Background The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. Objective The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. Methods Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. Results 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. Conclusion This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.

https://bmjopen.bmj.com/content/bmjopen/7/8/e016242.full.pdf

Telehealth and patient satisfaction: a systematic review and narrative analysis

The authors have limited consideration of motor speech disorders to dysarthrias of neurogenic nature. Aphasias (defined by the authors as problems of processing and symbolic formulation of the language code) are excluded. So are the deviant patterns of speech, such as developmental disorders of articulation and those disorders arising from structural impairments, such as cleft palate. A short but useful review of the basic motor process of speech production and its evaluation by clinical and other techniques is included. A more detailed description of relatively unfamiliar methods, such as palatography and videofluoroscopy would have been desirable. The neurologist will find the chapters on principles of neurologic function and hierarchy of motor organization rather basic. Other specialists may find these useful. On the other hand, many speech pathologists may find the section on motor speech examination somewhat devoid of detail. A disproportionately large space is allotted to the examination of the

Motor Speech Disorders

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant s...

https://pubs.asha.org/doi/pdf/10.1044/2019_PERSP-19-00146

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

Summary Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine—defined here as the use of real-time, synchronous videoconferencing to deliver medical care—could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues.

The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease

Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. Telemedicine for MDs has been mainly evaluated in Parkinson’s disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.

The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach.

Parkinson’s disease (PD) is a neurodegenerative condition associated with motor, neuropsychological, sensorial, and vocal symptoms. It has been suggested that eventual obstacles faced by many patients to reach speech therapy rehabilitation centers could be overcome with the use of synchronous telerehabilitation (real time) approach employing communication technologies. Purpose: To investigate the efficacy of vocal telerehabilitation in PD patients. Methods: Twenty patients diagnosed with PD and with vocal complaints participated in this study. Patients were evaluated by videoconference (Adobe Connect 8) before and after treatment. Evaluation method consisted of perceptual analysis of vocal quality measured by the GRBASI scale. Treatment was conducted following the extended version of Lee Silverman method (LSVT-X). At the end of treatment all patients were requested to fill a questionnaire to assess their experience with telerehabilitation. Results: Analysis revealed decrease in magnitude of voice quality changes after the intervention, indicating improvement of vocal pattern. All patients reported satisfaction and preference for telerehabilitation compared to face-to-face rehabilitation, as well as positive perception of audio and video. Some technological adversities have been identified but did not prevent the approaches to assessment and treatment. Conclusion: Present results suggest that telerehabilitation methods can be considered as an effective treatment for speech symptoms associated with PD and can be indicated to patients presenting limited access to speech therapy centers and technological readiness.

/pdf/telerreabilitacao-vocal-na-doenca-de-parkinson-15jrpmuo3s.pdf

Telerreabilitação vocal na doença de Parkinson

Embasamento: A eficacia na reabilitacao da voz em pacientes com doenca de Parkinson esta bem estabelecida. Tendo em vista as dificuldades de lidar com a locomocao de casa para centros de tratamento, o uso da telerreabilitacao pode representar uma ferramenta inestimavel para muitos pacientes. Objetivo: Analisar a influencia do desempenho cognitivo na aceitacao da telerreabilitacao. Metodos: Participaram cinquenta pacientes em estagios 2-4 de acordo com a escala de Hoehn-Yahr, com idade entre 45 e 87 anos, escores cognitivos de 19 a 30 no Mini-Exame do Estado Mental e escolaridade entre 4-17 anos. Todos foram submetidos a avaliacao da intensidade da voz antes e depois do tratamento pelo Lee Silverman Voice Treatment (LSVT) e foram convidados a responder um questionario sobre suas preferencias entre duas opcoes de tratamento. Resultados: O tratamento resultou em aumento medio de 14dBNPS. Quando questionados sobre a possibilidade de aceitacao para participar de um futuro programa de telerreabilitacao, 38 individuos concordaram e 12 nao. Em relacao a estes dois grupos, a competencia tecnologica foi referida em 26% e 17%, respectivamente. A aceitacao a telerreabilitacao foi positivamente relacionada com anos de estudo e estado cognitivo. Conclusao: As respostas ao Questionario apos a conclusao do LSVT tradicional mostraram que a maioria dos pacientes (76%) concordaria em participar de uma futura telerreabilitacao. Idade, sexo, estagio da doenca ou competencia tecnologica nao pareceu influenciar na adesao a telerreabilitacao enquanto que outros fatores, como estado cognitivo e anos de escolaridade foram positivamente relacionados com a aceitacao da nova forma de terapia.

/pdf/telerehabilitation-in-parkinson-s-disease-influence-of-1phtd2xjis.pdf

Telerehabilitation in Parkinson's disease: Influence of cognitive status.

Mild changes in voice quality and articulation of speech may be seen in early phases of Parkinson´s disease (PD). Voice and speech disturbances in PD constitute a hypocinetic dysarthria or dysarthrophonia and are characterized by monotony and reduced intensity of voice, imprecise articulation and disturbances of rhythm. Favorable results with an intensive method (Lee Silverman Voice Treatment) for the treatment of voice disturbances in PD were recently reported. The main goal of the method is to augment vocal intensity through the increment of phonatory effort. The purpose of the present study was to characterize vocal abnormalities (hoarseness, breathiness, articulatory pattern and inteligibility) in a group of patients with PD and to evaluate the therapeutic efficacy of the Lee Silverman method. Acoustic as well as perceptive-auditory analysis showed statistically significant differences between pre and post treatment groups. Although the articulatory pattern has not considerably changed, the benefits obtained with the improvement in vocal quality positively influenced overall quality of oral communication.

/pdf/tratamento-dos-disturbios-da-voz-na-doenca-de-parkinson-o-3dfnfv5zar.pdf

Tratamento dos distúrbios da voz na doença de Parkinson: o método Lee Silverman

Effects of Subthalamic Stimulation on Olfactory Function in Parkinson Disease

Speech disorders are common manifestations of Parkinson´s disease. Objective To compare speech articulation in patients according to age at onset of the disease. Methods Fifty patients was divided into two groups: Group I consisted of 30 patients with age at onset between 40 and 55 years; Group II consisted of 20 patients with age at onset after 65 years. All patients were evaluated based on the Unified Parkinson’s Disease Rating Scale scores, Hoehn and Yahr scale and speech evaluation by perceptual and acoustical analysis. Results There was no statistically significant difference between the two groups regarding neurological involvement and speech characteristics. Correlation analysis indicated differences in speech articulation in relation to staging and axial scores of rigidity and bradykinesia for middle and late-onset. Conclusions Impairment of speech articulation did not correlate with age at onset of disease, but was positively related with disease duration and higher scores in both groups.

/pdf/speech-disorders-did-not-correlate-with-age-at-onset-of-2q2s2vnjr5.pdf

Alice Estevo Dias

Papers

Telerreabilitação vocal na doença de Parkinson

Telerehabilitation in Parkinson's disease: Influence of cognitive status.

Tratamento dos distúrbios da voz na doença de Parkinson: o método Lee Silverman

Effects of Subthalamic Stimulation on Olfactory Function in Parkinson Disease

Speech disorders did not correlate with age at onset of Parkinson’s disease