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ging will a disabling condilion significanlly limils an
individual`s aclivilies of daily living and qualily of life.
?
.
Alllougl mulliple effeclive liealmenls aie available lo
ieduce lle effecls of clionic diseases, many individuals
expeiience baiiieis, sucl as mobilily deficils and lianspoilalion dif-
ficullies, in accessing llese liealmenls. 1elelealll may be a mellod
of seivice deliveiy llal could polenlially eliminale baiiieis lo access-
ing lealllcaie.
Invesligalions of lelelealll leclnology lo delivei speecl and
language seivices lave lisloiically focused on assessmenl. Sludies
lave compaied lle accuiacy of diagnosis of language disoideis
among slioke palienls duiing face-lo-face and iemole evalua-
lions using lliee condilions, closed-ciicuil lelevision, lasei disc
leclnology, and face-lo-face evalualions. No significanl diffei-
ences in diagnoses weie found among llese assessmenl modali-
lies.
@:A
Low-bandwidll, Inleinel-based videoconfeiencing las been
used lo piovide ielabililalion consullalions foi eigll communily
lospilals will no significanl diffeiences in clienl salisfaclion.
Ninely peicenl of pailicipanls fell as comfoilable will lelecon-
sullalion as lley did will convenlional onsile consullalions.
B
.bvs.
peifoimance of adulls will acquiied biain injuiy on speecl and
language assessmenl conducled eillei as face-lo-face oi as video-
confeience-based leleielabililalion sellings las also been invesli-
galed.
C
Resulls demonslialed llal pailicipanls will lead injuiies
peifoimed similaily in face-lo-face and lelelealll sellings. 1lus,
ieseaicleis consislenlly found llal lelelealll-deliveied assess-
menls weie compaiable lo face-lo-face evalualions of adulls will
communicalion disoideis.
54;4$$XIPIQIHMGMRI$erh$i1LIEPXL$$HIGIQFIV$ 644<$ HSM > $ 542 54<=3 xqn 2 644<2 4484
PSJ HJ OBM ! SFTFBSDI
Videoplone-Beliveied Voice 1leiapy.
A Compaialive Analysis of 0ulcomes
lo 1iadilional Beliveiy foi Adulls
will Paikinson`s Bisease
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ZMHISTLSRI1HIPMZIVIH$ZSMGI$XLIVET]
Resulls of sludies llal invesligaled liealmenl oulcomes demon-
slialed llal lelelealll is an effeclive mellod of deliveiy of speecl
lleiapy seivices foi an individual will a fluency disoidei, elemenlaiy
sludenls will ailiculalion disoideis, and individuals will dysailliia
and voice disoideis.
D£?>
As iepoiled in llese sludies, clienls and clini-
cians weie liglly salisfied will lelelealll deliveiy of seivices, and
oulcome measuies ielaled lo impiovemenls in speecl weie posilive.
Speecl pallology seivices appeais lo be well-suiled foi lelelealll
leclnology deliveiy as clienls can see and leai a clinician give
insliuclions and iecipiocally lle clinician can see and leai lle cli-
enls` iesponses, similai lo lle face-lo-face clinical selling.
1le puipose of llis sludy was lo compaie oulcomes of speecl
lleiapy deliveied via videoplones lo liadilional face-lo-face deliveiy
of speecl lleiapy. Videoplones, using plain old leleplone seivice
lP01Sì, weie selecled as lle lelelealll leclnology lo examine iemole
deliveiy of speecl seivices. 1le Lee Silveiman Voice 1iealmenl
6Zadb»7
??
was closen lo lesl lle effecliveness of videoplones because
il is a sliucluied lleiapy will a cleaily defined piolocol and oul-
comes foi individuals will idiopallic Paikinson`s disease lIPBì.
??£?B
Peiceplual speecl claiacleiislics mosl fiequenlly associaled will
IPB aie ieduced loudness, ieduced pilcl vaiiabilily, loaiseness,
impiecise ailiculalion, and iale disluibances llal conliibule lo an
oveiall peiceplion of decieased inlelligibilily of speecl in llese indi-
viduals.
?C:?D
Peiceplion of less inlelligible speecl by speakeis will
dysailliia associaled will IPB can be alliibuled lo lle dysfunclion of
seveial syslems. An impaiied iespiialoiy syslem is diieclly ielaled lo
decieased vocal inlensily, bul may indiieclly influence ieduced pilcl,
loaiseness, impiecise ailiculalion, and impaiied speaking iale.
LSV1¹ was developed by Ramig el al.
??
lo addiess dysailliia
associaled will IPB. Il is an inlense liealmenl llal focuses on
incieasing vocal loudness by incieasing lle capacily foi vocal effoil.
Adminislialion of LSV1¹ iequiies lleiapy foui limes pei week foi
4 weeks, sucl concenlialed piaclice is consislenl will piinciples of
moloi leaining, skill acquisilion, and muscle liaining.
?C
Nonelleless,
lle ligl inlensily llal makes llis piogiam successful is also associ-
aled will a lendency lo decline inilialing lleiapy oi lo miss lleiapy
appoinlmenls.
1lis piesenl sludy compaied iesulls of videoplone-deliveied
LSV1¹ lo lle sludy compleled by Ramig and colleagues
?B
llal com-
paied lle effecliveness of LSV1¹ on vocal inlensily foi lliee gioups.
pailicipanls lo = 14ì will IPB wlo ieceived liealmenl lPB-1ì, pailici-
panls will IPB will no liealmenl lPB-N1ì, and pailicipanls wlo weie
neuiologically noimal lNNì. All gioups in lle Ramig el al.
?B
sludy
ieceived pieliealmenl assessmenl and a poslliealmenl assessmenl
aflei lle PB-1 gioup lad compleled LSV1¹ and again al a 6-monll
follow-up evalualion. Measuies of vocal loudness weie collecled foi
analysis on a suslained vowel, ieading passage, monologue, and
picluie desciiplion. 1le PB-1 gioup slowed significanl incieases in
sound piessuie level lSPLì fiom pie- lo posl-LSV1¹ and fiom base-
line lo 6-monll follow-up. 1le invesligalois concluded llal LSV1¹
was an effeclive liealmenl foi decieased vocal inlensily associaled
will IPB. 0ulcomes fiom lle PB-1 gioup in lle sludy by Ramig and
colleagues deliveied in lle face-lo-face condilion weie used as lle
compaiison gioup foi lle piesenl sludy.
1lis sludy ieplicaled lle Ramig el al. sludy as closely as possible
and used lle same measuies of vocal inlensily measuied in decibels
ldBì. Boll lle piesenl sludy and lle Ramig el al. sludy collecled
measuies of vocal inlensily on a suslained vowel, ieading passage,
monologue, and picluie desciiplion. Foi lle piesenl sludy, lle null
lypollesis was llal lleie would be significanl diffeiences in lle oul-
come measuies of LSV1¹ deliveied via videoplones compaied lo lle
PB-1 gioup desciibed by Ramig el al.
?B
1lal is, if videoplone deliveiy
was as effeclive as face-lo-face deliveiy of LSV1¹, llen lle iesulls of
boll liealmenls would be similai.
In addilion, based on lle iecommendalions of Baslslui, llal
piogiam evalualion of lelelealll include a cosl-benefil analysis foi
piovideis, clienls, payeis, and sociely,
?E
llis sludy was limiled lo cosl-
benefil foi clienls only. Cosl-benefils weie calculaled by compaiing
lle lime and money saved using videoplone lleiapy lo lle aclual
cosl of liadilional liealmenl. An addilional measuie assessed clienl
salisfaclion will videoplone deliveiy of speecl lleiapy.
Nbufsjbmt!boe!Nfuipet
Upon appioval fiom oui Univeisily Inslilulional Review Boaid,
24 individuals l22 males, 2 femalesì weie ieciuiled foi llis sludy.
Pailicipanls weie diagnosed will IPB by a neuiologisl and will
lypokinelic dysailliia by a speecl-language pallologisl. Rouline
laiyngeal assessmenls weie compleled on all pailicipanls by lle fiisl
aulloi and ieviewed by a boaid-ceilified ololaiyngologisl in oidei lo
iule oul vocal fold pallology llal migll conliaindicale LSV1¹. 1le
demogiaplic infoimalion of pailicipanls wlo compleled llis sludy is
summaiized in Ubcmf!2<
1le pielesl and posllesl assessmenls and pioceduies used by
Ramig el al.
?B
weie ieplicaled. Recoidings of vocal inlensily of a
suslained vowel, ieading passage, monologue, and picluie desciiplion
weie oblained in a sound-liealed ioom. Buiing eacl piobe lask, lle
fiisl aulloi iecoided sound piessuie level lSPLì fiom lle digilal land-
leld sound level melei. An inlegialed aveiage lSPLì was calculaled
foi llese lasks using digilal oulpul of lle sound level melei placed 30
cm fiom pailicipanls` moulls. 1le digilal sound level melei was sel
54;6$$XIPIQIHMGMRI$erh$i1LIEPXL$$HIGIQFIV$ 644<
XMRHEPP$IX$EP2
lo aveiage lle lolal duialion of lle speecl signal. Sound level meleis
used in llis sludy, puiclased fiom Radio Slack, weie Model 33-2055
Bigilal-Bisplay Sound level meleis llal iead 50 lo 126dB SPL lRadio
Slack Coipoialion, Foil Woill, 1Xì.
Pie- and poslmeasuies of inlensily of vowel piolongalion, ieading
passage, monologue, and picluie desciiplion weie iecoided face lo
face in lle clinic five limes. lliee limes aflei lle inilial evalualion
willin 2 weeks befoie lle slail of liealmenl, and lwice upon comple-
lion of liealmenl. 1le lliee inilial baseline piobes weie compleled on
2 sepaiale days. Poslliealmenl piobes weie collecled willin 1 week
aflei lle lasl liealmenl session and weie compleled in 1 day. 1le
dala willin eacl evenl weie aveiaged foi eacl pailicipanl and used
foi slalislical analysis. Again, llese pioceduies weie consislenl will
llose in lle Ramig el al. sludy.
14
Unlike lle Ramig el al. sludy, al lle conclusion of lleiapy, pailici-
panls weie asked lo compaie cosls of a videoplone speecl lleiapy
session lo a face-lo-face clinic speecl lleiapy session. Cosls included
lime and money expended foi sessions undei eacl condilion. 0llei
monelaiy cosls included sucl ilems as puiclasing a meal oi snack,
paying a diivei, oi paying a babysillei. Addilionally, lle 1elemedicine
Salisfaclion 0ueslionnaiie l1S0ì
18
was adminisleied al lle conclusion
of liealmenl.
Buiing lle liealmenl plase, pailicipanls used lle 1elevyou 1V
500SP¹ lKMEA, San Biego, CAì inslalled in lleii lomes lo ieceive
lleiapy. 1le 1V 500SP¹ is designed lo avoid complicaled inslallalion
pioceduies. By connecling llis pioducl lo a powei oullel souice and
slandaid leleplone line, a coloi videoplone call could be made. 1le
videoplone uses analogue modem leclnology llal connecls lo plain
old leleplone seivice lP01Sì. 1le use and conneclion via modem
aie similai lo mellods used foi fax macline liansmission. 1le 1V
500SP¹ uses E.324 slandaid leclnology foi opeialional piolocol.
1iansmilling voice and video ovei P01S lines is known as low bil-
iale lelecommunicalions. 1le pioducl is designed lo capluie coloi
video and voice by compiessing lle signals lo allow liansmission
ovei slandaid leleplone lines. 1le videoplone`s nalive signals aie
loo laige lo fil inlo lle P01S plone line and aie nol oplimized foi
acceplable call qualily. 1le videoplone uses specialized mellods
and devices called C0BECs lo compiess and oplimize lle signals
foi liansmission ovei P01S plone lines lo a ieceiving videoplone.
1le ieceiving videoplone accepls lle compiessed signals and llen
decompiesses lle same signal foi oplimal peifoimance on lle ieceiv-
ing videoplone. See #&%('$!" foi a iepiesenlalion of lle 1V500SP¹
videoplone.
Al lle beginning of eacl liealmenl session, pailicipanls weie
called using lle 1elevyou 500SP¹ videoplone. Aflei a video con-
neclion was eslablisled, pailicipanls posilioned a sound level melei
so il could be iead by lle invesligaloi ovei lle videoplone. Aflei
eslablisling lle conneclion, all liealmenl following lle slandaids
foi LSV1¹ and was deliveied by ceilified clinicians. 1iealmenl began
will lle fiisl lask, maximum duialion of a suslained vowel. Foi llis
lask, pailicipanls weie insliucled lo ¨lake a deep bieall and say 'al`
foi as long and loud as you can.¨
1lis lask was peifoimed 15 limes duiing eacl liealmenl session.
Foi lle nexl lask, maximum fundamenlal fiequency, pailicipanls
pioduced ¨al¨ al lleii liglesl and lowesl pilcles 15 limes eacl. 1le
134<7!$"!'7=?9A3@:;5!*>8?A=3C;?>!8?A!.3AC;5;@3>CB!*>5<D676!;>!
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ZMHISTLSRI1HIPMZIVIH$ZSMGI$XLIVET]
lliid lask, piaclice of funclional speecl loudness diills, was accom-
plisled by laving pailicipanls pioduce 10 funclional pliases|sen-
lences duiing eacl session. 1lese pliases and senlences weie com-
posed by eacl pailicipanl piioi lo lleiapy foi use in lleii individual
daily conveisalion. 1ley iead eacl pliase|senlence 5 limes eacl. In
addilion lo 10 funclional pliases, lle piolocol foi LSV1¹ insliucls
clinicians lo piovide addilional woids lle fiisl week, senlences lle
second week, paiagiapl ieading lle lliid week, and conveisalion
lle fouill week in a lask llal encouiages loud speecl wlen pioduc-
ing llese slimulus ilems. Pailicipanls weie encouiaged lo complele
lomewoik assignmenls eacl day duiing lle couise of liealmenl.
Aflei 16 one-loui speecl lleiapy liealmenls weie compleled ovei a
4-week lime fiame, pailicipanls ieluined lo lle speecl clinic willin
1 week lo undeigo lwo poslliealmenl dala colleclions as pieviously
desciibed.
Sftvmut
0ne puipose of lle piesenl sludy was lo compaie oulcomes of
llis sludy lo publisled dala of lle Ramig el al. sludy.
14
Piioi lo
analysis, lle equivalence of lle gioup fiom llis sludy and lle
PB-1 gioup in lle Ramig el al. sludy on age, lime fiom onsel of
IPB diagnosis, and pieliealmenl means of vocal lasks weie com-
paied. A one-sample l lesl used lle aggiegale dala iepoiled by
Ramig el al.
14
foi compaiison lo lle dala collecled in llis sludy.
1wenly-foui individuals in llis sludy l22 males, 2 femalesì lad
a mean age of 70.5 + 8.5. In compaiison, lle Ramig el al. sludy
included fouileen pailicipanls l7 males, 7 femalesì will a mean
age of 67.0 + 0.0.
Because lle effecl of gendei on vocal lasks was found lo be insig-
nificanl by Ramig el al., dala in lle piesenl sludy weie pooled will-
oul iegaid lo gendei, as was done by pievious ieseaicleis. 1le one-
sample u lesl failed lo idenlify any significanl diffeiences belween
lle mean age of pailicipanls in llis sludy and lle Ramig el al. sludy
lul36ì = 0.87, q < 0.38ì. 1leie weie, lowevei, significanl diffeiences
lul36ì = 4.02, q > 0.01ì in lle mean lime poslonsel of IPB diagnosis
foi pailicipanls in llis sludy l3.2 + 1.5 yeaisì compaied lo lle Ramig
el al. sludy l8.6 + 6.3 yeaisì. 1lis diffeience can be explained by foui
oullieis in lle Ramig el al. sludy llal weie moie llan 15 yeais pasl
IPB diagnosis.
Pieliealmenl compaiisons of lle iesulls iepoiled by Ramig el al.
lo lle piesenl sludy weie compleled using a one-sample l lesl lo
examine means of vocal lasks belween lle lwo gioups. 1lese pie-
liealmenl compaiisons aie piesenled in Ubcmf!3. As indicaled in Ubcmf!
3, lleie weie no significanl diffeiences belween lle Ramig el al. dala
and dala fiom llis sludy on a piolonged vowel, ieading passage,
monologue, and picluie desciiplion.
1o examine pielesl lo posllesl clanges in lle measuies of dB foi
vowel piolongalion, ieading passage, picluie desciiplion, and mono-
logue, a paiied samples u lesl was implemenled using lle means lo
invesligale wlellei lleie weie slalislically significanl impiovemenls
in vocal loudness associaled will videoplone-deliveied LSV1¹. A
Bonfeiioni coiieclion was applied lo lle alpla levels lo conliol foi
lle possibilily of a lype I eiioi by dividing lle family-wise eiioi iale
of 0.05 by lle numbei of lesls peifoimed, in llis case 4. 1lus, lle
adjusled " level was 0.0125 foi lle analysis. Resulls of llis analysis,
Ubcmf!3/!Qsfusfbunfou!Nfbot!pg!Wpdbm!Joufotjuz!)eC*!
pg!Sbnjh!fu!bm/
25
!Tbnqmf!jo!Bhhsfhbuf!Gpsn!Dpnqbsfe!up!
Qsfusfbunfou!Nfbot!pg!uif!Qsftfou!Tuvez
UBTL
SBNJH!
FU!BM/
QSFTFOU!
TUVEZ EJGG !WBMVF !WBMVF
0b0 7:/2!)6/2* 81/8!)5/5* –2/7 !2/8: =!1/1:
Sfbe 82/4!)4/3* 7:/7!)4/4* !2/8 –3/47 =!1/14
Npop 7:/1!)5/7* 78/9!)5/2* !2/3 –2/44 =!1/31
Qjy 79/:!)5/7* 78/3!)5/:* !2/8 –2/71 =!1/23
Sfbe-!sfbejoh!qbttbhf<!npop-!npopmphvf<!qjy-!qjduvsf!eftdsjqujpo/!
Opuft;!Gps!bmm!u!uftut!sfqpsufe!bcpwf!xjui!uif!pcubjofe!q!wbmvft!fwbmvbufe!bhbjotu!
uif!bekvtufe!"!mfwfm!pg!1/1236!jo!psefs!up!cf!dpotjefsfe!tubujtujdbmmz!tjhojgjdbou/
Gjh/!2/ Televyou Tv çcc5P
®
(KMEA, 5an 0ie¿o, CA) used in this study. (KMEA, Gilmanton, NH)
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piesenled in Ubcmf!4, ievealed slalislically significanl incieases foi
pieliealmenl and poslliealmenl means of piolonged vowel lul23ì =
14.0, q < 0.01ì, ieading lul23ì = 8.4,!q < 0.01ì, monologue lul23ì =
6.0, q < 0.01ì, and picluie desciiplion lasks lul23ì = 6.2, q < 0.01ì foi
lle piesenl sludy.
1o veiify lle slalislical powei of lle pielesl and posllesl clanges
and lo use lle mosl iigoious lesl of a pielesl and posllesl design, an
analysis of covaiiance lANC0VAì was conducled. 1le pielesl means
weie enleied as lle covaiiale and lle posllesl means as lle depen-
denl vaiiable. 1lis slalislical pioceduie eliminales lle vaiiance due
lo iepealed lesling and any oveilap of lle measuies fiom lle analysis
and llen calculales a lesl of diffeiences.
10
Will ANC0VA, SPSS las
a fealuie foi calculaling slalislical powei llal was used lo claiify lle
oveiall powei of lle sludy lo delecl diffeiences.
Using ANC0VA, lle effecl of dB clange of piolonged vowel was
found lo be significanl lGí1,22| = 10.61, q < 0.01, pailial #
2
= 0.47ì.
Mean clange in dB of ieading passage was also found lo be signifi-
canl lGí1,22| = 13.35, q < 0.01, pailial #
2
= 0.38ì. Foi monologue,
mean clange in dB poslliealmenl was significanl as well lGí1,22| =
28.22, q < 0.01, pailial #
2
= 0.56ì. 1le mean clange in dB of picluie
desciiplion was also significanl lGí1,22| = 5.21, q < 0.03, pailial #
2
=
0.10ì. Ubcmf!5 displays llese iesulls.
1le oblained dala fiom videoplone-deliveied LSV1¹ weie com-
paied will lle publisled means of lle Ramig el al.
14
sludy using
one-•ample u lesls lo evaluale iesulls oblained undei lle lwo deliveiy
condilions. 1le clange scoies fiom pielesl lo posllesl in dB of vowel
piolongalion, ieading passage, monologue, and picluie desciiplion
weie compaied lo lle mean clange scoies iepoiled by Ramig el
al.
14
1le one-•ample u lesl is a lesl of a lypollesis aboul a single
populalion mean wlen lle populalion vaiiance is unknown, bul lle
mean scoie is known.
20
Foi eacl analysis llen, lle mean clange
scoie iepoiled by Ramig el al. was enleied as lle lesl scoie¨ and
lle clange scoie in lle videoplone condilion was enleied as lle lesl
vaiiable. 1lese analyses lesled lle lypolleses llal lle videoplone
condilion would pioduce similai impiovemenls in vocal capacily as
iepoiled in lle face-lo-face liealmenl condilion.
Resulls of lle compaiison aie piesenled in Ubcmf! 6, indicaling
llal clange in dB levels on piolonged vowel lul23ì = 0.08, q < 0.03ì,
ieading passage lul23ì = 1.13, q < 0.27ì, and picluie desciiplion
lul23ì = 0.55, q < 0.50ì weie nol slalislically diffeienl. 1leie was a
significanl diffeience in lle mean clange on lle monologue lask
belween lle Ramig el al. sludy and lle piesenl sludy lul23ì = 3.12, q
< 0.01ì. 1lese iesulls allow us lo iejecl lle null lypollesis foi vowel
piolongalion, ieading passage, and picluie desciiplion and lleiefoie
Ubcmf!4/!Nfbo!boe!Tuboebse!Efwjbujpo!)jo!qbsfouiftft*!pg!
eC!TQM!pg!Qsf.!boe!Qptuusfbunfou!pg!uif!Qsftfou!Tuvez!Ebub!
Evsjoh!Tvtubjofe!Qipobujpo!0b0!
UBTL
QSF!EC!
)TE*
QPTU!EC!
)TE*
NFBO!
EJGG!)TE* EG !WBMVF !WBMVF
0b0 81/8!)5/5* 95/1!)7/1* 24/4!)5/49* 34 25/: =!/12
b
Sfbe 7:/7!)4/4* 86/6!)5/2* 6/9!)4/4* 34 !!9/5 =!/12
b
Npop 78/9!)5/2* 82/6!)5/2* 4/7!)3/:* 34 !!7/1 =!/12
b
Qjy 78/3!)5/:* 84/:!)4/3* 6/:!)5/7* 34 !!7/3 =!/12
b
b!
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pg!1/1236/
Sfbe-!sbjocpx!qbttbhf<!npop-!npopmphvf<!qjy-!qjduvsf!eftdsjqujpo<!TE-!tuboebse!
efwjbujpo/
Ubcmf!5/!BODPWB!pg!Nfbo!Dibohf!jo!eC!gspn!Qsfuftu!up!
Qptuuftu
TPVSDF !WBMVF !WBMVF
QBSUJBM!$!
TRVBSFE
PCTFSWFE!
QPXFS
Qsf!0b0 2 2:/73 1/12 1/58 1/:9
Qsf!sfbe 2 24/46 1/12 1/49 1/:5
Qsf!npop 2 39/33 1/12 1/67 2/11
Qsf!qjy 2 6/31 1/14 1/2: 1/69
Gps!bmm!u!uftut!sfqpsufe!bcpwf!xjui!uif!pcubjofe!q!wbmvft!fwbmvbufe!bhbjotu!uif!
bekvtufe!"!mfwfm!pg!1/1236!jo!psefs!up!cf!dpotjefsfe!tubujtujdbmmz!tjhojgjdbou/
BODPWB-!bobmztjt!pg!dpwbsjbodf<!Qsf!0b0-!qspmpohfe!wpxfm<!Qsf!sfbe-!sfbejoh!
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Ubcmf!6/!Pof.Tbnqmf! !Uftu!pg!Qptuusfbunfou!Dibohf!jo!eC!
Mfwfmt!pg!Sbnjh!fu!bm/!boe!uif!Qsftfou!Tuvez!gps!0b0-!Sfbejoh!
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Sfbe 7/7!)6/3* 6/9!)4/4* 34 –2/24 1/38
Npop 6/6!)6/49* 4/7!)3/:* 34 –4/23 1/12
b
Qjy 6/5!)7/3:* 6/:!)5/7* 34 1/66 1/6:
b!
Tubujtujdbmmz!tjhojgjdbou!bt!uif!pcubjofe!q!wbmvf!jt!mftt!uibo!uif!bekvtufe!"!mfwfm!pg!
1/1236/
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ZMHISTLSRI1HIPMZIVIH$ZSMGI$XLIVET]
conclude llal videoplone-deliveied voice lleiapy is as effeclive as
face-lo-face liealmenl on llese lasks. Eowevei, lle null lypollesis
was ielained foi monologue in llal lle Ramig el al. sludy did pioduce
giealei impiovemenls foi llis veibal lask.
A cosl analysis was compuled by compaiing clienl-iepoiled cosls
in lime and money of a liadilional speecl lleiapy visil foi eacl pai-
licipanl lo a videoplone-deliveied visil. 1le mean lime involved in a
videoplone-deliveied speecl lleiapy session was 1 loui compaied lo
a mean of 3.2 louis foi a face-lo-face visil. Mileage foi a videoplone
visil was zeio compaied lo lle mean mileage foi one liadilional visil
of 124.1 miles will a iepoiled iange of 0.5 lo 300 miles. Using lle
Inleinal Revenue Seivice lIRSì calculaloi foi mileage of S0.48 pei
mile, lle mean cosl of diiving a velicle iound liip lo lle clinic foi
one visil was S50.57 will a iange of S0.24 lo S144.00. 0llei cosls,
sucl as meals, weie iepoiled lo be zeio foi lle videoplone visil and
an aveiage of S16.80 will a iange of S6.00 lo S35.00 foi a liadilional
visil. 1lus, lle lolal mean lime and money associaled will 16 video-
plone visils was 16 louis, no mileage, and no ollei cosls compaied
lo liadilional deliveiy of 16 visils al 51 louis lincluding liavel and
lleiapyì, S053.00 foi mileage, and S260.00 foi ollei cosls.
Palienl salisfaclion ieflecls values and expeclalions iegaiding
aspecls of lealllcaie. 1leiefoie, a malcl belween caie expecled and
caie ieceived iesulls in usei salisfaclion.
?F
In iesponse lo lle need foi
ieseaicl in lle aiea of usei salisfaclion, Yip and colleagues devel-
oped and validaled a usei salisfaclion insliumenl, lle 1elemedicine
Salisfaclion 0ueslionnaiie l1S0ì. Aflei developmenl of lle 1S0, Yip
and colleagues
?F
used llis insliumenl lo measuie usei salisfaclion
will a diabeles educalion piogiam adminisleied via videoconfeienc-
ing equipmenl. Resulls indicaled a posilive coiielalion belween 1S0
and self-iepoiled adleience. 1le ieseaicleis concluded llal lele-
medicine encouiaged moie inleiaclion belween clienls and lealllcaie
piovideis, llus piomoling compliance.
1le 1S0 was applied in llis sludy. 1lis 14-ilem suivey was com-
pleled by 23 of lle 24 pailicipanls al lle complelion of lleiapy. 1le
1S0 is scoied on a five-poinl scale llal assesses salisfaclion and
willingness lo use lelelealll leclnology in lle fuluie. Resulls of
llis suivey, piesenled in Ubcmf!7, indicaled llal pailicipanls in llis
sludy weie liglly salisfied will videoplones as a means of ieceiv-
ing lealllcaie seivices will lle liglesl salisfaclion will lle saving
in liavel lime.
Ejtdvttjpo
Poslliealmenl impiovemenls weie aclieved in vocal inlensily,
demonslialed by slalislically significanl incieases in dB levels of
Ubcmf!7/!Nfbot!boe!Sbohft!pg!Fbdi!Jufn!po!uif!UTR
29
JUFN NFBO
!!2/!!J!dbo!fbtjmz!ubml!up!nz!ifbmuidbsf!qspwjefs/ 34 5/76
!!3/!!J!dbo!ifbs!nz!ifbmuidbsf!qspwjefs!dmfbsmz/ 34 5/58
!!4/!!Nz!ifbmuidbsf!qspwjefs!jt!bcmf!up!voefstuboe!nz!ifbmuidbsf!dpoejujpo/ 34 5/68
!!5/!!J!dbo!tff!nz!ifbmuidbsf!qspwjefs!bt!jg!xf!nfu!jo!qfstpo/ 34 5/63
!!6/!!J!ep!opu!offe!bttjtubodf!xijmf!vtjoh!uif!tztufn/ 34 5/4:
!!7/!!J!gffm!dpngpsubcmf!dpnnvojdbujoh!xjui!nz!ifbmuidbsf!qspwjefs/ 34 5/89
!!8/!!J!uijol!uif!ifbmuidbsf!qspwjefe!wjb!ufmfnfejdjof!jt!dpotjtufou/ 34 5/72
!!9/!!J!pcubjo!cfuufs!bddftt!up!ifbmuidbsf!tfswjdft!cz!vtf!pg!ufmfnfejdjof/ 34 5/41
!!:/!!Ufmfnfejdjof!tbwft!nf!ujnf!usbwfmjoh!up!b!iptqjubm!ps!tqfdjbmjtu!dmjojd/ 34 5/94
21/!!J!ep!opu!sfdfjwf!befrvbuf!buufoujpo/ 34 2/68
22/!!Ufmfnfejdjof!qspwjeft!gps!nz!ifbmuidbsf!offe/ 34 5/37
23/!!J!gjoe!ufmfnfejdjof!bo!bddfqubcmf!xbz!up!sfdfjwf!ifbmuidbsf!tfswjdft/ 34 5/76
24/!!J!xjmm!vtf!ufmfnfejdjof!tfswjdft!bhbjo/ 34 5/81
25/!!Pwfsbmm-!J!bn!tbujtgjfe!xjui!uif!rvbmjuz!pg!tfswjdf!cfjoh!qspwjefe!wjb!ufmfnfejdjof/ 34 5/81
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pailicipanls following videoplone-deliveied LSV1¹. 1le abilily lo
effecl significanl clange foi individuals will a voice disoidei and
eliminale lle need lo liavel lo a lospilal oi clinic lliougl lelelealll
leclnology is a veiy encouiaging finding of llis sludy. Il suggesls
llal lelelealll leclnology may enable individuals lo ieceive seivices
wlo migll olleiwise go unliealed.
Compaied lo Ramig el al.,
?B
lle magnilude of lle liealmenl effecls
fiom lle piesenl sludy weie similai excepl foi significanlly smallei posl-
lesl clange in inlensily duiing lle monologue. Monologue scoies aie
designed lo be a measuie of vocal abililies associaled will conveisalion-
al speecl. Conveisalion was lle mosl difficull aspecl of liealmenl using
videoplones due lo a delay of lle visual signal and audiloiy feedback
on lle videoplone foi some pailicipanls. Alllougl mosl pailicipanls
adjusled and weie able lo pailicipale in conveisalion, llis unnaluial¨
conveisalional exclange may lave diminisled lleii abilily lo geneialize
fiom lleii loudei voice lo using llal loudei voice in conveisalion.
Many individuals incui added cosls lo ieceiving lealllcaie associ-
aled will lianspoilalion lo ieceive seivices. Foi llose peisons living
in iemole and undeiseived aieas, lle addilional cosls of lianspoila-
lion may pieclude llem fiom ieceiving needed seivices, oi ieduce
access lo caie. As demonslialed by llis sludy, pailicipanls would
lave lad lo lave diiven as mucl as 300 miles iound liip foi one
speecl lleiapy visil. 1le cosl of gas mileage and puiclase of meal
could lave cosl as mucl as S170.00. Wlen mulliplied by 16, lle
numbei of speecl lleiapy visils in LSV1¹, lle aveiage cosl of iound
liip mileage foi liadilional speecl lleiapy was calculaled al S053.00
and lle lolal numbei of louis calculaled al 51.0. 1le lolal cosl
savings in lime was 35 louis and in money was S1,220, cosls llal
aie nol ieimbuisable. 1lese lolals iepiesenl oul-of-pockel, nonieim-
buisable expenses foi individuals ieceiving speecl lleiapy. Fuluie
ieseaicl migll also include an analysis of cosl-benefil lo piovideis,
foi example in ieducing lle numbei of session no slows¨ of families
in ieducing caiegivei buiden as iecommended by Baslslui.
?E
Salisfaclion is an accepled indicaloi of lealllcaie seivices.
?F
.evs|.
lleie is a malcl belween caie expecled and caie ieceived, palienls
lave a ligl level of salisfaclion. Alllougl slandaid oulcome measuies
aie ciilical lo gauge lle effecl of an inleivenlion, if lle inleivenlion
is unacceplable lo llose using lle seivices, llen lle piogiam las less
value. In llis sludy, pailicipanls, on aveiage, iepoiled modeiale lo
veiy sliong agieemenl will all ilems measuiing salisfaclion. 1le dem-
onslialed benefils of videoplones coupled will ligl usei salisfaclion
fuillei suppoils lle success of lelelealll leclnology seivice deliveiy.
A videoplone in lle lome of an individual will a clionic disease
sucl as IPB may seive seveial addilional funclions sucl as moniloi-
ing foi clanges in medical slalus. Visual inspeclion of lle piogies-
sion of llis movemenl disoidei fiom lome may eliminale emeigency
ioom visils oi, alleinalively, aleil a lealllcaie piovidei llal a face-
lo-face encounlei is necessaiy.
1leie is a need lo ieplicale llese findings will ollei gioups of
individuals will IPB and lo deleimine if lle posilive iesulls of llis
sludy can be exlended lo ollei speecl and language impaiimenls, as
well as ollei leclnology. Effoils aie ongoing lo develop leclnolo-
gies llal will piovide access lo lealllcaie seivices. Compulei-based
piogiams using lle Inleinel, peisonal digilal assislanls lPBAì, and
compuleiized liealmenl piogiams aie examples of lelelealll lecl-
nologies llal may be useful in incieasing accessibilily of liealmenl
lo a giealei numbei of individuals. Rigoious invesligalions of llese
leclnologies lo piovide oi enlance liealmenl aie necessaiy in oidei
lo examine lleii efficacy as a lool lo delivei lealllcaie.
1le iesulls of lle piesenl sludy indicaled llal videoplone-deliveied
speecl lleiapy lolds lle piomise of expanding oplions of deliveiy
of speecl pallology seivices. 1le significanl clange in pieliealmenl
lo poslliealmenl measuies of vocal loudness, favoiable compaiison
lo publisled oulcomes and clienl salisfaclion will lle leclnology
combine lo make videoplone-deliveied lleiapy an effeclive allei-
nalive mellod of seivice deliveiy. Speecl pallology seivices may
be well-suiled foi lelelealll leclnology, lence, speecl-language
pallologisls looking foi alleinalive ways lo piovide effeclive, less
expensive caie slould considei examining lelelealll leclnology as
an oplion foi individuals wlo would olleiwise ieceive limiled oi no
speecl lleiapy seivices.
Bdlopxmfehnfout
We aie veiy gialeful lo Bi. 1oln 1. Slevin, Bi. Eeallei E. Wiigll,
and Bi. 1odelle F. Beem foi lleii lelp will numeious aspecls of llis
sludy. We also wanl lo iecognize lle leclnical assislance piovided by
Mike Byines fiom KMEA. Special gialilude is exlended lo lle pailici-
panls and lleii family membeis wlo pailicipaled in llis sludy.
Ejtdmptvsf!Tubufnfou
No compeling financial inleiesl exisls foi any aulloi of llis
manusciipl.
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dpnqbsjtpo!xjui!vousfbufe!qbujfout!boe!opsnbm!bhf.nbudife!dpouspmt/!Npwf!
Ejtpse!3112,10ì.70-83.
26/!Dsjudimfz!F/!Tqffdi!ejtpsefst!pg!Qbsljotpojtn;!B!sfwjfx/!K!Ofvspm!Ofvsptvsh!
Qtzdijbusz!2:92,44.7o1-7o8.
27/!Bspotpo!BF/!Dmjojdbm!wpjdf!ejtpsefst/!Ofx!Zpsl;!Uijfnf.Tusbuupo-!2::1/
28/!Cbtitivs!SM/!Ufmfnfejdjof!fggfdut;!Dptu-!rvbmjuz-!boe!bddftt/!K!Nfe!Tztu!
2::6,2.81-01.
29/!Zjq!N-!Diboh!B-!Dibo!K-!Nbdlfo{jf-!B/!Efwfmpqnfou!pg!uif!ufmfnfejdjof!tbu.
jtgbdujpo!rvftujpoobjsf!up!fwbmvbuf!qbujfou!tbujtgbdujpo!xjui!ufmfnfejdjof;!B!
qsfmjnjobsz!tuvez/!K!Ufmfnfe!Ufmfdbsf!3114,0.40-o0.
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31/!Uppuiblfs!MF-!Njmmfs!M/!Jouspevdupsz!tubujtujdt!gps!uif!cfibwjpsbm!tdjfodft-!3oe!fe/!
Qbdjgjd!Hspwf-!DB;!Cspplt.Dpmf!Qvcmjtijoh!Dp/-!2::7.408-400.
32/!Ebwjt!I-!Tjmwfsnjo!T/!Ifbsjoh!boe!efbgoftt/!Ofx!Zpsl;!Ipmu-!Sjofibsu-!boe!
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33/!Gpmtufjo!N-!Gpmtufjo!T-!NdIvhi!Q/!Njoj.nfoubm!tubuf;!B!qsbdujdbm!nfuipe!
gps!hsbejoh!uif!dphojujwf!tubuf!pg!qbujfout!gps!uif!dmjojdjbo/!K!Qtzdijbus!Sft!
2:86,12.180-108.
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F.nbjm; Lyn.1indallOva.gov
Sfdfjwfe; Maicl 28, 2008
Bddfqufe; May 27, 2008