These efforts performed in a stepwise approach will lead to an otolaryngology--head and neck surgery service that is on-line for the next millennium, with telemedicine advances normalized to the standard of care.
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.
The assessment of the ability of a talker to communicate with other persons, under given conditions, is normally accomplished by means of speech intelligibility testing. The resultant scores, however, do not provide any quantification of how well the communicating individuals performed the task at hand. An experiment was conducted in which professional military crews operated a tank simulator at five levels of speech intelligibility ranging from very good to extremely poor. Measures such as time to drive to an engagement location, number of targets hit, time to perform the entire mission, etc., were obtained. The results of this study will serve as a first step for establishing more realistic acoustical limits for military systems, guide the design of improved communication systems, and assist operations analysts in better defining war gaming parameters.
This paper describes a conceptual framework and human factors evaluation for usability assessment of commercially available telemedicine technology. Four criteria of human factors evaluation are utilized: (1) technical acceptability; (2) operational effectiveness; (3) clinical appropriateness; and (4) equipment selection. These criteria were applied to commercially available video-otoscope systems for otological evaluations.
Four experiments were performed to determine if changes in the level of speech intelligibility in an auditory task have an impact on performance in concurrent visual tasks. The auditory task used in each experiment was a memory search task in which subjects memorized a set of words and then decided whether authority presented probe items were members of the memorized set. The visual tasks used were an unstable tracking task, a spatial decision-making task, a mathematical reasoning task, and a probability monitoring task. Results showed that performance on the unstable tracking and probability monitoring tasks was unaffected by the level of speech intelligibility on the auditory task, whereas accuracy in the spatial decision-making and mathematical processing tasks was significantly worse at low speech intelligibility levels. The findings are interpreted within the framework of multiple resource theory.
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