{"id":559,"date":"2021-06-08T22:25:32","date_gmt":"2021-06-08T16:55:32","guid":{"rendered":"http:\/\/cpdm.iisc.ac.in\/utsaah\/?page_id=559"},"modified":"2021-06-08T22:25:33","modified_gmt":"2021-06-08T16:55:33","slug":"dhwani","status":"publish","type":"page","link":"https:\/\/dm.iisc.ac.in\/utsaah\/dhwani\/","title":{"rendered":"Dhwani"},"content":{"rendered":"\n

A holistic rehabilitation solution for children with hearing impairment <\/h2>\n\n\n\n

Hearing impairment interferes with the normal development of speech and language skills in children. The consequences of hearing impairment depend on myriad factors such as binaural\/monoaural loss, age of onset, degree, and type of impairment among others. Lack of auditory stimulation restricts the ability of children to communicate using spoken language. This disability hinders educational, social, and career choices for children as they grow up. The standard of care for children with hearing impairment involves providing appropriate amplification devices (external\/implanted) followed by rigorous speech and language therapy. Speech and language rehabilitation of\u202fhearing-impaired\u202fchildren is an economically and socially challenging situation in\u202fresource-constrained\u202fsettings. The economic challenge is due to the\u202fhigh costs\u202fof a hearing aid and the social challenge is due to the lack of adequate therapy personnel to provide a framework in the community after starting therapy within the hospital.\u202f\u00a0<\/p>\n\n\n\n

Understanding of the complete ecosystem and stakeholder analysis led to various unmet needs. These needs were converted into requirements for the design of Dhwani. The aim of this system is to assist parents in providing effective home-based speech therapy, eventually leading to rapid adoption. This would significantly improve the chances of speech development in the hearing-impaired child.\u00a0<\/p>\n\n\n\n

Dhwani is a platform comprising of a mobile application to assist and monitor home-based speech therapy, integrated with a hearing aid and an interactive response device to track responses from the child during speech therapy. Expert opinion rated the application high on novelty, relevance, and utility in\u202fresource-limited\u202fsettings of the Indian context.\u202fField\u202ftrials\u202fof the application will examine its effectiveness in providing a community-based framework for speech and language rehabilitation and reducing\u202fdropouts\u202ffrom therapy.\u202f It is to be noted that the innovation is not to be used as a replacement to the existing therapeutic sessions\u202fbut\u202fto aid\u202fthem. The innovation shall help parents continue therapy at home with the inputs to the application coming from the therapist.\u202f\u00a0<\/p>\n\n\n\n

What is the unmet need?<\/h2>\n\n\n\n

In a healthy child, the\u202fbrain\u202fdevelops speaking ability until the age of five. For a hearing-impaired child, speech development is affected since he\/ she\u202fis not able to\u202flisten to any environmental sounds around her. For that reason, it is important for a child with a\u202fhearing\u202fimpairment to adopt a hearing aid\u202fand attend regular therapy sessions before the age of five.\u202f\u00a0<\/p>\n\n\n\n

A clinical immersion found that parents are willing to invest\u202fin\u202fa hearing aid but are unable to take their child to therapy for\u202fvarious reasons. Therapy sessions are often expensive and are recommended to be held a minimum of three times a week. India has a\u202flimited\u202fnumber of therapists; it is estimated that there is one speech therapist for 200 children detected with hearing impairment in India and this makes it difficult to reach out to one. This becomes another\u202fhindrance\u202ffor some families since they end up having to travel long distances for each therapy session. The process of speech therapy is time and labor-intensive for all stakeholders and not particularly motivating since the child\u2019s progress isn\u2019t exactly structured or evident immediately. This leads some parents into believing the process was\u202fineffective as a whole.\u202fAll these factors contribute to high dropout rates after the initiation of speech and language therapy. There was a need for a system that made it easy for therapy to be conducted in households, provide a structure to it, and at the same time provide feedback to parents and the doctor\/ therapist regarding the child\u2019s progress.\u00a0<\/p>\n\n\n\n

What is the inspiration for this work?<\/h2>\n\n\n\n

The prohibitive cost of hearing aid was the initial targeted problem. Through the clinical immersion and interaction with 100+ stakeholders, it was understood that speech therapy was an important aspect of hearing rehabilitation. Further focus on understanding of the ecosystem and stakeholder interaction gave rise to numerous unmet needs in the domain of hearing rehabilitation.\u00a0 With the help of clinicians (Otolaryngologist and speech therapist) involved in the team and the insights gained from diverse stakeholder interactions, the area of focus was confined to reducing the lifetime cost of hearing aids for profound hearing loss patients, in addition to democratizing the means of therapy delivery by easing continued therapy delivery and reducing the cost of delivery.\u00a0\u00a0<\/p>\n\n\n\n

How does it work?<\/h2>\n\n\n\n

Dhwani comprises of a mobile application to assist and monitor home-based speech therapy, integrated with a hearing aid and an interactive response device to track responses from the child during speech therapy.\u00a0<\/p>\n\n\n\n

The hearing aid prototype developed, provides programmable amplification catering to various degrees of hearing impairment. It has a hearing aid mode and therapy mode. The hearing aid mode provides high-quality amplification. The therapy mode assists the parent to train the child in the multiple components of speech therapy.\u00a0These responses serve\u202fto monitor the\u202fprogress\u202fof therapy.\u00a0\u00a0The mobile application is designed to integrate with a prototype hearing aid and also an interactive response device to track the response of the child to the auditory stimuli provided\u202fby\u202fthe smartphone during speech therapy.\u202f A section of the application is devoted to providing motivation to parents by showcasing success stories of\u202fhearing-impaired\u202fchildren.\u00a0\u00a0<\/p>\n\n\n\n

The hardware response system consists of a toy kit with smart toys to track the child\u2019s response.\u202fThe child\u2019s response for these activities is logged for further analysis. A learning reinforcement for every correct response of the child, with a concurrent scoring mechanism. Through this workflow, the system should allow objective assessment of a child\u2019s progress in the rehabilitation process and enable therapists to make targeted course corrections to a child\u2019s therapy plan. In this way, Dhwani serves as a platform for parents, speech therapists, and E.N.T. specialists to increase the efficiency of rehabilitation.<\/p>\n\n\n\n

How was this developed?<\/h2>\n\n\n\n

The traditional waterfall-based design process has been used for designing Dhwani. Clinical immersion involved observations of various speech therapy centers and interviews of around 100 + stakeholders across India. This included children with hearing impairment, parent(s)\/caregivers of these children, schoolteachers educating these children, audiologists, otolaryngology specialists, community-based primary care ear workers or speech therapists and NGOs working towards hearing rehabilitation. A market survey was undertaken to understand current solutions available and corresponding drawbacks. Key insights were drawn based on the interactions and the market survey. Following this, stakeholder-need mapping was undertaken, to prepare a comprehensive list of stakeholders needs and a design input document. During this process, it was observed that designing an application for speech and language training also requires a user-centric approach. The use of design controls at several key stages was adopted. Subsequently, the conceptual design was undertaken to address these needs. The most appropriate of these concepts was selected for prototyping and implementation. Clinical collaboration with St. John\u2019s Hospital is the key in obtaining design input, system validation from the clinical experts, and user feedback frequently.\u00a0<\/p>\n\n\n\n

What is the novelty of this approach?<\/h2>\n\n\n\n

While the overall architecture of integrating a hearing aid with a smartphone application to deliver therapy is novel in general, specifically one feature that sets the system apart is the use of Bluetooth connectivity to deliver therapy from the smartphone directly into the hearing aid. This helps in delivering uninterrupted, noise-free therapeutic signals directly to the child\u2019s ear.\u00a0<\/p>\n\n\n\n

The other is the ability of the application and interactive response system to track the progress of the child and thereby keep the parent motivated to continue therapy at home which can cause a significant reduction in overall therapy cost over the rehabilitation process. The information stored in the application is also conveyed to the therapist to allow for prompt course correction if any. The system is aimed at creating a common platform for parents, speech therapists, and E.N.T. specialists to increase the efficiency of rehabilitation.\u00a0<\/p>\n\n\n\n

Grant Support<\/h2>\n\n\n\n

The project\u202fhas\u202fbeen awarded the PACE grant by Biotechnology Industry Research Assistance Council (BIRAC),\u202fUnder Department of Biotechnology, Government of India in collaboration with St. John\u2019s Medical College and Hospital <\/p>\n\n\n\n

Publications<\/strong>\u00a0<\/p>\n\n\n\n