Communication Activities of Daily Living (CADL-3) versión española. Adaptación al contexto español y análisis de fiabilidad

Publication date: January–March 2018
Source:Revista de Logopedia, Foniatría y Audiología, Volume 38, Issue 1
Author(s): Clàudia Roca, Ignasi Ivern, Olga Bruna, Mercedes Velasco
IntroducciónActualmente no se usa ninguna prueba estandarizada que proporcione la cuantificación de la comunicación funcional del paciente con afasia castellanohablante. El estudio tiene como principales objetivos la traducción y adaptación al contexto español y el análisis de fiabilidad del instrumento de evaluación llamado Communication Activities of Daily Living (CADL-3).MétodosSe llevó a cabo con una muestra de 107 pacientes con afasia. La media de edad fue 60.68 (DE=15.104). A todos ellos se les administró individualmente la prueba CADL-3 versión española. Este incluyó fases de traducción, adaptación y fiabilidad.ResultadosLa versión final de la prueba CADL-3 versión española incluye 50 ítems con calificaciones positivas en la revisión de expertos. Se obtuvo una alta fiabilidad con una alfa de Cronbach de .949 y un coeficiente de fiabilidad test-retest .903 (p<.001).ConclusiónLa prueba CADL-3 versión española facilita la evaluación de la capacidad del paciente para comunicarse funcionalmente, con la finalidad de desarrollar programas de rehabilitación que respondan de forma más específica a las necesidades del paciente.IntroductionAt present, no standardized test is used to provide quantification of functional communication of Spanish-speaking patients with aphasia. The aim of the study is to translate and adapt the assessment instrument called Communication Activities of Daily Living (CADL-3) for use in the Spanish context and to conduct reliability analysis of the instrument.MethodsThe study was conducted with 107 patients with aphasia. The mean age was 60.68 (SD=15.104). The CADL-3 test Spanish version was individually administered. The study included stages of translation, adaptation and reliability.ResultsThe final version of the CADL-3 test Spanish version included 50 ítems with positive ratings in the expert review. The CADL-3 coefficient alpha was .949 and test-retest reliability was .903 (p<.001).ConclusionThe CADL-3 test Spanish version could provide the evaluation of patients’ ability to communicate functionally and help in the development of rehabilitation programs that respond more specifically to patient needs.



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Communication Activities of Daily Living (CADL-3) versión española. Adaptación al contexto español y análisis de fiabilidad

Publication date: January–March 2018
Source:Revista de Logopedia, Foniatría y Audiología, Volume 38, Issue 1
Author(s): Clàudia Roca, Ignasi Ivern, Olga Bruna, Mercedes Velasco
IntroducciónActualmente no se usa ninguna prueba estandarizada que proporcione la cuantificación de la comunicación funcional del paciente con afasia castellanohablante. El estudio tiene como principales objetivos la traducción y adaptación al contexto español y el análisis de fiabilidad del instrumento de evaluación llamado Communication Activities of Daily Living (CADL-3).MétodosSe llevó a cabo con una muestra de 107 pacientes con afasia. La media de edad fue 60.68 (DE=15.104). A todos ellos se les administró individualmente la prueba CADL-3 versión española. Este incluyó fases de traducción, adaptación y fiabilidad.ResultadosLa versión final de la prueba CADL-3 versión española incluye 50 ítems con calificaciones positivas en la revisión de expertos. Se obtuvo una alta fiabilidad con una alfa de Cronbach de .949 y un coeficiente de fiabilidad test-retest .903 (p<.001).ConclusiónLa prueba CADL-3 versión española facilita la evaluación de la capacidad del paciente para comunicarse funcionalmente, con la finalidad de desarrollar programas de rehabilitación que respondan de forma más específica a las necesidades del paciente.IntroductionAt present, no standardized test is used to provide quantification of functional communication of Spanish-speaking patients with aphasia. The aim of the study is to translate and adapt the assessment instrument called Communication Activities of Daily Living (CADL-3) for use in the Spanish context and to conduct reliability analysis of the instrument.MethodsThe study was conducted with 107 patients with aphasia. The mean age was 60.68 (SD=15.104). The CADL-3 test Spanish version was individually administered. The study included stages of translation, adaptation and reliability.ResultsThe final version of the CADL-3 test Spanish version included 50 ítems with positive ratings in the expert review. The CADL-3 coefficient alpha was .949 and test-retest reliability was .903 (p<.001).ConclusionThe CADL-3 test Spanish version could provide the evaluation of patients’ ability to communicate functionally and help in the development of rehabilitation programs that respond more specifically to patient needs.



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Communication Activities of Daily Living (CADL-3) versión española. Adaptación al contexto español y análisis de fiabilidad

Publication date: January–March 2018
Source:Revista de Logopedia, Foniatría y Audiología, Volume 38, Issue 1
Author(s): Clàudia Roca, Ignasi Ivern, Olga Bruna, Mercedes Velasco
IntroducciónActualmente no se usa ninguna prueba estandarizada que proporcione la cuantificación de la comunicación funcional del paciente con afasia castellanohablante. El estudio tiene como principales objetivos la traducción y adaptación al contexto español y el análisis de fiabilidad del instrumento de evaluación llamado Communication Activities of Daily Living (CADL-3).MétodosSe llevó a cabo con una muestra de 107 pacientes con afasia. La media de edad fue 60.68 (DE=15.104). A todos ellos se les administró individualmente la prueba CADL-3 versión española. Este incluyó fases de traducción, adaptación y fiabilidad.ResultadosLa versión final de la prueba CADL-3 versión española incluye 50 ítems con calificaciones positivas en la revisión de expertos. Se obtuvo una alta fiabilidad con una alfa de Cronbach de .949 y un coeficiente de fiabilidad test-retest .903 (p<.001).ConclusiónLa prueba CADL-3 versión española facilita la evaluación de la capacidad del paciente para comunicarse funcionalmente, con la finalidad de desarrollar programas de rehabilitación que respondan de forma más específica a las necesidades del paciente.IntroductionAt present, no standardized test is used to provide quantification of functional communication of Spanish-speaking patients with aphasia. The aim of the study is to translate and adapt the assessment instrument called Communication Activities of Daily Living (CADL-3) for use in the Spanish context and to conduct reliability analysis of the instrument.MethodsThe study was conducted with 107 patients with aphasia. The mean age was 60.68 (SD=15.104). The CADL-3 test Spanish version was individually administered. The study included stages of translation, adaptation and reliability.ResultsThe final version of the CADL-3 test Spanish version included 50 ítems with positive ratings in the expert review. The CADL-3 coefficient alpha was .949 and test-retest reliability was .903 (p<.001).ConclusionThe CADL-3 test Spanish version could provide the evaluation of patients’ ability to communicate functionally and help in the development of rehabilitation programs that respond more specifically to patient needs.



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Tutorial and Guidelines on Measurement of Sound Pressure Level in Voice and Speech

Purpose

Sound pressure level (SPL) measurement of voice and speech is often considered a trivial matter, but the measured levels are often reported incorrectly or incompletely, making them difficult to compare among various studies. This article aims at explaining the fundamental principles behind these measurements and providing guidelines to improve their accuracy and reproducibility.

Method

Basic information is put together from standards, technical, voice and speech literature, and practical experience of the authors and is explained for nontechnical readers.

Results

Variation of SPL with distance, sound level meters and their accuracy, frequency and time weightings, and background noise topics are reviewed. Several calibration procedures for SPL measurements are described for stand-mounted and head-mounted microphones.

Conclusions

SPL of voice and speech should be reported together with the mouth-to-microphone distance so that the levels can be related to vocal power. Sound level measurement settings (i.e., frequency weighting and time weighting/averaging) should always be specified. Classified sound level meters should be used to assure measurement accuracy. Head-mounted microphones placed at the proximity of the mouth improve signal-to-noise ratio and can be taken advantage of for voice SPL measurements when calibrated. Background noise levels should be reported besides the sound levels of voice and speech.

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Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings

Purpose

Childhood apraxia of speech (CAS) is hypothesized to arise from deficits in speech motor planning and programming, but the influence of abnormal speech perception in CAS on these processes is debated. This study examined speech perception abilities among children with CAS with and without language impairment compared to those with language impairment, speech delay, and typically developing peers.

Method

Speech perception was measured by discrimination of synthesized speech syllable continua that varied in frequency (/dɑ/–/ɡɑ/). Groups were classified by performance on speech and language assessments and compared on syllable discrimination thresholds. Within-group variability was also evaluated.

Results

Children with CAS without language impairment did not significantly differ in syllable discrimination compared to typically developing peers. In contrast, those with CAS and language impairment showed significantly poorer syllable discrimination abilities compared to children with CAS only and typically developing peers. Children with speech delay and language impairment also showed significantly poorer discrimination abilities, with appreciable within-group variability.

Conclusions

These findings suggest that speech perception deficits are not a core feature of CAS but rather occur with co-occurring language impairment in a subset of children with CAS. This study establishes the significance of accounting for language ability in children with CAS.

Supplemental Materials

https://doi.org/10.23641/asha.5848056

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Tutorial and Guidelines on Measurement of Sound Pressure Level in Voice and Speech

Purpose

Sound pressure level (SPL) measurement of voice and speech is often considered a trivial matter, but the measured levels are often reported incorrectly or incompletely, making them difficult to compare among various studies. This article aims at explaining the fundamental principles behind these measurements and providing guidelines to improve their accuracy and reproducibility.

Method

Basic information is put together from standards, technical, voice and speech literature, and practical experience of the authors and is explained for nontechnical readers.

Results

Variation of SPL with distance, sound level meters and their accuracy, frequency and time weightings, and background noise topics are reviewed. Several calibration procedures for SPL measurements are described for stand-mounted and head-mounted microphones.

Conclusions

SPL of voice and speech should be reported together with the mouth-to-microphone distance so that the levels can be related to vocal power. Sound level measurement settings (i.e., frequency weighting and time weighting/averaging) should always be specified. Classified sound level meters should be used to assure measurement accuracy. Head-mounted microphones placed at the proximity of the mouth improve signal-to-noise ratio and can be taken advantage of for voice SPL measurements when calibrated. Background noise levels should be reported besides the sound levels of voice and speech.

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Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings

Purpose

Childhood apraxia of speech (CAS) is hypothesized to arise from deficits in speech motor planning and programming, but the influence of abnormal speech perception in CAS on these processes is debated. This study examined speech perception abilities among children with CAS with and without language impairment compared to those with language impairment, speech delay, and typically developing peers.

Method

Speech perception was measured by discrimination of synthesized speech syllable continua that varied in frequency (/dɑ/–/ɡɑ/). Groups were classified by performance on speech and language assessments and compared on syllable discrimination thresholds. Within-group variability was also evaluated.

Results

Children with CAS without language impairment did not significantly differ in syllable discrimination compared to typically developing peers. In contrast, those with CAS and language impairment showed significantly poorer syllable discrimination abilities compared to children with CAS only and typically developing peers. Children with speech delay and language impairment also showed significantly poorer discrimination abilities, with appreciable within-group variability.

Conclusions

These findings suggest that speech perception deficits are not a core feature of CAS but rather occur with co-occurring language impairment in a subset of children with CAS. This study establishes the significance of accounting for language ability in children with CAS.

Supplemental Materials

https://doi.org/10.23641/asha.5848056

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Tutorial and Guidelines on Measurement of Sound Pressure Level in Voice and Speech

Purpose

Sound pressure level (SPL) measurement of voice and speech is often considered a trivial matter, but the measured levels are often reported incorrectly or incompletely, making them difficult to compare among various studies. This article aims at explaining the fundamental principles behind these measurements and providing guidelines to improve their accuracy and reproducibility.

Method

Basic information is put together from standards, technical, voice and speech literature, and practical experience of the authors and is explained for nontechnical readers.

Results

Variation of SPL with distance, sound level meters and their accuracy, frequency and time weightings, and background noise topics are reviewed. Several calibration procedures for SPL measurements are described for stand-mounted and head-mounted microphones.

Conclusions

SPL of voice and speech should be reported together with the mouth-to-microphone distance so that the levels can be related to vocal power. Sound level measurement settings (i.e., frequency weighting and time weighting/averaging) should always be specified. Classified sound level meters should be used to assure measurement accuracy. Head-mounted microphones placed at the proximity of the mouth improve signal-to-noise ratio and can be taken advantage of for voice SPL measurements when calibrated. Background noise levels should be reported besides the sound levels of voice and speech.

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Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings

Purpose

Childhood apraxia of speech (CAS) is hypothesized to arise from deficits in speech motor planning and programming, but the influence of abnormal speech perception in CAS on these processes is debated. This study examined speech perception abilities among children with CAS with and without language impairment compared to those with language impairment, speech delay, and typically developing peers.

Method

Speech perception was measured by discrimination of synthesized speech syllable continua that varied in frequency (/dɑ/–/ɡɑ/). Groups were classified by performance on speech and language assessments and compared on syllable discrimination thresholds. Within-group variability was also evaluated.

Results

Children with CAS without language impairment did not significantly differ in syllable discrimination compared to typically developing peers. In contrast, those with CAS and language impairment showed significantly poorer syllable discrimination abilities compared to children with CAS only and typically developing peers. Children with speech delay and language impairment also showed significantly poorer discrimination abilities, with appreciable within-group variability.

Conclusions

These findings suggest that speech perception deficits are not a core feature of CAS but rather occur with co-occurring language impairment in a subset of children with CAS. This study establishes the significance of accounting for language ability in children with CAS.

Supplemental Materials

https://doi.org/10.23641/asha.5848056

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Persistent hair cell malfunction contributes to hidden hearing loss

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Wilhelmina H.A.M. Mulders, Ian L. Chin, Donald Robertson
Noise exposures that result in fully reversible changes in cochlear neural threshold can cause a reduced neural output at supra-threshold sound intensity. This so-called “hidden hearing loss” has been shown to be associated with selective degeneration of high threshold afferent nerve fiber-inner hair cell (IHC) synapses. However, the electrophysiological function of the IHCs themselves in hidden hearing loss has not been directly investigated. We have made round window (RW) measurements of cochlear action potentials (CAP) and summating potentials (SP) after two levels of a 10 kHz acoustic trauma. The more intense acoustic trauma lead to notch-like permanent threshold changes and both CAP and SP showed reductions in supra-threshold amplitudes at frequencies with altered thresholds as well as from fully recovered regions. However, the interpretation of the results in normal threshold regions was complicated by the likelihood of reduced contributions from adjacent regions with elevated thresholds. The milder trauma showed full recovery of all neural thresholds, but there was a persistent depression of the amplitudes of both CAP and SP in response to supra-threshold sounds. The effect on SP amplitude in particular shows that occult damage to hair cell transduction mechanisms can contribute to hidden hearing loss. Such damage could potentially affect the supra-threshold output properties of surviving primary afferent neurons.



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Simulated auditory nerve axon demyelination alters sensitivity and response timing to extracellular stimulation

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Jesse M. Resnick, Gabrielle O'Brien, Jay T. Rubinstein
Since cochlear implant function involves direct depolarization of spiral ganglion neurons (SGNs) by applied current, SGN physiological health must be an important factor in cochlear implant (CI) outcomes. This expected relationship has, however, been difficult to confirm in implant recipients. Suggestively, animal studies have demonstrated both acute and progressive SGN ultrastructural changes (notably axon demyelination), even in the absence of soma death, and corresponding altered physiology following sensorineural deafening. Whether such demyelination occurs in humans and how such changes might impact CI function remains unknown. To approach this problem, we incorporated SGN demyelination into a biophysical model of extracellular stimulation of SGN fibers. Our approach enabled exploration of the entire parameter space corresponding to simulated myelin diameter and extent of fiber affected. All simulated fibers were stimulated distally with anodic monophasic, cathodic monophasic, anode-phase-first (AF) biphasic, and cathode-phase-first (CF) biphasic pulses from an extracellular disc electrode and monitored for spikes centrally. Not surprisingly, axon sensitivity generally decreased with demyelination, resulting in elevated thresholds, however, this effect was strongly non-uniform. Fibers with severe demyelination affecting only the most peripheral nodes responded nearly identically to normally myelinated fibers. Additionally, partial demyelination (<50%) yielded only minimal increases in threshold even when the entire fiber was impacted. The temporal effects of demyelination were more unexpected. Both latency and jitter of responses demonstrated resilience to modest changes but exhibited strongly non-monotonic and stimulus-dependent relationships to more profound demyelination. Normal, and modestly demyelinated fibers, were more sensitive to cathodic than anodic monophasic pulses and to CF than AF biphasic pulses, however, when demyelination was more severe these relative sensitivities were reversed. Comparison of threshold crossing between nodal segments demonstrated stimulus-dependent shifts in action potential initiation with different fiber demyelination states. For some demyelination scenarios, both phases of biphasic pulses could initiate action potentials at threshold resulting in bimodal latency and initiation site distributions and dramatically increased jitter. In short, simulated demyelination leads to complex changes in fiber sensitivity and spike timing, mediated by alterations in action potential initiation site and slowed action potential conduction due to non-uniformities in the electrical properties of axons. Such demyelination-induced changes, if present in implantees, would have profound implications for the detection of fine temporal cues but not disrupt cues on the time scale of speech envelopes. These simulation results highlight the importance of exploring the SGN ultrastructural changes caused by a given etiology of hearing loss to more accurately predict cochlear implantation outcomes.

Graphical abstract

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Persistent hair cell malfunction contributes to hidden hearing loss

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Wilhelmina H.A.M. Mulders, Ian L. Chin, Donald Robertson
Noise exposures that result in fully reversible changes in cochlear neural threshold can cause a reduced neural output at supra-threshold sound intensity. This so-called “hidden hearing loss” has been shown to be associated with selective degeneration of high threshold afferent nerve fiber-inner hair cell (IHC) synapses. However, the electrophysiological function of the IHCs themselves in hidden hearing loss has not been directly investigated. We have made round window (RW) measurements of cochlear action potentials (CAP) and summating potentials (SP) after two levels of a 10 kHz acoustic trauma. The more intense acoustic trauma lead to notch-like permanent threshold changes and both CAP and SP showed reductions in supra-threshold amplitudes at frequencies with altered thresholds as well as from fully recovered regions. However, the interpretation of the results in normal threshold regions was complicated by the likelihood of reduced contributions from adjacent regions with elevated thresholds. The milder trauma showed full recovery of all neural thresholds, but there was a persistent depression of the amplitudes of both CAP and SP in response to supra-threshold sounds. The effect on SP amplitude in particular shows that occult damage to hair cell transduction mechanisms can contribute to hidden hearing loss. Such damage could potentially affect the supra-threshold output properties of surviving primary afferent neurons.



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Simulated auditory nerve axon demyelination alters sensitivity and response timing to extracellular stimulation

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Jesse M. Resnick, Gabrielle O'Brien, Jay T. Rubinstein
Since cochlear implant function involves direct depolarization of spiral ganglion neurons (SGNs) by applied current, SGN physiological health must be an important factor in cochlear implant (CI) outcomes. This expected relationship has, however, been difficult to confirm in implant recipients. Suggestively, animal studies have demonstrated both acute and progressive SGN ultrastructural changes (notably axon demyelination), even in the absence of soma death, and corresponding altered physiology following sensorineural deafening. Whether such demyelination occurs in humans and how such changes might impact CI function remains unknown. To approach this problem, we incorporated SGN demyelination into a biophysical model of extracellular stimulation of SGN fibers. Our approach enabled exploration of the entire parameter space corresponding to simulated myelin diameter and extent of fiber affected. All simulated fibers were stimulated distally with anodic monophasic, cathodic monophasic, anode-phase-first (AF) biphasic, and cathode-phase-first (CF) biphasic pulses from an extracellular disc electrode and monitored for spikes centrally. Not surprisingly, axon sensitivity generally decreased with demyelination, resulting in elevated thresholds, however, this effect was strongly non-uniform. Fibers with severe demyelination affecting only the most peripheral nodes responded nearly identically to normally myelinated fibers. Additionally, partial demyelination (<50%) yielded only minimal increases in threshold even when the entire fiber was impacted. The temporal effects of demyelination were more unexpected. Both latency and jitter of responses demonstrated resilience to modest changes but exhibited strongly non-monotonic and stimulus-dependent relationships to more profound demyelination. Normal, and modestly demyelinated fibers, were more sensitive to cathodic than anodic monophasic pulses and to CF than AF biphasic pulses, however, when demyelination was more severe these relative sensitivities were reversed. Comparison of threshold crossing between nodal segments demonstrated stimulus-dependent shifts in action potential initiation with different fiber demyelination states. For some demyelination scenarios, both phases of biphasic pulses could initiate action potentials at threshold resulting in bimodal latency and initiation site distributions and dramatically increased jitter. In short, simulated demyelination leads to complex changes in fiber sensitivity and spike timing, mediated by alterations in action potential initiation site and slowed action potential conduction due to non-uniformities in the electrical properties of axons. Such demyelination-induced changes, if present in implantees, would have profound implications for the detection of fine temporal cues but not disrupt cues on the time scale of speech envelopes. These simulation results highlight the importance of exploring the SGN ultrastructural changes caused by a given etiology of hearing loss to more accurately predict cochlear implantation outcomes.

Graphical abstract

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Persistent hair cell malfunction contributes to hidden hearing loss

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Wilhelmina H.A.M. Mulders, Ian L. Chin, Donald Robertson
Noise exposures that result in fully reversible changes in cochlear neural threshold can cause a reduced neural output at supra-threshold sound intensity. This so-called “hidden hearing loss” has been shown to be associated with selective degeneration of high threshold afferent nerve fiber-inner hair cell (IHC) synapses. However, the electrophysiological function of the IHCs themselves in hidden hearing loss has not been directly investigated. We have made round window (RW) measurements of cochlear action potentials (CAP) and summating potentials (SP) after two levels of a 10 kHz acoustic trauma. The more intense acoustic trauma lead to notch-like permanent threshold changes and both CAP and SP showed reductions in supra-threshold amplitudes at frequencies with altered thresholds as well as from fully recovered regions. However, the interpretation of the results in normal threshold regions was complicated by the likelihood of reduced contributions from adjacent regions with elevated thresholds. The milder trauma showed full recovery of all neural thresholds, but there was a persistent depression of the amplitudes of both CAP and SP in response to supra-threshold sounds. The effect on SP amplitude in particular shows that occult damage to hair cell transduction mechanisms can contribute to hidden hearing loss. Such damage could potentially affect the supra-threshold output properties of surviving primary afferent neurons.



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Simulated auditory nerve axon demyelination alters sensitivity and response timing to extracellular stimulation

Publication date: Available online 14 February 2018
Source:Hearing Research
Author(s): Jesse M. Resnick, Gabrielle O'Brien, Jay T. Rubinstein
Since cochlear implant function involves direct depolarization of spiral ganglion neurons (SGNs) by applied current, SGN physiological health must be an important factor in cochlear implant (CI) outcomes. This expected relationship has, however, been difficult to confirm in implant recipients. Suggestively, animal studies have demonstrated both acute and progressive SGN ultrastructural changes (notably axon demyelination), even in the absence of soma death, and corresponding altered physiology following sensorineural deafening. Whether such demyelination occurs in humans and how such changes might impact CI function remains unknown. To approach this problem, we incorporated SGN demyelination into a biophysical model of extracellular stimulation of SGN fibers. Our approach enabled exploration of the entire parameter space corresponding to simulated myelin diameter and extent of fiber affected. All simulated fibers were stimulated distally with anodic monophasic, cathodic monophasic, anode-phase-first (AF) biphasic, and cathode-phase-first (CF) biphasic pulses from an extracellular disc electrode and monitored for spikes centrally. Not surprisingly, axon sensitivity generally decreased with demyelination, resulting in elevated thresholds, however, this effect was strongly non-uniform. Fibers with severe demyelination affecting only the most peripheral nodes responded nearly identically to normally myelinated fibers. Additionally, partial demyelination (<50%) yielded only minimal increases in threshold even when the entire fiber was impacted. The temporal effects of demyelination were more unexpected. Both latency and jitter of responses demonstrated resilience to modest changes but exhibited strongly non-monotonic and stimulus-dependent relationships to more profound demyelination. Normal, and modestly demyelinated fibers, were more sensitive to cathodic than anodic monophasic pulses and to CF than AF biphasic pulses, however, when demyelination was more severe these relative sensitivities were reversed. Comparison of threshold crossing between nodal segments demonstrated stimulus-dependent shifts in action potential initiation with different fiber demyelination states. For some demyelination scenarios, both phases of biphasic pulses could initiate action potentials at threshold resulting in bimodal latency and initiation site distributions and dramatically increased jitter. In short, simulated demyelination leads to complex changes in fiber sensitivity and spike timing, mediated by alterations in action potential initiation site and slowed action potential conduction due to non-uniformities in the electrical properties of axons. Such demyelination-induced changes, if present in implantees, would have profound implications for the detection of fine temporal cues but not disrupt cues on the time scale of speech envelopes. These simulation results highlight the importance of exploring the SGN ultrastructural changes caused by a given etiology of hearing loss to more accurately predict cochlear implantation outcomes.

Graphical abstract

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Detection of Arytenoid Dislocation Using Pixel-valued Cuneiform Movement

Publication date: Available online 13 February 2018
Source:Journal of Voice
Author(s): Ashley P. O'Connell Ferster, Michael C. Ferster, Haley Glatthorn, Bartholomew J. Bacak, Robert T. Sataloff
ObjectivesThis study aims to assess utility of pixel-valued movement software in detecting arytenoid dislocation preoperatively.Study DesignThis is a retrospective analysis.MethodsTwenty-seven patients diagnosed with unilateral arytenoid dislocation were included. Diagnosis of arytenoid dislocation was confirmed by lack of vocal fold paralysis on preoperative laryngeal electromyography and by intraoperative findings of cricoarytenoid dislocation. A region-tracking software algorithm developed by Zhuang et al was used to analyze 27 preoperative endoscopic videos of patients diagnosed with arytenoid dislocation. Vector analysis measuring cuneiform movement during inspiration was used as an indirect measure of arytenoid movement. Values were normalized using vocal fold length. Two raters blinded to diagnosis of arytenoid dislocation measured vocal fold length and cuneiform movement on both the dislocated and the nondislocated sides.ResultsA Wilcoxon signed-rank test indicated that the mean pixel-valued cuneiform movement and standard deviation (SD) were greater for nondislocated (159.24, SD = 73.35) than for dislocated (92.49, SD = 72.11) arytenoids (Z = 3.29, P = 0.001). The interrater correlation coefficient was 0.87 for the dislocated side and 0.75 for the nondislocated side. The intrarater correlation coefficient was 0.87 for the dislocated side and 0.91 for the nondislocated side. The receiver operating characteristic curve revealed an area under the curve between 0.76 and 0.83 (95% confidence interval 0.63–0.90). Analysis by the first and second raters revealed misdiagnosis of laterality of arytenoid dislocation in four and six patients, respectively.ConclusionsThe software program developed by Zhuang et al provides a high-degree of precision, with good interrater and intrarater correlation coefficients. However, high rates of misdiagnosis of arytenoid dislocation and the laborious analysis process using this software program make it of limited utility as a clinical diagnostic tool in its present state.



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Comparing the Exposure-Response Relationships of Physiological and Traditional Vocal Warm-ups on Aerodynamic and Acoustic Parameters in Untrained Singers

Publication date: Available online 13 February 2018
Source:Journal of Voice
Author(s): Jing Kang, Chao Xue, Adriana Chou, Austin Scholp, Ting Gong, Yi Zhang, Zhen Chen, Jack J. Jiang
ObjectivesThe aim of this study was to quantify the effects of traditional and physiological warm-up exercises and to determine the optimal duration of these methods using acoustic and aerodynamic metrics.MethodsTwenty-six subjects were recruited to participate in both straw phonation exercises (physiological vocal warm-up) and traditional singing exercises (traditional vocal warm-up) for 20 minutes each, 24 hours apart. Phonation threshold pressure (PTP), fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were measured before the intervention (m0), as well as after 5 minutes (m5), 10 minutes (m10), 15 minutes (m15), and 20 minutes (m20) of intervention.ResultsPTP decreased significantly after straw phonation and reached a minimum value at 10 minutes (P < 0.001) and remained stable in traditional singing exercises. There were significant differences in fundamental frequency and shimmer from m0 to m15 and m20 in the traditional singing group (P = 0.001, P = 0.001, P = 0.001, and P = 0.002, respectively). No significant changes in acoustic parameters were observed after straw phonation.ConclusionsBoth straw phonation exercises and traditional singing exercises are effective for voice warm-up. Straw phonation improves the subjects' fatigue resistance and vocal economy, resulting in a reduced PTP, whereas traditional singing exercises focus on technical singing skills, leading to an improvement of acoustic variables.



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Adjustment of the Vocal Tract Shape via Biofeedback: A Case Study

Publication date: Available online 14 February 2018
Source:Journal of Voice
Author(s): Patrick Hoyer, Simone Graf
In this study, an adjustment of the vocal tract shape toward selected sound waves in the frequency range of the first and second formants without phonation is discussed. The sound waves of a loudspeaker in front of the open mouth and amplified by the vocal tract are used as biofeedback signals. It is shown that the resonance amplification of the vocal tract complies with the concept of forced oscillation, with the driver being the sound source and the resonator being the vocal tract. An adjustment toward increased amplification via vocal tract resonance can be related to smaller bandwidths and lower damping. Furthermore, the applied adjustment frequencies are preserved as vocal tract resonances during exhalation and even phonation. This novel form of biofeedback might enrich standard voice training procedures by exercises without phonation.



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Hearing Loss in Nursing Homes

As audiologists, we are uniquely aware that the elderly are disproportionally impacted by hearing loss and are aware of solutions that might be beneficial for those with hearing loss. Is this knowledge shared by all professionals who work with the elderly?

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Dual-task Related Gait Changes in Individuals with Trans-Tibial Lower Extremity Amputation

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Susan W. Hunter, Courtney Frengopoulos, Jeffrey Holmes, Ricardo Viana, Michael W.C. Payne
BackgroundThe improvement of gait and mobility are major rehabilitation goals following lower extremity amputations. However, when living in the community many daily activities require the multitasking of motor and cognitive tasks. The dual-task paradigm can be used to evaluate the concurrent performance of mobility and cognitive tasks.Research questionThe purpose of this study was to evaluate the effects of dual-task gait testing in older adults with trans-tibial amputations.MethodsTwenty-four people (15 men, mean age ± SD, 62.72 ± 8.59) with trans-tibial amputation walked on an electronic walkway at i) self-selected comfortable pace and ii) self-selected comfortable pace while counting backwards by threes from a number randomly selected between 100 and 150. Cognitive performance, in the form of corrected response rate, was also evaluated as a single-task.ResultsThe dual-task testing produced poorer performance in velocity (single-task = 58.15 ± 23.16 cm/s, dual-task = 50.92 ± 21.16 cm/s, p = 0.008), cadence (single-task = 76.65 ± 15.84 steps/min, dual-task = 67.85 ± 15.76 steps/min, p = 0.002) and stride time (single-task = 1094 ± 458.28 ms, dual-task = 1241.44 ± 513.73 ms, p = 0.005). Step length, stance time and single limb support time symmetry were also affected, such that less time was spent on the amputated limb during the dual-task testing.SignificanceDual-task testing demonstrated interference resulting in a poor performance in both gait and cognitive performance in trans-tibial amputees. Further research is suggested to evaluate the change in cognition-mobility effects over time and the relationship of this value to future adverse events such as falls and successful outcomes such as community ambulation and reintegration.



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Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Matteo Zago, Chiarella Sforza, Daniela Rita Bonardi, Enrico Eugenio Guffanti, Manuela Galli
BackgroundGait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD.Research questionThus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD.MethodsIn line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool.ResultsSeven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level.SignificanceA convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.



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Dual-task Related Gait Changes in Individuals with Trans-Tibial Lower Extremity Amputation

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Susan W. Hunter, Courtney Frengopoulos, Jeffrey Holmes, Ricardo Viana, Michael W.C. Payne
BackgroundThe improvement of gait and mobility are major rehabilitation goals following lower extremity amputations. However, when living in the community many daily activities require the multitasking of motor and cognitive tasks. The dual-task paradigm can be used to evaluate the concurrent performance of mobility and cognitive tasks.Research questionThe purpose of this study was to evaluate the effects of dual-task gait testing in older adults with trans-tibial amputations.MethodsTwenty-four people (15 men, mean age ± SD, 62.72 ± 8.59) with trans-tibial amputation walked on an electronic walkway at i) self-selected comfortable pace and ii) self-selected comfortable pace while counting backwards by threes from a number randomly selected between 100 and 150. Cognitive performance, in the form of corrected response rate, was also evaluated as a single-task.ResultsThe dual-task testing produced poorer performance in velocity (single-task = 58.15 ± 23.16 cm/s, dual-task = 50.92 ± 21.16 cm/s, p = 0.008), cadence (single-task = 76.65 ± 15.84 steps/min, dual-task = 67.85 ± 15.76 steps/min, p = 0.002) and stride time (single-task = 1094 ± 458.28 ms, dual-task = 1241.44 ± 513.73 ms, p = 0.005). Step length, stance time and single limb support time symmetry were also affected, such that less time was spent on the amputated limb during the dual-task testing.SignificanceDual-task testing demonstrated interference resulting in a poor performance in both gait and cognitive performance in trans-tibial amputees. Further research is suggested to evaluate the change in cognition-mobility effects over time and the relationship of this value to future adverse events such as falls and successful outcomes such as community ambulation and reintegration.



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Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Matteo Zago, Chiarella Sforza, Daniela Rita Bonardi, Enrico Eugenio Guffanti, Manuela Galli
BackgroundGait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD.Research questionThus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD.MethodsIn line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool.ResultsSeven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level.SignificanceA convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.



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Dual-task Related Gait Changes in Individuals with Trans-Tibial Lower Extremity Amputation

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Susan W. Hunter, Courtney Frengopoulos, Jeffrey Holmes, Ricardo Viana, Michael W.C. Payne
BackgroundThe improvement of gait and mobility are major rehabilitation goals following lower extremity amputations. However, when living in the community many daily activities require the multitasking of motor and cognitive tasks. The dual-task paradigm can be used to evaluate the concurrent performance of mobility and cognitive tasks.Research questionThe purpose of this study was to evaluate the effects of dual-task gait testing in older adults with trans-tibial amputations.MethodsTwenty-four people (15 men, mean age ± SD, 62.72 ± 8.59) with trans-tibial amputation walked on an electronic walkway at i) self-selected comfortable pace and ii) self-selected comfortable pace while counting backwards by threes from a number randomly selected between 100 and 150. Cognitive performance, in the form of corrected response rate, was also evaluated as a single-task.ResultsThe dual-task testing produced poorer performance in velocity (single-task = 58.15 ± 23.16 cm/s, dual-task = 50.92 ± 21.16 cm/s, p = 0.008), cadence (single-task = 76.65 ± 15.84 steps/min, dual-task = 67.85 ± 15.76 steps/min, p = 0.002) and stride time (single-task = 1094 ± 458.28 ms, dual-task = 1241.44 ± 513.73 ms, p = 0.005). Step length, stance time and single limb support time symmetry were also affected, such that less time was spent on the amputated limb during the dual-task testing.SignificanceDual-task testing demonstrated interference resulting in a poor performance in both gait and cognitive performance in trans-tibial amputees. Further research is suggested to evaluate the change in cognition-mobility effects over time and the relationship of this value to future adverse events such as falls and successful outcomes such as community ambulation and reintegration.



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Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

Publication date: Available online 13 February 2018
Source:Gait & Posture
Author(s): Matteo Zago, Chiarella Sforza, Daniela Rita Bonardi, Enrico Eugenio Guffanti, Manuela Galli
BackgroundGait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD.Research questionThus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD.MethodsIn line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool.ResultsSeven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level.SignificanceA convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.



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