Division of Speech Pathology, University of Queensland, St Lucia, Brisbane, QLD, Australia.
Int J Lang Commun Disord. 2010 Nov-Dec;45(6):630-44. doi: 10.3109/13682820903470569.
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.
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.
帕金森病患者在获得适当的评估和治疗方面面临着许多获取言语病理学服务的障碍。远程康复是解决这一问题的一种可能方法，通过远程通信和信息技术，可以将康复服务提供给患者。许多研究已经证明了远程康复能够提供可靠和有效的语音、声音和语言评估。然而，目前还没有专门针对帕金森病患者的评估研究。
研究一种远程康复应用程序评估帕金森病相关语音和嗓音障碍的有效性和可靠性。
61 名帕金森病伴运动障碍性构音障碍患者由两名言语语言病理学家同时在在线和面对面环境中进行评估。评估方案包括声音和口部运动功能的感知测量、发音准确性、言语可懂度以及嗓音声压级、发音时间和音域的声学测量。在线评估通过具有存储转发功能的基于个人计算机的视频会议系统进行，运行在 128 kbit/s 的互联网连接上。根据参数的不同，使用几种不同的分析方法确定在线和面对面评估之间的一致性程度。这些分析方法包括：百分比一致性、二次加权 Kappa 和 Bland 和 Altman 一致性界限。
在所有声音和口部运动参数、发音准确性和会话中的言语可懂度方面，两种环境之间的百分比一致性都在预定的 80%临床一致性标准内。基于二次加权 Kappa 的环境之间的一致性水平，对于嗓音参数为差到好，对于口部运动参数为从一般到非常好。Bland 和 Altman 一致性界限分析表明，在嗓音声压级、发音时间、音域、句子可懂度和阅读交流效率方面，在线和面对面环境之间具有可比性。在线和面对面环境之间的所有任务的内部和观察者间可靠性评分均具有可比性。
对于大多数参数，两种环境之间都达到了可比的一致性水平。在线评估帕金森病患者的语音和嗓音障碍似乎是有效和可靠的。本研究中描述的远程康复应用程序为帕金森病相关的构音障碍语音提供了在线评估的证据。
