Telehealth in Speech-Language Pathology and Hearing: science and technology

TEMA: a educação à distância (EaD) tem se tornado uma modalidade de impacto significante no ensino superior, oferecendo aos estudantes flexibilidade, mobilidade e escolha. É uma ferramenta de grande importância, uma vez que pode atender grandes contingentes de alunos e profissionais de forma mais efetiva que outras modalidades de ensino, sem reduzir a qualidade dos serviços oferecidos. O Brasil necessita desenvolver ações direcionadas a EaD na área da Fonoaudiologia, pois possui um território com dimensões continentais relevantes (8.514.215,3Km²) e distribuição irregular de profissionais fonoaudiólogos, o que acentua a heterogeneidade da qualidade e disponibilidade dos serviços oferecidos no país. Essa heterogeneidade é ainda agravada pela falta de uma estratégia nacional de educação continuada para atualização dos profissionais de saúde, causando diferenças importantes na capacitação dos especialistas de uma região para outra. OBJETIVO: apresentar estudos relacionados a Telessaúde realizados nos últimos cinco anos na área de Fonoaudiologia. CONCLUSÃO: a partir dos dados levantados observou-se a necessidade de desenvolver trabalhos nessa área, buscando a melhora na qualidade dos serviços oferecidos e facilidade de acesso a esses serviços, gerando impacto mais efetivo na prevenção, diagnóstico e tratamento dos distúrbios da comunicação.BACKGROUND: distance learning (DL) is becoming a higher education modality with a meaningful impact. It offers students flexibility, mobility and choices. Also it can reach a greater number of professionals and students in a more effective way, when compared to other learning modalities, without losing quality. Brazil needs to develop direct actions to DL in the fields of Speech-Language Pathology and Hearing, due to its great continental territory (8,514,215.3Km²) and irregular distribution of professionals who work in these specific fields (i.e. this situation emphasizes the differences in quality and availability of services offered throughout the country). Heterogeneity in the quality and availability of services is also aggravated by the absence of a national strategy for continued education in order to recycle health professionals. This situation causes important differences in the knowledge and abilities of specialists from one region to the next. AIM: to present Telehealth studies in the field of Speech-Language Pathology and Hearing that were developed in the last five years. CONCLUSION: the analyzed data indicate that more studies are needed in this specific field. These studies should aim at improving the quality and access to services which in turn would improve prevention, diagnosis and treatment of communication disorders

Using fMRI and Behavioural Measures to Investigate Rehabilitation in Post-Stroke Aphasic Deficits

In this thesis I investigated whether an intensive computerised, home-based therapy programme could improve phonological discrimination ability in 19 patients with chronic post-stroke aphasia. One skill specifically targeted by the treatment demonstrated an improvement due to the therapy. However, this improvement did not generalise to untreated items, and was only effective for participants without a lesion involving the frontal lobe, indicating a potentially important role for this region in determining outcome of aphasia therapy. Complementary functional imaging studies investigated activity in domain-general and domain-specific networks in both patients and healthy volunteers during listening and repeating simple sentences. One important consideration when comparing a patient group with a healthy population is the difference in task difficulty encountered by the two groups. Increased cognitive effort can be expected to increase activity in domain-general networks. I minimised the effect of this confound by manipulating task difficulty for the healthy volunteers to reduce their behavioural performance so that it was comparable to that of the patients. By this means I demonstrated that the activation patterns in domain-general regions were very similar in the two groups. Region-of-interest analysis demonstrated that activity within a domain-general network, the salience network, predicted residual language function in the patients with aphasia, even after accounting for lesion volume and their chronological age. I drew two broad conclusions from these studies. First, that computer-based rehabilitation can improve disordered phonological discrimination in chronic aphasia, but that lesion distribution may influence the response to this training. Second, that the ability to activate domain-general cognitive control regions influences outcome in aphasia. This allows me to propose that in future work, therapeutic strategies, pharmacological or behavioural, targeting domain-general brain systems, may benefit aphasic stroke rehabilitation.Open Acces