Sensory impairment, use of community support services, and quality of life in aged care clients

OBJECTIVE

To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients.

METHOD

The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits.

RESULTS

After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0-7.8).

CONCLUSION

Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

A Randomized Controlled Trial Evaluating the Active Communication Education Program for Older People with Hearing Impairment

OBJECTIVE

To evaluate the effectiveness of the Active Communication Education (ACE) program for older people with hearing impairment and to investigate factors that influence response to the program. The ACE is a group program that runs for 2 hr per week for 5 wk.

DESIGN

In this double-blinded, randomized, controlled trial, 178 older people with, on average, mild to moderate hearing impairment were randomly allocated to one of two groups. Approximately half had been fitted with hearing aid/s in the past. One group (N = 78) undertook a placebo social program for the first 5 wk, followed by the ACE program. They were assessed before the social program, immediately after it, and then again immediately post-ACE. The other group (N = 100) undertook the ACE program only and were assessed before and after ACE. In addition, 167 participants were reassessed 6 mo after completing ACE. Assessments were all self-report and included two sets of measures: 1) those administered both before and after the program-the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, the Ryff Psychological Well-Being Scale, the Short-Form 36 health-related quality of life measure; and 2) those administered postprogram only-the Client Oriented Scale of Improvement, the International Outcome Inventory-Alternative Interventions, and a qualitative questionnaire. All assessments were conducted by a researcher blinded to participants' group membership. The relationships between participant response to the ACE program and a number of client-related factors were also investigated. These factors were the participants' age, gender, hearing loss, hearing aid use, attitudes to hearing impairment (as measured using the Hearing Attitudes to Rehabilitation Questionnaire) and the involvement of significant others.

RESULTS

For those participants who completed the social program initially, significant improvements were found on the Quantified Denver Scale of Communicative Function and on the Mental Component Score of the Short-Form 36 only, when pre- and postprogram scores were compared. For those who completed the ACE program, there were significant pre-to-post improvements on the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, and the Ryff Psychological Well-Being Scale. These improvements after ACE were maintained at 6 mo. Higher scores on the Hearing Attitudes to Rehabilitation Questionnaire before the ACE program were associated with greater positive change on a number of the pre-post program measures. Using the Client Oriented Scale of Improvement, 75% of participants reported some improvement on the primary goal they wished to achieve with the ACE. Positive outcomes were also recorded with the International Outcome Inventory-Alternative Interventions.

CONCLUSIONS

This research study provides evidence for the effectiveness of the ACE program and indicates that such communication programs have an important place in the audiological rehabilitation of older adults. They should be considered as an alternative or a supplement to traditional interventions such as hearing aid fitting.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by congenital aplasia of the uterus and the upper part (2/3) of the vagina in women showing normal development of secondary sexual characteristics and a normal 46, XX karyotype. It affects at least 1 out of 4500 women. MRKH may be isolated (type I) but it is more frequently associated with renal, vertebral, and, to a lesser extent, auditory and cardiac defects (MRKH type II or MURCS association). The first sign of MRKH syndrome is a primary amenorrhea in young women presenting otherwise with normal development of secondary sexual characteristics and normal external genitalia, with normal and functional ovaries, and karyotype 46, XX without visible chromosomal anomaly. The phenotypic manifestations of MRKH syndrome overlap with various other syndromes or associations and thus require accurate delineation. For a long time the syndrome has been considered as a sporadic anomaly, but increasing number of familial cases now support the hypothesis of a genetic cause. In familial cases, the syndrome appears to be transmitted as an autosomal dominant trait with incomplete penetrance and variable expressivity. This suggests the involvement of either mutations in a major developmental gene or a limited chromosomal imbalance. However, the etiology of MRKH syndrome still remains unclear. Treatment of vaginal aplasia, which consists in creation of a neovagina, can be offered to allow sexual intercourse. As psychological distress is very important in young women with MRKH, it is essential for the patients and their families to attend counseling before and throughout treatment.

The effect of hearing loss on identification of asynchronous double vowels

This study determined whether listeners with hearing loss received reduced benefits due to an onset asynchrony between sounds. Seven normal-hearing listeners and 7 listeners with hearing impairment (HI) were presented with 2 synthetic, steady-state vowels. One vowel (the late-arriving vowel) was 250 ms in duration, and the other (the early-arriving vowel) varied in duration between 350 and 550 ms. The vowels had simultaneous offsets, and therefore an onset asynchrony between the 2 vowels ranged between 100 and 300 ms. The early-arriving and late-arriving vowels also had either the same or different fundamental frequencies. Increases in onset asynchrony and differences in fundamental frequency led to better vowel-identification performance for both groups, with listeners with HI benefiting less from onset asynchrony than normal-hearing listeners. The presence of fundamental frequency differences did not influence the benefit received from onset asynchrony for either group. Excitation pattern modeling indicated that the reduced benefit received from onset asynchrony was not easily predicted by the reduced audibility of the vowel sounds for listeners with HI. Therefore, suprathreshold factors such as loss of the cochlear nonlinearity, reduced temporal integration, and the perception of vowel dominance probably play a greater role in the reduced benefit received from onset asynchrony in listeners with HI.

Lost in translation

Although there are large numbers of people in the UK who are hearing-impaired or cannot speak English, signing and translation services in the NHS are all too often woefully inadequate.

Do mobile 'phones have a detrimental impact on auditory function?

Mobile telephones are now an integral part of modern telecommunications. The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. The effects of EMFs on human beings are under investigation. Anatomically, the ear is in close proximity to the mobile telephone during use. The effect of mobile phones on auditory function has rarely been studied. The aim of this review is to determine if there is evidence that mobile phones have a detrimental effect on auditory function.

How physical education teacher education majors should be prepared to teach students with hearing loss: a national needs assessment

A national needs assessment survey is described that gathered information on current practices in physical education in both center-based schools for the deaf and mainstream programs serving deaf and hard of hearing students, grades K-12. The manner in which deaf and hard of hearing students are being served in physical education programs, the depth and breadth of curricula, and the credentials needed to teach are described. The study compares similarities and differences among physical education programs in center-based deaf institutions and mainstream schools. In summary, the study identifies areas of concentration needed in curriculum, and methods of teaching appropriate for student teacher candidates. This information has value for physical education programs that are considering revising their curricula to prepare teacher candidates who wish to work with deaf students.

Longitudinal associations between dual sensory impairment and everyday competence among older adults

Given the prevalence of sensory impairment in older adults, the relationship of sensory impairment to everyday competence among older adults is gaining attention. Dual impairment, or concurrent impairments of vision and hearing, affects anywhere from 5% to 21% of older adults. Using Longitudinal Study on Aging data, we examined the longitudinal associations of self-reported dual sensory impairment with everyday competence in self-reported activities of daily living among adults aged 70 and older (N = 5,151). Self-reported dual sensory impairment was associated with higher levels of self-reported functional disability at baseline and at the 2-year follow-up interview, but the effect gradually diminished over time. However, self-reported dual sensory impairment was not associated with greater levels of self-reported disability as compared with self-reported visual impairment alone. Findings highlight the importance of vision and aural rehabilitation programs for older adults to mitigate the loss of competence in later life due to sensory impairment.

Guidelines for the medical management of Irish children and adolescents with Down syndrome

Down syndrome (DS) is the most common chromosomal cause of developmental disability in Ireland. Children with DS have a high incidence of associated treatable medical disorders where early intervention carries a better outcome. Currently there are no agreed protocols for the screening and management of children and adults with DS in Ireland. A cross-sectional study of 394 children and adolescents was undertaken in the Eastern Regional Health Authority (ERHA) to assess the medical needs of children and adolescents with DS, in order to develop medical management guidelines. This study provides evidence-based data that children and adolescents with DS have a high incidence of treatable medical disorders, which supports the need for the medical management guidelines presented.

[The experience in using of the induced otoacoustic emission in the practice of audiologist]

Described in the paper is the possibility of using the induced otoacoustic emission (registered by different devices) in the practice of audiologist. The devices used for the purpose confirm the method as promising.

Predictors of agitation in nursing home residents

Agitation in nursing home residents presents a serious challenge to caregivers and may place residents at risk for harm. Understanding the etiology of agitation can assist clinicians in developing nonpharmacologic interventions for preventing and treating this problem. The purpose of this study was to examine independent and common predictors of resident agitation with structural equation modeling. Agitation was measured with both a standardized staff report rating scale and direct behavioral observation. No indirect or mediating effects were found. Cognitive impairment, vision and hearing impairment, and gender were found to be independent predictors of agitation as measured by direct behavioral observation. Only cognitive impairment was found to be predictive of agitation as measured by the standardized staff report scale. An unexpected finding was that vision impairment appeared to exert a protective effect for agitation in these severely cognitively impaired residents. The clinical implications of these findings are discussed as well as the relative merits of the two methods of measuring agitation.

Metacognitive ability from a theory-of-mind perspective: a cross-cultural study of students with and without hearing loss

Theory of Mind (see, e.g., Bartsch & Estes, 1996) is a concept that can help educators understand how students think about their state of mind and that of others involved in various life situations. To examine the impact of culture and the impact of hearing loss on metacognition as explained by Theory of Mind, two samples of students with and without hearing losses who were from two different cultures were compared on their ability to choose pictures representing their perspectives on specific life situations. The two groups did not differ in their metacognitive interpretations of the experiences when they were from the same culture, although students from different cultures did differ, indicating that culture may have a greater impact on metacognition as explained by Theory of Mind than hearing loss. Data collected in the present study affirmed previous research showing that students with hearing losses could make metacognitive decisions about life situations just as ably as their hearing peers from the same culture.

Occupational injury and illness recording and reporting requirements. Final rule

The Occupational Safety and Health Administration (OSHA) is revising the hearing loss recording provisions of the Occupational Injury and Illness Recording and Reporting Requirements rule published January 19, 2001 (66 FR 5916-6135), scheduled to take effect on January 1, 2003 (66 FR 52031-52034). This final rule revises the criteria for recording hearing loss cases in several ways, including requiring the recording of Standard Threshold Shifts (10 dB shifts in hearing acuity) that have resulted in a total 25 dB level of hearing above audiometric zero, averaged over the frequencies at 2000, 3000, and 4000 Hz, beginning in year 2003.

Neuropsychological and neuropsychiatric perspectives on maternal cradling preferences

OBJECTIVE

To assess competing explanations for the universal preference of mothers to cradle infants on their left side and to propose a relation to hemispheric asymmetry for social attachment and communication behaviour.

METHODS

A review of observational, experimental, physiological, psychological, neuro-physiological, and neuro-psychological studies, including new findings on the cradling behaviour of mothers with auditory or visual impairments.

RESULTS

A significant left-cradling bias is observed in both right- and left-handed mothers which cannot adequately be explained by arguments based on handedness or closer contact to the soothing sound of the maternal heartbeat. Observations of primate behaviour have led to the suggestion that the left-cradling bias may be related to a left visual field (right hemisphere) advantage for monitoring an infant's facial expressions of distress. However, more than just monitoring, cradling subserves the mother's connection with the infant. For that reason, we have suggested that left cradling might be related to a right hemisphere specialisation for emotional communication, i.e. the speech melody, smiles, signals, and stroking which mothers use to interact with their infants. Studies of mother-infant interaction show that the sound of the mother's voice is more soothing when cradling on the left, more stimulating when cradling on the right. Cradling laterality may thus be related to emotional state and behavioural intent. There is also evidence to suggest that left cradling is linked to a special role of the right hemisphere in social attachment behaviour. This function may be disturbed in mothers with post-natal depression who show abnormal right hemisphere activity.

CONCLUSION

Cradling embodies the symbiotic relationship between mother and infant; various lines of evidence support the suggestion that the universal preference of mothers to cradle infants on their left side is related to a right hemisphere dominance for social attachment and communication behaviour.