Telerehabilitation may be a feasible solution to the current problems faced by people with Parkinson's disease in accessing speech pathology services. To investigate the validity and reliability of online delivery of the Lee Silverman Voice Treatment (LSVT®) for the speech and voice disorder associated with Parkinson's disease. Thirty-four participants with Parkinson's disease and mild-to-moderate hypokinetic dysarthria took part in the randomized controlled non-inferiority laboratory trial and received the LSVT® in either the online or the face-to-face environment. Online sessions were conducted via two personal computer-based videoconferencing systems with real-time and store-and-forward capabilities operating on a 128 kbit/s Internet connection. Participants were assessed pre- and post-treatment on acoustic measures of mean vocal sound pressure level, phonation time, maximum fundamental frequency range, and perceptual measures of voice, articulatory precision and speech intelligibility. Non-inferiority of the online LSVT® modality was confirmed for the primary outcome measure of mean change in sound pressure level on a monologue task. Additionally, non-significant main effects for the LSVT® environment, dysarthria severity, and interaction effects were obtained for all outcomes measures. Significant improvements following the LSVT® were also noted on the majority of measures. The LSVT® was successfully delivered online, although some networking difficulties were encountered on a few occasions. High participant satisfaction was reported overall. Online treatment for hypokinetic dysarthria associated with Parkinson's disease appears to be clinically valid and reliable. Suggestions for future research are outlined.

Background: Patients with Parkinson's disease face numerous access barriers to speech pathology services for appropriate assessment and treatment. Telerehabilitation is a possible solution to this problem, whereby rehabilitation services may be delivered to the patient at a distance, via telecommunication and information technologies. A number of studies have demonstrated the capacity of telerehabilitation to provide reliable and valid assessments of speech, voice and language. However, no studies have specifically focused on assessing patients with Parkinson's disease.Aims: To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinson's disease.Methods & Procedures: Sixty‐one participants with Parkinson's disease and hypokinetic dysarthria were simultaneously assessed in an online and face‐to‐face environment by two speech–language pathologists. The assessment protocol included perceptual measures of voice and oromotor function, articulatory precision, speech intelligibility, and acoustic measures of vocal sound pressure level, phonation time and pitch range. Online assessments were conducted via a personal computer‐based videoconferencing system with store‐and‐forward capabilities, operating on a 128 kbit/s Internet connection. The level of agreement between the online and face‐to‐face ratings was determined using several different analyses, depending on the parameter. These included per cent close agreement, quadratic weighted Kappa, and the Bland and Altman limits of agreement.Outcomes & Results: Per cent close agreement between the two environments was within a predetermined clinical criterion of 80% agreement for all voice and oromotor parameters, articulatory precision and speech intelligibility in conversation. Levels of agreement between the environments, based on quadratic weighted Kappa, ranged from poor to good for vocal parameters and from fair to very good for oromotor parameters. Bland and Altman limits of agreement analyses revealed comparability between online and face‐to‐face environments for vocal sound pressure level, phonation time, pitch range, sentence intelligibility and communication efficiency in reading. Intra‐ and inter‐rater reliability scores for all tasks were comparable between the online and face‐to‐face environments.Conclusions & Implications: For the majority of parameters, comparable levels of agreement were achieved between the two environments. Online assessment of disordered speech and voice in Parkinson's disease appears to be valid and reliable. The telerehabilitation application described in this study provides evidence for the delivery of online assessment for the dysarthric speech disorder associated with Parkinson's disease.

DYSPHAGIA, or impaired swallowing function, has been established as a predominant negative sequelae following laryngectomy and pharyngolaryngectomy surgery.^1-5 Despite this, few investigations have specifically examined the nature of the presenting dysphagia, including postoperative and long-term complications, patterns of recovery, or long-term dietary outcomes. In addition, the documented incidence figures for dysphagia following total laryngectomy and pharyngolaryngectomy are noted to vary widely from study to study. Presently, the incidence of dysphagia following total laryngectomy has been reported to range from 10%⁶ to 60%.⁷ Similarly, the overall reported incidence of dysphagia following pharyngolaryngectomy with free jejunal graft reconstruction currently ranges from 2%⁸ to 58%.⁹ The inconsistency in these figures in both patient populations seems to stem from the use of various definitions of "successful" swallowing. Many authors have categorized successful swallowing as the ability to achieve oral intake regardless of consistency, eg, "successful swallowing is the ability to maintain nutrition without tube feeding."¹⁰(p396) Others have included the ability to swallow modified consistencies as their optimal outcome, eg, "adequate swallowing is the ability to tolerate a soft diet."¹¹(p954) Although such broad definitions of swallowing success may be adequate when evaluating the outcomes of different surgical techniques, they fail to accurately reflect the true number of patients postsurgery who are unable to resume their normal, premorbid swallowing function. Consequently, it is possible that the figures reported in the literature may have underestimated the number of patients who may experience difficulties and associated distress related to altered swallowing function postsurgery.

Evidence supporting prophylactic swallow exercises for patients with head and neck cancer (HNC) has not been universally demonstrated. This RCT examined diet level, feeding tube use, swallow function, and quality of life (QOL) of patients undergoing chemoradiotherapy who performed prophylactic swallowing exercises. Sixty HNC patients were randomized into exercise versus control groups. Swallowing, oromotor, toxicity, and QOL data were recorded (baseline, 3, 6, 12, 24 months). Physiological swallow function was examined at baseline and 3 months. Swallow exercises were completed twice daily. Oral intake at 3 months was 10% better in the exercise group, which was not statistically significant (p = 0.49). Significant (p < 0.05) differences in secondary outcomes including oromotor function, pharyngeal impairment, oral pharyngeal swallow efficiency, and incisal opening were noted at early time points (3–6 months) in the exercise group. Possible positive early improvements in swallow function are associated with swallowing exercises, although these improvements are not significant longer term.