Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.

Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.

A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck 39: 932-939, 2017.

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.

Intensive, prophylactic swallowing therapy programs have been developed to improve dysphagia outcomes for patients with head/neck cancer (HNC) receiving (chemo)radiotherapy ([C]RT). Across studies, variable therapy adherence rates have been reported. Preliminary research suggests that service-delivery mode and demographic factors may influence adherence. This study examined patient adherence to a prophylactic swallowing therapy protocol across three service-delivery models: (1) clinician-directed face-to-face therapy, (2) technology-assisted therapy using the telepractice application, SwallowIT and (3) independent patient-directed therapy. The secondary aim explored the impact of patient factors on adherence. Patients with oropharyngeal HNC receiving definitive (C)RT were randomised to receive the Pharyngocise exercise protocol via clinician-directed (n = 26), patient-directed (n = 27) or SwallowIT-assisted (n = 26) models. Adherence was calculated as the percentage of prescribed exercise completed. Multiple patient factors were recorded at baseline. Adherence across the 6 weeks in all groups was low (27%), and declined from week 4 of (C)RT. The clinician-directed model yielded significantly (p = 0.014) better adherence than patient-directed therapy in weeks 1-3. There was also a trend for higher adherence in the SwallowIT group compared to patient-directed in weeks 1-3 (p = 0.064). Multivariable linear modelling identified active smoking at baseline (p < 0.001) and concomitant chemotherapy (p = 0.040) as significant negative predictors of adherence, with baseline reduced motivation trending towards significance. Although (C)RT-related toxicities will impact adherence, adopting service-delivery models with greater structure/support and providing extra assistance to patients with known risk factors may help optimise therapy adherence to prophylactic therapy programs. Telepractice may provide an alternate model to support adherence where service constraints limit intensive clinician-directed therapy.

Emerging research suggests that preventative swallowing rehabilitation, undertaken pre-or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters which are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation.Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. In total, 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, nineteen publications met the study's inclusion criteria.Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base of tongue (BOT) dysfunction, reduced pharyngeal contraction and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75% in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50%. Sub-analysis suggested a trend that the prevalence of key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention, and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.

We explored the feasibility of providing access to specialist speech pathology services via telehealth for patients with head and neck cancer. A weekly telehealth clinic was conducted between the speech pathology departments of a tertiary hospital and a regional hospital in Queensland. Over a 5-month period, 50 telehealth sessions were conducted for 18 patients. There were 38 patient consultations, nine case discussions between clinicians and three clinical training sessions relating to the skills needed for specific client management (e.g. voice prosthesis selection). Eight sessions had multidisciplinary involvement. All cases were successfully managed via telehealth. All patients agreed that they were comfortable using telehealth and would be happy to use it again in future. Both clinicians agreed that they could competently assess patients using the telehealth system. There appeared to be financial benefits for the patient, because by receiving specialist intervention at a local facility their travel expenses were lower. There was also the opportunity for workforce training and development through online case discussion and clinical consultation.

Aphasia, a language disturbance, frequently occurs following acquired brain impairment in adults. Because management of aphasia is often long-term, provision of ongoing and equitable access to treatment creates a significant challenge to speech-language pathologists (SLPs). This study aimed to determine the validity and reliability of assessing aphasia using standardized language assessments via an Internet-based videoconferencing system using a bandwidth of 128 kbits/sec. Thirty-two participants with aphasia due to stroke or traumatic brain injury were assessed simultaneously in either a face-to-face or online-led environment by two SLPs. Short forms of the Boston Diagnostic Aphasia Examination (BDAE-3) and the Boston Naming Test (BNT, 2nd edition) were administered. An eight-item participant satisfaction questionnaire was completed by 15 participants assigned to the online-led assessment. Results failed to identify any significant differences between the 24 subtest scores of the BDAE-3 and the BNT scores obtained in the online and face-to-face test environments (p > 0.01). Weighted kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two assessors for the 24 subtests and eight rating scales of the BDAE-3, the BNT, and for aphasia diagnosis. Good to very good inter- and intra-rater reliability for the online assessment was found across the majority of assessment tasks. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the online environment. This study supports the validity and reliability of delivering standardized assessments of aphasia online and provides a basis for ongoing development of telerehabilitation as an alternate mode of service delivery to persons with aphasia.