ArticleLiterature Review

Telerehabilitation for service delivery in speech-language pathology

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Abstract

Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person's everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.

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... themselves, but also their families might be affected by the impact of communication disorders [1,2]. Speech-language disorder refers to a disability affecting an individual's communication skills, such as speaking, reading, writing, or ...
... The assessment and treatment of those with speech-language disorders are sometimes difficult mainly due to the limited healthcare services available to help them and patients' socioeconomic conditions [2]. Other challenges, such as the shortage of therapists in some regions, travel costs, and waiting time for receiving healthcare services have also complicated getting access to speech-language pathology services [3,5]. ...
... Similarly, regular access to speech therapists to treat children may not be possible for single-parent families or families when both parents work fulltime [5]. As communication impairments require long-term care and rehabilitation [6], the use of flexible, sustainable, and responsive service provision models is suggested [2]. ...
Article
Purpose Tele-speech therapy refers to the application of telecommunication technologies to provide speech-language pathology services at a distance and establishes communication between a specialist and a patient for assessment, intervention, or consultation. Due to the shortage of speech therapists, the use of tele-speech therapy services can be helpful, especially for those who do not have access to speech-language therapists. The aim of this study was to investigate speech therapists' perspectives about using tele-speech therapy. Methods This was a qualitative study conducted in 2020. Data were collected through conducting in-depth semi-structured interviews with 12 faculty members who worked in three different medical universities. The interviews were recorded digitally and transcribed verbatim. The data were analysed by using framework analysis method and MAXQDA version 10. Results Having analysed the data, four themes, 10 categories, and 26 subcategories emerged. The main findings included necessary requirements for implementing and using tele-speech therapy in terms of developing academic courses, guidelines, and necessary technical infrastructure, advantages of using tele-speech therapy for specialists and patients, challenges of, and opportunities for, using tele-speech therapy. Conclusion Although tele-speech therapy has several benefits for specialists and patients, challenges of using this technology should not be underestimated. There are also a number of research opportunities in this field and their results can be helpful for successful implementation of this technology in the future. • Implications for rehabilitation • The clinical assessment and treatment of patients with speech-language disorders are sometimes difficult mainly due to the limited healthcare resources or the patient heath condition. • Tele-speech therapy can be regarded as an alternative approach or a complementary method for face-to-face visits, especially for patients who are not able to attend clinics. • Despite the advantages, the challenges of providing special groups of patients with tele-speech therapy should be taken into account. • Telerehabiliation and rehabilitation research centres can support future research in the field of tele-speech therapy to present more evidence regarding the strengths and weaknesses of this technology. • Implications for practice • Technical and non-technical infrastructures should be taken into account before implementing tele-speech therapy services. • Tele-speech therapy has a number of advantages for patients and specialists. • Challenges of providing tele-speech therapy services, such as risk of inaccurate evaluation and difficulty in interaction with patients should not be underestimated. • There are a number of research opportunities in the field of tele-speech therapy and tele-rehabilitation centres can support further research in this area. • The findings of this study can facilitate utilisation of tele-speech therapy in different settings.
... On the other hand, speech therapy conducted via videoconferencing treatments appears to be better suited to the use of real-time telerehabilitation (Theodoros et al., 2008), especially for the improvement of stuttering (Sicotte et al., 2003), voice disorders, laryngectomy, swallowing dysfunction, and speech and language disorders (Grogan-Johnson et al., 2010;Theodoros et al., 2008) in children, or in the treatment of chronic post-stroke aphasia in adult patients (Macoir et al., 2017;Øra et al., 2020). ...
... On the other hand, speech therapy conducted via videoconferencing treatments appears to be better suited to the use of real-time telerehabilitation (Theodoros et al., 2008), especially for the improvement of stuttering (Sicotte et al., 2003), voice disorders, laryngectomy, swallowing dysfunction, and speech and language disorders (Grogan-Johnson et al., 2010;Theodoros et al., 2008) in children, or in the treatment of chronic post-stroke aphasia in adult patients (Macoir et al., 2017;Øra et al., 2020). ...
... Considering the overall trajectories of both types of intervention, for the neuropsychological therapists' questionnaires, the item pattern was more spread out and between a score range of 3 and 4, while the trajectory for speech therapy was more compact, in a score range between 4 and 5. That is consistent with current literature, because speech therapy seems to fit better with the implementation of real-time telerehabilitation (Theodoros et al., 2008). Interestingly, speech-language pathologist questionnaires showed a deviation in all the 7 item scores around session 13, perhaps due to the effects of fatigue, even though the scores remained high. ...
Article
Full-text available
This study examined the feasibility and acceptability of a telerehabilitation intervention during the COVID-19 pandemic in a sample of children and young adults with Acquired Brain Injury (ABI). Thirteen patients and/or their families agreed to participate in the speech and neuropsychological telerehabilitation sessions. The treatment was synchronous, patient centered and aimed at improving specific abilities. Sessions were held twice a week over a 10-week period. Two questionnaires were completed both by parents and therapists to assess feasibility and acceptability. Neither technical issues nor clinical obstacles were found. The quality of the therapeutic relationship played a key role in the intervention. Synchronous telerehabilitation provided several advantages both for patients and therapists. Moreover, the patient centered intervention eased the burden of the caregivers at a time of high stress. The real-time telerehabilitation treatments were deemed suitable for children and young adults with ABI. Further studies are needed to support the use of telerehabilitation as an integral part of their standard care.
... While increasing access to services is a key driver for telehealth delivery, there is reason to suggest that benefits may extend further. Home-delivered therapy through telehealth methods may also improve engagement and adherence to treatment, and help facilitate the generalization of trained skills and strategies (Coleman et al., 2015;Theodoros, 2008). McCue et al. (2010) assert that rehabilitation outcomes can be enhanced for interventions delivered in a patient's natural environment by drawing on environmental context to help training generalize and translate more effectively to the patient's everyday functioning. ...
... The more customized intervention programme may provide for greater focus on specific strategies and application of skills relevant to the participant, translating to greater personal engagement. These results are also consistent with suggestions by Theodoros (2008) and McCue et al. (2010) that rehabilitation occurring within the patient's natural environment may allow for enhanced generalization of skills and integration of strategies in the individual context of everyday life, leading to better functional outcomes. ...
Article
Rehabilitation of memory remains an unmet need for many stroke survivors. Telehealth methods may provide a solution, however evidence supporting the efficacy of remotely-delivered therapy is needed. A non-concurrent multiple baseline design was used with randomized onset of intervention across five individuals with chronic stroke-related memory complaints. A six-week compensatory memory skills programme was delivered individually via internet videoconferencing. Target behaviours of frequencies of self-reported lapses of everyday and prospective memory were measured weekly across baseline, intervention, and follow-up phases. A secondary outcome of functional goal attainment was measured once per phase, with participants setting two personal rehabilitation goals. Data were analysed visually and statistically. Improvements in memory functioning were statistically significant on at least one measure of target behaviour for four out of five participants at intervention or follow-up. Visual evidence of level change indicated at least modest improvements for all participants by follow-up. All participants attained at least one functional goal by follow-up. High rates of treatment adherence and participant satisfaction were observed. Technological issues were minimal and did not impact content delivery or engagement. These results provide preliminary support for the efficacy of a telehealth-delivered rehabilitation programme in improving memory function and achieving memory-related goals for stroke survivors.
... There is a unique opportunity to use telemedicine solutions for providing therapy. Telerehabilitation represents a future service delivery model for aphasia beyond the traditional gold standard of "face-to-face" treatment [15]. Telerehabilitation has been defined as rehabilitation services delivered via information and communication technology, and is categorized as rehabilitation services provided at a distance [16,17]. ...
... Following stroke, significant fatigue and motor dysfunction can make traveling to receive therapy a challenging task. By receiving therapy in the home, patients with fatigue can focus their energies on aphasia rehabilitation rather than the journey to the rehabilitation centre [15]. Favorable patient satisfaction with telerehabilitation has been described [22,23]. ...
Article
Full-text available
Background: The Cochrane review on the effectiveness of speech and language therapy for aphasia following stroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide intervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation could widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the time spent on travel by the therapist and patient. The current academic literature within this field is in its infancy, with few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled trial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT. Method/design: Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be randomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the telerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference. This additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40 patients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at pre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3 months after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest. Secondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production, Communicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of patients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical between group comparisons will be in line with an intention-to-treat analysis. Discussion: This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to the field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for aphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will provide information for the development and delivery of future definitive RCTs. Trial registration: ClinicalTrials.gov, ID: NCT02768922 . Registered on 11 May 2016. Last updated on 17 November 2017.
... Резюме: Телепрактиката (Telepractice) е широко използвана в медицината на развитите страни за предоставяне на здравни услуги като цяло (Balas et al., 1997), и по-специално за провеждане на консултация, диагностика и терапия при езиково-говорната патлогия (Mashima и Doarn, 2008;Theodoros, 2008). Целта на представеното в статията изследване е да се проучат възможностите за провеждане на дистанционен биофийдбек тренинг при терапия на лице със заекване със сензор за домашна употреба "iFeel Bluetooth HRV" под супервизията на терапевт. ...
... Ключови думи: Телепрактика, Биофийдбек, вариабилност на сърдечната дейност, заекване, техника за пред-блокажна корекция Abstract: Telepractice is widely used in the medical practice in developed countries for the provision of healthcare services in general (Balas et al., 1997) and in particular for the provision of consultations, diagnostics and therapy of individuals with speech-language pathology (Mashima & Doarn, 2008;Theodoros, 2008). The objective of the research, presented in the current article, is to examine the possible implementation of a distance Biofeedback training in the course of providing therapy to an individual who stutters via an 'iFeel Bluetooth HRV' sensor for home use under a therapist's supervision. ...
Article
Full-text available
Telepractice) е широко използвана в медицината на развитите страни за предоставяне на здравни услуги като цяло (Balas et al., 1997), и по-специално за провеждане на консултация, диагностика и терапия при езиково-говорната патлогия (Mashima и Doarn, 2008; Theodoros, 2008). Целта на представеното в статията изследване е да се проучат възможностите за провеждане на дистанционен биофийдбек тренинг при терапия на лице със заекване със сензор за домашна употреба "iFeel Bluetooth HRV" под супервизията на терапевт. Представен е единичен случай на лице със заекване. В терапията е използвана специализирана апаратура за биологична обратна връзка (Биофийдбек) (Vezenkov, 2010; 2011) и техниката за пред-блокажна корекция (Preparatory set), която се използва за модифициране на заекването в момента на случването му (Ward, 2006). Терапията преминава през 6 фази: диагностика, супервизия, Биофийдбек тренинг, дихателен тренинг с включване на говорни задачи, трансфер на новите умения в говорна среда, и последваща диагностика. Първичните резултати показват 30% намаление на честотата на нарушените плавности веднага след провеждане на терапията, с което степента на тежест на заекването е намалена от тежка към лека. При средната продължителност на трите най-дълги спазъма и съпътстващите движения също се отчита подобрение в степента на тежест с 40%. Тези предварителни данни предполагат, че използването на Biofeedback метода в логопедичната практика има потенциала да осигури успешното провеждане на терапия за клиенти с нарушена плавност на речта, прилагайки Телепрактиката. Ключови думи: Телепрактика, Биофийдбек, вариабилност на сърдечната дейност, заекване, техника за пред-блокажна корекция
... In geographically dispersed countries, such as Australia, a particular challenge for children with speech and language difficulties is access to specialist services. Their geographical isolation in rural and remote areas means they can wait for many years to access treatment, if they are able to access treatment at all (Baker et al., 2014, O'Callaghan et al., 2005, Theodoros, 2008, Wilson et al., 2002. Geographic isolation can be further compounded when children do not have access to early learning opportunities that might facilitate development of communicative competence and the diagnosis of any difficulties (Baker et al., 2014). ...
... Geographic isolation can be further compounded when children do not have access to early learning opportunities that might facilitate development of communicative competence and the diagnosis of any difficulties (Baker et al., 2014). Telehealth offers a possible solution to ameliorating this and other barriers to access (Manzanares and Kan, 2014, Theodoros, 2008, Mashima and Doarn, 2008, Waite et al., 2010b, Waite et al., 2012. With early intervention widely recognised as having positive impacts on children's developmental trajectories and health outcomes (Campbell et al., 2014, Doyle et al., 2009, the opportunities created by telehealth services are relevant for very young children, particularly those who are geographically isolated. ...
... In 2020, the COVID-19 pandemic placed healthcare providers all over the world under significant pressure to switch their practice from traditional faceto-face (FTF) services -which present a risk of person-to-person infection -to TP delivery (Al Awaji, AlMudaiheem & Mortada, 2022). In the field of speech and language therapy (SLT), the use of TP has become an area of great interest, especially in relation to people with aphasia (PWA), who tend to have greater difficulty in accessing healthcare services due to their communication impairments (Mashima & Doarn, 2008;Theodoros, 2008). Furthermore, PWA represent an already vulnerable group, one that often also has chronic physical disabilities (Mayo, Wood-Dauphinee, Cote, Durcan, & Carlton, 2002). ...
... In traditional FTF assessments, the clinician generally scores the client's performance immediately and modifies the tasks according to the client's needs. It is argued that this is the same for TP, with clinicians able to monitor the clients, score their responses, and adjust the tasks as needed (Houston, 2013;Mashima & Doarn, 2008;Theodoros, 2008). Numerous studies have reported the feasibility of using TP to assess PWA using various types of assessments and technology (e.g. ...
... Asynchronous methods (i.e., store and access later) have been used as a supplement and as a way to validate what was observed through videoconferencing (Halpern et al., 2005;Hill et al., 2006;Perlman & Witthawaskui, 2002;Trail et al., 2005). Research has demonstrated that synchronous telepractice methods produce similar clinical outcomes when compared with in-person speech-language pathology services for neurogenic communication disorders, fluency disorders, voice disorders, dysphagia, and childhood speech and language disorders (Hill & Theodoros, 2002;Lowe, O'Brian, & Onslow, 2013;Mashima & Brown, 2011;Mashima & Doarn, 2008;Swanepoel & Hall, 2011;Theodoros, 2008). In addition to positive clinical outcomes that mirror those of in-person services, client and clinician satisfaction have been remarkably positive across the majority of studies (Brennan, 2006;Brennan, Georgeadis, & Baron, 2002;Georgeadis, Brennan, Barker, & Baron, 2004;Kully, 2002;Mashima et al., 2003), a finding consistent with other areas of telehealth research (Cardoso & Steinberg, 2010). ...
Article
Full-text available
This article describes the Global Voice Prevention Model (GVPM) facilitated with student teachers at West Chester University and the VoiceEvalU8 smartphone application (app) used to assess the effectiveness of the GVPM. Twenty-one participants completed 1 of 3 conditions (i.e., in-person GVPM, telepractice GVPM, and control). The in-person and telepractice conditions ran for 4 weeks during fall 2016, with 1 week dedicated to vocal education and vocal hygiene and 3 weeks spent in vocal training. The control condition ran for 1 week and included only vocal education and vocal hygiene. The VoiceEvalU8 app was used at pre- and post-condition twice a day for 5 days to record acoustic, perceptual, and aerodynamic voice measures. The study is ongoing; therefore, preliminary acoustic results for fundamental frequency (F0) and jitter% are presented from pre- to post-condition. During spring 2017, the participants were student teaching and using the VoiceEvalU8 app to record the voice measures before and after teaching all day. A new group of participants will be enrolled fall 2017 for selection into 1 of the 3 conditions and then continue on to student teaching spring 2018.
... 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.
... Over the past decade or so, the integration of computers and mobile devices has been shown to be very effective in treating patients with speech language disorders. 3,4,[19][20][21] This is the first report of a web-based home practice platform for children and adolescents with a voice disorder. Although the design of the VTP has some challenges, overall development and implementation of the home practice web portal were successful. ...
Article
Purpose: This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). Methods: A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Results: Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9-14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. Conclusion: The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.
... To be effective, these treatments must be "frequent, high-intensity, individualized, and naturalistic" [25]. However, scheduling appointments with SLPs can be difficult, especially for children who live far from clinics [35,44,45]. Thus, clinic-based intervention typically must be supplemented with considerable home practice. ...
Conference Paper
This paper presents Apraxia World, a remote therapy tool for speech sound disorders that integrates speech exercises into an engaging platformer-style game. In Apraxia World, the player controls the avatar with virtual buttons/joystick, whereas speech input is associated with assets needed to advance from one level to the next. We tested performance and child preference of two strategies for delivering speech exercises: during each level, and after it. Most children indicated that doing exercises after completing each level was less disruptive and preferable to doing exercises scattered through the level. We also found that children liked having perceived control over the game (character appearance, exercise behavior). Our results indicate that (i) a familiar style of game successfully engages children, (ii) speech exercises function well when decoupled from game control, and (iii) children are willing to complete required speech exercises while playing a game they enjoy.
... Recently, increasing numbers of SLPs have adopted telehealth or tele-rehabilitation services involving information and communication to enhance treatment methods [24]. Online speech therapy or tele-practice leverages internet-connected computers with a webcam, speakers and a microphone to form a clinical arrangement where the patient and an SLP can communicate faceto-face over the Internet from different locations [28]. For example, the LSVT LOUD companion software allows SLPs to access their patients homework and exercises completed outside the clinic environment [29]. ...
Article
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About 90 percent of people with Parkinson's disease (PD) experience decreased functional communication due to the presence of voice and speech disorders associated with dysarthria that can be characterized by monotony of pitch (or fundamental frequency), reduced loudness, irregular rate of speech, imprecise consonants, and changes in voice quality. Speech-language pathologists (SLPs) work with patients with PD to improve speech intelligibility using various intensive in-clinic speech treatments. SLPs also prescribe home exercises to enhance generalization of speech strategies outside of the treatment room. Even though speech therapies are found to be highly effective in improving vocal loudness and speech quality, patients with PD find it difficult to follow the prescribed exercise regimes outside the clinic and to continue exercises once the treatment is completed. SLPs need techniques to monitor compliance and accuracy of their patients exercises at home and in ecologically valid communication situations. We have designed EchoWear, a smartwatch-based system, to remotely monitor speech and voice exercises as prescribed by SLPs. We conducted a study of 6 individuals; three with PD and three healthy controls. To assess the performance of EchoWear technology compared with high quality audio equipment obtained in a speech laboratory. Our preliminary analysis shows promising outcomes for using EchoWear in speech therapies for people with PD. Keywords: Dysarthria; knowledge-based speech processing; Parkinson's disease; smartwatch; speech therapy; wearable system.
... Compared to traditional in-clinic therapy, TR uses the same principles of individualized care by a licensed therapist. This telehealth approach provides enhanced options compared to delivery of rehabilitation services using a brick-andmortar approach (29)(30)(31)(32)(33), potentially decreasing transportation needs for patients with functional limitations, boosting physical activity, and expanding access to care. ...
Article
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Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees ( n = 13) were median age 61 (IQR 52–65.5), and 129 (52–486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3–56.7) h. Non-compliance doubled during weeks 7–12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5–12.5) points in the arm and 1 (−0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue ( p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov , # NCT03460587.
... Tailored, intensive speech-language therapy may also be difficult to establish, due to geographical barriers, and co-morbidities like decreased motor function and fatigue seen in the stroke population. 6 In this context, telerehabilitation can constitute an unconventional strategy compared to more traditional forms of training as it represents one potential route to augment the dosage of therapy. In addition, telerehabilitation may facilitate equal services when access is limited due to geographical barriers and utilize available resources in local settings. ...
Article
Objective Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Design Pilot single-blinded randomized controlled trial. Setting Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. Subjects People with naming impairment due to aphasia following stroke. Intervention Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. Results No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Conclusion Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.
... Tele-rehabilitation techniques have successfully enabled people in remote areas to receive expert treatment from specialists located elsewhere in vast areas including cardiac rehabilitation (Kortke et al, 2006), speech and language therapy (Theodoros, 2008), and cognitive rehabilitation for people with traumatic brain injury (Man et al, 2006), as well as training and support of health-care personnel computerized guidelines to help clinicians use appropriate interventions (WHO, 2011b). ...
Thesis
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Background: Road traffic injuries (RTIs) are a major problem worldwide. In this mixedmethods thesis I investigated the trend of RTIs in Namibia, which is one of the worst affected countries globally. I also investigated the long-term impacts of RTIs and the role of a fuel levy fund - The Motor Vehicle Accident Fund (MVAF) - in enhancing the availability of rehabilitation and counselling services to RTI survivors in Namibia. Methods: Using quantitative methods, I conducted analysis of data sets on RTIs from 2012 to 2014. Descriptive analysis was used to characterise crashes, injuries and deaths, and people affected. Further to this, I conducted multinomial logistic regression in order to investigate the likelihood of having been injured or killed. Using qualitative methods, I conducted semi-structured interviews with RTI survivors in Namibia, and healthcare workers involved in caring for them, in order to investigate the long-term impacts of RTIs and the availability of rehabilitation and counselling services to road injury survivors in Namibia and the role played by the MVAF. Results: The quantitative analysis showed over 2012-2014, the rates of injury and death had risen by 3.9% and 1.1%. Logistic regression identified the road user group had the greatest influence on the risk of being injured and killed. The method of transportation to hospital had the greatest influence on the risk of dying among those admitted to hospital. The qualitative analysis showed that RTIs are associated with long-term physical and mental health sequalae, financial hardships, and various social problems. The analysis also showed the MVAF is effectively helping to enhance access to rehabilitation and other health services for RTI survivors. Conclusion: The present study adds to the knowledge of the long-term impact of RTIs and presents new information from Namibia, where no previous studies of this kind have been done.
... SLPs have expanded their modes of service delivery by providing intensive short-term therapy and teletherapy among other methods. Teletherapy enables clients to receive treatment without travel, and this has developed in areas of speech language pathology, including voice disorders [35]. Studies illustrating the efficacy between faceto-face and online therapy have been established [36][37][38] and SLPs in India have begun to explore the tele-therapy mode of service delivery [39]. ...
Article
In India, Speech Language Pathologists (SLPs) generally work with ENT surgeons and use a variety of treatment approaches, service delivery methods, feedback modes, and outcome measures in clinical practice while dealing with voice disorders. The practice preferences of the SLPs are based on theoretical and practical exposure during their graduate course, guidance from professional bodies, evidence-based practices, etc. The facilities in the work setting also determine the practice style of the SLP. This study reports information on demographics of the SLPs, nature of patients served, intervention methods, and evidence-based practices followed by the SLPs via an E-survey. Analysis of the survey from 55 SLPs in India, who work in the area of voice revealed that most SLPs had postgraduate (67.27%; n = 37) and doctorate degree (23.63%; n = 13) and worked in medical-related settings (81.81%; n = 45). Therapeutic approaches were practiced as stated in literature by 43.64% (n = 24) of SLPs. Although 56.36% (n = 31) of SLPs modified therapeutic approaches based on the client’s needs (75%), literacy (16.66%) and cultural variations (8.33%). Attending Continuing Education Programs and training workshops were required to practice voice. Voice therapy methods (protocols) used by the SLPs were not uniform across India. The development of an indigenous protocol/method for voice therapy is the need of the hour.
... Up to 2002, only 9% of SLPs used telepractice as a platform for therapeutic evaluation and intervention [28]. However, interest in research in this field has increased during the past decade [36], and numerous studies have reported the positive effects of using telepractice on evaluation and treatment of various speech-language disorders [27,28,35,[37][38][39]. Currently, the outbreak of COVID-19 disease has disrupted the provision of services in many SLP clinics, and closing of the clinics has resulted in canceling speech-language therapy sessions for children with speech and language disorders. ...
Article
Full-text available
Recently, a novel virus has spread worldwide causing the disease called COVID-19. In addition to putting people’s lives at risk and causing mortality, various problems have occurred due to the negative effects of the COVID-19 pandemic. Quarantine, social distancing, and the obligation to use protective tools have led to sometimes long term closing of various jobs and services, including rehabilitation services. For instance, the disease has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes. Therefore, here, we described the quality of providing SLP services during the COVID-19 pandemic and the negative effects of the disease on the provision of SLP services. In addition, we made an attempt to explain concerns and problems raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the outbreak of COVID-19.
... Later research describes applications that included interactive visualisations designed for the non-expert individuals who received speech training [17,5,35]. Teleconferencing multimedia applications provided the additional advantage that individuals receiving speech therapy could stay at home, reducing the number of journeys to a rehabilitation centre [21,33,6]. Web-based multimedia applications for speech therapy also provide this advantage and potentially enable intensified speech therapy in the home environment, reducing dependence on the availability of speech therapists [23,14,3]. Recently, research has also started to explore the possibilities of mobile applications to assist patients in training at home [34]. ...
Conference Paper
A potential consequence of the ageing population is an increased incidence of neurological diseases that cause communicative disorders. In turn, this may lead to an increasing demand of intensive and costly speech therapy. To alleviate this problem, multimedia applications in the area of telerehabilitation and web-based speech training have been developed to support speech therapy. However, due to the repetitive nature of some exercises, therapy is not always perceived as particularly motivating. This paper reports on research aimed at developing a multimedia game that incorporates Automatic Speech Recognition (ASR) technology to provide patients autonomous and motivating practice without the intervention of a speech therapist. Currently, the game includes visual feedback on two dimensions of dysarthric speech that often deviate from healthy speech. To explore the possibility of integrating feedback on dysarthric speech by using ASR technology, initial experiments were conducted on available speech databases. The results show that employing ASR is becoming feasible thanks to recent developments in acoustic modelling.
... Literature data shows that telerehabilitation can be a promising intervention for elderly (20), adults (21), children with neurological diseases (22), as well as for the treatment of motor (23,24), cognitive (25) and language disorders (26)(27)(28)(29)(30). In Italy, the healthcare system could be supported by telemedicine interventions, due to the aging population, the increase in chronicity and morbidity of diseases, and the presence of rural areas, islands, and mountains. ...
Article
Full-text available
Current research suggests that the management of neurological diseases, both in adults and children, requires an ever increasing commitment of resources for the national healthcare system (NHS). In Italy, due to the aging of the population, increase in chronicity and morbidity of pathologies, and presence of islands and rural areas, health needs to be supported by innovative technologies. Telemedicine is a method of providing healthcare services at distance, remotely connecting health professionals and patients (or two professionals). In Italy, telemedicine is under development, and the NHS has not yet exploited and independently developed all the possibilities that telemedicine offers. Tele-rehabilitation consists in the use of information and communication technologies for the remote support of rehabilitation services. By allowing “home care,” it represents a valid support during the home rehabilitation process. This review is aimed at evaluating the role of telerehabilitation in Italy, with regard to the motor and cognitive rehabilitation programs applied to neurological pathologies, in both pediatric and adult patients. We screened the studies published between 2010 and 2019 on PubMed, Scopus, Cochrane, and Web of Sciences databases. Using the PICO model, the search combined the terms “telerehabilitation”; “neurological disorders”; “neurodegenerative disease,” “motor telerehabilitation”; “cognitive rehabilitation.” This review showed that telerehabilitation is a promising healthcare tool, as it guarantees continuity of care over time (after discharge) and in space (from hospital to patient's home), especially in patients with stroke. Furthermore, it allows to increase the frequency and intensity of rehabilitation programs, provide individualized rehabilitation treatment in comfortable and familiar environment for patient, monitor and evaluate patients' needs and progress, stimulate patient motivation and achieve better patient satisfaction, verify the results achieved by the patients, and potentially reduce the service costs. Unfortunately, almost all neurorehabilitation studies are characterized by small samples and wide variability of results, and would benefit from standardized procedures, aims and targets. Future telerehabilitation trials should include cost-effectiveness analysis associated with clinical outcomes to better assess the validity of this promising tool.
... Tele-terapi, giderek sa lık hizmetlerinin sunum sistemlerine daha fazla entegre edilmektedir. Dil ve konu ma bozuklukları alanında tele-terapi uygulamaları; yeti kin nörojenik konu ma ve dil bozuklukları, kekemelik, ses bozuklukları, larenjektomi, yutma ve artkülasyon, dil bozukluklarını içeren pediatrik popülasyon alanlarında geli tirilmi tir (Theodoros, 2008). Bunların yanı sıra, teleterapi ileti im bozukluklarının de erlendirilmesi ve terapisinde yaygın olarak kullanılmaktadır. ...
... 27 Consequently, SLP telerehabilitation can be an option to offer individuals with aphasia equitable access to services and reduced treatment costs and travel expenses. [28][29][30] There is also evidence that telerehabilitation can not only improve aphasia outcomes but also, enhance patient satisfaction and increase quality of life. 31,32 SLP telerehabilitation may utilize various formats and settings. ...
Article
Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.
... From an international survey investigating intensive aphasia therapy programs, Rose et al. (2013) identified that the limited availability of facilities, staffing resources and funding were barriers to the further expansion of intensive interventions into usual face-to-face services. However, even if these barriers were removed, PWA whose primary accessibility barriers are mobility difficulties or geographical location may still be denied evidence-based treatments (Theodoros, 2008). ...
Article
Purpose: High-intensity language therapy has been shown to provide greater outcomes for people with aphasia (PWA). Unfortunately, a number of issues including the ageing population and a lack of rurally-based clinicians prevent high-intensity interventions. Computer-based therapies are a potential solution to the issues of intensity and accessibility; however, this service delivery model is not commonly used. A possible reason behind the poor uptake is that current computer-based aphasia therapy (CBAT) programs may not meet the needs of speech-language pathologists (SLPs). This study investigated the preferences of SLPs with regard to the features desired in their ideal CBAT program. Method: Phenomenological research methodology was used to explore the preferences of 10 SLPs. Data were analysed using qualitative thematic analysis. Result: Desired features were grouped into five themes: therapy activities, stimuli, cues, access and progress data. A range of sub-themes were also identified. Conclusion: The wide range of desirable features found in this study may reflect the extent to which current CBAT programs are considered to be useful, but perhaps do not meet the needs of users. The study's findings provide useful information for future CBAT developers to create programs with high clinician usability.
... In the field of speech and language pathology, research examining virtual reality (VR) to enable improved communication for people with communication disabilities is limited (Bryant et al. 2019). The need to develop VR environments to provide therapeutic activities has been emphasized (Theodoros 2008). Their value is in simulating real-world, everyday communicative situations to allow specific competences to be practiced, by sparking the patient's motivation. ...
Article
Full-text available
To achieve pedagogic goals and deal with environmental constraints such as noise when lecturing, teachers adapt their speech production in terms of frequency, intensity, and temporal aspects. The mastery of appropriate vocal skills is key to teachers’ speech intelligibility, health, and educational effectiveness. This project tests the relevance of virtual reality (VR) for training teachers’ vocal skills by simulating a lesson in a realistic VR environment characterized by adjustable constraints such as background noise and fidgety children. The VR environment depicts an elementary school classroom with 16 pupils aged 9 to 12 years old animated with typical childlike actions. To validate this virtual classroom in terms of speech characteristics, we conducted acoustic analyses on the speech productions of 30 female teachers in three conditions: (1) giving a free speech while facing the experimenter (control), (2) teaching in their usual classroom (in vivo), and (3) teaching the same lesson in a virtual classroom (in virtuo). The background noise in the VR setting was adjusted for each talker so it was similar to the level measured in vivo. Repeated measures ANOVAs showed that teachers significantly increased their voice frequency, intensity, and intonation, and made longer pauses while speaking in vivo and in virtuo, compared to the control condition (p < .001). These voice and speech adaptations (partly related to background noise), the strong feeling of presence and the lack of side effects suggest that the virtual classroom may facilitate voice training and rehabilitation for teachers.
... Teletherapy, or technology assisted/delivered therapy, provides an alternative to the brick-and-mortar approach of delivering rehabilitation services (10)(11)(12)(13)(14). In such an approach, therapy is delivered via a computer and over the internet asynchronously but follows the same basic principles of traditional person-to-person rehabilitation. ...
Article
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Background: Post-stroke aphasia is a chronic condition that impacts people's daily functioning and communication for many years after a stroke. Even though these individuals require sustained rehabilitation, they face extra burdens to access care due to shortages in qualified clinicians, insurance limitations and geographic access. There is a need to research alternative means to access intervention remotely, such as in the case of this study using a digital therapeutic. Objective: To assess the feasibility and clinical efficacy of a virtual speech, language, and cognitive digital therapeutic for individuals with post-stroke aphasia relative to standard of care. Methods: Thirty two participants completed the study (experimental: average age 59.8 years, 7 female, 10 male, average education: 15.8 years, time post-stroke: 53 months, 15 right handed, 2 left handed; control: average age 64.2 years, 7 female, 8 male, average education: 15.3 years, time post-stroke: 36.1 months, 14 right handed, 1 left handed). Patients in the experimental group received 10 weeks of treatment using a digital therapeutic, Constant Therapy-Research (CT-R), for speech, language, and cognitive therapy, which provides evidence-based, targeted therapy with immediate feedback for users that adjusts therapy difficulty based on their performance. Patients in the control group completed standard of care (SOC) speech-language pathology workbook pages. Results: This study provides Class II evidence that with the starting baseline WAB-AQ score, adjusted by −0.69 for every year of age, and by 0.122 for every month since stroke, participants in the CT-R group had WAB-AQ scores 6.43 higher than the workbook group at the end of treatment. Additionally, secondary outcome measures included the WAB-Language Quotient, WAB-Cognitive Quotient, Brief Test of Adult Cognition by Telephone (BTACT), and Stroke and Aphasia Quality of Life Scale 39 (SAQOL-39), with significant changes in BTACT verbal fluency subtest and the SAQOL-39 communication and energy scores for both groups. Conclusions: Overall, this study demonstrates the feasibility of a fully virtual trial for patients with post-stroke aphasia, especially given the ongoing COVID19 pandemic, as well as a safe, tolerable, and efficacious digital therapeutic for language/cognitive rehabilitation. Clinical Trial Registration: www.ClinicalTrials.gov , identifier NCT04488029.
... According to ASHA (2005a), telecommunication is defined as ''The application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation,''. Tele-practice has a number of advantages, including increased access to speech-language pathology and audiology services, improved access to services for clients with linguistic and cultural diversity, increased ease of collaboration among multidisciplinary team members, and cost savings for clients [2]. The terms tele-practice and tele therapy will be used interchangeably in this study. ...
Article
Full-text available
Outbreak of COVID-19 pandemic has affected immensely the service delivery to patients with communication disorders. Tele-rehabilitation has become a new norm for the service in the field of speech and hearing. Daily challenges in service delivery are widely being reported. The objective of study is to highlight challenges faced by Audiologists and Speech Language pathologists during tele-practice. A descriptive cross-sectional survey was carried out through a web-based questionnaire regarding challenges faced by Audiologists & Speech Language Pathologists, and their perspectives towards telepractice was compared. Total of 18 questions were divided into three sections. Section I included questions regarding training related to tele-practice, types of cases being handled, etc. Section II comprised of questions related to teletherapy resources and section III had questions related to evaluation and treatment by tele-mode. 118 participants (47% Postgraduate students, 29% undergraduate students and 24% Professionals) participated in the study. Only 16.1% of the clinicians were trained formally for service delivery via tele-mode. All the participants reported child language disorders, difficult to handle during sessions. Participants reported lack of evidence based tele resources for the use during their practice and also stated difficulty assessing and intervening clients via tele-mode. Results show telerehabilitation is being widely used. Challenges faced by Audiologists and Speech language pathologists are difficulty handling paediatric population, lack of evidence-based tele-resources, and difficulty in evaluation & management of the patients. Effective training regarding tele practice is the need of current scenario. Future research on developing evidence- based resources is emphasized.
... The only interventions available are almost all focused on motor functions (Surana et al., 2019). Most language interventions in telepractice have concerned children with neurodevelopmental disorders, namely speech-language disorders (Theodoros, 2008;Wales et al., 2017), stuttering disorder (O'Brian et al., 2013;Valentine, 2014), autism spectrum disorder (Simacek et al., 2017), and deafness (Constantinescu et al., 2014). Very few telepracticebased interventions have been specifically intended to improve language skills in children with ID (McCullough, 2001;McDuffie et al., 2016;van der Schuit et al., 2011). ...
Article
Purpose The aim of this pilot study is to gather preliminary results on the effectiveness of intensive, parent-oriented, telepractice-based intervention to improve language skills in preschool children with neuromotor and intellectual disorders. Method Nine preschool children ( M = 63 months, SD = 8.7 months) underwent a telepractice program 4 times a week designed to promote speech, lexical, and syntactic skills. Families were remotely connected from home with the therapists, who controlled the rehabilitation procedures from the hospital. The number of stable phonemes, of understood and repeated words, and of understood and repeated sentences were evaluated as outcome measures 3 months (prebaseline) and 1 week (baseline) before the intervention, immediately after the intervention (T1) and at a 3-month follow-up (T2). Results An increase in the number of stable phonemes was detected after the treatment, even if it was not statistically significant. After the intervention program, there was a significant increase in the number of understood words (ratio T1 vs. baseline: 1.33; 95% CI [1.03, 1.71]) and repeated words (ratio T1 vs. baseline: 1.39; 95% CI [1.00, 1.92]), as well as of understood sentences (ratio T1 vs. baseline: 1.80; 95% CI [1.24, 2.35]) and repeated sentences (ratio T1 vs. baseline: 4.23; 95% CI [1.96, 9.12]). No significant differences were found when comparing all the outcome measures at prebaseline and at baseline. Conclusion An intensive, parent-oriented, telepractice-based intervention has the potential to increase scores of lexical and syntactic tasks in children with neuromotor and intellectual disorders.
... One of the health professions whose services were disrupted by the COVID-19 pandemic is speech-language pathology (Fong, Tsai, & Yiu, 2021;Tohidast, Mansuri, Bagheri, & Azimi, 2020). Previous studies have shown the effectiveness of delivering services in speech, language, and swallowing with telepractice (Beijer et al., 2010;Burns et al., 2012;Ciccia, Whitford, Krumm, & McNeal, 2011;Keck & Doarn, 2014;Kully, 2000;Lewis, Packman, Onslow, Simpson, & Jones, 2008;Mashima & Doarn, 2008;Regina Molini-Avejonas, Rondon-Melo, de La Higuera Amato, & Samelli, & G, 2015;Taylor et al., 2014;Theodoros, 2008;Weidner & Lowman, 2020). Some associations around the world such as the American Speech-Language-Hearing Association (ASHA) and Speech Pathology Australia recognize telepractice as a service delivery model (Fong et al., 2021). ...
Article
The COVID-19 pandemic has required speech-language pathologists (SLPs) to use telepractice to deliver services. The present study aimed to investigate the knowledge, attitude, and practice (KAP) of SLPs relative to telepractice during the COVID-19 pandemic. This cross-sectional study was carried out during the coronavirus outbreak from July to December 2020. A valid and reliable self-administrated online questionnaire was sent to 600 SLPs who are members of the Iranian Speech Therapy Association. A total of 465 SLPs completed the questionnaire. SLPs who participated in the study had good attitudes toward telepractice (mean 3.99 ± 0.53 on a scale of 1–5). The mean of the knowledge score of the SLPs was 2.66 (±0.73), a value that is considered to be moderate. The mean for the practice score was 2.42 (±0.89), a score that is considered to be seldom to sometimes. Policymakers should take appropriate action in the field of effective telepractice for training SLPs especially during or prior to situations such as the COVID-19 pandemic.
... Telecommunication technologies are used to deliver SLT services at a distance to connect the clinician to clients or their parents/caregivers, provided that the standard of care is assured to be on par with the gold standard FTF consultation. 2 The potential outcomes of telerehabilitation have been examined in assessing and managing selected developmental and acquired language and communication disorders, fluency, motor speech and voice disorders. 3 Despite the rapid expansion in research across these areas of SLP practices, telerehabilitation appears to be theoretically posited and not readily implemented in the local scene and the region. ...
Article
This paper highlights issues, challenges, and lessons learnt from implementing a speech-language therapy teleclinic service delivery model by the Speech Sciences Program, Universiti Kebangsaan Malaysia (UKM) during the wake of the recent COVID-19 pandemic. The teleclinic service provision was initially started to help our student cohorts attain and complete the required direct contact speechlanguage therapy clinical hours for graduation during the pandemic. It has since evolved to be an integral part of the clinical practicum curriculum and a service delivery model that is here to stay. Although far from perfect, the program hopes to systematically continue our endeavours in telerehabilitation as one of our niche areas, realising the wealth of benefits that this service delivery model has to offer.
... According to the [29] the use of information and communication technologies is a resource that can enhance the capacity and accessibility of treatment measures by providing interventions remotely. These techniques have successfully enabled people in remote areas to receive expert treatment from specialists located elsewhere in vast areas including cardiac rehabilitation [30], speech and language therapy [31], and cognitive rehabilitation for people with traumatic brain injury [32], as well as training and support of health-care personnel computerized guidelines to help clinicians use appropriate interventions [29]. ...
Article
Full-text available
Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.
... Considering the possibility of providing SLP services remotely and the effectiveness of telepractice method of providing services shown in the previous studies [17][18][19][20][21][22][23][24][25][26], it seems that the use of telepractice in SLP is a suitable choice for pandemic conditions, such as the COVID-19 pandemic [10,12,27]. Scientific associations related to SLP, such as American Speech-Language-Hearing Association, have also emphasized the provision of SLP services through telepractice during the COVID-19 outbreak [28]. ...
Article
Purpose: With the outbreak of the COVID-19 and the need for physical distancing, the provision of Speech-Language Pathology (SLP) services via telepractice has been essential. One of the first steps in this field is the need to study telepractice among Speech and Language Pathologists (SLPs). However, there is currently no specific instrument to measure telepractice in SLP to achieve this aim. The present study was conducted to develop and evaluate the psychometric properties of a questionnaire to investigate telepractice among SLPs during the COVID-19 pandemic. Materials and methods: The study comprised of two stages: (1) development of the questionnaire according to an in-depth literature review and (2) evaluation of the validity and reliability of the questionnaire. The content validity of the instrument was determined by 10 experts in the field of SLP. To check the face validity of the questionnaire, 10 SLPs were interviewed and their opinions were incorporated in the questionnaire. A total of 221 SLPs completed the questionnaire to determine the construct validity and the internal consistency. To evaluate the test-retest reliability, 30 SLPs completed the questionnaire twice with two weeks of interval. Results: The final version of the questionnaire comprised of three sections and 31 items. The Cronbach's alpha coefficients for different sections of the questionnaire ranged between 0.902 and 0.92 and the Intra-class Correlation coefficients of the sections were found to be between 0.9 and 0.96 in the test-retest reliability. Conclusions: The questionnaire developed in the study is a valid and reliable scale to measure telepractice among SLPs for educational or research purposes.
... Solid evidence supports the effectiveness of speech and language therapy on PSA, although providing the rehabilitation regimes described in the trial protocols in a local or clinical setting is often challenging [6]. This is also a consequence of the growing demand, increasing cost, constrained resources, and limited speech and language pathology (SLP) therapists trained in PSA, as well as of some geographical barriers and co-morbidities (e.g., motor deficit and fatigue) commonly seen in persons with stroke [7]. ...
Article
Full-text available
We report on our remote speech therapy experience in post-stroke aphasia. The aim was to test the feasibility and utility of telerehabilitation to support future randomized controlled trials. Post-stroke aphasia is a common and disabling speech disorder, which significantly affects patients’ and caregivers’ health and quality of life. Due to COVID-19 pandemic, most of the conventional speech therapy approaches had to stop or “switch” into telerehabilitation procedures to ensure the safety of patients and operators but, concomitantly, the best rehabilitation level possible. Here, we planned a 5-month telespeech therapy programme, twice per week, of a patient with non-fluent aphasia following an intracerebral haemorrhage. Overall, treatment adherence based on the operator’s assessments was high, and incomplete adherence for technical problems occurred very rarely. In line with the patient’s feedback, acceptability was also positive, since he was constantly motivated during the sessions and the exercises performed autonomously, as confirmed by the speech therapist and caregiver, respectively. Moreover, despite the sequelae from the cerebrovascular event, evident in some writing tests due to the motor deficits in his right arm and the disadvantages typical of all telepractices, more relevant results were achieved during the telerehabilitation period compared to those of the “face-to-face” therapy before the COVID-19 outbreak. The telespeech therapy performed can be considered successful and the patient was able to return to work. Concluding, we support it as a feasible approach offering patients and their families the opportunity to continue the speech and language rehabilitation pathway, even at the time of pandemic.
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.
Chapter
This chapter addresses the nature of disability, how it can best be ameliorated, which training techniques and medical treatments are most effective, particularly after single incident brain injury, and the organisational structures required for their optimal delivery. A holistic biopsychosocial individualised multi&;#x02010;dimensional rehabilitation programme includes: reiterative multi&;#x02010;disciplinary assessment, problem definition and measurement, goal&;#x02010;setting and treatment planning, treatment delivery, evaluation of effectiveness, and reassessment with a view to further treatment. Non&;#x02010;invasive therapy interventions and task&;#x02010;related training in the context of neural damage are an integral part of the rehabilitation process after a neurological event, and aim to optimise a person&;#x00027;s functional ability. Cardio&;#x02010;respiratory training and exercise classes may reverse the detraining effects of immobility and reduced activity seen in many chronic conditions. Symptoms related to neurological impairments caused by either single incident or chronic progressive conditions can cause distress and impact on function.
Article
Purpose: Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early stuttering. Method: The design was a parallel, open plan, noninferiority randomized controlled trial of the standard Lidcombe Program treatment and the experimental webcam Lidcombe Program treatment. Participants were 49 children aged 3 years 0 months to 5 years 11 months at the start of treatment. Primary outcomes were the percentage of syllables stuttered at 9 months postrandomization and the number of consultations to complete Stage 1 of the Lidcombe Program. Results: There was insufficient evidence of a posttreatment difference of the percentage of syllables stuttered between the standard and webcam Lidcombe Program treatments. There was insufficient evidence of a difference between the groups for typical stuttering severity measured by parents or the reported clinical relationship with the treating speech-language pathologist. Conclusions: This trial confirmed the viability of the webcam Lidcombe Program intervention. It appears to be as efficacious and economically viable as the standard, clinic Lidcombe Program treatment.
Article
Full-text available
Executive function deficits are documented in many neurodevelopmental disorders and may contribute to clinical complexity or rehabilitation resilience. The present research was primarily aimed at presenting and evaluating the feasibility and effectiveness of a telerehabilitation program used during the pandemic period. MemoRAN (Anastasis), a computerised cognitive training to improve executive control during visual-verbal integration tasks was used in a sample of 42 children (5–11 years old) with specific learning or language disorders. The MemoRAN training was based on exercises of inhibition, cognitive flexibility and updating in working memory for three months, with a frequency of approximately three sessions per week. Afterwards, a comparison between a subgroup of children using Memo-RAN and an active control group, using a tele-rehabilitation program directed on reading was conducted. Effect size analysis in pre-post measurements suggests an average effect of MemoRAN in measurements that require control processes, such as accuracy in dictation, reading, inhibition and working memory testing. Comparison with the active control group and the clinical utility implications of these types of treatment will be discussed.
Article
Purpose: The global impact of the COVID-19 pandemic has opened opportunities for service providers and patients to continue with clinical services in certain extraordinary settings and circumstances. Telerehabilitation in the field of speech language pathology in India is still at its infancy, with a majority of the Speech Language Pathologists (SLP) accustomed with the conventional face-to-face system of service delivery. The present study aims to gather the knowledge, attitudes, and practices (KAP) of SLPs in India regarding telerehabilitation services during the pandemic. Methods: The study was conducted in three phases: phase I involved the development and validation of a questionnaire to explore the KAP of SLPs regarding telerehabilitation services. The items were framed based on a Likert rating scale (strongly agree, agree, neutral, disagree, and strongly disagree), yes-no-maybe format, open-ended, and multiple-choice format. Phase II involved data collection, while phase III involved data analysis. Descriptive statistics was done to derive the frequency and percentage for discrete variables and mean and SD for continuous variables. Results: Many SLPs feel underprepared in their technical knowledge and skills needed for telerehabilitation. Furthermore, a majority of the SLPs also did report patients to be relatively lesser motivated and satisfied with tele practices due to issues that are discussed in the paper. Conclusion: This study is an initial attempt to touch upon the fabric of telerehabilitation services delivered by SLPs of India. Future studies are directed to study the technical, professional, and personal issues encountered during telerehabilitation services specifically pertaining to specific communication disabilities.
Research
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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.
Article
Purpose Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language–Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online. Method The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric). Results Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good. Conclusions TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.
Chapter
The aim of this work is to analyze the trends and new advances carried out in the last decades in the field of Parkinson's disease monitoring and management and more specifically regarding wearable and mobile technologies. The challenges of such technologies is to monitor, to assess and to manage the full range of PD symptoms through monitoring and testing routines while not hampering the patient's daily activities, identifying the correlation between the different dimensions affecting the severity of symptoms and the evolution of the disease and enabling the clinician to manage more efficiently the patient by providing timely indications on the effectiveness of the therapy and suggestions on therapy changes.
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Purpose Road traffic injuries (RTIs) are a major public health issue worldwide. The importance of physical rehabilitation following RTI is well documented. However, globally there has been very little research on the accessibility of rehabilitation services following road injury. Namibia is one of the five African countries with a fuel tax levy fund (Motor Vehicle Accident Fund, MVAF), a system of case managers, medical care, and case management system for coordination of long-term care. Materials and methods We investigated the availability of physical rehabilitation services to RTI injured in Namibia, through interviews with RTI patients and health care workers. Results Unlike the few other studies done in Sub-Saharan Africa (SSA), most RTI injured individuals in Namibia report they are able to access some rehabilitation following injury. In large measure, this is due to the effective MVAF system which they felt ensures follow up care for many after having an RTI. However, we found that access to rehabilitation is skewed in favour of those living in Windhoek and other urban areas compared with those in non-urban areas. Conclusions The MVAF model seems to enhance access to rehabilitation and is a model which could be replicated in other SSA countries and other low and middle income countries. • Implications for rehabilitation • Road traffic injuries (RTIs) are a major global public health challenge with over 1.2 million people killed and a high burden of disability and Namibia is one of the worst affected countries globally. • There is lack of knowledge on the availability to physical rehabilitation following road injury in Namibia. • Our study shows the Motor Vehicle Accident Fund (MVAF) model seems to enhance access to rehabilitation and is a model which could be replicated in Sub-Saharan Africa and other low and middle income countries.
Chapter
The aim of this work is to analyze the trends and new advances carried out in the last decades in the field of Parkinson's disease monitoring and management and more specifically regarding wearable and mobile technologies. The challenges of such technologies is to monitor, to assess and to manage the full range of PD symptoms through monitoring and testing routines while not hampering the patient's daily activities, identifying the correlation between the different dimensions affecting the severity of symptoms and the evolution of the disease and enabling the clinician to manage more efficiently the patient by providing timely indications on the effectiveness of the therapy and suggestions on therapy changes.
Chapter
The world’s population is aging. Most elderly individuals are suffering from chronic illnesses and disorders requiring regular support from physicians. It is important to find ways to support the elderly and allow them to remain independent and healthy in their homes instead of being institutionalized or hospitalized. With telerehabilitation interventions in chronic disease management, patients receive continuous monitoring, early symptoms can be identified, and responses to their illnesses are immediate. In individuals with impairments or disabilities telemedicine may offer access to telerehabilitation services and deliver in real-time or recorded videoconferencing, providing evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching by rehabilitation health providers. Benefits include access to rehabilitation medicine services for people living in remote areas where physiatrists are missing, reductions in hospital admissions/readmissions and emergency department visits, and increased client self-care and self-management.
Article
Purpose COVID-19 has shifted models of health care delivery, requiring the rapid adoption of telehealth, despite limited evidence and few resources to guide speech-language pathologists. Management of dysarthria presents specific challenges in the telehealth modality. Evaluations of dysarthria typically rely heavily on perceptual judgments, which are difficult to obtain via telehealth given a variety of technological factors such as inconsistencies in mouth-to-microphone distance, changes to acoustic properties based on device settings, and possible interruptions in connection that may cause video freezing. These factors limit the validity, reliability, and clinicians' certainty of perceptual speech ratings via telehealth. Thus, objective measures to supplement the assessment of dysarthria are essential. Method This tutorial outlines how to obtain objective measures in real time and from recordings of motor speech evaluations to support traditional perceptual ratings in telehealth evaluations of dysarthria. Objective measures include pause patterns, utterance length, speech rate, diadochokinetic rates, and overall speech severity. We demonstrate, through clinical case vignettes, how these measures were completed following three clinical telehealth evaluations of dysarthria conducted via Zoom during the COVID-19 pandemic. This tutorial describes how each of these objective measures were utilized, in combination with subjective perceptual analysis, to determine deviant speech characteristics and their etiology, develop a patient-specific treatment plan, and track change over time. Conclusion Utilizing objective measures as an adjunct to perceptual ratings for telehealth dysarthria evaluations is feasible under real-world pandemic conditions and can be used to enhance the quality and utility of these evaluations.
Article
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Purpose Telepractice offers prevention, assessment, treatment, and consultation at a distance. This article provides an overview of telepractice with specific considerations and examples related to voice across licensure requirements, state and federal laws, reimbursement, documentation, and telepractice methods. Conclusion As technology continues to advance and as client demand for telepractice services increases, practitioners need to create successful telepractice programs. Supplemental Material https://doi.org/10.23641/asha.7645286
Background: Aphasia is a quite common and very disabling symptom following stroke, negatively affecting patient's quality of life. Aim of the study is to evaluate the effectiveness of a rehabilitation training for aphasia that employ a touch-screen tablet using a virtual reality rehabilitation system (VRRS-Tablet). Material and methods: Thirty patients with aphasia due to ischemic or hemorrhagic stroke were randomized into either the control or the experimental group and assessed by means of a specific neuropsychological evaluation. The study lasted 6 months and included 2 phases. During the former, the experimental group underwent an experimental linguistic treatment performed using the VRRS-Tablet, while the control group was trained with a traditional linguistic treatment. In the latter, the control groups were delivered to territorial services, while the experimental group was provided with the VRRS-Tablet. Results: The experimental group improves in all the investigated areas, except for writing, while the control group only improves in comprehension, depression, and quality of life. Conclusions: Our study has demonstrated the effectiveness of a home-based telerehabilitation program specific for poststroke aphasia. The use of telerehabilitation by means of VRRS-Tablet could be one of the best solutions to treat aphasic patients after their discharge, promoting continuity of care by monitoring functional outcomes, maintaining preserved abilities, reducing depression, and improving linguistic functions, besides the psychological well-being.
Article
Introduction: Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson's disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia. Methods: Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire. Results: Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method. Discussion: Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.
Article
Purpose To examine the experiences of people with ALS (pALS) and their communication partners (cALS) regarding receiving speech-generating device (SGD) evaluation and treatment via telepractice. Method Eight pALS along with a primary cALS participated in telepractice SGD evaluation and treatment with an augmentative and alternative communication (AAC) specialist and representatives from multiple SGD vendors. Participants were interviewed postevaluation and post-SGD training to examine their experiences. Mixed methods data were collected through Likert scale responses and qualitative interviews. Results Telepractice SGD evaluation and training were feasible and resulted in all pALS receiving SGDs they were able to use to communicate. In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability. Suggestions for improving the telepractice experience were provided. Conclusions Telepractice should be considered as an option to provide vital SGD services to patients who are geographically remote, mobility impaired, unable to leave their home, experience fatigue with travel, or otherwise would not have access to these specialized services. Telepractice allows patients to preserve their time and energy for the assessment and treatment sessions, resulting in perhaps deeper and more frequent engagement in evaluation and training. Telepractice could serve as an alternative to outpatient, in-person evaluations, or be utilized in conjunction with in-person appointments. Supplemental Material https://doi.org/10.23641/asha.15094257
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Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy. Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups. Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality. Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population.
Article
Digital games can make speech therapy exercises more enjoyable for children and increase their motivation during therapy. However, many such games developed to date have not been designed for long-term use. To address this issue, we developed Apraxia World, a speech therapy game specifically intended to be played over extended periods. In this study, we examined pronunciation improvements, child engagement over time, and caregiver and automated pronunciation evaluation accuracy while using our game over a multi-month period. Ten children played Apraxia World at home during two counterbalanced 4-week treatment blocks separated by a 2-week break. In one treatment phase, children received pronunciation feedback from caregivers and in the other treatment phase, utterances were evaluated with an automated framework built into the game. We found that children made therapeutically significant speech improvements while using Apraxia World, and that the game successfully increased engagement during speech therapy practice. Additionally, in offline mispronunciation detection tests, our automated pronunciation evaluation framework outperformed a traditional method based on goodness of pronunciation scoring. Our results suggest that this type of speech therapy game is a valid complement to traditional home practice.
Article
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Background: Telerehabilitation (telerehab) is the method of using technology to provide rehabilitation services at a distance. The concept of delivering remote speech-language pathology (SLP) services using telerehab tools and techniques has been acknowledged for more than 25 years. While research has demonstrated videoconference-based telerehab to be a feasible, effective, and appropriate method for providing SLP services to a broad range of clients, studies have been primarily limited to technical feasibility or demonstration projects with relatively small sample sizes. There is an expressed need in the literature for controlled, randomised studies that track both quantitative outcomes of services delivered via telerehab as well as qualitative measures of satisfaction. Aims: The purpose of the study was to measure performance of adults with acquired brain injury on a standardised SLP assessment conducted in both face-to-face (FF) and video-conference-based telerehab (T) settings. The objective was to determine if performance on the assessment, or subjective feedback from the participants, differed between settings. Methods & Procedures: A total of 40 participants with a recent onset of brain injuryÐ12 with traumatic brain injury (TBI), 14 with a left cerebrovascular accident (LCVA), and 14 with a right cerebrovascular accident (RCVA)Ðwere enrolled in the study. Participants were asked to retell stories from the Story Retell Procedure (Doyle, McNeil, Spencer, Goda, Cotrell, & Lustig, 1998) in both FF and T settings. Responses from the stories were scored by the clinician using the percent information unit scoring metric (McNeil, Doyle, Fossett, Park, & Goda, 2001). Additionally, a survey tool was used to probe each participant's level of satisfaction and willingness to use telerehab services in the future. Outcomes & Results: Across all participants, and within the TBI, LCVA, and RCVA groups, no significant difference in performance between the FF and T settings was found. Feedback from survey data demonstrated a high level of acceptance of the T setting. When compared to participants with LCVA or RCVA, however, participants with TBI were significantly more likely to show a lack of interest in future videoconferencing use. Conclusions: Story-retelling performance by brain-injured adults was not affected by setting. Additionally, participants expressed a high level of interest in using videoconferencing in the future. These findings offer additional support for telerehab as a viable alternative mode of SLP treatment for survivors of stroke and TBI. Further research is needed to investigate the utility of telerehab for delivering services to clients with attention impairments as well as those with severe cognitive-communicative impairment, dysarthria, or aphasia.
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Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
Article
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The Lee Silverman Voice Treatment (LSVT) has been shown to be highly effective in treating the speech disorder in Parkinson's Disease (PD). However, patient access to this treatment remains limited in Australia, due to availability of speech pathologists, patient mobility and distance issues. We have investigated the feasibility and effectiveness of an Internet-based telerehabilitation application (eREHAB) for the delivery of the LSVT to persons with PD and disordered speech. Ten participants with PD and dysarthria were treated online with the LSVT for a total of 16 sessions. There were significant improvements in sound pressure levels for vowel prolongation, reading and conversational monologue (P < 0.01), pitch range (P < 0.05) and in perceptual features of pitch and loudness variability, loudness level (P < 0.01) and breathiness (P < 0.05). A participant satisfaction questionnaire indicated that 70% of participants expressed overall satisfaction with the online treatment. Telerehabilitation was feasible and effective in delivering the LSVT to people with PD.
Article
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Following a brief review of lessons learned from first generation telemedicine projects, an analytical framework for assessing the potential effects of telemedicine on cost, quality, and accessibility of health care is provided. It is proposed that the effects of telemedicine on cost, quality, and accessibility are interconnected, and a comprehensive assessment should incorporate all three aspects, each considered from the perspectives of clients, providers, and society. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/44995/1/10916_2005_Article_BF02257059.pdf
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This evaluative study assessed the feasibility and outcome of delivering speech-language services from a distance to children and adolescents who stutter. All six patients who formed the first cohort seen in the telespeech programme were included in the study. The results demonstrated that interactive videoconferencing can provide a feasible and effective care delivery model. Patient attendance was maintained throughout the intervention. All participants showed improved fluency. Stuttering ranged from 13% to 36% before treatment and 2% to 26% after treatment. All participants maintained at least part of their improved fluency during the six-month follow-up, when stuttering ranged from 4% to 32%. The study demonstrates that full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine.
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Telehealth offers the potential to meet the needs of underserved populations in remote regions. The purpose of this study was a proof-of-concept to determine whether voice therapy can be delivered effectively remotely. Treatment outcomes were evaluated for a vocal rehabilitation protocol delivered under 2 conditions: with the patient and clinician interacting within the same room (conventional group) and with the patient and clinician in separate rooms, interacting in real time via a hard-wired video camera and monitor (video teleconference group). Seventy-two patients with voice disorders served as participants. Based on evaluation by otolaryngologists, 31 participants were diagnosed with vocal nodules, 29 were diagnosed with edema, 9 were diagnosed with unilateral vocal fold paralysis, and 3 presented with vocal hyperfunction with no laryngeal pathology. Fifty-one participants (71%) completed the vocal rehabilitation protocol. Outcome measures included perceptual judgments of voice quality, acoustic analyses of voice, patient satisfaction ratings, and fiber-optic laryngoscopy. There were no differences in outcome measures between the conventional group and the remote video teleconference group. Participants in both groups showed positive changes on all outcome measures after completing the vocal rehabilitation protocol. Reasons for participants discontinuing therapy prematurely provided support for the telehealth model of service delivery.
Article
Telehealth increasingly used to provide healthcare services to people living remote locations. This article describes the use of telehealth technology to provide speech-language pathology services to people living with head and neck cancer.
Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
Article
In the last three years, the delivery of rehabilitation services at a distance by means of electronic information and communication technologies has come to be known as telerehabilitation. It is part of both the larger spectrum of telemedicine activities that have waxed, waned and waxed again since the early seventies; and the growing array of non-medical applications of consumer electronics and communication technology that can provide 'tele-enhancement of independent living' for individuals with neurological and other disabilities. While telerehabilitation is still largely hypothetical, activities are underway at several clinical rehabilitation centers. Most commonly, inexpensive video phone connections are used to provide face-to-face two-way image and voice contact between patient and provider, but transmission of data from sensors that monitor health and rehabilitation is technically feasible and promising. Telerehabilitation provides access to quality services for patients who are immobile or geographically remote from direct service. Some view it as a means of compensating for shortened lengths of stay in acute rehabilitation hospitals, while others emphasize the cost reductions it offers. Telerehabilitation methods, both current and in-the-works, are promising but it remains to be seen whether and how the reimbursement policy-makers at HCFA and private payers will respond to its potential.
Article
We validated an Internet-based telerehabiliatation system designed to assess the oromotor, swallowing and communication outcomes of patients following laryngectomy. Simultaneous online and face-to-face (FTF) assessments were made of 20 patients. The online assessment was conducted using a videoconferencing system developed specifically for telerehabilitation. There was greater than 80% agreement between the online and FTF clinician for all variables relating to oromotor function, swallowing status and communication ability. However, visualization of the stoma was poor. Clinician satisfaction with the functionality of the system was low, although their ratings were high for ease of use and the potential for telerehabilitation as a service delivery method. Patients were 100% satisfied with the usability of the system and the quality of service received. The study suggests that online assessment is a potentially viable service delivery method for evaluating the speech and swallowing status of patients post laryngectomy.
Article
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.
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
The potential value of telecommunications systems in treating communication disorders is being increasingly recognized. This mode of service delivery shows particular promise in giving patients access to specialist services for problems like stuttering, which are difficult to manage and often require long-term follow-up support. The Institute for Stuttering Treatment and Research at the University of Alberta has used videoconferencing to provide follow-up support to geographically remote adults who have undergone intensive treatment on site.
Article
To assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT), a method designed to improve vocal function in patients with Parkinson's disease. Thirty three patients with idiopathic Parkinson's disease were stratified and randomly assigned to two treatment groups. One group received the LSVT, which emphasises high phonatory-respiratory effort. The other group received respiratory therapy (RET), which emphasises high respiratory effort alone. Patients in both treatment groups sustained vowel phonation, read a passage, and produced a monologue under identical conditions before, immediately after, and 24 months after speech treatment. Change in vocal function was measured by means of acoustic analyses of voice loudness (measured as sound pressure level, or SPL) and inflection in voice fundamental frequency (measured in terms of semitone standard deviation, or STSD). The LSVT was significantly more effective than the RET in improving (increasing) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up. The findings provide evidence for the efficacy of the LSVT as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease.
Article
Dysphagia is a serious health problem that affects persons of all ages, from the neonate to those of advanced age. Many smaller communities and areas with sparse populations do not have regular access to professionals with expertise in the area of oral/pharyngeal dysphagia. Telemedicine is one method by which people in these areas can receive quality of service. The intent of this work was to develop an Internet system that permits real-time, remote, interactive evaluation of oral/pharyngeal swallowing function. The system consists of two major components. The first is a PC that is located in the fluoroscopy suite of a hospital. The computer is connected to the fluoroscope output and is responsible for (1) capturing video signals, (2) converting the analog video data into digitized video formats of both full resolution and transmission-optimized resolution, (3) simultaneously transmitting the transmission-optimized video stream over the network while the examination is being performed, and (4) storing the full-resolution data as a file in local storage for later retrieval. The second component is the controller computer which is located at a site some distance from the hospital. That controller computer manages the video capture process at the remote hospital site, manages the transmission of the stored images, and is then used for video analysis. The delay between the image as it was captured at the remote hospital site and viewed on the controller computer in the Principal Investigator's (PI's) laboratory ranged from 3 to 5 s. Video transmission occurred over a standard T1 line.
Article
It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery. A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy. Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001). Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.
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
For telehealth to become an accepted component of rehabilitation, a scientific base verifying that telehealth improves outcomes must be developed. A conceptual framework based on theory and empirical findings is necessary for this area of inquiry to flourish. Most academic curricula possess such an educational pillar, which serves to help prepare professionals to practice in the new arena, and scholars to perform quality research. Currently, the authors are involved in developing areas of the biomedical engineering and nursing curricula at Marquette University to address key areas of telerehabilitation. This paper outlines the conceptual framework for these curricular areas. The conceptual framework is derived from three areas that modulate each other, and ultimately impact the outcomes of telerehabilitation. These areas are rehabilitative biosystems, human-technology interfaces, and behavioral compliance. Each can be viewed from the context of an optimization process, and the model can be applied to help identify the weak link for a given telerehabilitative approach under study. Examples of how the model can be used to frame telerehabilitation research are presented, with a special focus on designing home-based solutions for two societal challenges of large scope and great need-stroke and cardiac rehabilitation. The authors conclude that the proposed framework can be used to conceptualize, understand, and optimize the key components of a telerehabilitative process and to analyze alternative approaches for optimizing outcomes.
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This paper presents results from a study conducted at the Rehabilitation Engineering Research Center (RERC) on Telerehabilitation at the National Rehabilitation Hospital. The study was designed to measure performance by brain-injured subjects, with medical diagnoses of stroke or traumatic brain injury, on a standardized Speech-Language Pathology evaluation conducted in both face-to-face and videoconference-based telerehabilitation settings. The Story Retelling Procedure (SRP), which measures connected language production and comprehension of spoken narratives, was administered to each subject in both settings. The primary objectives of this study were to: (1) compare communication as measured by the SRP between experimental settings, and (2) determine if subject variables (such as age, education, technology experience or gender) had an effect on performance differences between settings. The rationale was that any difference in this aspect of performance must be identified and characterized before this mode of intervention can be used clinically. Across all subjects (n = 40), no significant difference (p > 0.05) was found between SRP performance measured in the two settings. Additionally, variables including age, education, technology experience, and gender did not significantly affect the difference between performance in the two settings. Overall, subjects reported a high level of acceptance of videoconferencing with 34 subjects responding "yes," 4 responding "no," and 2 responding "maybe" when asked if they would use videoconferencing again to talk to a clinician. Results of this study confirm the potential for SLP treatment using videoconferencing and indicate a need for continued research in the field.
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Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors. Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class. The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.
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Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.
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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.
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Unlabelled: This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals' time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants' subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed. Educational objectives: After reading this article, the reader will be able to-(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.
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In clinical practice, it is common for speech and language therapists to discontinue dysarthria treatment when a plateau in spontaneous recovery is reached. However, there is some evidence from single-case research studies that people with chronic dysarthria can improve their speech with intervention several years after the onset of the disorder. If this is so, it can be argued that speech treatment should still be an option available to them. Motor learning principles suggest that in order to be effective, treatment needs to involve frequent, consistent practice with feedback. To compare the effects of both traditional treatment for clients with longstanding, stable dysarthria with computerized speech therapy, which allows independent practice with feedback. DEVELOPMENT OF THE COMPUTER PROGRAM: A new computer program was developed through a European Union-funded, quality of life and management of human resources programme. The program was designed for use with people with speech disorders and was based on motor learning principles. Speech recognition technology was exploited to provide feedback on practice attempts. Seven clients with longstanding, stable dysarthria completed a within-participant ABAC/ACAB case series design to compare 6-week blocks of weekly traditional treatment with 6-week blocks of computer-based treatment over a 6-month period. The findings suggest that the participants improved their speech with treatment. The computerized therapy was as effective as traditional treatment. The participants spent more time (37%) with the computerized therapy than with traditional practice techniques. The participants with longstanding dysarthria in this study made improvements to their speech with treatment using both traditional and computer-based techniques. Computers could provide a method of delivering an effective dysarthria treatment service without placing high demands on therapy resources.