application of behavioral,academic, communication and

APPLICATION OF BEHAVIORAL,
ACADEMIC, COMMUNICATION AND
ELECTROPHYSIOLOGICAL MEASURES
TO DOCUMENT TREATMENT EFFICACY
ELIANE SCHOCHAT, Ph.D.
Sao Paulo University - School of Medicine
Speech and Hearing Department
Audiology Professor
Background & Rationale
¾ Does Auditory Training (A.T.) enhance central auditory
function ?
• How can this be measured?
– Questionnaires
– Psychophysical tests
– Electrophysiology
– Functional imaging
MLR as an index of improvement in (C)APD
1. generator sites (thalamo-cortical)
2. abnormal in defined lesions of CANS
3. some data indicates MLRs to be abnormal
in children with L.D.
MLR Waveform
Na – Pa amplitude
[
Pa latency
Pa
V
Na
0
10
20
.6 microvolts
Pb
Nb
30
40
msec
50
60
70
AUDITORY TRAINING
¾ The foundation of AT is brain plasticity
¾ AT can enhance various auditory processes
by the reorganization of auditory neural
substrate
¾ Reports of electrophysiologic changes
recorded in humans after AT
auditory) needs to be
¾ The system ((auditory)
challenged to trigger the changes in
structure and function
¾ Tasks need to be of moderate difficulty and
progress appropriately over time.
METHODS - SUBJECTS
¾ 30 normal subjects (age range from 8 to
14 years old)
¾ 30 subjects with APD (age range from 8
to 14 years old)
¾ all tested using two monaural tests and
two dichotic (SSW/dichotic digits, non
verbal dichotic test; PSI, filtered
speech/speech in noise).
SUBJECT CRITERIA
¾ Controls = Normal audiogram & normal
performance on central auditory test
battery. Normal school performance.
¾ (C)APD = Normal audiogram, & failed at
least 2 central auditory tests, reported
auditory difficulties
¾ Groups were age matched
METHODS - PROCEDURE
both groups
¾ BEFORE ((both
groups))
¾ Behavioral evaluation
¾ Electrophysiologic evaluation – MLR
¾ TRAINING (APD group
group))
three months
both groups
¾ AFTER ((three
months)) ((both
groups))
only APD group
¾ Behavioral evaluation ((only
group))
¾ Electrophysiologic evaluation – MLR
Treatment Battery (Musiek,
(Musiek, Schochat,
Schochat, 1998;
1998; Musiek,
Musiek, Baran,
Baran, Schochat,
Schochat,
1999)
1999)
ÁDIID
ÁFREQUENCY TRAINING
ÁINTENSITY TRAINING
ÁTEMPORAL TRAINING
ÁLOCALIZATION
ÁMEMORY (A.M.E.)
TRAINING – PROCEDURES
¾ FORMAL AND INFORMAL
¾ 8 SESSIONS – 2 MONTHS
¾ 50 MINUTES EACH SESSION
¾ 15 MINUTES DAILY - PARENTS
RESULTS
APD X NORMAL – PRE AMPLITUDE
C3A1
Ampl before
C4A1
C3A2
C4A2
Nl
APD
Nl
APD
Nl
APD
Nl
APD
Mean
1,18
0,84
1,48
1,01
1,00
0,69
1,18
0,96
Median
0,92
0,76
1,14
0,97
0,91
0,63
1,00
0,78
Stand Dev
0,65
0,39
0,77
0,51
0,46
0,31
0,66
0,60
22
31
22
30
22
30
22
29
N
p-value
0,022*
0,010*
0,005*
0,230
BEHAVIORAL - PRE/POST
pre
sd
post
sd
PSI (s/r - 15)
Speech noise
Non verb Dic
SSW
RE
RE
RE
RE
LE
LE
LE
LE
72
72
74
72
73
72
67
59
0,21
0,2
0,14
0,18
0,21
0,28
0,17
0,19
85
80
86
86
94
93
81
75
0,13
0,12
0,07
0,08
0,09
0,11
0,13
0,17
BEHAVIORAL
APD GROUP – PRE AND POST –
AMPLITUDE - ANOVA
APD –
Ampl.
C3A1
C4A1
C3A2
C4A2
Pre
Post
Pre
Post
Pre
Post
Pre
Post
Mean
0,84
1,59
1,01
1,33
0,69
1,24
0,96
1,18
Median
0,76
1,44
0,97
1,02
0,63
0,98
0,78
1,13
Stand dev
0,39
0,82
0,51
1,36
0,31
0,73
0,60
0,53
31
30
30
30
30
29
29
29
N
p-value
<0,001*
0,235
<0,001*
0,149
PRE X POST TRAINING
Amplitude
Amplitude means
means pre
pre and
and post
post Auditory
Auditory Training
Training
1,4
1,2
1
0,8
0,6
0,4
0,2
0
C3A1
C3A2
C4A1
C4A2
AUDITORY TRAINING:
EVALUATION OF THE
BENEFITS FOR
ELDERLY HEARING
AIDS USERS
METHOD - Subject
¾42 subjects – mild to moderate
hearing loss
¾60 – 90 years old
¾Bilateral hearing aids users
¾2 groups – EG/CG
METHOD - Procedure
¾ Both groups
• Auditory Processing evaluation (S/N
and DD)
––1st
1st and 8th session
• HHIE
––1st,
1st, 4th and 8th session
• APHAB
––1st,
1st, 4th and 8th session
METHOD - Procedure
¾ EG - auditory training program (8
sessions)
• 4 sessions without Hearing Aids
• 4 sessions with Hearing Aids
¾ CG - did not auditory training – regular
hearing aid fitting session
RESULTS
DICHOTIC DIGITS AND SPEECH IN NOISE TESTS BEFORE AND AFTER
AUDITORY TRAINING (STUDY AND CONTROL GROUPS)
100%
95%
100%
86,30%
90%
95%
90%
85%
80%
75%
70,70%
69,90%
70%
80%
75%
61,50%
65%
68,90%
66,80%
70%
65%
60%
60%
55%
50%
79,90%
85%
55%
GE
GC
1ª avaliação
2ª avaliação
DICHOTIC DIGITS
50%
GE
GC
1ª avaliação
SPEECH IN NOISE
2ª avaliação
68,90%
HHIE QUESTINAIRE BEFORE MIDDLE AND AFTER AUDITORY
TRAINING (STUDY AND CONTROL GROUPS)
70%
59,00%
60%
50,70%
50%
40%
29,90%
27,80%
30%
19,50%
14,40%
20%
10%
0%
GE
1ª Avaliação
GC
2ª Avaliação
3ª Avaliação
APHAB QUESTIONAIRE BEFORE, MIDDLE AND AFTER
AUDITORY TRAINING (STUDY AND CONTROL GROUPS)
90%
83,52%
82,48%
80%
77,10%
*
*
70%
60%
50%
40%
30%
34,29%
24,29%
26,19%
17,90%
20%
11,90%
13,86%
10,33%
19,19%
12,38%
10%
0%
FC
RV
1ª Avaliação
RA
2ª Avaliação
AS
3ª Avaliação
CONCLUSION
THE AUDITORY TRAINING
PROGRAM WAS
EFFECTIVE CONCERNING
THE BENEFIT DURING
THE HEARING AIDS
ADAPTATION PROCESS