Beware Using Telemedicine for Voice and Speech Therapy

As a result of the coronavirus pandemic, people across the world have experienced how teleconferencing platforms like Zoom help folks stay connected - playing games with friends, hosting virtual weddings, and even visiting a doctor. But when it comes to telemedicine, not all medical care is easily translated to a remote format.

In a virtual world, voice therapy presents a unique challenge because clinicians must rely on acoustic recordings of voice to evaluate the effectiveness of their treatments. But many teleconferencing platforms distort sounds in their efforts to eliminate background noise.

Boston University graduate researcher Hasini Weerathunge wanted to find out if popular teleconferencing platforms used for telemedicine could capture sounds accurately enough for clinicians to successfully treat and evaluate patients with voice and speech disorders. Weerathunge, a graduate student fellow at BU's Rafik B. Hariri Institute for Computing and Computational Science & Engineering and a Ph.D. candidate in biomedical engineering, does research in the lab of Cara Stepp, a College of Health & Rehabilitation Sciences: Sargent College associate professor of speech, language, and hearing sciences.

"Although the COVID-19 crisis appears to be waning, telepractice popularity is here to stay," Stepp says.

Weerathunge and Stepp teamed up with other BU researchers to put five different HIPAA-compliant teleconferencing platforms to the test: Cisco Webex, Microsoft Teams, Doxy.me, VSee Messenger, and Zoom.

As the pandemic unfolded and lockdowns moved much voice and speech therapy online, "there was no consensus among [voice and speech] clinicians [who were] trying to convert to telepractice therapy, and we wanted to determine the accuracy of the acoustic measures they can get through telepractice," Weerathunge says.

Although voice therapists had sometimes conducted telepractice sessions with patients before the pandemic, evaluations of the effectiveness of treatment were always carried out in person. During that process, a patient goes into the clinic and sits in a soundproof booth outfitted for speech recordings. The patient repeats sustained vowel sounds, like "aaa" or "ooo," or reads a short passage that reflects a wide variety of sounds and mouth movements in the English language. The recordings of the patient's voice are then evaluated by algorithms that measure acoustic properties, including the acoustic correlates of perceived pitch and loudness of the voice.

In-person voice evaluations came to halt, however, at the height of the COVID-19 pandemic. Voice evaluations moved to a virtual format, but until now, the accuracy of those evaluation procedures done online has never been examined.

In a soundproof room, the team recorded voice samples from 29 patients, aged 18 to 82, that had a variety of speech or voice diagnoses. These recordings were then played back to researchers through an external speaker over the teleconferencing platforms, simulating telepractice conversations.

The team quickly learned that each platform has its own audio enhancement algorithm that affects the quality of the sound. Zoom was the only platform that enabled users to turn off these audio enhancement features, allowing the researchers to test the platform's original audio.

Despite the enhancements, the team predicted the ability to measure vocal fundamental frequency (pitch) and vocal intensity (loudness) through teleconferencing platforms is not significantly affected.

But the researchers discovered that all the teleconferencing platforms did a poor job at capturing many measurements needed for accurate and clinically meaningful voice evaluations. Pitch varied significantly on all the virtual platforms compared to the real-life recordings. This might be due to internet connection or bandwidth issues that affect how and when sounds get transmitted through the platforms, the researchers say.

They also found the dynamic range of the vocal loudness measured over telepractice was very different from live recordings. "This was the biggest surprise for us," Weerathunge says. The effect was even true for Zoom, where the researchers could turn off the audio enhancements.

Overall, "Microsoft Teams performed the best, in that all our voice measures were the least affected in that platform," Weerathunge says.

Because many of the voice metrics collected from virtual platforms had clinically significant differences from those collected in person, Weerathunge and the team urge caution for voice and speech therapists using telepractice.

"This work is likely to have substantial impact on clinical practice, providing crucial information about the effects of these telepractice platforms on clinical voice evaluations," Stepp says.

Hasini R Weerathunge et al.
Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms.
Journal of Speech, Language, and Hearing Research, 2021. doi: 10.1044/2021_JSLHR-20-00625

Most Popular Now

Digital Health Webinar

14 September 2021, Webinar. The digital healthcare ecosystem is evolving with rapid speed. Technologies such as AI, robotics, telemedicine, and precision medicine are a mix of challenges and opportunities...

Using AI for Early Detection and Treatme…

Artificial intelligence (AI) will fundamentally change medicine and healthcare: Diagnostic patient data, e.g. from ECG, EEG or X-ray images, can be analyzed with the help of machine learning, so that...

Waiting Times for Medical Admissions Red…

Clinicians at Bolton NHS Foundation Trust have dramatically reduced patient waiting times, decreased hospital length of stay and improved patient safety after developing an electronic acute medical list solution to manage patient referrals.  The configuration was initially set-up to track referrals and admissions...

AI Algorithm Solves Structural Biology C…

Determining the 3D shapes of biological molecules is one of the hardest problems in modern biology and medical discovery. Companies and research institutions often spend millions of dollars to determine...

Novel AI Blood Testing Technology can ID…

A novel artificial intelligence blood testing technology developed by researchers at the Johns Hopkins Kimmel Cancer Center was found to detect over 90% of lung cancers in samples from nearly...

Accenture HealthTech Innovation Challeng…

Accenture (NYSE: ACN) has named eight companies as finalists in the Accenture HealthTech Innovation Challenge, which brings together leading-edge startups with prominent health companies to tackle some of North America's...

Clinerion Patent for Technology Underpin…

The new Clinerion patent underpins any medical EHR database infrastructure that incorporates a hybrid model of cloud-and-local server node installations at individual hospitals, as well as any method for search...

Data MATRIX Introduces an AI-Operated Pa…

Data MATRIX, a sole Real-World Evidence solutions provider in Russia, has presented a predictive analytics tool for estimating patient survival based on Real-World Data. An important feature of the presented tool for...

Researchers Use AI to Predict which COVI…

Researchers at Case Western Reserve University have developed an online tool to help medical staff quickly determine which COVID-19 patients will need help breathing with a ventilator. The tool, developed through...

A Game Changer: Virtual Reality Reduces …

It isn’t a matter of one needle puncture. Many children coming through the doors of Children's Hospital Los Angeles are seen for chronic conditions and often require frequent visits. Painful...

Bittium Expands Its Minority Holdings in…

Bittium Biosignals Ltd, a subsidiary of Bittium Corporation, and British ECG service provider, Technomed Limited, have today signed an agreement under which Bittium will purchase a 25 percent stake in...

Scientists Develop AI to Predict the Suc…

A study in which machine-learning models were trained to assess over 1 million companies has shown that artificial intelligence (AI) can accurately determine whether a startup firm will fail or...