Variability of spatiotemporal gait parameters in children with and without Down syndrome during treadmill walking

Publication date: Available online 27 November 2018

Source: Gait & Posture

Author(s): Matthew Beerse, Gena Henderson, Huaqing Liang, Toyin Ajisafe, Jianhua Wu

Abstract

Background: Increasing walking speed and including bilateral external ankle load have been shown to improve aspects of the gait pattern of children with Down syndrome (DS). However, it is unknown if speed and ankle load improves the cycle-to-cycle variability in a similar way.

Research question: How do changes of walking speed and external ankle load impact spatiotemporal variability during treadmill walking in children with and without DS?

Methods: Thirteen children with DS (aged 7-10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

Results and significance: Across all conditions, the DS group took shorter and wider steps than the TD group, but walked with a similar swing percentage, double support percentage, and foot rotation angle. Further, the DS group demonstrated greater variability of all spatiotemporal parameters, except for step width and foot rotation angle. Our results indicated that children with DS can modulate their spatiotemporal gait pattern accordingly like their TD peers when walking faster on a treadmill and/or with an external ankle load. Smaller step width variability in the DS group suggests that mediolateral stability may be prioritized during treadmill walking to safely navigate the treadmill and complete walking tasks. Similar temporal parameters but distinct spatial parameters in the DS group suggest that they may have developed similar rhythmic control but are confined by their spatial movement limitations.

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Is ACL deficiency always a contraindication for medial UKA? Kinematic and Kinetic Analysis of implanted and contralateral knees

Publication date: Available online 27 November 2018

Source: Gait & Posture

Author(s): Lorena Suter, Adrian Roth, Michael Angst, Fabian von Knoch, Stefan Preiss, Renate List, Stephen Ferguson, Thomas Zumbrunn

Abstract

Background

Prevalence of knee osteoarthritis increases because life expectancy continues to rise with an active patient population. Hence, the concept of unicompartmental knee arthroplasty (UKA) has regained popularity as a treatment option for unicompartmental knee osteoarthritis. Anterior cruciate ligament (ACL) deficiency is widely considered as a contraindication for UKA, however, there are conflicting reports. If otherwise indicated, some surgeons consider UKA for ACL-deficient patients using a modified surgical technique, with a reduction of posterior tibial slope.

Research question: The purpose of this study was to evaluate outcomes in UKA patients with ACL deficiency in comparison to a conventional UKA group (intact ACL) by the measurement of knee kinematics and kinetics.

Methods

Ten patients with conventional UKA and an intact ACL and eight patients with an ACL-deficient UKA and a reduced posterior tibial slope relative to the native knee were recruited. Three-dimensional joint kinematics of the knee were measured, using skin markers and an infrared optical motion capture system. Ground reaction forces (GRF) were measured with force plates in all three directions. Level walking, ramp descent and stair descent were analyzed, comparing implanted and contralateral native knees and the two UKA groups.

Results

No significant differences in kinetics and kinematics were observed between conventional UKA and ACL-deficient UKA groups for any of the activities. However, some asymmetries in GRF between the implanted and contralateral side were present for the ACL-deficient group, during level walking (unloading rate) and stair descent (stance time).

Significance

Promising outcomes of the ACL-deficient UKA group suggest that ACL deficiency may not always be a contraindication. Therefore, ACL-deficient UKA could be an alternative treatment option to total knee arthroplasty for an appropriate surgeon selected patient population.

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Variability of spatiotemporal gait parameters in children with and without Down syndrome during treadmill walking

Publication date: Available online 27 November 2018

Source: Gait & Posture

Author(s): Matthew Beerse, Gena Henderson, Huaqing Liang, Toyin Ajisafe, Jianhua Wu

Abstract

Background: Increasing walking speed and including bilateral external ankle load have been shown to improve aspects of the gait pattern of children with Down syndrome (DS). However, it is unknown if speed and ankle load improves the cycle-to-cycle variability in a similar way.

Research question: How do changes of walking speed and external ankle load impact spatiotemporal variability during treadmill walking in children with and without DS?

Methods: Thirteen children with DS (aged 7-10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

Results and significance: Across all conditions, the DS group took shorter and wider steps than the TD group, but walked with a similar swing percentage, double support percentage, and foot rotation angle. Further, the DS group demonstrated greater variability of all spatiotemporal parameters, except for step width and foot rotation angle. Our results indicated that children with DS can modulate their spatiotemporal gait pattern accordingly like their TD peers when walking faster on a treadmill and/or with an external ankle load. Smaller step width variability in the DS group suggests that mediolateral stability may be prioritized during treadmill walking to safely navigate the treadmill and complete walking tasks. Similar temporal parameters but distinct spatial parameters in the DS group suggest that they may have developed similar rhythmic control but are confined by their spatial movement limitations.

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Is ACL deficiency always a contraindication for medial UKA? Kinematic and Kinetic Analysis of implanted and contralateral knees

Publication date: Available online 27 November 2018

Source: Gait & Posture

Author(s): Lorena Suter, Adrian Roth, Michael Angst, Fabian von Knoch, Stefan Preiss, Renate List, Stephen Ferguson, Thomas Zumbrunn

Abstract

Background

Prevalence of knee osteoarthritis increases because life expectancy continues to rise with an active patient population. Hence, the concept of unicompartmental knee arthroplasty (UKA) has regained popularity as a treatment option for unicompartmental knee osteoarthritis. Anterior cruciate ligament (ACL) deficiency is widely considered as a contraindication for UKA, however, there are conflicting reports. If otherwise indicated, some surgeons consider UKA for ACL-deficient patients using a modified surgical technique, with a reduction of posterior tibial slope.

Research question: The purpose of this study was to evaluate outcomes in UKA patients with ACL deficiency in comparison to a conventional UKA group (intact ACL) by the measurement of knee kinematics and kinetics.

Methods

Ten patients with conventional UKA and an intact ACL and eight patients with an ACL-deficient UKA and a reduced posterior tibial slope relative to the native knee were recruited. Three-dimensional joint kinematics of the knee were measured, using skin markers and an infrared optical motion capture system. Ground reaction forces (GRF) were measured with force plates in all three directions. Level walking, ramp descent and stair descent were analyzed, comparing implanted and contralateral native knees and the two UKA groups.

Results

No significant differences in kinetics and kinematics were observed between conventional UKA and ACL-deficient UKA groups for any of the activities. However, some asymmetries in GRF between the implanted and contralateral side were present for the ACL-deficient group, during level walking (unloading rate) and stair descent (stance time).

Significance

Promising outcomes of the ACL-deficient UKA group suggest that ACL deficiency may not always be a contraindication. Therefore, ACL-deficient UKA could be an alternative treatment option to total knee arthroplasty for an appropriate surgeon selected patient population.

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The Relationship between Random Gap Detection and Hearing in Noise Test Performances.

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The Relationship between Random Gap Detection and Hearing in Noise Test Performances.

J Am Acad Audiol. 2018 Nov/Dec;29(10):948-954

Authors: Heeke P, Vermiglio AJ, Bulla E, Velappan K, Fang X

Abstract
BACKGROUND: Temporal acoustic cues are particularly important for speech understanding, and past research has inferred a relationship between temporal resolution and speech recognition in noise ability. A temporal resolution disorder is thought to affect speech understanding abilities because persons would not be able to accurately encode these frequency transitions, creating speech discrimination errors even in the presence of normal pure-tone hearing.
PURPOSE: The primary purpose was to investigate the relationship between temporal resolution as measured by the Random Gap Detection Test (RGDT) and speech recognition in noise performance as measured by the Hearing in Noise Test (HINT) in adults with normal audiometric thresholds. The second purpose was to examine the relationship between temporal resolution and spatial release from masking.
RESEARCH DESIGN: The HINT and RGDT protocols were administered under headphones according to the guidelines specified by the developers. The HINT uses an adaptive protocol to determine the signal-to-noise ratio where the participant recognizes 50% of the sentences. For HINT conditions, the target sentences were presented at 0° and the steady-state speech-shaped noise and a four-talker babble (4TB) was presented at 0°, +90°, or -90° for noise front, noise right, and noise left conditions, respectively. The RGDT is used to evaluate temporal resolution by determining the smallest time interval between two matching stimuli that can be detected by the participant. The RGDT threshold is the shortest time interval where the participant detects a gap. Tonal (0.5, 1, 2, and 4 kHz) and click stimuli random gap subtests were presented at 60 dB HL. Tonal subtests were presented in a random order to minimize presentation order effects.
STUDY SAMPLE: Twenty-one young, native English-speaking participants with normal pure-tone thresholds (≤25 dB HL for 500-4000 Hz) participated in this study. The average age of the participants was 20.2 years (SD = 0.66).
DATA COLLECTION AND ANALYSIS: Spearman rho correlation coefficients were conducted using SPSS 22 (IBM Corp., Armonk, NY) to determine the relationships between HINT and RGDT thresholds and derived measures (spatial advantage and composite scores). Nonparametric testing was used because of the ordinal nature of RGDT data.
RESULTS: Moderate negative correlations (p < 0.05) were found between eight RGDT and HINT threshold measures and a moderate positive correlation (p < 0.05) was found between RGDT click thresholds and HINT 4TB spatial advantage. This suggests that as temporal resolution abilities worsened, speech recognition in noise performance improved. These correlations were not statistically significant after the p value reflected the Bonferroni correction for multiple comparisons.
CONCLUSION: The results of the present study imply that the RGDT and HINT use different temporal processes. Performance on the RGDT cannot be predicted from HINT thresholds or vice versa.

PMID: 30479267 [PubMed - in process]

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Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

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Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

J Am Acad Audiol. 2018 Nov/Dec;29(10):936-947

Authors: Manchaiah V, Beukes EW, Granberg S, Durisala N, Baguley DM, Allen PM, Andersson G

Abstract
BACKGROUND: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model.
OBJECTIVE: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective.
RESEARCH DESIGN: A cross-sectional survey design was used.
STUDY SAMPLE: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.
DATA COLLECTION AND ANALYSIS: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions.
RESULTS: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor.
CONCLUSIONS: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.

PMID: 30479266 [PubMed - in process]

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A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs.

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A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs.

J Am Acad Audiol. 2018 Nov/Dec;29(10):928-935

Authors: Billings CJ, Dillard LK, Hoskins ZB, Penman TM, Reavis KM

Abstract
BACKGROUND: Department of Veterans Affairs (VA) audiologists have anecdotally reported examining numerous Veterans with normal pure-tone thresholds; however, the prevalence of these patients within the VA is unknown. The VA audiological data repository provides an ideal dataset to examine this group of Veterans. Knowing the prevalence of normal-hearing Veterans within the VA system is the first step to understanding the underlying referral patterns and clinical complaints of Veterans. Data repositories which capture data from both normal and impaired populations provide an indispensable view into hearing health care which can help to improve diagnosis and treatment of Veterans' hearing difficulties.
PURPOSE: Using the VA audiological data repository, this study aimed to (1) determine the prevalence of normal hearing thresholds among Veterans seeking hearing health care within the VA health care system and (2) determine the prevalence of abnormal clinical audiology test results among Veterans with normal hearing thresholds.
RESEARCH DESIGN: This study was a large-scale retrospective, descriptive observational analysis of uploaded audiological records from the VA Denver Acquisition and Logistics Center audiological data repository encompassing visits that took place between April 1991 and June 2015.
STUDY SAMPLE: At the time of data extraction, there were 3,641,326 audiological records in the repository, with 2,322,771 unique individual records. The study sample was further restricted to include only individuals with normal hearing (n = 235,091), which was defined as pure-tone thresholds better than, or equal to, 25 dB HL at octave frequencies from 250 to 8000 Hz, bilaterally. Patients ranged from 19 to 90+ years of age.
DATA COLLECTION AND ANALYSIS: We describe the data using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. In addition to hearing thresholds, the occurrence of abnormal results on other tests in the audiological test battery is also reported. We estimate the prevalence of normal hearing among all Veterans with records in the VA audiological data repository.
RESULTS: Veterans with normal hearing were on average 37 yr old. The prevalence of Veterans with normal hearing thresholds visiting VA audiology clinics in the current hearing repository dataset was 10.12%. Overall, 41% of Veterans with normal pure-tone thresholds had other clinically abnormal audiological test results; for example, contralateral acoustic reflex thresholds (31.7%) and tympanometry (21.5%) had the highest rate of abnormal test results.
CONCLUSIONS: Approximately one in ten Veterans seeking care within the VA healthcare system, and reported to the VA audiological data repository, has normal pure-tone hearing thresholds. This may be an underestimate of the true underlying prevalence of normal-hearing Veterans seeking audiology services at the VA because records with normal results were not consistently submitted to the repository. In addition, 41% of Veterans with normal pure-tone thresholds nonetheless presented with other audiological abnormalities. This study suggests that future work directed toward understanding referral patterns and clinical complaints of individuals who present to VA audiology clinics with normal hearing thresholds may be fruitful in the cause of improving diagnosis and treatment of Veterans' hearing difficulties.

PMID: 30479265 [PubMed - in process]

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Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors' Perceptions and Practices.

Related Articles

Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors' Perceptions and Practices.

J Am Acad Audiol. 2018 Nov/Dec;29(10):917-927

Authors: Muñoz K, Landon T, Corbin-Lewis K

Abstract
BACKGROUND: Counseling is a critical component within audiological service delivery. Partnering with patients to support them in learning to effectively cope with their hearing challenges is a key component in achieving desired outcomes. Even though there is agreement on the foundational role counseling plays in audiology service delivery, counseling instruction varies among audiology training programs.
PURPOSE: The purpose of this study was to investigate the perspectives and practices of supervisors in audiology graduate training programs related to mentoring students in the acquisition of counseling skills.
RESEARCH DESIGN: A cross-sectional design was used; participants completed a self-report survey.
STUDY SAMPLE: The survey was sent to 323 clinical supervisors in AuD graduate programs in the United States.
DATA COLLECTION AND ANALYSIS: Completed surveys were received from 205 supervisors. Responses were analyzed using descriptive statistics to identify practice trends.
RESULTS: Participants reported their perceptions about importance of teaching counseling skills to audiology students, their confidence in teaching skills, their self-efficacy for supporting student learning, how they provide feedback to students, and challenges they encounter. Most participants reported their program requires a counseling course (88%; n = 176). Most of the participants reported confidence in teaching counseling skills; however, fewer reported being very or extremely confident in teaching students how to talk with clients about their emotions (53%; n = 109) and explaining the rationale behind specific counseling strategies (47%; n = 97). Participants with more years of supervisory experience had statistically significantly higher self-ratings for teaching confidence and self-efficacy for supporting student learning in counseling than those with fewer years of experience.
CONCLUSIONS: Audiology supervisors in AuD programs believe counseling is important to teach to students; however, they report variability in use of methods for providing feedback, evaluating student performance, and in their self-efficacy for supporting student learning. Future audiologists would benefit from a more systematic approach within graduate training for teaching counseling skills.

PMID: 30479264 [PubMed - in process]

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Auditory P300 in Noise in Younger and Older Adults.

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Auditory P300 in Noise in Younger and Older Adults.

J Am Acad Audiol. 2018 Nov/Dec;29(10):909-916

Authors: McCullagh J, Shinn JB

Abstract
BACKGROUND: Older adults often report difficulty hearing in background noise which is not completely attributable to peripheral hearing loss. Although age-related declines in cognition and hearing in background noise occur, the underlying age-related changes in processing of auditory stimuli in background noise has yet to be fully understood. The auditory P300 has the potential to elucidate the effects of age on auditory and cognitive processing of stimuli in background noise, but additional research is warranted.
PURPOSE: The purpose of this study was to investigate age-related differences in cognitive processing of auditory stimuli by evoking the auditory P300 at multiple signal-to-noise ratios (SNRs).
RESEARCH DESIGN: A two-group, repeated measures study design was used.
STUDY SAMPLE: A convenience sample of 35 participants, 15 older adults (mean age of 66.4 yr) and 20 younger adults (mean age of 21.1 yr), participated in the study. All participants had negative otologic and neurological histories.
DATA COLLECTION AND ANALYSIS: The auditory P300 was evoked using an oddball paradigm with 500 (frequent) and 1000 Hz (target) tonal stimuli in quiet and in the presence of background noise at +20, +10, and 0 SNRs. P300 amplitudes and latencies were measured in each condition for every participant. Repeated measures analyses of variance were conducted for the amplitude and latency measures of the P300 for each group.
RESULTS: Results from this study demonstrated P300 latencies were significantly longer in older adults in noise at the most challenging condition (0 SNR) compared with the quiet condition and between the +10 SNR and 0 SNR conditions. Although older adults had significantly longer P300 latencies compared with younger adults, no significant group by listening condition interaction existed. No significant P300 amplitude differences were found for group, noise, or group × listening condition interactions.
CONCLUSIONS: Results provide evidence that auditory cortical processing, regardless of age, is poorer at more difficult SNRs. However, results also demonstrate that older adults perform significantly poorer than younger adults. This supports the notion that some degree of age-related decline in synchronous firing and rate of transmission of the auditory cortical neurons contributing to the auditory P300 exists. Studies are needed to further understand the impact of noise on auditory cortical processing across populations.

PMID: 30479263 [PubMed - in process]

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Psychometric Properties of the Turkish Version of the Satisfaction with Amplification in Daily Living Questionnaire in Hearing Aid Users.

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Psychometric Properties of the Turkish Version of the Satisfaction with Amplification in Daily Living Questionnaire in Hearing Aid Users.

J Am Acad Audiol. 2018 Nov/Dec;29(10):898-908

Authors: Genç M, Çildir B, Kaya M

Abstract
BACKGROUND: Assessing hearing aid satisfaction is important for hearing aid adaptation in individuals who have hearing loss. Each user should be compared to oneself during the adaptation of the hearing aid and the determination of the satisfaction level, because, each user has their own demands and expectations. Therefore, the survey evaluations which reveal the personal preferences and expectations gain importance in the determination of the benefit and satisfaction rate for hearing aid users.
PURPOSE: The purpose of this study was to evaluate the reliability of the Turkish version of the Satisfaction with Amplification in Daily Living (TSADL) among hearing aid users.
RESEARCH DESIGN: The original Satisfaction with Amplification in Daily Living (SADL) questionnaire was translated from English to the TSADL. Linguistic adaptation attempted to ensure equivalency, both grammatically and idiomatically, and was assessed by investigators related to the field.
STUDY SAMPLE: One hundred and sixty hearing aid users with sensorineural hearing loss, aged 18 to 90 yr (54.51 ± 18.21), who had been using a hearing aid regularly for more than 6 mo participated in the study; seventy three (45.10%) were male and 87 (54.30%) were female.
DATA COLLECTION: Participants completed the TSADL twice, 3 mo apart (long enough to forget their replies in the first application but short enough to prevent any changes to the measured properties).
RESULTS: When factor analysis of the questionnaire was performed, subdimension factor loadings were found to range from 0.744 to 0.854 for "Positive Effect," 0.62 to 0.985 for "Personal Image," and 0.903 to 0.913 for "Adverse Features"; the factor loading of "Service and Cost" was 0.983. Because all factor loadings were above 0.30, no items were excluded from the Turkish version of the questionnaire. Although the TSADL retained the original four factors, because of differences in Turkish social structures and perspectives, questions #12 and #15 revealed an association between the "Service and Cost" and "Positive Effects" subdimensions.
CONCLUSIONS: The SADL-TR scale can be reliably used in clinical studies to rapidly assess patient satisfaction, compare satisfaction levels, determine normative satisfaction level, compare various amplifications, and gather administrative outcome data.

PMID: 30479262 [PubMed - in process]

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Speech Recognition in Noise in Adults and Children Who Speak English or Chinese as Their First Language.

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Speech Recognition in Noise in Adults and Children Who Speak English or Chinese as Their First Language.

J Am Acad Audiol. 2018 Nov/Dec;29(10):885-897

Authors: Schafer EC, Aoyama K, Ho T, Castillo P, Conlin J, Jones J, Thompson S

Abstract
BACKGROUND: Speech recognition of individuals who are listening to a nonnative language is significantly degraded in the presence of background noise and may be influenced by proficiency, age of acquisition, language experience, and daily use of the nonnative language.
PURPOSE: The purpose of this study is to examine and compare speech recognition in noise performance across test conditions with varying signal-to-noise ratios (SNRs) as well as the presence of vocal and spatial cues in listeners who speak American English as a native language or Mandarin Chinese as a native language. Self-rated English proficiency and experience were collected for native Mandarin Chinese speakers to determine its relationship to performance on the test measures.
RESEARCH DESIGN: A cross-sectional repeated measures design was used for the study.
STUDY SAMPLE: Four groups of participants were included in the study. The adult groups consisted of 25 adults who speak native English and 25 adults who speak native Mandarin Chinese with English as an additional language. The pediatric groups consisted of 16 children who speak native English and 16 children who speak native Mandarin Chinese with English as an additional language.
DATA COLLECTION AND ANALYSES: Percent correct speech recognition in noise was assessed at three SNRs (-3, 0, +3 dB) using the adult or pediatric versions of the AzBio sentence test. The Listening in Spatialized Noise-Sentence (LiSN-S) test was used to determine the effect of providing spatial and vocal cues on the speech recognition in noise performance of the groups of participants. The data for each age group and test measure were analyzed with a repeated measures analysis of variance. Correlation analyses were performed to examine relationships between English proficiency and experience on performance across the speech recognition test conditions.
RESULTS: Analysis of the data from the adult or pediatric AzBio sentence test identified a significant effect of native language for adults but no significant effect for children. The higher SNRs yielded better performance for all listeners. On the LiSN-S test, results for the adult and pediatric groups were similar and showed significantly better performance for the native English speakers in every test condition. The demographic and language characteristics that most affected speech recognition performance across the test measures included the length of time the person lived in the United States, the age of English acquisition, the number of minutes per day English was spoken by the participant, and the self-rated English proficiency.
CONCLUSIONS: The findings in this study highlight the importance and benefit of higher SNRs as well as the provision of vocal and spatial cues for improving speech recognition performance in noise of adult and pediatric listeners who speak Mandarin Chinese as a native language.

PMID: 30479261 [PubMed - in process]

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The Effect of Presentation Mode and Production Type on Word Memory for Hearing Impaired Signers.

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The Effect of Presentation Mode and Production Type on Word Memory for Hearing Impaired Signers.

J Am Acad Audiol. 2018 Nov/Dec;29(10):875-884

Authors: Swead RT, Mama Y, Icht M

Abstract
BACKGROUND: Production effect (PE) is a memory phenomenon referring to better memory for produced (vocalized) than for non-produced (silently read) items. Reading aloud was found to improve verbal memory for normal-hearing individuals, as well as for cochlear implant users, studying visually and aurally presented material.
PURPOSE: The present study tested the effect of presentation mode (written or signed) and production type (vocalization or signing) on word memory in a group of hearing impaired young adults, sign-language users.
RESEARCH DESIGN: A PE paradigm was used, in which participants learned lexical items by two presentation modes, written or signed. We evaluated the efficacy of two types of productions: vocalization and signing, using a free recall test.
STUDY SAMPLE: Twenty hearing-impaired young adults, Israeli sign language (ISL) users, participated in the study, ten individuals who mainly use manual communication (MC) (ISL as a first language), and ten who mainly use total communication (TC).
DATA COLLECTION AND ANALYSIS: For each condition, we calculated the proportion of study words recalled. A mixed-design analysis of variance was conducted, with learning condition (written-vocalize, written-signed, and manual-signed) and production type (production and no-production) as within-subject variables, and group (MC and TC) as a between-subject variable.
RESULTS: Production benefit was documented across all learning conditions, with better memory for produced over non-produced words. Recall rates were higher when learning written words relative to signed words. Production by signing yielded better memory relative to vocalizing.
CONCLUSIONS: The results are explained in light of the encoding distinctiveness account, namely, the larger the number of unique encoding processes involved at study, the better the memory benefit.

PMID: 30479260 [PubMed - in process]

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6 Blind Men, an Elephant, and the Peer-Review Process.

Related Articles

6 Blind Men, an Elephant, and the Peer-Review Process.

J Am Acad Audiol. 2018 Nov/Dec;29(10):874

Authors: Jacobson GP

PMID: 30479259 [PubMed - in process]

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The Relationship between Random Gap Detection and Hearing in Noise Test Performances.

Related Articles

The Relationship between Random Gap Detection and Hearing in Noise Test Performances.

J Am Acad Audiol. 2018 Nov/Dec;29(10):948-954

Authors: Heeke P, Vermiglio AJ, Bulla E, Velappan K, Fang X

Abstract
BACKGROUND: Temporal acoustic cues are particularly important for speech understanding, and past research has inferred a relationship between temporal resolution and speech recognition in noise ability. A temporal resolution disorder is thought to affect speech understanding abilities because persons would not be able to accurately encode these frequency transitions, creating speech discrimination errors even in the presence of normal pure-tone hearing.
PURPOSE: The primary purpose was to investigate the relationship between temporal resolution as measured by the Random Gap Detection Test (RGDT) and speech recognition in noise performance as measured by the Hearing in Noise Test (HINT) in adults with normal audiometric thresholds. The second purpose was to examine the relationship between temporal resolution and spatial release from masking.
RESEARCH DESIGN: The HINT and RGDT protocols were administered under headphones according to the guidelines specified by the developers. The HINT uses an adaptive protocol to determine the signal-to-noise ratio where the participant recognizes 50% of the sentences. For HINT conditions, the target sentences were presented at 0° and the steady-state speech-shaped noise and a four-talker babble (4TB) was presented at 0°, +90°, or -90° for noise front, noise right, and noise left conditions, respectively. The RGDT is used to evaluate temporal resolution by determining the smallest time interval between two matching stimuli that can be detected by the participant. The RGDT threshold is the shortest time interval where the participant detects a gap. Tonal (0.5, 1, 2, and 4 kHz) and click stimuli random gap subtests were presented at 60 dB HL. Tonal subtests were presented in a random order to minimize presentation order effects.
STUDY SAMPLE: Twenty-one young, native English-speaking participants with normal pure-tone thresholds (≤25 dB HL for 500-4000 Hz) participated in this study. The average age of the participants was 20.2 years (SD = 0.66).
DATA COLLECTION AND ANALYSIS: Spearman rho correlation coefficients were conducted using SPSS 22 (IBM Corp., Armonk, NY) to determine the relationships between HINT and RGDT thresholds and derived measures (spatial advantage and composite scores). Nonparametric testing was used because of the ordinal nature of RGDT data.
RESULTS: Moderate negative correlations (p < 0.05) were found between eight RGDT and HINT threshold measures and a moderate positive correlation (p < 0.05) was found between RGDT click thresholds and HINT 4TB spatial advantage. This suggests that as temporal resolution abilities worsened, speech recognition in noise performance improved. These correlations were not statistically significant after the p value reflected the Bonferroni correction for multiple comparisons.
CONCLUSION: The results of the present study imply that the RGDT and HINT use different temporal processes. Performance on the RGDT cannot be predicted from HINT thresholds or vice versa.

PMID: 30479267 [PubMed - in process]

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Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

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Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

J Am Acad Audiol. 2018 Nov/Dec;29(10):936-947

Authors: Manchaiah V, Beukes EW, Granberg S, Durisala N, Baguley DM, Allen PM, Andersson G

Abstract
BACKGROUND: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model.
OBJECTIVE: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective.
RESEARCH DESIGN: A cross-sectional survey design was used.
STUDY SAMPLE: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.
DATA COLLECTION AND ANALYSIS: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions.
RESULTS: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor.
CONCLUSIONS: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.

PMID: 30479266 [PubMed - in process]

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A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs.

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A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs.

J Am Acad Audiol. 2018 Nov/Dec;29(10):928-935

Authors: Billings CJ, Dillard LK, Hoskins ZB, Penman TM, Reavis KM

Abstract
BACKGROUND: Department of Veterans Affairs (VA) audiologists have anecdotally reported examining numerous Veterans with normal pure-tone thresholds; however, the prevalence of these patients within the VA is unknown. The VA audiological data repository provides an ideal dataset to examine this group of Veterans. Knowing the prevalence of normal-hearing Veterans within the VA system is the first step to understanding the underlying referral patterns and clinical complaints of Veterans. Data repositories which capture data from both normal and impaired populations provide an indispensable view into hearing health care which can help to improve diagnosis and treatment of Veterans' hearing difficulties.
PURPOSE: Using the VA audiological data repository, this study aimed to (1) determine the prevalence of normal hearing thresholds among Veterans seeking hearing health care within the VA health care system and (2) determine the prevalence of abnormal clinical audiology test results among Veterans with normal hearing thresholds.
RESEARCH DESIGN: This study was a large-scale retrospective, descriptive observational analysis of uploaded audiological records from the VA Denver Acquisition and Logistics Center audiological data repository encompassing visits that took place between April 1991 and June 2015.
STUDY SAMPLE: At the time of data extraction, there were 3,641,326 audiological records in the repository, with 2,322,771 unique individual records. The study sample was further restricted to include only individuals with normal hearing (n = 235,091), which was defined as pure-tone thresholds better than, or equal to, 25 dB HL at octave frequencies from 250 to 8000 Hz, bilaterally. Patients ranged from 19 to 90+ years of age.
DATA COLLECTION AND ANALYSIS: We describe the data using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. In addition to hearing thresholds, the occurrence of abnormal results on other tests in the audiological test battery is also reported. We estimate the prevalence of normal hearing among all Veterans with records in the VA audiological data repository.
RESULTS: Veterans with normal hearing were on average 37 yr old. The prevalence of Veterans with normal hearing thresholds visiting VA audiology clinics in the current hearing repository dataset was 10.12%. Overall, 41% of Veterans with normal pure-tone thresholds had other clinically abnormal audiological test results; for example, contralateral acoustic reflex thresholds (31.7%) and tympanometry (21.5%) had the highest rate of abnormal test results.
CONCLUSIONS: Approximately one in ten Veterans seeking care within the VA healthcare system, and reported to the VA audiological data repository, has normal pure-tone hearing thresholds. This may be an underestimate of the true underlying prevalence of normal-hearing Veterans seeking audiology services at the VA because records with normal results were not consistently submitted to the repository. In addition, 41% of Veterans with normal pure-tone thresholds nonetheless presented with other audiological abnormalities. This study suggests that future work directed toward understanding referral patterns and clinical complaints of individuals who present to VA audiology clinics with normal hearing thresholds may be fruitful in the cause of improving diagnosis and treatment of Veterans' hearing difficulties.

PMID: 30479265 [PubMed - in process]

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Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors' Perceptions and Practices.

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Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors' Perceptions and Practices.

J Am Acad Audiol. 2018 Nov/Dec;29(10):917-927

Authors: Muñoz K, Landon T, Corbin-Lewis K

Abstract
BACKGROUND: Counseling is a critical component within audiological service delivery. Partnering with patients to support them in learning to effectively cope with their hearing challenges is a key component in achieving desired outcomes. Even though there is agreement on the foundational role counseling plays in audiology service delivery, counseling instruction varies among audiology training programs.
PURPOSE: The purpose of this study was to investigate the perspectives and practices of supervisors in audiology graduate training programs related to mentoring students in the acquisition of counseling skills.
RESEARCH DESIGN: A cross-sectional design was used; participants completed a self-report survey.
STUDY SAMPLE: The survey was sent to 323 clinical supervisors in AuD graduate programs in the United States.
DATA COLLECTION AND ANALYSIS: Completed surveys were received from 205 supervisors. Responses were analyzed using descriptive statistics to identify practice trends.
RESULTS: Participants reported their perceptions about importance of teaching counseling skills to audiology students, their confidence in teaching skills, their self-efficacy for supporting student learning, how they provide feedback to students, and challenges they encounter. Most participants reported their program requires a counseling course (88%; n = 176). Most of the participants reported confidence in teaching counseling skills; however, fewer reported being very or extremely confident in teaching students how to talk with clients about their emotions (53%; n = 109) and explaining the rationale behind specific counseling strategies (47%; n = 97). Participants with more years of supervisory experience had statistically significantly higher self-ratings for teaching confidence and self-efficacy for supporting student learning in counseling than those with fewer years of experience.
CONCLUSIONS: Audiology supervisors in AuD programs believe counseling is important to teach to students; however, they report variability in use of methods for providing feedback, evaluating student performance, and in their self-efficacy for supporting student learning. Future audiologists would benefit from a more systematic approach within graduate training for teaching counseling skills.

PMID: 30479264 [PubMed - in process]

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Auditory P300 in Noise in Younger and Older Adults.

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Auditory P300 in Noise in Younger and Older Adults.

J Am Acad Audiol. 2018 Nov/Dec;29(10):909-916

Authors: McCullagh J, Shinn JB

Abstract
BACKGROUND: Older adults often report difficulty hearing in background noise which is not completely attributable to peripheral hearing loss. Although age-related declines in cognition and hearing in background noise occur, the underlying age-related changes in processing of auditory stimuli in background noise has yet to be fully understood. The auditory P300 has the potential to elucidate the effects of age on auditory and cognitive processing of stimuli in background noise, but additional research is warranted.
PURPOSE: The purpose of this study was to investigate age-related differences in cognitive processing of auditory stimuli by evoking the auditory P300 at multiple signal-to-noise ratios (SNRs).
RESEARCH DESIGN: A two-group, repeated measures study design was used.
STUDY SAMPLE: A convenience sample of 35 participants, 15 older adults (mean age of 66.4 yr) and 20 younger adults (mean age of 21.1 yr), participated in the study. All participants had negative otologic and neurological histories.
DATA COLLECTION AND ANALYSIS: The auditory P300 was evoked using an oddball paradigm with 500 (frequent) and 1000 Hz (target) tonal stimuli in quiet and in the presence of background noise at +20, +10, and 0 SNRs. P300 amplitudes and latencies were measured in each condition for every participant. Repeated measures analyses of variance were conducted for the amplitude and latency measures of the P300 for each group.
RESULTS: Results from this study demonstrated P300 latencies were significantly longer in older adults in noise at the most challenging condition (0 SNR) compared with the quiet condition and between the +10 SNR and 0 SNR conditions. Although older adults had significantly longer P300 latencies compared with younger adults, no significant group by listening condition interaction existed. No significant P300 amplitude differences were found for group, noise, or group × listening condition interactions.
CONCLUSIONS: Results provide evidence that auditory cortical processing, regardless of age, is poorer at more difficult SNRs. However, results also demonstrate that older adults perform significantly poorer than younger adults. This supports the notion that some degree of age-related decline in synchronous firing and rate of transmission of the auditory cortical neurons contributing to the auditory P300 exists. Studies are needed to further understand the impact of noise on auditory cortical processing across populations.

PMID: 30479263 [PubMed - in process]

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Psychometric Properties of the Turkish Version of the Satisfaction with Amplification in Daily Living Questionnaire in Hearing Aid Users.

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Psychometric Properties of the Turkish Version of the Satisfaction with Amplification in Daily Living Questionnaire in Hearing Aid Users.

J Am Acad Audiol. 2018 Nov/Dec;29(10):898-908

Authors: Genç M, Çildir B, Kaya M

Abstract
BACKGROUND: Assessing hearing aid satisfaction is important for hearing aid adaptation in individuals who have hearing loss. Each user should be compared to oneself during the adaptation of the hearing aid and the determination of the satisfaction level, because, each user has their own demands and expectations. Therefore, the survey evaluations which reveal the personal preferences and expectations gain importance in the determination of the benefit and satisfaction rate for hearing aid users.
PURPOSE: The purpose of this study was to evaluate the reliability of the Turkish version of the Satisfaction with Amplification in Daily Living (TSADL) among hearing aid users.
RESEARCH DESIGN: The original Satisfaction with Amplification in Daily Living (SADL) questionnaire was translated from English to the TSADL. Linguistic adaptation attempted to ensure equivalency, both grammatically and idiomatically, and was assessed by investigators related to the field.
STUDY SAMPLE: One hundred and sixty hearing aid users with sensorineural hearing loss, aged 18 to 90 yr (54.51 ± 18.21), who had been using a hearing aid regularly for more than 6 mo participated in the study; seventy three (45.10%) were male and 87 (54.30%) were female.
DATA COLLECTION: Participants completed the TSADL twice, 3 mo apart (long enough to forget their replies in the first application but short enough to prevent any changes to the measured properties).
RESULTS: When factor analysis of the questionnaire was performed, subdimension factor loadings were found to range from 0.744 to 0.854 for "Positive Effect," 0.62 to 0.985 for "Personal Image," and 0.903 to 0.913 for "Adverse Features"; the factor loading of "Service and Cost" was 0.983. Because all factor loadings were above 0.30, no items were excluded from the Turkish version of the questionnaire. Although the TSADL retained the original four factors, because of differences in Turkish social structures and perspectives, questions #12 and #15 revealed an association between the "Service and Cost" and "Positive Effects" subdimensions.
CONCLUSIONS: The SADL-TR scale can be reliably used in clinical studies to rapidly assess patient satisfaction, compare satisfaction levels, determine normative satisfaction level, compare various amplifications, and gather administrative outcome data.

PMID: 30479262 [PubMed - in process]

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Speech Recognition in Noise in Adults and Children Who Speak English or Chinese as Their First Language.

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Speech Recognition in Noise in Adults and Children Who Speak English or Chinese as Their First Language.

J Am Acad Audiol. 2018 Nov/Dec;29(10):885-897

Authors: Schafer EC, Aoyama K, Ho T, Castillo P, Conlin J, Jones J, Thompson S

Abstract
BACKGROUND: Speech recognition of individuals who are listening to a nonnative language is significantly degraded in the presence of background noise and may be influenced by proficiency, age of acquisition, language experience, and daily use of the nonnative language.
PURPOSE: The purpose of this study is to examine and compare speech recognition in noise performance across test conditions with varying signal-to-noise ratios (SNRs) as well as the presence of vocal and spatial cues in listeners who speak American English as a native language or Mandarin Chinese as a native language. Self-rated English proficiency and experience were collected for native Mandarin Chinese speakers to determine its relationship to performance on the test measures.
RESEARCH DESIGN: A cross-sectional repeated measures design was used for the study.
STUDY SAMPLE: Four groups of participants were included in the study. The adult groups consisted of 25 adults who speak native English and 25 adults who speak native Mandarin Chinese with English as an additional language. The pediatric groups consisted of 16 children who speak native English and 16 children who speak native Mandarin Chinese with English as an additional language.
DATA COLLECTION AND ANALYSES: Percent correct speech recognition in noise was assessed at three SNRs (-3, 0, +3 dB) using the adult or pediatric versions of the AzBio sentence test. The Listening in Spatialized Noise-Sentence (LiSN-S) test was used to determine the effect of providing spatial and vocal cues on the speech recognition in noise performance of the groups of participants. The data for each age group and test measure were analyzed with a repeated measures analysis of variance. Correlation analyses were performed to examine relationships between English proficiency and experience on performance across the speech recognition test conditions.
RESULTS: Analysis of the data from the adult or pediatric AzBio sentence test identified a significant effect of native language for adults but no significant effect for children. The higher SNRs yielded better performance for all listeners. On the LiSN-S test, results for the adult and pediatric groups were similar and showed significantly better performance for the native English speakers in every test condition. The demographic and language characteristics that most affected speech recognition performance across the test measures included the length of time the person lived in the United States, the age of English acquisition, the number of minutes per day English was spoken by the participant, and the self-rated English proficiency.
CONCLUSIONS: The findings in this study highlight the importance and benefit of higher SNRs as well as the provision of vocal and spatial cues for improving speech recognition performance in noise of adult and pediatric listeners who speak Mandarin Chinese as a native language.

PMID: 30479261 [PubMed - in process]

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The Effect of Presentation Mode and Production Type on Word Memory for Hearing Impaired Signers.

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The Effect of Presentation Mode and Production Type on Word Memory for Hearing Impaired Signers.

J Am Acad Audiol. 2018 Nov/Dec;29(10):875-884

Authors: Swead RT, Mama Y, Icht M

Abstract
BACKGROUND: Production effect (PE) is a memory phenomenon referring to better memory for produced (vocalized) than for non-produced (silently read) items. Reading aloud was found to improve verbal memory for normal-hearing individuals, as well as for cochlear implant users, studying visually and aurally presented material.
PURPOSE: The present study tested the effect of presentation mode (written or signed) and production type (vocalization or signing) on word memory in a group of hearing impaired young adults, sign-language users.
RESEARCH DESIGN: A PE paradigm was used, in which participants learned lexical items by two presentation modes, written or signed. We evaluated the efficacy of two types of productions: vocalization and signing, using a free recall test.
STUDY SAMPLE: Twenty hearing-impaired young adults, Israeli sign language (ISL) users, participated in the study, ten individuals who mainly use manual communication (MC) (ISL as a first language), and ten who mainly use total communication (TC).
DATA COLLECTION AND ANALYSIS: For each condition, we calculated the proportion of study words recalled. A mixed-design analysis of variance was conducted, with learning condition (written-vocalize, written-signed, and manual-signed) and production type (production and no-production) as within-subject variables, and group (MC and TC) as a between-subject variable.
RESULTS: Production benefit was documented across all learning conditions, with better memory for produced over non-produced words. Recall rates were higher when learning written words relative to signed words. Production by signing yielded better memory relative to vocalizing.
CONCLUSIONS: The results are explained in light of the encoding distinctiveness account, namely, the larger the number of unique encoding processes involved at study, the better the memory benefit.

PMID: 30479260 [PubMed - in process]

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6 Blind Men, an Elephant, and the Peer-Review Process.

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6 Blind Men, an Elephant, and the Peer-Review Process.

J Am Acad Audiol. 2018 Nov/Dec;29(10):874

Authors: Jacobson GP

PMID: 30479259 [PubMed - in process]

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