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  • 1
    Online Resource
    Online Resource
    Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study
    American Speech Language Hearing Association ; 2022
    In:  American Journal of Speech-Language Pathology Vol. 31, No. 6 ( 2022-11-16), p. 2741-2758
    Details
    In: American Journal of Speech-Language Pathology, American Speech Language Hearing Association, Vol. 31, No. 6 ( 2022-11-16), p. 2741-2758
    Abstract: Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth. Method: Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures—a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST—within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR. Results: Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment. Conclusions: Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders. Supplemental Material: https://doi.org/10.23641/asha.21357669
    Type of Medium: Online Resource
    ISSN: 1058-0360 , 1558-9110
    URL: Article
    DOI: 10.1044/2022_AJSLP-22-00063
    Language: English
    Publisher: American Speech Language Hearing Association
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Obtaining Objective Clinical Measures During Telehealth Evaluations of Dysarthria
    American Speech Language Hearing Association ; 2021
    In:  American Journal of Speech-Language Pathology Vol. 30, No. 2 ( 2021-03-26), p. 503-516
    Details
    In: American Journal of Speech-Language Pathology, American Speech Language Hearing Association, Vol. 30, No. 2 ( 2021-03-26), p. 503-516
    Abstract: COVID-19 has shifted models of health care delivery, requiring the rapid adoption of telehealth, despite limited evidence and few resources to guide speech-language pathologists. Management of dysarthria presents specific challenges in the telehealth modality. Evaluations of dysarthria typically rely heavily on perceptual judgments, which are difficult to obtain via telehealth given a variety of technological factors such as inconsistencies in mouth-to-microphone distance, changes to acoustic properties based on device settings, and possible interruptions in connection that may cause video freezing. These factors limit the validity, reliability, and clinicians' certainty of perceptual speech ratings via telehealth. Thus, objective measures to supplement the assessment of dysarthria are essential. Method This tutorial outlines how to obtain objective measures in real time and from recordings of motor speech evaluations to support traditional perceptual ratings in telehealth evaluations of dysarthria. Objective measures include pause patterns, utterance length, speech rate, diadochokinetic rates, and overall speech severity. We demonstrate, through clinical case vignettes, how these measures were completed following three clinical telehealth evaluations of dysarthria conducted via Zoom during the COVID-19 pandemic. This tutorial describes how each of these objective measures were utilized, in combination with subjective perceptual analysis, to determine deviant speech characteristics and their etiology, develop a patient-specific treatment plan, and track change over time. Conclusion Utilizing objective measures as an adjunct to perceptual ratings for telehealth dysarthria evaluations is feasible under real-world pandemic conditions and can be used to enhance the quality and utility of these evaluations.
    Type of Medium: Online Resource
    ISSN: 1058-0360 , 1558-9110
    URL: Article
    DOI: 10.1044/2020_AJSLP-20-00243
    Language: English
    Publisher: American Speech Language Hearing Association
    Publication Date: 2021
    Location Call Number Limitation Availability
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