Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

Background: Patients with Parkinson's disease face numerous access barriers to speech pathology services for appropriate assessment and treatment. Telerehabilitation is a possible solution to this problem, whereby rehabilitation services may be delivered to the patient at a distance, via telecommunication and information technologies. A number of studies have demonstrated the capacity of telerehabilitation to provide reliable and valid assessments of speech, voice and language. However, no studies have specifically focused on assessing patients with Parkinson's disease. Aims: To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinson's disease. Methods & Procedures: Sixty-one participants with Parkinson's disease and hypokinetic dysarthria were simultaneously assessed in an online and face-to-face environment by two speech -language pathologists. The assessment protocol included perceptual measures of voice and oromotor function, articulatory precision, speech intelligibility, and acoustic measures of vocal sound pressure level, phonation time and pitch range. Online assessments were conducted via a personal computer-based videoconferencing system with store-and-forward capabilities, operating on a 128 kbit/s Internet connection. The level of agreement between the online and face-toface ratings was determined using several different analyses, depending on the parameter. These included per cent close agreement, quadratic weighted Kappa, and the Bland and Altman limits of agreement. Outcomes & Results: Per cent close agreement between the two environments was within a predetermined clinical criterion of 80% agreement for all voice and oromotor parameters, articulatory precision and speech intelligibility in conversation. Levels of agreement between the environments, based on quadratic weighted Kappa, ranged from poor to good for vocal parameters and from fair to very good for oromotor parameters. Bland and Altman limits of agreement analyses revealed comparability between online and face-to-face environments for vocal sound pressure level, phonation time, pitch range, sentence intelligibility and communication efficiency in reading. Intra-and interrater reliability scores for all tasks were comparable between the online and face-to-face environments. Conclusions & Implications: For the majority of parameters, comparable levels of agreement were achieved between the two environments. Online assessment of disordered speech and voice in Parkinson's disease appears to be valid and reliable. The telerehabilitation application described in this study provides evidence for the delivery of online assessment for the dysarthric speech disorder associated with Parkinson's disease.

SummaryThe 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 (Po0.01), pitch range (Po0.05) and in perceptual features of pitch and loudness variability, loudness level (Po0.01) and breathiness (Po0.05). 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.

We investigated the validity and feasibility of online delivery of the Lee Silverman Voice Treatment (LSVT) for the treatment of the speech disorder of a patient with idiopathic Parkinson's disease. The treatment was delivered in 16 sessions to the participant's home, 90 km from the speech language pathologist. A PC-based videoconferencing system was used, operating at 128 kbit/s over the public telecommunications network. The patient achieved substantial improvements in vocal sound pressure levels during sustained vowel phonation (6.13 dB), reading (12.28 dB) and conversational monologue (11.32 dB). There were improvements in the duration of sustained vowel phonation (4 s). Improvements were also perceived in the degree of breathiness and roughness in the voice, and in overall speech intelligibility in conversation. The patient was very satisfied with the audio and video quality of the conferencing, and with the online treatment overall. He reported a preference for online sessions for the future management of his condition, rather than face-to-face treatment. Remote LSVT delivery was found to be feasible and effective.

Auditory-Verbal Therapy (AVT) is an effective early intervention for children with hearing loss. The Hear and Say Centre in Brisbane offers AVT sessions to families soon after diagnosis, and about 20% of the families in Queensland participate via PC-based videoconferencing (Skype). Parent and therapist satisfaction with the telemedicine sessions was examined by questionnaire. All families had been enrolled in the telemedicine AVT programme for at least six months. Their average distance from the Hear and Say Centre was 600 km. Questionnaires were completed by 13 of the 17 parents and all five therapists. Parents and therapists generally expressed high satisfaction in the majority of the sections of the questionnaire, e.g. most rated the audio and video quality as good or excellent. All parents felt comfortable or as comfortable as face-to-face when discussing matters with the therapist online, and were satisfied or as satisfied as face-to-face with their level and their child's level of interaction/rapport with the therapist. All therapists were satisfied or very satisfied with the telemedicine AVT programme. The results demonstrate the potential of telemedicine service delivery for teaching listening and spoken language to children with hearing loss in rural and remote areas of Australia.

Regardless of the type of communication approach received, children diagnosed with hearing loss at an early age and children with a high level of family involvement had better post-implant language scores than children diagnosed later and with lower levels of family involvement. These findings emphasize the importance of early diagnosis and highlight the contribution families make to the language outcomes of children with cochlear implants.

Telemedicine ("telepractice") allows improved access to specialised early intervention services such as Auditory-Verbal Therapy (AVT) for children with hearing loss. We investigated the effectiveness of a tele-AVT programme (eAVT) in the spoken language development of a group of young children with hearing loss. In a retrospective study we compared the language outcomes of children with bilateral hearing loss receiving eAVT with a control group who received therapy In Person. Seven children in each group (mean age 2.4 years) were matched on pre-amplification hearing level for the better hearing ear, age at optimal amplification and enrolment in the AVT programme. The eAVT sessions were conducted via Skype. Results on the Preschool Language Scale-4 were compared at 2 years post optimal amplification. There were no significant differences in language scores between the two groups. Language scores for the children in the eAVT group were within the normal range for children with normal hearing. The results suggest that early intervention AVT via telepractice may be as effective as delivery In Person for children with hearing loss.

A longitudinal study reported positive speech and language outcomes for 29 children with hearing loss in an auditory-verbal therapy program (AVT group) (aged 2 to 6 years at start; mean PTA 79.39 dB HL) compared with a matched control group with typical hearing (TH group) at 9, 21, and 38 months after the start of the study. The current study investigates outcomes over 50 months for 19 of the original pairs of children matched for language age, receptive vocabulary, gender, and socioeconomic status. An assessment battery was used to measure speech and language over 50 months, and reading, mathematics, and self-esteem over the final 12 months of the study. Results showed no significant differences between the groups for speech, language, and self-esteem (p > 0.05). Reading and mathematics scores were comparable between the groups, although too few for statistical analysis. Auditory-verbal therapy has proved to be effective for this population of children with hearing loss.Is Auditory-Verbal Therapy Effective 365 for total language, receptive vocabulary, gender, and socioeconomic level (as measured by the education level of the head of the household). Participants Auditory-Verbal Therapy Group (AVT Group)Selection criteria for the participants were: Pure-Tone Average (PTA) at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz of ≥ 40dB hearing threshold levels in the better ear; prelingually deafened (at ≤ 18 months old); attended the educational program weekly for intensive one-on-one, parent-based AVT for a minimum of 6 months; wore hearing devices consistently (hearing aids and/or cochlear implants) and aided hearing was within the speech range or had received a cochlear implant; no other significant cognitive or physical disabilities reported by parents or educators; 2 to 6 years of age at the first test session; and both parents spoke only English to the child .The children attended one of the five regional centers of an AVT program in Queensland, Australia, which offers a range of services including audiology, early intervention, and a cochlear implant program. This program adheres to the Principles of Auditory-Verbal Therapy (adapted from Pollack, 1970; endorsed by the AG Bell Academy for Listening and Spoken Language, 2007). Even though a particular AVT program may adhere to all of these principals, programs may vary in the operational details. A description of the AVT program in this study can be found at http://www.hearandsaycenter.com.au/ mission-delivery.html.Of the 10 children who left the study between the 38-month and 50-month posttests, 2 had left the program because of diagnosis of additional disabilities, 6 had moved away or were unavailable for testing, and the departure of 2 TH group children from the study necessitated omitting their matched AVT group pair. The remaining AVT group participants had bilateral sensorineural hearing loss ranging from moderate to profound (mean PTA 79.39 dB HL; range = 45 dB to >110 dB). All children were fitted with hearing aids, commencing intervention within 3 months of diagn...