TELEPRACTICE FOR COCHLEAR IMPLANTS

描述（由申请人提供）：本项目的总体目标是验证远程实践在临床耳蜗植入（CI）服务中的应用。CI服务可能很难为许多收件人访问，因为CI中心，这代表了一个专业服务，是少之又少。居住在离CI中心相当远的地方的患者通常会产生大量的旅行费用和从工作/学校到诊所就诊的时间损失。或者，由于这些负担，接受者可能会放弃必要的服务，从而导致该设备的负面结果。通过远程实践远程获得CI服务将为可访问性成为问题的患者提供另一种选择。为了使远程实践得到广泛实施，在一次典型访问中提供的所有服务都必须针对远程应用进行验证。很少有研究经验评估远程CI服务提供的主要重点是比较编程水平在传统与远程条件下获得的成年收件人。这些研究的结果表明，传统和远程措施的结果相似，但是，需要进一步的研究，以评估其他CI服务和年龄组的远程实践。这是当前项目的目标。这个研究项目包括三个目标。目标1将验证使用远程练习的声音处理器编程与幼儿，谁需要使用不同于成人使用的临床技术。这些包括条件性游戏测听（CPA）或视觉强化测听（弗拉）。在目标1中，将比较使用CPA或弗拉获得的小儿CI接受者传统程控与远程程控的电刺激行为阈值。我们假设传统和远程测量之间没有显著差异。对于目标2，我们将开发和评估语音感知远程测试的替代方法。在我们早期的工作中，我们表明，语音感知是较差的远程条件下，因为不利的声学特性与缺乏一个健全的摊位。在目标2中，我们将评估语音处理器的直接音频输入（DAI）是否可以用作远程站点的音室测试的替代品。此外，我们将测量混响时间和噪声水平的各种组合的性能强度（PI）函数，以探索PI函数是否可以用于校正不同的背景噪声水平和混响时间在远程站点，作为替代DAI测试。对于目标3，我们将验证远程练习在成人听觉康复（AR）中的使用。具体而言，我们将比较三种不同干预措施的结果：（1）临床医生亲自指导的AR，（2）远程临床医生指导的AR，（3）自我指导的AR。我们假设传统和远程服务提供之间没有显着差异，并且两个临床医生导向组将显示出比自我导向组更大的收益。通过为CI接受者开发远程服务交付选项，我们最终可以改善对这些专业医疗服务的访问。

DESCRIPTION (provided by applicant): The overall goal of this project is to validate the application of telepractice for clinical cochlear-implant (CI) services. CI services may be difficut to access for many recipients because CI centers, which represent a specialty service, are few and far between. Patients who live a considerable distance from a CI center typically incur substantial travel expenses and loss of time from work/school to attend clinic visits. Alternatively, recipients may forego necessary services because of these burdens, resulting in negative outcomes with the device. Obtaining CI services remotely via telepractice would provide an alternative for patients for whom accessibility is an issue. For telepractice to be widely implemented, all services provided in a typical visit must be validated for remote applications. Few studies have empirically evaluated remote CI service delivery; the primary focus has been on comparing programming levels obtained in the traditional versus remote conditions for adult recipients. The results of those studies have shown similar outcomes for traditional and remote measures; however, further research is needed to evaluate telepractice for other CI services and age groups. This is the goal of the current project. This research project consists of three aims. Aim 1 will validate the use of telepractice for sound-processor programming with young children, who require the use of clinical techniques that differ from those used with adults. These include conditioned play audiometry (CPA) or visual reinforcement audiometry (VRA). In Aim 1, behavioral thresholds for electrical stimulation obtained with either CPA or VRA will be compared for traditional versus remote programming for pediatric CI recipients. We hypothesize that there will be no significant difference between traditional and remote measures. For Aim 2, we will develop and evaluate alternative methods for remote testing of speech perception. In our earlier work, we showed that speech perception is poorer in the remote condition because of unfavorable acoustical properties associated with the lack of a sound booth. In Aim 2, we will evaluate whether direct audio input (DAI) to the speech processor can be used as a substitute for sound-booth testing for remote sites. Further, we will measure performance-intensity (PI) functions for various combinations of reverberation times and noise levels to explore whether PI functions can be used to correct for different background noise levels and reverberation times at remote sites, as an alternative to DAI testing. For Aim 3, we will validate the use of telepractice for adult auditory rehabilitation (AR) Specifically, we will compare outcomes for three different interventions: (1) in-person clinician-directed AR, (2) remote clinician-directed AR, and (3) self-directed AR. We hypothesize that there will be no significant difference between traditional and remote service delivery, and that both clinician-directed groups will show greater gains than the self-directed group. By developing remote service delivery options for CI recipients, we can ultimately improve access to these specialized healthcare services.