Impact of Dysphagia Severity on Clinical Decision Making via Telerehabilitation

Ward, Elizabeth C.; Burns, Clare L.; Theodoros, Deborah; Russell, Trevor

doi:10.1089/tmj.2013.0198

Cited by 57 publications

(104 citation statements)

References 38 publications

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“…These results match well with those of 2 previous studies that found that dysphagia severity and cognitive impairment did not affect agreement between bedside and remote swallow screen diet recommendations [5,6]. Overall, our results support the use of teleswallow evaluations across a wide range of patients and impairment severities.…”

Section: Discussionsupporting

confidence: 92%

“…Using 3 measures of agreement with increasing rigor (Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank), we report outcomes that are similar to previous clinical teleswallow reports [3,5,6]. In terms of safety, only 2% of patients developed HAP, and after extensive review of the cases, it appeared that both were unrelated to diet.…”

Section: Discussionsupporting

confidence: 72%

“…Telehealth clinical swallow evaluations have been shown to be safe and reliable in a number of clinical contexts, including post-laryngectomy, head and neck cancer, mild cognitive impairment, general dysphagia, and pediatric dysphagia [3,4,5,6,7]. The majority of previous teleswallow research studies have utilized simultaneous assessment through videoconferencing between a face-to-face and online SLP.…”

Section: Introductionmentioning

confidence: 99%

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Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

Morrell¹,

Hyers²,

Stuchiner

et al. 2017

Cerebrovasc Dis

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Background: Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. Methods: A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. Results: We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p < 0.001; Wilcoxon signed rank = -0.818, p = 0.417) and solid (87% agreement; kappa = 0.792; Kendall's tau-b = 0.844, p < 0.001; Wilcoxon signed rank = 0.243, p = 0.808) dietary textures. From regression modeling, there is suggestive but inconclusive evidence that higher National Institute of Health Stroke Scale (NIHSS) scores correlate with lower levels of agreement for liquid diet recommendations (OR [95% CI] 0.895 [0.793-1.01]; p = 0.07). There was no impact of NIHSS score for solid diet recommendations and no impact of stroke location on solid or liquid diet recommendations. Qualitatively, we identified professional, logistical, technical, and patient barriers to implementation, many of which resolved with experience over time. Conclusions: Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

Morrell¹,

Hyers²,

Stuchiner

et al. 2017

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…This approach uses Artificial Neural Networks (ANN) and Classification and Regression Trees (CART) along 127 attributes of children's profiles to assist the therapists for precise assessment and appropriate treatment. Most recently, Ward, Burns, Theodoros and Russell [17] conducted an experiment to perform a Clinical Swallowing Examination (CSE) on 100 patients (25 nondysphagics and 25 mild, 25 moderate, and 25 severe dysphagics) using a telehealth system. Their research reported good levels of acceptance in each group of patients during the clinical decision making for safety of oral intake and the clinicians' perceptions of CSEs conducted via telerehabilitation.…”

Section: Swallowing Disorders: Dysphagiamentioning

confidence: 99%

A Proposal of an Ecosystem Based on Intelligent Ict Tools to Support the Diagnosis and Intervention of Patients With Communication Disorders

López‐Nores¹,

García‐Duque²,

Pazos‐Arias³

et al. 2016

ings

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“…Studies have compared the accuracy of online assessment and the effectiveness of online treatment with FTF service across a range of areas of speech pathology practice. To date the finding have been very positive with no significant differences found between traditional and FTF methods of service delivery across populations with various speech, language and swallowing disorders (Brennan, Georgeadis, Baron, & Barker, 2004;Carey et al, 2010;Constantinescu, Theodoros, Russell, Ward, Wilson, & Wootton, 2010;Duffy, Werven & Aronson, 1997;Georgeadis, Brenna, Barker, & Baron, 2004;Lasker, Stierwalt, Spence, & Calvin-Root, 2010;Mashima et al, 2003;Theodoros & Russell, 2008, Tindall, Huebner, Stemple, & Kleinert, 2008Ward, Burns, Theodoros, & Russell, 2013;Ward, Burns, Theodoros, & Russell, 2014).…”

Section: Alternative Methods Of Service Delivery: Telepracticementioning

confidence: 99%

Efficacy of intensive voice therapy for patients with vocal fold nodules

Fu¹

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The primary aetiologic factor for vocal fold nodules has been proposed to be cumulative perpendicular impact stress between the vocal folds over time, which increases with voice use (Titze, 1994). Many people with vocal fold nodules work in high vocal demand occupations, therefore, it is essential that they recover vocal function so that their ability to perform their jobs is not compromised (Karkos & McCormick, 2009). A number of studies have reported positive improvements in vocal fold nodules following various types of behavioural voice therapy, and as such, voice therapy is recommended as a first-line treatment .The majority of the intervention studies for patients with vocal fold nodules have examined treatment outcomes following traditional voice therapy models, typically delivered once a week over a period of multiple weeks. To date, no studies have systematically examined the impact of using an intensive, massed practice therapy approach. In that the rehabilitation process for vocal fold nodules requires the learning, maintenance and transfer of new behaviours, it is possible that a more condensed voice therapy protocol may yield equal or even greater benefit. Therefore, the primary aim of this thesis was to explore the efficacy of intensive voice therapy (eight sessions within 3 weeks) as compared with traditional voice therapy (one session per week for 8 weeks).Both the short and long term effects of the different treatments on perceptual, acoustic, and physiological outcomes were examined.Although it has been established that voice therapy is often effective, in many caseloads, rates of therapy completion are poor and this creates a challenge for clinicians (Portone-Maira, Wise, Johns, & Hapner, 2011). Traditional, face-to-face (FTF) voice therapy has shown dropout rates as high as 65% (Hapner, Portone-Maira, & Johns, 2009). Various factors contributing to nonattendance include travel time, inflexible work conditions, and inability to access due to physical barriers. Non-attendance not only affects treatment success, but also results in unnecessary extensions to treatment, and repeated examinations without sufficient behavioural change to effect improvement. Ultimately, there may be a loss of revenue or even employment if patients are unable to meet the vocal requirements of their occupations (Portone, et al., 2008;Portone-Maira et al., 2011). Consequently, there is a need to explore ways to help maximise attendance and ultimately enhance outcomes for people with vocal fold nodules. To this end, the secondary aim of this thesis iii was to examine the feasibility and outcomes of delivering intensive voice therapy via telepractice, as an alternative service delivery model for patients with vocal fold nodules.To address aim one, 53 female patients (56% professional voice users) with bilateral vocal fold nodules were recruited. Participants were matched in pairs according to their age, occupation, and severity of dysphonia and assigned to either of two treatment groups: traditional therapy of eigh...

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Impact of Dysphagia Severity on Clinical Decision Making via Telerehabilitation

Cited by 57 publications

References 38 publications

Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

A Proposal of an Ecosystem Based on Intelligent Ict Tools to Support the Diagnosis and Intervention of Patients With Communication Disorders

Efficacy of intensive voice therapy for patients with vocal fold nodules

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