52 / 56
158
JCPSLP
Volume 14, Number 3 2012
Journal of Clinical Practice in Speech-Language Pathology
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.
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