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Monika Lehnhardt answers the questions of experts and parents in the forum discussion on Remote Fitting and Rehabilitation on 09.06.2013

[Olga Prokhorova-Moscow] How are less experienced specialists supported – what are the conditions, and how can this be implemented? As a junior specialist (SLP) I have an interest in this.

Which types of remote cooperation are you interested in? Various institutions operating under this method exist in different countries. We will try to find an expert who can cooperate on the topic which matters for you, basing specifically on remote communication.

[Jana Frey] From June 11th through June 14th, a rehabilitation workshop will be conducted in Lviv – this is for experts. For parents the date is June 15th. You can access it via the PORA weblog and take part:  http://www.lehnhardt-akademie.net/weblog-ru/category/planning-lviv/

Additionally, the software used for remote fitting helps the experienced expert adjust the processor settings on the PC of the less experienced one; the two experts can communicate with each other, and also with the parents.

[Konstantin Nikiforov] This is a classic pattern of medical training – working with a patient in the presence of a more experienced colleague. But in this case, the colleague is present remotely. The main thing is that the student spreads his own wings afterwards.

As was said in the presentation, this is an additional plus to such remote sessions. It enables you to partner with another therapist in USA and Australia, and to choose among the most experienced, to have their consent. This is a significant learning experience.

* redirect to V. McDonell

[Olga Prokhorova-Moscow] I mostly work with pre-school children, teaching them how to speak and developing hearing perception. I am often approached with questions about remote classes. But so far I find it difficult to imagine remote interaction with very young children. Because of this, I would like to ask whether someone here might have experience of working in such a way.

During the Lviv seminar, we will definitely relay this question to Viktorija McDonell, the main presenter and expert there. She will answer this question and will probably be able to recommend an expert you could cooperate with in this area.

[Liubov_Osnabrück] How is the language issue resolved? Is a fitting e.g. between Russia and Poland conducted in English?

[Konstantin Nikiforov] The Polish side have Russian-speaking experts on their staff – a not insignificant number, as they say. I am not an expert in remote fitting. My view is – there must be language contact, at least between the expert and the parents. How can we do without it? No, I can do a fitting with NRT and no spoken contact. But how optimal will this fitting be?

For sure, with remote fitting both sides (expert-expert, expert-parent) should speak the same language. If the expert can’t speak the family’s language, an interpreter should be present online. In Poland, in the 20 centers grouped around the Institute of Sensory Disorders, all experts speak Polish. They provide remote services through, e.g., a link with Odessa, and, as K. Nikiforov rightly said, they have Russian-speaking staff, as do some German fitting centers.

[Liubov_Osnabrück] Is remote fitting possible immediately after the surgery (first fitting), or can it be adopted only for the subsequent fittings?

I think most of the experts present would agree that the patient’s coming back to the implanting clinic for the first fitting is highly desirable. Some centers launch remote fitting practice with adult patients to get more experience, because remote work with children is more challenging. Having accumulated experience, they involve younger patients into the practice.

[Konstantin Nikiforov] It is worth knowing that in some cases remote fitting is suboptimal. This concerns difficult cases – and there are real examples of this. A special consideration is the need for special equipment for troubleshooting the implant.

I agree. Remote fitting and work may be impossible in some cases, such as the need to check the functioning of the implant. The only option then is the traditional method.
Already now we can say that reporting issues with the implant is a problem that will be solved. The system might generate automatical reports about difficulties. These solutions are currently in development.

[ozontova] Our institute (LOR NII in St. Petersburg) has had experience in remote support with several partners over the course of a few years. This has included candidate selection, surgery, fitting, rehabilitation. We’ve developed a ranking of preferences: local help, if that should be impossible – remote help. Real-life work with patients remains as the foundation. 

I definitely agree with you. If the parents live in St. Petersburg or close by, there is no need to work remotely. But many families reside in rural areas, and for them the way to the clinic takes hours, as the distance may be 400, 600 km. In this case remote fitting would generate savings (financially and timewise).

[Konstantin Nikiforov] Around a year ago Cochlear announced the release of a remote control that would allow parents and users to program their CIs. They provided data from studies testifying to the high quality of such fittings (not much inferior to a fitting done by an expert). What do you think of such a format? Is this remote tool on the market? 

[Jana Frey] Studies are in progress; we confirm that there are new systems that enable remote measurement of NRT. So far this is not applied to fitting of patients and not offered in this way. This is the future.

[Olga Prokhorova-Moscow] Will the seminar of Viktorija McDonell last from  June 11th to June 14th? What is the exact time? 

[Jana Frey] The weblog contains a .pdf file with the seminar agenda. Please look up the schedule here: http://www.lehnhardt-akademie.net/weblog-ru/category/planning-lviv/

[Svetlana Kondratova-Petropavlov] I am considering implementing telepractice in the boarding school I work in. Children who’ve been taken ill, or are being schooled at home, can be taught with telepractice elements, especially as some of the kids come from remote districts of the oblast. This will prevent them from falling behind.

This is a very good opportunity to support these children. Please let us know which questions and ideas you have, and how we can be of assistance.

[Olga-Naberegnye Chelny] Who pays for access to the online room?

Doubtlessly, the sessions themselves must be paid for, but the online conference room, as you see, is free of charge.

[Olga-Naberegnye Chelny] I did not mean necessarily this very room. In case I want to do telepractice, where can I find a room like this? This is what I wanted to ask.

We have several online rooms; what you have to do is express your ambition and set a goal. This can then be realized with help from the Lehnhardt Foundation.

[Olga Мinsk] We experts are few and far between here, and remote regions experience problems with connection (our Internet is not exactly up to date), but we keep hoping and trying to realize new ideas. You are right, many parents are evasive, and need working with. 

I agree, there is a need to work with parents and make them understand that their role is the key one.

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