Technologic advances in aural rehabilitation: applications and innovative methods of service delivery

Improving older adults' understanding of challenging speech: Auditory training, rapid adaptation and perceptual learning

The literature surrounding auditory perceptual learning and auditory training for challenging speech signals in older adult listeners is highly varied, in terms of both study methodology and reported outcomes. In this review, we discuss some of the pertinent features of listener, stimulus, and training protocol. Literature regarding the elicitation of auditory perceptual learning for time-compressed speech, non-native speech, and noise-vocoded speech is reviewed, as are auditory training protocols designed to improve speech-in-noise recognition. The literature is synthesized to establish some over-arching findings for the aging population, including an intact capacity for auditory perceptual learning, but a limited transfer of learning to untrained stimuli.

Developing the computer-based auditory training program for adults with hearing impairment

Although it is known that auditory training is essential for hearing-impaired individuals, patients do not willingly participate in auditory training sessions, because individual training is a time-consuming and costly process. Computer-based auditory training programs are under development for reducing the cost and time. The aim of this study is to develop a computer-based auditory training program and to evaluate the usability of the program by applying it to adults with normal hearing indifferent age groups and professions. The developed auditory training program consists of nine modules: identification, discrimination, recognition, auditory closure, comprehension, auditory sequencing, phonological awareness, auditory memory, and attention. Forty adults (age ranges of 25-34, 35-44, 45-54, and 55-65 years), nine audiologists, and one software engineer were included in this study. The computer-based auditory training program was applied to all individuals. An evaluation form was filled out by the participants to evaluate the usability of and satisfaction with the program, and the average performances of the individuals were calculated for each module. The form measures five usability subscales: ease of use, comprehensibility, design, satisfaction, and motivation. The professionals evaluated the program and found it to be quite positive in terms of design, ease of use, motivation, and comprehensibility, and positive in terms of the satisfaction subscale. The participants evaluated all factors and found them to be quite positive. There were no statistically significant differences between the gender, age, and computer use groups in terms of the average performance value of the modules (p > 0.05). However, a significant difference was found in the average performance for the auditory sequencing module considering the educational status of individuals (p = 0.019). Furthermore, it was determined that computer experience (> 5 years) and having a personal computer have a significant effect on auditory memory (p = 0.049) and identification (p = 0.027). These results show that the instructions and information used in the program are clear and understandable, the colors and texts used in the program are readable, the program is easy to use, and the individuals are not disturbed by the sounds used in the program. However, it would be valuable to apply it to individuals with hearing losses to evaluate the efficacy of the program.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

Objective The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

Neural and behavioral changes after the use of hearing aids

OBJECTIVE

Individuals with age-related hearing loss (ARHL) can restore some loss of the auditory function with the use of hearing aids (HAs). However, what remains unknown are the physiological mechanisms that underlie how the brain changes with exposure to amplified sounds though the use of HAs. We aimed to examine behavioral and physiological changes induced by HAs.

METHODS

Thirty-five older-adults with moderate ARHL with no history of hearing aid use were fit with HAs tested in aided and unaided conditions, and divided into experimental and control groups. The experimental group used HAs during a period of six months. The control group did not use HAs during this period, but were given the opportunity to use them after the completion of the study. Both groups underwent testing protocols six months apart. Outcome measures included behavioral (speech-in-noise measures, self-assessment questionnaires) and electrophysiological brainstem recordings (frequency-following responses) to the speech syllable /ga/ in two quiet conditions and in six-talker babble noise.

RESULTS

The experimental group reported subjective benefits on self-assessment questionnaires. Significant physiological changes were observed in the experimental group, specifically a reduction in fundamental frequency magnitude, while no change was observed in controls, yielding a significant time × group interaction. Furthermore, peak latencies remained stable in the experimental group but were significantly delayed in the control group after six months. Significant correlations between behavioral and physiological changes were also observed.

CONCLUSIONS

The findings suggest that HAs may alter subcortical processing and offset neural timing delay; however, further investigation is needed to understand cortical changes and HA effects on cognitive processing.

SIGNIFICANCE

The findings of the current study provide evidence for clinicians that the use of HAs may prevent further loss of auditory function resulting from sensory deprivation.

Investigating the Knowledge, Skills, and Tasks Required for Hearing Aid Management: Perspectives of Clinicians and Hearing Aid Owners

PURPOSE

The purpose of this study is to identify hearing aid owners' and clinicians' opinions of the knowledge, skills, and tasks required for hearing aid management and the importance of each of these to overall success with hearing aids.

METHOD

Concept mapping techniques were used to identify key themes, wherein participants generated, sorted, and rated the importance of statements in response to the question "What must hearing aid owners do in order to use, handle, manage, maintain, and care for their hearing aids?" Twenty-four hearing aid owners (56 to 91 years of age; 54.2% men, 45.8% women) and 22 clinicians (32 to 69 years of age; 9.1% men, 90.9% women) participated.

RESULT

Participants identified 111 unique items describing hearing aid management within 6 concepts: (a) "Daily Hearing Aid Use," (b) "Hearing Aid Maintenance and Repairs," (c) "Learning to Come to Terms with Hearing Aids," (d) "Communication Strategies," (e) "Working With Your Clinician," and (f) "Advanced Hearing Aid Knowledge." Clinicians' opinions of the importance of each statement varied only slightly from the opinions of the hearing aid owner group. Hearing aid owners indicated that all 6 concepts were of similar importance, whereas clinicians indicated that the concept "Advanced Hearing Aid Knowledge" was significantly less important than the other 5 concepts.

CONCLUSION

The results highlight the magnitude of information and skill required to optimally manage hearing aids. Clinical recommendations are made to improve hearing aid handling education and skill acquisition.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study

OBJECTIVES

The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities.

DESIGN

We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round.

STUDY SAMPLE

An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round.

RESULTS

We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified.

CONCLUSIONS

This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial

OBJECTIVE

Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population.

OUTCOME MEASURES

The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention.

METHODS

We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37).

RESULTS

Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants.

CONCLUSIONS

This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention.

TRIAL REGISTRATION NUMBER

This trial is registered at ClinicalTrals.gov, NCT01837550; results.

Practices and views of audiologists regarding aural rehabilitation services for adults with acquired hearing loss

Background

Hearing loss in adults is one of the leading disabilities globally. It is managed through aural rehabilitation for which there is a paucity of literature in South Africa. This raises the question of interest, the integrity of holistic service provision amongst audiologists and whether interest and challenges affect current practices.

Objectives

To describe audiologists’ practices and views on aural rehabilitation services for adults, including interest and challenges experienced.

Method

A descriptive online survey was completed by 45 of 1440 invited practicing audiologists who were members of the two national professional associations in South Africa. Each association emailed the questionnaire link to all its members. Data were analysed using the Statistical Package for the Social Sciences version 21, and included the paired samples t-test and chi-squared tests.

Results

The most provided services were hearing aids (81.4%), communication strategies training (69.8%) and informational counselling (79.8%). A strong interest was reported by most for each service. Challenges included limited client compliance, unaffordability of services, limited undergraduate training, language barriers, unrealistic expectations and individual differences. Statistically significant differences between service provision, interest and challenges indicated that these are influential but not individually significant to service provision.

Conclusion

Imbalanced service provision, high interest and many more challenges are experienced. These factors contribute but are not solely markedly influential in service provision.

Postoperative Rehabilitation Strategies Used by Adults With Cochlear Implants: A Pilot Study

Objectives/Hypothesis

Aural rehabilitation is not standardized for adults after cochlear implantation. Most cochlear implant (CI) centers in the United States do not routinely enroll adult CI users in focused postoperative rehabilitation programs due to poor reimbursement and lack of data supporting (or refuting) the efficacy of any one specific approach. Consequently, patients generally assume a self‐driven approach toward rehabilitation. This exploratory pilot study examined rehabilitation strategies pursued by adults with CIs and associated these strategies with speech recognition and CI‐specific quality of life (QOL).

Study Design

Cross‐sectional study of 23 postlingually deafened adults with CIs.

Methods

Participants responded to an open‐ended questionnaire regarding rehabilitation strategies. A subset underwent in‐depth interviews. Thematic content analysis was applied to the questionnaires and interview transcripts. Participants also underwent word recognition testing and completed a CI‐related QOL measure. Participants were classified as having good or poor performance (upper or lower quartile for speech recognition) and high or low QOL (upper or lower quartile for QOL). Rehabilitation themes were compared and contrasted among groups.

Results

Five rehabilitation themes were identified: 1) Preimplant expectations of postoperative performance, 2) personal motivation, 3) social support, 4) specific rehabilitation strategies, and 5) patient‐perceived role of the audiologist. Patients with good speech recognition and high QOL tended to pursue more active rehabilitation and had greater social support. Patient expectations and motivation played significant roles in postoperative QOL.

Conclusion

Postoperative patient‐driven rehabilitation strategies are highly variable but appear to relate to outcomes. Larger‐scale extensions of this pilot study are needed.

Auditory Perceptual Learning in Adults with and without Age-Related Hearing Loss

Introduction : Speech recognition in adverse listening conditions becomes more difficult as we age, particularly for individuals with age-related hearing loss (ARHL). Whether these difficulties can be eased with training remains debated, because it is not clear whether the outcomes are sufficiently general to be of use outside of the training context. The aim of the current study was to compare training-induced learning and generalization between normal-hearing older adults and those with ARHL. Methods : Fifty-six listeners (60-72 y/o), 35 participants with ARHL, and 21 normal hearing adults participated in the study. The study design was a cross over design with three groups (immediate-training, delayed-training, and no-training group). Trained participants received 13 sessions of home-based auditory training over the course of 4 weeks. Three adverse listening conditions were targeted: (1) Speech-in-noise, (2) time compressed speech, and (3) competing speakers, and the outcomes of training were compared between normal and ARHL groups. Pre- and post-test sessions were completed by all participants. Outcome measures included tests on all of the trained conditions as well as on a series of untrained conditions designed to assess the transfer of learning to other speech and non-speech conditions. Results : Significant improvements on all trained conditions were observed in both ARHL and normal-hearing groups over the course of training. Normal hearing participants learned more than participants with ARHL in the speech-in-noise condition, but showed similar patterns of learning in the other conditions. Greater pre- to post-test changes were observed in trained than in untrained listeners on all trained conditions. In addition, the ability of trained listeners from the ARHL group to discriminate minimally different pseudowords in noise also improved with training. Conclusions : ARHL did not preclude auditory perceptual learning but there was little generalization to untrained conditions. We suggest that most training-related changes occurred at higher level task-specific cognitive processes in both groups. However, these were enhanced by high quality perceptual representations in the normal-hearing group. In contrast, some training-related changes have also occurred at the level of phonemic representations in the ARHL group, consistent with an interaction between bottom-up and top-down processes.

Learning to listen again: the role of compliance in auditory training for adults with hearing loss

PURPOSE

To examine the role of compliance in the outcomes of computer-based auditory training with the Listening and Communication Enhancement (LACE) program in Veterans using hearing aids.

METHOD

The authors examined available LACE training data for 5 tasks (i.e., speech-in-babble, time compression, competing speaker, auditory memory, missing word) from 50 hearing-aid users who participated in a larger, randomized controlled trial designed to examine the efficacy of LACE training. The goals were to determine: (a) whether there were changes in performance over 20 training sessions on trained tasks (i.e., on-task outcomes); and (b) whether compliance, defined as completing all 20 sessions, vs. noncompliance, defined as completing less than 20 sessions, influenced performance on parallel untrained tasks (i.e., off-task outcomes).

RESULTS

The majority, 84% of participants, completed 20 sessions, with maximum outcome occurring with at least 10 sessions of training for some tasks and up to 20 sessions of training for others. Comparison of baseline to posttest performance revealed statistically significant improvements for 4 of 7 off-task outcome measures for the compliant group, with at least small (0.2 < d < 0.3) Cohen's d effect sizes for 3 of the 4. There were no statistically significant improvements observed for the noncompliant group.

CONCLUSION

The high level of compliance in the present study may be attributable to use of systematized verbal and written instructions with telephone follow-up. Compliance, as expected, appears important for optimizing the outcomes of auditory training. Methods to improve compliance in clinical populations need to be developed, and compliance data are important to report in future studies of auditory training.

Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training for tinnitus

Background

Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive task-based training programmes relying on extrinsic factors to motivate participation. Studies reported limited improvement in tinnitus symptoms.

Purpose

To evaluate FDT exploiting intrinsic motivations by integrating training with computer-gameplay.

Methods

Sixty participants were randomly assigned to train on either a conventional task-based training, or one of two interactive game-based training platforms over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on tests of attention.

Results

Participants reported greater intrinsic motivation to train on the interactive game-based platforms, yet compliance of all three groups was similar (∼70%) and changes in self-reported tinnitus severity were not significant. There was no difference between groups in terms of change in tinnitus severity or performance on measures of attention.

Conclusion

FDT can be integrated within an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did not translate to additional compliance or therapeutic benefit.

Trial Registration

ClinicalTrials.gov NCT02095262

Speech Comprehension Training and Auditory and Cognitive Processing in Older Adults

Purpose

To provide a brief history of speech comprehension training systems and an overview of research on auditory and cognitive aging as background to recommendations for future directions for rehabilitation.

Method

Two distinct domains were reviewed: one concerning technological and the other concerning psychological aspects of training. Historical trends and advances in these 2 domains were interrelated to highlight converging trends and directions for future practice.

Results

Over the last century, technological advances have influenced both the design of hearing aids and training systems. Initially, training focused on children and those with severe loss for whom amplification was insufficient. Now the focus has shifted to older adults with relatively little loss but difficulties listening in noise. Evidence of brain plasticity from auditory and cognitive neuroscience provides new insights into how to facilitate perceptual (re-)learning by older adults.

Conclusions

There is a new imperative to complement training to increase bottom-up processing of the signal with more ecologically valid training to boost top-down information processing based on knowledge of language and the world. Advances in digital technologies enable the development of increasingly sophisticated training systems incorporating complex meaningful materials such as music, audiovisual interactive displays, and conversation.

O uso de um software na (re)habilitação de crianças com deficiência auditiva

OBJETIVO: Verificar a aplicabilidade de um software na (re)habilitação de crianças com deficiência auditiva. MÉTODOS: A amostra foi composta por 17 crianças com deficiência auditiva, sendo dez usuárias de Implante Coclear (IC) e sete usuárias de Aparelho de Amplificação Sonora Individual (AASI). Foi utilizado o "Software Auxiliar na Reabilitação de Distúrbios Auditivos (SARDA)". Aplicou-se o protocolo de treinamento durante 30 minutos, duas vezes por semana, pelo tempo necessário para a finalização das estratégias que compõe software. Para mensurar a aplicabilidade do software no treinamento da habilidade de percepção da fala no silêncio e no ruído, foram realizadas avaliações com o Hearing in Noise Test (HINT) pré e pós o treinamento auditivo. Os dados foram analisados estatisticamente. RESULTADOS: O grupo de usuários de IC necessitou em média 12,2 dias para finalizar as estratégias e o grupo de usuários de AASI em média 10,14 dias. Os dois grupos apresentaram diferença entre as avaliações pré e pós no silêncio e no ruído. As crianças mais novas apresentaram maior dificuldade durante a execução das estratégias, porém não houve correlação entre a idade e o desempenho. Não houve influência do tipo do dispositivo eletrônico durante o treinamento. As crianças apresentaram maior dificuldade na estratégia que envolvia estímulos não verbais e na estratégia com estímulos verbais que treina a habilidade de atenção sustentada. A atenção e a motivação da criança durante a estimulação foram fundamentais para o bom rendimento do treinamento auditivo. CONCLUSÃO: O treinamento auditivo com o SARDA foi eficaz, pois propiciou melhora na habilidade de percepção da fala, no silêncio e no ruído, das crianças com deficiência auditiva.

Effects of semantic context and feedback on perceptual learning of speech processed through an acoustic simulation of a cochlear implant

The effect of feedback and materials on perceptual learning was examined in listeners with normal hearing who were exposed to cochlear implant simulations. Generalization was most robust when feedback paired the spectrally degraded sentences with their written transcriptions, promoting mapping between the degraded signal and its acoustic-phonetic representation. Transfer-appropriate processing theory suggests that such feedback was most successful because the original learning conditions were reinstated at testing: Performance was facilitated when both training and testing contained degraded stimuli. In addition, the effect of semantic context on generalization was assessed by training listeners on meaningful or anomalous sentences. Training with anomalous sentences was as effective as that with meaningful sentences, suggesting that listeners were encouraged to use acoustic-phonetic information to identify speech than to make predictions from semantic context.

Development and plasticity of intra- and intersensory information processing

The functional architecture of sensory brain regions reflects an ingenious biological solution to the competing demands of a continually changing sensory environment. While they are malleable, they have the constancy necessary to support a stable sensory percept. How does the functional organization of sensory brain regions contend with these antithetical demands? Here we describe the functional organization of auditory and multisensory (i.e., auditory-visual) information processing in three sensory brain structures: (1) a low-level unisensory cortical region, the primary auditory cortex (A1); (2) a higher-order multisensory cortical region, the anterior ectosylvian sulcus (AES); and (3) a multisensory subcortical structure, the superior colliculus (SC). We then present a body of work that characterizes the ontogenic expression of experience-dependent influences on the operations performed by the functional circuits contained within these regions. We will present data to support the hypothesis that the competing demands for plasticity and stability are addressed through a developmental transition in operational properties of functional circuits from an initially labile mode in the early stages of postnatal development to a more stable mode in the mature brain that retains the capacity for plasticity under specific experiential conditions. Finally, we discuss parallels between the central tenets of functional organization and plasticity of sensory brain structures drawn from animal studies and a growing literature on human brain plasticity and the potential applicability of these principles to the audiology clinic.