Effectiveness of Therapy via Telemedicine following Cochlear Implants

描述（由申请人提供）：在美国，每100 000名儿童中约有200名出生时就患有感音神经性听力损失。这些儿童有不同程度的耳聋，并且可能有言语和语言障碍。他们中的许多人是人工耳蜗植入（CI）的候选人，这涉及在一只或两只耳朵中手术放置电子设备。植入物刺激第八脑神经，允许听觉输入绕过耳蜗中受损的毛细胞，从而刺激听觉皮层。在生命的前3.5年，CI可以促进正常的言语/语言发育，这是听觉皮层发育的敏感时期。只有在手术后进行常规的强化言语-语言-听力治疗时，才能恢复相对正常的言语清晰度和口语。如果在这一敏感时期没有适当的听力康复，正常言语和语言发育的可能性就会降低。不幸的是，美国的大部分地区很少或根本没有治疗师有资格提供这种必要的干预。一种有效的治疗方法后CI是听觉语言疗法（AVT）。远程保健，即利用电信和信息技术向距离提供者有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视听疗法的潜在有效途径。远程医疗有可能促进结果，并使CI的好处更广泛地获得，但远程医疗技术用于AVT尚未得到严格的研究。 我们的主要目标是评估交互式视频（IAV）远程医疗作为一种媒介，为患有感音神经性听力损失的儿童提供术后AVT的比较有效性。我们建议通过IAV技术评估AVT的行为、神经生理和成本结果。在一项为期2年的纵向交叉研究中，我们将使用精心选择的行为指标和皮层听觉诱发电位（CAEP）作为语言和大脑发育的指标，比较远程医疗和面对面护理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涉及语言和皮层发育的基础研究。目标如下。1)使用功能（行为）结局指标，比较通过远程医疗提供的AVT与面对面治疗的有效性。2)比较通过远程医疗提供的AVT与使用神经生理学测量的面对面治疗的有效性。3)评估通过远程医疗或亲自提供AVT的成本与结果的等效性。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医疗作为耳聋AVT和一般语言治疗媒介的有效性。研究团队在言语/语言发育和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、远程医疗和更广泛的健康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.