Elsevier

Mayo Clinic Proceedings

Volume 72, Issue 12, December 1997, Pages 1116-1122
Mayo Clinic Proceedings

Mayo Clinic Proceedings
Telemedicine and the Diagnosis of Speech and Language Disorders

https://doi.org/10.4065/72.12.1116Get rights and content

•Objective

To summarize results of telemedicine evaluations of speech and language disorders in patients in a small, rural hospital and in large multidisciplinary medical practices.

•Material and Methods

Eight patients underwent assessment as part of experiments with the National Aeronautics and Space Administration-launched Advanced Communications Technology Satellite. A second clinician was on-site with patients to assess the reliability of satellite observations. Twenty-four previously videotaped samples of speech disorders were also transmitted to assess agreement with original face-to-face clinical diagnoses. In addition, results of 150 telemedicine evaluations among Mayo Clinic practices in Minnesota, Arizona, and Florida were examined retrospectively.

•Results

Evaluations were reliable, and patient satisfaction was good. Diagnoses were consistent with lesion localization and medical diagnosis when they were known, and they frequently had implications for lesion localization and medical diagnosis and management when they were previously unknown. The frequency of uncertain diagnosis (13%) for evaluation among the Mayo practices was only slightly higher than that encountered in face-to-face practice. Faceto-face evaluations were considered necessary for only 6 of the 150 patients (4%).

•Conclusion

Telemedicine evaluations can be reliable, beneficial, and acceptable to patients with a variety of acquired speech and language disorders, both in rural settings and within large multidisciplinary medical settings.

Section snippets

METHODS

Environment and Examination Protocol (ACTS Project and Mayo TMCs).—The teleconference environment during the ACTS project and the Mayo TMCs enabled patients to see the clinician—usually from the waist up—on a television monitor. The loudness could be adjusted to a comfortable listening level. An overhead camera allowed projection of pictures and printed materials on the monitor, and size and focus were adjustable by the clinician or technical assistant.

The camera could be adjusted to provide

RESULTS

ACTS Project.—The characteristics of the eight patients who underwent assessment for the ACTS project are summarized in Table 1. Seven patients had a history of central nervous system disease and had signs and symptoms beyond those reflected in their speech and language. The duration of their disorders ranged from several months to 18 years. One patient had a long history of an unexplained voice problem. Five of the eight patients had hearing loss, visual impairment, or cognitive impairment; in

DISCUSSION

Our experiences with telemedicine have been positive for participating clinicians, referring health-care providers, and patients and their caregivers. They demonstrate that speech pathology consultation-by-satellite to both rural areas and large multidisciplinary medical settings can contribute to medical diagnosis and management of numerous communication disorders. The contributions range from evaluation and management recommendations for disorders commonly dealt with by speech-language

CONCLUSION

Our experience supports the conclusion that telemedicine is an appropriate medium for providing speech-language pathology consultation that is reliably accurate in identifying various acquired neurogenic and psychogenic speech disorders, with implications for lesion localization and, sometimes, specific medical diagnosis. Such evaluation may also identify a need for additional medical assessment or may help formulate appropriate medical or behavioral management strategies. Telemedicine

ACKNOWLEDGMENT

We thank the many members of the Mayo Foundation Video Communications staff who contributed to the ACTS project and to our Mayo TMCs. We appreciated the technical and administrative support and encouragement of Bijoy K. Khandheria, M.D., Marvin P. Mitchell, Abdul R. Bengali, Michael B. Wood, M.D., and Barry K. Gilbert, Ph.D., during the NASA project. We also thank the staff at St. Elizabeth's Hospital in Wabasha, Minnesota, for assistance in identifying and facilitating the assessment of

REFERENCES (3)

  • RT Wertz et al.

    Appraisal and diagnosis of neurogenic communication disorders in remote settings

There are more references available in the full text version of this article.

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