Objectives: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (
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Τρίτη 25 Απριλίου 2017
Speech Detection in Noise for Young Bilaterally Implanted Children: Is There Evidence of Binaural Benefit Over the Shadowed Ear Alone?.
Objectives: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (
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Speech Detection in Noise for Young Bilaterally Implanted Children: Is There Evidence of Binaural Benefit Over the Shadowed Ear Alone?.
Objectives: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (
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Cochlear Implantation in Adults With Asymmetric Hearing Loss: Benefits of Bimodal Stimulation.
Objective: This study addresses the outcome of cochlear implantation in addition to hearing aid use in patients with asymmetric sensorineural hearing loss. Study Design: Prospective longitudinal study. Setting: Tertiary referral center. Patients: Seven adults with asymmetric sensorineural hearing loss, i.e., less than 30% aided speech recognition in their worst hearing ear and 60 to 85% speech recognition in their best hearing ear. All patients had a postlingual onset of their hearing loss and less than 20 years of auditory deprivation of their worst hearing ear. Intervention: Cochlear implantation in the functionally deaf ear. Main Outcome Measures: Speech recognition in quiet, speech recognition in noise, spatial speech recognition, localization abilities, music appreciation, and quality of life. Measurements were performed before cochlear implantation and 3, 6, and 12 months after cochlear implantation. Results: Before cochlear implantation, the average speech recognition of the ear fitted with a hearing aid was 74%. Cochlear implantation eventually resulted in an average speech recognition of 75%. Bimodal stimulation yielded speech recognition scores of 82, 86, and 88% after 3, 6, and 12 months, respectively. At all time intervals, bimodal stimulation resulted in a significantly better speech recognition as compared with stimulation with only hearing aid or only cochlear implant (CI). Speech recognition in noise and spatial speech recognition significantly improved as well as the ability to localize sounds and the quality of life. Conclusion: This study demonstrated that patients are able to successfully integrate electrical stimulation with contralateral acoustic amplification and benefit from bimodal stimulation. Therefore, we think that cochlear implantation should be considered in this particular group of patients, even in the presence of substantial residual hearing on the contralateral side. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Preliminary Model for the Design of a Custom Middle Ear Prosthesis.
Hypothesis: Custom prostheses could be used to recreate the ossicular chain and improve hearing. Background: Ossicular discontinuity or fixation occurs in 55% of cases of conductive hearing loss, with most cases involving the incus. Reconstruction has been achieved by a variety of methods; however, there has been little improvement in hearing outcomes in decades. Methods: Precise measurements of anatomic dimensions, weight, and center of gravity were taken from 19 cadaveric incudes. These measurements were combined with measurements from the medical literature and micro-computed tomography (micro-CT) of cadaveric temporal bones to generate a rasterizable incus model. As a proof of concept, incudal replacements including possible anatomic variations were then three-dimensionally (3-D) printed and inserted into a cadaveric temporal bone. Results: Our measurements of cadaveric incudes corresponded well with those from the medical literature. These measurements were combined with anatomical information from micro-CT allowing identification of critical features of the incus, which remained constant. Other model features were modified to increase stability and facilitate synthesis, including broadening and thickening of the lenticular process and the incudomalleolar articulation. 3-D printed incudal replacements based on this model readily fit into a cadaveric temporal bone and successfully bridged the gap between malleus and incus. Conclusion: We have generated a model for custom 3-D synthesis of incudal prostheses. While current 3-D printing in biocompatible materials at the size required is limited, the technology is rapidly advancing, and 3-D printing of incudal replacements with polylactic acid (PLA) is of the correct size and shape. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
| Related Articles |
Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
Int J Audiol. 2017 Apr 22;:1-13
Authors: Hunter LL, Keefe DH, Feeney MP, Brown DK, Meinzen-Derr J, Elsayed AM, Amann JM, Manickam V, Fitzpatrick D, Shott SR
Abstract
OBJECTIVE: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs).
DESIGN: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226 kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS).
STUDY SAMPLE: Children with DS (n = 40; mean age 6.4 years), and TD children (n = 48; mean age 5.1 years) were included.
RESULTS: Wideband absorbance was significantly lower at 1-4 kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5 kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups.
CONCLUSIONS: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.
PMID: 28434272 [PubMed - as supplied by publisher]
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Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
| Related Articles |
Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
Int J Audiol. 2017 Apr 22;:1-13
Authors: Hunter LL, Keefe DH, Feeney MP, Brown DK, Meinzen-Derr J, Elsayed AM, Amann JM, Manickam V, Fitzpatrick D, Shott SR
Abstract
OBJECTIVE: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs).
DESIGN: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226 kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS).
STUDY SAMPLE: Children with DS (n = 40; mean age 6.4 years), and TD children (n = 48; mean age 5.1 years) were included.
RESULTS: Wideband absorbance was significantly lower at 1-4 kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5 kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups.
CONCLUSIONS: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.
PMID: 28434272 [PubMed - as supplied by publisher]
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Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
| Related Articles |
Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
Int J Audiol. 2017 Apr 22;:1-13
Authors: Hunter LL, Keefe DH, Feeney MP, Brown DK, Meinzen-Derr J, Elsayed AM, Amann JM, Manickam V, Fitzpatrick D, Shott SR
Abstract
OBJECTIVE: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs).
DESIGN: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226 kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS).
STUDY SAMPLE: Children with DS (n = 40; mean age 6.4 years), and TD children (n = 48; mean age 5.1 years) were included.
RESULTS: Wideband absorbance was significantly lower at 1-4 kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5 kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups.
CONCLUSIONS: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.
PMID: 28434272 [PubMed - as supplied by publisher]
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Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
| Related Articles |
Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction, conductive hearing loss and patent PE tubes.
Int J Audiol. 2017 Apr 22;:1-13
Authors: Hunter LL, Keefe DH, Feeney MP, Brown DK, Meinzen-Derr J, Elsayed AM, Amann JM, Manickam V, Fitzpatrick D, Shott SR
Abstract
OBJECTIVE: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs).
DESIGN: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226 kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS).
STUDY SAMPLE: Children with DS (n = 40; mean age 6.4 years), and TD children (n = 48; mean age 5.1 years) were included.
RESULTS: Wideband absorbance was significantly lower at 1-4 kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5 kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups.
CONCLUSIONS: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.
PMID: 28434272 [PubMed - as supplied by publisher]
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Undesirable properties of the dimensionless normalisation for spatio-temporal variables
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Balance training in individuals with Parkinson’s disease: Therapist-supervised vs. home-based exercise programme
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Speed dependent effects of laterally wedged insoles on gait biomechanics in healthy subjects
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Undesirable properties of the dimensionless normalisation for spatio-temporal variables
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Balance training in individuals with Parkinson’s disease: Therapist-supervised vs. home-based exercise programme
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Speed dependent effects of laterally wedged insoles on gait biomechanics in healthy subjects
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Undesirable properties of the dimensionless normalisation for spatio-temporal variables
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Source:Gait & Posture, Volume 55
Author(s): Kohleth Chia, Morgan Sangeux
We used theory and empirical data to demonstrate three undesirable properties of the dimensionless normalisation technique for gait spatio-temporal parameters. Firstly, it may not fully remove the correlation between leg length and spatio-temporal parameters. Secondly, it induces spurious correlation among spatio-temporal parameters, which might obscure their true correlation structure. Thirdly, it induces spurious correlation with external covariates, which complicates further statistical modelling. Therefore, depending on the objectives, we propose alternatives. If the objective is to compare datasets but remove the confounding effect of leg length, residualisation may be an alternative, although the generalisability of the residualisation is less well established than dimensionless normalisation. If the objective is to build a regression model, the raw spatio-temporal parameters could be used with leg length, or a function of leg length, as an explicit regressor to avoid spurious correlation. If correlation is the objective, partial correlation can be used instead.
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Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Source:Gait & Posture, Volume 55
Author(s): Meta N. Eek, Roland Zügner, Ingibjörg Stefansdottir, Roy Tranberg
The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.
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Balance training in individuals with Parkinson’s disease: Therapist-supervised vs. home-based exercise programme
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Source:Gait & Posture, Volume 55
Author(s): Elizabeth Maria Atterbury, Karen Estelle Welman
BackgroundPoor locomotion and balance in Parkinson’s disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD.MethodsAn experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI).ResultsBoth groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002).ConclusionThe home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD.
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Speed dependent effects of laterally wedged insoles on gait biomechanics in healthy subjects
Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Source:Gait & Posture, Volume 55
Author(s): Felix Kluge, Sebastian Krinner, Matthias Lochmann, Bjoern M. Eskofier
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies.Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity.No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes.Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Assessing Sensorineural Hearing Loss Using Various Transient-Evoked Otoacoustic Emission Stimulus Conditions.
Objectives: An important clinical application of transient-evoked otoacoustic emissions (TEOAEs) is to evaluate cochlear outer hair cell function for the purpose of detecting sensorineural hearing loss (SNHL). Double-evoked TEOAEs were measured using a chirp stimulus, in which the stimuli had an extended frequency range compared to clinical tests. The present study compared TEOAEs recorded using an unweighted stimulus presented at either ambient pressure or tympanometric peak pressure (TPP) in the ear canal and TEOAEs recorded using a power-weighted stimulus at ambient pressure. The unweighted stimulus had approximately constant incident pressure magnitude across frequency, and the power-weighted stimulus had approximately constant absorbed sound power across frequency. The objective of this study was to compare TEOAEs from 0.79 to 8 kHz using these three stimulus conditions in adults to assess test performance in classifying ears as having either normal hearing or SNHL. Design: Measurements were completed on 87 adult participants. Eligible participants had either normal hearing (N = 40; M|F = 16|24; mean age = 30 years) or SNHL (N = 47; M|F = 20|27; mean age = 58 years), and normal middle ear function as defined by standard clinical criteria for 226-Hz tympanometry. Clinical audiometry, immittance, and an experimental wideband test battery, which included reflectance and TEOAE tests presented for 1-min durations, were completed for each ear on all participants. All tests were then repeated 1 to 2 months later. TEOAEs were measured by presenting the stimulus in the three stimulus conditions. TEOAE data were analyzed in each hearing group in terms of the half-octave-averaged signal to noise ratio (SNR) and the coherence synchrony measure (CSM) at frequencies between 1 and 8 kHz. The test-retest reliability of these measures was calculated. The area under the receiver operating characteristic curve (AUC) was measured at audiometric frequencies between 1 and 8 kHz to determine TEOAE test performance in distinguishing SNHL from normal hearing. Results: Mean TEOAE SNR was >=8.7 dB for normal-hearing ears and
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Assessing Sensorineural Hearing Loss Using Various Transient-Evoked Otoacoustic Emission Stimulus Conditions.
Objectives: An important clinical application of transient-evoked otoacoustic emissions (TEOAEs) is to evaluate cochlear outer hair cell function for the purpose of detecting sensorineural hearing loss (SNHL). Double-evoked TEOAEs were measured using a chirp stimulus, in which the stimuli had an extended frequency range compared to clinical tests. The present study compared TEOAEs recorded using an unweighted stimulus presented at either ambient pressure or tympanometric peak pressure (TPP) in the ear canal and TEOAEs recorded using a power-weighted stimulus at ambient pressure. The unweighted stimulus had approximately constant incident pressure magnitude across frequency, and the power-weighted stimulus had approximately constant absorbed sound power across frequency. The objective of this study was to compare TEOAEs from 0.79 to 8 kHz using these three stimulus conditions in adults to assess test performance in classifying ears as having either normal hearing or SNHL. Design: Measurements were completed on 87 adult participants. Eligible participants had either normal hearing (N = 40; M|F = 16|24; mean age = 30 years) or SNHL (N = 47; M|F = 20|27; mean age = 58 years), and normal middle ear function as defined by standard clinical criteria for 226-Hz tympanometry. Clinical audiometry, immittance, and an experimental wideband test battery, which included reflectance and TEOAE tests presented for 1-min durations, were completed for each ear on all participants. All tests were then repeated 1 to 2 months later. TEOAEs were measured by presenting the stimulus in the three stimulus conditions. TEOAE data were analyzed in each hearing group in terms of the half-octave-averaged signal to noise ratio (SNR) and the coherence synchrony measure (CSM) at frequencies between 1 and 8 kHz. The test-retest reliability of these measures was calculated. The area under the receiver operating characteristic curve (AUC) was measured at audiometric frequencies between 1 and 8 kHz to determine TEOAE test performance in distinguishing SNHL from normal hearing. Results: Mean TEOAE SNR was >=8.7 dB for normal-hearing ears and
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Assessing Sensorineural Hearing Loss Using Various Transient-Evoked Otoacoustic Emission Stimulus Conditions.
Objectives: An important clinical application of transient-evoked otoacoustic emissions (TEOAEs) is to evaluate cochlear outer hair cell function for the purpose of detecting sensorineural hearing loss (SNHL). Double-evoked TEOAEs were measured using a chirp stimulus, in which the stimuli had an extended frequency range compared to clinical tests. The present study compared TEOAEs recorded using an unweighted stimulus presented at either ambient pressure or tympanometric peak pressure (TPP) in the ear canal and TEOAEs recorded using a power-weighted stimulus at ambient pressure. The unweighted stimulus had approximately constant incident pressure magnitude across frequency, and the power-weighted stimulus had approximately constant absorbed sound power across frequency. The objective of this study was to compare TEOAEs from 0.79 to 8 kHz using these three stimulus conditions in adults to assess test performance in classifying ears as having either normal hearing or SNHL. Design: Measurements were completed on 87 adult participants. Eligible participants had either normal hearing (N = 40; M|F = 16|24; mean age = 30 years) or SNHL (N = 47; M|F = 20|27; mean age = 58 years), and normal middle ear function as defined by standard clinical criteria for 226-Hz tympanometry. Clinical audiometry, immittance, and an experimental wideband test battery, which included reflectance and TEOAE tests presented for 1-min durations, were completed for each ear on all participants. All tests were then repeated 1 to 2 months later. TEOAEs were measured by presenting the stimulus in the three stimulus conditions. TEOAE data were analyzed in each hearing group in terms of the half-octave-averaged signal to noise ratio (SNR) and the coherence synchrony measure (CSM) at frequencies between 1 and 8 kHz. The test-retest reliability of these measures was calculated. The area under the receiver operating characteristic curve (AUC) was measured at audiometric frequencies between 1 and 8 kHz to determine TEOAE test performance in distinguishing SNHL from normal hearing. Results: Mean TEOAE SNR was >=8.7 dB for normal-hearing ears and
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Sonotubometric Assessment for Severity of Patulous Eustachian Tube.
Objective: To investigate the relationship between the morphological patency of the eustachian tube (ET) and sound transmission via the ET. Study Design: Retrospective chart review and model experiment. Setting: Tertiary referral center. Subjects: A total of 56 ears of 28 patients (9 men and 19 women, aged from 12 to 82 yr, mean 40.4 +/- 21.5 yr) who underwent sonotubometric measurement using postural change as well as computed tomography (CT) of the ET in the sitting position, including 26 ears with definite patulous ET, 9 ears with possible patulous ET, and 21 ears without patulous ET. Method: Commercial equipment for sonotubometry (JK-05A; RION Co., Ltd., Kokubunji, Tokyo, Japan) was used in the following two investigations. Retrospective survey: sound patency of 7 kHz band noise via the ET was assessed by comparison of acoustic transfer function via the ET in the sitting and forward-bending positions. Sound patency via the ET was compared with morphological patency of the ET (cross-sectional area in the narrowest portion) assessed by three-dimensional CT of the ET in the sitting position. Model experiment: effect of the ET caliber on the acoustic transfer function was examined using a simple model constructed with two truncated syringes with silicone barrels and a narrow connecting tube. Results: Sound patency assessed by sonotubometry was well correlated with the cross-sectional area at the narrowest portion of the ET in the sitting position (r = 0.786, p
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Intratympanic Dexamethasone in the Treatment of Meniere's Disease: A Comparison of Two Techniques.
Objective: To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Meniere's disease. Study Design: Prospective case series. Setting: Tertiary neurotology clinic. Patients: One hundred six consecutive adult patients with definite unilateral Meniere's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment. Interventions: Two different IT Dex regimes, either a single injection or a series of four injections, that were subsequently repeated as indicated. Main Outcome Measure: Requirement for subsequent ablative therapy in the form of intratympanic gentamicin, vestibular nerve section, or labyrinthectomy. Hearing outcomes were measured using pure-tone average of 0.5, 1, 2, and 3 kHz on standard audiometry. Results: The number of intratympanic dexamethasone injections per patient ranged from 1 to 29 (median = 4). Using the Kaplan-Meier method, predicted survival (patients not requiring ablative therapy) at 2 and 4 years after initial treatment was 83.9 and 79.3%, respectively. The injection series protocol ultimately yielded 5% better survival than the single injection protocol, but this was not statistically significant. Injections did not protect against hearing loss, and the most recent pure-tone averages declined compared with pretreatment values by an average of 8.27 dB (p
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