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Nagle KF, Pilkington B. Professionalism in the context of providing elective services: reflecting on bias. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-5. [PMID: 38426507 DOI: 10.1080/17538068.2024.2323852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
We examine the provision of elective pronunciation services, such as intelligibility enhancement, to non-native speakers by speech language pathologists (SLPs). Practices associated with the 'modification' of non-native accent raise significant professionalism questions about bias for SLPs and healthcare professionals. These questions arise partly due to the socio-cultural context in which SLPs practice and their clients live, and the relational nature of communication. We argue that due to the ambiguity inherent in accent modification practices, SLPs must weigh a variety of considerations before determining the circumstances in which such services are professionally acceptable. Our argument is rooted in consideration of the complex nature of professionalism related to communication. After surveying potentially relevant models from other healthcare professions and finding them wanting, we support our position in light of current literature on topics such as accounts of functionality. We conclude by generalizing our anti-bias recommendations to interprofessional healthcare professionalism.
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Affiliation(s)
- Kathleen F Nagle
- Department of Speech-Language Pathology, School of Health & Medical Sciences, Seton Hall University, Nutley, NJ, USA
| | - Bryan Pilkington
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
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Carolan PJ, Heinrich A, Munro KJ, Millman RE. Divergent effects of listening demands and evaluative threat on listening effort in online and laboratory settings. Front Psychol 2024; 15:1171873. [PMID: 38333064 PMCID: PMC10850315 DOI: 10.3389/fpsyg.2024.1171873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Listening effort (LE) varies as a function of listening demands, motivation and resource availability, among other things. Motivation is posited to have a greater influence on listening effort under high, compared to low, listening demands. Methods To test this prediction, we manipulated the listening demands of a speech recognition task using tone vocoders to create moderate and high listening demand conditions. We manipulated motivation using evaluative threat, i.e., informing participants that they must reach a particular "score" for their results to be usable. Resource availability was assessed by means of working memory span and included as a fixed effects predictor. Outcome measures were indices of LE, including reaction times (RTs), self-rated work and self-rated tiredness, in addition to task performance (correct response rates). Given the recent popularity of online studies, we also wanted to examine the effect of experimental context (online vs. laboratory) on the efficacy of manipulations of listening demands and motivation. We carried out two highly similar experiments with two groups of 37 young adults, a laboratory experiment and an online experiment. To make listening demands comparable between the two studies, vocoder settings had to differ. All results were analysed using linear mixed models. Results Results showed that under laboratory conditions, listening demands affected all outcomes, with significantly lower correct response rates, slower RTs and greater self-rated work with higher listening demands. In the online study, listening demands only affected RTs. In addition, motivation affected self-rated work. Resource availability was only a significant predictor for RTs in the online study. Discussion These results show that the influence of motivation and listening demands on LE depends on the type of outcome measures used and the experimental context. It may also depend on the exact vocoder settings. A controlled laboratory settings and/or particular vocoder settings may be necessary to observe all expected effects of listening demands and motivation.
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Affiliation(s)
- Peter J. Carolan
- School of Health Sciences, Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Antje Heinrich
- School of Health Sciences, Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kevin J. Munro
- School of Health Sciences, Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rebecca E. Millman
- School of Health Sciences, Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Pielage H, Plain BJ, Saunders GH, Versfeld NJ, Lunner T, Kramer SE, Zekveld AA. Copresence Was Found to Be Related to Some Pupil Measures in Persons With Hearing Loss While They Performed a Speech-in-Noise Task. Ear Hear 2023; 44:1190-1201. [PMID: 37012623 PMCID: PMC10426789 DOI: 10.1097/aud.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To assess if a manipulation of copresence was related to speech-in-noise task performance, arousal, and effort of persons with hearing loss. Task-related arousal and effort were measured by means of pupillometry. DESIGN Twenty-nine participants (mean age: 64.6 years) with hearing loss (4-frequency pure-tone average [4F-PTA] of 50.2 dB HL [SD = 8.9 dB] in the right ear and 51.3 dB HL [SD = 8.7 dB] in the left ear; averaged across 0.5, 1, 2, and 4 kHz) listened to and repeated spoken Danish sentences that were masked by four streams of continuous speech. Participants were presented with blocks of 20 sentences, during which copresence was manipulated by having participants do the task either alone or accompanied by two observers who were recruited from a similar age group. The task was presented at two difficulty levels, which was accomplished by fixing the signal-to-noise ratio of the speech and masker to match the thresholds at which participants were estimated to correctly repeat 50% (difficult) or 80% (easy) of the sentences in a block. Performance was assessed based on whether or not sentences were repeated correctly. Measures of pupil size (baseline pupil size [BPS], peak pupil dilation [PPD], and mean pupil dilation [MPD]) were used to index arousal and effort. Participants also completed ratings of subjective effort and stress after each block of sentences and a self-efficacy for listening-questionnaire. RESULTS Task performance was not associated with copresence, but was found to be related to 4F-PTA. An increase in BPS was found for copresence conditions, compared to alone conditions. Furthermore, a post-hoc exploratory analysis revealed that the copresence conditions were associated with a significantly larger pupil size in the second half of the task-evoked pupil response (TEPR). No change in PPD or MPD did was detected between copresence and alone conditions. Self-efficacy, 4F-PTA, and age were not found to be related to the pupil data. Subjective ratings were sensitive to task difficulty but not copresence. CONCLUSION Copresence was not found to be related to speech-in-noise performance, PPD, or MPD in persons with HL but was associated with an increase in arousal (as indicated by a larger BPS). This could be related to premobilization of effort and/or discomfort in response to the observers' presence. Furthermore, an exploratory analysis of the pupil data showed that copresence was associated with greater pupil dilations in the second half of the TEPR. This may indicate that participants invested more effort during the speech-in-noise task while in the presence of the observers, but that this increase in effort may not necessarily have been related to listening itself. Instead, other speech-in-noise task-related processes, such as preparing to respond, could have been influenced by copresence.
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Affiliation(s)
- Hidde Pielage
- Amsterdam UMC location Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, section Ear & Hearing, Amsterdam, the Netherlands
- Eriksholm Research Centre, Snekkersten, Denmark
| | - Bethany J. Plain
- Amsterdam UMC location Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, section Ear & Hearing, Amsterdam, the Netherlands
- Eriksholm Research Centre, Snekkersten, Denmark
| | - Gabrielle H. Saunders
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
| | - Niek J. Versfeld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, section Ear & Hearing, Amsterdam, the Netherlands
| | | | - Sophia E. Kramer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, section Ear & Hearing, Amsterdam, the Netherlands
| | - Adriana A. Zekveld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, section Ear & Hearing, Amsterdam, the Netherlands
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Venkitakrishnan S, Wu YH. Facial Expressions as an Index of Listening Difficulty and Emotional Response. Semin Hear 2023; 44:166-187. [PMID: 37122878 PMCID: PMC10147507 DOI: 10.1055/s-0043-1766104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Knowledge about listening difficulty experienced during a task can be used to better understand speech perception processes, to guide amplification outcomes, and can be used by individuals to decide whether to participate in communication. Another factor affecting these decisions is individuals' emotional response which has not been measured objectively previously. In this study, we describe a novel method of measuring listening difficulty and affect of individuals in adverse listening situations using automatic facial expression algorithm. The purpose of our study was to determine if facial expressions of confusion and frustration are sensitive to changes in listening difficulty. We recorded speech recognition scores, facial expressions, subjective listening effort scores, and subjective emotional responses in 33 young participants with normal hearing. We used the signal-to-noise ratios of -1, +2, and +5 dB SNR and quiet conditions to vary the difficulty level. We found that facial expression of confusion and frustration increased with increase in difficulty level, but not with change in each level. We also found a relationship between facial expressions and both subjective emotion ratings and subjective listening effort. Emotional responses in the form of facial expressions show promise as a measure of affect and listening difficulty. Further research is needed to determine the specific contribution of affect to communication in challenging listening environments.
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Affiliation(s)
- Soumya Venkitakrishnan
- Department of Communication Sciences and Disorders, California State University, Sacramento, California
| | - Yu-Hsiang Wu
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa
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Shatzer HE, Russo FA. Brightening the Study of Listening Effort with Functional Near-Infrared Spectroscopy: A Scoping Review. Semin Hear 2023; 44:188-210. [PMID: 37122884 PMCID: PMC10147513 DOI: 10.1055/s-0043-1766105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Listening effort is a long-standing area of interest in auditory cognitive neuroscience. Prior research has used multiple techniques to shed light on the neurophysiological mechanisms underlying listening during challenging conditions. Functional near-infrared spectroscopy (fNIRS) is growing in popularity as a tool for cognitive neuroscience research, and its recent advances offer many potential advantages over other neuroimaging modalities for research related to listening effort. This review introduces the basic science of fNIRS and its uses for auditory cognitive neuroscience. We also discuss its application in recently published studies on listening effort and consider future opportunities for studying effortful listening with fNIRS. After reading this article, the learner will know how fNIRS works and summarize its uses for listening effort research. The learner will also be able to apply this knowledge toward generation of future research in this area.
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Affiliation(s)
- Hannah E. Shatzer
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Frank A. Russo
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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Zhang M, Siegle GJ. Linking Affective and Hearing Sciences-Affective Audiology. Trends Hear 2023; 27:23312165231208377. [PMID: 37904515 PMCID: PMC10619363 DOI: 10.1177/23312165231208377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 11/01/2023] Open
Abstract
A growing number of health-related sciences, including audiology, have increasingly recognized the importance of affective phenomena. However, in audiology, affective phenomena are mostly studied as a consequence of hearing status. This review first addresses anatomical and functional bidirectional connections between auditory and affective systems that support a reciprocal affect-hearing relationship. We then postulate, by focusing on four practical examples (hearing public campaigns, hearing intervention uptake, thorough hearing evaluation, and tinnitus), that some important challenges in audiology are likely affect-related and that potential solutions could be developed by inspiration from affective science advances. We continue by introducing useful resources from affective science that could help audiology professionals learn about the wide range of affective constructs and integrate them into hearing research and clinical practice in structured and applicable ways. Six important considerations for good quality affective audiology research are summarized. We conclude that it is worthwhile and feasible to explore the explanatory power of emotions, feelings, motivations, attitudes, moods, and other affective processes in depth when trying to understand and predict how people with hearing difficulties perceive, react, and adapt to their environment.
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Affiliation(s)
- Min Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai, China
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Huang H, Ricketts TA, Hornsby BWY, Picou EM. Effects of Critical Distance and Reverberation on Listening Effort in Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4837-4851. [PMID: 36351258 DOI: 10.1044/2022_jslhr-22-00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Mixed historical data on how listening effort is affected by reverberation and listener-to-speaker distance challenge existing models of listening effort. This study investigated the effects of reverberation and listener-to-speaker distance on behavioral and subjective measures of listening effort: (a) when listening at a fixed signal-to-noise ratio (SNR) and (b) at SNRs that were manipulated so that word recognition would be comparable across different reverberation times and listening distances. It was expected that increased reverberation would increase listening effort but only when listening outside critical distance. METHOD Nineteen adults (21-40 years) with no hearing loss completed a dual-task paradigm. The primary task was word recognition and the secondary task was timed word categorization; response times indexed behavioral listening effort. Additionally, participants provided subjective ratings in each condition. Testing was completed at two reverberation levels (moderate and high, RT30 = 469 and 1,223 ms, respectively) and at two listener-to-speaker distances (inside and outside critical distance for the test room, 1.25 and 4 m, respectively). RESULTS Increased reverberation and listening distances worsened word recognition performance and both behavioral and subjective listening effort. The effect of reverberation was exacerbated when listeners were outside critical distance. Subjective experience of listening effort persisted even when word recognition was comparable across conditions. CONCLUSIONS Longer reverberation times or listening outside the room's critical distance negatively affected behavioral and subjective listening effort. This study extends understanding of listening effort in reverberant rooms by highlighting the effect of listener's position relative to the room's critical distance.
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Affiliation(s)
- Haiping Huang
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Todd A Ricketts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Benjamin W Y Hornsby
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Benefits of Text Supplementation on Sentence Recognition and Subjective Ratings With and Without Facial Cues for Listeners With Normal Hearing. Ear Hear 2022:00003446-990000000-00088. [PMID: 36534697 DOI: 10.1097/aud.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Recognizing speech through telecommunication can be challenging in unfavorable listening conditions. Text supplementation or provision of facial cues can facilitate speech recognition under some circumstances. However, our understanding of the combined benefit of text and facial cues in telecommunication is limited. The purpose of this study was to investigate the potential benefit of text supplementation for sentence recognition scores and subjective ratings of spoken speech with and without facial cues available. DESIGN Twenty adult females (M = 24 years, range 21 to 29 years) with normal hearing performed a sentence recognition task and also completed a subjective rating questionnaire in 24 conditions. The conditions varied by integrity of the available facial cues (clear facial cues, slight distortion facial cues, great distortion facial cues, no facial cues), signal-to-noise ratio (quiet, +1 dB, -3 dB), and text availability (with text, without text). When present, the text was an 86 to 88% accurate transcription of the auditory signal presented at a 500 ms delay relative to the auditory signal. RESULTS The benefits of text supplementation were largest when facial cues were not available and when the signal-to-noise ratio was unfavorable. Although no recognition score benefit was present in quiet, recognition benefit was significant in all levels of background noise for all levels of facial cue integrity. Moreover, participant subjective ratings of text benefit were robust and present even in the absence of recognition benefit. Consistent with previous literature, facial cues were beneficial for sentence recognition scores in the most unfavorable signal-to-noise ratio, even when greatly distorted. It is interesting that, although all levels of facial cues were beneficial for recognition scores, participants rated a significant benefit only with clear facial cues. CONCLUSIONS The benefit of text for auditory-only and auditory-visual speech recognition is evident in recognition scores and subjective ratings; the benefit is larger and more robust for subjective ratings than for scores. Therefore, text supplementation might provide benefit that extends beyond speech recognition scores. Combined, these findings support the use of text supplementation in telecommunication, even when facial cues are concurrently present, such as during teleconferencing or watching television.
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Xiu B, Paul BT, Chen JM, Le TN, Lin VY, Dimitrijevic A. Neural responses to naturalistic audiovisual speech are related to listening demand in cochlear implant users. Front Hum Neurosci 2022; 16:1043499. [DOI: 10.3389/fnhum.2022.1043499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
There is a weak relationship between clinical and self-reported speech perception outcomes in cochlear implant (CI) listeners. Such poor correspondence may be due to differences in clinical and “real-world” listening environments and stimuli. Speech in the real world is often accompanied by visual cues, background environmental noise, and is generally in a conversational context, all factors that could affect listening demand. Thus, our objectives were to determine if brain responses to naturalistic speech could index speech perception and listening demand in CI users. Accordingly, we recorded high-density electroencephalogram (EEG) while CI users listened/watched a naturalistic stimulus (i.e., the television show, “The Office”). We used continuous EEG to quantify “speech neural tracking” (i.e., TRFs, temporal response functions) to the show’s soundtrack and 8–12 Hz (alpha) brain rhythms commonly related to listening effort. Background noise at three different signal-to-noise ratios (SNRs), +5, +10, and +15 dB were presented to vary the difficulty of following the television show, mimicking a natural noisy environment. The task also included an audio-only (no video) condition. After each condition, participants subjectively rated listening demand and the degree of words and conversations they felt they understood. Fifteen CI users reported progressively higher degrees of listening demand and less words and conversation with increasing background noise. Listening demand and conversation understanding in the audio-only condition was comparable to that of the highest noise condition (+5 dB). Increasing background noise affected speech neural tracking at a group level, in addition to eliciting strong individual differences. Mixed effect modeling showed that listening demand and conversation understanding were correlated to early cortical speech tracking, such that high demand and low conversation understanding occurred with lower amplitude TRFs. In the high noise condition, greater listening demand was negatively correlated to parietal alpha power, where higher demand was related to lower alpha power. No significant correlations were observed between TRF/alpha and clinical speech perception scores. These results are similar to previous findings showing little relationship between clinical speech perception and quality-of-life in CI users. However, physiological responses to complex natural speech may provide an objective measure of aspects of quality-of-life measures like self-perceived listening demand.
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Carolan PJ, Heinrich A, Munro KJ, Millman RE. Quantifying the Effects of Motivation on Listening Effort: A Systematic Review and Meta-Analysis. Trends Hear 2022; 26:23312165211059982. [PMID: 35077257 PMCID: PMC8793127 DOI: 10.1177/23312165211059982] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Motivation influences the amount of listening effort (LE) exerted or experienced under challenging conditions, such as in high-noise environments. This systematic review and meta-analysis is the first to quantify the effects of motivation on LE. The review was pre-registered in PROSPERO, and performed in accordance with PRISMA guidelines. Eligible studies examined the influence of motivation or individual traits (related to motivation) on LE in adults. Motivational factors, coded as independent variables, included financial reward, evaluative threat, perceived competence, feedback, and individual traits. LE outcomes were categorized as subjective, behavioral, or physiological. The quality of evidence was assessed using an adaptation of the Cochrane Collaboration Risk of Bias Tool. Nested random-effects meta-analyses were performed to quantify and compare the influence of motivational factors across LE outcomes. After assessing 3,532 records, 48 studies met the inclusion criteria and 43 were included in the meta-analyses. Risk of bias was high, for example, many studies lacked sample size justification. Motivational factors had a small-to-medium effect (mean Cohen's d = 0.34, range: 0.11-0.72) on LE. When LE outcomes were considered collectively, an external manipulation of motivation (perceived competence) produced a larger mean effect size compared with individual traits. Some combinations of motivational factors and LE outcomes produced more robust effects than others, for example, evaluative threat and subjective LE outcomes. Although wide prediction intervals and high risk of bias mean that significant positive effects cannot be guaranteed, these findings provide useful guidance on the selection of motivational factors and LE outcomes for future research.
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Affiliation(s)
- Peter J Carolan
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Antje Heinrich
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rebecca E Millman
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Abstract
OBJECTIVES Listening effort may be defined as the attentional and cognitive resources needed to understand an auditory message, modulated by motivation. Despite the use of hearing devices such as hearing aids or cochlear implants (CIs), the requirement for high listening effort remains a challenge for individuals with hearing loss. The Listening Effort Questionnaire-Cochlear Implant (LEQ-CI) is a hearing-specific patient-reported outcome measure (PROM), which has been designed for use in the CI candidacy and rehabilitation process to assess perceived listening effort in everyday life in adults with severe-profound hearing loss. The LEQ-CI has been developed in line with international consensus-based standards for best practice in PROM construction. The aim of this study was to improve the measurement precision of the LEQ-CI and to assess its psychometric measurement properties. DESIGN A field test was undertaken with 330 CI patients from five National Health Service auditory implant centers in the United Kingdom. Participants were adults (≥18 years of age), had a severe-profound hearing loss, and met the UK candidacy criteria for cochlear implantation specified by the National Institute for Health and Care Excellence (NICE). Participants completed and returned an anonymized 29-item (each with a 5- or 7-point response option), draft version of the LEQ-CI (LEQ-CI29) and a demographic questionnaire. Rasch analysis was undertaken using Winsteps software and the partial credit model to assess rating scale function and item fit. Results informed refinements to produce a 21-item version (LEQ-CI21), which underwent a further Rasch analysis. RESULTS The sample was predominantly female: 60.3% (n = 191). Median age of participants was 66 (range 21 to 89) years, with 7.3% (n = 24) of respondents being CI candidates and 92.7% (n = 306) being CI recipients. Mean duration of implantation was 3.8 (SD = 4.8) years. Initial Rasch analysis of the LEQ-CI29 revealed poor rating scale functioning. Collapsing the 5- and 7-point rating scales to 3- and 4-point scales and removing eight items produced a 21-item PROM (LEQ-CI21). Rasch analysis of the LEQ-CI21 showed good fit to the Rasch measurement model. No items showed misfit and dimensionality analysis supported the existence of a single Rasch dimension, defined as perceived listening effort in daily life. Person reliability was 0.91 and the person separation index was 3.28, establishing four levels of person ability. The item separation index was 9.69, confirming the item hierarchy. No items showed differential item functioning for gender or age. The item difficulty range was -0.81 to 1.05, the person ability range for nonextreme persons was -3.54 to 2.49, and the mean person ability was -0.31. CONCLUSIONS Overall, the LEQ-CI21 was found to meet the Rasch model criteria for interval-level measurement. The LEQ-CI21 is the first PROM to be developed specifically for the measurement of perceived listening effort and one of the first patient-reported outcome measures for use with CI patients to be developed using Rasch analysis. The LEQ-CI21 has the potential to be used as a research tool and in clinical practice to evaluate perceived listening effort in daily life. Further psychometric evaluation of the LEQ-CI21 is planned.
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Carolan PJ, Heinrich A, Munro KJ, Millman RE. Financial reward has differential effects on behavioural and self-report measures of listening effort. Int J Audiol 2021; 60:900-910. [PMID: 33630718 DOI: 10.1080/14992027.2021.1884907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the effects of listening demands and motivation on listening effort (LE) in a novel speech recognition task. DESIGN We manipulated listening demands and motivation using vocoded speech and financial reward, respectively, and measured task performance (correct response rate) and indices of LE (response times (RTs), subjective ratings of LE and likelihood of giving up). Effects of inter-individual differences in cognitive skills and personality on task performance and LE were also assessed within the context of the Cognitive Energetics Theory (CET). STUDY SAMPLE Twenty-four participants with normal-hearing (age range: 19 - 33 years, 6 male). RESULTS High listening demands decreased the correct response rate and increased RTs, self-rated LE and self-rated likelihood of giving up. High financial reward increased subjective LE ratings only. Mixed-effects modelling showed small fixed effects for competitiveness on LE measured using RTs. Small fixed effects were found for cognitive skills (lexical decision RTs and backwards digit span) on LE measured using RTs and correct response rate, respectively. CONCLUSIONS The effects of listening demands on LE in the speech recognition task aligned with CET, whereas predictions regarding the influence of motivation, cognitive skills and personality were only partially supported.
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Affiliation(s)
- Peter J Carolan
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Antje Heinrich
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca E Millman
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Herrmann B, Johnsrude IS. A model of listening engagement (MoLE). Hear Res 2020; 397:108016. [DOI: 10.1016/j.heares.2020.108016] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022]
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14
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Zhang M, Siegle GJ, McNeil MR, Pratt SR, Palmer C. The role of reward and task demand in value-based strategic allocation of auditory comprehension effort. Hear Res 2019; 381:107775. [DOI: 10.1016/j.heares.2019.107775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
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Francis AL, Love J. Listening effort: Are we measuring cognition or affect, or both? WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2019; 11:e1514. [PMID: 31381275 DOI: 10.1002/wcs.1514] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Listening effort is increasingly recognized as a factor in communication, particularly for and with nonnative speakers, for the elderly, for individuals with hearing impairment and/or for those working in noise. However, as highlighted by McGarrigle et al., International Journal of Audiology, 2014, 53, 433-445, the term "listening effort" encompasses a wide variety of concepts, including the engagement and control of multiple possibly distinct neural systems for information processing, and the affective response to the expenditure of those resources in a given context. Thus, experimental or clinical methods intended to objectively quantify listening effort may ultimately reflect a complex interaction between the operations of one or more of those information processing systems, and/or the affective and motivational response to the demand on those systems. Here we examine theoretical, behavioral, and psychophysiological factors related to resolving the question of what we are measuring, and why, when we measure "listening effort." This article is categorized under: Linguistics > Language in Mind and Brain Psychology > Theory and Methods Psychology > Attention Psychology > Emotion and Motivation.
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Affiliation(s)
- Alexander L Francis
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Jordan Love
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, Indiana
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Müller JA, Wendt D, Kollmeier B, Debener S, Brand T. Effect of Speech Rate on Neural Tracking of Speech. Front Psychol 2019; 10:449. [PMID: 30906273 PMCID: PMC6418035 DOI: 10.3389/fpsyg.2019.00449] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/14/2019] [Indexed: 12/03/2022] Open
Abstract
Speech comprehension requires effort in demanding listening situations. Selective attention may be required for focusing on a specific talker in a multi-talker environment, may enhance effort by requiring additional cognitive resources, and is known to enhance the neural representation of the attended talker in the listener's neural response. The aim of the study was to investigate the relation of listening effort, as quantified by subjective effort ratings and pupil dilation, and neural speech tracking during sentence recognition. Task demands were varied using sentences with varying levels of linguistic complexity and using two different speech rates in a picture-matching paradigm with 20 normal-hearing listeners. The participants' task was to match the acoustically presented sentence with a picture presented before the acoustic stimulus. Afterwards they rated their perceived effort on a categorical effort scale. During each trial, pupil dilation (as an indicator of listening effort) and electroencephalogram (as an indicator of neural speech tracking) were recorded. Neither measure was significantly affected by linguistic complexity. However, speech rate showed a strong influence on subjectively rated effort, pupil dilation, and neural tracking. The neural tracking analysis revealed a shorter latency for faster sentences, which may reflect a neural adaptation to the rate of the input. No relation was found between neural tracking and listening effort, even though both measures were clearly influenced by speech rate. This is probably due to factors that influence both measures differently. Consequently, the amount of listening effort is not clearly represented in the neural tracking.
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Affiliation(s)
- Jana Annina Müller
- Cluster of Excellence ‘Hearing4all’, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Medizinische Physik, Department of Medical Physics and Acoustics, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Dorothea Wendt
- Hearing Systems, Hearing Systems Group, Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
- Eriksholm Research Centre, Snekkersten, Denmark
| | - Birger Kollmeier
- Cluster of Excellence ‘Hearing4all’, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Medizinische Physik, Department of Medical Physics and Acoustics, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Stefan Debener
- Cluster of Excellence ‘Hearing4all’, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Neuropsychology Lab, Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Thomas Brand
- Cluster of Excellence ‘Hearing4all’, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Medizinische Physik, Department of Medical Physics and Acoustics, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Moore TM, Picou EM. A Potential Bias in Subjective Ratings of Mental Effort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2405-2421. [PMID: 30208416 PMCID: PMC6195049 DOI: 10.1044/2018_jslhr-h-17-0451] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/28/2018] [Accepted: 05/21/2018] [Indexed: 05/19/2023]
Abstract
PURPOSE Subjective reports of listening effort are frequently inconsistent with behavioral and physiological findings. A potential explanation is that participants unwittingly substitute an easier question when faced with a judgment that requires computationally expensive analysis (i.e., heuristic response strategies). The purpose of this study was to investigate whether participants substitute the question "How did I perform?" when asked "How much effort did that take?". METHOD Participants completed 2 sets of online surveys containing a text-based, multiple-choice synonym task. Expected performance and mental effort were manipulated across sets in 4 experiments, using a visual masking technique shown to correlate with speech-reception-testing in noise. Experiment 1 was designed to yield stable accuracy and differing effort across sets. Experiment 2 elicited differing accuracy and stable effort. Experiments 3 and 4 manipulated accuracy and performance in opposite directions. Participants included 273 adults (aged 19-68 years, M = 38.4 years). RESULTS Experiment 1 revealed no influence of perceived performance on ratings of effort when accuracy was stable. Experiment 2 showed that ratings of effort differed inversely with ratings of performance (lower performance and increased effort). Experiments 3 and 4 also demonstrated that participants rated effort in a manner inversely related to performance, regardless of the effort inherent in the condition. CONCLUSIONS Participants likely substitute an easier question when asked to rate the multidimensional construct of mental effort. The results presented here suggest that perceived performance can serve as a ready heuristic and may explain the dissociation between subjective measures of listening effort and behavioral and physiological measures.
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Affiliation(s)
- Travis M. Moore
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Erin M. Picou
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Psychophysiological measurement of affective responses during speech perception. Hear Res 2018; 369:103-119. [PMID: 30135023 DOI: 10.1016/j.heares.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
When people make decisions about listening, such as whether to continue attending to a particular conversation or whether to wear their hearing aids to a particular restaurant, they do so on the basis of more than just their estimated performance. Recent research has highlighted the vital role of more subjective qualities such as effort, motivation, and fatigue. Here, we argue that the importance of these factors is largely mediated by a listener's emotional response to the listening challenge, and suggest that emotional responses to communication challenges may provide a crucial link between day-to-day communication stress and long-term health. We start by introducing some basic concepts from the study of emotion and affect. We then develop a conceptual framework to guide future research on this topic through examination of a variety of autonomic and peripheral physiological responses that have been employed to investigate both cognitive and affective phenomena related to challenging communication. We conclude by suggesting the need for further investigation of the links between communication difficulties, emotional response, and long-term health, and make some recommendations intended to guide future research on affective psychophysiology in speech communication.
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Abstract
OBJECTIVES A reliable and practical measure of listening effort is crucial in the aural rehabilitation of children with communication disorders. In this article, we propose a novel behavioral paradigm designed to measure listening effort in school-age children based on different depths and levels of verbal processing. The paradigm consists of a classic word recognition task performed in quiet and in noise coupled to one of three additional tasks asking the children to judge the color of simple pictures or a certain semantic category of the presented words. The response time (RT) from the categorization tasks is considered the primary indicator of listening effort. DESIGN The listening effort paradigm was evaluated in a group of 31 normal-hearing, normal-developing children 7 to 12 years of age. A total of 146 Dutch nouns were selected for the experiment after surveying 14 local Dutch-speaking children. Windows-based custom software was developed to administer the behavioral paradigm from a conventional laptop computer. A separate touch screen was used as a response interface to gather the RT data from the participants. Verbal repetition of each presented word was scored by the tester and a percentage-correct word recognition score (WRS) was calculated for each condition. Randomized lists of target words were presented in one of three signal to noise ratios (SNR) to examine the effect of background noise on the two outcome measures of WRS and RT. Three novel categorization tasks, each corresponding to a different depth or elaboration level of semantic processing, were developed to examine the effect of processing level on either WRS or RT. It was hypothesized that, while listening effort as measured by RT would be affected by both noise and processing level, WRS performance would be affected by changes in noise level only. The RT measure was also hypothesized to increase more from an increase in noise level in categorization conditions demanding a deeper or more elaborate form of semantic processing. RESULTS There was a significant effect of SNR level on school-age children's WRS: their word recognition performance tended to decrease with increasing background noise level. However, depth of processing did not seem to affect WRS. Moreover, a repeated-measure analysis of variance fitted to transformed RT data revealed that this measure of listening effort in normal-hearing school-age children was significantly affected by both SNR level and the depth of semantic processing. There was no significant interaction between noise level and the type of categorization task with regard to RT. CONCLUSIONS The observed patterns of WRS and RT supported the hypotheses regarding the effects of background noise and depth of processing on word recognition performance and a behavioral measure of listening effort. The magnitude of noise-induced change in RT did not differ between categorization tasks, however. Our findings point to future research directions regarding the potential effects of age, working memory capacity, and cross-modality interaction when measuring listening effort in different levels of semantic processing.
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Picou EM, Ricketts TA. The relationship between speech recognition, behavioural listening effort, and subjective ratings. Int J Audiol 2018; 57:457-467. [DOI: 10.1080/14992027.2018.1431696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Erin M. Picou
- Vanderbilt University Medical Center, Nashville, TN, USA
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Sahlén B, Haake M, von Lochow H, Holm L, Kastberg T, Brännström KJ, Lyberg-Åhlander V. Is children’s listening effort in background noise influenced by the speaker’s voice quality? LOGOP PHONIATR VOCO 2017; 43:47-55. [DOI: 10.1080/14015439.2017.1324914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Birgitta Sahlén
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
| | - Magnus Haake
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
- Division of Cognitive Science, Lund University, Lund, Sweden
| | - Heike von Lochow
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
| | - Lucas Holm
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
| | - Tobias Kastberg
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
| | - K. Jonas Brännström
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
| | - Viveka Lyberg-Åhlander
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
- Linneaus’ Environment Cognition, Communication and Learning, Lund University, Lund, Sweden
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Picou EM, Moore TM, Ricketts TA. The Effects of Directional Processing on Objective and Subjective Listening Effort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:199-211. [PMID: 28114609 DOI: 10.1044/2016_jslhr-h-15-0416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purposes of this investigation were (a) to evaluate the effects of hearing aid directional processing on subjective and objective listening effort and (b) to investigate the potential relationships between subjective and objective measures of effort. METHOD Sixteen adults with mild to severe hearing loss were tested with study hearing aids programmed with 3 settings: omnidirectional, fixed directional, and bilateral beamformer. A dual-task paradigm and subjective ratings were used to assess objective and subjective listening effort, respectively, in 2 signal-to-noise ratios. Testing occurred in rooms with either low or moderate reverberation. RESULTS Directional processing improved subjective and objective listening effort, although benefit for objective effort was found only in moderate reverberation. Subjective reports of work and tiredness were more highly correlated with word recognition performance than objective listening effort. However, subjective ratings about control were significantly correlated with objective listening effort. CONCLUSIONS Directional microphone technology in hearing aids has the potential to improve listening effort in moderately reverberant environments. In addition, subjective questions that probe a listener's desire to exercise control may be a viable method for eliciting ratings that are significantly related to objective listening effort.
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Affiliation(s)
- Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Travis M Moore
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Todd A Ricketts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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