Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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The Impact of Lexical Characteristics and Noise on Intelligibility of Parkinsonian Speech

Purpose

This study investigated the impact of lexical characteristics on the intelligibility of speakers with Parkinson's disease (PD). Intelligibility was compared for listening in a quiet versus a noisy environment.

Method

A total of 192 young listeners participated in the study, with 96 listeners listening in quiet and 96 listening in noise in which the spoken sentences were mixed with 10-talker babble. The listeners transcribed spoken sentences with target words controlled for word frequency and neighborhood density. The sentences were produced by 12 speakers with PD and 12 healthy control (HC) speakers. Transcription accuracy was compared across lexical categories between PD and HC and between the two listening conditions.

Results

Transcription accuracy was higher for high-frequency words than low-frequency words for both speaker groups in quiet and in noise. The neighborhood density effect was evident only in the noise condition with better intelligibility for words from sparse neighborhoods than from dense neighborhoods. Regardless of listening condition, the PD group was less intelligible with a significant decrease in intelligibility in noise relative to quiet.

Conclusions

The lexical properties of the words affected listeners' understanding of Parkinsonian speech. Frequent words in sparse neighborhood enhanced intelligibility, especially under adverse listening conditions. Babble noise had a detrimental impact on the intelligibility of Parkinsonian speech. The extent of the lexical effect on intelligibility increased in noise.

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Vocal Emotion Identification by Children Using Cochlear Implants, Relations to Voice Quality, and Musical Interests

Purpose

Listening tests for emotion identification were conducted with 8–17-year-old children with hearing impairment (HI; N = 25) using cochlear implants, and their 12-year-old peers with normal hearing (N = 18). The study examined the impact of musical interests and acoustics of the stimuli on correct emotion identification.

Method

The children completed a questionnaire with their background information and noting musical interests. They then listened to vocal stimuli produced by actors (N = 5) and consisting of nonsense sentences and prolonged vowels ([a:], [i:], and [u:]; N = 32) expressing excitement, anger, contentment, and fear. The children's task was to identify the emotions they heard in the sample by choosing from the provided options. Acoustics of the samples were studied using Praat software, and statistics were examined using SPSS 24 software.

Results

The children with HI identified the emotions with 57% accuracy and the normal hearing children with 75% accuracy. Female listeners were more accurate than male listeners in both groups. Those who were implanted before age of 3 years identified emotions more accurately than others (p < .05). No connection between the child's audiogram and correct identification was observed. Musical interests and voice quality parameters were found to be related to correct identification.

Conclusions

Implantation age, musical interests, and voice quality tended to have an impact on correct emotion identification. Thus, in developing the cochlear implants, it may be worth paying attention to the acoustic structures of vocal emotional expressions, especially the formant frequency of F3. Supporting the musical interests of children with HI may help their emotional development and improve their social lives.

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The Impact of Lexical Characteristics and Noise on Intelligibility of Parkinsonian Speech

Purpose

This study investigated the impact of lexical characteristics on the intelligibility of speakers with Parkinson's disease (PD). Intelligibility was compared for listening in a quiet versus a noisy environment.

Method

A total of 192 young listeners participated in the study, with 96 listeners listening in quiet and 96 listening in noise in which the spoken sentences were mixed with 10-talker babble. The listeners transcribed spoken sentences with target words controlled for word frequency and neighborhood density. The sentences were produced by 12 speakers with PD and 12 healthy control (HC) speakers. Transcription accuracy was compared across lexical categories between PD and HC and between the two listening conditions.

Results

Transcription accuracy was higher for high-frequency words than low-frequency words for both speaker groups in quiet and in noise. The neighborhood density effect was evident only in the noise condition with better intelligibility for words from sparse neighborhoods than from dense neighborhoods. Regardless of listening condition, the PD group was less intelligible with a significant decrease in intelligibility in noise relative to quiet.

Conclusions

The lexical properties of the words affected listeners' understanding of Parkinsonian speech. Frequent words in sparse neighborhood enhanced intelligibility, especially under adverse listening conditions. Babble noise had a detrimental impact on the intelligibility of Parkinsonian speech. The extent of the lexical effect on intelligibility increased in noise.

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Vocal Emotion Identification by Children Using Cochlear Implants, Relations to Voice Quality, and Musical Interests

Purpose

Listening tests for emotion identification were conducted with 8–17-year-old children with hearing impairment (HI; N = 25) using cochlear implants, and their 12-year-old peers with normal hearing (N = 18). The study examined the impact of musical interests and acoustics of the stimuli on correct emotion identification.

Method

The children completed a questionnaire with their background information and noting musical interests. They then listened to vocal stimuli produced by actors (N = 5) and consisting of nonsense sentences and prolonged vowels ([a:], [i:], and [u:]; N = 32) expressing excitement, anger, contentment, and fear. The children's task was to identify the emotions they heard in the sample by choosing from the provided options. Acoustics of the samples were studied using Praat software, and statistics were examined using SPSS 24 software.

Results

The children with HI identified the emotions with 57% accuracy and the normal hearing children with 75% accuracy. Female listeners were more accurate than male listeners in both groups. Those who were implanted before age of 3 years identified emotions more accurately than others (p < .05). No connection between the child's audiogram and correct identification was observed. Musical interests and voice quality parameters were found to be related to correct identification.

Conclusions

Implantation age, musical interests, and voice quality tended to have an impact on correct emotion identification. Thus, in developing the cochlear implants, it may be worth paying attention to the acoustic structures of vocal emotional expressions, especially the formant frequency of F3. Supporting the musical interests of children with HI may help their emotional development and improve their social lives.

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The Impact of Lexical Characteristics and Noise on Intelligibility of Parkinsonian Speech

Purpose

This study investigated the impact of lexical characteristics on the intelligibility of speakers with Parkinson's disease (PD). Intelligibility was compared for listening in a quiet versus a noisy environment.

Method

A total of 192 young listeners participated in the study, with 96 listeners listening in quiet and 96 listening in noise in which the spoken sentences were mixed with 10-talker babble. The listeners transcribed spoken sentences with target words controlled for word frequency and neighborhood density. The sentences were produced by 12 speakers with PD and 12 healthy control (HC) speakers. Transcription accuracy was compared across lexical categories between PD and HC and between the two listening conditions.

Results

Transcription accuracy was higher for high-frequency words than low-frequency words for both speaker groups in quiet and in noise. The neighborhood density effect was evident only in the noise condition with better intelligibility for words from sparse neighborhoods than from dense neighborhoods. Regardless of listening condition, the PD group was less intelligible with a significant decrease in intelligibility in noise relative to quiet.

Conclusions

The lexical properties of the words affected listeners' understanding of Parkinsonian speech. Frequent words in sparse neighborhood enhanced intelligibility, especially under adverse listening conditions. Babble noise had a detrimental impact on the intelligibility of Parkinsonian speech. The extent of the lexical effect on intelligibility increased in noise.

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Vocal Emotion Identification by Children Using Cochlear Implants, Relations to Voice Quality, and Musical Interests

Purpose

Listening tests for emotion identification were conducted with 8–17-year-old children with hearing impairment (HI; N = 25) using cochlear implants, and their 12-year-old peers with normal hearing (N = 18). The study examined the impact of musical interests and acoustics of the stimuli on correct emotion identification.

Method

The children completed a questionnaire with their background information and noting musical interests. They then listened to vocal stimuli produced by actors (N = 5) and consisting of nonsense sentences and prolonged vowels ([a:], [i:], and [u:]; N = 32) expressing excitement, anger, contentment, and fear. The children's task was to identify the emotions they heard in the sample by choosing from the provided options. Acoustics of the samples were studied using Praat software, and statistics were examined using SPSS 24 software.

Results

The children with HI identified the emotions with 57% accuracy and the normal hearing children with 75% accuracy. Female listeners were more accurate than male listeners in both groups. Those who were implanted before age of 3 years identified emotions more accurately than others (p < .05). No connection between the child's audiogram and correct identification was observed. Musical interests and voice quality parameters were found to be related to correct identification.

Conclusions

Implantation age, musical interests, and voice quality tended to have an impact on correct emotion identification. Thus, in developing the cochlear implants, it may be worth paying attention to the acoustic structures of vocal emotional expressions, especially the formant frequency of F3. Supporting the musical interests of children with HI may help their emotional development and improve their social lives.

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Cochlear Implantation in Adults With Asymmetric Hearing Loss: Speech Recognition in Quiet and in Noise, and Health Related Quality of Life

Objective: To examine the possible speech recognition and health related quality of life (HRQoL) benefits of cochlear implantation among adults with asymmetric sensorineural hearing loss. Study Design: Retrospective chart review, single-subject design. Methods: A total of 45 adult cochlear implant recipients with asymmetric sensorineural hearing loss where performance for the best-aided condition exceeded 60% correct open set sentence recognition in quiet, and the implanted ear met traditional candidacy criteria. End point testing of the implanted ear was evaluated with use of the Consonant-Vowel Nucleus-Consonant (CNC) word test and AzBio sentence test materials in quiet, and bimodally with the AzBio sentence test materials in noise at +5 dB signal-to-noise ratio (SNR). HRQoL was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Results: Measured in quiet, with the non-implanted ear plugged, the average CNC word scores increased from 9.1% preoperatively to 55.7% (p 

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Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Siobhan C. Strike, Daniela Acrone, Michael Orendurff
BackgroundDynamic Elastic Response prostheses are designed absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds.Research QuestionTo determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring.MethodsOverground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V.2.5 with Kistler force plates. Participants ran at self-selected running pace, 70% and 130% of that pace. Vertical, braking and propulsion peak ground reaction forces and impulses and vertical loading and decay rates were analysed between limbs at each speed (ANOVA) and their association with speed assessed (simple linear regression).ResultsThe vertical, braking forces and impulses and propulsive force were significantly less (p < 0.05) on the prosthetic limb than controls at the faster speed, but there was no difference in the propulsive impulse. The intact limb did not evidence increased vertical force at any speed, but experienced increased braking (p < 0.05) compared to both prosthetic limb and controls at the slow speed. For all limbs, braking and propulsive peak forces, decay rate, step length and step frequency were strongly (r > 0.6) and significantly (p < 0.05) associated with speed. On the prosthetic limb vertical impulse was strongly and significantly negatively associated with speed and control’s braking impulse was associated with speed.SignificanceA leg-specific response was found at different speeds. On the prosthetic limb the technique was to brake less not propel more at higher speeds with reduced vertical drive. Running at self-selected speed could be used for fitness without inducing detrimental ground reaction forces on the intact limb or evoking asymmetry in step length and frequency.



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Energy expenditure in people with transtibial amputation walking with crossover and energy storing prosthetic feet: A randomized within-subject study

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Cody L. McDonald, Patricia Kramer, Sara J. Morgan, Elizabeth G. Halsne, Sarah M. Cheever, Brian J. Hafner
BackgroundEnergy storing feet are unable to reduce the energy required for normal locomotion among people with transtibial amputation. Crossover feet, which incorporate aspects of energy storing and running specific feet, are designed to maximize energy return while providing stability for everyday activities.Research questionDo crossover prosthetic feet reduce the energy expenditure of walking across a range of speeds, when compared with energy storing feet among people with transtibial amputation due to non-dysvascular causes?MethodsA randomized within-subject study was conducted with a volunteer sample of twenty-seven adults with unilateral transtibial amputation due to non-dysvascular causes. Participants were fit with two prostheses. One had an energy storing foot (Össur Variflex) and the other a crossover foot (Össur Cheetah Xplore). Other components, including sockets, suspension, and interface were standardized. Energy expenditure was measured with a portable respirometer (Cosmed K4b2) while participants walked on a treadmill at self-selected slow, comfortable, and fast speeds with each prosthesis. Gross oxygen consumption rates (VO2 ml/min) were compared between foot conditions. Energy storing feet were used as the baseline condition because they are used by most people with a lower limb prosthesis. Analyses were performed to identify people who may benefit from transition to crossover feet.ResultsOn average, participants had lower oxygen consumption in the crossover foot condition compared to the energy storing foot condition at each self-selected walking speed, but this difference was not statistically significant. Participants with farther six-minute walk test distances, higher daily step counts, and higher Medicare Functional Classification Levels at baseline were more likely to use less energy in the crossover foot.SignificanceCrossover feet may be most beneficial for people with higher activity levels and physical fitness. Further research is needed to examine the effect of crossover feet on energy expenditure during high-level activities.



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Is Symmetry of Loading Improved for injured runners during Novice Barefoot Running?

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Adam S. Tenforde, Matthew C. Ruder, Steve T. Jamison, Pratham P. Singh, Irene S. Davis
BackgroundAs barefoot (BF) running provides important sensory information that influence landing patterns, it may also affect loading symmetry.Research questionThe purpose of this investigation was to examine whether symmetry of loading in a group of injured runners would be improved in a novice, barefoot condition.MethodsCross-sectional design evaluating 67 injured RFS runners. Each subject ran on an instrumented treadmill, first with their habitual shod pattern and then in a BF condition with a FFS pattern, both at the same self-selected speed. Data were averaged over 10 footstrikes. Variables of interest included vertical average load rate, vertical instantaneous load rate, and resultant instantaneous load rate. Symmetry indices (SI) for full population and within quartiles were compared for each loadrate variable (P≤.05) to evaluate changes between conditions.ResultsOn average, symmetry of loading was similar in a novice BF condition of injured runners compared with their habitual RFS shod condition. However, a subanalysis of quartiles revealed that the injured runners with the highest asymmetry (greatest SI values) displayed significantly lower asymmetry when running BF for all three loadrate measures.SignificanceThe addition of sensory input during barefoot running only improves symmetry of loading when habitual loading is highly asymmetric.



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Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Siobhan C. Strike, Daniela Acrone, Michael Orendurff
BackgroundDynamic Elastic Response prostheses are designed absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds.Research QuestionTo determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring.MethodsOverground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V.2.5 with Kistler force plates. Participants ran at self-selected running pace, 70% and 130% of that pace. Vertical, braking and propulsion peak ground reaction forces and impulses and vertical loading and decay rates were analysed between limbs at each speed (ANOVA) and their association with speed assessed (simple linear regression).ResultsThe vertical, braking forces and impulses and propulsive force were significantly less (p < 0.05) on the prosthetic limb than controls at the faster speed, but there was no difference in the propulsive impulse. The intact limb did not evidence increased vertical force at any speed, but experienced increased braking (p < 0.05) compared to both prosthetic limb and controls at the slow speed. For all limbs, braking and propulsive peak forces, decay rate, step length and step frequency were strongly (r > 0.6) and significantly (p < 0.05) associated with speed. On the prosthetic limb vertical impulse was strongly and significantly negatively associated with speed and control’s braking impulse was associated with speed.SignificanceA leg-specific response was found at different speeds. On the prosthetic limb the technique was to brake less not propel more at higher speeds with reduced vertical drive. Running at self-selected speed could be used for fitness without inducing detrimental ground reaction forces on the intact limb or evoking asymmetry in step length and frequency.



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Energy expenditure in people with transtibial amputation walking with crossover and energy storing prosthetic feet: A randomized within-subject study

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Cody L. McDonald, Patricia Kramer, Sara J. Morgan, Elizabeth G. Halsne, Sarah M. Cheever, Brian J. Hafner
BackgroundEnergy storing feet are unable to reduce the energy required for normal locomotion among people with transtibial amputation. Crossover feet, which incorporate aspects of energy storing and running specific feet, are designed to maximize energy return while providing stability for everyday activities.Research questionDo crossover prosthetic feet reduce the energy expenditure of walking across a range of speeds, when compared with energy storing feet among people with transtibial amputation due to non-dysvascular causes?MethodsA randomized within-subject study was conducted with a volunteer sample of twenty-seven adults with unilateral transtibial amputation due to non-dysvascular causes. Participants were fit with two prostheses. One had an energy storing foot (Össur Variflex) and the other a crossover foot (Össur Cheetah Xplore). Other components, including sockets, suspension, and interface were standardized. Energy expenditure was measured with a portable respirometer (Cosmed K4b2) while participants walked on a treadmill at self-selected slow, comfortable, and fast speeds with each prosthesis. Gross oxygen consumption rates (VO2 ml/min) were compared between foot conditions. Energy storing feet were used as the baseline condition because they are used by most people with a lower limb prosthesis. Analyses were performed to identify people who may benefit from transition to crossover feet.ResultsOn average, participants had lower oxygen consumption in the crossover foot condition compared to the energy storing foot condition at each self-selected walking speed, but this difference was not statistically significant. Participants with farther six-minute walk test distances, higher daily step counts, and higher Medicare Functional Classification Levels at baseline were more likely to use less energy in the crossover foot.SignificanceCrossover feet may be most beneficial for people with higher activity levels and physical fitness. Further research is needed to examine the effect of crossover feet on energy expenditure during high-level activities.



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Is Symmetry of Loading Improved for injured runners during Novice Barefoot Running?

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Adam S. Tenforde, Matthew C. Ruder, Steve T. Jamison, Pratham P. Singh, Irene S. Davis
BackgroundAs barefoot (BF) running provides important sensory information that influence landing patterns, it may also affect loading symmetry.Research questionThe purpose of this investigation was to examine whether symmetry of loading in a group of injured runners would be improved in a novice, barefoot condition.MethodsCross-sectional design evaluating 67 injured RFS runners. Each subject ran on an instrumented treadmill, first with their habitual shod pattern and then in a BF condition with a FFS pattern, both at the same self-selected speed. Data were averaged over 10 footstrikes. Variables of interest included vertical average load rate, vertical instantaneous load rate, and resultant instantaneous load rate. Symmetry indices (SI) for full population and within quartiles were compared for each loadrate variable (P≤.05) to evaluate changes between conditions.ResultsOn average, symmetry of loading was similar in a novice BF condition of injured runners compared with their habitual RFS shod condition. However, a subanalysis of quartiles revealed that the injured runners with the highest asymmetry (greatest SI values) displayed significantly lower asymmetry when running BF for all three loadrate measures.SignificanceThe addition of sensory input during barefoot running only improves symmetry of loading when habitual loading is highly asymmetric.



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Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Siobhan C. Strike, Daniela Acrone, Michael Orendurff
BackgroundDynamic Elastic Response prostheses are designed absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds.Research QuestionTo determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring.MethodsOverground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V.2.5 with Kistler force plates. Participants ran at self-selected running pace, 70% and 130% of that pace. Vertical, braking and propulsion peak ground reaction forces and impulses and vertical loading and decay rates were analysed between limbs at each speed (ANOVA) and their association with speed assessed (simple linear regression).ResultsThe vertical, braking forces and impulses and propulsive force were significantly less (p < 0.05) on the prosthetic limb than controls at the faster speed, but there was no difference in the propulsive impulse. The intact limb did not evidence increased vertical force at any speed, but experienced increased braking (p < 0.05) compared to both prosthetic limb and controls at the slow speed. For all limbs, braking and propulsive peak forces, decay rate, step length and step frequency were strongly (r > 0.6) and significantly (p < 0.05) associated with speed. On the prosthetic limb vertical impulse was strongly and significantly negatively associated with speed and control’s braking impulse was associated with speed.SignificanceA leg-specific response was found at different speeds. On the prosthetic limb the technique was to brake less not propel more at higher speeds with reduced vertical drive. Running at self-selected speed could be used for fitness without inducing detrimental ground reaction forces on the intact limb or evoking asymmetry in step length and frequency.



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Energy expenditure in people with transtibial amputation walking with crossover and energy storing prosthetic feet: A randomized within-subject study

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Cody L. McDonald, Patricia Kramer, Sara J. Morgan, Elizabeth G. Halsne, Sarah M. Cheever, Brian J. Hafner
BackgroundEnergy storing feet are unable to reduce the energy required for normal locomotion among people with transtibial amputation. Crossover feet, which incorporate aspects of energy storing and running specific feet, are designed to maximize energy return while providing stability for everyday activities.Research questionDo crossover prosthetic feet reduce the energy expenditure of walking across a range of speeds, when compared with energy storing feet among people with transtibial amputation due to non-dysvascular causes?MethodsA randomized within-subject study was conducted with a volunteer sample of twenty-seven adults with unilateral transtibial amputation due to non-dysvascular causes. Participants were fit with two prostheses. One had an energy storing foot (Össur Variflex) and the other a crossover foot (Össur Cheetah Xplore). Other components, including sockets, suspension, and interface were standardized. Energy expenditure was measured with a portable respirometer (Cosmed K4b2) while participants walked on a treadmill at self-selected slow, comfortable, and fast speeds with each prosthesis. Gross oxygen consumption rates (VO2 ml/min) were compared between foot conditions. Energy storing feet were used as the baseline condition because they are used by most people with a lower limb prosthesis. Analyses were performed to identify people who may benefit from transition to crossover feet.ResultsOn average, participants had lower oxygen consumption in the crossover foot condition compared to the energy storing foot condition at each self-selected walking speed, but this difference was not statistically significant. Participants with farther six-minute walk test distances, higher daily step counts, and higher Medicare Functional Classification Levels at baseline were more likely to use less energy in the crossover foot.SignificanceCrossover feet may be most beneficial for people with higher activity levels and physical fitness. Further research is needed to examine the effect of crossover feet on energy expenditure during high-level activities.



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Is Symmetry of Loading Improved for injured runners during Novice Barefoot Running?

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Adam S. Tenforde, Matthew C. Ruder, Steve T. Jamison, Pratham P. Singh, Irene S. Davis
BackgroundAs barefoot (BF) running provides important sensory information that influence landing patterns, it may also affect loading symmetry.Research questionThe purpose of this investigation was to examine whether symmetry of loading in a group of injured runners would be improved in a novice, barefoot condition.MethodsCross-sectional design evaluating 67 injured RFS runners. Each subject ran on an instrumented treadmill, first with their habitual shod pattern and then in a BF condition with a FFS pattern, both at the same self-selected speed. Data were averaged over 10 footstrikes. Variables of interest included vertical average load rate, vertical instantaneous load rate, and resultant instantaneous load rate. Symmetry indices (SI) for full population and within quartiles were compared for each loadrate variable (P≤.05) to evaluate changes between conditions.ResultsOn average, symmetry of loading was similar in a novice BF condition of injured runners compared with their habitual RFS shod condition. However, a subanalysis of quartiles revealed that the injured runners with the highest asymmetry (greatest SI values) displayed significantly lower asymmetry when running BF for all three loadrate measures.SignificanceThe addition of sensory input during barefoot running only improves symmetry of loading when habitual loading is highly asymmetric.



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Hearing Loss is Higher in Children with Post-Cardiac Surgery

Researchers at the Children's Hospital of Philadelphia found out that hearing loss in preschoolers who have undergone cardiac surgery during infancy could be 20 times more than in the one percent incidence in the general population.
 
Three hundred forty-eight children, who had surgery for their congenital heart disease (CHD), underwent audiologic and neurodevelopmental evaluations as part of a prospective study on neurodevelopmental progress at the age of 4. Researchers looked into the possible contributing factors of hearing loss and the impact of the hearing impairment on neurodevelopmental outcomes.
 
Senior author Nancy B. Burnham, RN, MSN, CRNP explained that the parent study was inspired by the increasing evidence of impaired neurodevelopmental outcomes in children with CHD who require surgery as infants. These outcomes have so many inter-individual variations.
 
"Audiological testing at the time of the National Institutes of Health (NIH) funded evaluation was primarily done because of the cognitive and speech evaluation to make sure they did not have associated hearing loss,” Burnham told The Hearing Journal. “I don’t know if we knew we would discover such a high prevalence of hearing loss.”
 
The study reported that the prevalence of hearing loss was 21.6 percent. Specifically, the prevalence of conductive hearing loss was 12.4 percent; the incidence of sensorineural hearing loss was 6.9 percent, and the indeterminate hearing loss was 2.3 percent. Only 18 preschoolers out of the 348 subjects were tested for hearing loss prior to the study. Ten subjects were already using hearing aids. The study suggested that hearing loss was associated with longer postoperative duration of stay, the presence of a genetic anomaly, and younger gestational age. Effects of the hearing loss included worse neurodevelopmental outcomes in language, cognition, and attention.
 
Burnham said that the impact of the findings of the study is "without a doubt, the importance of early screening and early testing."
 
When asked about possible measures to prevent the unintended hearing loss from cardiac surgery in infancy, given that younger gestational age, genetic anomaly, and longer postoperative duration of stay are the risk factors, Burnham explained: "There might be modifiable factors but additional research would be required.  Duration of stay is a potential area of research. What about the longer length of stay increases the risk for hearing impairment? Perhaps the many ototoxic drugs they receive during their hospital stay (a potential mechanism for future study). Research has shown babies with CHD brains are more immature than their associated GA at birth. If there were measures that would reduce preterm or near-term births that might have an impact."

Published: 3/27/2018 9:00:00 AM

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Hearing Loss is Higher in Children with Post-Cardiac Surgery

Researchers at the Children's Hospital of Philadelphia found out that hearing loss in preschoolers who have undergone cardiac surgery during infancy could be 20 times more than in the one percent incidence in the general population.
 
Three hundred forty-eight children, who had surgery for their congenital heart disease (CHD), underwent audiologic and neurodevelopmental evaluations as part of a prospective study on neurodevelopmental progress at the age of 4. Researchers looked into the possible contributing factors of hearing loss and the impact of the hearing impairment on neurodevelopmental outcomes.
 
Senior author Nancy B. Burnham, RN, MSN, CRNP explained that the parent study was inspired by the increasing evidence of impaired neurodevelopmental outcomes in children with CHD who require surgery as infants. These outcomes have so many inter-individual variations.
 
"Audiological testing at the time of the National Institutes of Health (NIH) funded evaluation was primarily done because of the cognitive and speech evaluation to make sure they did not have associated hearing loss,” Burnham told The Hearing Journal. “I don’t know if we knew we would discover such a high prevalence of hearing loss.”
 
The study reported that the prevalence of hearing loss was 21.6 percent. Specifically, the prevalence of conductive hearing loss was 12.4 percent; the incidence of sensorineural hearing loss was 6.9 percent, and the indeterminate hearing loss was 2.3 percent. Only 18 preschoolers out of the 348 subjects were tested for hearing loss prior to the study. Ten subjects were already using hearing aids. The study suggested that hearing loss was associated with longer postoperative duration of stay, the presence of a genetic anomaly, and younger gestational age. Effects of the hearing loss included worse neurodevelopmental outcomes in language, cognition, and attention.
 
Burnham said that the impact of the findings of the study is "without a doubt, the importance of early screening and early testing."
 
When asked about possible measures to prevent the unintended hearing loss from cardiac surgery in infancy, given that younger gestational age, genetic anomaly, and longer postoperative duration of stay are the risk factors, Burnham explained: "There might be modifiable factors but additional research would be required.  Duration of stay is a potential area of research. What about the longer length of stay increases the risk for hearing impairment? Perhaps the many ototoxic drugs they receive during their hospital stay (a potential mechanism for future study). Research has shown babies with CHD brains are more immature than their associated GA at birth. If there were measures that would reduce preterm or near-term births that might have an impact."

Published: 3/27/2018 9:00:00 AM

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Hearing Loss is Higher in Children with Post-Cardiac Surgery

Researchers at the Children's Hospital of Philadelphia found out that hearing loss in preschoolers who have undergone cardiac surgery during infancy could be 20 times more than in the one percent incidence in the general population.
 
Three hundred forty-eight children, who had surgery for their congenital heart disease (CHD), underwent audiologic and neurodevelopmental evaluations as part of a prospective study on neurodevelopmental progress at the age of 4. Researchers looked into the possible contributing factors of hearing loss and the impact of the hearing impairment on neurodevelopmental outcomes.
 
Senior author Nancy B. Burnham, RN, MSN, CRNP explained that the parent study was inspired by the increasing evidence of impaired neurodevelopmental outcomes in children with CHD who require surgery as infants. These outcomes have so many inter-individual variations.
 
"Audiological testing at the time of the National Institutes of Health (NIH) funded evaluation was primarily done because of the cognitive and speech evaluation to make sure they did not have associated hearing loss,” Burnham told The Hearing Journal. “I don’t know if we knew we would discover such a high prevalence of hearing loss.”
 
The study reported that the prevalence of hearing loss was 21.6 percent. Specifically, the prevalence of conductive hearing loss was 12.4 percent; the incidence of sensorineural hearing loss was 6.9 percent, and the indeterminate hearing loss was 2.3 percent. Only 18 preschoolers out of the 348 subjects were tested for hearing loss prior to the study. Ten subjects were already using hearing aids. The study suggested that hearing loss was associated with longer postoperative duration of stay, the presence of a genetic anomaly, and younger gestational age. Effects of the hearing loss included worse neurodevelopmental outcomes in language, cognition, and attention.
 
Burnham said that the impact of the findings of the study is "without a doubt, the importance of early screening and early testing."
 
When asked about possible measures to prevent the unintended hearing loss from cardiac surgery in infancy, given that younger gestational age, genetic anomaly, and longer postoperative duration of stay are the risk factors, Burnham explained: "There might be modifiable factors but additional research would be required.  Duration of stay is a potential area of research. What about the longer length of stay increases the risk for hearing impairment? Perhaps the many ototoxic drugs they receive during their hospital stay (a potential mechanism for future study). Research has shown babies with CHD brains are more immature than their associated GA at birth. If there were measures that would reduce preterm or near-term births that might have an impact."

Published: 3/27/2018 9:00:00 AM

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Auditory and language outcomes in children with unilateral hearing loss.

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Auditory and language outcomes in children with unilateral hearing loss.

Hear Res. 2018 Mar 13;:

Authors: Fitzpatrick EM, Gaboury I, Durieux-Smith A, Coyle D, Whittingham J, Nassrallah F

Abstract
OBJECTIVES: Children with unilateral hearing loss (UHL) are being diagnosed at younger ages because of newborn hearing screening. Historically, they have been considered at risk for difficulties in listening and language development. Little information is available on contemporary cohorts of children identified in the early months of life. We examined auditory and language acquisition outcomes in a contemporary cohort of early-identified children with UHL and compared their outcomes at preschool age with peers with mild bilateral loss and with normal hearing.
DESIGN: As part of the Mild and Unilateral Hearing Loss in Children Study, we collected auditory and spoken language outcomes on children with unilateral, bilateral hearing loss and with normal hearing over a four-year period. This report provides a cross-sectional analysis of results at age 48 months. A total of 120 children (38 unilateral and 31 bilateral mild, 51 normal hearing) were enrolled in the study from 2010 to 2015. Children started the study at varying ages between 12 and 36 months of age and were followed until age 36-48 months. The median age of identification of hearing loss was 3.4 months (IQR: 2.0, 5.5) for unilateral and 3.6 months (IQR: 2.7, 5.9) for the mild bilateral group. Families completed an intake form at enrolment to provide baseline child and family-related characteristics. Data on amplification fitting and use were collected via parent questionnaires at each annual assessment interval. This study involved a range of auditory development and language measures. For this report, we focus on the end of follow-up results from two auditory development questionnaires and three standardized speech-language assessments. Assessments included in this report were completed at a median age of 47.8 months (IQR: 38.8, 48.5). Using ANOVA, we examined auditory and language outcomes in children with UHL and compared their scores to children with mild bilateral hearing loss and those with normal hearing.
RESULTS: On most measures, children with UHL performed poorer than those in the mild bilateral and normal hearing study groups. All children with hearing loss performed at lower levels compared to the normal hearing control group. However, mean standard scores for the normal hearing group in this study were above normative means for the language measures. In particular, children with UHL showed gaps compared to the normal hearing control group in functional auditory listening and in receptive and expressive language skills (three quarters of one standard deviation below) at age 48 months. Their performance in receptive vocabulary and speech production was not significantly different from that of their hearing peers.
CONCLUSIONS: Even when identified in the first months of life, children with UHL show a tendency to lag behind their normal hearing peers in functional auditory listening and in receptive and expressive language development.

PMID: 29573881 [PubMed - as supplied by publisher]

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Elevated SLC26A4 gene promoter methylation is associated with the risk of presbycusis in men.

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Elevated SLC26A4 gene promoter methylation is associated with the risk of presbycusis in men.

Mol Med Rep. 2017 Jul;16(1):347-352

Authors: Xu J, Zheng J, Shen W, Ma L, Zhao M, Wang X, Tang J, Yan J, Wu Z, Zou Z, Bu S, Xi Y

Abstract
Presbycusis affects approximately one-third of people over the age of 65 and is a worldwide health problem. In the current study, whether the methylation level of solute carrier family 26 member 4 (SLC26A4) predicted an increased risk of presbycusis was investigated. Peripheral blood samples from 102 patients with presbycusis and 104 controls were collected, and the methylation of the CpG sites of SLC26A4 was measured by applying pyrosequencing technology combined with sodium bisulfate DNA conversion chemistry. Within the SLC26A4 promoter region, one CpG site (CpG3) exhibited a significantly (P<0.0001) greater methylation level in the patients with presbycusis (26.5±5.56%) compared with the controls (23.8±3.85%). Significantly different CpG3 methylation levels were observed between the patients with presbycusis and the controls among the male participants (P=0.0004). In addition, a significant decrease in the transcriptional level of SLC26A4 in peripheral blood was observed in the patients with presbycusis compared with the controls. Furthermore, analyses of the receiver operating characteristic (ROC) curves indicated that CpG3 methylation at the SLC26A4 promoter predicted the risk of presbycusis in the male participants (AUC=0.684, 95% CI=0.584‑0.784, P=0.001). The results demonstrated the significance of the CpG site methylation level of SLC26A4, and thus provides a potential marker for the diagnosis of presbycusis.

PMID: 28498466 [PubMed - indexed for MEDLINE]

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Gesture Use in 14-Month-Old Toddlers With Hearing Loss and Their Mothers' Responses.

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Gesture Use in 14-Month-Old Toddlers With Hearing Loss and Their Mothers' Responses.

Am J Speech Lang Pathol. 2016 Nov 01;25(4):519-531

Authors: Ambrose SE

Abstract
Purpose: This study examined the gesture use of 14-month-old toddlers with hearing loss (HL) and mothers' responses to children's early gesture use. Comparisons were made to symbolic language and to dyads in which the toddler had normal hearing (NH).
Method: Participants were 25 mother-toddler dyads in which the child had HL and a socioeconomic-status matched group of 23 mother-toddler dyads in which the child had NH. Thirty-minute mother-child interactions were video-recorded, transcribed for spoken language, sign, and gesture use, and coded for maternal responses to children's gestures. Mothers also reported on children's gestural and spoken language abilities.
Results: Toddlers with HL used gesture similarly to their peers with NH, but demonstrated delays in spoken language. Spoken language and gesture were not significantly related for either group. Hearing levels were related to spoken language, but not gesture for the HL group. Maternal and child gesture were only related for signing mothers. Mothers of children with HL were more likely than their counterparts to provide no response to children's gestures.
Conclusion: Although toddlers' gesture abilities remain intact in the presence of HL, mothers were not maximally responsive to those gestures and thus should be coached to increase their provision of contingent feedback.

PMID: 27701626 [PubMed - indexed for MEDLINE]

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Assessing Vocal Development in Infants and Toddlers Who Are Hard of Hearing: A Parent-Report Tool.

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Assessing Vocal Development in Infants and Toddlers Who Are Hard of Hearing: A Parent-Report Tool.

J Deaf Stud Deaf Educ. 2016 Jul;21(3):237-48

Authors: Ambrose SE, Thomas A, Moeller MP

Abstract
The main purpose of the current investigation was to determine whether the Vocal Development Landmarks Interview-Experimental Version (VDLI-E) was sensitive to variation in the vocal development of infants and toddlers who are hard of hearing. The VDLI-E is an interactive parent interview that uses audio samples of authentic infant vocalizations to make targeted vocal behaviors clear and understandable to parents without the need for technical terms, verbal descriptions, or adult modeling of infant productions. The VDLI-E was found to be sensitive to age and hearing and was related to performance on concurrent measures of early auditory skills, expressive vocabulary, and overall expressive language abilities. These findings provide preliminary support for the utility of this measure in monitoring the impact of early auditory experiences on vocal development for 6- to 18-month-old children who are hard of hearing.

PMID: 27141092 [PubMed - indexed for MEDLINE]

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Hearing Parents' Appraisals of Parenting a Deaf or Hard-of-Hearing Child: Application of a Positive Psychology Framework.

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Hearing Parents' Appraisals of Parenting a Deaf or Hard-of-Hearing Child: Application of a Positive Psychology Framework.

J Deaf Stud Deaf Educ. 2016 Jul;21(3):249-58

Authors: Szarkowski A, Brice PJ

Abstract
Hearing parents of deaf and hard-of-hearing children face unique challenges and stressors, the understanding of which has been the focus of numerous studies; yet, relatively little is known about their positive experiences. Using a qualitative purposive sampling design, interviews were conducted with 11 hearing parents (8 mothers, 3 fathers) exploring parents' positive appraisals of their experiences in raising a child who is deaf or hard of hearing (D/HH). Interviews were transcribed and a thematic analysis was conducted, which allowed the researchers to identify themes and patterns in the parents' appraisals. Nine key themes emerged, which characterized parents' positive perceptions of raising a child who is D/HH: knowing the child, appreciating everyday positives, increasing involvement with the child, relishing the highs, taking less for granted, letting go, learning, advocating, and experiencing personal growth A positive psychology framework was employed to foster understanding of the interview findings and their implications. When asked about the positive aspects of raising a D/HH child, hearing parents were readily able to identify ways in which their parenting experience had been enhanced and their lives improved as a result of their unique situations. The implications of these findings are discussed.

PMID: 26977097 [PubMed - indexed for MEDLINE]

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