Cognitive and Visual Speech Contributions to Speech Perception in Challenging Listening Conditions

Speech perception routinely takes place in noisy or degraded listening environments, leading to ambiguity in the identity of the speech token. Here, I present one review paper and two experimental papers that highlight cognitive and visual speech contributions to the listening process, particularly in challenging listening environments. First, I survey the literature linking audiometric age-related hearing loss and cognitive decline and review the four proposed causal mechanisms underlying this link. I argue that future research in this area requires greater consideration of the functional overlap between hearing and cognition. I also present an alternative framework for understanding causal relationships between age-related declines in hearing and cognition, with emphasis on the interconnected nature of hearing and cognition and likely contributions from multiple causal mechanisms. I also provide a number of testable hypotheses to examine how impairments in one domain may affect the other. In my first experimental study, I examine the direct contribution of working memory (through a cognitive training manipulation) on speech in noise comprehension in older adults. My results challenge the efficacy of cognitive training more generally, and also provide support for the contribution of sentence context in reducing working memory load. My findings also challenge the ubiquitous use of the Reading Span test as a pure test of working memory. In a second experimental (fMRI) study, I examine the role of attention in audiovisual speech integration, particularly when the acoustic signal is degraded. I demonstrate that attentional processes support audiovisual speech integration in the middle and superior temporal gyri, as well as the fusiform gyrus. My results also suggest that the superior temporal sulcus is sensitive to intelligibility enhancement, regardless of how this benefit is obtained (i.e., whether it is obtained through visual speech information or speech clarity). In addition, I also demonstrate that both the cingulo-opercular network and motor speech areas are recruited in difficult listening conditions. Taken together, these findings augment our understanding of cognitive contributions to the listening process and demonstrate that memory, working memory, and executive control networks may flexibly be recruited in order to meet listening demands in challenging environments.

Equivalent Hearing Loss in Children

Early intervention is the key to spoken language for hearing impaired children. A severe hearing loss diagnosis in young children raises the urgent question on the optimal type of hearing aid device. As there is no recent data on comparing selection criteria for a specific hearing aid device, the goal of the Hearing Evaluation of Auditory Rehabilitation Devices (hEARd) project (Coninx & Vermeulen, 2012) evolved to collect and analyze interlingually comparable normative data on the speech perception performances of children with hearing aids and children with cochlear implants (CI). METHOD: In various institutions for hearing rehabilitation in Belgium, Germany and the Netherlands the Adaptive Auditory Speech Test AAST was used in the hEARd project, to determine speech perception abilities in kindergarten and school aged hearing impaired children. Results in the speech audiometric procedures were matched to the unaided hearing loss values of children using hearing aids and compared to results of children using CI. 277 data sets of hearing impaired children were analyzed. Results of children using hearing aids were summarized in groups as to their unaided hearing loss values. The grouping was related to the World Health Organization’s (WHO) grading of hearing impairment from mild (25–40 dB HL) to moderate (41–60 dB HL), severe (61-80 dB HL) and profound hearing impairment (80 dB HL and higher). RESULTS: AAST speech recognition results in quiet showed a significantly better performance for the CI group in comparison to the group of profoundly impaired hearing aid users as well as the group of severely impaired hearing aid users. However the CI users’ performances in speech perception in noise did not vary from the hearing aid users’ performances. Within the collected data analyses showed that children with a CI show an equivalent performance on speech perception in quiet as children using hearing aids with a “moderate” hearing impairment.

Relación entre atrofia cortical difusa y desempeño cognitivo : estudio en población mayor de 60 años en un hospital universitario en la ciudad de Bogotá

El presente trabajo tuvo como objetivo evaluar la existencia de la relación entre la atrofia cortical difusa objetivada por neuroimagenes cerebrales y desempeños cognitivos determinados mediante la aplicación de pruebas neuropsicológicas que evalúan memoria de trabajo, razonamiento simbólico verbal y memoria anterógrada declarativa. Participaron 114 sujetos reclutados en el Hospital Universitario Mayor Méderi de la ciudad de Bogotá mediante muestreo de conveniencia. Los resultados arrojaron diferencias significativas entre los dos grupos (pacientes con diagnóstico de atrofia cortical difusa y pacientes con neuroimagenes interpretadas como dentro de los límites normales) en todas las pruebas neuropsicológicas aplicadas. Respecto a las variables demográficas se pudo observar que el grado de escolaridad contribuye como factor neuroprotector de un posible deterioro cognitivo. Tales hallazgos son importantes para determinar protocoles tempranos de detección de posible instalación de enfermedades neurodegenerativas primarias.

Marginalising the mainstream : a signed performance of The Miracle Worker places deaf issues centre-stage

William Gibson’s The Miracle Worker was staged at the Brisbane Powerhouse June 2009 by Crossbow Productions. In this adaption, people with hearing impairment were privileged through the use of shadow-signing, unscripted signing and the appropriation of signing as a theatrical language in itself. 250 people living with hearing impairment attended the production, 70 had never attended a theatrical event before. During the post-performance discussions hearing audience members expressed feelings of displacement through experiencing the culture of the deaf society and not grasping some of the ideas. This paper argues that this inversion enhanced meaning making for all and illustrates a way forward to encourage the signing of more theatrical events.

Phase III trial of gemcitabine and carboplatin versus mitomycin, ifosfamide, and cisplatin or mitomycin, vinblastine, and cisplatin in patients with advanced nonsmall cell lung carcinoma

BACKGROUND. The authors compared gemcitabine and carboplatin (GC) with mitomycin, ifosfamide, and cisplatin (MIC) or mitomycin, vinblastine, and cisplatin (MVP) in patients with advanced nonsmall cell lung carcinoma (NSCLC). The primary objective was survival. Secondary objectives were time to disease progression, response rates, evaluation of toxicity, disease-related symptoms, World Health Organization performance status (PS), and quality of life (QoL). METHODS. Three hundred seventy-two chemotherapy-naïve patients with International Staging System Stage III/IV NSCLC who were ineligible for curative radiotherapy or surgery were randomized to receive either 4 cycles of gemcitabine (1000 mg/m2 on Days 1, 8, and 15) plus carboplatin (area under the serum concentration-time curve, 5; given on Day 1) every 4 weeks (the GC arm) or MIC/MVP every 3 weeks (the MIC/MVP arm). RESULTS. There was no significant difference in median survival (248 days in the MIC/MVP arm vs. 236 days in the GC arm) or time to progression (225 days in the MIC/MVP arm vs. 218 days in the GC arm) between the 2 treatment arms. The 2-year survival rate was 11.8% in the MIC/MVP arm and 6.9% in the GC arm. The 1-year survival rate was 32.5% in the MIC/MVP arm and 33.2% in the GC arm. In the MIC/MVP arm, 33% of patients responded (4 complete responses [CRs] and 57 partial responses [PRs]) whereas in the GC arm, 30% of patients responded (3 CRs and 54 PRs). Nonhematologic toxicity was comparable for patients with Grade 3-4 symptoms, except there was more alopecia among patients in the MIC/MVP arm. GC appeared to produce more hematologic toxicity and necessitated more transfusions. There was no difference in performance status, disease-related symptoms, of QoL between patients in the two treatment arms. Fewer inpatient stays for complications were required with GC. CONCLUSIONS. The results of the current study failed to demonstrate any difference in efficacy between the newer regimen of GC and the older regimens of MIC and MVP. © 2003 American Cancer Society.

Quality of life and survival in patients treated with radical chemoradiation alone for oesophageal cancer

Aims: To report cancer-specific and health-related quality-of-life outcomes in patients undergoing radical chemoradiation (CRT) alone for oesophageal cancer. Materials and methods: Between 1998 and 2005, 56 patients with oesophageal cancer received definitive radical CRT, due to local disease extent, poor general health, or patient choice. Data from European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-30 and QLQ-OES24 were collected prospectively. Questionnaires were completed at diagnosis, and at 3, 6 and 12 months after CRT where applicable. Results: The median follow-up was 18 months. The median overall survival was 14 months, with a 51, 26 and 13% 1-, 3- and 5-year survival, respectively. At 12 months after treatment there was a significant improvement compared with before treatment with respect to dysphagia and pain. Global health scores were not significantly affected. Conclusions: Considering the relatively short long-term survival for this cohort of patients, maximising the quality of those final months should be very carefully borne in mind from the outset. The health-related quality-of-life data reported herein helps to establish benchmarks for larger evaluation within randomised clinical trials. © 2007 The Royal College of Radiologists.

The challenges of meeting the needs of children with Autism Spectrum Disorders (ASD) during out of hospital interactoins with Paramedics

This poster presents the results of a critical review of the literature on the intersection between paramedic practice with Autism Spectrum Disorder (ASD) and previews the clinical and communication challenges likely to be experienced with these patients. Paramedics in Australia provide 24/7 out-of-hospital care to the community. Although their core business is to provide emergency care, paramedics also provide care for vulnerable people as a consequence of the social, economic or domestic milieu. Little is known about the frequency of use of emergency out-of-hospital services by children with ASD and their families. Similarly, little is known about the attitudes and perceptions of paramedics to children with ASD and their emergency health care. However, individuals with ASD are likely to require paramedic services at some point across the life span and may be more frequent users of health services as a consequence of the challenges they face. The high rate of co-morbidities of people diagnosed with ASD is reported and includes seizure disorders, gastro-intestinal disorders, metabolic disorders, hormonal dysfunction, ear, nose and throat infections, hearing impairment, hypertension, allergies/anaphylaxis, immune disorders, migraine and diabetes, gross/fine motor skill dysfunction, premature birth, birth defects, obesity and mental illness. Individuals with ASD may frequently experience concurrent communication, behaviour and sensory challenges. Consequently, Paramedics can encounter difficulties gathering important patient information which may compromise sensitive care. These interactions occur often in high pressure and emotionally challenging environments, which add to the difficulties in communicating the treatment and transport needs of this population.

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

Prevalência do medo de quedas em idosos e sua associação com fatores clínicos,funcionais e psicossociais: Estudo FIBRA-RJ

Introdução: Com o expressivo aumento da população idosa, as quedas são eventos comuns e levam a desfechos adversos à saúde. As consequências do medo de quedas podem ser tão incapacitantes como as quedas. Objetivo: O presente estudo teve como objetivo estimar a prevalência do medo de quedas em idosos e sua associação com fatores clínicos, funcionais e psicossociais. Métodos: Utilizaram-se os dados do Estudo FIBRA-RJ, que avaliou clientes de uma operadora de saúde, residentes na Zona Norte do município do Rio de Janeiro. A seleção desta amostra foi realizada através de amostragem aleatória inversa, de acordo com estratos de faixa etária e sexo do cadastro oferecido pela operadora. As entrevistas foram realizadas face a face no domicilio. O medo de quedas, variável dependente, foi avaliado através da FES-I-BR. As seguintes variáveis clínicas, funcionais e psicossociais foram avaliadas como variáveis independentes: histórico de quedas, fratura pós-queda, número de comorbidades, número de medicamentos, internação no último ano, uso de dispositivo de auxílio à marcha, dependência funcional nas atividades básicas e instrumentais de vida diária, dificuldade visual e auditiva, força de preensão palmar, velocidade de marcha, autopercepção de saúde, sintomas depressivos, alteração cognitiva, morar só, apoio social instrumental e nível de atividade. As associações foram avaliadas através de regressão logística. Resultados: Dentre os 742 idosos avaliados, 51,9% apresentaram medo de quedas, sendo esta prevalência maior no sexo feminino e nos mais idosos. Na análise logística multivariada, houve associação com histórico de 1 ou 2 quedas (OR=2,18; IC95%1,42-3,36), 3 ou mais quedas (OR=2,72; IC95% 1,10-6,70), usar 7 ou mais medicamentos (OR=1,70; IC95%1,04-2,80), dificuldade auditiva (OR=1,66; IC95% 1,10-2,49), ter dependência funcional nas atividades de vida diária (AVDs) (OR=1,73; IC95%1,07-2,79), velocidade de marcha diminuída (OR=1,64; IC95%1,04-2,58), autopercepção de saúde regular (OR=1,89; IC95%1,30-2,74) e ruim/muito ruim (OR=4,92; IC95%1,49-16,27) e sintomas depressivos (OR=1,68; IC95%1,07-2,63). Conclusão: Os resultados obtidos mostram a prevalência elevada de medo de quedas. Destaca-se a necessidade de avaliação desta condição nos idosos. Identificar os fatores associados é útil para desenvolver estratégias efetivas de intervenção dos possíveis fatores modificáveis.

The differences in the social competence of children who attend integrated junior infant classes and children who attend segregated learning environments

There are a number of reasons why this researcher has decided to undertake this study into the differences in the social competence of children who attend integrated Junior Infant classes and children who attend segregated learning environments. Theses reasons are both personal and professional. My personal reasons stem from having grown up in a family which included both an aunt who presented with Down Syndrome and an uncle who presented with hearing impairment. Both of these relatives' experiences in our education system are interesting. My aunt was considered ineducable while her brother - my uncle - was sent to Dublin (from Cork) at six years of age to be educated by a religious order. My professional reasons, on the other hand, stemmed from my teaching experience. Having taught in both special and integrated classrooms it became evident to me that there was somewhat 'suspicion' attached to integration. Parents of children without disabilities questioned whether this process would have a negative impact on their children's education. While parents of children with disabilities debated whether integrated settings met the specific needs of their children. On the other hand, I always questioned whether integration and inclusiveness meant the same thing. My research has enabled me to find many answers. Increasingly, children with special educational needs (SEN) are attending a variety of integrated and inclusive childcare and education settings. This contemporary practice of educating children who present with disabilities in mainstream classrooms has stimulated vast interest on the impact of such practices on children with identified disabilities. Indeed, children who present with disabilities "fare far better in mainstream education than in special schools" (Buckley, cited in Siggins, 2001,p.25). However, educators and practitioners in the field of early years education and care are concerned with meeting the needs of all children in their learning environments, while also upholding high academic standards (Putman, 1993). Fundamentally, therefore, integrated education must also produce questions about the impact of this practice on children without identified special educational needs. While these questions can be addressed from the various areas of child development (i.e. cognitive, physical, linguistic, emotional, moral, spiritual and creative), this research focused on the social domain. It investigates the development of social competence in junior infant class children without identified disabilities as they experience different educational settings.

Stream segregation on a single electrode as a function of pulse rate in cochlear implant listeners.

While cochlear implants (CIs) usually provide high levels of speech recognition in quiet, speech recognition in noise remains challenging. To overcome these difficulties, it is important to understand how implanted listeners separate a target signal from interferers. Stream segregation has been studied extensively in both normal and electric hearing, as a function of place of stimulation. However, the effects of pulse rate, independent of place, on the perceptual grouping of sequential sounds in electric hearing have not yet been investigated. A rhythm detection task was used to measure stream segregation. The results of this study suggest that while CI listeners can segregate streams based on differences in pulse rate alone, the amount of stream segregation observed decreases as the base pulse rate increases. Further investigation of the perceptual dimensions encoded by the pulse rate and the effect of sequential presentation of different stimulation rates on perception could be beneficial for the future development of speech processing strategies for CIs.

Sign language in Spanish television. Study on reception

The present article analyses the preferences of the deaf who use sign language and are users of the TV interpretation service to sign language, as well as the characteristics with which TV channels provide that service in television in Spain. The objective is to establish whether the way in which the aforementioned accessibility service is provided matches the preferences of users or differ from them. The analysis presents the opinion on this service of the deaf that use the Spanish sign language as their first language for communication. A study has also been conducted on the programmes broadcast with sign language during week 10-16/03/2014. The main data collected reveal that the deaf are dissatisfied with broadcasting times. They ask for news programmes with sign language, they would rather have the interpretation carried out by deaf people who use sign language and they prefer that the interpreter is the main image on screen. Concerning the analysis of the programmes broadcast, the study shows that the majority of programmes with sign language are broadcast at night, they are entertainment programmes, the interpretation is carried out by hearing people who use sign language and that their image is displayed in a corner of the screen.

Development of a genotyping microarray for Usher syndrome

Usher syndrome, a combination of retinitis pigmentosa (RP) and sensorineural hearing loss with or without vestibular dysfunction, displays a high degree of clinical and genetic heterogeneity. Three clinical subtypes can be distinguished, based on the age of onset and severity of the hearing impairment, and the presence or absence of vestibular abnormalities. Thus far, eight genes have been implicated in the syndrome, together comprising 347 protein-coding exons.

From embryonic stem cells to sensory hair cells : a programming approach

Tese de doutoramento, Ciências Biomédicas (Biologia do Desenvolvimento), Universidade de Lisboa, Faculdade de Medicina, 2014

Développement des habiletés linguistiques chez les enfants porteurs d'un implant cochléaire

Cette thèse examine le développement du langage des enfants sourds qui ont reçu un implant cochléaire (IC) en bas âge. Une première étude rapporte une revue systématique qui avait pour but d’évaluer les connaissances actuelles concernant le développement du vocabulaire et de la grammaire chez les enfants qui ont reçu un IC avant l’âge de trois ans. Vingt-huit études ont été sélectionnées; une analyse descriptive de même qu’une méta-analyse ont été effectuées séparément pour chaque aspect du langage évalué (vocabulaire et grammaire, aspect réceptif et expressif). Au résultat, en dépit de la variabilité observée dans les études, il appert que l’implant cochléaire influence positivement le développement langagier; toutefois, seule une minorité de participants aux études a atteint des niveaux de langage comparables à ceux d’enfants entendants de même âge chronologique. La majorité des enfants continuent de présenter divers degrés de retard de langage, tant au plan réceptif qu’expressif, et ce, après jusqu’à cinq années de port de l’appareil. Les résultats suggèrent aussi, malgré la variabilité observée dans les études, que les bénéfices langagiers sont influencés par le fait de recevoir l’implant à deux ans plutôt qu’à trois ans. À partir des tendances retrouvées dans la littérature, les habiletés de vocabulaire et de grammaire chez 27 enfants qui ont reçu l’implant cochléaire en bas âge (entre 8 et 28 mois) ont été comparées avec celles d’un groupe d’enfants entendants, en utilisant des outils d’évaluation standardisés. Alors que les résultats de groupe montrent que les enfants qui reçoivent un IC autour de l’âge de deux ans atteignent des niveaux de langage dans les limites de la normale, les résultats individuels d’un sous-groupe formé de enfants les plus âgés font état de quatre profils de développement, soit des niveaux de langage dans les limites de la normale pour l’ensemble des composantes, un retard généralisé à l’ensemble des composantes, des habiletés lexicales dans la norme assorti d’un retard morphosyntaxique et enfin un profil atypique montrant des disparités importantes à travers les composantes du langage. Dans trois des quatre profils, la compréhension des phrases était particulièrement faible. Ces résultats suggèrent que le fait de recevoir un implant cochléaire entre l’âge d’un et deux ans ne garantit pas l’atteinte de niveaux de langage dans les limites de la normale malgré une expérience de port de l’appareil d’une durée appréciable. Une étape antérieure du développement linguistique a été examinée de plus près dans la troisième étude. La taille et la composition du vocabulaire expressif de onze enfants ayant reçu un IC à un âge moyen de 15 mois ont été comparées à celles de l’échantillon d’enfants entendants ayant servi à établir les normes en français québécois pour le questionnaire Mots et énoncés des Inventaires MacArthur-Bates du développement de la communication (IMBDC). Les scores d’âge équivalent selon la taille totale du vocabulaire des enfants avec IC étaient supérieurs à l’âge auditif (correspondant à la durée de port de l’appareil) mais inférieurs à l’âge chronologique. La représentation grammaticale en fonction de la taille du vocabulaire des enfants avec IC suit la tendance observée dans la norme. Ces résultats suggèrent que le profil lexical des enfants avec implant est très similaire à celui des enfants entendants lorsque le nombre total de mots acquis est le même. Les résultats de cette thèse suggèrent que l’implant peut, de manière générale, avoir un effet « normalisant » sur le langage ; toutefois, il semble que l’amélioration de l’accès auditif ne suffise pas pour rattraper à coup sûr le niveau de langage des pairs entendants dans l’ensemble des composantes du langage. Alors que les habiletés lexicales se rapprochent du profil typique, les habiletés de compréhension morphosyntaxique sont fortement atteintes chez une majorité d’enfants, suggérant un profil apparenté à un trouble de langage.