Παρασκευή 2 Ιουνίου 2017
Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
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Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
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Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!
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The Art and Science of Lifelong Singing
Source:Journal of Voice
Author(s): Brenda Smith
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Toward Defining “Vocal Constriction”: Practitioner Perspectives
Source:Journal of Voice
Author(s): Belinda Lemon-McMahon, Diane Hughes
ObjectivesThis research investigated the terminology used in relation to constriction of the singing voice from a range of practitioner perspectives. It focused on the locality, causes, consequences, management, trends, identification, and vocabulary of constriction. The research aimed to develop a holistic understanding of the term “vocal constriction” from participant experiences and perceptions (N = 10).MethodData collection occurred through in-depth, semi-structured interviews with a range of voice care professionals. Participants included three professional groups: (1) Ear, Nose, and Throat medical specialists or laryngologists, (2) speech pathologists or speech therapists, and (3) singing teachers. Purposive sampling was used to ensure that the participants from groups 1 and 2 had extensive experience with singers in their practice. The singing teachers were experienced in either classical or contemporary styles, or both.ResultsParticipant responses highlighted a discrepancy in preferred terminology, with “constriction” being less favored overall. Several anatomical locations were identified including postural, supraglottic (anteroposterior and false fold), articulatory, and in the intrinsic and extrinsic laryngeal musculature; psychological issues were also identified. Primary causes, secondary causes, and influencing factors were identified. Inefficient technique and poor posture or alignment were considered primary causes; similarly, emotion and anxiety or stress were identified as influencing factors by the majority of participants. There was less uniformity in responses regarding other causes.ConclusionsThe major findings of this research are the respective participant group distinctions, an uncertainty regarding anteroposterior constriction, and that the location and effects of constriction are individual to the singer and must be considered contextually. A definition is offered, and areas for further research are identified.
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Use of HT Associated with Higher Risk of Hearing Loss Among Women
Women who take postmenopausal hormone therapy (HT) to alleviate symptoms of menopause may be subject to an increased risk of hearing loss, according to a new study (Menopause. 2017 May 8 [Epub ahead of print]). Researchers at Brigham and Women's Hospital in Boston, MA, analyzed the data of 80,972 women aged 27 to 44 in the Nurses' Health Study II collected over 22 years (1991-2013). Among menopausal women, oral HT, whether it's estrogen therapy or estrogen plus progestogen therapy, was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk as well. The adjusted risk of hearing loss among women who used oral HT was 1.15 (95% CI 1.06, 1.24) for five to 9.9 years and 1.21 (95% CI 1.07, 1.37) for more than 10 years, compared with women who never used HT.
Heather Currie, MB BS, FRCOG, DRCOG, MRCGP, chairman of the British Menopause Society, warned people not to jump to conclusions immediately based on this study. "This type of trial relies on women's self-reported hearing loss, and does not prove that [HT] causes this — only that there may be an association," Dr. Currie said in an email to Medscape. "This should not terrify women and, as we have always said, the decision about [HT] should be an individual choice based on the balance of benefits and risks."
Published: 6/2/2017 9:13:00 AM
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Consumers Can Now Buy Earwax MD Through Amazon
Eosera (http://eosera.com/) is launching their over-the-counter earwax removal product Earwax MD with Amazon Exclusives. The popular online retailer will be the first to carry this product besides the company's website. Elyse Dickerson, founder and CEO of Eosera, said they decided to go with Amazon.com because they reach all consumers. "Our earwax solution will help people worldwide, and Amazon is the first step," Dickerson said. "By bringing this innovation to market, our goal is to improve the lives of both doctors and patients by saving people time and money."
Amazon Exclusives features new and innovative items, including products showcased on "Shark Tank." Earwax MD, a topical drop that dissolves earwax buildup recently introduced to the market, was found in a clinical evaluation by Eosera to fully clear the cerumen impaction in 86 percent of the test subjects in 15 to 30 minutes. This product was first reported in The Hearing Journal in the March issue (The Hearing Journal. 2017;70[3]:58; http://bit.ly/2rowNF1).
Published: 5/26/2017 9:14:00 AM
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Use of HT Associated with Higher Risk of Hearing Loss Among Women
Women who take postmenopausal hormone therapy (HT) to alleviate symptoms of menopause may be subject to an increased risk of hearing loss, according to a new study (Menopause. 2017 May 8 [Epub ahead of print]). Researchers at Brigham and Women's Hospital in Boston, MA, analyzed the data of 80,972 women aged 27 to 44 in the Nurses' Health Study II collected over 22 years (1991-2013). Among menopausal women, oral HT, whether it's estrogen therapy or estrogen plus progestogen therapy, was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk as well. The adjusted risk of hearing loss among women who used oral HT was 1.15 (95% CI 1.06, 1.24) for five to 9.9 years and 1.21 (95% CI 1.07, 1.37) for more than 10 years, compared with women who never used HT.
Heather Currie, MB BS, FRCOG, DRCOG, MRCGP, chairman of the British Menopause Society, warned people not to jump to conclusions immediately based on this study. "This type of trial relies on women's self-reported hearing loss, and does not prove that [HT] causes this — only that there may be an association," Dr. Currie said in an email to Medscape. "This should not terrify women and, as we have always said, the decision about [HT] should be an individual choice based on the balance of benefits and risks."
Published: 6/2/2017 9:13:00 AM
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Consumers Can Now Buy Earwax MD Through Amazon
Eosera (http://eosera.com/) is launching their over-the-counter earwax removal product Earwax MD with Amazon Exclusives. The popular online retailer will be the first to carry this product besides the company's website. Elyse Dickerson, founder and CEO of Eosera, said they decided to go with Amazon.com because they reach all consumers. "Our earwax solution will help people worldwide, and Amazon is the first step," Dickerson said. "By bringing this innovation to market, our goal is to improve the lives of both doctors and patients by saving people time and money."
Amazon Exclusives features new and innovative items, including products showcased on "Shark Tank." Earwax MD, a topical drop that dissolves earwax buildup recently introduced to the market, was found in a clinical evaluation by Eosera to fully clear the cerumen impaction in 86 percent of the test subjects in 15 to 30 minutes. This product was first reported in The Hearing Journal in the March issue (The Hearing Journal. 2017;70[3]:58; http://bit.ly/2rowNF1).
Published: 5/26/2017 9:14:00 AM
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Use of HT Associated with Higher Risk of Hearing Loss Among Women
Women who take postmenopausal hormone therapy (HT) to alleviate symptoms of menopause may be subject to an increased risk of hearing loss, according to a new study (Menopause. 2017 May 8 [Epub ahead of print]). Researchers at Brigham and Women's Hospital in Boston, MA, analyzed the data of 80,972 women aged 27 to 44 in the Nurses' Health Study II collected over 22 years (1991-2013). Among menopausal women, oral HT, whether it's estrogen therapy or estrogen plus progestogen therapy, was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk as well. The adjusted risk of hearing loss among women who used oral HT was 1.15 (95% CI 1.06, 1.24) for five to 9.9 years and 1.21 (95% CI 1.07, 1.37) for more than 10 years, compared with women who never used HT.
Heather Currie, MB BS, FRCOG, DRCOG, MRCGP, chairman of the British Menopause Society, warned people not to jump to conclusions immediately based on this study. "This type of trial relies on women's self-reported hearing loss, and does not prove that [HT] causes this — only that there may be an association," Dr. Currie said in an email to Medscape. "This should not terrify women and, as we have always said, the decision about [HT] should be an individual choice based on the balance of benefits and risks."
Published: 6/2/2017 9:13:00 AM
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Consumers Can Now Buy Earwax MD Through Amazon
Eosera (http://eosera.com/) is launching their over-the-counter earwax removal product Earwax MD with Amazon Exclusives. The popular online retailer will be the first to carry this product besides the company's website. Elyse Dickerson, founder and CEO of Eosera, said they decided to go with Amazon.com because they reach all consumers. "Our earwax solution will help people worldwide, and Amazon is the first step," Dickerson said. "By bringing this innovation to market, our goal is to improve the lives of both doctors and patients by saving people time and money."
Amazon Exclusives features new and innovative items, including products showcased on "Shark Tank." Earwax MD, a topical drop that dissolves earwax buildup recently introduced to the market, was found in a clinical evaluation by Eosera to fully clear the cerumen impaction in 86 percent of the test subjects in 15 to 30 minutes. This product was first reported in The Hearing Journal in the March issue (The Hearing Journal. 2017;70[3]:58; http://bit.ly/2rowNF1).
Published: 5/26/2017 9:14:00 AM
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Static and dynamic validation of inertial measurement units
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
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Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
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Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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A little trouble getting started: Initial slowness in Parkinson’s disease step negotiation
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Static and dynamic validation of inertial measurement units
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
from #Audiology via ola Kala on Inoreader http://ift.tt/2snacpz
via IFTTT
Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
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Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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A little trouble getting started: Initial slowness in Parkinson’s disease step negotiation
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Static and dynamic validation of inertial measurement units
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.
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Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
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Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.
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Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.
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A little trouble getting started: Initial slowness in Parkinson’s disease step negotiation
Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Source:Gait & Posture, Volume 57
Author(s): Amanda E. Stone, Jared W. Skinner, Hyo Keun Lee, Chris J. Hass
Bradykinesia is a prominent problem for persons with Parkinson’s disease (PD) and has been studied extensively with upper extremity tasks; however there is a lack of research examining bradykinesia in targeted lower extremity tasks related to mobility. Navigating steps and curbs are challenging tasks for older adults and neurologically impaired and thus utilizing these behaviors provides ecological validity to the study of bradykinesia. Herein we assess differences in step negotiation performance between individuals with PD and aged matched older adults. Three-dimensional kinematics and ground reaction forces were collected while 12 participants with PD and 12 older adults performed a single step up onto a platform. Persons with PD spent a significantly greater amount of time in the heel lift phase (P=0.0003, d=1.80). Peak vertical foot velocity of the lead foot was also significantly less in PD (P=0.02, d=1.05). Lastly, persons with PD displayed reduced sagittal hip and knee range of motion during the trail step (P=0.01, d=1.20 and P=0.02, d=1.05, respectively). Parkinson’s participants exhibited slight decrement in step negotiation execution. Increased step time and decreased foot velocity and range of motion were attributes associated with Parkinson’s step negotiation performance. Contrary to our hypothesis, in many comparisons, persons with PD during their best medicated state performed comparable to older adults, indicative of successful pharmacotherapy. Rehabilitation efforts can seek to improve performance in motor control tasks such as step negotiation, by restoring the relationship between perceived and actual motor output and enhancing muscle coordination and output as well as ranges of motion.
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Vowel production of Mandarin-speaking hearing aid users with different types of hearing loss
by Yu-Chen Hung, Ya-Jung Lee, Li-Chiun Tsai
In contrast with previous research focusing on cochlear implants, this study examined the speech performance of hearing aid users with conductive (n = 11), mixed (n = 10), and sensorineural hearing loss (n = 7) and compared it with the speech of hearing control. Speech intelligibility was evaluated by computing the vowel space area defined by the Mandarin Chinese corner vowels /a, u, i/. The acoustic differences between the vowels were assessed using the Euclidean distance. The results revealed that both the conductive and mixed hearing loss groups exhibited a reduced vowel working space, but no significant difference was found between the sensorineural hearing loss and normal hearing groups. An analysis using the Euclidean distance further showed that the compression of vowel space area in conductive hearing loss can be attributed to the substantial lowering of the second formant of /i/. The differences in vowel production between groups are discussed in terms of the occlusion effect and the signal transmission media of various hearing devices.from #Audiology via xlomafota13 on Inoreader http://ift.tt/2qJ3NEc
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[HORIZONTAL CANAL - BENIGN PAROXYSMAL POSITIONAL VERTIGO (HC-BPPV) - CLINICAL DIAGNOSTIC PROCEDURES].
| Related Articles |
[HORIZONTAL CANAL - BENIGN PAROXYSMAL POSITIONAL VERTIGO (HC-BPPV) - CLINICAL DIAGNOSTIC PROCEDURES].
Harefuah. 2017 Mar;(3):176-180
Authors: Zur O, Ilan O, Ben-Rubi Shimron H, Carmeli E
Abstract
INTRODUCTION: Horizontal canal benign paroxysmal positional vertigo (HCBPPV) is one form of benign paroxysmal positional vertigo. HC-BPPV is characterized by intermittent recurrent episodes of vertigo following a change in head position relative to gravity. HC-BPPV prevalence ranges from 5%-33% of all dizziness cases seen in otolaryngology, neurology and family physician clinics. Various factors, such as ear and head injury, can cause HC-BPPV. Cardiovascular disease and iatrogenic reasons are also implicated. Despite the prevalence of the disease, there are various forms of diagnostic procedures, some of which are unfamiliar to the therapist and some are controversial. This review aims to present the full range of methods of diagnosis of HC-BPPV, presenting their advantages and disadvantages.
PMID: 28551938 [PubMed - in process]
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Cochlear implants in children: A cross-sectional investigation on the influence of geographic location in Saudi Arabia.
| Related Articles |
Cochlear implants in children: A cross-sectional investigation on the influence of geographic location in Saudi Arabia.
J Family Community Med. 2017 May-Aug;24(2):118-121
Authors: Al-Sayed AA, AlSanosi A
Abstract
INTRODUCTION: The role of the family in detecting a child's hearing difficulty and the age at which an implantation is done have been identified as strong predictors of the outcomes of pediatric cochlear implantation. In the absence of screening programs for hearing loss in Saudi neonates, the family's role is of paramount importance. The aim of this study was to investigate the influence of geographic location on the course of identification, examination, and cochlear implantation in children in Saudi Arabia.
MATERIALS AND METHODS: Pediatric patients who had received either unilateral or bilateral cochlear implantation at King Abdulaziz University Hospital in Riyadh, Saudi Arabia, between January 1, 2012, and December 31, 2014, were surveyed.
RESULTS: A total of 156 pediatric patients have had a cochlear implant between January 1, 2012, and December 31, 2014. The one-way analysis of variance test to compare the means of the independent sample groups in various geographic zones showed that with a hundred percent access to primary health care, the geographic location of the population had an influence on the detection of hearing loss but not on the cochlear implantation.
CONCLUSION: This study found that the geographic location of the population has an influence on the time of detection of hearing loss in children but not on the time of cochlear implantation. Raising parental awareness of the importance of early detection of hearing loss is necessary. Further research is also required to define the role of factors such as the income and the educational level of parents on the early detection of neonatal hearing loss.
PMID: 28566977 [PubMed - in process]
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Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation.
Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation.
Otol Neurotol. 2017 May 31;:
Authors: Maxwell AK, Hartl RMB, Greene NT, Benichoux V, Mattingly JK, Cass SP, Tollin DJ
Abstract
HYPOTHESIS: Acoustic stimulation generates measurable sound pressure levels in the semicircular canals.
BACKGROUND: High-intensity acoustic stimuli can cause hearing loss and balance disruptions. To examine the propagation of acoustic stimuli to the vestibular end-organs, we simultaneously measured fluid pressure in the cochlea and semicircular canals during both air- and bone-conducted sound presentation.
METHODS: Five full-cephalic human cadaveric heads were prepared bilaterally with a mastoidectomy and extended facial recess. Vestibular pressures were measured within the superior, lateral, and posterior semicircular canals, and referenced to intracochlear pressure within the scala vestibuli with fiber-optic pressure probes. Pressures were measured concurrently with laser Doppler vibrometry measurements of stapes velocity during stimulation with both air- and bone-conduction. Stimuli were pure tones between 100 Hz and 14 kHz presented with custom closed-field loudspeakers for air-conducted sounds and via commercially available bone-anchored device for bone-conducted sounds.
RESULTS: Pressures recorded in the superior, lateral, and posterior semicircular canals in response to sound stimulation were equal to or greater in magnitude than those recorded in the scala vestibuli (up to 20 dB higher). The pressure magnitudes varied across canals in a frequency-dependent manner.
CONCLUSION: High sound pressure levels were recorded in the semicircular canals with sound stimulation, suggesting that similar acoustical energy is transmitted to the semicircular canals and the cochlea. Since these intralabyrinthine pressures exceed intracochlear pressure levels, our results suggest that the vestibular end-organs may also be at risk for injury during exposure to high-intensity acoustic stimuli known to cause trauma in the auditory system.
PMID: 28570420 [PubMed - as supplied by publisher]
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Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation.
Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation.
Otol Neurotol. 2017 May 31;:
Authors: Maxwell AK, Hartl RMB, Greene NT, Benichoux V, Mattingly JK, Cass SP, Tollin DJ
Abstract
HYPOTHESIS: Acoustic stimulation generates measurable sound pressure levels in the semicircular canals.
BACKGROUND: High-intensity acoustic stimuli can cause hearing loss and balance disruptions. To examine the propagation of acoustic stimuli to the vestibular end-organs, we simultaneously measured fluid pressure in the cochlea and semicircular canals during both air- and bone-conducted sound presentation.
METHODS: Five full-cephalic human cadaveric heads were prepared bilaterally with a mastoidectomy and extended facial recess. Vestibular pressures were measured within the superior, lateral, and posterior semicircular canals, and referenced to intracochlear pressure within the scala vestibuli with fiber-optic pressure probes. Pressures were measured concurrently with laser Doppler vibrometry measurements of stapes velocity during stimulation with both air- and bone-conduction. Stimuli were pure tones between 100 Hz and 14 kHz presented with custom closed-field loudspeakers for air-conducted sounds and via commercially available bone-anchored device for bone-conducted sounds.
RESULTS: Pressures recorded in the superior, lateral, and posterior semicircular canals in response to sound stimulation were equal to or greater in magnitude than those recorded in the scala vestibuli (up to 20 dB higher). The pressure magnitudes varied across canals in a frequency-dependent manner.
CONCLUSION: High sound pressure levels were recorded in the semicircular canals with sound stimulation, suggesting that similar acoustical energy is transmitted to the semicircular canals and the cochlea. Since these intralabyrinthine pressures exceed intracochlear pressure levels, our results suggest that the vestibular end-organs may also be at risk for injury during exposure to high-intensity acoustic stimuli known to cause trauma in the auditory system.
PMID: 28570420 [PubMed - as supplied by publisher]
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Head Shadow and Binaural Squelch for Unilaterally Deaf Cochlear Implantees.
Background: Cochlear implants (CIs) can improve speech-in-noise performance for listeners with unilateral sensorineural deafness. But these benefits are modest and in most cases are limited to head-shadow advantages, with little evidence of binaural squelch. Hypothesis: The goal of the investigation was to determine whether CI listeners with normal hearing or moderate hearing loss in the contralateral ear would receive a larger head-shadow benefit for target speech and noise originating from opposite sides of the head, and whether listeners would experience binaural squelch in the free field in a test involving interfering talkers. Methods: Eleven CI listeners performed a speech-identification task in the presence of interfering noise or speech. Six listeners had single-sided deafness (normal or near-normal audiometric thresholds in the acoustic ear) and five had asymmetric hearing loss (hearing loss in the acoustic ear treated with a hearing aid). Listeners were tested with the acoustic ear only and bilaterally with the CI turned on. One set of conditions examined head-shadow effects with target speech and masking noise presented from azimuths of 0 or +/-108 degrees. A second set of conditions examined binaural squelch, with target speech presented from the front and interfering talkers symmetrically placed on both sides. Results: On average, the largest head-shadow benefit (5 dB) occurred when the target and masking noise were presented on opposite sides of the head. Listeners also showed an average of 2 dB of squelch, but only when the target speech was masked by interfering talkers of the same sex as the target. Conclusions: CIs provide listeners with unilateral deafness important benefits for speech perception in complex spatial environments, including a larger head-shadow benefit when speech and noise originate on opposite sides of the head, and an improved ability to perceptually organize an auditory scene with multiple competing voices. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Inflammatory Pseudotumor of the Temporal Bone: a Case Series.
Objective: Inflammatory pseudotumor of the temporal bone is a benign, idiopathic inflammatory process that is locally invasive and a cause of significant morbidity. This study reviews our experience with seven patients and is currently the largest series to date. Study Design: Retrospective review from January 1, 2014 to January 1, 2016. Setting: Single tertiary medical center. Patients: There were five male and two female (n = 7) subjects with a diagnosis of temporal bone inflammatory pseudotumor. The mean age at presentation was 41 years old. The most common presenting symptoms were hearing loss (7/7) and headache (4/7). Four patients demonstrated an inflammatory aural polyp. Two patients experienced facial nerve paralysis. Intervention(s): Seven patients underwent computed tomography and six underwent magnetic resonance imaging. Corticosteroids and antibiotics were the initial treatment of choice. Five patients also underwent surgery. As adjuvant therapy, two patients received Rituximab, one patient received radiation, and one received mycophenolate mofetil. Main Outcome Measure(s): Clinical courses were followed with focus on symptoms, disease recurrence, duration, and treatment. Mean follow-up was 17.8 months. Results: The primary lesions demonstrated T2 hypo-intensity and enhancement as well as diffuse dural thickening on magnetic resonance imaging in five of six patients. Histopathology demonstrated chronic inflammation in the setting of hyalinized fibrosis (7/7). All the patients are currently symptomatically stable. Conclusion: Inflammatory pseudotumor of the temporal bone can cause devastating effects on neurological function and quality of life. Recognition of characteristic imaging and histopathology can expedite appropriate treatment. Patients may require chronic steroid therapy. Adjunctive therapy with radiation and immuno-modulation are currently being explored. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Vestibular Restoration and Adaptation in Vestibular Neuritis and Ramsay Hunt Syndrome with Vertigo.
Objective: To evaluate vestibular restoration and the evolution of the compensatory saccades in acute severe inflammatory vestibular nerve paralysis, including vestibular neuritis and Ramsay Hunt syndrome with vertigo. Study Design: Prospective. Setting: Tertiary referral center. Patients: Vestibular neuritis (n = 18) and Ramsay Hunt syndrome patients with vertigo (n = 13) were enrolled. Intervention: After treatment with oral corticosteroids, patients were followed up for 6 months. Main Outcome Measures: Functional recovery of the facial nerve was scored according to the House-Brackman grading system. Caloric and video head impulse tests were performed in every patient at the time of enrolment. Subsequently, successive video head impulse test (vHIT) exploration was performed at the 1, 3, and 6-month follow-up. Results: Eighteen patients with vestibular neuritis and 13 with Ramsay Hunt syndrome and associated vertigo were included. Vestibular function was significantly worse in patients with Ramsay Hunt syndrome than in those with vestibular neuritis. Similar compensatory saccades velocity and latency values were observed in both groups, in both the caloric and initial vHIT tests. Successive vHIT results showed a significantly higher vestibulo-ocular reflex gain recovery in vestibular neuritis patients than in Ramsay Hunt syndrome patients. A significantly faster reduction in the latency, velocity, and organization of the compensatory saccades was observed in neuritis than in Ramsay Hunt syndrome patients. Conclusions: In addition to the recovery of the vestibulo-ocular reflex, the reduction of latency, velocity and the organization of compensatory saccades play a role in vestibular compensation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Cochlear Implant Electrode Localization Using an Ultra-High Resolution Scan Mode on Conventional 64-Slice and New Generation 192-Slice Multi-Detector Computed Tomography.
Hypothesis: A new generation 192-slice multi-detector computed tomography (MDCT) clinical scanner provides enhanced image quality and superior electrode localization over conventional MDCT. Background: Currently, accurate and reliable cochlear implant electrode localization using conventional MDCT scanners remains elusive. Methods: Eight fresh-frozen cadaveric temporal bones were implanted with full-length cochlear implant electrodes. Specimens were subsequently scanned with conventional 64-slice and new generation 192-slice MDCT scanners utilizing ultra-high resolution modes. Additionally, all specimens were scanned with micro-CT to provide a reference criterion for electrode position. Images were reconstructed according to routine temporal bone clinical protocols. Three neuroradiologists, blinded to scanner type, reviewed images independently to assess resolution of individual electrodes, scalar localization, and severity of image artifact. Results: Serving as the reference standard, micro-CT identified scalar crossover in one specimen; imaging of all remaining cochleae demonstrated complete scala tympani insertions. The 192-slice MDCT scanner exhibited improved resolution of individual electrodes (p
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Ultra-high-field (9.4 T) MRI Analysis of Contrast Agent Transport Across the Blood-Perilymph Barrier and Intrastrial Fluid-Blood Barrier in the Mouse Inner Ear.
Hypothesis: Effective paramagnetic contrast agent for the penetration of the perilymphatic spaces of the scala tympani, scala vestibuli, and scala media of the mouse inner ear can be determined using intravenous injection of various gadolinium (Gd) complexes and ultra-high-field magnetic resonance imaging (MRI) at 9.4 Tesla. Background: A number of contrast agents have been explored in experimental high-field MRI to determine the most effective Gd complex for ideal signal-to-noise ratio and maximal visualization of the in vivo mammalian inner ear in analyzing the temporal and spatial parameters involved in drug penetration of the blood-perilymph barrier and intrastrial fluid-blood barrier in the mouse model using MRI. Methods: Gadoteric acid (Dotarem), Gadobutrol (Gadovist), Gadodiamide (Omniscan), Gadopent acid (Magnevist), and Mangafodipir (Teslascan) were administered intravenously using the tail vein of 60 Balb/C mice. High-resolution T1 images of drug penetration were acquired with a horizontal 9.4 T Agilent magnet after intravenously injection. Signal intensity was used as a metric of temporal and spatial parameters of drug delivery and penetration of the perilymphatic and endolymphatic spaces. Results: ANOVA analysis of the area under the curve of intensity enhancement in perilymph revealed a significant difference (p
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Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation.
Hypothesis: Acoustic stimulation generates measurable sound pressure levels in the semicircular canals. Background: High-intensity acoustic stimuli can cause hearing loss and balance disruptions. To examine the propagation of acoustic stimuli to the vestibular end-organs, we simultaneously measured fluid pressure in the cochlea and semicircular canals during both air- and bone-conducted sound presentation. Methods: Five full-cephalic human cadaveric heads were prepared bilaterally with a mastoidectomy and extended facial recess. Vestibular pressures were measured within the superior, lateral, and posterior semicircular canals, and referenced to intracochlear pressure within the scala vestibuli with fiber-optic pressure probes. Pressures were measured concurrently with laser Doppler vibrometry measurements of stapes velocity during stimulation with both air- and bone-conduction. Stimuli were pure tones between 100 Hz and 14 kHz presented with custom closed-field loudspeakers for air-conducted sounds and via commercially available bone-anchored device for bone-conducted sounds. Results: Pressures recorded in the superior, lateral, and posterior semicircular canals in response to sound stimulation were equal to or greater in magnitude than those recorded in the scala vestibuli (up to 20 dB higher). The pressure magnitudes varied across canals in a frequency-dependent manner. Conclusion: High sound pressure levels were recorded in the semicircular canals with sound stimulation, suggesting that similar acoustical energy is transmitted to the semicircular canals and the cochlea. Since these intralabyrinthine pressures exceed intracochlear pressure levels, our results suggest that the vestibular end-organs may also be at risk for injury during exposure to high-intensity acoustic stimuli known to cause trauma in the auditory system. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Professional Reimbursement by Medicaid for Cochlear Implants and Related Services.
Hypothesis: Medicaid reimbursement rates for cochlear implants and related services fall short of the federal benchmark set by Medicare. Background: The financial hardships of cochlear implant centers around the United States may be a repercussion of poor Medicaid reimbursement. In time, these reimbursement discrepancies could force additional Otolaryngologists and cochlear implant centers to not provide these crucial services due to financial limitations. Methods: Based on Medicare (MCR) claims data, current procedural terminology (CPT) codes used for cochlear implantation and related services were selected. Medicaid (MCD) and Medicare (MCR) payment schemes were queried for the same services in 49 states and Washington, D.C. The difference in MCD and MCR payment in dollars and percent was determined and reimbursement per relative value of work (RVU) calculated. MCD reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the MCR benchmark. Results: Marked differences in MCD and MCR reimbursement exist for all cochlear implant related services, most commonly as a substantial shortfall. The MCD shortfall varied in amount between states and great variability in reimbursement exists within and between audiology, surgery, and speech services. Shortfalls and excesses were not consistent between procedures or states. Conclusions: The variation in MCD payment models reflects marked differences in the value of the same work provided, which in many cases is far less than federal benchmarks. These results question the fairness of the MCD reimbursement scheme in cochlear implantation with potential serious implications on access to care for this underserved patient population. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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