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服务可能难以访问，因为代表专业服务的CI中心少之又少。住在离CI中心相当远的地方的患者通常需要花费大量的差旅费和从工作/学校请假去诊所就诊的时间。或者，接受者可能因为这些负担而放弃必要的服务，导致使用该设备的负面结果。通过远程诊疗获得远程CI服务将为无障碍问题患者提供另一种选择。为了使远程诊疗得到广泛实施，在一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；主要的重点是比较在传统条件下和在偏远条件下为成人接受者所获得的方案编制水平。这些研究的结果表明，传统和远程测量的结果相似；然而，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。这个研究项目有三个目的。目标1将验证声音处理器编程在幼儿中的远程实践使用，他们需要使用不同于成人使用的临床技术。这些包括条件播放测听法（CPA）或视觉强化测听法（VRA）。在目的1中，将比较传统编程与远程编程对儿童CI受者的电刺激行为阈值。我们假设传统测量和远程测量之间不会有显著差异。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。在我们早期的研究中，我们发现语音感知在远程条件下较差，这是由于与缺乏音箱相关的不利声学特性。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扩音室测试的替代品。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，我们将验证远程实践在成人听觉康复（AR）中的应用。具体而言，我们将比较三种不同干预措施的结果：(1)当面临床指导的AR，(2)远程临床指导的AR和(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著差异，并且两个临床指导组都比自我指导组表现出更大的收益。通过为CI接收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保健服务的访问。

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.