Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation.

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.

Students' Evaluation of Simulation-Based Training in a Communication Sciences and Disorders Program.

The current study aimed to evaluate simulation-based medical education (SBME) training and its contribution to the learning process of students in a communication sciences and disorders (CSD) program. The training was integrated in different stages of the program, over 4 years, with different students. The content and complexity of each of the simulation activities targeted specific skills, tailored to the students' learning phase. Students completed a nine-item survey at the end of the first and second semesters of the second year, evaluating the simulation training program structure and students' self-efficacy relating to the building of relationships between care givers and patients. A total of 246 questionnaires were analyzed. Students reported significantly increased self-efficacy in a range of clinical skills and perceived the inclusion of simulated patients (SPs) into a clinical skills program as valuable. Our data suggest that scenarios that reflect real-life situations (environment, atmosphere, equipment, etc.) have the strongest impact on the students' ability to implement professional and communication skills. A strong positive correlation was found between the video-based debriefing and students' perception of the improvement in their professional and communication skills. These findings suggest that this is a feasible and powerful training approach that can be applied in the CSD curriculum.

Binaural masking level difference in skilled reading children and children with dyslexia.

BACKGROUND: Combining stimuli arriving at both ears makes it possible to locate sounds in the environment and to better detect signals or understand speech in noise when the sound sources are separated spatially. The sensitivity of the binaural system to interaural differences in time and amplitude can be investigated by means of the binaural masking level difference (BMLD). The age at which the BMLD reaches adult levels appears to depend partly upon masker bandwidth. Less is known about the effect of masker's level on the development of BMLD in children. In the present study we assessed the effect of masker level on the BMLD of 3rd and 5th grade skilled reading children. In view of possible binaural hearing effects in dyslexia, the BMLD of a group of 5th grade children with reading difficulties was measured. METHODS: Detection thresholds of 500 Hz pure tone were measured at noise levels of 40 dBHL, 50 dBHL and 60 dBHL. RESULTS: All subjects presented increased MLD values with the rise of noise intensity between 40 dBHL and 60 dBHL. Among the skilled readers the results showed that younger children had smaller BMLDs than older children at all masker levels. However, a significant group-by-intensity interaction indicated that although the reading disabled group had reduced BMLD values than older skilled readers at noise levels of 50 dBHL and 60 dBHL, no difference was found between their BMLD values and those of the young skilled readers at noise levels of 50 dBHL and 60 dBHL. Moreover, their BMLD values at noise level of 40 dBHL were higher than those of the 3rd grade typically reading students while no difference was found between them and 5th grade efficient readers. CONCLUSIONS: These results support the existence of both quantitative and qualitative differences in binaural hearing of children with developmental dyslexia.

Effects of speech in noise and dichotic listening intervention programs on central 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.

A comparison between vocal reaction time and word recognition measures of children with APD and age-matched peers using auditory word discrimination test.

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.