical settings to cope with the pandemic's effects on service delivery. The discrepancy between their perceptions and the evidence in the literature for some practices and populations strengthens the need for more information and education on telepractice. What this paper adds What is already known on the subject • The proportion of speech-language pathologists (SLPs) in Canada who use telepractice for clinical activities is unknown. Knowing this information became crucial in the context of the coronavirus disease 2019 (COVID-19) pandemic because non-essential activities were interrupted to halt the spread of the disease. What this paper adds to existing knowledge • The findings from this survey study confirmed that the use of telepractice in SLP in Quebec increased significantly during the COVID-19 pandemic. Moreover, the majority of the respondents began using telepractice because of the pandemic, and most planned to continue doing so after it ends. This demonstrates how SLP professionals rapidly took advantage of existing technologies in their clinical settings to cope with the pandemic's effects on service delivery. What are the potential or actual clinical implications of this work? • Although the SLPs expressed an overall positive perception of telepractice, they also highlighted barriers to its optimal use. The findings of this study should help employers and regulatory bodies in Quebec to bring down those barriers and make telepractice in SLP a durable, effective and efficient service delivery model.
Article
This exploratory study evaluated the effectiveness of Apple (Cupertino, CA) iPad(®) (second generation) to deliver telepractice speech and/or language services. Five children and their parents/guardians, as well as four adult participants, received services for communication disorders in a university clinic setting over two academic semesters. The children met some of their speech goals and all of their language goals. All adult clients met some of their communication goals. Personal opinions about telepractice did not change statistically before and after therapy. The major problem identified during the study was skipping and/or freezing of images on the iPads during interactions with FaceTime(®) (Apple). Further studies are needed to investigate the feasibility of using Apple iPads in telepractice.
Article
The American Speech-Language-Hearing Association (ASHA) supports the use of telespeech (also called telepractice) to expand access to speech-language pathology and audiology services; however, widespread acceptance has been influenced by the reluctance of payers to reimburse this method of service delivery. At the present time, schools are leading the way in implementing telespeech, while adoption in health-care settings lags behind. This article provides a brief background about ASHA's activities with regard to telepractice and discusses the status of reimbursement for telespeech in various settings, including schools, private insurance, Medicare, and Medicaid.
Article
This paper describes new improvements carried out in an integrated tool that was previously developed for the diagnosis of voice disorders. Such tool was developed for the analysis and screening of pathological voices, so the experts can store a complete history and anamnesis of the patient to track his/her evolution by simultaneous recording of speech, electroglottographic (EGG), and videoendoscopic signals. The multimodal explorations are stored on a relational database, together with the patient's personal information, anamnesis, diagnosis, visits, explorations and any other comment that the specialist may wish to include. The application was initially developed to be used as a desktop tool, so it was necessary to add new functionalities that would let the experts interact among them sharing the information recorded trough the Internet. In this sense, the application has been migrated to be compliant with the client/server paradigm paying special attention to the encryption of the data stored and exchanged. The improvements presented let speech therapists, phoniatricians and ENT professionals interact in a collaborative way, reducing the number of explorations suffered by the patient, improving the assistance process, and therefore reducing significantly the costs associated as well as the time dedicated to each patient. The paper highlights the security problems that appear in the aforementioned scenario and provides solutions that let the experts interact among them ciphering the data stored as well as the communications in a transparent way. The solution presented has been integrated in the available tool, and its performance has been evaluated in a real context under the new premises. Results suggest that, despite the huge amount of data exchanged, in those communication environments with a nominal speed over 100Mbit/s is possible to ensure a real time interaction among specialists keeping the confidentiality.
Article
A new era in speech-language pathology practice is pending, and one that impels us to innovate and diversify as we move forward into the 21(st) century. The impetus for this transformation will include the increasing cost and demand for healthcare services as the population ages, changes in Australian society, rapid developments in technology, and major advances in neuroscience. New models of service delivery will need to be considered in line with evidence-based treatment protocols, the concept of a continuum of care for chronic disorders, and the need to engage clients in self-management. Innovations in technology will provide the means by which these new models of service delivery might be achieved. The exponential increase in electronic therapy resources and devices will transform the therapeutic process and provide clinicians with engaging and flexible therapy options. Clinicians will be challenged by this paradigm shift in service delivery, and their long-held perceptions of their clients' capacity to respond to these changes. Other challenges will include the preparation of future speech-language pathologists, reimbursement for services, availability of appropriate technology, and widespread connectivity. The future of the profession is an exciting one as we move forward into an era of unprecedented change.
Article
To gain insight into factors which may influence future acceptance of dysphagia management via telerehabilitation, patients' perceptions were examined before and after a telerehabilitation assessment session. Forty adult patients with dysphagia (M =66 years, SD =16.25) completed pre- and post-session questionnaires which consisted of 14 matched questions worded to suit pre- and post-conditions. Questions explored comfort with the use of telerehabilitation, satisfaction with audio and video quality, benefits of telerehabilitation assessments and patients' preferred assessment modality. Questions were rated on a 5-point scale (1 = strongly disagree, 3 = unsure, 5 = strongly agree). Patients' comfort with assessment via telerehabilitation was high in over 80% of the group both pre- and post-assessment. Pre-assessment, patients were unsure what to expect with the auditory and visual aspects of the videoconference, however there were significant positive changes reported post-experience. In relation to perceived benefits of telerehabilitation services in general, most patients believed in the value of telerehabilitation and post-assessment this increased to 90-100% agreement. Although 92% felt they would be comfortable receiving services via telerehabilitation, 45% of patients indicated ultimate preference for a traditional face-to-face assessment. The data highlight that patients are interested in and willing to receive services via telerehabilitation; however, any concerns should be addressed pre-assessment.
Article
Background: Large-scale multi-site experimental and clinical speech protocols require high-fidelity, easy-to-use speech recording technologies. However, little is known about the reliability and comparability of affordable, portable and commonly used technologies with traditional well-validated devices (e.g., a hard disc recorder with a high-quality microphone). Objective: To examine the comparability of speech and voice samples acquired from protocols involving high- and low-quality devices. Methods: Speech samples were acquired simultaneously from 15 healthy adults using four devices and analyzed acoustically for measures of timing and voice quality. For the purpose of making initial comparisons, methods were deemed comparable if the resultant acoustic data yielded root mean squared error values ≤10% and statistically significant Spearman's correlation coefficients. Results: The data suggest that there is significant and widespread variability in the quality and reliability between different acquisition methods for voice and speech recording. Not one method provided statistically similar data to the protocol using the benchmark device (i.e., a high-quality recorder coupled with a condenser microphone). Acoustic analysis cannot be assumed to be comparable if different recording methods are used to record speech. Conclusions: Findings have implications for researchers and clinicians hoping to make comparisons between labs or, where lower-quality devices are suggested, to offer equal fidelity.
Article
We examined the validity and reliability of an Internet-based telehealth system for screening speech intelligibility and oro-motor structure, and function in children with speech disorders. Twenty children aged 4-9 years were assessed by a clinician in the conventional, face-to-face (FTF) manner; simultaneously, they were assessed by a second clinician via the videoconferencing system using a 128-kbit/s Internet connection. Speech intelligibility in conversation was rated and an informal assessment of oro-motor structure and function was conducted. There was a high level of agreement between the online and FTF speech intelligibility ratings, with 70% exact agreement and 100% close agreement (within ± point on a 5-point scale). The weighted kappa statistic revealed very good agreement between raters (kappa = 0.86). Data for online and FTF ratings of oro-motor function revealed overall exact agreement of 73%, close agreement of 96%, moderate or good strength of agreement for six variables (kappa = 0.48-0.74), and poor to fair agreement for six variables (kappa = 0.12-0.36). Intra- and inter-rater reliability measures (ICCs) were similar between the online and FTF assessments. Low levels of agreement for some oro-motor variables highlighted the subjectivity of this assessment. However, the overall results support the validity and reliability of Internet-based screening of speech intelligibility and oro-motor function in children with speech disorders.
Article
Background: Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS. Aim: To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years. Methods & procedure: A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out. Outcome & results: A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment. Conclusions & implications: The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS. What this paper adds: What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.
Article
This article provides a review of the evidence base for telepractice in speech-language pathology, the challenges that exist, and the future directions for this field. It describes the benefits of telepractice for clients and their families and outlines the evidence currently available to support the validity and reliability of this mode of delivery in the management of adult neurogenic communication disorders (aphasia, dysarthria, apraxia of speech); voice disorders; stuttering; dysphagia; laryngectomy; and articulation, language, and literacy disorders in children. The challenges facing telepractice in speech-language pathology and the future directions for this field are discussed. Telepractice is an emerging area of service delivery in speech-language pathology that is likely to become an integral part of mainstream practice in the future. In order to achieve this, it is imperative that the profession accelerates its program of research and clinical endeavor in this area.
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The purpose of this article is to describe the characteristics and effectiveness of a telepractice speech-language therapy program for school-age children. Outcome data related to the caseload, type and amount of intervention, and student progress from a school-based telepractice therapy program were compared with the K-12 Schools National Outcomes Measurement System (NOMS) of the American Speech-Language-Hearing Association. NOMS provides data for students receiving intervention through direct, in-person service delivery models. The findings suggest many similarities between the characteristics of the telepractice and direct, in-person service delivery models. The telepractice service delivery model was effective for most students included in the study. Results of this study support the described telepractice service delivery model as a viable option for speech-language therapy services delivered to public school students with communication impairments. Limitations of this study are discussed with guidance provided for future research studies exploring the efficacy of speech-language therapy delivered via telepractice.
Article
Telepractice is the use of telecommunications technology to deliver speech therapy and audiology services to a client who is in a different physical location than the practitioner. This article presents a general overview of telepractice, including terminology and definitions; ethical considerations; privacy and security; reimbursement policy and trends; considerations for client selection; and telepractice resources. It was written to provide foundational information about telepractice for practitioners who are engaged with alternative and augmentative communication (AAC).
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For more than 30 years, speech therapy telepractice has been recognized as an effective substitute when no therapist was available. This chapter describes a speech therapy telepractice model that can provide treatment better than traditional methods and is not restricted to patients living in areas without qualified professionals. Using web-hosted applications, telepractice can be provided securely and effectively on virtually any computer, smart phone, or tablet at low cost to the therapist and no cost to the patient. This chapter provides the information necessary to develop an effective speech telepractice program, including low-cost/no-cost telepractice video connections and digital treatment materials and use of Web 2.0 approaches to enhance treatment and competencies required for effective speech therapy telepractice.
Article
Purpose: The objectives of this study were to investigate the efficacy of a speech-language pathology teletherapy program for children attending schools and early childcare settings in rural New South Wales, Australia, and their parents' views on the program's feasibility and acceptability. Method: Nineteen children received speech-language pathology sessions delivered via Adobe Connect®, Facetime(©) or Skype(©) web-conferencing software. During semi-structured interviews, parents (n = 5) described factors that promoted or threatened the program's feasibility and acceptability. Result: Participation in a speech-language pathology teletherapy program using low-bandwidth videoconferencing improved the speech and language skills of children in both early childhood settings and primary school. Emergent themes related to (a) practicality and convenience, (b) learning, (c) difficulties and (d) communication. Conclusion: Treatment outcome data and parental reports verified that the teletherapy service delivery was feasible and acceptable. However, it was also evident that regular discussion and communication between the various stakeholders involved in teletherapy programs may promote increased parental engagement and acceptability.
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Speech-language pathology services are eminently suited to delivery via telerehabilitation owing to the audio–visual nature of the interaction between the clinician and the client. An increasing need for alternate modes of service delivery in this profession is evident because of the growing demand and cost of health care, a changing society, and rapid developments in technology. Equitable access to services, improvement in quality of care, ongoing intervention, and the promotion of self-management are several benefits to be derived from telerehabilitation. The evidence base supporting the use of telerehabilitation in speech-language pathology continues to grow, with research conducted in neurogenic communication disorders, stuttering, voice disorders, dysphagia, laryngectomy, and pediatric speech, language, and literacy disorders. A variety of technologies are now available to support a continuum of care for people with chronic communication and swallowing disorders. The future of telerehabilitation in speech-language pathology is promising, although several challenges such as clinician confidence, education and training, professional portability, reimbursement, and economic evaluation need to be addressed.
Article
Purpose: COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology. Method: A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey. Results: All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment. Conclusions: This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use. Supplemental material: https://doi.org/10.23641/asha.19593367.
Article
Background: Many children in rural and remote areas do not have access to professionals providing literacy interventions. However, delivery of services through videoconferencing would increase access and choice for end users. Introduction: This pilot study investigated the efficacy of videoconferencing literacy interventions. As videoconferencing platforms become easier and cheaper to use, this form of telehealth delivery is increasing in popularity. However, there is currently no strong evidence base to support this practice. Materials and Methods: We studied 18 children, aged 7-12 years, with poor reading and/or spelling, and whose literacy interventions were videoconferenced into their homes and/or schools. Children were tested on three reading measures: (1) reading words, (2) reading nonwords, and (3) letter-sound knowledge, twice before their interventions commenced and once after their intervention concluded. Results: Children's raw and standardized scores on 2 of 3 outcome measures increased significantly more during the intervention than in the no-intervention period before their training commenced. Discussion and Conclusions: This study demonstrates that videoconferencing is a promising delivery mode for literacy interventions, and the results justify running a larger, randomized controlled trial.
Article
Purpose Access to speech-language therapy services for children with communication difficulties is limited in vulnerable countries within the Majority world, such as Small Island Developing States. The use of information and communication technology (ICT) has been identified as a possible solution to provide equitable access to services in Minority world countries. This study explored ICT-related conditions in remote schools of the Maldives, a Small Island Developing State, in order to identify potential service delivery approaches. Method A mixed methods approach was used, involving (a) an online survey of 107 teachers, (b) observational data from four schools, (c) interviews with 31 teachers and the four principals of participating schools, and (d) 13 relevant online documents. Content analysis was used to analyze and integrate data from all sources. Results Teachers' access to ICT devices and fixed broadband Internet varied across schools. The government had limited funds to provide adequate fixed broadband Internet for them. However, favorable prospects were also discovered, including high access to 4G mobile broadband Internet in islands, high levels of confidence among teachers to use ICT, a variety of ICT uses currently employed by teachers, and the presence of financial aid for students with special education needs. Conclusions The findings of the study support the potential for using mobile broadband Internet, available ICT devices, and teachers as agents of service delivery in remote schools to enhance speech-language therapy service delivery in the Maldives. The creation of relevant digital educational content for teachers could further support children with communication difficulties in the country. Supplemental Material https://doi.org/10.23641/asha.14143910
Article
School-based speech-language pathologists (SLPs) are implementing telecommunication technologies for service provision. Telepractice is one among an array of service delivery models that can be successfully implemented in the public-school setting. While many school-based SLPs have been plunged into telepractice with the recent pandemic, this temporary shift to emergency instruction is not the same as fully implementing a telepractice service delivery model. SLPs who recognize the potential application of telecommunications would profit from additional training and experience to take advantage of the benefits of this service delivery model. The purpose of this article is to explore the concept of telepractice as a service delivery model, and to answer the who, what, when, where, and why questions of school-based telepractice. Telepractice is one of several service delivery models that school-based SLPs can confidently utilize to provide effective speech and language therapy services to school-age students.
Article
Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children. In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.
Article
Purpose The purpose of this study is to evaluate the effects of switching from in-person assessment to virtual assessment during the COVID-19 pandemic on the growth trajectories of children with hearing loss who are learning spoken language. Method Sixty-eight children with typical hearing, 44 children with cochlear implants, and 47 children with hearing aids were assessed with a norm-referenced measure of receptive vocabulary, a criterion-referenced measure of phonological awareness, and a criterion-referenced measure of conceptual print knowledge at least 4 times, at 6-month intervals, between the ages of 4 and 6 years. Of those participants, 26 children with typical hearing, 13 children with cochlear implants, and 13 children with hearing aids entered virtual testing as a result of the COVID-19 pandemic. The slopes of growth for children who entered virtual testing were compared to their own slopes prepandemic and to the growth slopes of children who completed all testing in-person, prepandemic. Results Within-subject comparisons across all measures did not show a change in growth slopes prepandemic to postpandemic. For the measure of conceptual print knowledge, children who were tested during the pandemic showed slower overall growth than children who were tested prepandemic. No effects of hearing status were found across growth on any measure. Conclusion These preliminary data support the use of virtual assessment to measure growth in receptive vocabulary, phonological awareness, and conceptual print knowledge in children with hearing loss learning spoken language.
Article
Speech-language pathology relies on auditory-perceptual judgment as a central tool for classifying and measuring a variety of disorders of communication. Over the history of the field, a great deal has been written about the use of perceptual judgments for research and clinical practice. Auditory-perceptual methods carry strong advantages of convenience, economy, and robustness, but it is also clear that these judgments are susceptible to a variety of sources of error and bias. Awareness of these threats to validity and reliability is a major step in the effective and refined use of perceptual methods. Several common themes are evident in contemporary research on the perceptual assessment of voice disorders, stuttering, dysarthria, aphasia, and apraxia of speech. These five disorders are taken as primary foci in a discussion that (a) identifies threats to reliability and validity, and (b) offers suggestions for the improvement of auditory-perceptual methods, whether used alone or in combination with instrumental techniques.
Article
Telemedicine is proving valuable in the delivery of health care services. With increased competition in telecommunication markets and lower costs, the possibility of providing affordable teletherapy services for the 21(st) century is now a goal that can be achieved. Recognition that parent training is a vital component of successful treatment programmes makes the use of teletherapy from clinic to home an ideal medium of sharing skills with carers. Commercially available products were selected on the basis of cost effectiveness, user friendliness and audio-visual quality. Parents reported increased knowledge and confidence in developing their child's communication skills and teletherapy was demonstrated to be an effective, reliable and exciting addition to a new era of therapy provision.
Article
Indices of interjudge reliability and inter- and intrajudge agreement were calculated from the ratings made by 15 experienced speech clinicians on five deviant speech dimensions with respect to 15 speakers with ataxic dysarthria. Speakers were chosen to cover a wide range of speech intelligibility (16-97%) as measured by the sentence intelligibility transcriptions of the Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981). Intraclass correlation coefficients derived from each judge on two occasions were above .6 for imprecise consonants, excess and equal stress, and harsh voice, but below .6 for distorted vowels and below .5 for irregular articulatory breakdown. The last dimension also had the lowest percent agreement for the interjudge and intrajudge comparisons. Poor speech dimension definition seems to be the most likely source of error on irregular articulatory breakdown. Judges agreed equally well in rating dysarthric speech across the range from low to high intelligibility.
Article
We have conducted a preliminary validation of an Internet-based telehealth application for assessing motor speech disorders in adults with acquired neurological impairment. The videoconferencing module used NetMeeting software to provide realtime videoconferencing through a 128 kbit/s Internet link, as well as the transfer of store-and-forward video and audio data from the participant to the clinician. Ten participants with dysarthria following acquired brain injury were included in the study. An assessment of the overall severity of the speech disturbance was made for each participant face to face (FTF) and in the online environment; in addition, a 23-item version of the Frenchay Dysarthria Assessment (FDA) (which measures motor speech function) and the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) (which gives the percentage word and sentence intelligibility, words per minute and a rating of communication efficiency) were administered in both environments. There was a 90% level of agreement between the two assessment environments for the rating of overall severity of dysarthria. A 70-100% level of agreement was achieved for 17 (74%) of the 23 FDA variables. On the ASSIDS there was a significant difference between the FTF and online assessments only for percentage word intelligibility. These findings suggest that Internet-based assessment has potential as a reliable method for assessing motor speech disorders.
Article
This article describes and reports data-based outcomes of a low-tech telehealth adaptation of the Lidcombe Program of Early Stuttering Intervention. Participants were 5 children with early stuttering, ranging in age from 3;5 (years;months) to 5;7, and their families. All children met the speech criteria for completion of Stage 1 of the Lidcombe Program. Data suggested that the treatment method may be viable and that favorable outcomes may be achievable. Mean posttreatment stuttering rates in everyday speaking situations were available 12 months posttreatment for 4 children. Two children scored a mean percent syllables stuttered of less than 1.0 at that time, and 2 children scored a mean of below 2.0. As occurs often in standard delivery of the Lidcombe Progam, 1 child relapsed after Stage 1, apparently because of parental noncompliance, but this relapse was managed successfully. Follow up data were unavailable for 1 child. For 4 of the 5 cases, the number of consultations required exceeded established benchmarks for standard Lidcombe Program delivery, suggesting that telephone-based telehealth may be a less efficient version of the treatment. The implications of these preliminary data are discussed.
Article
Background: Children with speech difficulties may have associated educational problems. This paper reports a study examining the educational attainment of children at Key Stage 1 of the National Curriculum who had previously been identified with a speech difficulty. Aims: (1) To examine the educational attainment at Key Stage 1 of children diagnosed with speech difficulties two/three years prior to the present study. (2) To compare the Key Stage 1 assessment results of children whose speech problems had resolved at the time of assessment with those whose problems persisted. Sample(s): Data were available from 39 children who had an earlier diagnosis of speech difficulties at age 4/5 (from an original cohort of 47) at the age of 7. A control group of 35 children identified and matched at preschool on age, nonverbal ability and gender provided comparative data. Methods: Results of Statutory Assessment Tests (SATs) in reading, reading comprehension, spelling, writing and maths, administered to children at the end of Year 2 of school were analysed. Performance across the two groups was compared. Performance was also compared to published statistics on national levels of attainment. Results: Children with a history of speech difficulties performed less well than controls on reading, spelling and maths. However, children whose speech problems had resolved by the time of assessment performed no differently to controls. Children with persisting speech problems performed less well than controls on tests of literacy and maths. Spelling performance was a particular area of difficulty for children with persisting speech problems. Conclusions: Children with speech difficulties are likely to perform less well than expected on literacy and maths SAT's at age 7. Performance is related to whether the speech problem resolves early on and whether associated language problems exist. Whilst it is unclear whether poorer performance on maths is because of the language components of this task, the results indicate that speech problems, especially persisting ones, can affect the ability to access the National Curriculum to expected levels.
Article
This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J. M. Bland and D. G. Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.