Análise da aplicabilidade de um protocolo de avaliação da linguagem via teleconsulta para crianças com risco e com diagnóstico de deficiência auditiva

Abstract

Introduction: The unequal distribution of specialized professionals has spurred research in digital health to address the needs of oral language care in childhood, given that language delays are common complaints during this period. In this sense, this dissertation, composed of two research articles presented below, aimed to contribute to the field. Article 1: A scoping review investigated: “Which instruments are applicable for screening and assessing oral language in early childhood using digital health?” Studies were included if they utilized screening and assessment tests for oral language via teleconsultation, applications, and web-based tools, without restrictions on time, language, or ethnicity, in clinical, educational, and non-clinical settings. The databases consulted were PubMed, Web of Science, LILACS, Embase, and Scopus, in addition to gray literature via Google Scholar and ProQuest Dissertations and Theses. Out of 2,435 studies identified, 20 comprised the final sample. Eleven studies evaluated language skills screening and nine investigated digital language assessment. Fourteen studies adapted previously validated in-person tests to an online format; four developed specific teleconsultation tools, and two conducted synchronous or asynchronous observations without defined protocols. Most research was conducted in clinical settings with speech-language pathologists, although community health workers also participated in some studies. Videoconferencing was the most frequently used digital modality. The findings of this review reinforce the feasibility of telehealth for screening and assessing oral language, highlighting the need for further research to consolidate evidence-based practice in teleaudiology Article 2: This prospective clinical study, approved by an Institutional Ethics Committee (protocol no. 6.754.773), involved 12 children of both sexes, aged between 21 and 74 months. Of these, seven had bilateral sensorineural hearing loss ranging from moderate to profound, and five exhibited language alterations without confirmed hearing loss. All were evaluated using the Behavioral Observation Protocol (PROC), administered both remotely and in person by trained, blinded researchers. Agreement between scores obtained in each session was assessed using the intraclass correlation coefficient (ICC) and the Kappa index, comparing in-person and remote evaluations. Results: In the hearing-impaired group, the ICC for the overall score was 0.964 (p ≤ 0.05), and in the at-risk group, it was 0.888 (p ≤ 0.05), with a Kappa of 1.0 (p ≤ 0.05) for both groups. In the at-risk group, variable ICCs were observed when analyzing the individual sections of the PROC separately. Conclusion: Language assessment via synchronous teleconsultation using the PROC demonstrated clinical applicability in the studied population.