Assessing disordered speech and voice in Parkinson's disease: a telerehabilitation application

Abstract

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.

Delivery of Intensive Voice Therapy for Vocal Fold Nodules Via Telepractice: A Pilot Feasibility and Efficacy Study

“…Pre and post treatment, the majority saw telepractice as a way to improve access to healthcare, save time and money and believed telepractice to be a viable option to FTF therapy. These findings are consistent with much of the literature, 19,30,40,41 with patients' perception of telepractice services in general to be very positive. The results also align with the comments made by Mashima et al 25 about the benefits of delivering voice therapy via telepractice.…”

Speech and language screening for children with medical complexity: A comparison of telepractice and in-person methods

“…Overall, caregivers were satisfied with telepractice screening and assessment (33,38,41), and in one study parents even showed a preference for telepractice services (38). These results are consistent with research into adult speech pathology clients, which has also reported high satisfaction with telepractice assessment (204)(205)(206)(207)(208). However, telepractice may not be satisfactory for all caregivers.…”

“…If the method-comparison study concludes that the techniques are equivalent, the new method can be introduced into clinical care (241). This study design has previously been used in a number of studies into the use of telepractice for speech and language assessment or screening for paediatric clients (33)(34)(35)(36)(37)(38)(39)(40)(41) and adult clients (199,204,205,207,(242)(243)(244)(245). In my study, the new technique evaluated was speech and language screening via telepractice.…”

Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia

“…Significant improvement in vocal intensity post therapy was reported, and the results were in good agreement with those obtained by Ramig et al (2001) for in-person therapy. Constantinescu et al (2010aConstantinescu et al ( , 2010bConstantinescu et al ( , 2011 reported a series of studies demonstrating the utility of telepractice in voice assessment and treatment of individuals with Parkinson's disease. In their first study (Constantinescu et al, 2010a), the authors examined the validity of assessing speech and voice in 61 individuals with Parkinson's disease in telepractice versus in-person sessions and reported comparable results for vocal sound pressure level, phonation time, pitch range, sentence intelligibility, and communication efficiency in reading.…”

“…Constantinescu et al (2010aConstantinescu et al ( , 2010bConstantinescu et al ( , 2011 reported a series of studies demonstrating the utility of telepractice in voice assessment and treatment of individuals with Parkinson's disease. In their first study (Constantinescu et al, 2010a), the authors examined the validity of assessing speech and voice in 61 individuals with Parkinson's disease in telepractice versus in-person sessions and reported comparable results for vocal sound pressure level, phonation time, pitch range, sentence intelligibility, and communication efficiency in reading. Furthermore, the authors reported a case report (Constantinescu et al, 2010b) validating the utility of online delivery of LSVT.…”