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

Abstract

BACKGROUND Technologies allowing home-based rehabilitation may be a key means saving financial resources, but also facilitating people’s access to treatment. After cochlear implantation (CI) auditory training is necessary to adapt the brain to the new auditory signals transmitted by the CI. So far auditory training takes place in a face-to-face setting in a specialized center. But due to the world-wide COVID-19 pandemic with a tremendous impact on health care, the urge for new therapeutic settings has emerged. OBJECTIVE The aims of this study were 1) to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and 2) to compare the clinical outcome with regard to a conventional face-to-face rehabilitation setting in a clinic. METHODS 20 experienced adult CI users with a mean age of 59.4 years (SD 16.3) participated in the study. For 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 noise. The secondary outcomes were the usability of the CBAT system and participants’ subjective rating of their own listening abilities. The amount of time necessary to complete face-to-face sessions and CBAT sessions was noted for CI users and for therapists. RESULTS Greater benefits were observed after the CBAT than after standard therapy in nearly all speech outcome measures. Significant improvement was found in sentence comprehension in noise (Pw.0036), speech tracking (Pw .0036), and syllable differentiation (vowels: Pw .002; consonants: Pw.023) after CBAT. Only speech tracking improved significantly after conventional therapy (Pw.0095). The program’s usability was judged to be high; only 2/20 participants could not imagine using the program without support. The different features of the training platform were rated high except for videoconferencing, which could not replace personal contact with the therapist. Therapists spent 360 min per week on face-to-face sessions and 60 min per week on CBAT. For CI users, attending face-to-face sessions necessitated approximately 2 hours of travel time per week. CONCLUSIONS The new teletherapeutic approach for hearing rehabilitation enables a good clinical outcome while saving time for CI users and clinicians. The promising speech understanding results might be due to the increased CI users’ empowerment, as shown by the high satisfaction of the users with the CBAT program. Teletherapy might be a solution to address to the global challenge of current or further pandemics.