Profil penerima Implan Koklea Kebangsaan bagi kanak-kanak bermasalah pendengaran pralingual di Malaysia

Kementerian Kesihatan Malaysia (KKM) telah melaksanakan Program Implan Koklea Kebangsaan sejak tahun 2008. Sehingga November 2014, program ini telah mengimplan sejumlah 205 orang individu yang mempunyai masalah pendengaran di mana sebahagian besarnya adalah kes kanak-kanak bermasalah pendengaran pralingual (71%). Kajian ini bertujuan memprofil penerima implan koklea kanak-kanak pralingual di bawah program KKM. Data yang dilaporkan meliputi 121 penerima implan koklea (82.8%) dari sembilan buah hospital satelit yang terlibat dalam program ini. Dari jumlah tersebut, 58 adalah kanak-kanak lelaki dan majoritinya ialah Melayu (66.9%). Seramai 39 daripada mereka (32.2%) mempunyai faktor berisiko tinggi dan majoriti mempunyai beberapa faktor berisiko tinggi (46%) untuk kehilangan pendengaran kekal. Dalam kohort ini, hanya 12 orang kanak-kanak (9.9%) telah dikenal pasti melalui program saringan pendengaran bayi baru lahir. Umur diagnosis masalah pendengaran adalah antara 1 hingga 46 bulan (Min = 24.3 ± 10.2 bulan). Alat bantu pendengaran telah dipasang pada usia 4 hingga 46 bulan (Min = 27.5 ± 9.9 bulan). Min umur pemasangan implan koklea adalah 41.5 ± 10.3 bulan. Min keseluruhan tempoh menunggu dari lawatan pertama berjumpa audiologis hingga implan koklea diaktifkan adalah 18.5 ± 9.1 bulan. Data deskriptif menunjukkan bahawa kanak-kanak ini didiagnos dan menerima implan pada usia lewat secara relatif untuk perkembangan bahasa dan pertuturan. Program saringan pendengaran bayi baru lahir kebangsaan yang sedia ada perlu lebih diperkemas dan dimantapkan supaya mampu menjadi penyumbang utama untuk mengenal pasti awal masalah pendengaran bagi penerima implan kanak-kanak di bawah Program Implan Koklea KKM. Seterusnya pengesanan awal masalah pendengaran diharapkan dapat mengurangkan usia pemasangan implan koklea dalam kalangan kanak-kanak pada masa hadapan

THE EFFECTS OF FAMILIAR, UNFAMILIAR MUSIC AND AUDIOBOOKS EXPOSURE ON SPEECH PARAMETERS OF ELDERLY WITH ALZHEIMER’S DISEASE: A WITHIN CASE STUDIES

Alzheimer’s disease is a cognitive disorder common among elderly whereby neurode generation occurs rapidly as a result of decline in brain activity. There have been many studies linking music memory with cognition among patients with Alzheimer’s disease. However, the types of music exposed, the familiarity of the music and their effects on speech production is still not adequately explained. Improvement in speech can be demonstrated in alteration of several speech parameters. This multiple case study (n = 3), seeks to investigate the effects of familiar and unfamiliar music on the speech fundamental frequency (F0), intensity range, and speech rate of 3 elderly subjects with Alzheimer’s disease. The speech parameters after exposure to familiar and unfamiliar music were measured longitudinally over a period of 21 weeks. A listening task to an audiobook was treated as control. Data revealed that in all of these subjects, there was wide variability in performance with no common pattern for familiar music. However, for unfamiliar music, two subjects showed increase in their speech rate. The third subject showed increase in F0 range. It is suggested that there may be more to understand how familiar and novel stimuli influence speech production in patients with Alzheimer’s disease.&nbsp

Evaluation of two-channel source separation using exploratory projection pursuit technique

Difficulty of understanding speech in noise among the elderly necessitates the need for Auditory Training which has made a renewal of interest in the last decade with the auditory training applications. This interest is perhaps spurred by advances in computer-based technology. In computer-based auditory training, speech signals are considered as auditory training stimuli where input speech signals need to be verified prior to training as the speech signals are mixed with noise signals. Computer-based Auditory Training System can be embedded with input speech verifying module. Input speech verifying module is employed with speech and noise separator simulator. This simulator needs to guarantee accurate separation of speech from noise signals. Therefore, in this research, Exploratory Projection Pursuit (EPP) technique under semi-Blind Source Separation (BSS) method is intended to separate the speech source signals which are mixed with competing speech (multitalker speech babble). This training uses Malay language based sentences which differ in word length and hence number of sample values. The experimental simulation considers two-channel random, linear mixing of speech sources and competing speech. The aim of this study is to evaluate the performance of source separation using the anticipated EPP technique for various sample values of speech signals which varies in time duration due to word length dissimilarity. Simulation results show that EPP technique is feasible for source separation. As a consequence, high correlation value of r ≥ 0.99 is obtained between extracted speech signal and original speech signal for all categories of speech signals. It is further verified by the maximum nongaussianity of extracted speech signal which has high kurtosis value of 32 approximately

Pencapaian auditori kanak-kanak pengguna implan koklea di bawah Program Implan Koklea Kebangsaan

Implan koklea merupakan pilihan intervensi utama untuk mereka yang bermasalah pendengaran sensorineural pada tahap yang teruk dan sangat teruk. Kajian ini bertujuan untuk mengukur pencapaian auditori dalam kalangan kanak-kanak bermasalah pendengaran pralingual yang telah memakai alat implan koklea menggunakan pengukuran terus persepsi terhadap pertuturan (objektif) dan soal selidik ibu bapa (subjektif) serta mengenal pasti faktor demografi yang signifikan menyumbang kepada pencapaian mereka. Seramai 48 orang kanak-kanak daripada Program Implan Koklea di bawah Kementerian Kesihatan Malaysia (KKM) yang berumur pendengaran antara 12 hingga 89 bulan (min = 42.60 ± 19.46 bulan) terlibat dalam kajian ini. Ujian persepi pertuturan dijalankan menggunakan ujian-ujian yang dipilih daripada Evaluation of Auditory Response to Speech (EARS) versi Bahasa Melayu manakala penilaian ibu bapa terhadap pencapaian kanak-kanak dikumpulkan melalui soal selidik Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) versi Bahasa Melayu. Stimulus pertuturan terakam dipersembahkan kepada kanak-kanak dalam medan bebas pada kekuatan bunyi 65 dB SPL dalam bilik terawat bunyi. Keputusan ujian persepsi pertuturan kemudian dikategorikan menggunakan Indeks Kategori Pencapaian Auditori versi Bahasa Melayu (My-CAPI) yang mempunyai 10 kategori bermula daripada ‘0’ hingga ‘9’. Keputusan menunjukkan kebanyakan subjek (N = 20, 41.7%) berada pada kategori ‘2’ dalam tahap My-CAPI (persepsi pertuturan set tertutup yang terhad), manakala tiga orang subjek mencapai kategori maksimum ‘9’ (persepsi pertuturan set terbuka yang tinggi dalam situasi bising). Mod komunikasi adalah satu-satunya faktor demografi yang signifikan berkorelasi dengan My-CAPI dan skor PEACH (p < 0.01). Koefisyen korelasi Pearson menunjukkan perhubungan yang kuat di antara skor PEACH dan My-CAPI (p < 0.01; r = 0.71) mencadangkan soal selidik PEACH boleh memberikan indikasi prestasi auditori jika ujian pertuturan tidak dapat dijalankan. Dapatan kajian menunjukkan majoriti kanak-kanak implan koklea yang diuji belum mencapai prestasi auditori yang memberangsangkan dan penggunaan komunikasi lisan merupakan faktor utama yang dikaitkan dengan pencapaian auditori yang lebih baik

Efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognitive ability among older adults with normal cognition and with neurocognitive impairment

To evaluate the efficacy of a newly developed auditory–cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI). Methods: A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory–cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12. Results: Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P < 0.001) and NCI (P < 0.01). The NC group also showed significant training effects in the Malay Hearing in Noise Test (quiet) (P < 0.01), Gaps in Noise Test (P < 0.001) and Pitch Pattern Sequence Test (humming) (P < 0.05). All training effects were sustained up to 4 weeks after the training ended. Conclusions: The present study suggests that the newly developed auditory–cognitive training system has the potential to improve general cognition and some of the auditory processing abilities in both the NC and NCI groups. Because of the short test–retest intervals used in the present study, it is possible that the training effects were influenced by learning effect and, therefore, should be considered cautiously. Geriatr Gerontol Int 201

Kesan penuaan ke atas kehubungan berkesan otak semasa pemprosesan persepsi pertuturan daripada perspektif pemodelan sebab dan akibat dinamik: satu kajian fMRI

Proses penuaan seringkali dikaitkan dengan kemerosotan pada sistem kognitif. Kemerosotan kognitif bermula seawal usia dua puluhan dan berterusan secara linear. Selain itu, kemerosotan kognitif juga menjadi lebih nyata dengan kehadiran hingar latar. Walau bagaimanapun, kesan penuaan ke atas mekanisme pemprosesan persepsi pertuturan menggunakan tugasan mengulang secara terus (FRT) dalam senyap dan hingar belum difahami dengan jelas. Dalam kajian ini, pengimejan resonans magnet kefungsian (fMRI) digunakan untuk membandingkan kesan penuaan ke atas kehubungan efektif otak yang terhasil daripada tugasan FRT ke atas subjek normal dengan empat kumpulan umur yang berlainan iaitu 20 - 29 tahun (n = 15), 30 - 39 tahun (n = 15), 40 - 49 tahun (n = 10) dan 50 - 65 tahun (n = 14). Satu siri lima perkataan yang diselang-seli dalam keadaan hingar dengan senyap diberikan secara auditori. Pemetaan statistik berparameter (SPM8) dan pemodelan dinamik penyebab (DCM10) digunakan untuk menentukan kehubungan efektif otak. Kawasan yang terlibat dalam pembinaan model kehubungan efektif otak adalah STG, HG dan PCG. Model optimum yang dipilih dalam kajian ini adalah model yang menunjukkan keseimbangan antara ketepatan dan kesukaran. Keputusan fMRI kehubungan efektif menunjukkan bahawa komunikasi antara intrahemisfera tidak berubah dengan menggunakan tugasan FRT ini apabila seseorang semakin berusia, tetapi komunikasi antara interhemisfera menjadi semakin kompleks

Hearing loss and risk factors among community dwelling older adults in Selangor

There is a lack of population-based data on prevalence of hearing loss in Malaysia. The purpose of this population-based study was to determine the prevalence of hearing loss and its risk factors among 382 older adults aged 60 years and above, recruited through multistage random sampling in Selangor. Hearing level was measured using pure tone audiometry. Hearing loss was classified into at least mild hearing loss and significant hearing loss based on the pure tone average (PTA) of 0.5, 1, 2 and 4 kHz. The examination also included face-to-face interview on hearing related medical history, noise exposure and hearing aid use. Overall, the prevalence of at least mild hearing loss and significant hearing loss were 73.6% (95% CI: 69.4 - 77.4) and 24.6% (95% CI: 20.8 - 28.7), respectively. The odds for at least ‘mild hearing loss’ were male gender, Chinese ethnicity, residing in urban areas, had no formal education or primary school education and history of hypertension. The risk for ‘significant hearing loss’ was significantly higher in males, those who lived in urban areas and elderly with cognitive impairment. Chinese and Indian ethnicities had significantly lower risks than Malay ethnic to have significant hearing loss. Despite the high prevalence of hearing loss, only 4.4% who might benefit from hearing aids wore them. In conclusion, findings from this study show high prevalence of hearing loss among the elderly population. Given the significant association between hearing loss and cognitive impairment, future studies should explore the role of hearing amplification in alleviating or slowing the progress of cognitive decline

Brain activation display functional asymmetry in response to action, background and tonal frequency during a pitch memory processing: an fMRI study

In this study, the asymmetry of the main effects of action, background and tonal frequency during a pitch memory processing were investigated by means of brain activation. Eighteen participants (mean age 27.6 years) were presented with low and high frequency tones in quiet and in noise. They listen, discriminate and recognize the target tone against the final tone in a series of four distracting tones. The main effects were studied using the analysis of variance (ANOVA) with action (to wring (rubber bulb) vs. not to wring), background (in quiet vs. in noise) and frequency (low vs. high) as the factors (and levels respectively). The main effect of action is in the right pre-central gyrus (PCG), in conformation with its contralateral behavior. The main effect of background indicated the bilateral primary auditory cortices (PAC) and is right lateralized, attributable to white noise. The main effect of frequency is also observed in PAC but bilaterally equal and attributable to low frequency tones. Despite the argument that the temporo-spectral lateralization dichotomy is not especially rigid as revealed by the main effect of frequency, right lateralization of PAC for the respective main effect of background clearly demonstrates its functional asymmetry suggesting different perceptual functionality of the right and left PAC

Pembangunan bahan bahasa pertuturan untuk latihan pertuturan dalam hingar bagi golongan dewasa

Kajian ini menerangkan proses sistematik dalam pembangunan bahan ayat pertuturan dalam hingar yang mempunyai kebolehfahaman yang sama dan bersesuaian dengan budaya bagi kegunaan dalam protokol latihan pertuturan dalam hingar untuk golongan dewasa di Malaysia. Proses pembangunan ini melibatkan tiga fasa iteratif iaitu fasa (1) analisis, (2) rekabentuk dan (3) pembangunan. Dalam fasa analisis, pembolehubah yang diperlukan dalam membangunkan bahan pertuturan dikenalpasti melalui kajian kepustakaan dan perbincangan bersama pakar dalam bidang. Seterusnya, dalam fasa rekabentuk, kompilasi dan pembentukan ayat, penilaian kesemulajadian dan rakaman bahan pertuturan telah dilakukan. Fasa yang terakhir iaitu fasa pembangunan melibatkan penilaian penentuan graf fungsi pencapaian intensiti dan penyamaan kebolehfahaman ayat telah dijalankan. Hasil akhir daripada fasa-fasa ini adalah 171 ayat yang mempunyai kebolehfahaman yang sama dan boleh digunakan secara bergilir-gilir dalam protokol latihan pertuturan dalam hingar untuk golongan dewasa di Malaysia

Optimization of number of scans for a sparse temporal sampling (STS) functional magnetic resonance imaging (fMRI)

High sensitivity signal detection for a sparse temporal sampling (STS) functional magnetic resonance imaging (fMRI) is compensated by the increase in the number of scans (Ns) and consequently the scan time. A long scan time would result in fatigue and restlessness in participants, while a short scan time is undesirable for an STS-fMRI due to insufficient Ns for averaging. The purpose of this study was to determine the Ns practically sufficient for a sparse fMRI study. Eighteen participants were presented with white noise during a sparse fMRI scan. The height extent of activation was determined via t statistics and region of interest (ROI) based percentage of signal change (PSC). The t statistics and PSC for Heschl’s gyrus (HG) and superior temporal gyrus (STG) during which the participants listened to the white noise were calculated for different number of scans which were 6, 12, 18, 24, 30 and 36. The t statistics and PSC values calculated for the bilateral HG and STG qualitatively indicated a minimal change over Ns = 12 to 36. Both ROIs showed a consistent common right lateralization of activation for all Ns, indicating the right-hemispheric dominance of auditory cortex in processing white noise stimulus. It was proposed that for a sparse fMRI study, Ns may practically fall between 12 and 36