ACQ Vol 13 no 2 2011

Assessment

Around the journals

subjectivity in judging severity levels. But they stressed that agreement between the two environments was generally high across the assessments and that, on a satisfaction questionnaire, participants were satisfied with the online modality. Despite some audio-visual challenges, including the speed and quality of the connection affecting the image and sound, the authors argued convincingly for telerehabilition as useful for on-line assessment of speech and voice in PD. Using perception of wet vocal quality to assess for penetration/aspiration during swallowing Groves-Wright, K. J., Boyce, S., & Kelchner, L. (2010). Perception of wet vocal quality in identifying penetration/ aspiration during swallowing. Journal of Speech, Language, and Hearing Research , 53 , 620–632. Sue-Ellen Hogg This paper investigated the association between wet vocal quality (WVQ) and the presence of ingested material in the larynx, and in turn, WVQ’s usefulness in identifying individuals at risk of aspiration in a clinical assessment. Listening for WVQ after a swallow is often included in dysphagia assessment protocols, as it is commonly believed to be suggestive of the presence of ingested material in the larynx. While some previous studies have found positive correlations between the presence of WVQ and aspiration, results have been variable. In addition, issues associated with reliability between raters in voice perception, inconsistent terminology, and lack of proximity of acoustic sampling and imaging in these studies has meant a definitive relationship remains unclear. The aim of this study was to investigate whether there was a positive relationship between perception of WVQ and ingested material in the larynx during post-swallow phonation, and whether experienced dysphagia clinicians were reliable in their perception of this relationship. In order to overcome some of the issues identified in previous studies, collection of continuous and simultaneous acoustic and videofluroscopic data occurred and multiple raters were used to calculate interrater reliability. A total of 78 participants were recruited and participated in the study following referral for evaluation of dysphagia. Aetiology of the participants’ dysphagia varied and individuals with a known vocal fold pathology or pathophysiology were excluded from the study. Each participant underwent videofluoroscopic evaluation of swallowing, where they were given boluses of thin, nectar, honey and puree consistencies. Immediately following each of the swallows, participants were cued to phonate / α / for approximately 3 seconds, and then cough. Five experienced dysphagia clinicians were then asked to perceptually rate the randomly ordered audio samples as having WVQ or not.

Assessment via telerehabilitation for Parkinson’s disease

Constantinescu, G., Theodoros, D., Russell, T., Ward, E., Wilson, S., & Wootton, R. (2010). Assessing disordered speech and voice in Parkinson’s disease: A telerehabilitation application. International Journal of Language and Communication Disorders , 45, 630–644. Deborah Hersh There are good reasons for exploring alternative service delivery options for people with Parkinson’s disease (PD). Despite approximately half this population having speech difficulties, a disparity between supply and demand of speech-language pathology services leads to poor availability and accessibility for many. The authors argued that telerehabilitation (the delivery of rehabilitation services to patients at a distance via telecommunication and information technologies) is a possible solution to this situation. Telerehabilitation has already been demonstrated as effective in assessment and treatment for patients with other neurological impairments and Internet-based video-conferencing via personal computer is making the process increasingly accessible. This study, based in Queensland, aimed to investigate the validity and reliability of an Internet-based assessment protocol for the speech and voice disturbances in PD by comparing it to standard face-to-face assessment. Sixty-one participants diagnosed with PD and hypokinetic dysarthria were involved. They were not expected to be proficient computer users and, during assessments, the speech-language pathologist (SLP) controlled all displays on the participant’s screen. Participants were randomly assigned to either face-to-face assessment ( n = 31) or online assessment ( n = 30). Three experienced SLPs conducted the assessments, following a 3-hour training session. In each assessment session, two of the three SLPs were involved, with one leading the assessment session and the other as a silent rater. The assessment battery took one hour and included perceptual ratings of voice and oromotor parameters, articulatory precision, speech intelligibility in reading and conversation as well as instrumental evaluation of sound pressure levels, prolonged vowel duration and pitch range (using the Lee Silverman Voice Treatment (LSVT) Evaluation Protocol). The results, overall, suggested that an Internet-based assessment of speech and voice in PD was reliable and valid with generally good agreement across the range of assessments. Some vocal parameters (including breathiness, roughness, strained-strangled, and pitch breaks) were below the clinical criterion of good agreement and similarly, there was variability in judging masked facial expression and lip retraction. The authors suggested that such findings of lower agreement reflect general inter-rater variability in judging perceptual ratings of voice as well as

98

ACQ Volume 13, Number 2 2011

ACQ uiring Knowledge in Speech, Language and Hearing