Effectiveness of Therapy via Telemedicine following Cochlear Implants

描述（由申请人提供）：在美国，每10万名儿童中约有200名患有感音神经性听力损失。这些儿童有不同程度的耳聋，并且很可能有言语和语言障碍。他们中的许多人都是人工耳蜗植入（CI）的候选者，这涉及在一只或两只耳朵中植入电子设备的手术。植入物刺激第八脑神经，使听觉输入绕过耳蜗受损的毛细胞，从而刺激听觉皮层。在生命的前3.5年里，脑机刺激可以促进正常的言语/语言发展，这是听觉皮层发育的敏感时期。当且仅当在手术后进行定期的强化言语听力治疗时，才可能导致相对正常的言语清晰度和口语。在这个敏感时期，如果没有适当的听觉康复，正常言语和语言发展的可能性就会降低。不幸的是，在美国的大部分地区，很少或根本没有有资格提供这种必要干预的治疗师。一种有效的治疗方法是听觉语言疗法（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儿提供AVT的潜在有效方式。远程医疗有可能促进结果，并使更广泛地获得持续医疗的好处，但尚未对AVT使用远程医疗技术进行严格研究。

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.