Development of Oral Communication in Infants with a Profound Hearing Loss: Pre- and Post-cochlear Implantation

An in-depth, longitudinal study of the speech and oral language development of eight infants with a profound hearing loss who receive early interventions focused on developing their auditory, speech and oral language capacity is presented in this thesis. Infants were tracked for two years, during the period when they are changed from a hearing aid to a cochlear implant. All infants in this study had their hearing loss identified early and were fitted with hearing aids between 1 and 7 months of age and received their cochlear implant between 8 and 16 months of age. They attended a number of different auditory-verbal early intervention programs (depending on where they lived) all of which focused on developing speech and language skills through listening. Attendance at their particular early intervention program at least once a week was in addition to weekly attendance the Sydney Cochlear Implant Centre for therapy and audiological services. A broad range of measures has been used to track the infants’ acquisition of oral language skills, including measures of communicative intention, pre-speech and speech development, and oral language development. Despite a wide range of individual differences across the group of infants, the results suggest some general trends. In the area of communicative intent most infants followed typical development patterns in terms of both the types (e.g. requesting, answering etc) and forms (gestural, vocal, verbal) used, but they showed delays in their frequency of usage of these types and forms. For speech development the infants demonstrated typical speech skills by 18-months post-cochlear implantation in the areas of consonant inventories, severity of phonological involvement (speech intelligibility) and phonological process development, but they showed delays in vowel and consonant acquisition. Finally, for language development the infants were delayed relative to typical development at 18 months post-implantation. The findings support and extend previous studies which have demonstrated the benefits of early intervention for communication development in infants with hearing loss (Calderon & Naidu, 2000; Mayne, Yoshinaga-Itano & Sedey, 2000; Moeller, 2000; Yoshinaga-Itano & Apuzzo, 1998). However, the delays in the oral communication skills of the infants in the current study suggest that more intensive long-term intervention is required if the infants are to attain typical oral speech and language development. The findings capture the complexity of early oral language development, which has been lacking in previous studies of infants with significant hearing loss, receiving a cochlear implant (Dettman, Briggs, & Dowell, 2005; Houston, Ying, Pisoni, & Iler Kirk, 2003; Schauwers, Gillis, Daemers, De Beukelaer, & Govaerts, 2004). The present data also provide some limited support for earlier implantation, that is, before 12 months of age, as the infants made little progress in oral language development while using hearing aids. The reduced amount of auditory signal available to them prior to implantation may be the determining factor in their inability to follow typical rates and patterns of development. However, rates of development with the implant were not straightforward and further research on this population is needed. Universal neonatal screening programs for hearing loss will potentially provide a larger population of early identified infant for future research. This will create the opportunity for large scale, prospective, longitudinal, studies examining the acquisition of speech and oral language development. Limitations of this study, tracking the early stages of speech and language development over a two year period are identified. Future studies are needed to follow the infants for a longer time to determine if their rate of development is sufficient for them to catch up in areas of delay and maintain their performance in areas where they match their typically developing peers

Acoustic voice characteristics with and without wearing a facemask

Facemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0–1 kHz and 1–8 kHz regions, an energy ratio between 0–1 and 1–8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1–8 kHz region and there was no significant change in this measure at 0–1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Conversation and Pragmatic Skills in Children who are Deaf or Hard of Hearing: A Scoping Review

Background: Technological and therapeutic advances, along with newborn hearing screening that many children who are born deaf or hard of hearing (DHH) are now starting school with typical speech and language skills. Despite this, many continue to find everyday conversations challenging. Objective: This scoping review will map out the evidence relating to the development of conversation and pragmatic skills of children with permanent hearing loss who are learning to listen and speak. Methods: This scoping review will be conducted following the methodological framework originally proposed by Arksey and O’Malley (2005) and elaborated on by Levac et al. (2010) and Peters et al. (2015; 2020; 2020). The review is reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist (Tricco et al., 2018). Search terms, including both Medical Subject Headings (Ganesh et al., 2022) and non-MeSH terms, key words, and truncations, will be developed and tested using the logic grid technique described by Aromataris and Riitano (2014). The scoping review has been pre-registered on the Open Science Framework (OSF) with details of the scoping review made publicly available prior to commencing the review. Search Terms Key Words Alternative Words Child*.mp. OR p?ediatric*.mp. OR congenit*.mp. OR Infant*.mp. OR adolescent.mp. OR school age.mp. OR preschool.mp. OR preschool age*.mp. AND Hearing loss* OR hearing impair*.mp. OR deaf.mp. OR hard of hearing.mp. AND Communicat* listen and speak.mp. OR talk*.mp. OR speak*.mp. OR oral.mp. OR oral language.mp. OR speech.mp. OR spoken language.mp. OR language*.mp. AND Hearing aid*.mp. OR hearing device*.mp. OR cochlear implant*.mp. OR “hearing technology”.mp. Children with typical hearing AND Convers*.mp. OR pragmatic*.mp. A combination of subject specific and multi-disciplinary databases has been selected to cover depth and breadth of coverage in the literature search. The initial search strategy will be designed, tested, and executed in Medline via Ovid, before the search is translated for use with additional databases which will include: Embase via Ovid SP (1946-2022), Eric via Ovid SP (1966-2022), CINAHL via EBSCO (1982-2022) and Scopus (2004-2022). Reference lists from studies published in the last five years will also be hand searched for completeness. All searches were conducted on 12th of April 2022 and results from each search will be exported into EndNote X9 for reference management, and into Covidence, a web-based collaboration software platform that streamlines the production of systematic and other literature reviews (www.covidence.com.au). Articles will be included if they are: • written in English, • published during or after year 2000 (but before • about children who are DHH and learning spoken language rather than sign language, • peer reviewed articles, • focused on children before school age or at school age (0-18 years), • about children with permanent congenital hearing loss, • about children with bilateral hearing loss, • about children without other developmental concerns impacting their communication skills, • about children using hearing aids or implantable hearing technology to give them access to sound (aided), • about conversation and/or pragmatic language skills, • presenting novel research. Both automatic de-duplication in Covidence and manual checks will be used to verify and remove duplicate records (Bramer et al., 2016). Remaining records will be screened by title and abstract, and then full texts will assessed against a-priori inclusion criteria which are listed above. Where decisions are conflicting, both authors will re-read the entire article and engaged in discussion of their perspective on the fit of the study to the research question until 100% consensus agreement is reached (Li et al., 2022). While Arksey and O’Malley (2005) state that quality appraisal is not required in scoping reviews, Tricco and colleagues (2018) suggest quality appraisal as a useful addition to improve methodological rigour. Therefore, quality appraisal on 20% of the included articles using the Joanna Briggs Institute (JBI) (2017) checklist for analytical cross-sectional studies. Data will be extracted including; details of the article (title, authors, year, country, participant language), objective/s or research question/s, participant characteristics and context, and relevant study outcomes (Peters et al., 2020). Finally, inductive thematic analysis will be conducted following Braun and Clarke’s (2006) six-phase approach. Global themes, and associated sub-themes will be discussed and refined by the research team to ensure that the core concepts outlined in the literature are well captured

Hear here : children with hearing loss learn words by listening

Objectives: Early use of hearing devices and family participation in auditory-verbal therapy has been associated with age-appropriate verbal communication outcomes for children with hearing loss. However, there continues to be great variability in outcomes across different oral intervention programmes and little consensus on how therapists should prioritise goals at each therapy session for positive clinical outcomes. This pilot intervention study aimed to determine whether therapy goals that concentrate on teaching preschool children with hearing loss how to distinguish between words in a structured listening programme is effective, and whether gains in speech perception skills impact on vocabulary and speech development without them having to be worked on directly in therapy. Method: A multiple baseline across subjects design was used in this within-subject controlled study. 3 children aged between 2:6 and 3:1 with moderate-severe to severe-profound hearing loss were recruited for a 6-week intervention programme. Each participant commenced at different stages of the 10-staged listening programme depending on their individual listening skills at recruitment. Speech development and vocabulary assessments were conducted before and after the training programme in addition to speech perception assessments and probes conducted throughout the intervention programme. Results: All participants made gains in speech perception skills as well as vocabulary and speech development. Speech perception skills acquired were noted to be maintained a week after intervention. In addition, all participants were able to generalise speech perception skills learnt to words that had not been used in the intervention programme. Conclusions: This pilot study found that therapy directed at listening alone is promising and that it may have positive impact on speech and vocabulary development without these goals having to be incorporated into a therapy programme. Although a larger study is necessary for more conclusive findings, the results from this preliminary study are promising in support of emphasise on listening skills within auditory-verbal therapy programmes

Evidence-based practice self-efficacy of undergraduate speech pathology students following training

Aim: The aims of this study were to determine the self-efficacy of speech pathology students in conducting evidence-based practice before and after a comprehensive evidence-based practice course, and the impact of timing of the course (Semester 1/2). Method: Students attended a 13-week course in their final year of study. The evidence-based practice confidence scale (EPIC) was used to measure the students’ self-efficacy pre- and post-training. Results: Ninety-two percent of students enrolled over six semesters participated. Students began the evidence-based practice course with high confidence in asking patients their preferences but low confidence in interpreting and analysing statistics. A significant improvement in confidence in all evidence-based practice areas was found, with greatest improvement occurring in the critical appraisal of research. Overall, the teaching had greatest effect on a group of skills for finding valid EBP information. There were significant differences between semester one and two students in only 18% of responses. Semester two students were more confident in half of these responses. Conclusions: An evidence-based practice course made a significant difference to student self-efficacy across all aspects, with few differences related to timing of the course. Implications are discussed.Implications for Rehabilitation Health professionals must be confident implementing evidence-based practice throughout the course of their careers, as best practice changes over time. A capstone unit of study/course for undergraduate speech pathology students significantly improved their self-efficacy in implementing evidence-based practice. This has positive implications for evidence-based practice across a wide range of clinical settings including rehabilitation and disability as the graduate entry level students enter the workforce. For on-going success, graduate entry level students must continue to implement evidence-based practice as clinicians if they are to maintain their confidence and further develop their skill set

Parents' views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait

Objectives: Developed countries (such as the Unites States of America, the United Kingdom, and Australia) provide high-quality services to children with hearing loss and their parents, including universal newborn hearing screening, early fitting of hearing devices and access to high quality early, aural intervention. In contrast, many developing countries lack the resources to provide these services. Research evidence suggests that one way to compensate for delays in identification and rehabilitation for children with hearing loss is to involve the family in the early intervention process. However, evidence is deficient around the facilitation of parental involvement in early intervention for families from developing countries. The aim of this study was to investigate the perception of parents from a developing country who have a child with hearing loss to discover the factors that may influence their involvement in early intervention, identify facilitators/barriers for their involvement, and identify the specific needs of involved parents. Method: A qualitative collective case study methodology was used in the form of semi-structured interviews with twenty-one participants. Results: Two global themes emerged. Firstly, factors influencing parental involvement. This included five subthemes: better communication as the key to building rapport and providing support; disappointment with the service; physical and human resources make a difference; consideration of life beyond the habilitation sessions; and my child matters the most. The second global theme-parental needs-included four subthemes: building trust; ensuring generalization; improving child outcomes; and managing needs of parents versus services. All the discussed themes are supported by quotations from the interviews. Conclusion: The findings suggest that parents of children with hearing loss in developing countries perceive the services provided for their children to be disjointed and not well coordinated. Based on the parent perceptions a set of guidelines that provide a scaffold for service providers working with children with hearing loss in developing countries is outlined. The guidelines are designed to assist services for children with hearing loss in developing countries improve the delivery of their services and increase family involvement, which in turn; will assist in improving their child and family related outcomes

A new training package (3Cs: Connect, Communicate and Collaborate) for improving family responsive service delivery in early intervention for children with hearing loss : a proof of concept study

Background: An objective of early intervention for children with hearing loss is to enhance family engagement in therapy to maximise a child’s speech and language potential. However, requiring a service provider to work collaboratively with a child’s family can create problems in developing and underdeveloped countries, where skilled service providers and services for children with hearing loss are lacking and where an expert model of intervention prevails. Objectives: To determine the preliminary effectiveness of a new training package Connect, Communicate and Collaborate (3Cs), in improving the knowledge and confidence of service providers in the delivery of family responsive services in an early intervention program for children with hearing loss. Methods: Five learning modules were developed based on service provider experience working with children with hearing loss, and parents of children with hearing loss. Six participants completed the training package comprising five training modules and an introductory session over a 6-week period. Participants’ confidence and knowledge in providing family responsive practice was measured pre and post training using visual analogue scales, and participants were also invited to provide their reflections on the program. Results: Pre- and post-training confidence ratings revealed significant improvements in the perceptions of participants in the implementation of responsive family practice across four of five of programme learning modules (p < 0.002). Participant reflection statements indicate they became more considerated in their family responsive practice. Despite positive experiences working with parents, participants stated they had ongoing difficulties guiding families through the decision-making processes of habilitation. The reflection process assisted learning and improved practice by supporting participants to build on their strengths. Conclusion: The 3Cs package improved the confidence in and knowledge of delivery of responsive family services for six participants in Kuwait. It also improved the participant’s self-evaluation skills. The 3Cs provides professional development that meets the needs of service providers working with children with hearing loss to improve inclusion of families in the therapy process