JCPSLP vol 14 no 3 2012

life. The Lee Silverman Voice Treatment (LSVT ® ) has been proven to be an effective treatment for hypokinetic dysarthria in people with PD (Wenke, Cornwell, & Theodoros, 2010). However, the relatively low number of LSVT qualified speech-language pathologists (SLPs), low caseload priority for people with PD, and the physical difficulties people with PD experience in travelling to services are all barriers that hinder the delivery of speech pathology services to this population. Telehealth presents a promising mode of service delivery that could increase access to services and support gains in speech and quality of life. The present study was designed to investigate the validity and reliability of online delivery of LSVT for speech and voice disorders associated with PD. Constantinescu and colleagues employed a single-blinded, randomised controlled trial to compare online and face-to-face treatment of LSVT. Thirty-four participants who had been diagnosed with PD were included: 18 participants had mild hypokinetic dysarthria while 16 had moderate dysarthria. The participants were stratified and randomly assigned to a treatment group, resulting in 17 participants in each group (9 participants with mild dysarthria and 8 with moderate dysarthria in each group). Four SLPs were randomised to both treatment environments. No patients were assessed by their treating clinician during post-treatment assessments which allowed for blinding of the SLPs to the participants’ treatment group. Therapy for both groups adhered to the LSVT program. A PC-based videoconferencing application was developed for the online environment. The system allowed for: videoconferencing in real time; presentation of phrases and reading material during session tasks; the ability to adjust the remote web cameras to maximise the viewing; high-quality audio and video recordings; and calibrated average measures of sound pressure level (SPL), and fundamental frequency (Hz) and duration (sec) through the use of an acoustic speech processor. LSVT was administered following standard practice in the face-to-face treatment environment. The key outcome measures for the two LSVT service delivery models were: SPL in a monologue, acoustic measures from the LSVT evaluation protocol, and perceptual speech and voice judgements by two independent SLPs using direct magnitude estimation. The Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981) was used also as a secondary

measure looking at intelligibility and communication efficiency. Treatment gains made in the online LSVT environment were comparable to gains made by administering LSVT face-to-face. This study confirms that online delivery of LSVT is equivalent to face-to-face delivery. Additionally, participants in the online treatment reported the treatment to be “very good” and that they were “more than satisfied”. The paper’s robust study design provides confidence in the online delivery of LSVT for people with PD. However, as online treatment was administered using a specifically designed videoconferencing application, the results cannot be easily transferred to clinical practice. Technological development is necessary before clinicians will have the opportunity to deliver LSVT in an online environment similar to that of the present study. Similarly, development of technology is needed to design studies that yield significant results while using easily accessible forms of technology. Further research is also required to explore online treatment for people at more advanced stages of PD and with moderate to severe hypokinetic dysarthria. SpeechBITE ratings

Eligibility specified: Y Random allocation: Y Concealed allocation: N Baseline comparability: N Blind subjects: N Blind therapists: N Blind assessors: Y Adequate follow-up: Y Intention-to-treat analysis: Y Between-group comparisons: Y Point estimates and variability: Y References

Ramig, L., Fox, C., & Sapir, S. (2004). Parkinson’s disease: Speech and voice disorders and their treatment with the Lee Silverman Voice Treatment. Seminars in Speech and Language , 25 , 169–180. Wenke, R. J., Cornwell, P. & Theodoros, D. G. (2010) Changes to articulation following LSVT(R) and traditional dysarthria therapy in non-progressive dysarthria. International Journal of Speech Language Pathology , 12 , 203–20. Yorkston, K. M., & Beukelman, D. R. (1981). Assessment of intelligibility of dysarthric speech . Austin, TX: Pro-Ed.

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JCPSLP Volume 14, Number 3 2012

Journal of Clinical Practice in Speech-Language Pathology