Customized Versus Noncustomized Sound Therapy for Treatment of Tinnitus: A Randomized Crossover Clinical Trial.

ObjectivesTo determine the effectiveness of a customized sound therapy and compare its effectiveness to that of masking with broadband noise.MethodsSubjects were randomized to receive either customized sound therapy or broadband noise for 2 hours per day for 3 months and then switched to the other treatment after a washout period. The outcome variables were tinnitus loudness (scored 0-10), Tinnitus Handicap Inventory (THI), Beck Anxiety Inventory (BAI), minimum masking levels (MML), and residual inhibition (RI).ResultsEighteen subjects completed the study. Mean age was 53 ± 11 years, and mean tinnitus duration was 118 ± 99 months. With customized sound therapy, mean loudness decreased from 6.4 ± 2.0 to 4.9 ± 1.9 ( P = .001), mean THI decreased from 42.8 ± 21.6 to 31.5 ± 20.3 ( P < .001), mean BAI decreased from 10.6 ± 10.9 to 8.3 ± 9.9 ( P = .01), and MML decreased from 22.3 ± 11.6 dB SL to 17.2 ± 10.6 dB SL ( P = .005). After 3 months of broadband noise therapy, only BAI and, to a lesser degree, MML decreased ( P = .003 and .04, respectively).ConclusionsCustomized sound therapy can decrease the loudness and THI scores of tinnitus patients, and the results may be superior to broadband noise

Using AR to Teach AR: Learning Outcomes of a Guided, Augmented Reality Hearing Loss and Auditory Rehabilitation Simulation with SLP Graduate Students

Recent research has found that practicing speech-language pathologists report feeling underprepared to provide services for individuals with hearing loss. At the same time, graduate SLP programs report that students have fewer training opportunities with low-incidence populations. This study examines learning outcomes for a cohort of graduate SLP students using a novel application of an immersive, augmented reality, hearing loss simulation. Results show encouraging outcomes for the simulation experience’s effects on empathy, knowledge, and clinical skills. This simulation offers a unique way to provide training related to auditory rehabilitation in SLP

The Listening Shift: Evaluating a Communication-Strategies Training Program for Telepractice Nurses Experiencing Hearing Challenges

Workers who wish to remain employed should be supported in doing so, even if they are experiencing age-related disabilities, such as hearing loss. I aimed to better understand the strategies from which workers with hearing loss might benefit, and how they can be supported in adopting these strategies. To collect rich data, I recruited telepractice nurses who rely on listening to make critical decisions about triaging and health care recommendations. My first research question was: What strategies exist for making telephone speech more intelligible for health care providers and patients with hearing challenges? I performed a scoping review following the Joanna Briggs Institute’s protocol. I identified 11 types of strategies, many of which required cooperation from, and disclosure to, providers’ employers, co-workers, and clients. This led me to consider the public narrative workers associated themselves with when they disclosed. Thus, my second research question was: How do Canadian newspapers portray workers with hearing loss? Through a thematic analysis of newspapers articles on this topic, I found they are predominantly portrayed as striving cheerfully both towards functioning normally and towards differentiating themselves and their hearing loss as unique and positive. To further explore how a subset of adults with hearing loss strive to work with a hearing loss, I developed an online communication-strategies training program tailored to nurses with hearing challenges. I then used a multiple case study to answer the following research question: How do nurses with hearing challenges change in terms of their telephone performance and workplace wellbeing in response to participation in an online communication strategies training program? Results suggested that nurses engaged in a problem-solving process before adopting strategies, and that strategy adoption could positively contribute to their performance. Together, the findings from these studies suggest that strategies exist to enhance the performance of workers with hearing loss, but the process of adopting these strategies can be demanding. Organizations should take steps to proactively support their nurses, health-care providers, and potentially other workers with hearing loss in identifying communication strategies and adapting them to their unique context

How Can eHealth Meet the Hearing and Communication Needs of Adults With Hearing Impairment and their Significant Others? A Group Concept Mapping Study

Objectives: To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally. / Design: Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, “One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to….” The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to “How helpful would this idea be to you?” using a 5-point Likert scale. Hierarchical cluster analysis was applied to the “sorting” data to develop a cluster map using the Concept Systems software. The “rating” data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests. / Results: Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the “sorting” data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home). / Conclusions: These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions

Speech-Language Pathology Graduate Students’ Experiences with the Use of Case-Based Learning to Develop Skills for Evidence-Based Practice

The American Speech-Language Hearing Association (ASHA) states that practitioners should use the principles of evidence-based practice (EBP) for clinical decision making. However, speech-language pathologists (SLPs) often report a lack of understanding, time, and resources to implement EBP. Clinicians who were exposed to EBP training during their graduate program or clinical fellowship are more likely to use EBP in their clinical practice; therefore, graduate programs in SLP must provide explicit EBP training to upcoming clinicians. At present, no consensus exists on the best way to train students in the principles of EBP. The present study sought to investigate student experiences and perceptions of a case-based learning (CBL) approach to training EBP. Thirty-two graduate SLP students completed a semester-long CBL activity which required them to create a PICO question, complete a literature review and annotated bibliography, and write a plan of care for a hypothetical clinical case. At the end of the semester, students were asked to write reflections on their use and learning of EBP during the course of the project. Those reflections were analyzed to understand the students’ experiences with CBL as a method to learn the principles of EBP

Vestibular rehabilitation with virtual reality in Ménière's disease

Virtual reality technology can provide a wide range of sensory stimuli to generate conflicts of varying degrees of complexity in a safe environment. OBJECTIVE: To verify the effect of a virtual realitybased balance rehabilitation program for patients with Menière's disease. METHOD: This observational clinical study included 44 patients aged between 18 and 60 years diagnosed with Menière's disease submitted to a controlled randomized therapeutic intervention. The case and control groups took betahistine and followed a diet. Case group subjects underwent 12 rehabilitation sessions with virtual reality stimuli in a Balance Rehabilitation Unit (BRU TM). Patients were assessed based on DHI scores, the dizziness visual analogue scale, and underwent posturography with virtual reality before and after the intervention. RESULTS: After the intervention, the case group showed significantly lower scores in DHI (p < 0,001) and in the dizziness visual analog scale (p = 0.012), and had significantly greater limit of stability areas (p = 0.016) than controls. CONCLUSION: Virtual reality-based balance rehabilitation effectively improved dizziness, quality of life, and limit of stability of patients with Menière's disease.A tecnologia de realidade virtual fornece uma grande variedade de estímulos que geram conflitos sensoriais em diferentes níveis de dificuldades e em ambiente seguro. OBJETIVO: Verificar o efeito de um programa de reabilitação vestibular do equilíbrio corporal com estímulos de realidade virtual em pacientes com doença de Ménière. Forma de estudo: Estudo clínico observacional. MÉTODO: Quarenta e quatro pacientes, com idade entre 18 e 60 anos e doença de Ménière definida, distribuídos em dois grupos - experimental (GE) e controle (GC) - fizeram uso de betaistina e dieta alimentar; o grupo experimental foi submetido adicionalmente a 12 sessões de reabilitação com realidade virtual da BRU TM. Os pacientes responderam ao Dizziness Handicap Inventory (DHI), à escala analógica de tontura e realizaram a posturografia com realidade virtual antes e após a intervenção. RESULTADOS: Após a intervenção, o GE apresentou valores significantemente menores do DHI (p < 0,001) e da escala analógica de tontura (p = 0,012) e valores significantemente maiores da área do limite de estabilidade (p = 0,016), em comparação com o GC. CONCLUSÃO: A reabilitação do equilíbrio corporal com estímulos de realidade virtual é eficaz na melhora da tontura, da qualidade de vida e do limite de estabilidade de pacientes com doença de Ménière.FMU curso de FonoaudiologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Pós-Graduação em Distúrbios da Comunicação HumanaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Programa de Pós-Graduação em Distúrbios da Comunicação HumanaUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

The Role of Modular Robotics in Mediating Nonverbal Social Exchanges

This paper outlines the use of modular robotics to encourage and facilitate non-verbal communication during therapeutic intervention in dementia care. A set of new socially interactive modular robotic devices called Rolling Pins (RPs) have been designed and developed to assist the therapist in interacting with dementia affected patients. The RPs are semi-transparent plastic tubes capable of measuring their orientation and the speed of their rotation; at a local level they have three types of feedback: RGB light, sound and vibration. The peculiarity of the RPs is that they are able to communicate with each other or with other devices equipped with the same radio communication technology. The RPs are usually used in pairs, as the local feedback of an RP can be set depending not only on its own speed and orientation, but also on the speed and the orientation of the peer RP. The system is not used as a therapeutic tool per se but as facilitator and mediator of social dynamics during normal therapy to counteract social isolation that can result in dementia through the loss of social skills. An experiment is reported showing that using the RPs the patients participated in the activity, coordinating their behaviour with the therapist and imitating the same interaction patterns generated by the therapist

Factors in the Client-Clinician Interaction That Are Perceived to Influence Hearing Aid Adoption in First Time Hearing Aid Candidates and Their Rated Importance by Clients and Clinicians

The purpose of this dissertation was to gain a better understanding of the impact of the client-clinician interaction in the hearing aid adoption process. The specific goals of this dissertation were: 1) to identify factors in client-clinician interactions that were perceived by clients and clinicians to influence hearing aid adoption in first time adult hearing aid candidates, 2) to investigate the importance of the identified factors from clients and clinicians perspectives, and 3) to compare the importance of the identified factors between clients and clinicians. These goals were achieved using a mixed-methods approach. Three studies were undertaken. In the first study a concept mapping approach was used to explore the collective views of clients and clinicians in identifying factors in client-clinician interaction that influence hearing aid adoption. Ten audiologists and 13 clients generated 122 statements that formed eight conceptually homogenous clusters of factors. The concepts were: 1) ensuring client comfort, 2) understanding and meeting client needs, 3) client-centered traits and actions, 4) acknowledging client as an individual, 5) imposing undue pressure and discomfort, 6) conveying device information by clinician, 7) supporting choices and shared decision making, and 8) factors in client readiness. In the second study, nine audiologists and 11 clients who participated in the first study rated the importance of the 122 statements. Clients rated the concept conveying device information by clinician more important than audiologists. In the third study, a broad and geographically diverse sample of clients and clinicians including audiologists and hearing instrument practitioners rated the importance of the 122 items identified in the first study. The comparison of the client and clinician groups’ ratings revealed discrepancies between the groups’ ratings. The largest discrepancy was between the importance each participant group assigned to the concepts conveying device information by clinician, which was rated much higher by clients and factors in client readiness, which was rated much higher by clinicians. This work contributes to the literature on client-clinician interaction in the audiological encounter. Results have implications for training of students and clinicians in facilitating the integration of shared decision making and client-centered care in hearing aid adoption process

The Development and Evaluation of the Hearing Intervention Battery in Arabic (HIBA) for Auditory Perception in Children with Cochlear Implants

The Hearing Intervention Battery in Arabic (HIBA), is a multi-modal auditory training intervention, that was developed based on the recommendations from our published systematic review of the literature on the effectiveness of auditory training (AT) for children with cochlear implants (CIs). HIBA was primarily intended to help improve speech and pitch perception in Arabic-speaking children with CIs. Due to the lack of auditory and speech assessment tools for the Arabic language, the A-CAPT, an Arabic version of the English Chear Auditory Perception Test (CAPT) was developed. The A-CAPT was validated prior its use in this project with 26 children with typical hearing. There was a strong agreement between the test and retest measures and normative data and the critical difference values were calculated which were similar to the British English CAPT. A randomized control trial (RCT) to evaluate the HIBA training programme was conducted with 14, 5- to 13-year-old Arabic-speaking children with CIs. The control group received art training following step-by-step drawing and face-paint exercises while the HIBA multi-modal training group received games involving communication interactions (DiaPix), speech cue discrimination (Alefbata.com), and pitch discrimination (musical discrimination using a keyboard). All tasks were interactive and designed to be completed by the children together with their parents or caregivers. There was a double baseline measurement, followed by a 4-week intervention period before a post intervention assessment. There was a significant improvement in consonant perception for children who received the HIBA multi-modal training intervention but this was not observed in the active control group. There was some evidence of generalization of learning, as observed by improvements in the non-trained task (phoneme discrimination) for the intervention group but not for controls. It was unclear if one particular element of the HIBA led to these improvements. Parents were actively involved in the multi-modal training group and their feedback indicated that the most preferred part of multi-modal training was the communication interaction tasks using the Diapix. To understand which element of the HIBA led to improvements in speech perception and whether the duration of training and sample size masked any gains, a trial forward in a larger scale should be conducted. In addition, to improve the quality of evidence of the study, collaboration is need to achieve a double blinded study and minimize bias. Findings of this project may suggest that children with CIs and their parents can benefit from regular and sustained access to age-appropriate auditory training materials and activities. In addition, findings would extend the current understanding of the impact of auditory training on CI outcomes in children and provide inspiration for a more comprehensive rehabilitation scheme for CI users