Development- and noise-induced changes in central auditory processing at the ages of 2 and 4 years

Abstract To be able to acquire, produce, and comprehend language, precise central auditory processing (CAP), neural processes utilized for managing auditory input, is essential. However, the auditory environments are not always optimal for CAP because noise levels in children’s daily environments can be surprisingly high. In young children, CAP and its developmental trajectory as well as the influence of noise on it have scarcely been investigated. Event-related potentials (ERPs) offer promising means to study different stages of CAP in small children. Sound processing, preattentive auditory discrimination, and attention shifting processes can be addressed with obligatory responses, mismatch negativity (MMN), and novelty P3 of ERPs, respectively. In this thesis the developmental trajectory of CAP from 2 to 4 years of age as well as noise-induced changes on it, were investigated. In addition, the feasibility of the multi-feature paradigm with syllable stimuli and novel sounds in children was evaluated. To this end, obligatory responses (P1, N2, and N4) and MMNs for consonant, frequency, intensity, vowel, and vowel duration changes, as well as novelty P3 responses, were recorded in a silent condition and with babble noise using the multi-feature paradigm. The participants were voluntary, typically developing children. Significant P1, N2, N4, and MMN responses were elicited at both ages. Also a significant novelty P3, studied at the age of 2 years, was found. From 2 to 4 years, the P1 and N2 latencies shortened. The amplitudes of N2, N4, and MMNs increased and the increment was the largest at frontal electrode locations. During noise, P1 decreased, N2 increased, and the latency of N4 diminished as well as MMNs degraded. The noise-induced changes were largely similar at both ages. In conclusion, the multi-feature paradigm with five syllable deviant types and novel sounds was found to be an appropriate measure of CAP in toddlers. The changes in ERP morphology from 2 to 4 years of age suggest maturational changes in CAP. Noise degraded sound encoding, representation forming, and auditory discrimination. The children were similarly vulnerable to hampering effects of noise at both ages. Thus, noise might potentially harmfully influence language processing and thereby its acquisition in childhood.Tiivistelmä Kielen omaksumiselle, tuottamiselle sekä ymmärtämiselle on tärkeää tarkka keskushermostollinen kuulotiedon käsittely eli ne hermostolliset prosessit, joita käytetään kuullun aineksen käsittelyyn. Kuunteluympäristöt eivät kuitenkaan aina ole optimaalisia kuulotiedon käsittelylle, sillä melutasot lasten elinympäristöissä voivat olla hyvinkin korkeita. Pienten lasten kuulotiedon käsittelyä, sen kehittymistä ja melun vaikutusta siihen on tutkittu vähän. Kuuloherätevasteet ovat toimiva tapa tarkastella pienten lasten kuulotiedon käsittelyä eri näkökulmista. Äänen käsittelyä, esitietoista kuuloerottelua ja tarkkaavuuden siirtymistä voidaan tarkastella obligatoristen vasteiden, poikkeavuusnegatiivisuuden ja novelty P3 -vasteiden avulla. Tässä väitöskirjassa tarkastellaan kuulotiedon käsittelyn kehittymistä kahden vuoden iästä neljän vuoden ikään sekä melun vaikutusta siihen. Lisäksi arvioidaan tavuärsykkeitä ja poikkeavia ääniä sisältävän monipiirreparadigman soveltuvuutta lapsitutkimuksiin. Tutkimuksissa rekisteröitiin monipiirreparadigman avulla obligatorisia vasteita (P1, N2 ja N4); konsonantin, taajuuden, intensiteetin, vokaalin ja vokaalin keston muutokselle syntyneitä MMN-vasteita sekä novelty P3 -vasteita hiljaisuudessa ja taustamelussa. Tutkimuksen osallistujat olivat vapaaehtoisia tyypillisesti kehittyviä lapsia. Molemmilla tutkimuskerroilla P1, N2, N4 ja MMN poikkesivat merkitsevästi nollatasosta samoin kuin kaksivuotiailta tutkittu novelty P3. Kahden vuoden iästä neljään vuoteen P1- ja N2-vasteiden latenssi lyheni sekä N2, N4 ja MMN vahvistuivat, muutoksen ollessa suurinta frontaalisilla elektrodeilla. Melun aikana P1 heikkeni, N2 vahvistui ja N4-vasteen latenssi lyhentyi. Lisäksi MMN-vaste heikkeni. Melun aiheuttamat muutokset olivat samankaltaisia sekä kahden että neljän vuoden iässä. Johtopäätöksenä voidaan todeta viittä eri tavuärsyketyyppiä ja yllättäviä ääniä sisältävän monipiirreparadigman olevan toimiva menetelmä taaperoiden kuulotiedon käsittelyn tutkimiseen. Kahden ja neljän ikävuoden välillä tapahtuvat muutokset vasteissa kuvastavat kehityksellisiä muutoksia kuulotiedon käsittelyssä. Melu heikentää äänitiedon peruskäsittelyä, edustumien muodostumista ja esitietoista kuuloerottelua. Lapset olivat lähes yhtä alttiita melun vaikutuksille sekä kahden että neljän vuoden iässä. Melu voi siis haitata kielen prosessointia ja sen omaksumista

Teachers’ and children’s experiences after an acoustic intervention and a noise-controlling workshop in two elementary classrooms

Abstract Introduction: Treating sources of noise is a novel aspect of voice ergonomics intended to enhance the preconditions for good voice production and easy listening. Objective: To improve experiences of listening and voice ergonomics in classrooms. Methods: Participants were two female elementary school teachers with voice symptoms and their pupils (n = 50). Two interventions were performed: the acoustic intervention and then the workshop intervention where the teachers and pupils were active. Teachers’ voice symptoms and pupils’ and teachers’ experiences of the interventions were elicited by questionnaire. Results: The teacher with many voice symptoms experienced more annoyance from sounds and benefitted more from the interventions. After the interventions both teachers suffered fewer voice breaks and voice symptoms such as lump and mucus in the throat. The pupils reported improvement in the teachers’ voice clarity and audibility (p = 0.001). Pupils aged 12–13 years were more annoyed by sounds than those aged 8–9 years (p = 0.003). The older pupils experienced less sound annoyance after both interventions and the younger ones after the workshop intervention. Conclusions: The importance of good acoustics and individuals’ ability to improve voice ergonomics and listening conditions was demonstrated

Noise equally degrades central auditory processing in 2-and 4-year-old children

Abstract Purpose: The aim of this study was to investigate developmental and noise-induced changes in central auditory processing indexed by event-related potentials in typically developing children. Method: P1, N2, and N4 responses as well as mismatch negativities (MMNs) were recorded for standard syllables and consonants, frequency, intensity, vowel, and vowel duration changes in silent and noisy conditions in the same 14 children at the ages of 2 and 4 years. Results: The P1 and N2 latencies decreased and the N2, N4, and MMN amplitudes increased with development of the children. The amplitude changes were strongest at frontal electrodes. At both ages, background noise decreased the P1 amplitude, increased the N2 amplitude, and shortened the N4 latency. The noise-induced amplitude changes of P1, N2, and N4 were strongest frontally. Furthermore, background noise degraded the MMN. At both ages, MMN was significantly elicited only by the consonant change, and at the age of 4 years, also by the vowel duration change during noise. Conclusions: Developmental changes indexing maturation of central auditory processing were found from every response studied. Noise degraded sound encoding and echoic memory and impaired auditory discrimination at both ages. The older children were as vulnerable to the impact of noise as the younger children

A randomized controlled trial with female teachers:are there differences between and within the outcomes in voice therapy groups with and without carryover strategies?

Abstract Purpose: We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). Method: A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f₀, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). Results: No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f₀ increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f₀ decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls’ eight-week non-therapy period (P = 0.003). Conclusions: The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group’s voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life

Vuorovaikutuksen ja kohtaamisen osaaminen sairaanhoitajien ja lääkäreiden palliatiivisen hoidon ja saattohoidon koulutuksessa

Tiivistelmä Ihmisillä on moninaisia keinoja kommunikoida. Ihmiselle luonnollinen ilmaisutapa on puhuminen. Puhe voi kuitenkin häiriintyä erinäisistä syistä johtuen tai puuttua kokonaan. Sairaanhoitaja- ja lääkärikoulutuksen tulee edistää vuorovaikutukseen ja kohtaamiseen liittyvää osaamista ja koulutuksen tulee antaa valmiudet tunnistaa ja tukea kommunikaatiossa tapahtuvia muutoksia. Terveysalan ammattilaisten tulee osata hyödyntää tulkkipalveluita ja puheterapeutin osaamista osana moniammatillista yhteistyötä. Potilaalle ja hänen läheisilleen on tärkeää tulla kuulluksi, ymmärretyksi ja kohdatuksi elämänsä loppuun saakka. Tavoitteena on löytää yhteinen kieli tai vuorovaikutuksen tapa, jolla tämä kohtaaminen ja ymmärretyksi tuleminen mahdollistuu.Abstract Competence in interaction and encounter included in the education of nurses and physicians in palliative and end of life care People have a variety of ways to communicate. The most natural way of human expression is to speak, but it can be disturbed for various reasons, or it can be either wholly absent or otherwise deficient. The training of nurses and physicians should include the skills of interaction and encounter. The training should also provide the ability to identify and support possible changes in communication. Professionals must utilize an interpreter’s services and a speech therapist’s expertise as part of multi-professional collaboration. It is essential for the patients and their loved ones to be heard, understood and encountered for the rest of their lives. The goal is to find a common language or means to interact that makes this encounter and understanding possible