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.
Children with congenital sensorineural deafness can acquire relatively normal language if they undergo cochlear implantation surgery followed by aural rehabilitation therapy in the first 3 or 4 years of life. High quality therapy, however, may not be available in many areas. The proposed study will assess the effectiveness of post-implant Auditory Verbal Therapy (AVT) delivered by means of telemedicine technology. This will be accomplished by examining speech and language development, maturation of the auditory cortex of the brain, and costs as outcome measures. These outcome data also will be studied to address basic questions regarding brain and language development in pediatric cochlear implant users.