Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study

Abstract

Background Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people’s access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic’s impact on health care, the need for new therapeutic settings has intensified. Objective The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants’ subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program’s usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics.

Outcome measures following tele-rehabilitation and conventional face to face rehabilitation in paediatric cochlear implant users during COVID-19 pandemic: A pilot study in a tertiary care setup

“…Results of present study revealed that both the service delivery modalities were successful; however; conventional therapy mode had more impact on speech, language, and auditory skills. Results of the present study is in contrary to the findings of studies conducted by Piron et al, (2008) , Hughes et al, (2012) , Malandraki et al, (2014) , Blosser (2015) , Bush et al, (2016) , Volter et al, (2021) , and Choudhary et al, (2021) . The differences between the findings of the present study and the other studies in the past could be attributed to the age differences of the participants considered.…”

“…In March 2020, the Ministry of Health and Family Welfare (MoHFW) published the revised guidelines for telemedicine service delivery whereas, in October 2020, the Indian Speech-Language and Hearing Association (ISHA) published the guidelines for teleservice in the speech-language pathology and audiology due to COVID-19 pandemic. After COVID-19 outbreak, various studies ( Fritz et al, 2021 ; Chaudhary et al, 2021 ; Tambyraja et al, 2021 ; Volter et al, 2021 ) got published on delivery of teleservices for diverse populations with speech-language disorders and sudden increase in the use of tele-therapy modality was observed in the field of speech-language pathology & audiology services in India ( Aggarwal et al, 2020 ). Chaudhary et al, (2021) compared the outcomes of tele-therapy and conventional face-to-face therapy for various speech-language disorders (i.e.…”

“…The results revealed that teleservice was effective and satisfactory method for service delivery among speech-language disorders. Volter et al, (2021) assessed the feasibility of tele-therapeutic auditory rehabilitation among adult CI users and revealed that tele-therapy has good outcomes for speech perception. Many authors ( Al Awaji et al, 2021 ; Chadd et al, 2021 ; Saxena et al, 2021 ) investigated the parental perception and clinician perception regarding the efficacy of tele-therapy.…”

Poor Performer: A Distinct Entity in Cochlear Implant Users?

“…Besides, engagement of external and internal motivation of the user is mandatory for the success of the training [Henshaw et al, 2015;Völter et al, 2020b]. Computer-based training platforms based on modern learning concepts might be a promising way to train with high frequency and fun, independently of time and place [Tuz et al, 2021;Völter et al, 2021a].…”

Teletherapie nach Cochleaimplantation in der COVID-19-Pandemie

“…Diesen mangelt es häufig an Komplexität, Adaptivität, Feedback-und Motivationselementen [43]. Computerbasierte Trainingsplattformen, die eine standardisierte Online-Hörrehabilitation in Analogie zum Training vor Ort beinhalten, sind noch in der Entwicklung [45]. Videotherapeutische Settings wurden bisher in der Logopädie vornehmlich zur Behandlung sprachtherapeutischer Störungsbilder, wie der Aphasie, Dysphagie, Dysphonie und des Stotterns bei Patienten unterschiedlichen Alters eingesetzt [6,16,22,29,33,34,46].…”