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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Barriers to Rehabilitation Care in Pediatric Cochlear Implant Recipients
Bryce Noblitt1, Kristan P Alfonso, Margaret Adkins
1Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.
Insights
Pediatric cochlear implant (CI) recipients face significant rehabilitation barriers, especially in rural areas. Addressing socioeconomic factors and improving access to audiology and speech therapy are crucial for optimal outcomes.
Area of Science:
- Pediatric audiology
- Rehabilitation sciences
- Speech-language pathology
Background:
- Cochlear implantation (CI) offers significant benefits for children with hearing loss.
- Access to essential rehabilitation services, including audiology and speech therapy, is critical for maximizing CI outcomes.
- Disparities in healthcare access may disproportionately affect pediatric CI recipients, particularly those in rural settings.
Purpose of the Study:
- To evaluate the barriers to audiology and speech therapy services for pediatric cochlear implant (CI) recipients.
- To identify factors influencing CI use and performance in children.
- To compare rehabilitation access and outcomes between rural and urban CI recipients.
Main Methods:
- A cross-sectional questionnaire study was conducted with parents of pediatric CI recipients.
- Participants were recruited from a tertiary medical center.
- Data collected included factors related to service access, CI use, and child performance using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) scale.
Main Results:
- Rural CI recipients experienced significant barriers to audiology services compared to urban counterparts (p=0.01).
- Mechanical CI complications were more frequent in rural children (70% vs 33%, p=0.05), impacting consistent use.
- Access to speech therapy was substantially lower for rural children (10% vs 42%, p=0.04).
- Low socioeconomic status and Medicaid insurance correlated with limited speech therapy access and CI complications.
- Higher parental education was linked to better child performance on the PEACH scale in quiet conditions (p=0.04).
Conclusions:
- Rural pediatric CI recipients face delays in accessing crucial rehabilitation services.
- Barriers such as low socioeconomic status, insurance type, and parental education impact service utilization and potentially language development.
- Enhanced follow-up and expanded access to care are essential to optimize the benefits of cochlear implantation for all children.
Objective:
The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear implant (CI) recipients.
Study Design:
Cross-sectional questionnaire study.
Setting:
Tertiary medical center.
Patients:
Parents of children who received a CI from October 1996 to June 2013.
Main Outcome Measure(S):
Factors related to access to and barriers in audiology and speech therapy services, factors related to CI use, and performance with CI using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH).
Results:
Thirty-five parents participated in the study (21 rural residents and 14 urban residents). Distance was a significant barrier to audiology services for rural participants compared with urban participants (p = 0.01). Consistent CI use was complicated by mechanical complications or malfunction in 70% of rural children compared with 33% of urban children (p = 0.05). Only 10% of rural children were able to access speech therapy services at diagnosis compared with 42% of urban children (p = 0.04). Low socioeconomic (SES) status and Medicaid insurance were associated with a lack of local speech therapists and medical/mechanical CI complications. Higher parental educational attainment was associated with higher PEACH scores in quiet conditions compared with families with lower parental education (p = 0.04).
Conclusions:
Rural children are often delayed in receipt of CI rehabilitation services. Multiple barriers including low SES, insurance type, and parental education can affect utilization of these services and may impact the recipient language development. Close follow-up and efforts to expand access to care are needed to maximize CI benefit.
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