Examining a New Method to Studying Velopharyngeal Structures in a Child With 22q11.2 Deletion Syndrome

Purpose

To date, no studies have imaged the velopharynx in children with 22q11.2 deletion syndrome (22q11.2 DS) without the use of sedation. Dysmorphology in velopharyngeal structures has been shown to have significant negative implications on speech among these individuals. This single case study was designed to assess the feasibility of a child-friendly magnetic resonance imaging (MRI) scanning protocol in this clinically challenging population and to determine the utility of this MRI protocol for future work in this area.

Method

One 6-year-old White girl diagnosed with 22q11.2 DS was imaged using a child-friendly, nonsedated MRI protocol. Quantitative and qualitative measures of the velopharyngeal area and associated structures were evaluated, and comparisons were made to age-matched control subjects with normal velopharyngeal anatomy.

Results

MRI data were successfully obtained using the child-friendly scanning protocol in the subject in the present study. Quantitative and qualitative differences of the levator muscle and associated velopharyngeal structures were noted. Using these MRI and structural analyses methods, insights related to muscle morphology can be obtained and considered as part of the research and clinical examination of children with 22q11.2 DS.

Conclusion

The imaging protocol described in this study presents an effective means to counteract difficulties in imaging young children.

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Electrophysiology of Perception and Processing of Phonological Information as Indices of Toddlers' Language Performance

Purpose

The toddler years are a critical period for language development and growth. We investigated how event-related potentials (ERPs) to repeated and novel nonwords are associated with clinical assessments of language in young children. In addition, nonword repetition (NWR) was used to measure phonological working memory to determine the unique and collective contribution of ERP measures of phonemic discrimination and NWR as predictors of language ability.

Method

Forty children between the ages of 24–48 months participated in an ERP experiment to determine phonemic discrimination to repeated and novel nonwords in an old/new design. Participants also completed a NWR task to explore the contribution of phonological working memory in predicting language.

Results

ERP analyses revealed that faster responses to novel stimuli correlated with higher language performance on clinical assessments of language. Regression analyses revealed that an earlier component was associated with lower level phonemic sensitivity, and a later component was indexing phonological working memory skills similar to NWR.

Conclusion

Our findings suggest that passive ERP responses indexing phonological discrimination and phonological working memory are strongly related to behavioral measures of language.

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Examining a New Method to Studying Velopharyngeal Structures in a Child With 22q11.2 Deletion Syndrome

Purpose

To date, no studies have imaged the velopharynx in children with 22q11.2 deletion syndrome (22q11.2 DS) without the use of sedation. Dysmorphology in velopharyngeal structures has been shown to have significant negative implications on speech among these individuals. This single case study was designed to assess the feasibility of a child-friendly magnetic resonance imaging (MRI) scanning protocol in this clinically challenging population and to determine the utility of this MRI protocol for future work in this area.

Method

One 6-year-old White girl diagnosed with 22q11.2 DS was imaged using a child-friendly, nonsedated MRI protocol. Quantitative and qualitative measures of the velopharyngeal area and associated structures were evaluated, and comparisons were made to age-matched control subjects with normal velopharyngeal anatomy.

Results

MRI data were successfully obtained using the child-friendly scanning protocol in the subject in the present study. Quantitative and qualitative differences of the levator muscle and associated velopharyngeal structures were noted. Using these MRI and structural analyses methods, insights related to muscle morphology can be obtained and considered as part of the research and clinical examination of children with 22q11.2 DS.

Conclusion

The imaging protocol described in this study presents an effective means to counteract difficulties in imaging young children.

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Electrophysiology of Perception and Processing of Phonological Information as Indices of Toddlers' Language Performance

Purpose

The toddler years are a critical period for language development and growth. We investigated how event-related potentials (ERPs) to repeated and novel nonwords are associated with clinical assessments of language in young children. In addition, nonword repetition (NWR) was used to measure phonological working memory to determine the unique and collective contribution of ERP measures of phonemic discrimination and NWR as predictors of language ability.

Method

Forty children between the ages of 24–48 months participated in an ERP experiment to determine phonemic discrimination to repeated and novel nonwords in an old/new design. Participants also completed a NWR task to explore the contribution of phonological working memory in predicting language.

Results

ERP analyses revealed that faster responses to novel stimuli correlated with higher language performance on clinical assessments of language. Regression analyses revealed that an earlier component was associated with lower level phonemic sensitivity, and a later component was indexing phonological working memory skills similar to NWR.

Conclusion

Our findings suggest that passive ERP responses indexing phonological discrimination and phonological working memory are strongly related to behavioral measures of language.

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Examining a New Method to Studying Velopharyngeal Structures in a Child With 22q11.2 Deletion Syndrome

Purpose

To date, no studies have imaged the velopharynx in children with 22q11.2 deletion syndrome (22q11.2 DS) without the use of sedation. Dysmorphology in velopharyngeal structures has been shown to have significant negative implications on speech among these individuals. This single case study was designed to assess the feasibility of a child-friendly magnetic resonance imaging (MRI) scanning protocol in this clinically challenging population and to determine the utility of this MRI protocol for future work in this area.

Method

One 6-year-old White girl diagnosed with 22q11.2 DS was imaged using a child-friendly, nonsedated MRI protocol. Quantitative and qualitative measures of the velopharyngeal area and associated structures were evaluated, and comparisons were made to age-matched control subjects with normal velopharyngeal anatomy.

Results

MRI data were successfully obtained using the child-friendly scanning protocol in the subject in the present study. Quantitative and qualitative differences of the levator muscle and associated velopharyngeal structures were noted. Using these MRI and structural analyses methods, insights related to muscle morphology can be obtained and considered as part of the research and clinical examination of children with 22q11.2 DS.

Conclusion

The imaging protocol described in this study presents an effective means to counteract difficulties in imaging young children.

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Electrophysiology of Perception and Processing of Phonological Information as Indices of Toddlers' Language Performance

Purpose

The toddler years are a critical period for language development and growth. We investigated how event-related potentials (ERPs) to repeated and novel nonwords are associated with clinical assessments of language in young children. In addition, nonword repetition (NWR) was used to measure phonological working memory to determine the unique and collective contribution of ERP measures of phonemic discrimination and NWR as predictors of language ability.

Method

Forty children between the ages of 24–48 months participated in an ERP experiment to determine phonemic discrimination to repeated and novel nonwords in an old/new design. Participants also completed a NWR task to explore the contribution of phonological working memory in predicting language.

Results

ERP analyses revealed that faster responses to novel stimuli correlated with higher language performance on clinical assessments of language. Regression analyses revealed that an earlier component was associated with lower level phonemic sensitivity, and a later component was indexing phonological working memory skills similar to NWR.

Conclusion

Our findings suggest that passive ERP responses indexing phonological discrimination and phonological working memory are strongly related to behavioral measures of language.

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Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT.

Hypothesis: The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea. Background: An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed. Methods: Clinical and micro-CT images of 20 cadaveric cochleae were acquired. Four specialists measured A-values on clinical CT images using both standard views and multiplanar reconstructed (MPR) views. Measurements were repeated to assess for intraobserver variability. Observer variabilities were evaluated using intra-class correlation and absolute differences. Accuracy was evaluated by comparison to the gold standard micro-CT images of the same specimens. Results: Interobserver variability was good (average absolute difference: 0.77 +/- 0.42 mm) using standard views and fair (average absolute difference: 0.90 +/- 0.31 mm) using MPR views. Intraobserver variability had an average absolute difference of 0.31 +/- 0.09 mm for the standard views and 0.38 +/- 0.17 mm for the MPR views. MPR view measurements were more accurate than standard views, with average relative errors of 9.5 and 14.5%, respectively. Conclusion: There was significant observer variability in A-value measurements using both the standard and MPR views. Creating the MPR views increased variability between experts, however MPR views yielded more accurate results. Automated A-value measurement algorithms may help to reduce variability and increase accuracy in the future. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Emerging Therapies for Sensorineural Hearing Loss.

Objective: To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss. Data Sources: US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed. Study Selection & Data Extraction: A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised. Data Synthesis: Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration. Conclusion: A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Influence of Floating-mass Transducer Coupling Efficiency for Active Middle-ear Implants on Speech Recognition.

Objective: The efficiency of vibroplasty (coupler-floating mass transducer [FMT] assembly) can be monitored by direct stimulation of the inner ear through the active middle-ear implant system and comparison of the vibroplasty in vivo threshold and the postoperative bone-conduction pure-tone threshold. The aim of this study was to compare the vibroplasty in vivo threshold with the postoperative speech recognition in patients with a high preoperative maximum word recognition score. Study Design: Retrospective cohort study of German-speaking patients implanted with a vibrating ossicular prosthesis (VORP) 502 or VORP 503 and high preoperative maximum word recognition score between the years of 2011 and 2015. Setting: Multicenter study of four German centers. Patients: Twenty-three active middle-ear implant users. Intervention: Rehabilitative. Main Outcome Measures: Bone-conduction pure-tone and vibroplasty thresholds, postoperative aided word recognition score (WRS) at 65 dB SPL (sound pressure level) and preoperative maximum WRS with Freiburg monosyllabic words. Results: The mean postoperative aided WRS at 65 dB SPL was 82%. An increasing difference between vibroplasty thresholds and bone-conduction thresholds was associated with a higher discrepancy between the unaided maximum WRS and the postoperative aided WRS. Only if this difference was less than 20 dB, an articulation index of 0.5 (WRS = 75%) or more was achieved. Conclusions: Audiological outcome after vibroplasty depends on the coupling efficiency reflected by the vibroplasty threshold. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Voice Handicap Index and Interpretation of the Cutoff Points Using Receiver Operating Characteristic Curve as Screening for Young Adult Female Smokers

Publication date: Available online 6 April 2017
Source:Journal of Voice
Author(s): Dionysios Tafiadis, Evangelia I. Kosma, Spyridon K. Chronopoulos, Aggelos Papadopoulos, Konstantinos Drosos, Vassiliki Siafaka, Eugenia I. Toki, Nausica Ziavra
The relationship between smoking and alterations of the vocal tract and larynx is well known. This pathology leads to the degradation of voice performance in daily living. Multiple assessment methods of vocal tract and larynx have been developed, and in recent years they were enriched with self-reported questionnaires such as Voice Handicap Index (VHI). This study determined the cutoff points of VHI's total score and its three domains for young female smokers in Greece. These estimated cutoff points could be used by voice specialists as an indicator for further clinical evaluation (foreseeing a potential risk of developing a vocal symptom because of smoking habits). A sample of 120 female nondysphonic smokers (aged 18–31) was recruited. Participants filled out the VHI and Voice Evaluation Form. VHI's cutoff point of total score was calculated at the value of 19.50 (sensitivity: 0.780, specificity: 0.133). Specifically, the construct domain of functional was 7.50 (sensitivity: 0.900, specificity: 0.217), for physical it was 8.50 (sensitivity: 0.867, specificity: 0.483), and for emotional it was 7.50 (sensitivity: 0.833, specificity: 0.200) through the use of receiver operating characteristic. Furthermore, VHI could be used as a monitoring tool for smokers and as a feedback for smoking cessation.



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Increased risk of sudden sensorineural hearing loss in patients with hepatitis virus infection

by Hsin-Chien Chen, Chi-Hsiang Chung, Chih-Hung Wang, Jung-Chun Lin, Wei-Kuo Chang, Fu-Huang Lin, Chang-Huei Tsao, Yung-Fu Wu, Wu-Chien Chien

The etiology of sudden sensorineural hearing loss (SSNHL) remains unclear. Possible causes of SSNHL include vascular diseases, viral infection, and autoimmune disorders. Therefore, we investigated whether hepatitis virus infection is correlated with the risk of SSNHL. Using data from the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched-cohort study to compare patients diagnosed with hepatitis B or C virus (HBV/HCV) infections from January 1, 2000, to December 31, 2010, (N = 170,942) with frequency-matched controls (N = 512,826) at a ratio of 1:3 by sex, age, and index year. We followed each patient until the end of 2010 and evaluated the incidence of SSNHL. At the end of the follow-up period, 647 (0.38%, 647/170,942) patients developed SSNHL in the HBV/HCV group compared with 978 (0.19%, 978/512,826) in the control groups, with a statistical significance of P

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On the role of ephrinA2 in auditory function

Publication date: Available online 5 April 2017
Source:Hearing Research
Author(s): Neil J. Ingham, Karen P. Steel, Uwe Drescher
Recent findings suggest that the manipulation of the EphA/ephrinA system can improve hearing threshold sensitivity in the auditory system (Yates et al., 2014). These results appear to open-up the possibility that pharmacological manipulation of this system could lead to the development of treatments to cure some types of hearing loss. As a first step towards this goal, we have performed a further series of auditory brainstem evoked potential recordings on ephrinA2 homozygous knockout mice and their wildtype littermates in order to replicate the previously reported findings. However, we found that ephrinA2 knockout mice had auditory threshold sensitivity for click and 3–42 kHz tone pip frequencies comparable to that of their wildtype littermates. Evoked potential wave amplitudes, latencies and inter-peak intervals were also comparable between ephrinA2 knockout mice and wild type control littermates. Thus in our experiments we could not replicate the findings of Yates et al. (2014). Whilst the EphA/ephrinA system may therefore play a role in the development of innervation of the cochlea and neural circuitry of the auditory brainstem, there appears to be a functional redundancy between members of this family such that loss of ephrinA2 function alone is insufficient to alter auditory function in the mouse.



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On the role of ephrinA2 in auditory function

Publication date: Available online 5 April 2017
Source:Hearing Research
Author(s): Neil J. Ingham, Karen P. Steel, Uwe Drescher
Recent findings suggest that the manipulation of the EphA/ephrinA system can improve hearing threshold sensitivity in the auditory system (Yates et al., 2014). These results appear to open-up the possibility that pharmacological manipulation of this system could lead to the development of treatments to cure some types of hearing loss. As a first step towards this goal, we have performed a further series of auditory brainstem evoked potential recordings on ephrinA2 homozygous knockout mice and their wildtype littermates in order to replicate the previously reported findings. However, we found that ephrinA2 knockout mice had auditory threshold sensitivity for click and 3–42 kHz tone pip frequencies comparable to that of their wildtype littermates. Evoked potential wave amplitudes, latencies and inter-peak intervals were also comparable between ephrinA2 knockout mice and wild type control littermates. Thus in our experiments we could not replicate the findings of Yates et al. (2014). Whilst the EphA/ephrinA system may therefore play a role in the development of innervation of the cochlea and neural circuitry of the auditory brainstem, there appears to be a functional redundancy between members of this family such that loss of ephrinA2 function alone is insufficient to alter auditory function in the mouse.



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On the role of ephrinA2 in auditory function

Publication date: Available online 5 April 2017
Source:Hearing Research
Author(s): Neil J. Ingham, Karen P. Steel, Uwe Drescher
Recent findings suggest that the manipulation of the EphA/ephrinA system can improve hearing threshold sensitivity in the auditory system (Yates et al., 2014). These results appear to open-up the possibility that pharmacological manipulation of this system could lead to the development of treatments to cure some types of hearing loss. As a first step towards this goal, we have performed a further series of auditory brainstem evoked potential recordings on ephrinA2 homozygous knockout mice and their wildtype littermates in order to replicate the previously reported findings. However, we found that ephrinA2 knockout mice had auditory threshold sensitivity for click and 3–42 kHz tone pip frequencies comparable to that of their wildtype littermates. Evoked potential wave amplitudes, latencies and inter-peak intervals were also comparable between ephrinA2 knockout mice and wild type control littermates. Thus in our experiments we could not replicate the findings of Yates et al. (2014). Whilst the EphA/ephrinA system may therefore play a role in the development of innervation of the cochlea and neural circuitry of the auditory brainstem, there appears to be a functional redundancy between members of this family such that loss of ephrinA2 function alone is insufficient to alter auditory function in the mouse.



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On the role of ephrinA2 in auditory function

Publication date: Available online 5 April 2017
Source:Hearing Research
Author(s): Neil J. Ingham, Karen P. Steel, Uwe Drescher
Recent findings suggest that the manipulation of the EphA/ephrinA system can improve hearing threshold sensitivity in the auditory system (Yates et al., 2014). These results appear to open-up the possibility that pharmacological manipulation of this system could lead to the development of treatments to cure some types of hearing loss. As a first step towards this goal, we have performed a further series of auditory brainstem evoked potential recordings on ephrinA2 homozygous knockout mice and their wildtype littermates in order to replicate the previously reported findings. However, we found that ephrinA2 knockout mice had auditory threshold sensitivity for click and 3–42 kHz tone pip frequencies comparable to that of their wildtype littermates. Evoked potential wave amplitudes, latencies and inter-peak intervals were also comparable between ephrinA2 knockout mice and wild type control littermates. Thus in our experiments we could not replicate the findings of Yates et al. (2014). Whilst the EphA/ephrinA system may therefore play a role in the development of innervation of the cochlea and neural circuitry of the auditory brainstem, there appears to be a functional redundancy between members of this family such that loss of ephrinA2 function alone is insufficient to alter auditory function in the mouse.



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On the role of ephrinA2 in auditory function

Publication date: Available online 5 April 2017
Source:Hearing Research
Author(s): Neil J. Ingham, Karen P. Steel, Uwe Drescher
Recent findings suggest that the manipulation of the EphA/ephrinA system can improve hearing threshold sensitivity in the auditory system (Yates et al., 2014). These results appear to open-up the possibility that pharmacological manipulation of this system could lead to the development of treatments to cure some types of hearing loss. As a first step towards this goal, we have performed a further series of auditory brainstem evoked potential recordings on ephrinA2 homozygous knockout mice and their wildtype littermates in order to replicate the previously reported findings. However, we found that ephrinA2 knockout mice had auditory threshold sensitivity for click and 3–42 kHz tone pip frequencies comparable to that of their wildtype littermates. Evoked potential wave amplitudes, latencies and inter-peak intervals were also comparable between ephrinA2 knockout mice and wild type control littermates. Thus in our experiments we could not replicate the findings of Yates et al. (2014). Whilst the EphA/ephrinA system may therefore play a role in the development of innervation of the cochlea and neural circuitry of the auditory brainstem, there appears to be a functional redundancy between members of this family such that loss of ephrinA2 function alone is insufficient to alter auditory function in the mouse.



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Deaf or hard of hearing children in Saudi Arabia: Status of early intervention services.

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Deaf or hard of hearing children in Saudi Arabia: Status of early intervention services.

Int J Pediatr Otorhinolaryngol. 2016 Jul;86:142-9

Authors: Alyami H, Soer M, Swanepoel A, Pottas L

Abstract
OBJECTIVE: This study aims to determine the status of early intervention services provided to children who are deaf or hard of hearing and their parents/caregivers from birth to five years of age at two main state hospitals in Riyadh, Saudi Arabia, based on their parents' perceptions.
METHOD: A descriptive quantitative research design was used to determine the status of early intervention services for deaf or hard of hearing children in Saudi Arabia based on their parents' perceptions. Semistructured interviews based on a questionnaire were conducted with 60 research participants from two main state hospitals where early detection and intervention services are provided. A purposive sampling technique was employed. Descriptive and inferential statistical analyses were performed on the data collected.
RESULTS: The participants' children were diagnosed at a substantially late age, resulting in delayed ages for initial hearing aid fitting and enrolment in early intervention services. A significant relationship was found between the residential area of the participants and timely access to intervention services. The results indicated that participants residing in Riyadh were fitted with hearing aids and enrolled into EI services earlier than those living outside of Riyadh. The delivery of information also emerged as a weakness in the EI system for the majority of participants.
CONCLUSION: The findings of the study suggested that limited services of detection and intervention for deaf or hard of hearing children and residential area of participants are likely to be barriers to early access to intervention services. It is proposed that the benefits of UNHS accompanied by appropriate early intervention services should be made available in all regions throughout Saudi Arabia.

PMID: 27260597 [PubMed - indexed for MEDLINE]

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Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study.

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Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study.

Am J Audiol. 2016 Jun 01;25(2):110-26

Authors: Henderson RJ, Johnson AM, Moodie ST

Abstract
BACKGROUND: A scoping review of the literature was conducted, resulting in the development of a conceptual framework of parent-to-parent support for parents with children who are Deaf or hard of hearing. This is the 2nd stage of a dual-stage scoping review.
PURPOSE: This study sought stakeholder opinion and feedback with an aim to achieve consensus on the constructs, components, and design of the initial conceptual framework.
RESEARCH DESIGN: A modified electronic Delphi study was completed with 21 handpicked experts from 7 countries who have experience in provision, research, or experience in the area of parent-to-parent support. Participants completed an online questionnaire using an 11-point Likert scale (strongly disagree to strongly agree) and open-ended questions to answer various questions related to the descriptor terms, definitions, constructs, components, and overall design of the framework.
RESULTS: Participant responses led to the revision of the original conceptual framework.
CONCLUSION: The findings from this dual-stage scoping review and electronic Delphi study provide a conceptual framework that defines the vital contribution of parents in Early Hearing Detection and Intervention programs that will be a useful addition to these programs.

PMID: 27249168 [PubMed - indexed for MEDLINE]

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Comparison of the Classifier Oriented Gait Score and the Gait Profile Score based on imitated gait impairments

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Christian Josef, Kröll Josef, Schwameder Hermann
Common summary measures of gait quality such as the Gait Profile Score (GPS) are based on the principle of measuring a distance from the mean pattern of a healthy reference group in a gait pattern vector space. The recently introduced Classifier Oriented Gait Score (COGS) is a pathology specific score that measures this distance in a unique direction, which is indicated by a linear classifier. This approach has potentially improved the discriminatory power to detect subtle changes in gait patterns but does not incorporate a profile of interpretable sub-scores like the GPS. The main aims of this study were to extend the COGS by decomposing it into interpretable sub-scores as realized in the GPS and to compare the discriminative power of the GPS and COGS. Two types of gait impairments were imitated to enable a high level of control of the gait patterns. Imitated impairments were realized by restricting knee extension and inducing leg length discrepancy. The results showed increased discriminatory power of the COGS for differentiating diverse levels of impairment. Comparison of the GPS and COGS sub-scores and their ability to indicate changes in specific variables supports the validity of both scores. The COGS is an overall measure of gait quality with increased power to detect subtle changes in gait patterns and might be well suited for tracing the effect of a therapeutic treatment over time. The newly introduced sub-scores improved the interpretability of the COGS, which is helpful for practical applications.



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Ankle Muscle Co-Contractions During Quiet Standing Are Associated with Decreased Postural Steadiness in the Elderly

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Albert H. Vette, Dimitry G. Sayenko, Michael Jones, Masaki O. Abe, Kimitaka Nakazawa, Kei Masani
It has been reported that the elderly use co-contraction of the tibialis anterior (TA) and plantarflexor muscles for longer duration during quiet standing than the young. However, the particular role of ankle muscle co-contractions in the elderly during quiet standing remains unclear. Therefore, the objective of this study was to investigate the association between ankle muscle co-contractions and postural steadiness during standing in the elderly. Twenty-seven young (27.2±4.5 yrs) and twenty-three elderly (66.2±5.0 yrs) subjects were asked to stand quietly on a force plate for five trials. The center of pressure (COP) trajectory and its velocity (COPv) as well as the center of mass (COM) trajectory and its velocity (COMv) and acceleration (ACC) were calculated using the force plate outputs. Electromyograms were obtained from the right TA, soleus (SOL), and medial gastrocnemius (MG) muscles. Periods of TA activity (TAon) and inactivity (TAoff) were determined using an EMG threshold based on TA resting level. Our results indicate that, in the elderly, the COPv, COMv, and ACC variability was significantly larger during TAon periods compared to TAoff periods. However, in the young, no significant association between respective variability and TA activity was found. We conclude that ankle muscle co-contractions in the elderly are not associated with an increase, but a decrease in postural steadiness. Future studies are needed to clarify the causal relationship between (1) ankle muscle co-contractions and (2) joint stiffness and multi-segmental actions during standing as well as their changes with aging.



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Assessment of stability during gait in patients with spinal deformity − A preliminary analysis using the dynamic stability margin

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Anne-Laure Simon, Vipul Lugade, Kathie Bernhardt, A. Noelle Larson, Kenton Kaufman
Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables’ accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1m.s⁻¹ versus 1.3m.s⁻¹) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management.



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Comparison of the Classifier Oriented Gait Score and the Gait Profile Score based on imitated gait impairments

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Christian Josef, Kröll Josef, Schwameder Hermann
Common summary measures of gait quality such as the Gait Profile Score (GPS) are based on the principle of measuring a distance from the mean pattern of a healthy reference group in a gait pattern vector space. The recently introduced Classifier Oriented Gait Score (COGS) is a pathology specific score that measures this distance in a unique direction, which is indicated by a linear classifier. This approach has potentially improved the discriminatory power to detect subtle changes in gait patterns but does not incorporate a profile of interpretable sub-scores like the GPS. The main aims of this study were to extend the COGS by decomposing it into interpretable sub-scores as realized in the GPS and to compare the discriminative power of the GPS and COGS. Two types of gait impairments were imitated to enable a high level of control of the gait patterns. Imitated impairments were realized by restricting knee extension and inducing leg length discrepancy. The results showed increased discriminatory power of the COGS for differentiating diverse levels of impairment. Comparison of the GPS and COGS sub-scores and their ability to indicate changes in specific variables supports the validity of both scores. The COGS is an overall measure of gait quality with increased power to detect subtle changes in gait patterns and might be well suited for tracing the effect of a therapeutic treatment over time. The newly introduced sub-scores improved the interpretability of the COGS, which is helpful for practical applications.



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Ankle Muscle Co-Contractions During Quiet Standing Are Associated with Decreased Postural Steadiness in the Elderly

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Albert H. Vette, Dimitry G. Sayenko, Michael Jones, Masaki O. Abe, Kimitaka Nakazawa, Kei Masani
It has been reported that the elderly use co-contraction of the tibialis anterior (TA) and plantarflexor muscles for longer duration during quiet standing than the young. However, the particular role of ankle muscle co-contractions in the elderly during quiet standing remains unclear. Therefore, the objective of this study was to investigate the association between ankle muscle co-contractions and postural steadiness during standing in the elderly. Twenty-seven young (27.2±4.5 yrs) and twenty-three elderly (66.2±5.0 yrs) subjects were asked to stand quietly on a force plate for five trials. The center of pressure (COP) trajectory and its velocity (COPv) as well as the center of mass (COM) trajectory and its velocity (COMv) and acceleration (ACC) were calculated using the force plate outputs. Electromyograms were obtained from the right TA, soleus (SOL), and medial gastrocnemius (MG) muscles. Periods of TA activity (TAon) and inactivity (TAoff) were determined using an EMG threshold based on TA resting level. Our results indicate that, in the elderly, the COPv, COMv, and ACC variability was significantly larger during TAon periods compared to TAoff periods. However, in the young, no significant association between respective variability and TA activity was found. We conclude that ankle muscle co-contractions in the elderly are not associated with an increase, but a decrease in postural steadiness. Future studies are needed to clarify the causal relationship between (1) ankle muscle co-contractions and (2) joint stiffness and multi-segmental actions during standing as well as their changes with aging.



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Assessment of stability during gait in patients with spinal deformity − A preliminary analysis using the dynamic stability margin

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Anne-Laure Simon, Vipul Lugade, Kathie Bernhardt, A. Noelle Larson, Kenton Kaufman
Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables’ accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1m.s⁻¹ versus 1.3m.s⁻¹) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management.



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Comparison of the Classifier Oriented Gait Score and the Gait Profile Score based on imitated gait impairments

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Christian Josef, Kröll Josef, Schwameder Hermann
Common summary measures of gait quality such as the Gait Profile Score (GPS) are based on the principle of measuring a distance from the mean pattern of a healthy reference group in a gait pattern vector space. The recently introduced Classifier Oriented Gait Score (COGS) is a pathology specific score that measures this distance in a unique direction, which is indicated by a linear classifier. This approach has potentially improved the discriminatory power to detect subtle changes in gait patterns but does not incorporate a profile of interpretable sub-scores like the GPS. The main aims of this study were to extend the COGS by decomposing it into interpretable sub-scores as realized in the GPS and to compare the discriminative power of the GPS and COGS. Two types of gait impairments were imitated to enable a high level of control of the gait patterns. Imitated impairments were realized by restricting knee extension and inducing leg length discrepancy. The results showed increased discriminatory power of the COGS for differentiating diverse levels of impairment. Comparison of the GPS and COGS sub-scores and their ability to indicate changes in specific variables supports the validity of both scores. The COGS is an overall measure of gait quality with increased power to detect subtle changes in gait patterns and might be well suited for tracing the effect of a therapeutic treatment over time. The newly introduced sub-scores improved the interpretability of the COGS, which is helpful for practical applications.



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Ankle Muscle Co-Contractions During Quiet Standing Are Associated with Decreased Postural Steadiness in the Elderly

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Albert H. Vette, Dimitry G. Sayenko, Michael Jones, Masaki O. Abe, Kimitaka Nakazawa, Kei Masani
It has been reported that the elderly use co-contraction of the tibialis anterior (TA) and plantarflexor muscles for longer duration during quiet standing than the young. However, the particular role of ankle muscle co-contractions in the elderly during quiet standing remains unclear. Therefore, the objective of this study was to investigate the association between ankle muscle co-contractions and postural steadiness during standing in the elderly. Twenty-seven young (27.2±4.5 yrs) and twenty-three elderly (66.2±5.0 yrs) subjects were asked to stand quietly on a force plate for five trials. The center of pressure (COP) trajectory and its velocity (COPv) as well as the center of mass (COM) trajectory and its velocity (COMv) and acceleration (ACC) were calculated using the force plate outputs. Electromyograms were obtained from the right TA, soleus (SOL), and medial gastrocnemius (MG) muscles. Periods of TA activity (TAon) and inactivity (TAoff) were determined using an EMG threshold based on TA resting level. Our results indicate that, in the elderly, the COPv, COMv, and ACC variability was significantly larger during TAon periods compared to TAoff periods. However, in the young, no significant association between respective variability and TA activity was found. We conclude that ankle muscle co-contractions in the elderly are not associated with an increase, but a decrease in postural steadiness. Future studies are needed to clarify the causal relationship between (1) ankle muscle co-contractions and (2) joint stiffness and multi-segmental actions during standing as well as their changes with aging.



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Assessment of stability during gait in patients with spinal deformity − A preliminary analysis using the dynamic stability margin

Publication date: Available online 5 April 2017
Source:Gait & Posture
Author(s): Anne-Laure Simon, Vipul Lugade, Kathie Bernhardt, A. Noelle Larson, Kenton Kaufman
Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables’ accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1m.s⁻¹ versus 1.3m.s⁻¹) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management.



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Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

Objectives: Severe-to-profound sudden sensorineural hearing loss (SSNHL) has a poor prognosis. We aimed to compare the efficacy of simultaneous and sequential oral and intratympanic steroids for this condition. Methods: Fifty patients with severe-to-profound SSNHL (>70 dB HL) were included from 7 centers. The simultaneous group (27 patients) received oral and intratympanic steroid injections for 2 weeks. The sequential group (23 patients) was treated with oral steroids for 2 weeks and intratympanic steroids for the subsequent 2 weeks. Pure-tone averages (PTA) and word discrimination scores (WDS) were compared before treatment and 2 weeks and 1 and 2 months after treatment. Treatment outcomes according to the modified American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria were also analyzed. Results: The improvement in PTA and WDS at the 2-week follow-up was 23 ± 21 dB HL and 20 ± 39% in the simultaneous group and 31 ± 29 dB HL and 37 ± 42% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-week follow-up was observed in 26% of the simultaneous group and 30% of the sequential group; this was also not significant. The improvement in PTA and WDS at the 2-month follow-up was 40 ± 20 dB HL and 37 ± 35% in the simultaneous group and 41 ± 25 dB HL and 48 ± 41% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-month follow-up was observed in 33% of the simultaneous group and 35% of the sequential group; this was also not significant. Seven patients in the sequential group did not need intratympanic steroid injections for sufficient improvement after oral steroids alone. Conclusions: Simultaneous oral/intratympanic steroid treatment yielded a recovery similar to that produced by sequential treatment. Because the addition of intratympanic steroids can be decided upon based on the improvement after an oral steroid, the sequential regimen can be recommended to avoid unnecessary intratympanic injections.
Audiol Neurotol 2016;21:399-405

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Automatic Localization of Cochlear Implant Electrode Contacts in CT.

Objectives: Determining the exact location of cochlear implant (CI) electrode contacts after implantation is important, as it helps quantifying the relation between CI positioning and hearing outcome. Unfortunately, localization of individual contacts can be difficult, because the spacing between the electrode contacts is near the spatial resolution limit of high-resolution clinical computed tomography (CT) scanners. This study introduces and examines a simple, automatic method for the localization of intracochlear electrode contacts. CI geometric specifications may provide the prior knowledge that is essential to accurately estimate contact positions, even though individual contacts may not be visibly resolved. Design: The prior knowledge in CI geometry is used to accurately estimate intracochlear electrode contact positions in high-resolution CT scans of seven adult patients implanted with a CI (Cochlear Ltd.). The automatically detected electrode contact locations were verified against locations marked by two experienced observers. The interobserver errors and the errors between the averaged locations and the automatically detected locations were calculated. The estimated contact positions were transformed to a cylindrical cochlear coordinate system, according to an international consensus, in which the insertion angles and the radius and elevation were measured. Results: The linear correlation of the automatically detected electrode contact positions with the manually detected locations was high (R2 = 0.98 for the radius, and R2 = 1.00 for the insertion angle). The errors in radius and in insertion angle between the automatically detected locations and the manually detected locations were 0.12 mm and 1.7[degrees]. These errors were comparable to the interobserver errors. Geometrical measurements were in line with what is usually found in human cochleae. The mean insertion angle of the most apical electrode was 410[degrees] (range: 316[degrees] to 503[degrees]). The mean radius of the electrode contacts in the first turn of the cochlear spiral was 3.0 mm, and the mean radius of the remainder in the second turn was 1.7 mm. Conclusions: With implant geometry as prior knowledge, automatic analysis of high-resolution CT scans enables accurate localization of CI electrode contacts. The output of this method can be used to study the effect of CI positioning on hearing outcomes in more detail. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Automatic Localization of Cochlear Implant Electrode Contacts in CT.

Objectives: Determining the exact location of cochlear implant (CI) electrode contacts after implantation is important, as it helps quantifying the relation between CI positioning and hearing outcome. Unfortunately, localization of individual contacts can be difficult, because the spacing between the electrode contacts is near the spatial resolution limit of high-resolution clinical computed tomography (CT) scanners. This study introduces and examines a simple, automatic method for the localization of intracochlear electrode contacts. CI geometric specifications may provide the prior knowledge that is essential to accurately estimate contact positions, even though individual contacts may not be visibly resolved. Design: The prior knowledge in CI geometry is used to accurately estimate intracochlear electrode contact positions in high-resolution CT scans of seven adult patients implanted with a CI (Cochlear Ltd.). The automatically detected electrode contact locations were verified against locations marked by two experienced observers. The interobserver errors and the errors between the averaged locations and the automatically detected locations were calculated. The estimated contact positions were transformed to a cylindrical cochlear coordinate system, according to an international consensus, in which the insertion angles and the radius and elevation were measured. Results: The linear correlation of the automatically detected electrode contact positions with the manually detected locations was high (R2 = 0.98 for the radius, and R2 = 1.00 for the insertion angle). The errors in radius and in insertion angle between the automatically detected locations and the manually detected locations were 0.12 mm and 1.7[degrees]. These errors were comparable to the interobserver errors. Geometrical measurements were in line with what is usually found in human cochleae. The mean insertion angle of the most apical electrode was 410[degrees] (range: 316[degrees] to 503[degrees]). The mean radius of the electrode contacts in the first turn of the cochlear spiral was 3.0 mm, and the mean radius of the remainder in the second turn was 1.7 mm. Conclusions: With implant geometry as prior knowledge, automatic analysis of high-resolution CT scans enables accurate localization of CI electrode contacts. The output of this method can be used to study the effect of CI positioning on hearing outcomes in more detail. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Automatic Localization of Cochlear Implant Electrode Contacts in CT.

Objectives: Determining the exact location of cochlear implant (CI) electrode contacts after implantation is important, as it helps quantifying the relation between CI positioning and hearing outcome. Unfortunately, localization of individual contacts can be difficult, because the spacing between the electrode contacts is near the spatial resolution limit of high-resolution clinical computed tomography (CT) scanners. This study introduces and examines a simple, automatic method for the localization of intracochlear electrode contacts. CI geometric specifications may provide the prior knowledge that is essential to accurately estimate contact positions, even though individual contacts may not be visibly resolved. Design: The prior knowledge in CI geometry is used to accurately estimate intracochlear electrode contact positions in high-resolution CT scans of seven adult patients implanted with a CI (Cochlear Ltd.). The automatically detected electrode contact locations were verified against locations marked by two experienced observers. The interobserver errors and the errors between the averaged locations and the automatically detected locations were calculated. The estimated contact positions were transformed to a cylindrical cochlear coordinate system, according to an international consensus, in which the insertion angles and the radius and elevation were measured. Results: The linear correlation of the automatically detected electrode contact positions with the manually detected locations was high (R2 = 0.98 for the radius, and R2 = 1.00 for the insertion angle). The errors in radius and in insertion angle between the automatically detected locations and the manually detected locations were 0.12 mm and 1.7[degrees]. These errors were comparable to the interobserver errors. Geometrical measurements were in line with what is usually found in human cochleae. The mean insertion angle of the most apical electrode was 410[degrees] (range: 316[degrees] to 503[degrees]). The mean radius of the electrode contacts in the first turn of the cochlear spiral was 3.0 mm, and the mean radius of the remainder in the second turn was 1.7 mm. Conclusions: With implant geometry as prior knowledge, automatic analysis of high-resolution CT scans enables accurate localization of CI electrode contacts. The output of this method can be used to study the effect of CI positioning on hearing outcomes in more detail. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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