Asynchronous telemedicine applications in rehabilitation of acquired speech-language disorders in neurologic patients

Lilian Beijer,1 Toni Rietveld2 1Sint Maartenskliniek, 2Centre of Language Studies, Radboud University of Nijmegen, Nijmegen, The Netherlands Abstract: In this time of an aging population in the Western world and a concomitant need for cost reduction, there is an obvious need for innovative health care delivery. One of the consequences is that a growing number of telemedicine applications are emerging in different health care domains. Also in the area of speech-language (SL) disorders, particularly neurogenic disorders, telemedicine is rapidly gaining interest. In this paper, we place applications for neurogenic SL disorders in a telemedicine taxonomy in order to establish common features along the dimensions of functionality, application, and technology, and their components. Thus, we aim at identifying common features in a wide variety of telemedicine applications and to establish common interests of stakeholders in health care for classified groups of telemedicine applications. This may facilitate decision-making with regard to expansion of innovative products, and give directions to measures needed for upscaling and structural embedding of feasible and effective SL telemedicine applications in health care. Common interests of stakeholders in health care, established using telemedicine taxonomy, is a key factor in decision-making with regard to which telemedicine applications should be given priority for genuine utilization. Priorities of health care institutions, patients, and reimbursement companies are also leading for researchers aiming at solid scientific evidence for the beneficial effects of target applications. That is, although research results tend to indicate the potential of telemedicine in the area of SL pathology, the alleged benefits of most applications have not been confirmed according to the accepted standards for clinical outcome testing as yet. Methodologic obstacles and the lack of adequate speech materials and suitable outcome measures for efficacy and effectiveness testing partially account for this. From the perspective of scientific evidence, the benefits of asynchronous SL telemedicine applications concern data storage and data analyses. To facilitate implementation of telemedicine, there is a call for development of information and communication technology infrastructures that allow feasible applications which meet requirements with regard to licensure and medical privacy laws. For applications with evidence for beneficial effects, we are challenged to develop new business models that apply to a new health care environment. Keywords: telemedicine, speech, language, disorders, rehabilitation&nbsp