Telehealth Platforms Can Create Obstacles to Virtual Speech Therapy

Like many specialty healthcare providers, speech and language pathologists have leveraged telehealth during the pandemic to treat their patients. But a new study from the Journal of Speech, Language, and Hearing Research finds that the poor quality of many video conferencing platforms may be hindering that treatment.

Telehealth has increased access to treatment for people who live in rural areas and others who face barriers to accessing care, particularly during the pandemic. And specialists offering speech-language pathology services have used connected health platforms to expand their reach and treat more patients who might otherwise not receive care.

But both audio-visual and audio-only telehealth platforms, while beneficial for medical issues that do not require hands-on procedures, still need unobstructed, unaltered audio to diagnose and treat conditions like speech and voice disorders. Perfect sound quality is not always a given when it comes to telehealth.

For their study, researchers from Boston University took voice samples from 29 patients living with voice disorders such as muscle tension dysphonia and vocal fold nodules using a sound-reducing booth. They then asked the patients to use one of six commercially available video conferencing platforms, including Zoom, Microsoft Teams, and Cisco WebEx. 

According to the study, telemedicine technology in the platforms had a significant impact on almost every aspect of sound transmission. Researchers had told the patients to disable sound enhancements while using the platform, but the combination of ambient noise and platform qualities still impaired the acoustic measures.

While the telehealth platforms did not produce perfect recordings, researchers found that they could still provide clinically relevant information, including accurate measurements of fundamental frequency and smoothed cepstral peak prominence.

“Changes in acoustic measures of voice quality due to transmission were as large or larger than differences reported between individuals with and without voice disorders in previous work, suggesting that telepractice platform transmission imposes clinically relevant degradations to these measures,” the study concluded.

Despite those findings, the researchers pointed out that these platforms can still be used by speech and language pathologists if they understand the limitations. They advise clinicians to take note of how these platforms can impact acoustic measures and point to the benefits of designing a telehealth platform that is catered to voice therapy and conducting telehealth visits in quiet or sound-proof areas.

“They can request clients to send separate prerecorded voice samples prior to the telepractice session and utilize them for voice evaluations,” researchers wrote. “If clinicians are using voice samples taken during telepractice sessions, they may have to revise which acoustic measures, and which teleconferencing platforms, should be utilized for voice evaluations.”

In April 2021, The Centers for Medicare & Medicaid Services expanded Medicare telehealth coverage for many different types of care providers, including speech-language pathologists, to counter the effects of the pandemic on in-person care. This coverage only applies to services for the duration of the federal public health emergency, which is expected to run into 2022.