Therapist-guided telerehabilitation for adult cochlear implant users: Developmental and feasibility study.

Cochlear implants (CI) can provide auditory perception to many people with hearing impairment who derive insufficient benefit from hearing aid use. For optimal speech perception with a CI, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the CI. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with CIs are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be of great usefulness.The purpose of this multidisciplinary study, funded by "Europäische Fonds für regionale Entwicklung EFRE 0800737 GE-1-2-023D", was to evaluate Train2hear, which is an internet-based teletherapeutic multimodal system. Train2hear enables adult CI users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own.The study was conducted in 3 phases: 1) we searched databases from Jan-2005 to Oct-2018 for auditory training programs suitable for adult CI users; 2) we developed a prototype of Train2hear based on speech and language development theories; 3) 18 CI users (mean age 61, SD 15.4 yrs) and 10 speech and language therapists (mean age 34, SD 10.9 yrs) assessed the usability and the feasibility of the prototype. This was done via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM).The key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health (ICF), a range of different hierarchically-based exercises, and an automatic and dynamic adaption of the different tasks to the CI user's progress. In addition to motivational mechanisms (such as supportive feedback), a comprehensive statistical analysis is given to the CI user and the therapist. In general, CI users enjoyed their training as assessed by the KIM (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), users rated the Train2hear program as excellent (total mean 88 SD 10.5). Age (P.007) and sex (P .013) had a significant impact on the SUS score with regard to the usability of the program. The therapists (SUS Score mean 93, SD 9.2) gave slightly more positive feedback than CI users (SUS Score mean 85, SD 10.3).Based on this first evaluation, Train2hear was well accepted by CI users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation suited to individual CI user's characteristics.