≪

Telemedicine and the Diagnosis of Speech and Language DisordersISSN: 0025‐6196Accession: 00005625‐199712000‐00004

Author(s):

Duffy, Joseph R. PhD; Werven, Gerry W. MS; Aronson, Arnold E. PhD

Issue:

Volume 72(12), December 1997, pp 1116‐1122

PublicationType:

[Articles]

Publisher:

Institution(s):

From the Division of Speech Pathology, Mayo Clinic Rochester, Rochester, Minnesota.Address reprint requests to Dr. J. R. Duffy. Division of Speech Pathology, Mayo Clinic Rochester,200 First Street SW, Rochester, MN 55905.AbstractObjective: To summarize results of telemedicine evaluations of speech and language disorders in patients in asmall, rural hospital and in large multidisciplinary medical practices.Material and Methods: Eight patients underwent assessment as part of experiments with the National Aeronauticsand Space Administration‐launched Advanced Communications Technology Satellite. A second clinician was on‐sitewith 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. Inaddition, results of 150 telemedicine evaluations among Mayo Clinic practices in Minnesota, Arizona, and Floridawere examined retrospectively.Results:Evaluations were reliable, and patient satisfaction was good. Diagnoses were consistent with lesionlocalization and medical diagnosis when they were known, and they frequently had implications for lesionlocalization 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 encounteredin face‐to‐face practice. Face‐to‐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.(Mayo Clin Proc 1997;72:1116‐1122)ACTS = Advanced Communications Technology Satellite; NASA = National Aeronautics and Space Administration;TMCs = telemedicine consultationsDisorders of speech or language can be the first or only apparent clinical evidence of disease. In such cases, theircareful examination may provide valuable information about localization of lesions and may contribute to themedical diagnosis and management. Often the examination itself can be conducted rapidly, noninvasively, andwithout costly and time‐consuming instrumental analyses.The diagnosis of speech and language disorders traditionally involves face‐to‐face verbal interaction betweenclinician and patient. Language use, auditory perceptual features of speech, and visible characteristics of speechmovements are the most salient information on which such diagnoses are based. Because of these crucial "listenand look" traits, examination of at least some types of speech and language disorders should be possible on‐line "ata distance," as long as the auditory and visual transmission is of sufficient quality to allow adequate patientparticipation and reliable and valid interpretation of signs and symptoms. The limited study of speech andlanguage examinations conducted at a distance suggests that such assessments can lead to clinical diagnoses thatare consistent with those obtained during face‐to‐face interaction. [1,2] In a sense, the assessment of many speech and language disorders is ideally suited to clinical telemedicine.The Mayo Clinic has taken advantage of the apparent compatibility between telemedicine and the practice of speech‐language pathology for several years. In 1987, speech pathology telemedicine consultations (TMCs) wereamong the first clinical TMCs provided among the Mayo Clinic facilities in Rochester, Minnesota, Scottsdale,Arizona, and Jacksonville, Florida. These consultations have been a valuable resource for difficult‐to‐diagnosecases, particularly when a speech or language disorder has been the only or the most prominent complaint andclinical finding. This value was appreciated during the planning of recent telemedicine experiments using a

National Aeronautics and Space Administration (NASA)‐launched Advanced Communications Technology Satellite(hereafter referred to as the ACTS project). One arm of this project included the provision of speech pathologyconsultation‐by‐satellite.In this report, we summarize our speech pathology consultation‐by‐satellite experience, with emphasis on themethods used, information obtained, difficulties encountered and overcome, and types of speech and languageproblems that have been evaluated through this medium. We will address separately our experience during theACTS project and our more "routine" experience among three Mayo Clinic sites (hereafter referred to as Mayo TMCs)because the technology, goals, and types of patients served differed between these two experiences.METHODSEnvironment 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 wereadjustable by the clinician or technical assistant.The camera could be adjusted to provide anything from a full‐body view of the seated patient to a close‐up focuson the lips, tongue, and palate. The patient usually wore or was near a microphone, and the loudness could beadjusted on request by the clinician.The following paragraphs summarize the range of tasks beyond elicitation of the history and recording of complaints that were most often used. For most cases, only those tasks necessary to establish the nature andgeneral severity of the primary problem were used. For example, if the only complaint or evident problem was amotor speech disorder, formal assessment of language was not pursued.Oral Mechanism Examination.With use of close‐up views, the size, symmetry, and range of motion of the jaw, face, tongue, and palate could beobserved at rest or during movements on command or imitation (for example, tongue protrusion, smiling, palatalmovement during vowel prolongation, and coughing). Oral reflexes and responses to strength testing of the jaw,tongue, and face conducted by an on‐site assistant could be observed. This examination was most often used whena neurologic speech disorder was suspected.Motor Speech Examination.