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ACQ
Volume 13, Number 2 2011
ACQ
uiring Knowledge in Speech, Language and Hearing
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
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