A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy

Background: Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. Aim: To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. Methods and procedures: Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. Outcomes and results: Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, K_W = 0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, K_W = 0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, K_W = 1); interrater agreement was substantial (85%; K_W = 0.76). Conclusions and implications: Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.