Awareness of social care needs in people with epilepsy and intellectual disability.

BACKGROUND: Nearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PURPOSE: To compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. METHOD: A multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher's exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. RESULTS: Social and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. CONCLUSIONS: A gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.

Perceived sound quality of hearing aids.

Four experiments dealing with perceived sound quality of hearing aids are described. The purposes were (a) to find a limited number of perceptual dimensions suitable for describing variations in perceived sound quality, (b) to find the positions of the selected hearing aids in these dimensions, (c) to explore the relations between the perceptual dimensions and the physical characteristics of the hearing aids, and (d) to explore the relations between the perceptual dimensions and overall evaluations of the selected hearing aids. Using various multivariate techniques for dimension analysis, the resulting dimensions were interpreted as 'Sharpness/Hardness - Softness', 'Clearance/Distinctness', 'Brightness - Darkness', 'Fullness', 'Feeling of space', 'Nearness', 'Loudness', and 'Disturbing sounds'. Their relations to characteristics of the hearing aids were explored as well as their relations to overall evaluations. The implications for continued research and audiological applications are discussed.

Perceived sound quality of sound-reproducing systems.

Perceived sound quality of loudspeakers, headphones, and hearing aids was investigated by multivariate techniques from experimental psychology with the purpose (a) to find out and interpret the meaning of relevant dimensions in perceived sound quality, (b) find out the positions of the investigated systems in these dimensions, (c) explore the relations between the perceptual dimensions and the physical characteristics of the systems, and (d) explore the relations between the perceptual dimensions and overall evaluations of the systems. The resulting dimensions were interpreted as "clearness/distinctness," "sharpness/hardness softness," "brightness-darkness," "fullness-thinness," "feeling of space," "nearness," "disturbing sounds," and "loudness." Their relations to physical variables were explored by studying the positions of the investigated systems in the respective dimensions. Their relations to overall evaluations were studied, and the implications of the investigations for continued research are discussed.

Questionnaires on desirable properties of hearing aids.

Three questionnaires were presented to 49 hearing-impaired patients. They were asked to rank different properties of behind-the-ear hearing aids with regard to their importance. The first questionnaire dealt with physical properties such as size, weight, and battery-cost, but also with the importance of good sound quality. The second questionnaire focused on the relative importance of various sound quality dimensions, such as softness, clarity, fullness, and others. The third questionnaire asked for suitable sound programs to be used in the procedure of hearing aid fitting in the clinic. Sound quality scored the highest rank by 43 of the patients, and clarity was considered to be the most important sound quality dimension. The most preferred sound programs included male and female voices with or without a background of other voices.

The effects of different frequency responses on sound quality judgments and speech intelligibility.

Four speech programs and two music programs were reproduced using five different frequency responses: one flat and the others combinations of reductions at lower frequencies and/or increases at higher frequencies. Twelve hearing impaired (HI) and 8 normal hearing (NH) subjects listened monaurally to the reproductions at comfortable listening level and judged the sound quality on seven perceptual scales and a scale for total impression. Speech intelligibility was measured for phonetically balanced (PB) word lists and for sentences in noise. Significant differences among the reproductions appeared in practically all scales. The most preferred system was characterized by a flat response at lower frequencies and a 6 dB/octave increase thereafter. There were certain differences between the NH and HI listeners in the judgments of the other systems. The intelligibility of PB word lists did not differ among the systems, and the S/N threshold for the sentences in noise only distinguished the flat response as worse than all others for the HI listeners. There was little correspondence between intelligibility measures and sound quality measures. The latter provided more information and distinctions among systems.

Perceived sound quality of reproductions with different frequency responses and sound levels.

Three programs (female voice, jazz music, and pink noise) were reproduced using four different frequency responses and two different sound levels. Fourteen normal hearing subjects listened to the reproduction via earphones and judged the sound quality on seven perceptual scales (loudness, clarity, fullness, spaciousness, brightness, softness/gentleness, and nearness) and a fidelity scale. Significant differences among the reproductions appeared in all scales and could be attributed to the differences in frequency response or sound level or both. Interactions between the reproductions and the programs could be explained by the relations between the spectrum of the programs and the frequency responses used. The results for the noise program were similar to those for the jazz music program.

Perceived sound quality in a hearing aid with vented and closed earmould equalized in frequency response.

Nine normal-hearing subjects listened to speech and music in a hearing aid, either through a vented earmould or a closed earmould. The complex frequency responses of the two systems were made equal by compensating the aid and closed mould combination with a digital filter. The subjects rated the perceived sound quality of the systems on seven perceptual scales and a scale for overall impression. The results of the ratings support the hypothesis that there is no difference in perceived sound quality between vented and closed earmoulds that are equalized in frequency response, provided that the perceived loudness is the same in both cases.

Frequency discrimination for bands of noise.

Recoding of speech in order to improve discrimination for profoundly deaf people has been tried in various ways. One of these is frequency transposition of voiceless consonants. Some authors report positive and very promising results. Others, however, have not found any significant difference when using control groups with normal amplification. One reason might be a poor frequency discrimination. Is it possible to establish what minimum hearing capacity the listener must show for a successful use of frequency transposition? Using noise bands with different Q factors and varying the levels, the thresholds as minimum midfrequency shift have been measured. Great individual variations have been shown. There is a significant difference between (1) threshold values at different Q factors, (2) threshold values at different frequencies, and (3) threshold values for increasing and decreasing frequency, position of deltaf. There is a significant interaction between (1) frequency and position of deltaf, (2) Q factor and position of deltaf, and (3) between Q factor and frequency. There is also a significant triple interaction between Q factor, frequency, and position of deltaf.

Sound quality judgment during acclimatization of hearing aid.

This study included 10 subjects with sensorineural hearing loss. They had not previously used hearing aids. The hearing aid fitting with "behind-the-ear' aids was based on the NAL method. Judging the sounds in their ordinary home environment, three sound situations (programmes) were selected, permitting the subjects to listen to one programme with speech, another with music and a third with "background noise'. For the group as a whole, significant differences were found between the sound quality judgements with and without the hearing aid. When the judgements of the programmes with background noise were excluded in the analysis, there were significant differences over time in the group as a whole on the scales for clarity and total impression.