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人工耳蜗术(CI)服务中的应用。对于许多接受者来说，CI服务可能很难获得，因为代表专业服务的CI中心很少。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，并损失从工作/学校到诊所就诊的时间。或者，接受者可能会因为这些负担而放弃必要的服务，从而导致设备的负面结果。通过远程实践远程获得CI服务将为患者提供另一种选择，因为对他们来说，可获得性是一个问题。要广泛实施远程实践，必须验证典型访问中提供的所有服务是否适用于远程应用。很少有研究经验性地评估远程CI服务的提供；主要的重点是比较成人接受者在传统条件下与远程条件下获得的规划水平。这些研究的结果显示，传统和远程测量的结果相似；然而，还需要进一步的研究来评估其他CI服务和年龄组的远程实践。这是当前项目的目标。本研究项目由三个目标组成。AIM 1将验证对幼儿进行声音处理器编程的远程练习的使用，这些幼儿需要使用与成人不同的临床技术。这些测试包括条件性游戏测听(CPA)或视觉强化测听(VRA)。在目标1中，使用CPA或VRA获得的电刺激的行为阈值将在儿童CI接受者的传统编程和远程编程中进行比较。我们假设，传统措施和远程措施之间不会有显著差异。对于目标2，我们将开发和评估远程语音感知测试的替代方法。在我们早期的工作中，我们发现，在偏远的环境中，由于缺乏音响隔间所带来的不良声学特性，人们的语言感知能力会变差。在目标2中，我们将评估语音处理器的直接音频输入(DAI)是否可以替代远程站点的音箱测试。此外，我们将测量混响时间和噪声级别的各种组合的性能强度(PI)函数，以探索是否可以使用PI函数来校正远程站点的不同背景噪声级别和混响时间，作为DAI测试的替代方案。对于目标3，我们将验证远程练习在成人听力康复(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)面对面临床医生指导的AR，(2)远程临床医生指导的AR，和(3)自我指导的AR。我们假设，传统和远程服务交付之间没有显著差异，而且两个临床医生指导组都将比自我指导组显示出更大的收益。通过为CI接受者开发远程服务交付选项，我们最终可以改善获得这些专业医疗服务的机会。

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.