title: A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy.
abstract: BACKGROUND
  Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated.
  
  
  OBJECTIVE
  To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment.
  
  
  METHODS
  Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity.
  
  
  RESULTS
  Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76).
  
  
  CONCLUSIONS
  Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.
authors.affiliation: Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA. Electronic address: ckantarc@purdue.edu.
authors.forename: Cagla
authors.initials: C
authors.lastname: Kantarcigil
authors.affiliation: Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA. Electronic address: jjs74@tc.columbia.edu.
authors.forename: Justine Joan
authors.initials: JJ
authors.lastname: Sheppard
authors.affiliation: Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA. Electronic address: ag275@tc.columbia.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. Electronic address: kaf3001@med.cornell.edu.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
authors.affiliation: Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA. Electronic address: malandraki@purdue.edu.
authors.forename: Georgia A
authors.initials: GA
authors.lastname: Malandraki
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D019370:Observation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods*; D014741:Video Recording
keywords: Asynchronous evaluations; Cerebral palsy; Developmental disability; Pediatric dysphagia; Telehealth