Effectiveness of Therapy via Telemedicine following Cochlear Implants

人工耳蜗植入后远程医疗治疗的有效性

基本信息

批准号：
8452532
负责人：
JAMES P GRIGSBY
金额：
$ 88.57万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8452532
关键词：
Academy Address Adopted Age Age-Years Area Auditory Auditory Evoked Potentials Auditory area Basic Science Behavioral Brain Caring Certification Child Childhood Cities Clinical Cochlea Cochlear Implants Cochlear implant procedure Colorado Continuing Education Cranial Nerves Critiques Cross-Over Studies Data Development Devices Ear Effectiveness Electronics Ensure Environment Evoked Potentials Family Geographic Locations Hair Cells Health Services Health Services Accessibility Health Services Research Hearing Hearing Impaired Persons Human Resources Implant Information Technology Intervention Joints Language Language Development Language Therapy Learning Life Measures Mediating Mentors Modality Oklahoma Operative Surgical Procedures Oral Outcome Outcome Measure Persons Postoperative Period Provider Public Health Published Comment Qualifying Rehabilitation therapy Research Research Personnel Rural Schools Sensorineural Hearing Loss Services Speech Speech Development Speech Sound Speech Therapy Study Section Technology Telecommunications Telemedicine Testing Therapeutic Time United States Videoconferences Videoconferencing behavior measurement care delivery comparative effectiveness compare effectiveness control trial cost cost effective cost effectiveness deafness experience follow-up health information technology high risk improved instrument interest meetings neurophysiology response rural area standardize measure telehealth therapy outcome urban area

项目摘要

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.

描述（由申请人提供）：在美国，每 100,000 人中大约有 200 名儿童出生时患有感音神经性听力损失。这些儿童有不同程度的耳聋，并且可能有言语障碍。他们中的许多人都是人工耳蜗植入（CI）的候选人，这涉及通过手术将电子设备放置在一只或两只耳朵中。植入物刺激第八脑神经，允许听觉输入绕过耳蜗中受损的毛细胞，从而刺激听觉皮层。 CI 可以促进生命前 3.5 年的正常言语/语言发育，这是听觉皮层发育的敏感期。当且仅当手术后进行定期、强化的言语-语言-听力治疗时，才可能产生相对正常的发音和口语。在这个敏感时期如果没有适当的听力康复，正常言语和语言发展的可能性就会降低。不幸的是，美国大部分地区很少或没有有资格提供这种基本干预的治疗师。 CI 后的一种有效治疗方法是听觉语言疗法 (AVT)。远程医疗是利用电信和信息技术向距离提供者一定距离的人提供医疗服务，是向服务欠缺地区的聋哑儿童提供 AVT 的潜在有效方式。远程医疗有潜力促进结果，并使 CI 的好处更广泛地获得，但远程医疗技术在 AVT 中的使用尚未得到严格研究。我们的主要目标是评估交互式视频 (IAV) 远程医疗作为为患有感音神经性听力损失 (CI) 的儿童提供术后 AVT 的媒介的相对有效性。我们建议评估通过 IAV 技术提供的 AVT 的行为、神经生理学和成本结果。在一项为期 2 年随访的纵向交叉研究中，使用精心选择的行为测量和皮质听觉诱发电位 (CAEP) 作为语言和大脑发育的测量，我们将比较远程医疗和 AVT 现场护理的结果。前三个具体目标将评估远程医疗对结果的影响，而目标 4 涉及语言和皮质发育的基础研究。目标如下。 1) 使用功能（行为）结果测量，比较通过远程医疗提供的 AVT 与现场治疗的有效性。 2) 比较通过远程医疗提供的 AVT 与使用神经生理学措施进行的现场治疗的有效性。 3) 评估通过远程医疗或亲自提供的 AVT 的成本与结果的等效性。 4) 检查行为、神经生理学、临床和人口统计学变量之间的关系。拟议的研究将首次详细检查远程医疗作为耳聋 AVT 以及一般言语治疗媒介的有效性。该研究团队在语音/语言发展和 AVT、人工耳蜗植入儿童的神经生理学结果、公共卫生、卫生服务研究、远程医疗和更广泛的健康信息技术方面拥有丰富的经验和专业知识。