Gabriella Constantinescu

Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial.

BACKGROUND Telerehabilitation may be a feasible solution to the current problems faced by people with Parkinsons disease in accessing speech pathology services. AIM To investigate the validity and reliability of online delivery of the Lee Silverman Voice Treatment (LSVT®) for the speech and voice disorder associated with Parkinsons disease. METHOD & PROCEDURES Thirty-four participants with Parkinsons disease and mild-to-moderate hypokinetic dysarthria took part in the randomized controlled non-inferiority laboratory trial and received the LSVT® in either the online or the face-to-face environment. Online sessions were conducted via two personal computer-based videoconferencing systems with real-time and store-and-forward capabilities operating on a 128 kbit/s Internet connection. Participants were assessed pre- and post-treatment on acoustic measures of mean vocal sound pressure level, phonation time, maximum fundamental frequency range, and perceptual measures of voice, articulatory precision and speech intelligibility. OUTCOMES & RESULTS Non-inferiority of the online LSVT® modality was confirmed for the primary outcome measure of mean change in sound pressure level on a monologue task. Additionally, non-significant main effects for the LSVT® environment, dysarthria severity, and interaction effects were obtained for all outcomes measures. Significant improvements following the LSVT® were also noted on the majority of measures. The LSVT® was successfully delivered online, although some networking difficulties were encountered on a few occasions. High participant satisfaction was reported overall. CONCLUSIONS & IMPLICATIONS Online treatment for hypokinetic dysarthria associated with Parkinsons disease appears to be clinically valid and reliable. Suggestions for future research are outlined.

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

BACKGROUND Patients with Parkinsons 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 Parkinsons disease. AIMS To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinsons disease. METHODS & PROCEDURES Sixty-one participants with Parkinsons 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-to-face 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 inter-rater 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 Parkinsons 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 Parkinsons disease.

Treating the speech disorder in Parkinson's disease online:

The Lee Silverman Voice Treatment (LSVT) has been shown to be highly effective in treating the speech disorder in Parkinsons 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 (P<0.01), pitch range (P<0.05) and in perceptual features of pitch and loudness variability, loudness level (P<0.01) and breathiness (P<0.05). 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.

Home-based speech treatment for Parkinson's disease delivered remotely: a case report

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 Parkinsons disease. The treatment was delivered in 16 sessions to the participants 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.

Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study.

Objective: Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. Study Design: This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. Patients: Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). Main Outcome Measure(s): Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. Results: Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and &khgr;2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. Conclusions: 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.

Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs.

Objective The relative impact of early intervention approach on speech perception and language skills was examined in these 3 well-matched groups of children using cochlear implants. Study Design Eight children from an auditory verbal intervention program were identified. From a pediatric database, researchers blind to the outcome data, identified 23 children from auditory oral programs and 8 children from bilingual-bicultural programs with the same inclusion criteria and equivalent demographic factors. Patients All child participants were male, had congenital profound hearing loss (pure tone average >80 dBHL), no additional disabilities, were within the normal IQ range, were monolingual English speakers, had no unusual findings on computed tomography/magnetic resonance imaging, and received hearing aids and cochlear implants at a similar age and before 4 years of age. Main Outcome Measures Open-set speech perception (consonant-nucleus-consonant [CNC] words and Bamford-Kowal-Bench [BKB] sentences) and the Peabody Picture Vocabulary Test (PPVT) were administered. Results The mean age at cochlear implant was 1.7 years (range, 0.8–3.9; SD, 0.7), mean test age was 5.4 years (range, 2.5–10.1; SD, 1.7), and mean device experience was 3.7 years (range, 0.7–7.9; SD, 1.8). Results indicate mean CNC scores of 60%, 43%, and 24% and BKB scores of 77%, 77%, and 56% for the auditory-verbal (AV), aural-oral (AO), and bilingual-bicultural (BB) groups, respectively. The mean PPVT delay was 13, 19, and 26 months for AV, AO, and BB groups, respectively. Conclusion Despite equivalent child demographic characteristics at the outset of this study, by 3 years postimplant, there were significant differences in AV, AO, and BB groups. Results support consistent emphasis on oral/aural input to achieve optimum spoken communication outcomes for children using cochlearimplants.

Satisfaction with telemedicine for teaching listening and spoken language to children with hearing loss

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 childs 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.

Language outcomes for children with cochlear implants enrolled in different communication programs

Abstract Objectives The aims of this study were to (a) compare language outcomes in pediatric cochlear implant users enrolled in three different communication programs: sign and spoken language, auditory–oral, and auditory–verbal therapy, and (b) examine factors influencing language outcomes. Methods Post-implant standard scores on language assessments of receptive vocabulary, auditory comprehension, and expressive communication were collected from files of 42 children with prelingual hearing loss who were implanted by 3;6 years of age. Early intervention history, device details, and demographic information were obtained for each child. Family involvement was evaluated using a rating scale. Results After adjusting for potential covariates, there were no significant differences in language outcomes across the three groups. Overall, there was a large degree of variability with some children achieving below average scores and others achieving above average scores. Age at diagnosis of hearing loss and family involvement were significantly associated with language outcomes. Conclusion 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.

A pilot study of telepractice delivery for teaching listening and spoken language to children with hearing loss

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.