Auditory training and adult rehabilitation:a critical review of the evidence

Auditory Training (AT) describes a regimen of varied listening exercises designed to improve an individual’s ability to perceive speech. The theory of AT is based on brain plasticity (the capacity of neurones in the central auditory system to alter their structure and function) in response to auditory stimulation. The practice of repeatedly listening to the speech sounds included in AT exercises is believed to drive the development of more efficient neuronal pathways, thereby improving auditory processing and speech discrimination. This critical review aims to assess whether auditory training can improve speech discrimination in adults with mild-moderate SNHL. The majority of patients attending Audiology services are adults with presbyacusis and it is therefore important to evaluate evidence of any treatment effect of AT in aural rehabilitation. Ideally this review would seek to appraise evidence of neurophysiological effects of AT so as to verify whether it does induce change in the CAS. However, due to the absence of such studies on this particular patient group, the outcome measure of speech discrimination, as a behavioural indicator of treatment effect is used instead. A review of available research was used to inform an argument for or against using AT in rehabilitative clinical practice. Six studies were identified and although the preliminary evidence indicates an improvement gained from a range of AT paradigms, the treatment effect size was modest and there remains a lack of large-sample RCTs. Future investigation into the efficacy of AT needs to employ neurophysiological studies using auditory evoked potentials in hearing-impaired adults in order to explore effects of AT on the CAS.

Interviewing adult witnesses and victims

In this chapter, we discuss the interviewing of adult witnesses and victims with reference to how the extant psychological and linguistic literature has contributed to understanding and informing interview practice over the past 20 years and how it continues to support practical and procedural improvements. We have only scratched the surface of this important and complex topic, but throughout this chapter we have directed readers to many in-depth reviews and some of the most contemporary research literature currently available in this domain. We have introduced the PEACE model and described the Cognitive Interview procedure and its development. We have also discussed rapport building, question types and communication style, all with reference to witness memory and practical interviewing. Finally, we highlight areas that would benefit from research, for example conducting interviews with interpreters, and how new training initiatives are seeking to improve interview procedures and interviewer practice.

Tale of two studies:challenges in field research with low-literacy adult learners in a developed country

Efforts to address the problems of literacy are often focused on developing countries. However, functional illiteracy is a challenge encountered by up to 50% of adults in developed countries. In this paper we reflect on the challenges we faced in trying to design and study the use of a mobile application to support adult literacy with two user groups: adults enrolled in literacy classes and carpenters without a high school education enrolled in an essential skills program. We also elaborate on aspects of the evaluations that are specific to a marginalized, functionally illiterate, group in a developed country - aspects that are less frequently present in similar studies of mobile literacy support technologies in developing countries. We conclude with presenting the lessons learnt from our evaluations and the impact of the studies' specific challenges on the outcome and uptake of such mobile assistive technologies in providing practical support to low-literacy adults in conjunction with literacy and essential skills training.

Is there a role for telemedicine in adult allergy services?

Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store-and-forward and real-time interactive services. Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomised controlled studies and lack of data relating to cost-effectiveness, health related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre-assessment for specialised treatments such as allergen immunotherapy; follow up to assess treatment response and side effects; and education in self-management plan including training updates for self-injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Well-designed prospective studies are needed to evaluate its role. This article is protected by copyright. All rights reserved.