Current Status and Perspectives of Telepractice in Voice and Speech Therapy

비대면 음성언어치료의 현황과 전망

  • Seung Jin, Lee (Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University)
  • 이승진 (한림대학교 자연과학대학 언어청각학부 및 청각언어연구소)
  • Received : 2022.10.09
  • Accepted : 2022.11.29
  • Published : 2022.12.31


Voice and speech therapy can be performed in various ways depending on the situation, although it is generally performed in a face-to-face manner. Telepractice refers to the provision of specialized voice and speech therapy by speech-language pathologists for assessment, therapy, and counseling by applying telecommunication technology from a remote location. Recently, due to the pandemic situation and the active use of non-face-to-face platforms, interest in telepractice of voice and speech therapy has increased. Moreover, a growing body of literature has been advocating its clinical usefulness and non-inferiority to traditional face-to-face intervention. In this review, the existing discussions, guidelines, and preliminary studies on non-face-toface voice and speech therapy were summarized, and recommendations on the tools for telepractice were provided.



This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2018S1A5A2A03032902).


  1. Grillo EU. Building a successful voice telepractice program. Perspect ASHA Spec Interest Groups 2019;4(1):100-10.
  2. Cason J, Cohn ER. Telepractice: An overview and best practices. Perspect Augment Altern Commun 2014;23(1):4-17.
  3. Desai AN, Mehrotra P. Medical masks. JAMA 2020;323(15):1517-8.
  4. Benito DA, Pasick LJ, Mulcahy CF, Rajasekaran K, Todd-Hesham H, Joshi AS, et al. Local spikes in COVID-19 cases: Recommendations for maintaining otolaryngology clinic operations. Am J Otolaryngol 2020;41(6):102688.
  5. Vaughn GR. Tel-communicology: Health-care delivery system for persons with communicative disorders. ASHA 1976;18(1):13-7.
  6. Duffy JR, Werven GW, Aronson AE. Telemedicine and the diagnosis of speech and language disorders. Mayo Clin Proc 1997;72(12):1116-22.
  7. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson's disease online: A randomized controlled non-inferiority trial. Int J Lang Commun Disord 2011;46(1):1-16.
  8. Grillo EU. An online telepractice model for the prevention of voice disorders in vocally healthy student teachers evaluated by a smartphone application. Perspect ASHA Spec Interest Groups 2017;2(3):63-78.
  9. Lowe R, O'Brian S, Onslow M. Review of telehealth stuttering management. Folia Phoniatr Logop 2013;65(5):223-38.
  10. McGill M, Noureal N, Siegel J. Telepractice treatment of stuttering: A systematic review. Telemed J E Health 2019;25(5):359-68.
  11. Mashima PA, Brown JE. Remote management of voice and swallowing disorders. Otolaryngol Clin North Am 2011;44(6):1305-16, viii.
  12. Pullins V, Grogan-Johnson S. A clinical decision making example: Implementing intensive speech sound intervention for school-age students through telepractice. Perspect ASHA Special Interest Groups 2017;2(18):15-26.
  13. Kim JY. A literature review of telepractice for children with speech disorders. J Speech Lang Hear Disord 2020;29(4):71-8.
  14. Chan MY, Chu SY, Ahmad K, Ibrahim NM. Voice therapy for Parkinson's disease via smartphone videoconference in Malaysia: A preliminary study. J Telemed Telecare 2021;27(3):174-82.
  15. Becker DR, Gillespie AI. In the zoom where it happened: Telepractice and the voice clinic in 2020. Semin Speech Lang 2021;42(1):64-72.
  16. Fong R, Tsai CF, Yiu OY. The implementation of telepractice in speech language pathology in Hong Kong during the COVID-19 pandemic. Telemed J E Health 2021;27(1):30-8.
  17. Singh SJ, Kamarudin K, Sharma S. The implementation of telepractice by Malaysian speech-language pathologists during the COVID-19 pandemic. Commun Sci Disord 2022;27(1):239-50.
  18. Aggarwal K, Patel R, Ravi R. Uptake of telepractice among speechlanguage therapists following COVID-19 pandemic in India. Speech Lang Hear 2020;24(4):228-34.
  19. Cantarella G, Barillari MR, Lechien JR, Pignataro L. The challenge of virtual voice therapy during the COVID-19 pandemic. J Voice 2021;35(3):336-7.
  20. Mattei A, Amy de la Breteque B, Crestani S, Crevier-Buchman L, Galant C, Hans S, et al. Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020;137(3):173-5.
  21. Castillo-Allendes A, Contreras-Ruston F, Cantor-Cutiva LC, Codino J, Guzman M, Malebran C, et al. Voice therapy in the context of the COVID-19 pandemic: Guidelines for clinical practice. J Voice 2021;35(5):717-27.
  22. Pearlman AN, Tabaee A, Sclafani AP, Sulica L, Selesnick SH, Kutler DI, et al. Establishing an office-based framework for resuming otolaryngology care in academic practice during the COVID-19 pandemic. Otolaryngol Head Neck Surg 2021;164(3):528-41.
  23. Gray R, Michael D, Hoffmeister J, Lunos S, Zach S, Butcher L, et al. Patient satisfaction with virtual vs in-person voice therapy. J Voice. In press 2022.
  24. Little CC, Russell S, Hwang C, Goldberg L, Brown S, Kirke D, et al. Applications of telemedicine in speech-language pathology: Evaluation of patient satisfaction. Laryngoscope. In press 2022.
  25. Zughni LA, Gillespie AI, Hatcher JL, Rubin AD, Giliberto JP. Telemedicine and the interdisciplinary clinic model: During the COVID-19 pandemic and beyond. Otolaryngol Head Neck Surg 2020;163(4):673-5.
  26. Guzman M, Ortega A, Rocha C, Salgado L, Quezada C. Efficacy of voice therapy with acapella choice® device in subjects with vocal fatigue delivered via telepractice. J Voice. In press 2022.
  27. Fu S, Theodoros DG, Ward EC. Delivery of intensive voice therapy for vocal fold nodules via telepractice: A pilot feasibility and efficacy study. J Voice 2015;29(6):696-706.
  28. Grillo EU. A nonrandomized trial for student teachers of an in-person and telepractice global voice prevention and therapy model with estill voice training assessed by the VoiceEvalU8 app. Am J Speech Lang Pathol 2021;30(2):566-83.
  29. Liu H, Hao G, Chen S, Ouyoung L, Liu Y, Li J, et al. Effectiveness and feasibility of telepractice on voice therapy for female teachers in elementary schools with self-reported voice disorders. J Voice. In press 2021.
  30. Hseu AF, Spencer G, Jo S, Kagan S, Thompson K, Woodnorth G, et al. Telehealth for treatment of pediatric dysphonia. J Voice. In press 2021.
  31. Myers B, Hary E, Ellerston J, Barkmeier-Kraemer JM. Telepractice considerations for evaluation and treatment of voice disorders: Tailoring to specific populations. Am J Speech Lang Pathol 2022;31(2):678-88.
  32. Mari G, Marchese MR, Longobardi Y, Proietti I, Marenda ME, Di Cesare T, et al. Voice telerehabilitation in iatrogenic unilateral vocal fold paralysis: From necessity to opportunity in the COVID-19 time. J Voice. In press 2022.
  33. Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice therapy for benign voice disorders in the elderly: A randomized controlled trial comparing telepractice and conventional face-to-face therapy. J Speech Lang Hear Res 2020;63(7):2132-40.
  34. Schneider SL, Habich L, Weston ZM, Rosen CA. Observations and considerations for implementing remote acoustic voice recording and analysis in clinical practice. J Voice. In press 2021.
  35. Payten CL, Nguyen DD, Novakovic D, O'Neill J, Chacon AM, Weir KA, et al. Telehealth voice assessment by speech language pathologists during a global pandemic using principles of a primary contact model: An observational cohort study protocol. BMJ Open 2022;12(1):e052518.
  36. Lee E, Choi SY, Hwang M. A review of the use of telepractice in speech language pathology. Cult Converg 2021;43(1):785-807.
  37. Lee HN, Yoo JY, Park JH. Effect of online and offline voice therapy programs in patients with hyperfunctional voice disorder: A case study. Commun Sci Disord 2019;24(3):814-26.
  38. Lee G, Park SN. A case of voice therapy for patient who voice changed after total thyroidectomy using contactless voice and speech therapy service platform. J Korean Soc Laryngol Phoniatr Logop 2021;32(1):43-7.
  39. Cho NB, Cho SR, Choi SH, You H, Nam SI, Kim H. Short-term and Long-term efficacy of oropharyngolaryngeal strengthening training on voice using a mobile healthcare application in elderly women. Commun Sci Disord 2021;26(1):219-30.
  40. Kim JS, Choi SH. Effect of non-face-to-face voice therapy using the self-voice health care program for vocal fatigue. Commun Sci Disord 2021;26(2):501-9.
  41. Ryu HS, Kim J. Effect of semi-occluded vocal tract exercise via telepractice on subjective voice evaluation of early childhood teachers. Phonetics Speech Sci 2021;13(4):67-74.
  42. Park SN, Ha JW, Bae YS, Park KS, Lee G. The effect of articulation intervention using telepractice on the production of/ㅅ/in children with speech sound disorder. J Speech Lang Hear Disord 2021;30(1):1-12.
  43. Kim GH, Lee YW, Bae IH, Park HJ, Kwon SB. Effect of mobile-based voice therapy on the voice quality of patients with dysphonia. Clin Arch Commun Disord 2021;6(1):48-54.
  44. Halpern AE, Ramig LO, Matos CE, Petska-Cable JA, Spielman JL, Pogoda JM, et al. Innovative technology for the assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease. Am J Speech Lang Pathol 2012;21(4):354-67.
  45. Van Eerdenbrugh S, Schraeyen K, Leysen H, Mostaert C, D'haenens W, Vandenborre D. Delivery of speech-language therapy and audiology services across the world at the start of the COVID-19 pandemic: A survey. Perspect ASHA Special Interest Groups 2022;7(2):635-46.
  46. Seong CJ. Guidance to the Praat, a software for speech and acoustic analysis. J Korean Soc Laryngol Phoniatr Logop 2022;33(2):64-76.
  47. Kim GH, Lee YW, Bae IH, Park HJ, Wang SG, Kwon SB. Validation of the acoustic voice quality index in the Korean language. J Voice 2019;33:948.e1-948.e9.
  48. Lester-Smith RA, Jebaily CG, Story BH. The effects of remote signal transmission and recording on acoustical measures of simulated essential vocal tremor: Considerations for remote treatment research and telepractice. J Voice. In press 2021.
  49. Lee SJ, Lee KY, Choi HS. Clinical usefulness of voice recordings using a smartphone as a screening tool for voice disorders. Commun Sci Disord 2018;23(4):1065-77.
  50. Grillo EU, Corej B, Wolfberg J. Normative values of client-reported outcome measures and self-ratings of six voice parameters via the VoiceEvalU8 app. J Voice. In press 2021.
  51. Lee SJ, Choi HS, Kim H, Byeon HK, Lim SE, Yang MK. Korean version of the voice activity and participation profile (K-VAPP): A validation study. Commun Sci Disord 2016;21(4):695-708.
  52. Lee AR, Sim HS. The Korean version of the singing voice handicap index. Commun Sci Disord 2013;18(2):194-202.
  53. Park SS, Kwon TK, Choi SH, Lee WY, Hong YH, Jeong NG, et al. Reliability and validity of the Korean version of pediatric voice handicap index: In school age children. Int J Pediatr Otorhinolaryngol 2013;77(1):107-12.
  54. Lee JM, Jung SY, Kim BN, Kim HS. Validation of the Korean voice perceived present control scale: A pilot study. J Korean Soc Laryngol Phoniatr Logop 2022;33(2):103-9.
  55. Weerathunge HR, Segina RK, Tracy L, Stepp CE. Accuracy of acoustic measures of voice via telepractice videoconferencing platforms. J Speech Lang Hear Res 2021;64(7):2586-99.
  56. Knickerbocker K, Bryan C, Ziegler A. Phonogenic voice problems among speech-language pathologists in synchronous telepractice: An overview and recommendations. Semin Speech Lang 2021;42(1):73-84.
  57. Ribeiro VV, Dassie-Leite AP, Pereira EC, Santos ADN, Martins P, Irineu RA. Effect of wearing a face mask on vocal self-perception during a pandemic. J Voice 2022;36(6):878.e1-7.
  58. Diaz J. Managing vocal fatigue during the COVID-19 pandemic [Internet] [published 2020 August 5; cited 2022 October 9]. Available from:
  59. Lee SJ, Kang MS, Park YM, Lim JY. Reliability of acoustic measures in dysphonic patients with glottic insufficiency and healthy population: A COVID-19 perspective. J Voice. In press 2022.
  60. Dubas E. Keeping adult clients motivated at home during physical distancing [Internet] [published 2020 April 7; cited 2022 October 9]. Available from:
  61. Hseu AF, Spencer G, Woodnorth G, Kagan S, Kawai K, Nuss RC. Barriers to voice therapy in dysphonic children. J Voice. In press 2021.
  62. Kim ME, Sund LT, Morton M, Kim J, Choi JS, Castro ME. Provider and patient satisfaction with telemedicine voice therapy during the COVID-19 pandemic. J Voice. In press 2022.
  63. Choi SH. Speech-language pathologists' voice assessment and voice therapy practices: A survey for standard clinical guideline and evidence-based practice. Commun Sci Disord 2013;18(4):473-85.
  64. Hapner E, Portone-Maira C, Johns MM 3rd. A study of voice therapy dropout. J Voice 2009;23(3):337-40.
  65. Jung SI, Lim S, Jo E, Sim HS, Sung JE, Kim YT. The efficacy of telepractice intervention for children & adolescents with speech, language & hearing impairments: A meta-analysis. Commun Sci Disord 2020;25(4):976-86.
  66. Kim NY, Ha JW, Park KS, Lee G, Park SN, Bae YS. Perception of Korean speech-language pathologists on telepractice service. Commun Sci Disord 2020;25(4):987-97.
  67. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The voice handicap index (VHI) development and validation. Am J Speech Lang Pathol 1997;6(3):66-70.
  68. Kim JO, Lim SE, Park SY, Choi SH, Choi JN, Choi HS. Validity and reliability of Korean-version of voice handicap index and voice-related quality of life. Speech Sciences 2007;14(3):111-25.
  69. Yun YS, Kim H, Son YI, Choi HS. Validation of the Korean voice handicap index (K-VHI) and the clinical usefulness of Korean VHI-10. Commun Sci Disord 2008;13(2):216-41.
  70. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114(9):1549-56.
  71. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 1999;13(4):557-69.
  72. Zur KB, Cotton S, Kelchner L, Baker S, Weinrich B, Lee L. Pediatric voice handicap index (pVHI): A new tool for evaluating pediatric dysphonia. Int J Pediatr Otorhinolaryngol 2007;71(1):77-82.
  73. Ricci-Maccarini A, De Maio V, Murry T, Schindler A. Development and validation of the children's voice handicap index-10 (CVHI-10). J Voice 2013;27(2):258.e23-8.
  74. Ra SH, Choi SH, Lee K, Choi CH. Validity and reliability of the Korean version of the children's voice handicap index-10 (CVHI-10) in school age children: ROC curve and cutoff analysis for diagnostic test. Commun Sci Disord 2022;27(1):202-11.
  75. Cohen SM, Jacobson BH, Garrett CG, Noordzij JP, Stewart MG, Attia A, et al. Creation and validation of the singing voice handicap index. Ann Otol Rhinol Laryngol 2007;116(6):402-6.
  76. Ma EP, Yiu EM. Voice activity and participation profile: Assessing the impact of voice disorders on daily activities. J Speech Lang Hear Res 2001;44(3):511-24.
  77. Nanjundeswaran C, Jacobson BH, Gartner-Schmidt J, Verdolini Abbott K. Vocal fatigue index (VFI): Development and validation. J Voice 2015;29(4):433-40.
  78. Kang YA, Chang JW, Koo BS. Relationship between voice fatigue and voice assessment in patients with voice disorders and applicability of voice fatigue index in Korean version. Korean J OtorhinolaryngolHead Neck Surg 2017;60(5):232-42.
  79. Kim M. Relationship between vocal fatigue index and voice handicap index for professional voice users [dissertation]. Seoul: Ewha Womans Univ.;2017.
  80. Deary IJ, Wilson JA, Carding PN, MacKenzie K. VoiSS: A patient-derived voice symptom scale. J Psychosom Res 2003;54(5):483-9.
  81. Son HY, Lee CY, Kim KA, Kim S, Jeong HS, Kim JP. The Korean version of the voice symptom scale for patients with thyroid operation, and its use in a validation and reliability study. J Voice 2018;32(3):367-73.
  82. Etter NM, Hapner ER, Barkmeier-Kraemer JM, Gartner-Schmidt JL, Dressler EV, Stemple JC. Aging voice index (AVI): Reliability and validity of a voice quality of life scale for older adults. J Voice 2019;33(5):807.e7-12.
  83. Bae IH, Sung ES, Lee JC. Validity and reliability of Korean version of the aging voice index (KAVI). J Korean Soc Laryngol Phoniatr Logop 2019;30(1):21-7.
  84. Pyo HY, Lim JY, Lim SE, Lee SJ. Comparison of voice-related quality of life for the elderly with and without voice disorders according to genders by aging voice index-Korean version. Commun Sci Disord 2021;26(4):933-43.
  85. Shoffel-Havakuk H, Chau S, Hapner ER, Pethan M, Johns MM 3rd. Development and validation of the voice catastrophization index. J Voice 2019;33(2):232-8.
  86. Lee YW, Kim GH, Bae IH, Park HJ, Kwon SB. Korean voice catastrophization index (K-VCI): Validation of the voice catastrophization index for Koreans. J Voice 2021;35(1):160.e7-13.
  87. Lopes LW, de Oliveira Florencio V, Silva POC, da Nobrega E Ugulino AC, Almeida AA. Vocal tract discomfort scale (VTDS) and voice symptom scale (VoiSS) in the evaluation of patients with voice disorders. J Voice 2019;33(3):381.e23-32.
  88. Lee HN, Yoo JY, Han JH, Park YS, Jung DY, Park JH. Transcultural adaptation and validation of the Korean version of the vocal tract discomfort scale. J Voice 2022;36(1):143.e15-23.
  89. Misono S, Meredith L, Peterson CB, Frazier PA. New perspective on psychosocial distress in patients with dysphonia: The moderating role of perceived control. J Voice 2016;30(2):172-6.
  90. Epstein R, Hirani SP, Stygall J, Newman SP. How do individuals cope with voice disorders? Introducing the voice disability coping questionnaire. J Voice 2009;23(2):209-17.
  91. Jang MH, Kim HJ. Validation and clinical usefulness of voice disability coping questionnaire (VDCQ) for Korean. J Speech Lang Hear Disord 2022;31(2):1-9.