TELEPRACTICE FOR COCHLEAR IMPLANTS

人工耳蜗的远程练习

• 批准号: 8995651
• 负责人: Michelle L Hughes
• 金额: $ 31.62万
• 依托单位: FATHER FLANAGAN'S BOYS' HOME
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-05 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8995651
• 关键词: Adult; Age; Area; Attention; Audiometry; Behavioral; Belief; Child; Childhood; Clinic; Clinic Visits; Clinical; Clinical Services; Cochlear Implants; Communication; Computers; Devices; Electric Stimulation; Environment; Evidence based practice; Family; Foundations; Goals; Health; Hour; Implant; Improve Access; Internet; Intervention; Laboratories; Lead; Life; Measures; Methods; Noise; Outcome; Patients; Performance; Persons; Play; Population; Property; Provider; Psychological reinforcement; Publishing; Qualifying; Research; Research Project Grants; Research Support; Schools; Self-Administered; Services; Site; Speech; Speech Perception; Techniques; Technology; Telephone; Testing; Time; Transportation; Travel; Underserved Population; Visit; Visual; Work; age group; auditory rehabilitation; base; behavioral study; follow-up; health care service; improved; improved outcome; medical specialties; metropolitan; novel; programs; rehabilitation service; sound; standard of care

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.

描述（由申请人提供）：该项目的总体目标是验证远程医疗在临床人工耳蜗（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 中心少之又少。居住地距离 CI 中心较远的患者通常会产生大量的差旅费用，并且会浪费从工作/学校到诊所就诊的时间。或者，接收者可能会因为这些负担而放弃必要的服务，从而导致设备产生负面结果。通过远程医疗远程获得 CI 服务将为无法访问的患者提供另一种选择。为了广泛实施远程医疗，每次典型就诊中提供的所有服务都必须针对远程应用程序进行验证。很少有研究对远程 CI 服务交付进行实证评估；主要重点是比较成人接收者在传统条件与偏远条件下获得的编程水平。这些研究的结果表明，传统措施和远程措施的结果相似；然而，需要进一步研究来评估其他 CI 服务和年龄组的远程医疗。这是当前项目的目标。该研究项目包括三个目标。目标 1 将验证远程练习对幼儿进行声音处理器编程的用途，幼儿需要使用与成人不同的临床技术。其中包括条件游戏测听 (CPA) 或视觉强化测听 (VRA)。在目标 1 中，将比较儿科 CI 接受者的传统编程与远程编程通过 CPA 或 VRA 获得的电刺激的行为阈值。我们假设传统措施和远程措施之间不会有显着差异。对于目标 2，我们将开发和评估用于远程测试语音感知的替代方法。在我们早期的工作中，我们表明，由于缺乏音响室而导致不利的声学特性，因此在远程条件下语音感知较差。在目标 2 中，我们将评估是否可以使用语音处理器的直接音频输入 (DAI) 来替代远程站点的音响室测试。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 函数是否可用于校正远程站点的不同背景噪声水平和混响时间，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) 现场临床医生指导的 AR，(2) 远程临床医生指导的 AR，以及 (3) 自我指导的 AR。我们假设传统服务提供和远程服务提供之间不会有显着差异，并且临床医生指导组将比自我指导组表现出更大的收益。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。