Effectiveness of Therapy via Telemedicine following Cochlear Implants

描述(申请人提供)：在美国，每100,000名儿童中约有200名出生时患有感音神经性听力损失。这些孩子有不同程度的耳聋，很可能有言语和语言障碍。他们中的许多人都是人工耳蜗术(CI)的候选者，这种手术涉及在一只或两只耳朵中放置一个电子设备。植入物刺激第8脑神经，允许听觉输入绕过耳蜗中受损的毛细胞，从而刺激听觉皮质。CI可以在生命的前3.5年--听觉皮质发育的敏感期--促进正常的言语/语言发展。如果且只有在手术后进行常规、强化的语言听力治疗，才可能产生相对正常的语音清晰度和口语。在这个敏感的时期，如果没有适当的听力康复，正常言语和语言发展的可能性就会降低。不幸的是，在美国的大片地区，很少或根本没有治疗师有资格提供这种必要的干预。脑梗塞后的一种有效治疗方法是听觉-言语疗法(AVT)。远程保健，即利用电信和信息技术向距离提供者一定距离的人提供保健服务，是向服务不足地区的聋哑儿童提供AVT的潜在有效方式。远程医疗有可能促进结果，并使CI的好处更广泛地获得，但远程医疗技术在AVT中的使用尚未得到严格的研究。 我们的主要目标是评估互动视频(IAV)远程健康作为一种媒介在接受脑梗塞(CI)的先天感音神经性耳聋患儿术后实施AVT的比较有效性。我们建议评估通过IAV技术实施的AVT的行为、神经生理学和成本结果。在一项为期2年的纵向交叉研究中，我们将使用精心挑选的行为测量和皮质听觉诱发电位(CAEP)作为语言和大脑发育的测量指标，比较远程医疗和面对面护理的AVT的结果。前三个具体目标将评估远程保健对结果的影响，而目标4涉及语言和皮质发育的基础研究。目标如下。1)使用功能(行为)结果测量，比较通过远程健康提供的AVT和面对面治疗的有效性。2)比较通过远程保健和通过神经生理测量进行面对面治疗的AVT的有效性。3)评估远程医疗或亲自提供AVT的费用与结果的等价性。4)研究行为、神经生理、临床和人口统计学变量之间的关系。 这项拟议的研究将是第一次详细检查远程健康作为耳聋AVT和一般语言治疗的媒介的有效性。研究团队在语音/语言开发和AVT、人工耳蜗植入儿童的神经生理学结果、公共卫生、卫生服务研究、远程保健以及更广泛的卫生信息技术方面拥有丰富的经验和专业知识。

DESCRIPTION (provided by applicant): In the U.S., approximately 200 children per 100,000 are born with sensorineural hearing loss. These children have varying degrees of deafness, and are likely to have impaired speech and language. Many of them are candidates for cochlear implantation (CI), which involves surgical placement of an electronic device in one or both ears. The implant stimulates the 8th cranial nerve, allowing auditory input to circumvent damaged hair cells in the cochlea, and hence to stimulate the auditory cortex. CI can facilitate normal speech/language development during the first 3.5 years of life-a sensitive period for development of the auditory cortex. Relatively normal speech articulation and spoken language may result if, and only if, surgery is followed by regular, intensive speech-language-listening therapy. Without appropriate aural rehabilitation during this sensitive period, the likelihood of normal speech and language development is reduced. Unfortunately, large geographic regions in the U.S. have few or no therapists who are qualified to provide this essential intervention. One effective therapeutic approach following CI is Auditory-Verbal Therapy (AVT). Telehealth, the use of telecommunications and information technology to provide health services to persons located at some distance from a provider, is a potentially effective way to deliver AVT to deaf children in underserved areas. Telehealth has the potential to facilitate outcomes, and to make the benefits of CI more widely accessible, but the use of telehealth technology for AVT has not been rigorously studied. Our primary objective is to evaluate the comparative effectiveness of interactive video (IAV) telehealth as a medium for delivering post-operative AVT for children born with sensorineural hearing loss who undergo (CI). We propose to assess behavioral, neurophysiologic, and cost outcomes of AVT delivered via IAV technology. In a longitudinal crossover study with 2-year follow-up, using carefully chosen behavioral measures and cortical auditory evoked potentials (CAEPs) as measures of language and brain development, we will compare outcomes of telemedicine and in-person care delivery of AVT. The first three Specific Aims will assess the effects of telehealth on outcomes, while Aim 4 involves basic research on language and cortical development. The Aims are the following. 1) To compare the effectiveness of AVT delivered via telehealth with in-person therapy, using functional (behavioral) outcome measures. 2) To compare the effectiveness of AVT delivered via telehealth with in-person therapy using neurophysiologic measures. 3) To assess the equivalence of costs, in relation to outcomes, of AVT delivered by telehealth or in person. 4) To examine relationships among behavioral, neurophysiological, clinical, and demographic variables. The proposed study will be the first detailed examination of the effectiveness of telehealth as a medium for AVT in deafness, and for speech therapy in general. The research team has considerable experience and expertise in speech/language development and AVT, neurophysiologic outcomes in cochlear implanted children, public health, health services research, telehealth, and health information technology more broadly.