Analysis of the variability of auditory brainstem response components through linear regression

(ABR) is of fundamental importance to the investiga- tion of the auditory system behavior, though its in- terpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analyzing the ABR, clinicians are often interested in the identi- fication of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave la- tency) is a practical tool for the diagnosis of disorders affecting the auditory system. In this context, the aim of this research is to compare ABR manual/visual analysis provided by different examiners. Methods: The ABR data were collected from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). A total of 160 data samples were analyzed and a pair- wise comparison between four distinct examiners was executed. We carried out a statistical study aiming to identify significant differences between assessments provided by the examiners. For this, we used Linear Regression in conjunction with Bootstrap, as a me- thod for evaluating the relation between the responses given by the examiners. Results: The analysis sug- gests agreement among examiners however reveals differences between assessments of the variability of the waves. We quantified the magnitude of the ob- tained wave latency differences and 18% of the inves- tigated waves presented substantial differences (large and moderate) and of these 3.79% were considered not acceptable for the clinical practice. Conclusions: Our results characterize the variability of the manual analysis of ABR data and the necessity of establishing unified standards and protocols for the analysis of these data. These results may also contribute to the validation and development of automatic systems that are employed in the early diagnosis of hearing loss.

Assessment of inter-examiner agreement and variability in the manual classification of auditory brainstem response

Abstract Background: The analysis of the Auditory Brainstem Response (ABR) is of fundamental importance to the investigation of the auditory system behaviour, though its interpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analysing the ABR, clinicians are often interested in the identification of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave latency) is a practical tool for the diagnosis of disorders affecting the auditory system. Significant differences in inter-examiner results may lead to completely distinct clinical interpretations of the state of the auditory system. In this context, the aim of this research was to evaluate the inter-examiner agreement and variability in the manual classification of ABR. Methods: A total of 160 ABR data samples were collected, for four different stimulus intensity (80dBHL, 60dBHL, 40dBHL and 20dBHL), from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). Four examiners with expertise in the manual classification of ABR components participated in the study. The Bland-Altman statistical method was employed for the assessment of inter-examiner agreement and variability. The mean, standard deviation and error for the bias, which is the difference between examiners’ annotations, were estimated for each pair of examiners. Scatter plots and histograms were employed for data visualization and analysis. Results: In most comparisons the differences between examiner’s annotations were below 0.1 ms, which is clinically acceptable. In four cases, it was found a large error and standard deviation (>0.1 ms) that indicate the presence of outliers and thus, discrepancies between examiners. Conclusions: Our results quantify the inter-examiner agreement and variability of the manual analysis of ABR data, and they also allows for the determination of different patterns of manual ABR analysis.

Memo test: standardisation of computerised assessment of auditory verbal short-term memory

Short-term memory (STM) impairments are prevalent in adults with acquired brain injuries. While there are several published tests to assess these impairments, the majority require speech production, e.g. digit span (Wechsler, 1987). This feature may make them unsuitable for people with aphasia and motor speech disorders because of word finding difficulties and speech demands respectively. If patients perceive the speech demands of the test to be high, the may not engage with testing. Furthermore, existing STM tests are mainly ‘pen-and-paper’ tests, which can jeopardise accuracy. To address these shortcomings, we designed and standardised a novel computerised test that does not require speech output and because of the computerised delivery it would enable clinicians identify STM impairments with greater precision than current tests. The matching listening span tasks, similar to the non-normed PALPA 13 (Kay, Lesser & Coltheart, 1992) is used to test short-term memory for serial order of spoken items. Sequences of digits are presented in pairs. The person hears the first sequence, followed by the second sequence and s/he decides whether the two sequences are the same or different. In the computerised test, the sequences are presented in live voice recordings on a portable computer through a software application (Molero Martin, Laird, Hwang & Salis 2013). We collected normative data from healthy older adults (N=22-24) using digits, real words (one- and two-syllables) and non-words (one- and two- syllables). Their performance was scored following two systems. The Highest Span system was the highest span length (e.g. 2-8) at which a participant correctly responded to over 7 out of 10 trials at the highest sequence length. Test re-test reliability was also tested in a subgroup of participants. The test will be available as free of charge for clinicians and researchers to use.

Sensory enhancement, a pilot perceptual study of subdermal magnetic implants

Subdermal magnetic implants originated as an art form in the world of body modification. To date an in depth scientific analysis of the benefits of this implant has yet to be established. This research explores the concept of sensory extension of the tactile sense utilising this form of implantation. This relatively simple procedure enables the tactile sense to respond to static and alternating magnetic fields. This is not to say that the underlying biology of the system has changed; i.e. the concept does not increase our tactile frequency response range or sensitivity to pressure, but now does invoke a perceptual response to a stimulus that is not innately available to humans. Within this research two social surveys have been conducted in order to ascertain one, the social acceptance of the general notion of human enhancement, and two the perceptual experiences of individuals with the magnetic implants themselves. In terms of acceptance to the notion of sensory improvement (via implantation) ~39% of the general population questioned responded positively with a further ~25% of the respondents answering with the indecisive response. Thus with careful dissemination a large proportion of individuals may adopt this technology much like this if it were to become available for consumers. Interestingly of the responses collected from the magnetic implants survey ~60% of the respondents actually underwent the implant for magnetic vision purposes. The main contribution of this research however comes from a series of psychophysical testing. In which 7 subjects with subdermal magnetic implants, were cross compared with 7 subjects that had similar magnets superficially attached to their dermis. The experimentation examined multiple psychometric thresholds of the candidates including intensity, frequency and temporal. Whilst relatively simple, the experimental setup for the perceptual experimentation conducted was novel in that custom hardware and protocols were created in order to determine the subjective thresholds of the individuals. Abstract iv The overall purpose of this research is to utilise this concept in high stress scenarios, such as driving or piloting; whereby alerts and warnings could be relayed to an operator without intruding upon their other (typically overloaded) exterior senses (i.e. the auditory and visual senses). Hence each of the thresholding experiments were designed with the intention of utilising the results in the design of signals for information transfer. The findings from the study show that the implanted group of subjects significantly outperformed the superficial group in the absolute intensity threshold experiment, i.e. the implanted group required significantly less force than the superficial group in order to perceive the stimulus. The results for the frequency difference threshold showed no significant difference in the two groups tested. Interestingly however at low frequencies, i.e. 20 and 50 Hz, the ability of the subjects tested to discriminate frequencies significantly increased with more complex waveforms i.e. square and sawtooth, when compared against the typically used sinewave. Furthermore a novel protocol for establishing the temporal gap detection threshold during a temporal numerosity study has been established in this thesis. This experiment measured the subjects’ capability to correctly determine the number of concatenated signals presented to them whilst the time between the signals, referred to as pulses, tended to zero. A significant finding was that when altering the length of, the frequency of, and the number of cycles of the pulses, the time between pulses for correct recognition altered. This finding will ultimately aid in the design of the tactile alerts for this method of information transfer. Preliminary development work for the use of this method of input to the body, in an automotive scenario, is also presented within this thesis in the form of a driving simulation. The overall goal of which is to present warning alerts to a driver, such as rear-to-end collision, or excessive speeds on roads, in order to prevent incidents and penalties from occurring. Discussion on the broader utility of this implant has been presented, reflecting on its potential use as a basis for vibrotactile, and sensory substitution, devices. This discussion furthers with postulations on its use as a human machine interface, as well as how a similar implant could be used within the ear as a hearing aid device.

Multi-sensory treatment for children with developmental motor speech disorders

What this paper adds? What is already known on the subject? Multi-sensory treatment approaches have been shown to impact outcome measures positively, such as accuracy of speech movement patterns and speech intelligibility in adults with motor speech disorders, as well as in children with apraxia of speech, autism and cerebral palsy. However, there has been no empirical study using multi-sensory treatment for children with speech sound disorders (SSDs) who demonstrate motor control issues in the jaw and orofacial structures (e.g. jaw sliding, jaw over extension, inadequate lip rounding/retraction and decreased integration of speech movements). What this paper adds? Findings from this study indicate that, for speech production disorders where both the planning and production of spatiotemporal parameters of movement sequences for speech are disrupted, multi-sensory treatment programmes that integrate auditory, visual and tactile–kinesthetic information improve auditory and visual accuracy of speech production. The training (practised in treatment) and test words (not practised in treatment) both demonstrated positive change in most participants, indicating generalization of target features to untrained words. It is inferred that treatment that focuses on integrating multi-sensory information and normalizing parameters of speech movements is an effective method for treating children with SSDs who demonstrate speech motor control issues.

A `Rubber-hand` illusion reveals a relationship between perceptual body image and unhealthy body change

The ‘rubber-hand’ illusion, in which individuals misattribute tactile sensations felt by their hand to a rubber prosthetic hand that they see being stimulated, was employed to examine the relationship between perceptual body image and unhealthy body change in 128 volunteers. Variance in unhealthy body development in males (22%) and in bulimic symptomatology in both females and males (10%), was explained by susceptibility to the illusion. The illusion, which is relatively free from cognitive and emotional ‘contamination’, could be used to identify individuals most responsive to therapies designed to correct inaccurate body perceptions–individuals whose perceptual body image is malleable.

Desempenho perceptual-auditivo e ortográfico de consoantes fricativas na aquisição da escrita

OBJETIVO: Verificar os desempenhos perceptual-auditivo e ortográfico de escolares no que se refere à identificação de contrastes entre as fricativas do Português Brasileiro, e investigar em que medida esses dois tipos de desempenhos se relacionam. MÉTODOS: Foram analisados dados de desempenho perceptual-auditivo e de desempenho ortográfico extraídos de 20 crianças das duas primeiras séries do ensino fundamental de uma escola pública do município de Mallet (PR). A coleta de dados de percepção auditiva foi feita com base no Instrumento de Avaliação da Percepção de Fala (PERCEFAL), com o uso do software Perceval. Já a coleta de dados de ortografia foi feita por meio de um ditado das mesmas palavras que compõem o instrumento PERCEFAL. RESULTADOS: Foram observadas: maior acurácia perceptual-auditiva do que ortográfica; tendência de menor tempo de resposta e de menor variabilidade nos acertos perceptuais-auditivos do que nos erros; não correspondência de erros de percepção-auditiva e ortografia, já que, na percepção, o maior percentual de erros envolveu o ponto de articulação das fricativas, enquanto que, na ortografia, o maior percentual envolveu o vozeamento. CONCLUSÃO: Embora se mostrem relacionados, os desempenhos perceptual-auditivo e ortográfico não apresentam correspondência termo a termo. Portanto, na prática clínica, a atenção deve-se voltar não apenas para os aspectos que aproximam esses dois desempenhos, mas, também, para os aspectos que os diferenciam.

Contraste fônico encoberto entre /t/ e /k/: um estudo de caso de normalidade e de transtorno fonológico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Auditory stimulation and cardiac autonomic regulation

Previous studies have already demonstrated that auditory stimulation with music influences the cardiovascular system. In this study, we described the relationship between musical auditory stimulation and heart rate variability. Searches were performed with the Medline, SciELO, Lilacs and Cochrane databases using the following keywords: auditory stimulation, autonomic nervous system, music and heart rate variability. The selected studies indicated that there is a strong correlation between noise intensity and vagal-sympathetic balance. Additionally, it was reported that music therapy improved heart rate variability in anthracycline-treated breast cancer patients. It was hypothesized that dopamine release in the striatal system induced by pleasurable songs is involved in cardiac autonomic regulation. Musical auditory stimulation influences heart rate variability through a neural mechanism that is not well understood. Further studies are necessary to develop new therapies to treat cardiovascular disorders.

Estudo epidemiológico de disfonias em crianças de 4 a 12 anos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Acute psychotic disorders induced by topiramate: report of two cases

Relatamos dois pacientes epilépticos que manifestaram quadro psicótico agudo induzido por topiramato (TPM). Um paciente apresentou agitação psicomotora grave, heteroagressividade, alucinações auditivas e visuais, e delírios de conteúdo paranóide e místico. O outro paciente apresentou agitação psicomotora, despersonalização, desrealização, ansiedade intensa e delírio de que estava perdendo a memória. Ambos os pacientes foram conduzidos ao serviço de emergência e, após a interrupção do TPM em um deles e redução da droga em outro, houve remissão total dos sintomas psicóticos sem necessidade de medicação antipsicótica. Alertamos os clínicos para o risco de surgimento de sintomas psicóticos em pacientes em uso do TPM.

Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia

A hiperbilirrubinemia é tóxica às vias auditivas e ao sistema nervoso central, deixando sequelas como surdez e encefalopatia. OBJETIVOS: avaliar a audição de neonatos portadores de hiperbilirrubinemia, utilizando-se a pesquisa das emissões otoacústicas evocadas transientes (EOAET) e dos potenciais evocados auditivos do tronco encefálico (PEATE). Estudo prospectivo. CASUÍSTICA E MÉTODOS: Constituíram-se dois grupos: GI (n-25), neonatos com hiperbilirrubinemia; GII (n-22), neonatos sem hiperbilirrubinemia e sem fatores de risco para surdez. Todos os neonatos tinham até 60 dias de vida e foram submetidos à EOAET e ao PEATE. RESULTADOS: 12 neonatos de GI e 10 de GII eram meninas e 13 de GI e 12 de GII eram meninos. As EOAET estavam presentes em todas as crianças, porém com amplitudes menores em GI, especialmente nas frequências de 2 e 3KHz (p < 0,05). No PEATE, observou-se discreto prolongamento de PV e de LI-V em GI. As alterações observadas nesses testes não se correlacionaram aos níveis séricos da bilirrubinemia. CONCLUSÕES: em neonatos portadores de hiperbilirrubinemia, menores amplitudes das EOAET e discreto prolongamento de PV e de LI-V foram constatados indicando comprometimento coclear e retrococlear das vias auditivas, salientando-se a importância da utilização e da interpretação minuciosa de ambos os testes nessas avaliações.

TEMPORAL COUPLING BETWEEN EXTERNAL AUDITORY INFORMATION AND THE PHASES OF WALKING

The purpose of this study was to investigate the effects of an imposed external auditory constraint upon the temporal organization of walking. Ten subjects were videotaped walking normally (N) and with instructions to couple naturally, at mid-swing, or at toe-off to a metronome beat. Based upon an analysis of variance and post hoc Scheffe tests most temporal variables were not significantly different among conditions. The duration of swing phase was significantly different between natural coupling and toe-off. The deviation from the metronome beat was significantly different between the natural coupling and both mid-swing and toe-off. Subjects generally were not successful in achieving coupling during the latter conditions. Thigh and shank phase portraits were used to describe the system's organization to the external constraint.

Relationship between cardiac autonomic regulation and auditory mechanisms: Importance for growth and development

The literature has already demonstrated that auditory stimulation with music influences the cardiovascular system. In this study, we performed a literature review in order to investigate the relationship between auditory mechanisms and cardiac autonomic regulation. The selected studies indicated that there is a strong correlation between noise intensity and vagal-sympathetic balance. Also, it was reported that music therapy improved heart rate variability in anthracycline-treated breast cancer patients. It was hypothesized that dopamine release in the striatal system induced by pleasure songs are involved in the cardiac autonomic regulation. Further studies are necessary to add new elements in the literature to improve new therapies to treat cardiovascular disorders.