تاثیر آموزش از راه دور برنامهٔ توان‌بخشی شنیداری خانواده‌محور نوایش بر رشد مهارت‌های اجتماعی و زبانی کودکان ناشنوا با تجربهٔ کاشت حلزون شنوایی

زمینه و هدف: آموزش مجازی یکی از روش‌های نوین در حیطهٔ توان‌بخشی شنیداری است. پژوهش حاضر با هدف تاثیر آموزش از راه دور برنامهٔ توان‌بخشی شنیداری خانواده‌محور نوایش بر رشد مهارت‌های اجتماعی و زبانی کودکان ناشنوای کاشت حلزون‌شده انجام پذیرفت. روش ‌بررسی: روش پژوهش نیمه‌آزمایشی و طرح آن به‌صورت پیش‌آزمون-پس‌آزمون با گروه گواه و مرحلۀ پیگیری بود. با روش نمونه‌گیری هدف‌مند، 40 نفر از کودکان ناشنوای کاشت حلزون‌شده از مرکز کاشت حلزون شنوایی ایران، شهر تهران در سال 1397 انتخاب شدند و به‌صورت تصادفی در دو گروه آزمایش و گواه قرار گرفتند. مادران آزمودنی‌های گروه آزمایش، برنامهٔ توان‌بخشی شنیداری را ازطریق سامانه، کانال‌های پیام‌رسان و آپارات طی 80 جلسه (10 جلسۀ حضوری و 70 جلسۀ غیرحضوری) دریافت کردند. برای بررسی مهارت‌های اجتماعی و زبانی از پرسشنامهٔ سنین و مراحل-ویرایش سوم (اسکوایرز و بریکر، 2009) و شاخص وضوح گفتار‌ (آلن و همکاران، 1993) استفاده شد. داده‌های جمع‌آوری‌شده در قبل، بعد و یک‌ ماه پس از پایان جلسات توان‌بخشی ازطریق آزمون‌ تحلیل واریانس با اندازه‌گیری مکرر در سطح معناداری 0/05 با استفاده از نرم‌افزار spss نسخهٔ 23 تحلیل شدند.یافته‌ها: نتایج تفاوت معناداری را پس از مداخله بین گروه آزمایش و گروه گواه در مهارت‌های اجتماعی (0/001>p) و زبانی (0/001>p) نشان داد؛ همچنین در گروه آزمایش بین میانگین نمرات سه مرحلهٔ پیش‌آزمون، پس‌آزمون و پیگیری در مهارت‌های اجتماعی و زبانی تفاوت معنادار مشاهده شد (0/001>p). نتیجه‌گیری: براساس یافته‌های این پژوهش، برنامهٔ توان‌بخشی شنیداری خانواده‌محور نوایش مبتنی‌بر آموزش از راه دور، عملکرد اجتماعی و زبانی کودکان ناشنوای کاشت حلزون‌شده را بهبود بخشید.

effects of navayesh family-based aural rehabilitation program of distance education on the development of language and communication skills in hearing-impaired children with cochlear implant

background & objectives: distance education is a novel method of aural rehabilitation. virtual rehabilitation is among the top approaches in providing new education. educating parents is one of the main factors in the virtual aural rehabilitation of hearing-impaired children with cochlear implants. the vast size of iran and the dispersion of the cochlear implanted population throughout the country; the lack of access to numerous cochlear implants by specialist rehabilitation centers in the city of residence; the importance of interventions at the youngest age; the long duration of rehabilitation (≥1 year); the inappropriate rehabilitation clinical settings for very young children; the increased use of online counseling and psychotherapy approaches, and the access of more individuals to the virtual world using a smartphone have led to the aural rehabilitation program developing using new technologies. thus, this study aimed to determine the effect of the navayesh family-based aural rehabilitation program of distance education on the development of language and communication skills in hearing-impaired children with a cochlear implant.methods: this was a quasi–experimental study with pretest–posttest–follow–up and a control group design. in total, 40 hearing–impaired children with the cochlear implant of the cochlear implant center at rasul akram hospital, tehran city, iran, in 2018 were selected using the purposive sampling method. the study subjects were randomly divided into two groups (experimental & control; n=20/group). the inclusion criteria of the study were age (1–9 years), the age of cochlear implant (not more than two years passed since cochlear implantation), the parents’ educational level (literacy), internet access, the possibility of attending monthly meetings, no history of receiving rehabilitation programs and having a smartphone. parents with frequent absence from the program (virtually & in–person) sessions (n=10) were excluded from the current study. the experimental group mothers received the navayesh family–based aural rehabilitation program by portal (http://user.navayesh.ir) and the channel of messenger and aparat (https://www.aparat.com/navayesh) in 80 sessions (online-offline). in the first phase, the design of the online portal and assignment classification, i.e., based on the navayesh program was presented in the form of multimedia (audio, image, text), online, and offline. in the second phase, a pilot study was performed in the experimental group. the purpose of this program was to improve communication and language skills. the ages and stages questionnaires–third edition (asq–3) (bricker, 2009) and the speech intelligibility rating (sir) (allen et al., 1993) were used as the pretest and posttest scales to measure communication and language skills. the obtained data were analyzed using descriptive statistics (mean & standard deviation) and inferential statistics, i.e., repeated–measures analysis of variance (anova) at the significance level of 0.05 in spss.results: the repeated–measures anova data of speech intelligibility presented that in the source of the effect related to time, speech intelligibility was significant (p<0.001). besides, the results were significant on the interaction of time and group (p<0.001).according to the eta squared of 0.62, approximately 62% of the intragroup changes were explained by auditory perception. the eta squared of 0.55 indicated that about 55% of the changes in auditory perception were explained by grouping. there was a significant difference between the experimental and control groups in the between-group aspect (p<0.001).the repeated–measures anova data on social skill revealed that in the source of the effect related to time, the social skill was significant (p<0.001); the results were also significant about the interaction of time and group (p<0.001).the eta squared of 0.67 indicated that approximately 67% of the intragroup changes belonged to auditory perception; the eta squared of 0.26 signified that almost 26% of the changes in auditory perception were induced by grouping. there was a significant difference between the experimental and control groups in the between-group dimension (p<0.001).conclusion: the present study results suggested the effects of the navayesh family-based aural rehabilitation program of distance education on the language and communication performance in the explored hearing–impaired children with a cochlear implant. therefore, it is recommended that this program be used at rehabilitation cochlear implant centers.