Short-term Aural Rehabilitation Efficacy for Adult CI Users

Transcription

1 Short-term Aural Rehabilitation Efficacy for Adult CI Users Diane Brewer, George Washington University Claire Bernstein, Gallaudet University Matthew Bakke, Gallaudet University

2 Purpose To provide evidence of possible benefits resulting from short-term aural rehabilitation therapy(ar) for post-lingually deafened cochlear implant (CI) users. Specifically, to evaluate AR in a randomized controlled clinical trial.

3 Research Design Par.cipant Characteris.cs Timeline Treatment Protocol

4 Participant Characteristics Thirty post-lingually deafened adult CI users. Three months to three years post-activation. No AR therapy post-implantation. Speech tracking rate 20 words per minute. Sentence recognition between 10%-85% (CasperSent). English speaking. Normal cognitive function.

5 Timeline Session 1 Pre-Assessment Session 2-7 AR Group Control Group Session 8 1 week Post-Assessment Session 9 2 month Post-Assessment Session 10 6 month Post-Assessment

6 Treatment Protocol Aural Rehabilitation Group (AR) Informational Counseling CI orientation Hardware Assistive listening devices Telephone use Communication Strategies Training Auditory Training Sentence identification Vowel and consonant contrasts KTH Speech Tracking

7 Treatment Protocol Cognitive Training Group (CT) Cognitive Training Exercises Spot the Difference Crossword Puzzles Ken-Ken Word Searches Sudoku Choice of 3 activities

8 Outcome Measures Speech Recognition Sentence Recognition CasperSent (Boothroyd, 1987) Speech Tracking KTH Speech Tracking (Gnospelius & Spens, 1992)

9 Outcome Measures Psychosocial Self-Assessment Client Oriented Scale of Improvement (COSI) (Dillon et al., 1977) Glasgow Benefit Inventory (GBI) (Robinson et al., 1996) Hearing Handicap Inventory (HHIE/A) (Ventry & Weinstein, 1982; Newman et al., 1990) Nijmegen Cochlear Implant Questionnaire (NCIQ) (Hinderink et al., 2000) Visual Analog Scale - Aural Rehabilitation (VASAR) (Brewer & Bernstein, 2009)

10 Results Speech Tracking Sentence Recogni.on Psychosocial Measures

11 60 KTH Speech Tracking Word Per Minute AR Group: Speech Tracking for minute trials over six sessions (N=7)

12 Speech recognioon in percent Pre- Treatment Post- 1 Week CasperSent: AR Group Post- 2 Month Post- 6 Month AR Group: Sentence RecogniOon Pre and Post IntervenOon (N=7) *Post- 6 Month (N=5) *

13 100 CasperSent: CT Group Speech recognioon in percent CT01 CT Pre- Treatment Post- 1 Week Post- 2 Month Post- 6 Month CT Group: Sentence RecogniOon Pre and Post IntervenOon

14 Mean Improvement in Percent CasperSent Change Post- Training AR Group (N=7) 16.5 N=5 at 6 months CT Group (N=2) N=1 at 2, 6 months Post 1 Week Post 2 Months Post 6 Months CasperSent Post- Treatment Percent Change Scores

15 Participant Pre-Treatment Post 1 Week Post 2 Month Post 6 Month AR AR AR AR AR AR AR CT CT Individual CasperSent Scores Pre and Post- Treatment in Descending IniOal Performance Order.

16 HHIA/E Scores HHIA/E Emo.onal Social Situa.onal Total Pre- Treatment Post- 1 Week Post- 2 Month Post- 6 Month * AR Group: Pre and Post- Treatment Scores (N=7) *Post- 6 Month (N=5)

17 CT01 HHIA/E Pre- Treatment Post- 1 Week Post- 2 Month 80 Post- 6 Month HHIA/E Scores Emo.onal Social Situa.onal Total CT Group: Pre and Post- Treatment Scores (N- 1)

18 CT02 HHIA/E Pre- Treatment Post- 1 Week 80 HHIA/E Scores Emo.onal Social Situa.onal Total CT Group: Pre and Post- Treatment Scores (N- 1)

19 % Time can hear saosfactorily COSI Pre- Treatment Post- 1 Week Post- 2 Month * Post- 6 Month 0 Goal 1 Goal 2 Goal 3 AR Group: Pre and Post Treatment Listening Ability Scores (N=7) *Post- 6 Month (N=5)

20 % Time can hear saosfactorily CT01 COSI Pre- treatment Post- 1 Week Post- 2 Month Post- 6 Month 0 Goal 1 Goal 2 Goal 3 CT Group: Pre and Post Treatment Listening Ability Scores (N=1)

21 COSI % Time can hear saosfactorily CT02 Goal 1 Goal 2 Goal 3 Pre- treatment Post- 1 Week CT Group: Pre and Post Treatment Listening Ability Scores (N=1)

22 NCIQ Pre- Treatment Post- 1 Week Post- 2 Month 80 Post- 6 Month * Subscale Scores Basic Speech Advanced Speech Speech ProducOon Self- Esteem AcOvity LimitaOon Social InteracOon AR Group: Pre and Post- Treatment Scores (N=7) *Post- 6 Month (N=5)

23 CT01 NCIQ Pre- treatment Post- 1 week Post- 2 month Post- 6 month 80 Subscale Scores Basic Speech Advanced Speech Speech ProducOon Self- Esteem AcOvity LimitaOon CT Group: Pre and Post- Treatment Scores (N=1) Social InteracOon

24 CT02 NCIQ Pre- treatment Post- 1 week 80 Subscale Scores Basic Speech Advanced Speech Speech ProducOon Self- Esteem AcOvity LimitaOon CT Group: Pre and Post- Treatment Scores (N=1) Social InteracOon

25 IntervenOon change raong GBI Post- 1 Week Post- 2 Month Post- 6 Month * - 10 General Social Support Physical Health Overall AR Group: RaOngs of Change Post Treatment (N=7) *Post- 6 Month (N=5)

26 50 GBI Post- 1 Week Post- 2 Month IntervenOon change raong CT01 Post- 6 Month 0 General Social Support Physical Health Overall CT Group: RaOngs of Change Post- Treatment (N=1)

27 IntervenOon change raong CT02 GBI General Social Support Physical Health Overall Post- 1 Week CT Group: RaOngs of Change Post- Treatment (N=1)

28 Visual Analogue Scale- AR Pre- Treatment Post- 1 Week Post- 2 Month Post- 6 Month * VAS RaOng Self- Confidence Ease Communica.on Social Par.cipa.on Fa.gue ** Quality of Life AR Group: RaOng Pre and Post Treatment (N=7) *Post- 6 Month (N=5) **reverse score

29 CT01 Visual Analog Scale- AR Pre- treatment Post- 1 week Post- 2 month Post- 6 month VAS RaOng Self- confidence Ease communicaoon Social parocipaoon FaOgue Quality of life CT Group: RaOng Pre and Post- Treatment (N=1) ** reverse score **

30 Visual Analog Scale- AR CT02 Pre- treatment Post- 1 week VAS RaOng Self- confidence Ease communicaoon Social parocipaoon FaOgue Quality of life CT Group: RaOng Pre and Post- Treatment (N=1) ** reverse score **

31 Discussion Speech Recogni.on Measures Psychosocial Measures

32 Speech Recognition AR Group All participants showed improved speech recognition on an independent measure posttraining (6.5 to 28.3%). Mean improvement post-training was 18.47% at one week 19.25% at two months 16.5% at six months CT Group Participants showed no improvement in sentence recognition following treatment.

33 AR Group Psychosocial Measures Improvement was seen in personal goals (COSI). Improvement was seen on self- assessed communica.on func.on (HHIE/A, NCIQ, VAS- AR). Improvement was seen on general benefit scale (GBI). CT Group Improvement was seen in ease of communica.on, social par.cipa.on and reduc.on of fa.gue (VAS- AR); and some scales of the NCIQ and GBI for CT01. No improvement was seen on HHIE/A or COSI.

34 Anecdotal Comments Participant Pre-Treatment Mean Change AR04 ** AR AR AR AR AR AR02 ** CT01 ** CT

35 Conclusions AR interven.on contributed to increased speech recogni.on and to self- perceived improvement in psychosocial func.on. This preliminary data suggests that short- term AR can improve outcomes for adult CI users.

36 Acknowledgements *We gratefully acknowledge the generosity of three sites who allow us to provide interven.on in their facili.es. Hearing Loss Associa.on of America Hearing and Speech Agency of Bal.more Northern Virginia Resource Center *We welcome three new collabora.ng sites. *This research is supported by the Na.onal Ins.tute on Disability and Rehabilita.on Research (NIDRR), US Department of Educa.on Grant #H133E80006