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Assessing hearing capacity and hearing skill in infants 2

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Assessing hearing capacity and hearing skill in infants 2

  1. 1. Assessing Hearing Capacity and HearingSkill in Children aged 6 months to 3 years Misura dell’udito e delle abilità uditive nei bambini da 6 mesi a 3 anni Arthur Boothroyd Presented to short course on Childhood Deafness and Language Amplifon Center for Research and Study Milan, October 2012 Director: Edoardo Arslan University of Padua
  2. 2. AcknowledgementsLaurie Eisenberg, House Research Institute Amy Martinez, House Research Institute NIDCD grant numbers: DC 006238 and DC 004433
  3. 3. Pediatric Aural Habilitation1. Best hearing capacity2. Best hearing skill3. Best use of hearing for: Cognitive development Social development Language development
  4. 4. Hearing CAPACITY SKILL CentralConductive Sensorineural mechanismmechanism mechanism (brain)Deliverers Translators Analysts, decision makers, and responders
  5. 5. Best capacity + Best skill ? ?Hearing Capacity Perception = Perception Discrimination Hearing Skill Hearing Sensitivity & Association Detection x Capacity Resolution x --------------- = Hearing Attention x Transmission Cognition Cognition Recognition Skill Space-time Localization Objects Interpretation Events Properties Cause/effect Audiologic Habilitative managementmanagement
  6. 6. Assessment? Hearing Capacity Percep- Hearing Skill ? ? = Hearing Sensitivity tion Detection x Capacity Resolution x & = Hearing Attention x Recognition Transmission Cognition Skill Localization Interpretation Needed for Needed forPlanning assistance Planning habilitationMeasuring outcome Measuring outcomePlanning habilitation Audiologic feedback
  7. 7. Behavioral assessmentHearing Capacity Perception Hearing Skill = Hearing Sensitivity & Detection x Capacity Resolution x Cognition = Hearing Attention x Recognition Transmission Skill Localization Interpretation Behavior Alerting Speech Acting output Imitating Answering
  8. 8. Behavioral assessmentHearing Capacity Perception Hearing Skill = Hearing Sensitivity & Arousal x Capacity Resolution x Cognition = Hearing Attention x Recognition Transmission Skill Localization Interpretation Behavior Alerting Acting Imitating Answering
  9. 9. Behavioral assessmentHearing Capacity Perception Hearing Skill = Hearing Sensitivity & Arousal x Capacity Resolution x Cognition = Hearing Attention x Recognition Transmission Skill Localization Interpretation Behavior Speech Alerting output Acting Imitating Answering
  10. 10. Operational definitionsSkill = current performanceCapacity = maximum possible performancePerformance Capacity 0 1 2 3 4 5 6 7 Hearing Age in years
  11. 11. Imitation Sensitivity Resolution Transmission RecognitionSpeechoutput
  12. 12. IMSPAC (on-line) Primary computer Secondary monitor Visual Video Visual Mask Mask Speech NoiseTester Imita- Child Mixer/ tion Auditory mask amplifier
  13. 13. Tester
  14. 14. Performance of 31 hearing children on an imitative task involving 5 phonetic contrasts 3/9 co-operated and passed 2/9 co-operated 22/22 co-operated but failed and passed 4/9 did not co- operate
  15. 15. Rate of learning depends on the taskPerformance Capacity 0 1 2 3 4 5 6 7 Age in years
  16. 16. Visual Response AudiometryStimulus = Sound ChangeSilence  Sound (Sensitivity)Sound A  Sound B (Resolution)Response =Head turn
  17. 17. Video here
  18. 18. Behavioral assessment: the idealStimulus Sensory device Aided Child’s speech hearing perception system capacity Response
  19. 19. Behavioral assessment: realityStimulus State: Task-related Sensory - comfort, interest, variables device attention, motivation Aided speech Auditory Knowledge: perception system - world (cognition) capacity - people (social cognition) - language - phonology - vocabulary - syntax Processing skills: - auditory, linguistic Motor skills: - gross, fine, speech Response?
  20. 20. Behavioral tests of capacityCapacity inferred from performancePositive results  confidenceNegative results  uncertainty After training:Negative results  less uncertainty
  21. 21. Electrophysiological Assessment? Hearing Capacity Percep- Hearing Skill = Hearing Sensitivity tion Detection x Capacity Resolution x x & = Attention Recognition Transmission Cognition Localization Interpretation Response ABR – Brain stemN1P2 – Cortex (onset)ACC – cortex (change)
  22. 22. Electrophysiological Assessment? Hearing Capacity Percep- Hearing Skill = Hearing Sensitivity tion Detection x Capacity Resolution x x & = Attention Recognition Transmission Cognition Localization Interpretation Response ABR – Brain stemN1P2 – Cortex (onset)ACC – cortex (change)
  23. 23. Electrophysiological Assessment? Hearing Capacity Percep- Hearing Skill = Hearing Sensitivity tion Detection x Capacity Resolution x x & = Attention Recognition Transmission Cognition Localization Interpretation Response ABR – Brain stemN1P2 – Cortex (onset)ACC – cortex (change)
  24. 24. Can electrophysiology fill the gap, and avoid learning, and behavioral effects? Onset The Acoustic Change Complex (ACC) Offsetooee ooee ooee ooee ooee ooee ooee ooee……...
  25. 25. Group mean waveforms Adult data (n=7) x x ? / / / /From:Ostroff (1999)PhDDissertationCUNY
  26. 26. 32 Hz
  27. 27. 77%32 Hz
  28. 28. Acoustic Change Complex in children Data courtesy of Dr. Laurie Eisenberg of the House Research Institute
  29. 29. ACC in response to ooee 5 normally hearing children. Mean age 2y11mAmplitude (µV) P1 N2 Time re change onset (msec)
  30. 30. ACC in response to ooee 6 hearing-impaired children. Aged 2y3m to 6y3mAmplitude (µV) 5 normally hearing children. Mean age 2y11m Time re change onset (msec)
  31. 31. ACC in response to ooee 2y7mAmplitude (µV) 2y3m P1? 5 normally hearing children. Mean age 2y11m Time re change onset (msec)
  32. 32. 5 year old hearing aid user ooaa aided ooee aided ooee unaidedAmplitude (µV) Time re change onset (msec)
  33. 33. Acoustic Change Complex• Objective indicator of resolution• Obtainable between 2 and 3 years• Possibly lower• Responds to amplification• Still under development
  34. 34. In summaryHearing Capacity + Skill  PerformanceAssess performance  infer skill/capacityResponse to sound  sensitivity √Response to change  resolution ?Imitation  sensitivity, and resolutionElectrophysiology: ABR  sensitivity √ ACC  resolution ?
  35. 35. Thank you

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