Online Assessment and Treatment of Childhood Speech, Language, and Literacy Disorders

Waite, Monique (2010). Online Assessment and Treatment of Childhood Speech, Language, and Literacy Disorders PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

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Author Waite, Monique
Thesis Title Online Assessment and Treatment of Childhood Speech, Language, and Literacy Disorders
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2010-06-01
Thesis type PhD Thesis
Supervisor Deborah Theodoros
Trevor Russell
Louise Cahill
Total pages 375
Total colour pages 11
Total black and white pages 364
Subjects 11 Medical and Health Sciences
Abstract/Summary Telehealth, the provision of health services at a distance using information technology and telecommunications, is recognised as a valuable service delivery model in many health fields, including speech-language pathology. Its potential for providing more accessible services to rural and remote populations is particularly important. Validation of telehealth applications is necessary for it to become accepted by service providers and clinicians. Although preliminary evidence for telehealth applications for the assessment and treatment of childhood communication disorders is emerging, there is a need for more robust studies. Therefore, this thesis aimed to determine the validity and reliability of the assessment of childhood speech, language and literacy disorders via an Internet-based telehealth system, and to provide proof of concept for an online phonological awareness intervention. This research was conducted in two stages. The first phase aimed to validate the online assessment of speech, language and literacy in children by comparing assessment over the Internet with traditional, face-to-face (FTF) methods. This phase included 60 children aged between 4 and 13 years who had an identified or suspected speech, language or literacy disorder. Participants were placed in one or more of the following groups, depending on their communication difficulties: speech (n = 6 and 20), language (n = 25), and literacy (n = 20). The participants in each group were assessed on a battery of commonly used informal or standardised tests. The assessments were administered by either an online or a FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. The online assessments utilised a custom-built telehealth system connected via the Internet over a 128 kbit/s. The online and FTF ratings were compared and the inter- and intra-rater reliability of both the online and FTF assessments was determined. An informal evaluation of the impact of technical, logistical, and child factors on the assessments was also undertaken. Phase two consisted of a proof of concept of an upgraded telehealth system for the treatment of children with literacy disorder using the Phonological Awareness for Literacy (PAL) program. Eight children aged between 8 and 10 years were treated via the system twice weekly for a period of 10 weeks. The online treatment was evaluated in terms of clinical outcomes (improvement in phonological awareness, reading and spelling), as well as participant and parent satisfaction. Overall, the results support the validity and reliability of the assessment of paediatric communication disorders via an Internet-based telehealth system. A high overall level of agreement was found between the online and FTF clinicians for the speech assessments (>80% agreement overall for transcription, stimulability, and phonological process analysis; >85% close [+/-1] agreement for severity, intelligibility and oromotor rating scales). The overall inter- and intra-rater reliability was also high for the online assessments (>85% for articulation and phonological assessment; >90% close agreement for severity, intelligibility and oromotor). Several parameters on the informal speech assessments, as well as the diagnosis of type of speech disorder failed to reach pre-determined clinically important levels of agreement. However, these discrepancies were largely due to difficulties inherent in the perceptual judgement of children’s speech that were not exclusive to the online environment. This finding was supported by similar levels of inter- and intra-rater reliability for the FTF assessment. The standardised language and literacy assessments were amenable to administration in the online environment, and yielded high overall levels of agreement between the online and FTF clinicians (κ = .93-> .99 for language and .92-1.00 for literacy), as well as very good overall inter- and intra-rater reliability (ICC = .84- 1.00 for language and .89-1.00 for literacy). Four individual parameters on the literacy assessments did not reach pre-determined clinically significant levels of agreement between the online and FTF raters. However this finding was largely attributed to differences in the raters’ subjective judgement, rather than system issues. The informal analysis of the technical capabilities of the telehealth system highlighted its many benefits, but also identified a small number of limitations (e.g., audio break-up), which largely affected the usability of the system, rather than the reliability of the scoring in the online condition. Participant factors, such as attention and behaviour, made both online and FTF assessments challenging at times. While only preliminary, the findings of the treatment study provided evidence of the feasibility of an Internet-based telehealth system for the treatment of children’s literacy using the PAL program. Although significant group effects were only found for nonword spelling and text reading accuracy, there were trends towards improvements on most other measures. There was also high participant and parent satisfaction. Further research in the form of a large scale randomised trial is needed to verify the results of this study. This thesis is the first comprehensive evaluation of telehealth applications for the assessment and treatment of childhood communication disorders. The results provide evidence that telehealth is a feasible alternate service delivery model for paediatric speech-language pathology. Future research including field trials, cost-benefit analyses, and studies investigating other technology, logistical and client factors would provide additional evidence to guide the widespread implementation of telehealth in paediatric speech-language pathology services.
Keyword telehealth
speech-language pathology
Additional Notes Pages to be printed in colour: 183, 219, 274, 275, 276, 277, 278, 281, 284, 286, 287 Landscape pages: 224,282,285

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Created: Fri, 19 Nov 2010, 18:49:54 EST by Ms Monique Waite on behalf of Library - Information Access Service