Electric-Acoustic Stimulation Outcomes in Children

Objectives: This study investigates outcomes in children fit with electric-acoustic stimulation (EAS) and addresses three main questions: (1) Are outcomes with EAS superior to outcomes with conventional electric-only stimulation in children? (2) Do children with residual hearing benefit from EAS and conventional electric-only stimulation when compared with the preoperative hearing aid (HA) condition? (3) Can children with residual hearing derive benefit from EAS after several years of listening with conventional electric-only stimulation? Design: Sixteen pediatric cochlear implant (CI) recipients between 4 and 16 years of age with an unaided low-frequency pure tone average of 75 dB HL in the implanted ear were included in two study arms. Arm 1 included new recipients, and Arm 2 included children with at least 1 year of CI experience. Using a within-subject design, participants were evaluated unilaterally with the Consonant-Nucleus-Consonant (CNC) word list in quiet and the Baby Bio at a +5 dB SNR using an EAS program and a conventional full electric (FE) program. Arm 1 participants’ scores were also compared with preoperative scores. Results: Speech perception outcomes were statistically higher with the EAS program than the FE program. For new recipients, scores were significantly higher with EAS than preoperative HA scores for both the CNC and Baby Bio in noise; however, after 6 months of device use, results in the FE condition were not significantly better than preoperative scores. Long-term FE users benefited from EAS over their FE programs based on CNC word scores. Conclusions: Whether newly implanted or long-term CI users, children with residual hearing after CI surgery can benefit from EAS. Cochlear implantation with EAS fitting is a viable option for children with HAs who have residual hearing but have insufficient access to high-frequency sounds and poor speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: The authors wish to thank Dr. Emily Buss for her assistance with statistical analysis. This study was supported by Cochlear Americas. Holly Teagle serves on the audiology advisory board for Cochlear. The authors have no other conflicts of interest to disclose. Portions of this article were presented at The 13th International Conference on Cochlear Implants and Other Implantable Technologies, Toronto, Ontario, Canada, May 12, 2016, and at The 15th International Conference on Cochlear Implants and Other Implantable Technologies, Antwerp, Belgium, June 29, 2018. Received February 10, 2018; accepted August 10, 2018. Address for correspondence: Lisa R. Park, The Children’s Cochlear Implant Center at UNC, University of North Carolina at Chapel Hill, 5501 Fortunes Ridge Drive, Suite A, Durham, NC 27713, USA. Phone: 919-419-1449. Fax: 919-419-1399. E-mail: Lisa_Park@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Electric-Acoustic Stimulation Outcomes in Children

Objectives: This study investigates outcomes in children fit with electric-acoustic stimulation (EAS) and addresses three main questions: (1) Are outcomes with EAS superior to outcomes with conventional electric-only stimulation in children? (2) Do children with residual hearing benefit from EAS and conventional electric-only stimulation when compared with the preoperative hearing aid (HA) condition? (3) Can children with residual hearing derive benefit from EAS after several years of listening with conventional electric-only stimulation? Design: Sixteen pediatric cochlear implant (CI) recipients between 4 and 16 years of age with an unaided low-frequency pure tone average of 75 dB HL in the implanted ear were included in two study arms. Arm 1 included new recipients, and Arm 2 included children with at least 1 year of CI experience. Using a within-subject design, participants were evaluated unilaterally with the Consonant-Nucleus-Consonant (CNC) word list in quiet and the Baby Bio at a +5 dB SNR using an EAS program and a conventional full electric (FE) program. Arm 1 participants’ scores were also compared with preoperative scores. Results: Speech perception outcomes were statistically higher with the EAS program than the FE program. For new recipients, scores were significantly higher with EAS than preoperative HA scores for both the CNC and Baby Bio in noise; however, after 6 months of device use, results in the FE condition were not significantly better than preoperative scores. Long-term FE users benefited from EAS over their FE programs based on CNC word scores. Conclusions: Whether newly implanted or long-term CI users, children with residual hearing after CI surgery can benefit from EAS. Cochlear implantation with EAS fitting is a viable option for children with HAs who have residual hearing but have insufficient access to high-frequency sounds and poor speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: The authors wish to thank Dr. Emily Buss for her assistance with statistical analysis. This study was supported by Cochlear Americas. Holly Teagle serves on the audiology advisory board for Cochlear. The authors have no other conflicts of interest to disclose. Portions of this article were presented at The 13th International Conference on Cochlear Implants and Other Implantable Technologies, Toronto, Ontario, Canada, May 12, 2016, and at The 15th International Conference on Cochlear Implants and Other Implantable Technologies, Antwerp, Belgium, June 29, 2018. Received February 10, 2018; accepted August 10, 2018. Address for correspondence: Lisa R. Park, The Children’s Cochlear Implant Center at UNC, University of North Carolina at Chapel Hill, 5501 Fortunes Ridge Drive, Suite A, Durham, NC 27713, USA. Phone: 919-419-1449. Fax: 919-419-1399. E-mail: Lisa_Park@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Body weight support through a walking cane in inexperienced users with knee osteoarthritis

Publication date: Available online 24 September 2018

Source: Gait & Posture

Author(s): Julia Hart, Michelle Hall, Tim V. Wrigley, Charlotte J. Marshall, MPhty, Kim L. Bennell

ABSTRACT

Background

Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.

Research question

1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?

Methods

Seventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 minutes of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.

Results

Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 minutes of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p > 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).

Significance

A short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.

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Dynamic evaluation of simulated leg length inequalities and their effects on the musculoskeletal apparatus

Publication date: Available online 24 September 2018

Source: Gait & Posture

Author(s): Aylin Beeck, Valentin Quack, Björn Rath, Michael Wild, Roman Michalik, Hanno Schenker, Marcel Betsch

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Body weight support through a walking cane in inexperienced users with knee osteoarthritis

Publication date: Available online 24 September 2018

Source: Gait & Posture

Author(s): Julia Hart, Michelle Hall, Tim V. Wrigley, Charlotte J. Marshall, MPhty, Kim L. Bennell

ABSTRACT

Background

Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.

Research question

1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?

Methods

Seventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 minutes of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.

Results

Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 minutes of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p > 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).

Significance

A short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.

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Dynamic evaluation of simulated leg length inequalities and their effects on the musculoskeletal apparatus

Publication date: Available online 24 September 2018

Source: Gait & Posture

Author(s): Aylin Beeck, Valentin Quack, Björn Rath, Michael Wild, Roman Michalik, Hanno Schenker, Marcel Betsch

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Cortical correlates of speech intelligibility measured using functional near-infrared spectroscopy (fNIRS).

Publication date: Available online 25 September 2018

Source: Hearing Research

Author(s): Rachael J. Lawrence, Ian M. Wiggins, Carly A. Anderson, Jodie Davies-Thompson, Douglas E.H. Hartley

Abstract

Functional neuroimaging has identified that the temporal, frontal and parietal cortex support core aspects of speech processing. An objective measure of speech intelligibility based on cortical activation in these brain regions would be extremely useful to speech communication and hearing device applications. In the current study, we used noise-vocoded speech to examine cortical correlates of speech intelligibility in normally-hearing listeners using functional near-infrared spectroscopy (fNIRS), a non-invasive, neuroimaging technique that is fully-compatible with hearing devices, including cochlear implants. In twenty-three normally-hearing adults we measured (1) activation in superior temporal, inferior frontal and inferior parietal cortex bilaterally and (2) behavioural speech intelligibility. Listeners heard noise-vocoded sentences targeting five equally spaced levels of intelligibility between 0 and 100% correct. Activation in superior temporal regions increased linearly with intelligibility. This relationship appears to have been driven in part by changing acoustic properties across stimulation conditions, rather than solely by intelligibility per se. Superior temporal activation was also predictive of individual differences in intelligibility in a challenging listening condition. Beyond superior temporal cortex, we identified regions in which activation varied non-linearly with intelligibility. For example, in left inferior frontal cortex, activation peaked in response to heavily degraded, yet still somewhat intelligible, speech. Activation in this region was linearly related to response time on a simultaneous behavioural task, suggesting it may contribute to decision making. Our results indicate that fNIRS has the potential to provide an objective measure of speech intelligibility in normally-hearing listeners. Should these results be found to apply similarly in the case of individuals listening through a cochlear implant, fNIRS would demonstrate potential for a clinically useful measure not only of speech intelligibility, but also of listening effort.

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Cortical correlates of speech intelligibility measured using functional near-infrared spectroscopy (fNIRS).

Publication date: Available online 25 September 2018

Source: Hearing Research

Author(s): Rachael J. Lawrence, Ian M. Wiggins, Carly A. Anderson, Jodie Davies-Thompson, Douglas E.H. Hartley

Abstract

Functional neuroimaging has identified that the temporal, frontal and parietal cortex support core aspects of speech processing. An objective measure of speech intelligibility based on cortical activation in these brain regions would be extremely useful to speech communication and hearing device applications. In the current study, we used noise-vocoded speech to examine cortical correlates of speech intelligibility in normally-hearing listeners using functional near-infrared spectroscopy (fNIRS), a non-invasive, neuroimaging technique that is fully-compatible with hearing devices, including cochlear implants. In twenty-three normally-hearing adults we measured (1) activation in superior temporal, inferior frontal and inferior parietal cortex bilaterally and (2) behavioural speech intelligibility. Listeners heard noise-vocoded sentences targeting five equally spaced levels of intelligibility between 0 and 100% correct. Activation in superior temporal regions increased linearly with intelligibility. This relationship appears to have been driven in part by changing acoustic properties across stimulation conditions, rather than solely by intelligibility per se. Superior temporal activation was also predictive of individual differences in intelligibility in a challenging listening condition. Beyond superior temporal cortex, we identified regions in which activation varied non-linearly with intelligibility. For example, in left inferior frontal cortex, activation peaked in response to heavily degraded, yet still somewhat intelligible, speech. Activation in this region was linearly related to response time on a simultaneous behavioural task, suggesting it may contribute to decision making. Our results indicate that fNIRS has the potential to provide an objective measure of speech intelligibility in normally-hearing listeners. Should these results be found to apply similarly in the case of individuals listening through a cochlear implant, fNIRS would demonstrate potential for a clinically useful measure not only of speech intelligibility, but also of listening effort.

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Cortical correlates of speech intelligibility measured using functional near-infrared spectroscopy (fNIRS).

Publication date: Available online 25 September 2018

Source: Hearing Research

Author(s): Rachael J. Lawrence, Ian M. Wiggins, Carly A. Anderson, Jodie Davies-Thompson, Douglas E.H. Hartley

Abstract

Functional neuroimaging has identified that the temporal, frontal and parietal cortex support core aspects of speech processing. An objective measure of speech intelligibility based on cortical activation in these brain regions would be extremely useful to speech communication and hearing device applications. In the current study, we used noise-vocoded speech to examine cortical correlates of speech intelligibility in normally-hearing listeners using functional near-infrared spectroscopy (fNIRS), a non-invasive, neuroimaging technique that is fully-compatible with hearing devices, including cochlear implants. In twenty-three normally-hearing adults we measured (1) activation in superior temporal, inferior frontal and inferior parietal cortex bilaterally and (2) behavioural speech intelligibility. Listeners heard noise-vocoded sentences targeting five equally spaced levels of intelligibility between 0 and 100% correct. Activation in superior temporal regions increased linearly with intelligibility. This relationship appears to have been driven in part by changing acoustic properties across stimulation conditions, rather than solely by intelligibility per se. Superior temporal activation was also predictive of individual differences in intelligibility in a challenging listening condition. Beyond superior temporal cortex, we identified regions in which activation varied non-linearly with intelligibility. For example, in left inferior frontal cortex, activation peaked in response to heavily degraded, yet still somewhat intelligible, speech. Activation in this region was linearly related to response time on a simultaneous behavioural task, suggesting it may contribute to decision making. Our results indicate that fNIRS has the potential to provide an objective measure of speech intelligibility in normally-hearing listeners. Should these results be found to apply similarly in the case of individuals listening through a cochlear implant, fNIRS would demonstrate potential for a clinically useful measure not only of speech intelligibility, but also of listening effort.

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Cortical correlates of speech intelligibility measured using functional near-infrared spectroscopy (fNIRS).

Publication date: Available online 25 September 2018

Source: Hearing Research

Author(s): Rachael J. Lawrence, Ian M. Wiggins, Carly A. Anderson, Jodie Davies-Thompson, Douglas E.H. Hartley

Abstract

Functional neuroimaging has identified that the temporal, frontal and parietal cortex support core aspects of speech processing. An objective measure of speech intelligibility based on cortical activation in these brain regions would be extremely useful to speech communication and hearing device applications. In the current study, we used noise-vocoded speech to examine cortical correlates of speech intelligibility in normally-hearing listeners using functional near-infrared spectroscopy (fNIRS), a non-invasive, neuroimaging technique that is fully-compatible with hearing devices, including cochlear implants. In twenty-three normally-hearing adults we measured (1) activation in superior temporal, inferior frontal and inferior parietal cortex bilaterally and (2) behavioural speech intelligibility. Listeners heard noise-vocoded sentences targeting five equally spaced levels of intelligibility between 0 and 100% correct. Activation in superior temporal regions increased linearly with intelligibility. This relationship appears to have been driven in part by changing acoustic properties across stimulation conditions, rather than solely by intelligibility per se. Superior temporal activation was also predictive of individual differences in intelligibility in a challenging listening condition. Beyond superior temporal cortex, we identified regions in which activation varied non-linearly with intelligibility. For example, in left inferior frontal cortex, activation peaked in response to heavily degraded, yet still somewhat intelligible, speech. Activation in this region was linearly related to response time on a simultaneous behavioural task, suggesting it may contribute to decision making. Our results indicate that fNIRS has the potential to provide an objective measure of speech intelligibility in normally-hearing listeners. Should these results be found to apply similarly in the case of individuals listening through a cochlear implant, fNIRS would demonstrate potential for a clinically useful measure not only of speech intelligibility, but also of listening effort.

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