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

• 批准号: 9123578
• 负责人: JAMES P GRIGSBY
• 金额: $ 76.14万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 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/9123578
• 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; 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; behavioral outcome; care delivery; comparative effectiveness; compare effectiveness; control trial; cost; cost effective; cost effectiveness; deafness; experience; follow-up; health information technology; high risk; improved outcome; instrument; interest; meetings; neurophysiology; response; rural area; standardize measure; telehealth; therapy outcome; urban area; 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; 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; behavioral outcome; care delivery; comparative effectiveness; compare effectiveness; control trial; cost; cost effective; cost effectiveness; deafness; experience; follow-up; health information technology; high risk; improved outcome; instrument; interest; meetings; neurophysiology; response; rural area; standardize measure; telehealth; therapy outcome; urban area

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名大约200名儿童出生时具有感觉性听力损失。这些孩子的耳聋程度不同，言语和语言可能受损。其中许多是人工耳蜗（CI）的候选者，其中涉及将电子设备手术放置在一个或两只耳朵中。植入物刺激第八个颅神经，使听觉输入能够绕过耳蜗中受损的毛细胞，从而刺激听觉皮层。 CI可以在生命的前3。5年中促进正常的语音/语言发展 - 对听觉皮层的发展敏感时期。相对正常的语音表达和口语可能会导致，并且只有在手术后进行常规，密集的语音语言疗法治疗。在这个敏感时期，如果没有适当的听觉康复，则降低了正常语音和语言发展的可能性。不幸的是，美国的大型地理区域几乎没有或没有治疗师有资格提供这种必不可少的干预措施。 CI之后的一种有效的治疗方法是听觉语言疗法（AVT）。远程医疗是使用电信和信息技术向距提供商一定距离的人提供保健服务的潜在有效方法，可以将AVT运送到服务不足的地区的聋哑儿童。远程医疗有可能促进结果，并使CI的好处更广泛地访问，但是对AVT的远程医疗技术的使用并未经过严格的研究。 我们的主要目标是评估互动视频（IAV）远程医疗的比较有效性，作为为患有感官听力损失的儿童提供术后AVT（CI）的媒介。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。在一项为期两年随访的纵向跨界研究中，使用精心选择的行为措施和皮质听觉诱发电位（CAEP）作为语言和大脑发育的措施，我们将比较远程医疗和AVT的个人护理的结果。前三个具体目标将评估远程医疗对结果的影响，而目标4涉及语言和皮质发展的基础研究。目的是以下。 1）使用功能性（行为）结果指标比较通过远程医疗提供的AVT与亲自疗法的有效性。 2）将通过远程医疗传递的AVT与使用神经生理学措施的亲自疗法进行比较。 3）评估远程医疗或亲自交付的AVT的成本的等效性。 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。 拟议的研究将是对远程医疗作为耳聋的媒介的有效性的首次详细研究，总体上进行了言语治疗。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结果，公共卫生，卫生服务研究，远程医疗和健康信息技术方面具有丰富的经验和专业知识。