Feasibility of Speech Telerehabilitation for a Patient with Parkinson's Disease in a Low-Resource Country during the Pandemic: A Case Report

  • Francis Exequiel M. Laxamana Department of Physical Medicine and Rehabilitation, St. Luke’s Medical Center - Quezon City, Philippines
  • Carl Froilan D. Leochico Department of Physical Medicine and Rehabilitation, St. Luke’s Medical Center - Quezon City, Philippines
  • Adrian I. Espiritu Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
  • Gabrielle Ionne T. Sy Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  • Reynaldo R. Rey-Matias Department of Physical Medicine and Rehabilitation, St. Luke’s Medical Center - Quezon City, Philippines
  • Roland Dominic G. Jamora Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
Keywords: Speech therapy, telerehabilitation, teletherapy, parkinson’s disease, voice disorders, coronavirus disease 2019, acoustic measurement, Lee Silverman Voice Therapy

Abstract

Parkinson’s disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country.

We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy; use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, pre-recorded exercise videos) techniques.

Notable speech improvements were observed by the clinicians, patient, and patient’s frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient’s lack of compliance with the prescribed home exercise program.

Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country

Published
2021-08-05
Section
Articles