title: Using telerehabilitation to assess apraxia of speech in adults.
abstract: BACKGROUND
  Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of studies that have used videoconferencing to assess speech and language skills in people with acquired neurogenic communication disorders. However, few studies have focused on cases of apraxia of speech. In order to perform accurately differential diagnosis via the telerehabilitation medium, it is important that validation of the assessment of apraxia of speech be established as part of the overall evidence base for telerehabilitation communication assessment protocols.
  
  
  OBJECTIVE
  To determine if valid and reliable assessment of apraxia of speech using a standardized assessment tool was feasible via telerehabilitation.
  
  
  METHODS
  Eleven participants with an acquired apraxia of speech were assessed simultaneously via telerehabilitation and face-to-face methods on the Apraxia Battery for Adults - 2 (ABA-2). A custom-built telerehabilitation system developed at the University of Queensland enabled real-time telerehabilitation assessment over a 128 kbit/s internet connection. Data analysis included tests of significant difference between raw scores using the Wilcoxon signed rank statistic and analysis of the degree of agreement between the two methods using weighted Kappa statistics. Inter- and intra-rater reliabilities were also examined for the telerehabilitation-led assessments.
  
  
  RESULTS
  Results revealed no significant differences between the subtest scores of the ABA-2 obtained in the telerehabilitation and face-to-face test environments (p = 0.06-0.68). Weighted Kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two environments for the subtests of the ABA-2. The reliability study was hampered by small sample size; however, the data were suggestive of reasonable reliability. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the telerehabilitation environment. The speech-language pathologists (SLP) reported some difficulties assessing participants with severe apraxia of speech via the telerehabilitation system.
  
  
  CONCLUSIONS
  This study suggests that valid assessment of apraxia of speech using the ABA-2 over the internet is feasible. The reliability study on the telerehabilitation assessments was encouraging with results suggesting that telerehabilitation assessment using the ABA-2 could be reliable. Findings from the participant satisfaction questionnaire were favourable. However, comments from the SLP suggested that participants exhibiting severe apraxia of speech might be better suited to face-to-face assessment. These findings may have implications for the development of evidence-based guidelines for the use of telerehabilitation in the assessment of apraxia of speech. The authors propose that future research should include larger sample sizes with a range of participant severity levels and be conducted over higher bandwidth connections to explore further the validity and reliability of telerehabilitation assessment of apraxia of speech.
authors.affiliation: Division of Speech Pathology, The University of Queensland, Brisbane, Australia. a.hill@shrs.uq.edu.au
authors.forename: Anne Jane
authors.initials: AJ
authors.lastname: Hill
authors.forename: Deborah
authors.initials: D
authors.lastname: Theodoros
authors.forename: Trevor
authors.initials: T
authors.lastname: Russell
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001072:Apraxias / Q000175:diagnosis* / Q000534:rehabilitation; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019114:Remote Consultation; D013064:Speech Disorders / Q000175:diagnosis* / Q000534:rehabilitation; D013068:Speech Production Measurement / Q000379:methods; D013066:Speech-Language Pathology / Q000379:methods; D055815:Young Adult