Publications

BACKGROUND: Sensory processing abnormalities are common in schizophrenia (SZ) and impact everyday functions, such as speech perception in noisy environments. Auditory-based targeted cognitive training (TCT) is a "bottom up" cognitive remediation intervention designed to enhance the speed and accuracy of low-level auditory information processing. However, the effects of TCT on behavioral measures of central auditory processing (CAP) and the role of CAP function on verbal learning outcomes in SZ are unknown.

METHODS: SZ (n = 42) and healthy subjects (CTL; n = 18) underwent comprehensive clinical, neurocognitive, and auditory assessments, including tests of hearing sensitivity and speech recognition (Words-in-Noise (WIN), Quick Speech-in-Noise (SIN)). SZ patients were randomized to receive either treatment-as-usual (TAU); or 30-h of TCT + TAU using a stratified, parallel design. SZ patients repeated assessments  10-12 weeks later.

RESULTS: Patients exhibited deficits in both WIN (p < 0.05, d = 0.50) and SIN (p < 0.01, d = 0.63). A treatment × time interaction on WIN (p < 0.05, d = 0.74), but not SIN discriminability, was seen in the TCT group relative to TAU. Specific enhancements in the 4-dB over background range drove gains in WIN performance. Moreover, SZ patients with greater CAP deficits experienced robust gains in verbal learning after 30-h of TCT relative to SZ patients without CAP impairment (p < 0.01, d = 1.28).

CONCLUSION: Findings demonstrate that intensive auditory training enhances the fidelity of auditory processing and perception, such that specific CAP deficits were 'normalized' and were predictive of gains in verbal learning after TCT. It is conceivable that patients with deficiencies in CAP measures may benefit most from TCT and other interventions targeting auditory dysfunction in SZ.

OBJECTIVES: This work describes the development of a manualized best-practice hearing intervention for older adults participating in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled clinical trial. Manualization of interventions for clinical trials is critical for assuring intervention fidelity and quality, especially in large multisite studies. The multisite ACHIEVE randomized controlled trial is designed to assess the efficacy of a hearing intervention on rates of cognitive decline in older adults. We describe the development of the manualized hearing intervention through an iterative process that included addressing implementation questions through the completion of a feasibility study (ACHIEVE-Feasibility).

DESIGN: Following published recommendations for manualized intervention development, an iterative process was used to define the ACHIEVE-hearing intervention elements and create an initial manual. The intervention was then delivered within the ACHIEVE-Feasibility study using one-group pre-post design appropriate for assessing questions related to implementation. Participants were recruited from the Tampa, Florida area between May 2015 and April 2016. Inclusion criteria were cognitively healthy adults aged 70 to 89 with symmetrical mild-to-moderately severe sensorineural hearing loss. The ACHIEVE-Feasibility study sought to assess the implementation of the manualized hearing intervention by: (1) confirming improvement in expected outcomes were achieved including aided speech-in-noise performance and perception of disease-specific self-report measures; (2) determining whether the participants would comply with the intervention including session attendance and use of hearing aids; and (3) determining whether the intervention sessions could be delivered within a reasonable timeframe.

RESULTS: The initial manualized intervention that incorporated the identified best-practice elements was evaluated for feasibility among 21 eligible participants and 9 communication partners. Post-intervention expected outcomes were obtained with speech-in-noise performance results demonstrating a significant improvement under the aided condition and self-reported measures showing a significant reduction in self-perceived hearing handicap. Compliance was excellent, with 20 of the 21 participants (95.2%) completing all intervention sessions and 19 (90.4%) returning for the 6-month post-intervention visit. Furthermore, self-reported hearing aid compliance was >8 hr/day, and the average daily hearing aid use from datalogging was 7.8 hr. Study completion was delivered in a reasonable timeframe with visits ranging from 27 to 85 min per visit. Through an iterative process, the intervention elements were refined, and the accompanying manual was revised based on the ACHIEVE-Feasibility study activities, results, and clinician and participant informal feedback.

CONCLUSION: The processes for the development of a manualized intervention described here provide guidance for future researchers who aim to examine the efficacy of approaches for the treatment of hearing loss in a clinical trial. The manualized ACHIEVE-Hearing Intervention provides a patient-centered, yet standardized, step-by-step process for comprehensive audiological assessment, goal setting, and treatment through the use of hearing aids, other hearing assistive technologies, counseling, and education aimed at supporting self-management of hearing loss. The ACHIEVE-Hearing Intervention is feasible in terms of implementation with respect to verified expected outcomes, compliance, and reasonable timeframe delivery. Our processes assure intervention fidelity and quality for use in the ACHIEVE randomized controlled trial (ClinicalTrials.gov Identifier: NCT03243422).

Purpose The lack of culturally and linguistically appropriate interventions contributes to unsatisfactory hearing health care service delivery and outcomes for Spanish-speaking persons from Hispanic/Latino background. To address this issue, our objective was to cross-culturally adapt a "Hearing Loss Toolkit for Self-Management" for use with Spanish-speaking adults seen in a clinical setting. In this clinical focus article, we describe a process for translation and cross-cultural adaptation of patient education materials based on current best practices guidelines. Method We utilized guidelines from the International Society for Pharmoeconomics Outcomes Research Task Force for Translation and Cultural Adaptation, the World Health Organization, and the International Collegium of Rehabilitative Audiology to complete a comprehensive, systematic, cross-cultural adaptation process of the source materials. The adaptation stages included forward translation and reconciliation, back translation and review, field testing with representative end users from the target population, and finalization. Results We successfully cross-culturally adapted the source materials following best practice guidelines. The Spanish-language adaptation was deemed understandable, actionable, aesthetically pleasing, and culturally appropriate by a group of native Spanish speakers. Conclusions There is an unmet need for the development of hearing loss self-management materials that incorporate cultural and linguistic competence with best health literacy practices. High-quality cross-cultural adaptations that consider the intersection of culture, language, and health literacy are a positive step toward reducing barriers to hearing health care related to language access for U.S. Hispanic/Latino adults with hearing loss.

BACKGROUND: In the 1950s, with monitored live voice testing, the vu meter time constant and the short durations and amplitude modulation characteristics of monosyllabic words necessitated the use of the carrier phrase amplitude to monitor (indirectly) the presentation level of the words. This practice continues with recorded materials. To relieve the carrier phrase of this function, first the influence that the carrier phrase has on word recognition performance needs clarification, which is the topic of this study.

PURPOSE: Recordings of Northwestern University Auditory Test No. 6 by two female speakers were used to compare word recognition performances with and without the carrier phrases when the carrier phrase and test word were (1) in the same utterance stream with the words excised digitally from the carrier (VA-1 speaker) and (2) independent of one another (VA-2 speaker). The 50-msec segment of the vowel in the target word with the largest root mean square amplitude was used to equate the target word amplitudes.

RESEARCH DESIGN: A quasi-experimental, repeated measures design was used.

STUDY SAMPLE: Twenty-four young normal-hearing adults (YNH; M = 23.5 years; pure-tone average [PTA] = 1.3-dB HL) and 48 older hearing loss listeners (OHL; M = 71.4 years; PTA = 21.8-dB HL) participated in two, one-hour sessions.

DATA COLLECTION AND ANALYSES: Each listener had 16 listening conditions (2 speakers × 2 carrier phrase conditions × 4 presentation levels) with 100 randomized words, 50 different words by each speaker. Each word was presented 8 times (2 carrier phrase conditions × 4 presentation levels [YNH, 0- to 24-dB SL; OHL, 6- to 30-dB SL]). The 200 recorded words for each condition were randomized as 8, 25-word tracks. In both test sessions, one practice track was followed by 16 tracks alternated between speakers and randomized by blocks of the four conditions. Central tendency and repeated measures analyses of variance statistics were used.

RESULTS: With the VA-1 speaker, the overall mean recognition performances were 6.0% (YNH) and 8.3% (OHL) significantly better with the carrier phrase than without the carrier phrase. These differences were in part attributed to the distortion of some words caused by the excision of the words from the carrier phrases. With the VA-2 speaker, recognition performances on the with and without carrier phrase conditions by both listener groups were not significantly different, except for one condition (YNH listeners at 8-dB SL). The slopes of the mean functions were steeper for the YNH listeners (3.9%/dB to 4.8%/dB) than for the OHL listeners (2.4%/dB to 3.4%/dB) and were <1%/dB steeper for the VA-1 speaker than for the VA-2 speaker. Although the mean results were clear, the variability in performance differences between the two carrier phrase conditions for the individual participants and for the individual words was striking and was considered in detail.

CONCLUSION: The current data indicate that word recognition performances with and without the carrier phrase (1) were different when the carrier phrase and target word were produced in the same utterance with poorer performances when the target words were excised from their respective carrier phrases (VA-1 speaker), and (2) were the same when the carrier phrase and target word were produced as independent utterances (VA-2 speaker).

Purpose The lack of culturally and linguistically appropriate interventions contributes to unsatisfactory hearing health care service delivery and outcomes for Spanish-speaking persons from Hispanic/Latino background. To address this issue, our objective was to cross-culturally adapt a "Hearing Loss Toolkit for Self-Management" for use with Spanish-speaking adults seen in a clinical setting. In this clinical focus article, we describe a process for translation and cross-cultural adaptation of patient education materials based on current best practices guidelines. Method We utilized guidelines from the International Society for Pharmoeconomics Outcomes Research Task Force for Translation and Cultural Adaptation, the World Health Organization, and the International Collegium of Rehabilitative Audiology to complete a comprehensive, systematic, cross-cultural adaptation process of the source materials. The adaptation stages included forward translation and reconciliation, back translation and review, field testing with representative end users from the target population, and finalization. Results We successfully cross-culturally adapted the source materials following best practice guidelines. The Spanish-language adaptation was deemed understandable, actionable, aesthetically pleasing, and culturally appropriate by a group of native Spanish speakers. Conclusions There is an unmet need for the development of hearing loss self-management materials that incorporate cultural and linguistic competence with best health literacy practices. High-quality cross-cultural adaptations that consider the intersection of culture, language, and health literacy are a positive step toward reducing barriers to hearing health care related to language access for U.S. Hispanic/Latino adults with hearing loss.

BACKGROUND: In the 1950s, with monitored live voice testing, the vu meter time constant and the short durations and amplitude modulation characteristics of monosyllabic words necessitated the use of the carrier phrase amplitude to monitor (indirectly) the presentation level of the words. This practice continues with recorded materials. To relieve the carrier phrase of this function, first the influence that the carrier phrase has on word recognition performance needs clarification, which is the topic of this study.

PURPOSE: Recordings of Northwestern University Auditory Test No. 6 by two female speakers were used to compare word recognition performances with and without the carrier phrases when the carrier phrase and test word were (1) in the same utterance stream with the words excised digitally from the carrier (VA-1 speaker) and (2) independent of one another (VA-2 speaker). The 50-msec segment of the vowel in the target word with the largest root mean square amplitude was used to equate the target word amplitudes.

RESEARCH DESIGN: A quasi-experimental, repeated measures design was used.

STUDY SAMPLE: Twenty-four young normal-hearing adults (YNH; M = 23.5 years; pure-tone average [PTA] = 1.3-dB HL) and 48 older hearing loss listeners (OHL; M = 71.4 years; PTA = 21.8-dB HL) participated in two, one-hour sessions.

DATA COLLECTION AND ANALYSES: Each listener had 16 listening conditions (2 speakers × 2 carrier phrase conditions × 4 presentation levels) with 100 randomized words, 50 different words by each speaker. Each word was presented 8 times (2 carrier phrase conditions × 4 presentation levels [YNH, 0- to 24-dB SL; OHL, 6- to 30-dB SL]). The 200 recorded words for each condition were randomized as 8, 25-word tracks. In both test sessions, one practice track was followed by 16 tracks alternated between speakers and randomized by blocks of the four conditions. Central tendency and repeated measures analyses of variance statistics were used.

RESULTS: With the VA-1 speaker, the overall mean recognition performances were 6.0% (YNH) and 8.3% (OHL) significantly better with the carrier phrase than without the carrier phrase. These differences were in part attributed to the distortion of some words caused by the excision of the words from the carrier phrases. With the VA-2 speaker, recognition performances on the with and without carrier phrase conditions by both listener groups were not significantly different, except for one condition (YNH listeners at 8-dB SL). The slopes of the mean functions were steeper for the YNH listeners (3.9%/dB to 4.8%/dB) than for the OHL listeners (2.4%/dB to 3.4%/dB) and were <1%/dB steeper for the VA-1 speaker than for the VA-2 speaker. Although the mean results were clear, the variability in performance differences between the two carrier phrase conditions for the individual participants and for the individual words was striking and was considered in detail.

CONCLUSION: The current data indicate that word recognition performances with and without the carrier phrase (1) were different when the carrier phrase and target word were produced in the same utterance with poorer performances when the target words were excised from their respective carrier phrases (VA-1 speaker), and (2) were the same when the carrier phrase and target word were produced as independent utterances (VA-2 speaker).

OBJECTIVES: This work describes the development of a manualized best-practice hearing intervention for older adults participating in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled clinical trial. Manualization of interventions for clinical trials is critical for assuring intervention fidelity and quality, especially in large multisite studies. The multisite ACHIEVE randomized controlled trial is designed to assess the efficacy of a hearing intervention on rates of cognitive decline in older adults. We describe the development of the manualized hearing intervention through an iterative process that included addressing implementation questions through the completion of a feasibility study (ACHIEVE-Feasibility).

DESIGN: Following published recommendations for manualized intervention development, an iterative process was used to define the ACHIEVE-hearing intervention elements and create an initial manual. The intervention was then delivered within the ACHIEVE-Feasibility study using one-group pre-post design appropriate for assessing questions related to implementation. Participants were recruited from the Tampa, Florida area between May 2015 and April 2016. Inclusion criteria were cognitively healthy adults aged 70 to 89 with symmetrical mild-to-moderately severe sensorineural hearing loss. The ACHIEVE-Feasibility study sought to assess the implementation of the manualized hearing intervention by: (1) confirming improvement in expected outcomes were achieved including aided speech-in-noise performance and perception of disease-specific self-report measures; (2) determining whether the participants would comply with the intervention including session attendance and use of hearing aids; and (3) determining whether the intervention sessions could be delivered within a reasonable timeframe.

RESULTS: The initial manualized intervention that incorporated the identified best-practice elements was evaluated for feasibility among 21 eligible participants and 9 communication partners. Post-intervention expected outcomes were obtained with speech-in-noise performance results demonstrating a significant improvement under the aided condition and self-reported measures showing a significant reduction in self-perceived hearing handicap. Compliance was excellent, with 20 of the 21 participants (95.2%) completing all intervention sessions and 19 (90.4%) returning for the 6-month post-intervention visit. Furthermore, self-reported hearing aid compliance was >8 hr/day, and the average daily hearing aid use from datalogging was 7.8 hr. Study completion was delivered in a reasonable timeframe with visits ranging from 27 to 85 min per visit. Through an iterative process, the intervention elements were refined, and the accompanying manual was revised based on the ACHIEVE-Feasibility study activities, results, and clinician and participant informal feedback.

CONCLUSION: The processes for the development of a manualized intervention described here provide guidance for future researchers who aim to examine the efficacy of approaches for the treatment of hearing loss in a clinical trial. The manualized ACHIEVE-Hearing Intervention provides a patient-centered, yet standardized, step-by-step process for comprehensive audiological assessment, goal setting, and treatment through the use of hearing aids, other hearing assistive technologies, counseling, and education aimed at supporting self-management of hearing loss. The ACHIEVE-Hearing Intervention is feasible in terms of implementation with respect to verified expected outcomes, compliance, and reasonable timeframe delivery. Our processes assure intervention fidelity and quality for use in the ACHIEVE randomized controlled trial (ClinicalTrials.gov Identifier: NCT03243422).