Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Aug 12, 2019
Date Accepted: Feb 26, 2020
Date Submitted to PubMed: Apr 7, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Computer-based guided telerehabilitation for cochlear implant recipients
ABSTRACT
Background:
Cochlear implantation has become a successful concept in treating hearing impaired. To obtain an adequate speech understanding, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the hearing device. So far, face-to-face settings are usually offered in rehabilitation centers. With regard to demographic changes and the growing number of hearing impaired eldery, new cost- and personal-efficient strategies have to be developed as the feasibility of the established therapeutic interventions is limited. Due to immense technical development and a wide access to digital media, computer-assisted training programs might be an option for cochlear implant recipients to perform an auditory training independent of time and location.
Objective:
The purpose of this multidisciplinary study* („train2hear“) funded by the “Europäische Fonds für regionale Entwicklung (EFRE)” was to develop and to evaluate an internet based teletherapeutic multimodal system, which enables cochlear implant patients to perform a well structured and therapist guided hearing rehabilitation on their own.
Methods:
Databases from 01/2005 to 10/2018 were searched for auditory training programs suitable for cochlear implanted adults. Hereby, the principle elements of the new hearing program were defined and a hierarchical structure of the exercises was integrated in a teletherapeutic platform. Feedback mechanisms as well as motivational enhancement techniques according to established learning theories were included. 18 postlingually deaf CI recipients as well as 10 experienced speech and language therapists assessed the usability as well as the feasibility of the prototype by using the SUS questionnaire as well a semi-structured interview.
Results:
The key component of the train2hear training program is an initial analysis assessing not only the patient´s body functions, but also the environmental and personal factors according to the International Classification of Functioning, Disability and Health. 30 tasks covering a wide range from non-verbal stimuli to texts in quiet and noise of different levels of difficulty were implemented in an imaginery journey from Berlin to London. Various mechanisms of adaptivity were included with regard to an automatic and dynamic adaption to the training progress. Supporting feedback is given after each response. Comprehensive statistic analysis of the training results tracks the progress and helps the therapist to monitor the training in detail. A video tool allows to chat between patient and therapist. The feasibility of the program has been judged as high by CI patients as well as by therapists.
Conclusions:
Computer-based auditory training platforms are a promising cost-effective treatment option providing a highly personalized rehabilitation training suited to the individual characteristics of each patient. So far, many questions are still unsolved especially concerning the adherence of the patients as well as the efficiency, which have to be studied in large-scaled studies. Clinical Trial: Ethics Committee of the Ruhr-University of Bochum (number 18-6423-BR and 18-6423_1-BR)
Citation
