Gallaudet University
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Abstracts Harvey
Abrams, PhD Scott Bally,
PhD
Dragana Barac-Cikoja, PhD Ruth Bentler,
PhD
Arthur Boothroyd, PhD
Mark Brennan, PhD and Scott
Bally, PhD
Theresa
Chisolm, PhD
Cynthia Compton-Conley, PhD and Claire Marcus Bernstein, PhD
Qian-Jie Fu,
PhD
Qian-Jie
Fu, PhD
Ken Grant, PhD
Judy Harkins,
PhD
Harry Levitt,
PhD
Arlene Neuman,
PhD
Andrew Oxenham, PhD Jill
Preminger, PhD
Gabrielle Saunders, PhD and Patricia
Kricos, PhD Carren Stika,
PhD and B.J. LeJeune, MEd
Mario Svirsky,
PhD
Robert Sweetow, PhD
Emily Toby,
PhD
Nancy Tye-Murray, PhD and Lea Hyvärinen,
MD
Harvey Abrams, PhD Administrators, third party payers, and patients seek evidence that our treatments make meaningful differences. An impressive array of outcome measures is available for documenting the efficacy of aural rehabilitation, particularly as they apply to the selection and fitting of hearing instruments including hearing aids, cochlear implants and hearing assistive technology. This presentation will provide an overview of those measures using the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) as a foundation for the discussion. The appropriate use of objective and subjective measures of outcome will be highlighted within the context of the hearing loss management process. Participants will be introduced to less common outcome measures such as utility scales, health economic analyses, and health-related quality of life assessments as emerging methods for determining the success of aural rehabilitation. The presentation will be followed with a brief forum focusing on relevant research findings, recent systematic reviews, and critical research needs.
Scott Bally, PhD This presentation examines the history, use and efficacy of peer mentoring in the allied health professions and explores its applicability and viability as a means of meeting the biopsychosocial needs of the 28 million individuals who are coping with the challenges of hearing loss in the United States. Presenters will describe the design and development of a 2-year online peer mentoring training program at Gallaudet University, now in its second year, and how it will interface with certified hearing professionals.
Dragana Barac-Cikoja, PhD Users of hearing assistive technology (HAT) often complain that their voice sounds hollow, delayed, or not clear. User's satisfaction with the quality of one's own speech feedback, as surveys have shown, affects HAT acceptance. In order to systematically assess the effects of advanced signal processing on self-hearing, this research investigates both the limits on the speakers' ability to detect various alterations to their speech feedback, and the effects of those alterations on their speech production. In a series of studies we assessed the minimal detectable speech feedback delays for hard of hearing (HOH) individuals (both hearing aid [HA] and cochlear implant [CI] users) as well as individuals with normal hearing. The results showed that delays smaller than 10 ms were noticeable to some HA and CI users. Acoustic analyses of speech indicated that for some HOH individuals, feedback delays in excess of 25 ms might significantly reduce the speaking rate and affect voice pitch. In another study, speech of HA and CI users' was investigated as a function of the degree of spectral smearing of the feedback signal. We found that reduced feedback intelligibility (caused by spectral smearing) lead to a noticeable decline in speech quality. Our findings suggest that tolerance to various alterations in speech feedback requires greater consideration when fitting the individual with HAT. Ruth
Bentler, PhD There has been recent focus on clarifying the relationship between AR and positive outcomes from hearing aid use. The issues surrounding this focus are complex. Outcome measures are used to quantify “success” in many domains, including handicap (activity limitation), disability (participation restriction), device use, satisfaction, and quality of life, along with economic considerations such as cost-benefit and cost-utility. Equally complex is defining the term “aural rehabilitation.” To many, the entire process of diagnosis, counseling, hearing aid provision, communication strategy training, and assistive listening device provision -- in summary -- constitutes AR. For others, either group or individual information-based counseling in conjunction with the provision of amplification define AR. For others still, AR (auditory rehabilitation) is used in reference to individual auditory training, accomplished often at-home using interactive software. The purpose of this session review current evidence that any of these approaches are effective in increasing the measured success of hearing aid users in any domain. What we will discover is that the evidence is sparse, due in part, to study quality issues, the cost of carrying out such research, and the ethical considerations that must be weighed. Several current and ongoing studies will be presented and the need for additional research proposed.
Arthur Boothroyd, PhD CasperSent is a multi-media program whose main purpose is sentence-level speech-perception training and testing for persons with hearing loss. Design is informed by a model of speech perception with four key components: i) sensory evidence, ii) contextual evidence, iii) knowledge, and iv) skill. The principal target is perceptual skill, which is assumed to include such things as attention, use and balance of sensory and contextual evidence, balance of speed and accuracy, confidence, risk-tolerance, and error-handling. The principal target of testing is performance in a conversational context. Secondary targets are the effects of talker, perceptual modality, topic-knowledge, sentence length, and sentence type. The software is designed to operate on a standard Personal Computer with a minimum of peripheral equipment. Testing and training can be self-administered, helper-administered, or clinician-controlled. Stimuli consist of 60 sets of CUNY topic-related sentences, presented by lipreading, hearing, or the two in combination. Scores are based on sets of 12 sentences, and are automatically logged for later recall and analysis. Presentation modality, talker, viewing angle, feedback, and topic-knowledge are under software control. Learning effects have been demonstrated in subjects with hearing loss, and the effects of feedback type on learning rate, and of topic-knowledge on performance, have been demonstrated in subjects with normal hearing. CasperSent can be used clinically, and it can contribute to research into the nature, efficacy and cost-effectiveness of computer-assisted speech perception training. The program can also be used for teaching and demonstration. An example is demonstration of the synergy between lipreading and rudimentary hearing, which is made possible by having fundamental frequency as an audio choice for one of the talkers.
Mark Brennan, PhD and Scott
Bally, PhD Dual sensory loss, or concurrent impairments of hearing and vision, is an emerging area for practitioners, providers and researchers. The majority of individuals affected by this condition are older adults with age-related visual and hearing impairment; estimated prevalence of dual impairment in this group ranges from 5% to 21%. With the aging of the population, the incidence and prevalence of dual impairment is likely to increase substantially in the coming years. Clinicians have only addressed this topic relatively recently, and most research on dual sensory loss has been descriptive and not addressed the particular adaptations required by this condition. However, much can be extrapolated from the body of work that has focused on single impairments of hearing or vision. Examining this condition from a bio-psycho-social-spiritual perspective, the onset of dual sensory impairment requires significant adaptations in physical functioning, cognitive and emotional processing, behavioral adaptation, social relations, and spirituality. Adaptation to dual sensory loss is further complicated through the loss of the compensatory sensory pathway typically involved in hearing loss (i.e., vision) and visual impairment (i.e., hearing). Maladaptive forms of coping, such as emotion-focused strategies, likely lead to negative psychosocial outcomes from this condition, while adaptation may be fostered through the activation of personal, social and spiritual resources. Given the impact of dual sensory loss and its growing prevalence, it is imperative that more professionals and counselors receive training on this condition.
Theresa Chisolm, PhD Recently, the American Academy of Audiology (AAA) developed an evidence-based practice guideline “Guidelines for the Audiological Management of Adult Hearing Impairment”. In the development of the guideline, it was recognized that a comprehensive treatment approach was needed for achieving the best outcomes for adults with hearing loss. The guideline notes that a key component to a comprehensive treatment is the use of technology other than hearing aids, referred to as “hearing assistive technology” (HAT). This session will review the guideline’s Summary of Evidence for HAT and the resultant recommendations for clinical practice. In addition recent evidence from a clinical trial of the use of FM devices by older adults will be presented. The trial was designed to assess the role of counseling, coaching and instruction on the outcomes of FM use. A total of 36 veterans participated. Comparison of outcomes obtained with hearing aids alone to hearing aids + FM after a 6-week trial period and after 1-year of FM use provides further evidence supporting HAT as key component in the comprehensive audiological management of the adult patient.
Cynthia Compton-Conley, PhD and
Claire Marcus Bernstein, PhD This presentation will report on the initial developmental work being completed on a project at Gallaudet University’s Rehabilitation Engineering Research Center (RERC) on Hearing Enhancement and funded by the United States Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) in the Office of Special Education and Rehabilitation Services (OSERS). We are in the processing of developing an on-line needs assessment tool, the Hearing Assistance Technology Needs Assessment Profile (HATNAP), that will comprehensively analyze an individual’s receptive communication needs and will generate a receptive communication “profile” for that individual. The profile will serve as a guide to help identify and select the most appropriate combination of technology and training to provide a wider range of communication access and specifically match that individual’s needs and lifestyle. The needs assessment profile and recommendation process will be supported by an on-line tutorial, designed to educate both consumers and audiologists regarding the various assistive technologies and communication strategies available.
Qian-Jie Fu, PhD With the most advanced implant and speech processor technology, many cochlear implant (CI) patients receive great benefit, and are even capable of conversing with friends and family over the telephone. However, considerable variability remains in individual patient outcomes. Some patients receive little benefit from their implant device, even after many years of daily use. This variability in patient outcomes is reflected not only in differences in speech recognition performance, but also in the time course of adaptation to speech via electric hearing. Our recent research has shown that targeted auditory training may significantly enhance the benefits of the implant device. Given the limited number of speech pathologists working with CI patients and the high costs associated with auditory rehabilitation, it has long been urgent to develop an inexpensive and effective auditory training system for CI patients, especially for those patients who have the greatest difficulty with speech understanding. One such tool is the CAST software developed at House Ear Institute. CAST is a computer-assisted speech training software program that allows CI patients to conduct auditory rehabilitation using their home computer. CAST allows CI patients to practice at home, monitor their progress, and share results with their audiologists or speech pathologists. More importantly, CAST provides comprehensive training tasks, individualized training protocols, and convenient review of test/training results and progress tracking. By providing the tools and resources for auditory rehabilitation, CI patients may find the necessary motivation and momentum to get the most from their implant.
Qian-Jie Fu, PhD A large spectral shift may produce a significant deficit in the speech performance of cochlear implant (CI) users. To see whether CI patients can adapt to a spectral shift through daily listening, speech performance for three CI patients was measured over a three-month period, during which subjects continuously wore “experimental” speech processors with a shifted frequency-to-electrode assignment. Results showed that the experimental processors produced significantly lower performance for all speech recognition measures immediately following implementation. Over the three-month test period, significant improvements were observed in all speech recognition measures. However, performance remained significantly worse than with subjects’ clinically-assigned processors at the end of the three-month period. Daily “passive” exposure may not be sufficient to fully adapt to severely-shifted speech. To see whether moderate speech training can accelerate adaptation, sixteen normal-hearing listeners were trained with spectrally-shifted speech using an 8-channel acoustic CI simulation. Short daily training sessions were conducted over five consecutive days. Sentence training provided little improvement in recognition of shifted vowels. However, targeted phoneme training significantly improved the recognition of shifted vowels, as well as consonants and sentences. Targeted phoneme training was further evaluated in ten CI patients. Using a personal computer, auditory training was conducted at home for one hour per day, five days per week, for a period of 1 month or longer. Results showed a significant improvement in all patients' phoneme recognition performance. These results demonstrate that targeted auditory training may significantly accelerate the adaptation process in CI patients.
Ken Grant, PhD Hearing aids generally do an excellent job of compensating for the loss of sensitivity resulting from hearing impairment. However, when used in noisy environments, hearing aids do little to compensate for suprathreshold distortion experienced by persons with sensorineural hearing loss. Consequently, hearing-impaired individuals often complain that understanding speech in noise is difficult, and that their hearing aids do little to help remedy the situation. One strategy to improve speech communication in noise is to improve the speech-to-noise ratio (SNR). Hearing aids with directional microphones have the ability to reduce noise behind and to the side of the listener thus improving the SNR for signals originating from the front. Laboratory measures of benefit from directional processing can be substantial. However, in real-world environments with multiple noise sources and reverberation, directional benefits are significantly smaller than in the laboratory. Because of this, many patients fail to realize the potential benefits of directional processing because 1) they don’t always know which listening situations would benefit from directional processing, and 2) because the differences between directional (DIR) and omnidirectional (OMNI) processing are sometimes too small for the amount of effort involved in manually switching between microphone modes. Automatic directionality has been recently offered in some hearing aid models to address this problem. These devices operate by sensing various aspects of the acoustic environment, and automatically place the hearing aid in either OMNI or DIR mode based on these analyses. Unfortunately, many of the algorithms that automatically switch between microphone modes have not met with much success. Recent work at Walter Reed Army Medical Center has made use of computer-based auditory processing models that provide detailed representations of auditory input at various stages of neural processing. These representations can be used to provide estimates of the total distortion of an input speech signal due to influences from environmental factors and hearing-aid processing. These estimates can be used to identify the best processing mode for a given listening environment. This talk will focus on our recent efforts to apply this technology to the problem of automatic switching between DIR and OMNI microphone modes.
Judy Harkins, PhD The RERC on Hearing Enhancement, in cooperation with the Gallaudet Research Institute, conducted a web survey of consumers in the summer of 2005. The topic was assistive listening devices and systems, with an emphasis on face-to-face communication and ALDs in public places. This presentation will cover the responses of the 424 respondents to the survey. Respondents were primarily people with severe to profound hearing loss, using BTEs with telecoils. Results indicated that people benefit from using ALDs, but are much more inclined to use them in public venues where the speaker is more than ten feet away, than in personal listening situations. Respondents indicated that they had experienced an array of problems with ALDs in public places, and most were receptive to the idea of a universal receiver that would be usable in a variety of venues. Most respondents also indicated interest in obtaining individual help with using ALDs and other hearing technology through an Internet-based service. They offered a variety of suggestions for improving ALDs.
Harry Levitt, PhD The method of speech tracking is widely used for both training and evaluation of communication skills of people with hearing loss. The training involves interactive communication between the participant and the tester/trainer, a key characteristic of real-life communication. A major problem with the tracking technique, however, is its high variability due, in large measure, to inter-speaker differences and how the participant responds to this source of variability. Methods for reducing the variability of the technique are being devised. A new software platform has been developed for face-to-face speech tracking using a procedure developed in Sweden by Gnosspelius and Spens. Computer-based methods of tracking maintain the inherent interactive nature of the communication process while, at the same time, bring the major sources of variability under control. The system is being evaluated experimentally as a training technique to improve communication skills for adult cochlear implant users. It is also being adapted for self-training applications using recorded materials.
Arlene Neuman, PhD Recent advances in hearing aid technology make it possible to provide signal processing that is sensitive to the characteristics of the environment in which the hearing aid is used. But to have signal processing hearing aids work optimally for the individual hearing aid user, what do we need to know about that hearing aid user, his/her listening environment, and his/her listening preferences? Research focused on studying the interaction between the hearing aid, the sound environment, and the individual user will be reviewed. New techniques for fitting and assessing “real world” outcomes will be described.
Andrew Oxenham, PhD The outer, middle and inner ear perform an amazing feat in preprocessing sound for transmission along the auditory nerve to the brain. The task of the cochlear implant is to mimic that preprocessing as closely as possible. Because it is not currently possible to recreate the action of the thousands of inner hair cells that populate the cochlea, some engineering compromises must be made. To make informed decisions about these compromises, we need to understand how the information from cochlea and auditory nerve is extracted by the brain. This talk will give a brief overview of some perceptual studies designed to tell us more about spectral and temporal processing in the normal ear, and their implications for cochlear-implant design.
Jill Preminger, PhD Research on the psychosocial benefits of audiologic rehabilitation has typically shown significant reductions in hearing handicap as a result of participation in group classes. Reduction in hearing handicap has not been measured, however, in all class participants. The purpose of this research was to determine whether benefit from audiologic rehabilitation class participation was related to class content and to individual subject characteristics. Ninety one adult hearing aid users between the ages of 55 and 75 participated in 5 types of classes: 1) informational lectures plus psychosocial exercises, 2) lipreading and auditory training plus psychosocial exercises, 3) communication strategies training plus psychosocial exercises, 4) lipreading and auditory training alone, and 5) communication strategies training alone. An additional 16 subjects served as controls. Subjects were evaluated with the Hearing Handicap Scale for the Elderly/Adults and the World Health Organization Disability Assessment Scale at three time points: prior to class participation, immediately after participation in a 6-week class, and 6 months after class participation. The results revealed that all subjects (including the controls) demonstrated a significant reduction in hearing handicap as measured by the HHIE/A at the second visit, and this reduction was maintained at the third visit. Individual subject demographic characteristics were evaluated to determine whether they could separate out those subjects who demonstrated a significant change in HHIE/A scores from the pre-class to the post-class test points. Pre-class HHIE/A scores were significantly related to pre-class HHIE/A scores. No other demographic characteristics (age, income, education, gender, class type) were significantly related to change in HHIE/A score.
Gabrielle Saunders, PhD and Patricia Kricos, PhD This presentation will focus on the current state of the science related to audiologic rehabilitation of individuals with dual sensory impairment, with an emphasis on considerations for provision of appropriate hearing assistive technology for this population. A substantial increase in the number of older adults is predicted in the coming years, many of whom will have significant age-related impairments in hearing and vision. Thus, hearing care professionals will increasingly be called upon to attend to the special needs of individuals with dual sensory impairment to ensure their maximal quality of life and independence. Access to sound is a critical issue for individuals who live with compromises in both vision and hearing. The auditory sense, when enhanced by hearing assistive technology, may improve speech perception and aid the person’s connection and orientation to the environment, as well as mobility. Thus, the audiologist’s provision of appropriate and carefully selected hearing assistive technology may contribute dramatically to the quality of life of the individual with dual sensory loss. This presentation will describe pre-fitting, fitting, and post-fitting considerations in providing hearing aids and other assistive technology to individuals with dual sensory impairment. Candidacy issues, hearing aid features, assistive technology options beyond hearing aids, and post-fitting considerations will be discussed.
Carren Stika, PhD and
B.J. LeJeune, MEd It is well documented that age-related vision and hearing loss are common in older adults. As the population of older individuals increases, so too does the prevalence of individuals with combined vision and hearing loss. Research suggests that those faced with dual sensory impairment experience different challenges in communication, employment, and daily living skills than those with a hearing loss or a vision loss alone. With the increasing prevalence of dual sensory impairment in older adults, there has been a growing interest in the assessment and rehabilitation treatment of this population. In November 2002, the Rehabilitation Research and Training Center on Blindness and Low Vision at Mississippi State University, the Rehabilitation Research and Training Center on Persons who are Hard of Hearing or Late Deafened in San Diego, and the Helen Keller National Center for Deaf-Blind Youths and Adults were awarded a grant from the National Institute on Disabilities and Rehabilitative Research to study the impact of vision loss combined with hearing loss on older individuals, and to investigate assistive technologies, accommodations, and coping strategies that can be used to ameliorate the disabling effects of dual sensory impairment. This presentation will discuss preliminary findings from this project, which include identification of the unique effects of combined vision loss and hearing loss on daily functioning and personal adjustment of older individuals, recommendations for promising practices, barriers to accessing rehabilitative services, and critical components for inclusion in rehabilitative intervention programs designed especially for the needs of older individuals with dual sensory loss.
Mario Svirsky, PhD The human brain is a remarkable speech recognizer, even in the face of extreme input distortions. However, the simultaneous application of two types of distortion, such as a 1 or 2 octave frequency shift combined with the spectral degradation inherent in an 8-channel noise vocoder, renders the input speech signal unintelligible. This has important clinical implications because this type of combined distortion is a reasonable model of the speech input received by cochlear implant (CI) users. Fortunately, it is possible to learn how to interpret such a signal so that it becomes more intelligible over time. We hypothesize that this perceptual learning may be facilitated by a gradual approach: start with correct frequency-place alignment to allow listeners to adapt to the spectrally degraded signal first, and then gradually increase the basalward shift to allow them to adapt to it over time. A first study compared the gradual approach described above to the approach normally used with CI users: immediate exposure to a constant frequency shift that does not change over time. Speech perception scores were initially much higher with the gradual approach than with the sudden approach, but differences decreased over time. A second study also employed spectrally degraded, frequency shifted speech, but listeners were allowed to adjust the input filter bank in real time to a preferred setting. Untrained performance with this listener-selected map was better than that with a map that distorts the signal to provide low-frequency information. Taken together, these results may have significant implications for the optimal fitting of sensory aids such as cochlear implants and frequency transposition hearing aids.
Robert Sweetow, PhD Hearing-impaired individuals have neural plastic changes along with relearning of sound patterns. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. Modern hearing aids can provide audibility, but may not rectify spectral and temporal resolution, susceptibility to noise, or degradation of cognitive skills associated with aging. Auditory training has long been advocated to enhance communication but has never been time or cost-effective. LACE (Listening and Auditory Communication Enhancement), is a cost effective, home-based, interactive adaptive computer program designed to engage the adult hearing impaired listener in the hearing aid fitting process, provide listening strategies, build confidence, and address cognitive changes characteristic of the aging process. In addition, it provides the audiologist or speech-language pathologist with a means of performing remote monitoring of patient progress. Concepts underlying the development of this therapy will be described. The software will be demonstrated and multi-site validation data will be presented.
Emily Toby, PhD The purpose of this work was to: 1) explore regional cerebral blood flow (rCBF) responses to auditory stimulation that may be associated with the perceptual performance variation in cochlear implant recipients; and 2) investigate the potential benefit of pharmacologically-enhanced aural rehabilitation therapy as a means of increasing speech tracking skills in adult cochlear implant users. 26 normal hearing subjects and 18 cochlear implant subjects underwent rCBF imaging during various conditions using Single Photon Emission Computed Tomography (SPECT). Adult cochlear implant participants received either 10 mg d-amphetamine or a placebo 60 minutes prior to a 1.5 hour intensive aural rehabilitation session occurring twice a week for two months. Treatment consisted of a multi-step rehabilitation program individualized for each participant to develop auditory-only speech tracking skills. Individuals with minimal open set speech perception scores demonstrated unilateral activation of the cortex on the hemisphere contralateral to the ear of implantation. Speech tracking scores of the placebo and treatment groups were similar before the intervention. In the placebo group, speech tracking performance increased 13.5% for visual plus auditory and auditory only presentations as a function of aural habilitation alone. The d‑amphetamine facilitated program resulted in minimal increases in visual plus auditory tracking scores (2%) but led to a 43% increase for auditory-only speech tracking. rCBF imaging indicated both the extent and magnitude of primary and associative auditory cortex activations increased significantly in the pharmacologically-enhanced treatment group. Data, however, are preliminary and further study is warranted. This research was supported by grants from the NIH (NIDCD R01‑DC04558) and the Dana Foundation.
Nancy Tye-Murray, PhD and Lea Hyvärinen,
MD
In the assessment of vision of individuals with dual sensory loss, the two important specific features are: assessment of vision for communication and finding a proper communication for each assessment. The important areas in assessment of vision for communication are:
Development of communication for assessment of vision was felt to be critical for improvement of services when the Nordic Staff Training Centre for Deaf-Blind Services started its training programs in 1981. The monograph that I wrote at the Smith-Kettlewell Eye Research Institute in 1987-88 describes the usual details in arranging communication during assessment of vision:
Each of these special features of the assessment is simple and easy but requires flexibility from the doctor and a skilful interpreter. Programs for doctors to increase understanding of deaf culture and the different types of vision loss are still needed to improve the quality of vision care.
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Copyright 2006 by the RERC on Hearing Enhancement--All Rights Reserved This page last updated: September 21, 2006 |
