Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.
Listening skills were compared before and after a structured intervention program for a group of 20 children with auditory processing disorders (APD). Comparisons of pre-and post-management measures indicated a significant increase in speech recognition performance in degraded listening conditions (background noise and competing speech). The APD management approach was integrative and included top-down and bottom-up strategies. These findings add to a growing body of literature suggesting that interactive auditory training can improve communication skills.Learning Outcomes: Upon completion of this article, the reader will (1) become familiar with one of the measures of auditory processing, the index of performance accuracy, which reflects a global assessment of auditory information processing; (2) recognize the value of performance accuracy scores in degraded listening conditions in evaluating treatment efficacy for auditory processing disorders; and (3) recognize some of the limitations of the performance accuracy index and the possible contribution of temporal measures in indicating auditory processing difficulties and in evaluating treatment efficacy for auditory processing disorders.
Twenty children with central auditory processing disorders [(C)APD] were subjected to a structured intervention program of listening skills in quiet and in noise. Their performance was compared to that of a control group of 10 children with (C)APD with no special treatment. Pretests were conducted in quiet and in degraded listening conditions (speech noise and competing speech). The (C)APD management approach was integrative and included top-down and bottom-up strategies. It focused on environmental modifications, remediation techniques, and compensatory strategies. Training was conducted with monosyllabic and polysyllabic words, sentences and phrases in quiet and in noise. Comparisons of pre- and post-management measures indicated increase in speech recognition performance in background noise and competing speech for the treatment group. This improvement was exhibited for both ears. A significant difference between ears was found with the left ear showing improvement in both the short and the long versions of competing sentence tests and the right ear performing better in the long competing sentences only following intervention. No changes were documented for the control group. These findings add to a growing body of literature suggesting that interactive auditory training can improve listening skills.
The purpose of this study was to investigate the possibility of improving speech recognition testing sensitivity in children with auditory processing disorders (APD) by incorporating response time measures. A group of children identified in a clinical setting as having APD was compared to an age-matched peer group using a vocal reaction time (VRT) format. The participants were between the ages of 5.5 and 15 years. All children were presented spoken monosyllabic words of the clinical Hebrew speech discrimination test. Statistically significant differences were found, with means in the APD children reflecting slower performance than that of their peers. The two groups did not differ in their performance accuracy. These data show that combining response time measures with percent correct scores improved test sensitivity. Such an approach may hold promise for future clinical applications in the assessment of APD.
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