Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders

Abstract

Telerehabilitation (telerehab) offers cost-effective services that potentially can improve access to care for those with acquired neurologic communication disorders. However, regulatory issues including licensure, reimbursement, and threats to privacy and confidentiality hinder the routine implementation of telerehab services into the clinical setting. Despite these barriers, rapid technological advances and a growing body of research regarding the use of telerehab applications support its use. This article reviews the evidence related to acquired neurologic speech and language disorders in adults, focusing on studies that have been published since 2000. Research studies have used telerehab systems to assess and treat disorders including dysarthria, apraxia of speech, aphasia, and mild Alzheimer disease. They show that telerehab is a valid and reliable vehicle for delivering speech and language services. The studies represent a progression of technological advances in computing, Internet, and mobile technologies. They range on a continuum from working synchronously (in real-time) with a speech-language pathologist to working asynchronously (offline) with a stand-in virtual therapist. One such system that uses a virtual therapist for the treatment of aphasia, the Web-ORLA™ (Rehabilitation Institute of Chicago, Chicago, IL) system, is described in detail. Future directions for the advancement of telerehab for clinical practice are discussed.

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Figures

Figure 1

Diagram of the Web-ORLA™ telerehabilitation system consisting of separate SLP and participant applications that communicate with each other through the Internet or a private local network.

Figure 2

Web-ORLA™ screen with practice sentence seen by the participant. The virtual therapist (new version shown) provides cues, feedback and encouragement in the same way a SLP provides ORLA treatment. In the example, the virtual therapist is reading the practice sentence aloud and modeling oral-motor movements in synchrony with highlighted text. Note that the ear icon in the bottom right corner of the screen is highlighted, indicating that the SLP is monitoring the session remotely by listening in. The eye icon is not highlighted, indicating that video monitoring is not being used.

Figure 3

Web-ORLA™ screen seen by the speech language pathologist. Names of participants are shown on the left of the screen. A watch window shows the synchronous real-time data for the selected participant including session length, and current activity. Note that the eye and ear icons have been selected allowing the SLP to monitor the participant using real-time audio and video. By instead selecting the text, camera or microphone icons, the SLP can switch to full text, audio and/or video messaging with the participant. A summary window provides additional information on treatment protocol and treatment progress.