Children with voice disorders (dysphonia) are at a distinct social and educational disadvantage and access to adequate services for diagnosis and treatment can be difficult. Childhood dysphonia is associated with social withdrawal and depression that can negatively influence social, emotional, educational and occupational outcomes. Secure Internet transmission of voice (speech) and visual data is emerging as an effective means by which to increase patient access to specialized allied health services but treatment of childhood voice disorders is not yet among them. Given the need for access to highly specialized clinical skills, the documented suitability of individual voice therapy to this model of care in adults, extending the telehealth concept to treatment of pediatric voice disorders is a novel, albeit logical step. The purpose of this study is to determine the feasibilit of using a telehealth solution for delivering pediatric voice therapy via secure teleconferencing and Web-based systems. We will also gather preliminary efficacy data and carefully evaluate the use of telehealth by patients, families and pediatric voice care specialists. The motivating hypothesis is that an informed, feasible and personalized approach to pediatric voice care via telehealth is possible and will result in improved patient access to quality care and result in greater opportunity for self management and clinical monitoring. This application responds to the documented criteria listed for PAR-08-269.
It aims to support patient centered care and the delivery of care across settings (e.g., hospital based service to home). This investigation is intended to collect preliminary data for a larger R01 application. Long-term we aim to prove that this model of service delivery can be standardized and used to consistently deliver a high level of care, evaluate treatment outcomes and reduce the chronic nature of childhood voice disorders. In time its application to other childhood communication disorders can be made. We expect that a telehealth approach will also relieve a family's burden related to access, travel and the complex nature of family schedules and scheduling therapy. We plan to accomplish the objectives of this application by the following specific aims: 1). Test a pilot program of personalized voice therapy in ten children using a telehealth approach. Assessing the quality and stability of synchronous Internet and Web-based audio/video data transmission and measuring progress in therapy will be the principal components of this aim;and 2). Explore the personal and interpersonal benefits and obstacles surrounding delivery of pediatric voice therapy using telehealth. Outcome measures will include satisfaction, compliance, and cost. We will also seek to identify what adaptations are needed to deliver voice therapy via the Internet. Our findings will provide proof of systems capability and reliability relative to the needed technical equipment, reliability of Internet operations and Web-portal access for this type of patient care. At the conclusion of this project we will be able to inform traditional healthcare an telehealth professionals about the ability of our patients to the use technology as an essential ingredient of their care. We will have the necessary preliminary data to develop a large outcomes based efficacy study that compares face to face (FTF) and telehealth (TH) options for this important population.

Public Health Relevance

Having a voice disorder during childhood can negatively impact social and educational development. Unfortunately, many children do not have access to quality voice care and effective treatment. In an effort to improve access to care, this project wil test how computer technology and the Internet can be used to provide voice therapy directly to children in their homes.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Health Care Technology and Decision Science (HTDS)
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Nunley, Angela
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University of Cincinnati
Other Health Professions
Schools of Allied Health Profes
United States
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