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Semin Speech Lang 2012; 33(03): 243-258
DOI: 10.1055/s-0032-1320044
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Telerehabilitation, Virtual Therapists, and Acquired Neurologic Speech and Language Disorders

Leora R. Cherney
1   Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago
2   Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Sarel van Vuuren
3   Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado
4   Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado
› Author Affiliations
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Publication History

Publication Date:
31 July 2012 (online)

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Abstract

Telerehabilitation (telerehab) offers cost-effective services that potentially can improve access to care for those with acquired neurologic communication disorders. However, regulatory issues including licensure, reimbursement, and threats to privacy and confidentiality hinder the routine implementation of telerehab services into the clinical setting. Despite these barriers, rapid technological advances and a growing body of research regarding the use of telerehab applications support its use. This article reviews the evidence related to acquired neurologic speech and language disorders in adults, focusing on studies that have been published since 2000. Research studies have used telerehab systems to assess and treat disorders including dysarthria, apraxia of speech, aphasia, and mild Alzheimer disease. They show that telerehab is a valid and reliable vehicle for delivering speech and language services. The studies represent a progression of technological advances in computing, Internet, and mobile technologies. They range on a continuum from working synchronously (in real-time) with a speech-language pathologist to working asynchronously (offline) with a stand-in virtual therapist. One such system that uses a virtual therapist for the treatment of aphasia, the Web-ORLA™ (Rehabilitation Institute of Chicago, Chicago, IL) system, is described in detail. Future directions for the advancement of telerehab for clinical practice are discussed.

Keywords

Telerehabilitation - telepractice - dysarthria - apraxia of speech - aphasia - virtual therapist - assessment - treatment
 

  • References

  • 1 Brennan DM, Tindall L, Theodoros D , et al; American Telemedicine Association. A blueprint for telerehabilitation guidelines—October 2010. Telemed J E Health 2011; 17 (8) 662-665
    CrossrefPubMedGoogle Scholar
  • 2 Brown J. ASHA and the evolution of telepractice. Perspect Telepract 2011; 1: 4-9
    PubMedGoogle Scholar
  • 3 Cason J, Brannon JA. Telehealth regulatory and legal considerations: frequently asked questions. Int J Telerehabil 2011; 3: 15-18
    PubMedGoogle Scholar
  • 4 Cohn ER, Watzlaf VJM. Privacy and Internet-based telepractice. Perspect Telepract 2011; 1: 26-37
    PubMedGoogle Scholar
  • 5 Vaughn GR. Tel-communicology: health-care delivery system for persons with communicative disorders. ASHA 1976; 18 (1) 13-17
    PubMedGoogle Scholar
  • 6 Wertz RT, Dronkers NF, Bernstein-Ellis E , et al. Appraisal and diagnosis of neurogenic communication disorders in remote settings. Clin Aphasiology 1987; 17: 117-123
    PubMedGoogle Scholar
  • 7 Wertz RT, Dronkers NF, Bernstein-Ellis E , et al. Potential of telephonic and television technology for appraising and diagnosing neurogenic communication disorders in remote settings. Aphasiology 1992; 6: 195-202
    CrossrefPubMedGoogle Scholar
  • 8 Duffy JR, Werven GW, Aronson AE. Telemedicine and the diagnosis of speech and language disorders. Mayo Clin Proc 1997; 72 (12) 1116-1122
    CrossrefPubMedGoogle Scholar
  • 9 Hill AJ, Theodoros DG, Russell TG, Cahill LM, Ward EC, Clark KM. An Internet-based telerehabilitation system for the assessment of motor speech disorders: a pilot study. Am J Speech Lang Pathol 2006; 15 (1) 45-56
    CrossrefPubMedGoogle Scholar
  • 10 Enderby P. Frenchay Dysarthria Assessment. San Diego, CA: College-Hill Press; 1983
    Google Scholar
  • 11 Yorkston KM, Beukelman DR. Assessment of Intelligibility of Dysarthric Speech. Austin, TX: Pro-Ed; 1988
    Google Scholar
  • 12 Darley FL, Aronson AE, Brown JR. Motor Speech Disorders. Philadelphia, PA: WB Saunders; 1975
    Google Scholar
  • 13 Hill AJ, Theodoros DG, Russell TG, Ward EC. The re-design and re-evaluation of an internet-based telerehabilitation system for the assessment of dysarthria in adults. Telemed J E Health 2009; 15: 840-850
    CrossrefPubMedGoogle Scholar
  • 14 Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Assessing disordered speech and voice in Parkinson's disease: a telerehabilitation application. Int J Lang Commun Disord 2010; 45 (6) 630-644
    CrossrefPubMedGoogle Scholar
  • 15 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17 (5) 427-442
    CrossrefPubMedGoogle Scholar
  • 16 Dabul BL. Apraxia Battery for Adults. 2nd ed. Austin, TX: Pro-Ed Inc.; 2000
    Google Scholar
  • 17 Hill AJ, Theodoros DG, Russell TG, Ward EC. Using telerehabilitation to assess apraxia of speech in adults. Int J Lang Commun Disord 2009; 44 (5) 731-747
    CrossrefPubMedGoogle Scholar
  • 18 Ramig LO, Dromey C. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease. J Speech Hear Res 1996; 39 (4) 798-807
    PubMedGoogle Scholar
  • 19 Ramig LO, Sapir S, Fox C, Countryman S. Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls. Mov Disord 2001; 16 (1) 79-83
    CrossrefPubMedGoogle Scholar
  • 20 Sapir S, Ramig LO, Hoyt P, Countryman S, O'Brien C, Hoehn M. Speech loudness and quality 12 months after intensive voice treatment (LSVT) for Parkinson's disease: a comparison with an alternative speech treatment. Folia Phoniatr Logop 2002; 54 (6) 296-303
    CrossrefPubMedGoogle Scholar
  • 21 Ramig LO, Sapir S, Countryman S , et al. Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. J Neurol Neurosurg Psychiatry 2001; 71 (4) 493-498
    CrossrefPubMedGoogle Scholar
  • 22 Baumgartner CA, Sapir S, Ramig TO. Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory effort treatment for individuals with Parkinson disease. J Voice 2001; 15 (1) 105-114
    CrossrefPubMedGoogle Scholar
  • 23 Sapir S, Spielman J, Ramig L, Story BH, Fox C. Effects of intensive voice treatment (LSVT) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: Acoustic and perceptual findings. J Speech Lang Hear Res 2007; 50: 899-912
    CrossrefPubMedGoogle Scholar
  • 24 Theodoros D, Ramig L. Telepractice supported delivery of LSVTOUD. Perspect Neurophysiol Neurogen Speech Lang Disord 2011; 21: 107-119
    PubMedGoogle Scholar
  • 25 Tindall LR, Huebner RA, Stemple JC, Kleinert HL. Video-phone delivered voice therapy: A comparative analysis of outcomes to traditional delivery for adults with Parkinson's disease. Telemed J E Health 2008; 14: 1070-1077
    CrossrefPubMedGoogle Scholar
  • 26 Howell S, Tripoliti E, Pring T. Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study. Int J Lang Commun Disord 2009; 44 (3) 287-300
    CrossrefPubMedGoogle Scholar
  • 27 Theodoros DG, Constantinescu G, Russell T, Ward EC, Wilson SJ, Wootton R. Treating the speech disorder in Parkinson's disease online. J Telemed Telecare 2006; 12 (Suppl. 03) 88-91
    PubMedGoogle Scholar
  • 28 Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial. Int J Lang Commun Disord 2011; 46 (1) 1-16
    PubMedGoogle Scholar
  • 29 Constantinescu GA, Theodoros DG, Russell TG, Ward EC, Wilson SJ, Wootton R. Home-based speech treatment for Parkinson's disease delivered remotely: a case report. J Telemed Telecare 2010; 16 (2) 100-104
    CrossrefPubMedGoogle Scholar
  • 30 Tindall LR, Huebner RA. The impact of an application of telerehabilitation technology on caregiver burden. Int J Telerehabil 2009; 1: 3-7
    PubMedGoogle Scholar
  • 31 Halpern A, Matos C, Ramig L, Petska J, Spielman J. LSVTC - A PDA supported speech treatment for Parkinson's disease. 9th International Congress of Parkinson's Disease and Movement Disorders. New Orleans, LA: 2005
    Google Scholar
  • 32 Georgeadis AC, Brennan DM, Barker LM, Baron CR. Telerehabilitation and its effect on story retelling by adults with neurogenic communication disorders. Aphasiology 2004; 18: 639-652
    CrossrefPubMedGoogle Scholar
  • 33 Doyle P, McNeil M, Spencer K, Goda A, Cotrell K, Lustig A. The effects of concurrent picture presentation on retelling of orally presented stories by adults with aphasia. Aphasiology 1998; 12: 561-574
    CrossrefPubMedGoogle Scholar
  • 34 McNeil M, Doyle P, Fossett T, Park G, Goda A. Reliability and concurrent validity of the information unit scoring metric for the story retelling procedure. Aphasiology 2001; 15: 991-1006
    CrossrefPubMedGoogle Scholar
  • 35 Brennan DM, Georgeadis AC, Baron CR, Barker LM. The effect of videoconference-based telerehabilitation on story retelling performance by brain-injured subjects and its implications for remote speech-language therapy. Telemed J E Health 2004; 10 (2) 147-154
    CrossrefPubMedGoogle Scholar
  • 36 Palsbo SE. Equivalence of functional communication assessment in speech pathology using videoconferencing. J Telemed Telecare 2007; 13 (1) 40-43
    PubMedGoogle Scholar
  • 37 Goodglass H, Kaplan E, Barresi B. Boston Diagnostic Aphasia Examination. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001
    Google Scholar
  • 38 Theodoros D, Hill A, Russell T, Ward E, Wootton R. Assessing acquired language disorders in adults via the Internet. Telemed J E Health 2008; 14 (6) 552-559
    CrossrefPubMedGoogle Scholar
  • 39 Hill AJ, Theodoros DG, Russell TG, Ward EC, Wootton R. The effects of aphasia severity on the ability to assess language disorders via telerehabilitation. Aphasiology 2009; 23: 627-642
    CrossrefPubMedGoogle Scholar
  • 40 Kaplan E, Goodglass H, Weintraub S. The Boston Naming Test. Philadelphia, PA: Lee & Ferbiger; 2000
    Google Scholar
  • 41 Vestal L, Smith-Olinde L, Hicks G, Hutton T, Hart Jr J. Efficacy of language assessment in Alzheimer's disease: comparing in-person examination and telemedicine. Clin Interv Aging 2006; 1 (4) 467-471
    CrossrefPubMedGoogle Scholar
  • 42 Benton A, Hamsher K, Sivan A. Multilingual Aphasia Examination. 3rd ed. Iowa City, IA: AJA Associates; 2000
    Google Scholar
  • 43 Dechene L, Tousignant M, Boissy P , et al. Simulated in-home teletreatment for anomia. Int J Telerehabil 2011; 3 (2) 3-10
    PubMedGoogle Scholar
  • 44 Rende B, Ramsberger G. Telepractice experiences in a university training clinic. Perspect Neurophysiol Neurogen Speech Lang Disord 2011; 21: 120-129
    PubMedGoogle Scholar
  • 45 Ramsberger G, Rende B, Messamer P. TeleCILT: Constraint-Induced Language Therapy delivered via telerehabilitation. Presented at: Annual Convention of the American Speech Language Hearing Association. Philadelphia, PA: ; November 18–20, 2012
    Google Scholar
  • 46 Maher LM, Kendall D, Swearengin JA , et al. A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. J Int Neuropsychol Soc 2006; 12 (6) 843-852
    PubMedGoogle Scholar
  • 47 Kertesz A. Western Aphasia Battery. San Antonio, TX: The Psychological Corp.; 1982
    Google Scholar
  • 48 Mortley J, Wade J, Enderby P. Superhighway to promoting a client-therapist partnership? Using the Internet to deliver word-retrieval computer therapy, monitored remotely with minimal speech and language input. Aphasiology 2004; 18: 193-211
    CrossrefPubMedGoogle Scholar
  • 49 Wade J, Mortley J, Enderby P. Talk about IT: views of people with aphasia and their partners on receiving remotely monitored computer-based word finding therapy. Aphasiology 2003; 17: 1031-1056
    CrossrefPubMedGoogle Scholar
  • 50 Cherney LR, Merbitz CT, Grip JC. Efficacy of oral reading in aphasia treatment outcome. Rehabil Lit 1986; 47 (5-6) 112-118
    PubMedGoogle Scholar
  • 51 Cherney LR. Efficacy of oral reading in the treatment of two patients with chronic Broca's aphasia. Top Stroke Rehabil 1995; 2: 57-67
    PubMedGoogle Scholar
  • 52 Cherney LR. Oral Reading for Language in Aphasia (ORLA): impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia. Semin Speech Lang 2010; 31: 42-51
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Cherney LR. Oral reading for language in aphasia (ORLA): evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Top Stroke Rehabil 2010; 17 (6) 423-431
    CrossrefPubMedGoogle Scholar
  • 54 Cherney LR, Kaye RC, Hitch RS. The best of both worlds: combining synchronous and asynchronous telepractice in the treatment of aphasia. Perspect Neurophysiol Neurogen Speech Lang Disord 2011; 21: 83-93
    PubMedGoogle Scholar
  • 55 Cherney L, Babbit E, Kwang-Youn K, Van Vuuren S, Ngampatipatpong N. Aphasia Treatment over the Internet: A Randomized Placebo-Controlled Clinical Trial. Presented at: Clinical Aphasiology Conference. Ft. Lauderdale, FL; May 31–June 4, 2011
    PubMedGoogle Scholar
  • 56 Cherney LR, Van Vuuren S, Ngampatipatpong N. Telerehabilitation for Aphasia: From Real to Virtual Therapists. Presented at: Annual Convention of the American-Speech Language Hearing Association (ASHA). Philadelphia, PA: ; November 18–20, 2010
    Google Scholar
  • 57 Van Vuuren S. Technologies that power pedagogical agents - vision and future. Educ Technol 2007; 24: 4-10
    PubMedGoogle Scholar
  • 58 Van Vuuren S. Read My Lips: An Animated Agent with Accurate Visible Speech for Learning on the Web. Second Innovative Seed Grant Competition. University of Colorado Boulder; 2008
    Google Scholar
  • 59 Van Vuuren S, Ngampatipatpong N. Interactive Learning Assistants for Online and Mobile Accessibility. Presented at: 1st IEEE conference on Accessing the Future. Boston, MA; July 19–20, 2009
    PubMedGoogle Scholar
  • 60 Van Vuuren S, Ngampatipatpong N. Digital Agents for Mobile, Tablet and HTML5 based Interactive Prompting. Presented at: 11th Annual Coleman Institute Conference. Westminster, CO; October 13, 2011
    Google Scholar
  • 61 Ma J, Cole R, Ward W, Wise B. Accurate Automatic Visible Speech Synthesis of Arbitrary 3D Models Based on Concatenation of Di-Viseme Motion Capture Data. J Comp Anim Virtual Worlds 2004; 15: 485-500
    PubMedGoogle Scholar
  • 62 Horrigan J. Wireless Internet Usage 2009. Washington, D.C.: Pew Internet & American Life Project. An initiative of the Pew Research Center 2009. Available at: http://pewinternet.org . Accessed July, 2009
    Google Scholar
  • 63 Fox S, Purcell K. Chronic Disease and the Internet. Pew Internet & American Life Project. An initiative of the Pew Research Center 2010. Available at: http://pewinternet.org/Reports/2010/Chronic-Disease . Accessed April 14, 2012
    PubMedGoogle Scholar
  • 64 Smith A. 46% of American Adults are Smartphone Owners. Pew Research Center's Internet & American Life Project 2012. Available at http://www.perinternet.org/Reports/2012/Smartphone-Update-2012.aspx . Accessed March 31, 2012
    PubMedGoogle Scholar
  • 65 Fox S. Medicine 2.0: Peer-to-peer healthcare. Pew Internet & American Life Project. An initiative of the Pew Research Center 2011. Available at: http://pewinternet.org/Reports/2011/Medicine-20 . Accessed April 14, 2012.
    PubMedGoogle Scholar
  • 66 Cherney LR, Van Vuuren S. Aphasia Rehabilitation: Modulating Cues, Feedback and Practice Conditions. National Institutes of Health 2011; 1R01DC011754–01
    PubMedGoogle Scholar
  • 67 Cherney LR, Halper AS, Holland AL, Cole R. Computerized script training for aphasia: preliminary results. Am J Speech Lang Pathol 2008; 17 (1) 19-34
    CrossrefPubMedGoogle Scholar
  • 68 Manheim LM, Halper AS, Cherney LR. Patient-reported changes in communication after computer-based script training for aphasia. Arch Phys Med Rehabil 2009; 90 (4) 623-627
    CrossrefPubMedGoogle Scholar