It is well-established and widely acknowledged that aural rehabilitation is essential in supporting cochlear implant recipients to reach their communication potential.[5][8][12][13][14]

In past years, telepractice—remote rehabilitation via video conferencing—had gained some traction, but there was limited uptake as clinicians continued to express reservations, despite telepractice being acceptable and as effective as face-to-face therapy.[1][7]

Effective aural rehabilitation via telepractice isn’t achieved by simply moving face-to-face therapy sessions to Zoom calls. Telepractice requires different materials, techniques, and roles for those involved and relies more heavily on a clinician’s coaching skills for intervention to be effective.

Barriers, such as internet connectivity issues, behavior management, lack of confidence, and access to training and appropriate therapy resources, have been cited as challenges to telepractice delivery.[3]

However, since the COVID-19 pandemic, there has been exponential growth of telepractice in aural rehabilitation, and in speech and language pathology and health services more broadly.[3][6]

Uptake in Telepractice Since 2020

A study published in 2021 investigated the changes in aural rehabilitation practice and perceptions in the first half of 2020.[3] More than 270 professionals from more than 40 countries shared their experience and opinions on telepractice. The overall timing of the research provided a unique opportunity to study changes in practice and perceptions as pandemic restrictions rapidly evolved in the first half of 2020. Here are the key findings.

Telepractice Experience

In the initial survey conducted in February 2020, most of the respondents were clinicians who were experienced in delivering in-person aural rehabilitation. However, most had never tried telepractice.

But by the time of the follow-up survey in May 2020, 91% of responders had delivered telepractice, which is indeed a dramatic increase.

Confidence in Telepractice

In the first survey, respondents were equally likely to agree (35.2%) or to disagree (35.5%) with the statement:

“I feel as confident delivering intervention via telepractice as a I do with in-person lessons.”

Notably, clinicians with at least 1 year of experience in telepractice were much more likely to report feeling confident in telepractice.

Also, most clinicians with at least 1 year of telepractice experience reported that “therapy outcomes from telepractice are likely to be the same as in-person sessions.”

This is a promising result showing that—with telepractice experience—many clinicians do perceive telepractice as providing comparably beneficial outcomes.

Barriers to Telepractice

Clinicians were asked to rate different factors as barriers to telepractice delivery, and how much of a positive impact they felt their use of the Remote Lesson Kits had on those factors.

The top 5 factors were:

• Internet connectivity (72.2% report “very significant” or “significant” impact)
• Child management (72.0%)
• Clinician’s use of parent coaching strategies (70.3%)
• Clinician’s experience in telepractice (65.6%)
• Accessing or developing appropriate therapy resources (65.6%)

Consistent with other studies, both experienced and inexperienced telepractitioners reported “connectivity issues” as a major barrier. Interestingly, when clinicians were stratified by experience, “parent coaching” was the top factor that impacted telepractice delivery for clinicians experienced with telepractice. The Remote Lesson Kits had a positive impact on many of the factors.

Telepractice Trends and Future Directions

Since 2021, studies have investigated caregiver and professional satisfaction with telepractice in paediatric cochlear implant recipient populations during the pandemic. Studies found that both professionals and caregivers were satisfied with telepractice. However, there were mixed findings on how families wished to continue once face-to-face services were available again.[4][10][11]

Studies also discussed barriers around clinician and child rapport building and interaction during telepractice.[2][11] This demonstrates the continued need for clinician training in parent coaching for telepractice, as family-centered early intervention for children who are deaf or hard of hearing should promote family-provider partnerships and facilitate family-child interactions.[9]