Assessment of Acquired Neurogenic Communication Disorders in Adults using a Telerehabilitation Application

Anne Hill (2008). Assessment of Acquired Neurogenic Communication Disorders in Adults using a Telerehabilitation Application PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

       
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Author Anne Hill
Thesis Title Assessment of Acquired Neurogenic Communication Disorders in Adults using a Telerehabilitation Application
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2008-08
Thesis type PhD Thesis
Supervisor Deborah Theodoros
Elizabeth Ward
Trevor Russell
Total pages 306
Total colour pages 7
Total black and white pages 299
Subjects 320000 Medical and Health Sciences
Formatted abstract Telerehabilitation, which is the provision of rehabilitation services at a distance, has
been proposed as a service delivery model with the potential to address some of the issues of
equitable access and quality of care currently facing the discipline of rehabilitation. One
rehabilitation discipline which is well suited to telerehabilitation is speech-language
pathology. However, a paucity of research into the delivery of speech-language pathology
services via telerehabilitation has limited the implementation of this mode of service delivery.
In an attempt to add empirical data to the body of research and move towards the
development of evidence-based guidelines for the practice of telerehabilitation in speechlanguage
pathology, this series of studies aimed to determine the validity and reliability of the
assessment of acquired neurogenic communication disorders in adults via telerehabilitation
methods.
A total of 86 adults with an acquired neurogenic communication disorder participated
in this research. Participants were grouped according to their dominant communication
disorder resulting in four study cohorts, dysarthria (n = 19 and 24), aphasia (n = 32) and
apraxia of speech (n = 11). A series of studies investigated the validity and reliability of
telerehabilitation assessment of each cohort, in comparison to traditional face-to-face
assessment. Participants were assessed using standardised and/or informal assessment tools
commonly used in speech-language pathology clinics. A custom-built telerehabilitation
system utilizing low bandwidth Internet Protocol (IP) connections was used during the
telerehabilitation assessments. This bandwidth was chosen as it is consistent with the
minimum bandwidth connection available in Queensland Health facilities, including those in
regional and remote areas.
Overall, the findings presented in this thesis served to establish the validity and
reliability of assessing acquired neurogenic communication disorders in adults via
telerehabilitation. The results provide evidence that the use of standardised and informal
assessment tools in a telerehabilitation environment allow for the accurate description ofaphasia and apraxia of speech in adults. While high levels of agreement for the assessment of
dysarthria were also established, the low agreement between the speech-language pathologists
(SLPs) for the diagnosis of type of dysarthria was unexpected. It was considered that this
discrepancy was a result of differences between the SLPs rather than an effect of the
telerehabilitation assessment. Reliability within the telerehabilitation assessment environment
was established for dysarthria and aphasia; however, reliability was not confirmed for apraxia
of speech due to restricted sample size, highlighting the need for further research within this
population.
Previous research had suggested that the severity of the presenting communication
disorder may have implications for telerehabilitation assessment in speech pathology. Such
concerns regarding the effects of severity of communication disorder upon the accuracy of the
telerehabilitation assessment were resolved in the case of severe aphasia. However, further
research into the effects of severe apraxia of speech upon the ability to use telerehabilitation
assessment methods was recommended.
Continued research to firmly establish the validity and reliability of assessing acquired
neurogenic communication disorders via telerehabilitation, with the goal of developing
evidence-based guidelines for the use of telerehabilitation in speech pathology was recognised
as an imperative direction for future research. Furthermore, the potential for telerehabilitation
methods to expand and inform traditional rehabilitation research and practices was suggested.
Keyword telerehabilitation, speech-language pathology, communication, assessment, aphasia, dysarthria, apraxia of speech.

 
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Created: Tue, 25 Nov 2008, 19:58:09 EST by Ms Anne Hill on behalf of Library - Information Access Service