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Telerehabilitation for service delivery in speech-language pathology
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.
... Based on the frequency of studies, the geographical distribution reveals that the majority were conducted in the United States (n = 15, 29 %) [17,19,22,[28][29][30][31]33,35,36,46,48,50,55,61], followed by Australia (n = 8, 15 %) [20,21,23,34,38,39,44,57], and UK (n = 6, 11 %) [14,16,24,27,42,54] (Fig. 2.). The majority of the studies were published in 2016 (n = 6) [37][38][39][40][41][42], and 2022 (n = 7) [55][56][57][58][59][60][61] (Fig. 3.). ...
... The most common diseases and disorders for which telespeech was used in treatment and rehabilitation were aphasia (n = 17) [16,18-20, 23,33,37,39-43,46,47,50,53,56], stuttering (n = 7) [15,21,28,29,45,52,[57][58][59], and Parkinson's disease (n = 6) [22,24,25,27,51,60], respectively (more details in Table 2). ...
... The most commonly used interventions for providing telehealth services were videoconferences (n = 32, 63 %) [13][14][15][19][20][21][22][23][24][27][28][29][30][31][32]34,36,38,42,43,45,49,52,53,[55][56][57][58][59][62][63][64], web-based platforms (n = 13, 24 %) [16][17][18]25,26,33,35,40,41,47,54,60,61], and mobile applications (n = 7, 13 %) [37,39,44,46,48,50,51], respectively (Fig. 4.). Most of these services were provided in synchronous (n = 33, 63 %) [13][14][15][19][20][21][22][23][24][27][28][29][30][31][32]34,36,38,42,43,45,49,[52][53][54][55][56][57][58][59][62][63][64], and then in asynchronous forms (n = 19, 37 %) [16][17][18]25,26,33,35,37,[39][40][41]44,[46][47][48]50,51,60,61]. ...
Background: Speech disorders can significantly impact communication, social interaction, and overall quality of life, affecting individuals of all ages. Telespeech therapy has emerged as an innovative solution, leveraging technology to provide accessible and effective speech interventions remotely. This approach offers flexibility and convenience, addressing barriers such as geographical limitations and scheduling conflicts. This review aims to explore key interventions, applications, benefits, and challenges of telespeech therapy to enhance understanding of its potential in improving speech and language outcomes. Methods: The scoping review was carried out in alignment with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Three electronic databases PubMed, Scopus, and Web of Science were searched. Two authors independently screened and selected the studies. Results: Of the 2,587 papers, 52 articles were included in our review. Telespeech was most commonly used for treating aphasia (n = 17), stuttering (n = 8), and Parkinson's disease (n = 6). The primary interventions included videoconferencing (63 %), web-based platforms (24 %), and mobile applications (13 %), with most services delivered synchronously (63 %) and some asynchronously (37 %). The most common applications were "rehabilitation and treatment" (59 %) and "performance assessment of patients"(35 %). A total of 264 tele-speech benefits and challenges were identified and later consolidated into 40 items (26 benefits, 14 challenges). Key benefits included "reliable access to healthcare services and addressing disparities" (n = 26), "cost savings" (n = 23), and "improving patient outcomes and quality of care" (n = 21). Major challenges were "low-speed internet" (n = 13), "lack of technology skills" (n = 11), and "limited access to technology" (n = 8). Conclusion: Telespeech therapy can be effectively integrated into routine practice, especially in underserved or remote areas. It offers a flexible, cost-effective solution for rehabilitation and performance assessment, improving patient outcomes and addressing healthcare gaps. Continued technological advancements and targeted training can further enhance its benefits and effectiveness.
... TR services are provided to adults and children with disabilities by a wide range of rehabilitation specialists, including physiotherapists (15,16), speech and language pathologists (17)(18)(19), occupational therapists (20), rehabilitation physicians, and nurses, rehabilitation engineers, assistive technology specialists, and teachers, psychologists, and nutritionists. Non-specialists, such as patients'families and caregivers, are other contributors to TR (11). ...
... Lots of studies (12,18,29,30,(32)(33)(34)(35) introduced the lack of information security and privacy as one of the most important challenges that most of the participants in our study acknowledged. Also, Nyika's study introduced social issues as another challenge, which in our study expressed in the form of psychosocial and family issues (30). ...
... Low acceptance among beneficiaries come from ignorance, lack of knowledge or lack of manpower, budget or sufficient facilities. Studies have shown that patients are more inclined to attend face-toface therapy and even have a second therapist but are reluctant to use this approach (18,30). In our study, not only patients but also therapists were reluctant to use TR. ...
Background:Telerehabilitation is an emerging technology that uses digital technologies to perform evaluation, counseling, treatment, and telemonitoring to provide rehabilitative care to patients in various locations such as homes, communities, health centers, and workplaces. This approach has advantages such as reducing costs and overcoming barriers of distance and time. Reducing patient-rehabilitator interaction, and being hard to teamwork and express thoughts and feelings are some disadvantages of this approach. TR services are provided by a variety of rehabilitation specialists. The aim of the study was to identify barriers in the way of implementing TR in Iran
Methods:This study was conducted using a conventional content analysis method based on a qualitative approach. 26 people were selected as participants based on purposive sampling with maximum diversity. Data were collected through semi-structured interviews and managed using MAXQDA 10 software.
Results:765 codes were extracted by conducting interviews and coding. The findings of this study are classified into seven main categories and 32 sub-categories. The main categories are insufficient infrastructure, legal, physical, and moral hazards, lack of priority and insufficient determination, insufficient support of the public and non-governmental organizations, poor knowledge in using equipment, Lack of knowledge and negative attitude, and low capacity in comparison with face-to-face rehabilitation.
Conclusion:This study shows that based on the insights from the experiences of participants, inadequate infrastructure and poor knowledge of the use of equipment are the most important obstacles in the way of TR. This study reveals that the implementation of TR in Iran encounters several obstacles and eliminating them requires serious effort.
... 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. ...
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.
... 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]. ...
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.
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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.
... Advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are also used to aid in the diagnosis of PD. These methods provide detailed images of the brain, allowing for the identification of structural abnormalities Theodoros [2008]. However, the primary limitation of these techniques is their high cost and the need for specialized equipment and trained personnel Ogbole et al. [2018]. ...
... Research indicates that certain types of vocal tasks are more effective at revealing the subtle vocal characteristics affected by PD Hinton et al. [2012]. The primary vocal tests used for PD detection include sustained vowel phonations, sentence readings, and complex speech tasks Theodoros [2008]. Each test type provides unique insights into different aspects of vocal function affected by PD. ...
PPINtonus is a system for the early detection of Parkinson's Disease (PD) utilizing deep-learning tonal analysis, providing a cost-effective and accessible alternative to traditional neurological examinations. Partnering with the Parkinson's Voice Project (PVP), PPINtonus employs a semi-supervised conditional generative adversarial network to generate synthetic data points, enhancing the training dataset for a multi-layered deep neural network. Combined with PRAAT phonetics software, this network accurately assesses biomedical voice measurement values from a simple 120-second vocal test performed with a standard microphone in typical household noise conditions. The model's performance was validated using a confusion matrix, achieving an impressive 92.5 \% accuracy with a low false negative rate. PPINtonus demonstrated a precision of 92.7 \%, making it a reliable tool for early PD detection. The non-intrusive and efficient methodology of PPINtonus can significantly benefit developing countries by enabling early diagnosis and improving the quality of life for millions of PD patients through timely intervention and management.
... 10,11,17 In addition, the American Speech-Language-Hearing Association has published guidelines on how to perform telepractice in speech therapy. 9 According to this guideline, the therapist has to observe ethical principles when conducting teletherapy sessions. 15 In addition, the therapist should consider the proposed ethical frameworks, observe the principle of safe treatment for the patient, the independence of clients in choosing the treatment method, and be aware of cultural and linguistic variables. ...
... The most important advantage or opportunity of telepractice sessions was maintaining the health of the therapists, clients, and their families. 9 Teletherapy was performed in the child's living environment, and the stimuli used in this type of treatment were more natural and tangible than those used during in-person therapy sessions in the clinic. 4,24,34,35 The family plays a connecting role between the therapist and the child in the treatment sessions and takes most of the responsibility for the treatment. ...
In 2020, with the onset of the COVID-19 pandemic, the treatment and rehabilitation process faced problems and challenges. One of the most efficient therapy approaches in this period was telerehabilitation. Telepractice in speech therapy presents many challenges and opportunities. In this article, we review published articles up to June 2023 and summarize the challenges and opportunities of the COVID-19 pandemic for speech therapy. Researchers and clinicians have found that tele-speech therapy is an effective tool for improving access to high-quality services and a viable mechanism for delivering speech and language interventions. The results of teletherapy or telepractice during the COVID-19 pandemic were divided into opportunities and challenges. Speech therapy has moved toward telerehabilitation to improve treatment competence during the pandemic. Finally, teletherapy methods were more suitable for speech and language pathology.
... The literature search identified 40 papers dedicated to voice or speech disorder telerehabilitation. Among them, 11 publications met our inclusion criteria ( Fig. 1) [8][9][10][11][12][13][14][15][16][17][18]. The included papers were dedicated to recommendations [8][9][10], conference consensus [10], principles [12], review [13][14][15], survey of practitioner perception [10,16,17] or COVID-19 consensus [18]. ...
... Among them, 11 publications met our inclusion criteria ( Fig. 1) [8][9][10][11][12][13][14][15][16][17][18]. The included papers were dedicated to recommendations [8][9][10], conference consensus [10], principles [12], review [13][14][15], survey of practitioner perception [10,16,17] or COVID-19 consensus [18]. There were no guidelines of scientific societies in the literature, which was recently deplored by the Canadian Agency for Drugs and Technologies in Health [19]. ...
Objectives
To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders.Methods
The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60–80% of experts were improved and resubmitted to voting until they were validated or rejected.ResultsThe French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions.Conclusions
This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.
... 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. ...
Purpose
The outbreak of COVID-19 impacted the delivery of outpatient services by various healthcare systems, including speech and language therapy services for people with aphasia (PWA). One possible solution here is telepractice (TP). Previous studies have shown TP to be comparable to the traditional face-to-face (FTF) delivery method for the assessment of PWA. However, these studies have largely been conducted in Western, English-speaking countries. This study evaluates the feasibility of TP to assess PWA using the Short Aphasia Test for Gulf Arabic speakers (SATG).
Method
The feasibility study adopted a within-subject cross-over study design, involving 19 individuals with post-stroke aphasia aged 25–64. Each participant was assessed twice using the SATG, once with each delivery method (FTF and TP) and the scores were compared. We collected a number of feasibility measures, including a comparison of the scores for FTF and TP. Anecdotal cultural influences on participant preferences for TP were noted by researchers.
Results
The Wilcoxon rank-sum tests showed a non-significant difference between the two methods in the overall scores and the subsection scores, except for the auditory comprehension task which showed significantly lower scores for TP delivery. High satisfaction with TP was reported, and practical considerations for implementing TP are discussed.
Conclusion
This study provides evidence of the feasibility of adopting TP to assess PWA in Saudi Arabia and Kuwait and highlights the influence of cultural aspects on the use of videoconferencing. Participants reported a preference for some FTF contact to support setting up TP and prior to the first TP session.
... Research reports 40% of the tele-based services conducted on communication disabilities, primarily focused on assessment or intervention, with the largest number of published studies on the same being reported from the United States of America (32%), followed by Australia (29%) (5) . The applications of telerehabilitation in the field of speech language pathology have been reported in the areas of stuttering, swallowing dysfunction, speech and language disorders in children, adult neurogenic language and speech disorders, laryngectomy, and voice disorders (6) . Mohan et al. (4) carried out a survey among 205 Indian SLPs and audiologists about telepractice services. ...
... Telerehabilitation services are found to be a valid and reliable vehicle (19) for delivering communication and swallowing rehabilitation related services (4) , with a capacity to enhance functional outcomes by enabling generalization of intervention effects within the person's daily environment, permitting monitoring of the same on a long-term basis (6) . It was also reported that clinicians can optimize the intensity, duration, and timing of therapy when using telerehabilitation services, which was not possible when following the traditional faceto-face treatment protocols (20) . ...
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.
... 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. ...
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.
... 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. ...
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
... For swallowing, videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) have enhanced the dysphagia diagnostic process (Helliwell et al. 2023), while neuromuscular electrical stimulation has improved dysphagia outcomes when coupled with traditional swallowing therapy (Alamer et al. 2020). Telehealth has also facilitated service delivery across the scope of speech-language pathology practice (Theodoros 2008) and was mandated in certain countries during the COVID-19 pandemic. Indeed, technology has been incorporated into the clinical toolkit of many speech-language pathologists (SLPs). ...
Background
Technologies such as videofluoroscopy, therapy applications, and telehealth have been translated into the clinical toolkit of many speech–language pathologists (SLPs). Transcranial magnetic stimulation (TMS) is an emerging technology that shows therapeutic promise for communication and swallowing disorders and, once suitable for clinical use, SLPs will likely be responsible for delivering this treatment. As such, it is critical that SLP opinions and attitudes towards TMS, as well as broader translation issues facing the profession, are considered early in the TMS research and translation process.
Aims
(1) To explore in‐depth the determinants of SLP behaviour that could influence translation of TMS into speech–language pathology practice; and (2) to examine these behavioural determinants within the context of profession‐wide research‐to‐practice gaps.
Methods and Procedures
Semi‐structured interviews were conducted with 10 SLPs, who were classified into novice, intermediate, or expert TMS knowledge/experience levels. Reflexive thematic analysis conventions were used to inductively and deductively code interview data. The refined Theoretical Domains Framework (rTDF) informed study design, analysis, interpretation, and reporting, and served as a theoretical lens through which recommendations were developed.
Outcomes and Results
Four main themes were derived from interview data, representing four overarching determinants of SLP behaviour: actual knowledge/experience; perceptions of professional role and capabilities; optimism/pessimism mindset and emotions; and environmental factors. Results within each theme were categorised as TMS‐specific (aim 1) or profession‐wide (aim 2).
Conclusions and Implications
Many TMS‐specific behavioural determinants could impact the translation of TMS into speech–language pathology, however these exist against the backdrop of larger, profession‐wide translation issues. A taxonomy of nine recommendations for bridging technology translation gaps in speech–language pathology is provided, with a view to facilitating future implementation of TMS and other technologies.
WHAT THIS PAPER ADDS
What is already known on the subject Transcranial magnetic stimulation (TMS) might one day be used as a treatment for communication and swallowing disorders, and speech–language pathologists (SLPs) will likely be responsible for delivering this treatment. Previous research has investigated SLPs’ opinions and attitudes towards TMS to identify determinants of SLP behaviour that could impact translation of TMS into practice. However, more in‐depth investigation is required within the context of profession‐wide translation issues.
What this paper adds to the existing knowledge The present study highlights behavioural determinants that could impact translation of TMS, as well as profession‐wide research‐to‐practice gaps. We suggest important strategies and lines of enquiry to bridge translation gaps for use of technologies in speech–language pathology, which are summarised as a taxonomy of nine recommendations.
What are the potential or actual clinical implications of this work? Results from this study may help SLPs to acknowledge and characterise translation issues in their own practice and across the broader profession. Our taxonomy of recommendations can be used in clinical, research, and implementation science settings to address technology translation issues in speech–language pathology, facilitating future integration of TMS and other technologies into practice.
... 5 In this context, telerehabilitation (TR) emerges as a viable solution to ensure continuity of care for rehabilitation of post-stroke symptoms while optimising timing, intensity and sequencing of interventions that are likely to produce the greatest functional outcome for the patient. 6 It is defined as the delivery of rehabilitation services via information and communication technologies. 7 The use of TR is particularly useful in a context such as Italy, where in some regions, there are geographical barriers that make access to rehabilitation sites difficult for patients with motor impairments and developing TR systems feasible and easy to use is fundamental to guarantee a certain continuity of care and equity to rehabilitative services access. ...
Objective
This study aims to evaluate the feasibility of an integrated multi-domain telerehabilitation (TR) system in stroke patients and to observe whether there are changes in the quality of life (QoL) levels of patients undergoing TR treatments.
Methods
Patients were enrolled for a longitudinal multicentric pilot study conducted in six Italian research hospitals (IRCCS). The primary outcome was the feasibility of an integrated TR system, assessed by calculating treatment adherence and by collecting data from the Technology Acceptance Model and the System Usability Scale (SUS). Information on time and travel distance savings was also collected. As secondary outcomes, we evaluated changes in QoL levels with the EuroQol 5-dimensions (EQ-5D) and the Short Form-36 (SF-36) and in caregiver burden through the Zarit Burden Inventory.
Results
We enrolled 84 patients. Our system turned out to be feasible (treatment adherence = 85%), usable (SUS = 73.36/100, classifying it as a ‘good’ system) and well accepted by patients. Quality of life levels improved significantly from pre- to post-treatment (EQ-5D: p = 0.0014; SF-36 general health: p = 0.047). Caregivers perceived little or no significant care burden.
Conclusions
Telerehabilitation has been confirmed to be a feasible, usable and acceptable solution to guarantee continuity of care and improve accessibility to rehabilitation treatments to post-stroke patients. Furthermore, the strength of TR is in the possibility to improve patients’ QoL, which in turn could impact on functioning.
... In addition, the use of telerehabilitation in speechlanguage pathology has been explored, indicating the potential for managing speech and language disorders in children through innovative approaches (Theodoros, 2008). Furthermore, the incidence of speech therapy has been found to be higher than estimated in earlier literature for children with conditions such as unilateral cleft lip and palate, emphasizing the substantial need for speech therapy in such cases (Alaluusua et al., 2022). ...
This article critically analyzes the role of speech therapy in enhancing the communication skills of children with exceptional needs. It explores the multifaceted nature of speech therapy, encompassing a range of interventions tailored to individual needs. The discussion includes the benefits of speech therapy, such as improvements in speech production, language abilities, social communication, and pragmatic language skills. Challenges and limitations within the field are also examined, along with a comparative analysis of speech therapy against other interventions. Current trends, latest developments, and research gaps in speech therapy are addressed, emphasizing the need for continued research and innovation. The article concludes with policy recommendations and practical implications for evidence-based speech therapy practices, highlighting their significance in promoting holistic development and well-being in children with exceptional needs.
... With respect to this last item, the relatively young average age of our cohort might suggest higher technical literacy and fewer cognitive impairments. Deficits in vision, communication, cognition, or a heightened fall risk may also significantly impact the effectiveness of predominantly asynchronous therapy programs and raise safety concerns (56,57). Overall, these points only serve to highlight the critical role of therapists in properly selecting and recommending home-based neurorehabilitation only to appropriate patients. ...
Following a stroke, both accumulating scientific evidence and medical guidelines recommend that patients receive high-dose neurorehabilitation to aid in recovery. The reality, however, is that most patients receive a fraction of the dose required. This gap between required and actual dose is due to implementational barriers, with lack of therapist availability and costs of high-dose delivery arguably being the two main ones. Here, we investigated the extent to which these barriers could be alleviated by using gamified self-training technologies at home under remote therapist supervision.
We delivered a comprehensive full-body, high-dose neurorehabilitation program to chronic stroke patients entirely at home. The goal was to achieve approximately 36 hours of Active Training Time (ATT) over 12-18 weeks. The program was designed to be resource efficient, relying mostly on the patient training on their own (asynchronously) with the MindMotion GO gamified therapy solution. Additional telerehabilitation (synchronous) sessions with a therapist were interspersed once weekly, during which therapists used teleconference technologies to deliver additional training and provide direct feedback. Throughout, therapists were able to use a web application to continuously monitor and manage the training program remotely.
We assessed effectiveness through reporting ATT, a measure more closely reflecting delivered dosage as opposed to scheduled dose. Patient recovery was evaluated with standardized impairment and functional clinical measures, and patient self-reported outcome measures. Finally, a cost model was computed to evaluate the resource efficiency of the program.
Data from 17 patients was included in this retrospective analysis of a real-world clinical service. Patients completed an average cumulative ATT dose of 39.7 ±21.4 hours and maintained high levels of training adherence over the course of 19.2 ±3.3 weeks. The majority of the total ATT was delivered asynchronously (82.2 ±10.8% of total ATT). Patients showed improvements in both upper-limb (Fugl-Meyer Upper Extremity, 6.4 ±5.1 points; p<0.01) and gait and balance measures (Functional Gait Assessment, 3.1 ±2.6 points; p<0.01; Berg Balance Scale, 6.1 ±4.4 points; p<0.01). Overall, the program was viewed very favorably amongst patients, with 73.7% respondents being satisfied or very satisfied, while 63.2% of respondents reporting subjective improvements in physical abilities. Finally, therapist costs associated with the program amounted to 1903 USD).
This work demonstrates that effective high-dose neurorehabilitation can be delivered via gamified therapy technologies in the home setting. Furthermore, we show that training time can be successfully decoupled from therapist-presence without compromising therapy delivery and outcomes or patient satisfaction. In the context of a growing concern over therapist availability worldwide, this program presents a human resource-efficient model that delivers high-dose neurorehabilitation as mandated by recent medical guidelines, complementing existing clinic-based approaches.
... In recent years, the discipline of CSD has undergone remarkable advancements, such as the adoption of telepractice (ASHA, n.d.-b;Theodoros, 2008) and the emerging integration of augmented reality (e.g., Boisvert, 2023;Bryant & Hemsley, 2022;Keighrey et al., 2017;Lee & Hwang, 2018;Park et al., 2020) and virtual reality (e.g., Bryant et al., 2018;Keighrey et al., 2017). Currently, the integration of ChatGPT stands as a catalyst for transformative advancements in education. ...
Purpose
This article explores the potential of using ChatGPT, an artificial intelligence–powered chatbot, as a tool to teach plain language writing to students in communication sciences and disorders (CSD). It addresses the importance of plain language writing in health care communication and identifies the challenges faced by graduate students in adopting plain language writing.
Conclusions
Integrating ChatGPT into CSD education can empower students to develop effective plain language writing skills, with the potential of ultimately improving their communication skills and patient outcomes. The article highlights the potential positive impact of ChatGPT on clinical documentation and health communication, emphasizing the potential to enhance accuracy, consistency, productivity, efficiency, and language accessibility. While considering the limitations and ethical considerations of ChatGPT, the article concludes by emphasizing the need for a balanced approach that combines ChatGPT technology with human instruction to ensure responsible utilization and promote student competency in plain language writing.
... Telepractice has been identified as an acceptable means of service delivery with benefits similar to in-person treatment (Edwards et al., 2012;Hall et al., 2014;Milman et al., 2020;Theodoros, 2008). ASHA suggests that audiologists and speech-language pathologists (SLPs) may use telepractice as a supplement to in-person services or as the primary means of service delivery across client needs and settings (Brown, 2011). ...
With advances in technology and the COVID-19 Public Health Emergency (2020–2023), telepractice has become a prominent service delivery model. This study explores the evolution of telepractice service delivery research published by the American Speech-Language-Hearing Association (ASHA) and the impact of the COVID-19 Public Health Emergency on ASHA publications through searches of the ASHAWire database using “telepractice OR telehealth OR virtual OR teletherapy” in February 2021, 2022, 2023 and April 2023. In February 2023, 1,683 records were identified and hand searched for relevance to the evolution of telepractice. In April 2023, 471 records published from 2020 to 2023 were systematically screened for relevance to reveal 148 articles that met inclusion criteria. ASHAWire is a reputable resource for articles on telepractice service delivery, especially after the COVID-19 Public Health Emergency. It is important, however, for researchers and clinicians to carefully examine methodology of studies as the use of technology may conflate search results.
... Although face-to-face treatment has long been regarded the 'gold standard' of care, phoniatricians must take into account alternate means to provide services to meet the communication needs of a changing community and to guarantee that the most effective treatment plans are carried out. The application of telemedicine to augment or, in certain circumstances, replace conventional face-to-face interventions is one potential remedy for these service issues (Theodoros, 2008). ...
... Telerehabilitation (TR), a dynamic and evolving branch of telemedicine, has emerged as a promising approach to provide comprehensive rehabilitation services remotely [8]. By using technological advancements, TR is uniquely positioned to address the different impairments associated with these neurological conditions, offering a wide range of therapeutic exercises, educational resources, and emotional support in patients' own homes, by providing synchronous (i.e., online, with the presence of the therapist in real time) and asynchronous (i.e., by monitoring patients' training) treatments [9]. ...
Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients’ quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson’s disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment.
... Ongoing, consistent intervention is therefore crucial. The disruption to face-toface interactions caused by the COVID-19 pandemic resulted in SLTs rapidly exploring alternative forms of service delivery, such as telerehabilitation, to ensure continued access to service as far as possible (Campbell & Goldstein, 2021;Elsami Jahromi, Farokhzadian, & Ahmadian, 2021;Kraljević, Matić, & Dokoza, 2020;Sutherland et al., 2021;Theodoros, 2008;Tohidast, Mansuri, Bagheri, & Azimi, 2020). ...
Background: There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020.
Objectives: To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD.
Method: A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis.
Results: Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client’s and SLT’s travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits.
Conclusion: Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs’ knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included.
... 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 (Theodoros, 2008). ...
Background:
The coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on every facet of life. This directly included the delivery of health care from allied health professionals such as speech-language pathologists (SLPs) in South Africa. Research has shown that there is limited research done locally on the impact of COVID-19 relating to stroke care. Consequently, this results in a lack of research on the provision of speech, language and swallowing intervention using teletherapy after a stroke from an SLP point of view.
Objectives:
The aim of this study was to explore the experiences of SLPs with regard to their use of teletherapy in a COVID-19 context when providing speech, language and swallowing intervention for patients after a stroke.
Methods:
This study made use of a qualitative approach. An electronic questionnaire was sent to SLPs inviting them to participate in the study. Purposive sampling was used to recruit participants and thematic content analysis was used to analyse the open-ended qualitative questions.
Results:
The findings show that SLPs experienced a variety of facilitators and barriers to using teletherapy. Additionally, issues of access differ across the private and public sector SLPs for both the clients and the SLPs.
Conclusion:
The current study provided research in the field of teletherapy, which is relatively new in the South African context. The study, whilst small in scale, provided some insight into the changes experienced from the shift to teletherapy.
... 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. ...
Bu araştırmanın amacı, kekemelik terapisinin yüz yüze ve tele-terapi yoluyla sunumunun, kekemelik şiddeti, kekemeliğin bireyin yaşamına etkisi ve kekemeliğe ilişkin tutumlar üstünde etkisini incelemek ve katılımcıların tele-terapi deneyimlerini keşfetmektir. Araştırmanın katılımcıları kekemeliği olan 20 yetişkin bireydir. Katılımcılar tercihlerine ve koşullarına bağlı olarak tele-terapi ve yüz yüze terapi grubuna eşit sayıda atanmıştır. Tele-terapi grubu katılımcıları 8 farklı şehirden tele-terapi hizmeti almışlardır. Kekemelik terapisinde akıcılık biçimlendirme, kekemelik değiştirme ve danışmanlık yaklaşımları entegre şekilde kullanılmıştır. Araştırmanın deseni, nicel ve nitel verilerin kullanıldığı bir karma araştırma yöntemi olan eş zamanlı desendir. Nicel araştırma kapsamında, kontrol gruplu, eşitlenmiş, eşdeğer etkililik; öntest, sontest, izleme yarı-deneysel modeli kullanılmıştır. Nitel araştırmada ise fenomenoloji yaklaşımı kullanılmıştır. Araştırmanın birincil nicel verilerini üç durumda kekelenen hece oranları, kekemeliğin değerlendirilmesine ilişkin SSI-4 puanları ve katılımcıların özdeğerlendirmelerine ilişkin puanlar oluşturmaktadır. İkincil verileri ise algısal kekemelik şiddeti ve konuşma doğallığı puanları, tutumlara ilişkin OASES ve SL-ILP-S puanları oluşturmaktadır. Araştırmanın nitel verilerini yarı yapılandırılmış mülakatlardan elde edilen veriler ve klinisyen görüşleri oluşturmaktadır. Araştırmanın bulgularına göre tele-terapi ve yüz yüze terapi grupları, kekelenen hece oranlarını ve objektif klinik verilere ilişkin puanlarını anlamlı düzeyde düşürmüştür. Sontest ve/veya izleme evrelerinde iki gruptan elde edilen bu veriler arasında ise anlamlı bir farklılık bulunmamıştır (p>.05). Nitel analiz sonuçlarına göre katılımcıların %90'ı tele-terapiyi kendileri için uygun bulduklarını ve bu hizmetten yarar gördüklerini bildirmiştir. Nicel ve nitel bulguların üçgenlenmesi bu veri setlerinin genel anlamda uyumlu olduğunu ve birbirlerini doğruladıklarını göstermektedir. Bu araştırmada tele-terapinin, kekemeliği olan bireylere hizmet vermede uygun ve yüz yüze terapi kadar etkili bir hizmet sunum yöntemi olduğu görülmüştür.
... 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]. ...
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.
... Telepractice approaches can be applied to any setting and are classified as synchronous (interactive in real time), asynchronous (communications recorded for offline use), and hybrid (combination of interactive and off-line methods). Whereas there is a body of literature on telepractice and the efficacy of online versus in-person intervention for communication disorders (e.g., Brennan et al., 2004;Theodoros, 2008;Wales et al., 2017) and teleaudiology services (e.g., Ciccia et al., 2011;Muñoz et al., 2020;Stuart, 2016;Visagie et al., 2015), studies on the equivalence of in-person versus online administration of formal diagnostic speech and Correspondence to Beula M. Magimairaj: beula.m@usu.edu. Publisher Note: This article is part of the Forum: Can You See My Screen? ...
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.
... 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. ...
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.
... 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]. ...
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.
... 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]. ...
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.
... 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. ...
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.
... 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). ...
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.
... For patients with physical disabilities, accessing SLP services through telepractice can also be a more effective use of their time and limited energy. In particular, breaking longer sessions into a larger number of shorter appointments proves advantageous (Constantinescu et al., 2010;Howell et al., 2009;Matthews, 2014;Theodoros, 2008). ...
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
... 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). ...
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.
... 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. ...
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.
... 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. ...
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.
... 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. ...
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 US864 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.
... 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. ...
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. ...
... 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. ...
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.
... 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. ...
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.
... 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]. ...
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.
Proglašenje COVID-19 pandemije u ožujku 2020. godine rezultiralo je privremenom obustavom pružanja logopedske terapije u standardnom obliku i znatnim povećanjem korištenja usluga logopedske teleterapije u sustavu zdravstva. Budući da je mišljenje i zadovoljstvo korisnika i njihovih roditelja/skrbnika provedenom teleterapijom značajan čimbenik koji može utjecati na učinkovitost terapije i budućnost teleterapije u logopediji, cilj je bio ispitati mišljenje korisnika i/ ili njihovih roditelja/ skrbnika o provedenoj teleterapiji, otkriti što korisnici vide kao prednosti, a što kao nedostatke ovakvog načina rada i doznati njihovo mišljenje o provođenju iste izvan okvira COVID-19 pandemije. Za potrebe ovog istraživanja oblikovan je anonimni upitnik s 19 pitanja pod nazivom „Logopedska terapija na daljinu - stavovi korisnika“, sastavljen pomoću platforme Survey Monkey. Upitnik je ispunilo 252 sudionika, koji su tijekom COVID-19 pandemije sudjelovali u nekom od oblika teleterapije. U istraživanju su sudjelovali korisnici stariji od 16 godina koji su mogli samostalno ispuniti anketu i roditelji/skrbnici djece mlađe od 16 godina, te roditelji/skrbnici odraslih osoba koji nisu mogli samostalno ispuniti anketu, a bili su uključeni u neki od oblika logopedske terapije na daljinu u sustavu zdravstva. Od ukupnog broja sudionika, njih 79,2 %, izjasnilo se zadovoljnim pruženom uslugom. Kao najznačajniju prednost teleterapije vide dostupnost logopedske terapije tijekom izolacije i/ ili bolesti, te kontinuitet u radu. Od 252 sudionika, njih 137 (54,46 %) smatra da bi terapija na daljinu trebala postati jedan od uobičajenih oblika logopedskog rada i nakon COVID-19 pandemije. Rezultati koji su dobiveni analizom odgovora sudionika o zadovoljstvu, kao i navedenim prednostima logopedske teleterapije, potiču na razmišljanje o mogućnosti uređenja terapije na daljinu u sustavu zdravstva Republike Hrvatske kao dijela redovite ponude u načinima provođenja logopedske usluge.
BACKGROUND
The growing need and popularity of telepractice over conventional direct therapy by speech-language pathologists (SLPs) demand validation of oral language and literacy assessments via telepractice mode. Considering the limited research on the validation of standardised oral language and literacy tele-assessment in autistic children, it is vital to explore the feasibility of standardised oral language assessments in specific cultural and linguistic contexts.
OBJECTIVE
To examine the reliability of standardised oral language and emergent literacy assessments delivered via telepractice in autistic children.
METHODS
Emergent literacy and oral language skills of ten autistic children aged between 4 to 8 years were assessed using the Test of Emergent Literacy Assessment (TELA), and Assessment of Language Development (ALD) through in-person and tele-assessment with a gap of 15 days.
RESULTS
The findings of the present study establish the reliability of standardised oral language and literacy tele-assessment in autistic children by demonstrating a high level of agreement between in-person and tele-assessment modes.
CONCLUSIONS
Telepractice, may therefore, be a feasible and reliable mode of oral language and literacy assessment in autistic children, with adequate knowledge of the required special accommodation(s), training and strong collaboration with the facilitator(s).
У статті досліджено роль студентського самоврядування у процесі формування та поглиблення цифрової компетентності майбутніх вчителів спеціальної освіти. Акцентовано увагу на актуальності використання інформаційно-комунікаційних технологій в освіті: наданні дистанційно корекційно-розвиткових послуг дітям з особливими освітніми потребами, забезпеченні підтримки інклюзивного навчання. Наведено результати онлайн опитування, якими підтверджена зацікавленість майбутніх вчителів спеціальної освіти у підвищенні рівня своєї цифрової компетентності. Висловлена думка щодо необхідності пошуку закладами вищої освіти нових підходів до оптимізації навчального процесу відповідно до сучасних вимог; дієвих способів її формування та поглиблення. Обґрунтована можливість використання в якості одного з інструментів формування та поглиблення цифрової компетентності майбутнього вчителя спеціальної освіти потенціалу студентського самоврядування. Викладене власне бачення автора щодо його вагомого місця у підтримці наскрізного характеру процесу формування та поглиблення цифрової компетентності майбутніх вчителів спеціальної освіти. Зазначено, що важливою в цьому контексті бачиться творча співпраця органів студентського самоврядування та науково-педагогічних працівників кафедри закладу вищої освіти, що забезпечує підготовку майбутніх вчителів спеціальної освіти. Свого детального опису отримали форми участі студентського самоврядування у формуванні та поглибленні цифрової компетентності майбутніх вчителів спеціальної освіти. Запропоновано створення простору для неформальної освіти на рівні спеціальності 016 Спеціальна освіта – ЦифроХаб, з можливістю проведення в його рамках безкоштовних онлайн заходів з метою формування та поглиблення цифрової компетентності студентів в позанавчальний час. Деталізовано змістове наповнення івентів в авторській збірці «Handbook: керівництво з формування цифрової компетентності». Розроблено путівник з цифровими інструментами для початківців – «Guide для початківців: упевнений юзер у цифровому світі».
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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
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.
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.
This article describes and reports databased 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 telephonebased telehealth may be a less efficient version of the treatment. The implications of these preliminary data are discussed.
Purpose
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.
Method
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.
Results
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.
Conclusions
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.