Short-term Aural Rehabilitation Efficacy for Adult CI Users

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

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.

Research Design Par.cipant Characteris.cs Timeline Treatment Protocol

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.

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

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

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

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

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)

Results Speech Tracking Sentence Recogni.on Psychosocial Measures

60 KTH Speech Tracking 50 54.21 Word Per Minute 40 30 20 10 0 29.37 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 AR Group: Speech Tracking for 30 5- minute trials over six sessions (N=7)

Speech recognioon in percent 100 90 80 70 60 50 40 30 20 10 0 53.32 Pre- Treatment Post- 1 Week CasperSent: AR Group 71.79 72.75 65.4 Post- 2 Month Post- 6 Month AR Group: Sentence RecogniOon Pre and Post IntervenOon (N=7) *Post- 6 Month (N=5) *

100 CasperSent: CT Group Speech recognioon in percent 90 80 70 60 50 40 30 83.5 79.25 80.0 78.25 36.75 37.0 CT01 CT02 20 10 0 Pre- Treatment Post- 1 Week Post- 2 Month Post- 6 Month CT Group: Sentence RecogniOon Pre and Post IntervenOon

Mean Improvement in Percent 25 20 15 10 5 0-5 - 10 CasperSent Change Post- Training 18.42 19.25 AR Group (N=7) 16.5 N=5 at 6 months CT Group (N=2) N=1 at 2, 6 months - 2-3.5-5.2 Post 1 Week Post 2 Months Post 6 Months CasperSent Post- Treatment Percent Change Scores

Participant Pre-Treatment Post 1 Week Post 2 Month Post 6 Month AR04 78.5 95.3 95.8 96 AR03 75.0 86.5 89.0 81.5 AR01 71.5 91.0 93.8 - - - - - - AR07 57.3 82.0 82.0 - - - - - - AR06 32.5 60.0 60.8 60.8 AR05 30.0 53.0 51.8 53.8 AR02 28.5 34.8 35.0 35.0 CT01 83.5 79.3 80.0 78.3 CT02 36.75 37.0 - - - - - - - - - - - - Individual CasperSent Scores Pre and Post- Treatment in Descending IniOal Performance Order.

HHIA/E Scores 100 90 80 70 60 50 40 30 20 10 0 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)

100 90 CT01 HHIA/E Pre- Treatment Post- 1 Week Post- 2 Month 80 Post- 6 Month HHIA/E Scores 70 60 50 40 30 20 10 0 Emo.onal Social Situa.onal Total CT Group: Pre and Post- Treatment Scores (N- 1)

100 90 CT02 HHIA/E Pre- Treatment Post- 1 Week 80 HHIA/E Scores 70 60 50 40 30 20 10 0 Emo.onal Social Situa.onal Total CT Group: Pre and Post- Treatment Scores (N- 1)

% Time can hear saosfactorily 80 70 60 50 40 30 20 10 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)

% Time can hear saosfactorily 80 70 60 50 40 30 20 10 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)

COSI % Time can hear saosfactorily 80 70 60 50 40 30 20 10 0 CT02 Goal 1 Goal 2 Goal 3 Pre- treatment Post- 1 Week CT Group: Pre and Post Treatment Listening Ability Scores (N=1)

100 90 NCIQ Pre- Treatment Post- 1 Week Post- 2 Month 80 Post- 6 Month * Subscale Scores 70 60 50 40 30 20 10 0 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)

100 90 CT01 NCIQ Pre- treatment Post- 1 week Post- 2 month Post- 6 month 80 Subscale Scores 70 60 50 40 30 20 10 0 Basic Speech Advanced Speech Speech ProducOon Self- Esteem AcOvity LimitaOon CT Group: Pre and Post- Treatment Scores (N=1) Social InteracOon

100 90 CT02 NCIQ Pre- treatment Post- 1 week 80 Subscale Scores 70 60 50 40 30 20 10 0 Basic Speech Advanced Speech Speech ProducOon Self- Esteem AcOvity LimitaOon CT Group: Pre and Post- Treatment Scores (N=1) Social InteracOon

IntervenOon change raong 50 40 30 20 10 0 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)

50 GBI Post- 1 Week Post- 2 Month IntervenOon change raong 40 30 20 10 CT01 Post- 6 Month 0 General Social Support Physical Health Overall CT Group: RaOngs of Change Post- Treatment (N=1)

IntervenOon change raong 50 40 30 20 10 0-10 - 20-30 - 40 CT02 GBI General Social Support Physical Health Overall Post- 1 Week CT Group: RaOngs of Change Post- Treatment (N=1)

10 9 8 7 Visual Analogue Scale- AR Pre- Treatment Post- 1 Week Post- 2 Month Post- 6 Month * VAS RaOng 6 5 4 3 2 1 0 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

10 9 8 7 CT01 Visual Analog Scale- AR Pre- treatment Post- 1 week Post- 2 month Post- 6 month VAS RaOng 6 5 4 3 2 1 0 Self- confidence Ease communicaoon Social parocipaoon FaOgue Quality of life CT Group: RaOng Pre and Post- Treatment (N=1) ** reverse score **

Visual Analog Scale- AR 10 9 8 7 CT02 Pre- treatment Post- 1 week VAS RaOng 6 5 4 3 2 1 0 Self- confidence Ease communicaoon Social parocipaoon FaOgue Quality of life CT Group: RaOng Pre and Post- Treatment (N=1) ** reverse score **

Discussion Speech Recogni.on Measures Psychosocial Measures

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.

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.

Anecdotal Comments Participant Pre-Treatment Mean Change AR04 ** 78.5 17.2 AR03 75.0 10.7 AR01 71.5 20.9 AR07 57.3 24.7 AR06 32.5 28.0 AR05 30.0 22.9 AR02 ** 28.5 6.4 CT01 ** 83.5-4.3 CT02 36.75 0.3

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.

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