Remote Management of Voice and Swallowing Disorders
Section snippets
Telehealth in speech-language pathology
SLPs have documented the use of telehealth since the 1970s. Early applications and investigations in the use of telecommunication technologies focused on diagnosing and supplementing in-person treatment of neurogenic communication disorders in Veterans’ Administration and Mayo Clinic facilities.9, 10, 11 More recently, significant research in the area of telehealth in speech-language pathology has been conducted in Australia, where distances and limited access to SLPs make telehealth a
Developing telehealth applications for voice and swallowing disorders
It is estimated that voice disorders affect as much as 10% of the United States population and are more prevalent in professional voice users who depend on their voice for work, such as teachers.35 SLPs and otolaryngologists evaluate patients with voice complaints, and recommend treatment. Voice therapy provided by certified SLPs is effective in addressing behavioral issues contributing to hoarseness.35, 36
Approximately 10 million Americans with swallowing difficulties are evaluated each year.37
Remote management of voice disorders
Empirical studies by SLPs support the use of telehealth to diagnose and treat voice disorders remotely. Duffy and colleagues9 conducted telemedicine consultations at Mayo Clinic facilities between 1987 and 1994. In a review of 150 consultations, 82 patients were diagnosed with voice disorders including spasmodic dysphonia, voice tremor, psychogenic dysphonia, and musculoskeletal tension dysphonia. Otolaryngologic intervention was recommended for 50 patients. The investigators concluded that
Remote management of swallowing disorders
There are few published reports of telehealth applications in the area of dysphagia. Three articles describe remote videofluoroscopic examination of oral/pharyngeal swallowing function. In 2002 at the University of Illinois, Urbana-Champaign, Perlman and Witthawaskul32 developed an Internet-based system that allowed a swallowing specialist to direct a videofluorosocopic study remotely by viewing synchronous video transmission of swallowing images in near real time captured from a fluoroscope at
Professional issues in telehealth for SLPs
While the research to date and interest in telehealth support continues to grow, major barriers to the expansion of telehealth by SLPs are licensure and reimbursement. At present, state licensure laws that address telehealth require SLPs to hold a full license in the state where the patient resides, and in their own state. ASHA has suggested the use of a limited license for telehealth to mitigate this burden.24
Telemedicine legislation passed by Congress in 1997 and 2000 designated eligible
Future directions in remote management of voice and swallowing disorders
Additional research is needed to investigate clinical and operational aspects of remote management of voice and swallowing disorders. Outcome measures including clinical effectiveness and clinician and patient satisfaction have been positive in the limited studies available, with the general exception of degraded quality of audio and video signals at low bandwidth transmission (eg, 128 Kbps). This assessment is consistent with a review conducted by Jarvis-Selinger and colleagues54 in 2008 of
Summary
Telehealth or telepractice in speech-language pathology has significant potential to address personnel shortages, unavailability of subspecialists, and barriers in accessing services. Evaluative data are needed to establish evidence-based guidelines and minimal technical requirements to support clinical decision-making for accurate diagnoses and effective treatment comparable to in-person delivery. Additional studies are needed to advance the remote management of voice and swallowing disorders
Acknowledgments
The authors thank Dr Michael Holtel, Ms Julia Notarianni, Dr Mark Syms, Mr Greg Suenaga, Mr Neil Sakauye, Mr Sean Wong, Dr Douglas Miller, Dr Lawrence Burgess, Dr Joseph Sniezek, Dr Reese Omizo, Dr Dimitry Goufman, Dr Deborah Birkmire-Peters, Dr Les Peters, and Dr Stan Saiki.
References (54)
- et al.
Telemedicine and the diagnosis of speech and language disorders
Mayo Clin Proc
(1997) - et al.
Clinical practice guideline: hoarseness (dysphonia)
Otolaryngol Head Neck Surg
(2009) - et al.
Telemedicine in otolaryngology
Otolaryngol Clin North Am
(2002) - et al.
Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory effort treatment for individuals with Parkinson disease
J Voice
(2001) - Bureau of Labor Statistics, U.S. Department of Labor. Occupational outlook handbook, 2010-11 edition, speech-language...
2009 SLP health care survey summary report: number and type of responses
(2009)2005 SLP health care survey summary report: frequency report
(2005)Moving toward the future: providing speech-language pathology services via telehealth
Home Healthc Nurse
(2007)Telemedicine for speech-language pathology: history, challenges, and opportunities
(2006)- et al.
Managing urban speech therapy caseloads successfully by using telehealth
Caring
(2006)
Telepractice in the city: the story of the visiting nurse service of New York home care
ASHA Lead
Telehealth applications in speech-language pathology
J Healthc Inf Manag
Tele-communicology: health-care delivery system for persons with communication disorders
ASHA
Potential of telephonic and television technology for appraising and diagnosing neurogenic communication disorders in remote settings
Aphasiology
An internet-based telerehabilitation system for the assessment of motor speech disorders: a pilot study
Am J Speech Lang Pathol
Telehealth delivery of the Camperdown Program for adults who stutter: a phase I trial
J Speech Lang Hear Res
Assessing acquired language disorders in adults via the Internet
Telemed J E Health
Treating the speech disorder in Parkinson’s disease online
J Telemed Telecare
A pilot study of online assessment of childhood speech disorders
J Telemed Telecare
Assessment of communication and swallowing function post laryngectomy: a telerehabilitation trial
J Telemed Telecare
Telehealth adaptation of the Lidcombe Program of early stuttering intervention: five case studies
Am J Speech Lang Pathol
Using telerehabilitation to assess apraxia of speech in adults
Int J Lang Commun Disord
Assessing disordered speech and voice in Parkinson’s disease: a telerehabilitation application
Int J Lang Commun Disord
Cited by (27)
Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?
2024, Journal of VoiceCitation Excerpt :Increased demand for telehealth services has led to changes in the evaluation and treatment of voice disorders.1,10 Despite preliminary evidence suggesting that this model is feasible,9 a major concern is determining when a laryngeal examination is urgent versus when it can reasonably be delayed.10 This study examined how accurately otolaryngology residents could determine medical urgency of voice disorders using auditory-perceptual voice assessments performed via Zoom.
Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists
2023, International Journal of Pediatric OtorhinolaryngologyExamining Use and Effectiveness of Teletherapy for Patients with Dysphonia
2023, Journal of Voice
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.