Consideration of Demographic Variables in Behavioral Interventions Pertaining to Children With Hearing Loss: A Systematic Review.

PURPOSE: Equitable representation of children with hearing loss who are members of marginalized or minority groups in behavioral intervention studies enhances inclusivity in the scientific process and generalizability of results. The goal of this systematic review was to ascertain the percentage of studies conducted in the United States in the past 2 decades that reported relevant demographic variables. METHOD: Studies were searched across eight databases and clinical trial registries in October 2022. Variations of the following search strings were used to retrieve peer-reviewed published studies and unpublished clinical trials: children, hearing loss, and intervention. RESULTS: Thirty-nine intervention studies met the inclusion criteria. The selected studies were reviewed and coded for the following demographic variables: area and type of intervention, participant age, hearing technology data, sample size, gender, race/skin color and ethnicity, primary/home language(s), additional disabilities, parental education, family income, and parental occupation. Results revealed that many demographic variables were remarkably underreported, with parental education, family income, and parental occupation variables being the least reported data. CONCLUSIONS: Demographic data can be an important tool for changing disparities related to intervention outcomes. This systematic review suggests that inclusive research practices should be extended to low-literacy or low-economic resources, non-White, and non-English-speaking groups. Inclusion practices coupled with sufficient sample sizes will ultimately aid in identifying hearing health disparities.

Efficacy of cogmed working memory training program in improving working memory in school-age children with and without neurological insults or disorders: A meta-analysis.

This meta-analysis assessed the efficacy of the Cogmed Working Memory Training program in improving near-transfer measures (verbal and visuospatial working memory) and far-transfer measures (attention, executive function, and academic achievement) in school-age children with and without neurological insults or disorders. Relevant studies were searched in databases and clinical trial registries using the keyword Cogmed. Ten published studies and unpublished data from one study met the inclusion criteria. Hedges g was calculated for each outcome measure obtained at pre-intervention, post-intervention, and 3-6 month time points. Analysis compared outcome measures in the control versus experimental groups and examined the role of moderators on treatment effects (control group intervention, intervention environment). Data revealed significant medium-size effects of the Cogmed program in improving verbal and visuospatial working memory post-intervention and for verbal working memory only at the 3-6 month time point. However, the training did not generalize to the far-transfer measures. Analyses indicated that only the type of intervention provided for the control group moderated treatment effects on verbal and visual working memory. Meta-analytic findings suggest that the Cogmed program leads to short-term improvements and in some cases, long-term improvements in working memory in school-age children; however, these effects may not generalize to far-transfer measures.

Global Rehabilitation Health Worker Certification: Global Agenda, Local Imperative.

Rehabilitation, seen as a disability-specific service needed only by few of the world's population, has not been prioritized in countries and is under-resourced. A rehabilitation-ready health workforce is potentially the most important resource for improving functioning and the quality of life for the 2.41 billion people worldwide needing this care. In April 2019, CGFNS International, Inc., and the Association of Schools Advancing Health Professions (ASAHP) partnered to respond to the World Health Organization's Rehab 2030, which emphasizes the need for global action by professional organizations, development agencies, and civil society to develop and maintain a sustainable workforce for rehabilitation under different healthcare models in different economies. The global certification framework presented in this article provides a mechanism to validate rehabilitation knowledge and practice competence of individual health workers. The impact of certification on upgrading rehabilitation education and upskilling the world's rehabilitation health workforce cannot be overstated.

Effects of longstanding degraded auditory signal on visuospatial, visuomotor, and visual attention skills in adults with hearing loss.

OBJECTIVE: This study examined the consequences of long-term auditory deprivation on visuospatial functions, visuomotor functions, and visual attention skills in adults with early-onset hearing loss. METHODS: Fifteen adults with bilateral, early-onset (before age 3), severe-to-profound hearing loss who used spoken language participated in this study. Visuospatial (figure ground, form constancy, visual perception) and visuomotor functions (visuomotor integration, visual search) were examined using norm-referenced tests. Visual attention scales were examined using a computerized program, IVA plus continuous performance test. RESULTS: As a group, participants performed in the average range on visuospatial and visuomotor functions when compared to normative data presented in the test instruments. However, participants demonstrated below average performance on sustained visual attention. Duration of cochlear implant use positively correlated with one of the visual attention scales, namely visual speed. CONCLUSIONS: The findings of the current study suggest that adults with early-onset hearing loss may demonstrate difficulties in sustaining attention to visual information. Data also suggest that increased experience with cochlear implant may ameliorate deficits associated with visual attention. Future studies should explore challenges experienced by adults with early-onset hearing loss in their daily activities that may result from this deficit and intervention programs that may enhance visual attention skills.

An exploratory study of visual sequential processing in children with cochlear implants.

OBJECTIVE: The objective of the study was to compare visual sequential processing in school-age children with cochlear implants (CIs) and their normal-hearing (NH) peers. Visual sequential processing was examined using both behavioral and an event-related potential (ERP) measures. METHODS: Eighteen children with CIs and nineteen children who had hearing within normal limits (NH) participated in the behavioral study. Subtests from the Test of Visual Perceptual Skills and the Sensory Integration and Praxis Test were administered to all children. ERP measures were collected from five children with CI and five age-matched peers. Peak latencies (N200 and P300) and reaction times for visual sequential processing were compared in these two groups. RESULTS: The findings of the study revealed significant group differences in visual sequential memory and visuo-motor sequencing tasks suggesting that children with severe-profound hearing loss may have difficulties in visual sequential tasks. The study also revealed longer P300 latencies and longer reaction times for a visual sequential matching task in children with CI when compared to their NH peers suggesting slower or delayed processing of visual sequential stimuli. CONCLUSIONS: This exploratory study involving behavioral and ERP measures showed that as a group, children with prelingual, severe-profound hearing loss who use CIs have difficulties with visual sequential processing. These findings may have implications for rehabilitation for children with hearing loss in the light of recent evidence that accurate and efficient processing of sequentially presented visual stimuli is important for language and reading outcomes.

Working memory, short-term memory and reading proficiency in school-age children with cochlear implants.

OBJECTIVE: The objective of the study was to examine short-term memory and working memory through both visual and auditory tasks in school-age children with cochlear implants. The relationship between the performance on these cognitive skills and reading as well as language outcomes were examined in these children. METHODS: Ten children between the ages of 7 and 11 years with early-onset bilateral severe-profound hearing loss participated in the study. Auditory and visual short-term memory, auditory and visual working memory subtests and verbal knowledge measures were assessed using the Woodcock Johnson III Tests of Cognitive Abilities, the Wechsler Intelligence Scale for Children-IV Integrated and the Kaufman Assessment Battery for Children II. Reading outcomes were assessed using the Woodcock Reading Mastery Test III. RESULTS: Performance on visual short-term memory and visual working memory measures in children with cochlear implants was within the average range when compared to the normative mean. However, auditory short-term memory and auditory working memory measures were below average when compared to the normative mean. Performance was also below average on all verbal knowledge measures. Regarding reading outcomes, children with cochlear implants scored below average for listening and passage comprehension tasks and these measures were positively correlated to visual short-term memory, visual working memory and auditory short-term memory. Performance on auditory working memory subtests was not related to reading or language outcomes. CONCLUSIONS: The children with cochlear implants in this study demonstrated better performance in visual (spatial) working memory and short-term memory skills than in auditory working memory and auditory short-term memory skills. Significant positive relationships were found between visual working memory and reading outcomes. The results of the study provide support for the idea that WM capacity is modality specific in children with hearing loss. Based on these findings, reading instruction that capitalizes on the strengths in visual short-term memory and working memory is suggested for young children with early-onset hearing loss.

Multisensory processing in children with cochlear implants.

OBJECTIVE: The objective of the study was to investigate the functions of the vestibular, tactile, visual, and proprioceptive modalities in children with prelinguistic hearing loss. Specifically, the study sought to examine evidence for the compensation hypothesis (auditory deprivation leads to enhancements in functions of other sensory systems) versus the deficiency hypothesis (functions of the spared senses are compromised as a result of auditory deprivation). METHODS: Twelve children between the ages of 5 years, 1 month and 8 years, 11 months with bilateral severe-profound hearing loss participated in the study. All children used bilateral cochlear implants. Subtests of two norm-referenced instruments, the Sensory Integration and Praxis Test and the Beery-Buktenica Developmental Test of Visual-Motor Integration, were administered to all of the children. Mean subtest scores for children with hearing loss were compared with the mean scores for the normative group. RESULTS: As expected, a majority of children demonstrated vestibular dysfunction. Assessment of other modalities revealed significantly below average performance on two tasks by children with hearing loss when compared to the normative group. Both tasks involved temporal processing of tactile or proprioceptive signals. Conversely, children with hearing loss showed significantly better performance compared to the normative group for a spatial task that involved localization of a tactile stimulus. No group differences were found for any of the visual tasks. CONCLUSIONS: Results supported both the compensation and the deficiency hypotheses. The findings have implications for both assessment and intervention of young children with hearing loss. Further investigations are necessary to replicate these findings with a more comprehensive set of measures on a larger cohort of children with prelinguistic, severe-profound hearing loss.

Sensory-processing disorder in children with cochlear implants.

We examined sensory-processing disorder (SPD) in children with cochlear implants and explored the relationship between SPD and duration of hearing loss or duration of cochlear implant use. Caregivers of 30 children completed the Sensory Profile Questionnaire (SPQ). Seventy percent of the children showed "at-risk" or "different" behaviors in one or more of five categories of the SPQ: auditory, visual, vestibular, tactile, and oral processing. No noteworthy relationships surfaced between duration of deafness or duration of cochlear implant use and the atypical behaviors identified. To validate these findings further, postrotary nystagmus (PRN) testing and Miller's Assessment for Preschoolers (MAP) were administered to a subset of children. PRN was atypical in all 6 children tested. MAP findings revealed atypical sensory processing in 4 of the 6 children. Findings suggested that children with cochlear implants may be at risk for SPD. The findings are discussed in light of clinician and teacher referral for occupational therapy evaluations.

Efficacy of the discreteness of voicing category (DOVC) measure for characterizing voicing errors in children with cochlear implants: a report.

PURPOSE: This investigation explored the utility of an acoustic measure, called the discreteness of voicing category (DOVC), in identifying voicing errors in stop consonants produced by children with cochlear implants. Another objective was to examine the perceptual relevance of the DOVC measure and 2 commonly used voice onset time (VOT)-based measures, namely, mean VOT and DeltaVOT (e.g., VOT /t/-VOT /d/). METHOD: Phonetic transcription and acoustic analyses were carried out on syllable-initial /t / and /d/ produced by 10 children with cochlear implants. The DOVC was calculated as the difference between the shortest VOT value of a voiceless stop and the longest VOT value of a voiced stop across several productions of each. RESULTS: Phonetic transcription revealed that 4 of the 10 talkers demonstrated atypical voicing distinctions. Acoustic analyses indicated that the DOVC measure identified these same 4 talkers as producing atypical values, whereas mean VOT and DeltaVOT identified a different set of talkers as demonstrating values outside the normal ranges. CONCLUSION: Preliminary findings suggest that the DOVC measure corresponded with perceptual data better than the other acoustic measures examined in the present study. Data indicate that the DOVC measure may provide perceptually relevant information concerning the production of voicing distinctions.

Effects of auditory feedback deprivation length on the vowel /epsilon/ produced by pediatric cochlear-implant users.

Effects of auditory deprivation on speech production by ten cochlear-implanted children were investigated by turning off the implant for durations ranging from 0.3 to 5.0 s and measuring the formant frequencies (F1 and F2) of the vowel /epsilon/. In five of the ten talkers, F1 and/or F2 shifted when auditory feedback was eliminated. Without feedback, F2 frequency lowered consistently, suggesting vowel centralization. Phonetic transcription indicated that some of these acoustic changes led to perceptible shifts in phonetic quality. The results provide evidence that brief periods of auditory deprivation can produce perceptible changes in vowels produced by some cochlear-implanted children.

Influences of electromagnetic articulography sensors on speech produced by healthy adults and individuals with aphasia and apraxia.

PURPOSE: This study examined whether the intraoral transducers used in electromagnetic articulography (EMA) interfere with speech and whether there is an added risk of interference when EMA systems are used to study individuals with aphasia and apraxia. METHOD: Ten adult talkers (5 individuals with aphasia/apraxia, 5 controls) produced 12 American English vowels in /hVd/ words, the fricative-vowel (FV) words (/si/, /su/, /ei/, /eu/), and the sentence She had your dark suit in greasy wash water all year, in EMA sensors-on and sensors-off conditions. Segmental durations, vowel formant frequencies, and fricative spectral moments were measured to address possible acoustic effects of sensor placement. A perceptual experiment examined whether FV words produced in the sensors-on condition were less identifiable than those produced in the sensors-off condition. RESULTS: EMA sensors caused no consistent acoustic effects across all talkers, although significant within-subject effects were noted for a small subset of the talkers. The perceptual results revealed some instances of sensor-related intelligibility loss for FV words produced by individuals with aphasia and apraxia. CONCLUSIONS: The findings support previous suggestions that acoustic screening procedures be used to protect articulatory experiments from those individuals who may show consistent effects of having devices placed on intraoral structures. The findings further suggest that studies of fricatives produced by individuals with aphasia and apraxia may require additional safeguards to ensure that results are not adversely affected by intraoral sensor interference.

Effects of auditory feedback on fricatives produced by cochlear-implanted adults and children: acoustic and perceptual evidence.

Acoustic analyses and perception experiments were conducted to determine the effects of brief deprivation of auditory feedback on fricatives produced by cochlear implant users. The words /si/ and /Si/ were recorded by four children and four adults with their cochlear implant speech processor turned on or off. In the processor-off condition, word durations increased significantly for a majority of talkers. These increases were greater for children compared to adults, suggesting that children may rely on auditory feedback to a greater extent than adults. Significant differences in spectral measures of /S/ were found between processor-on and processor-off conditions for two of the four children and for one of the four adults. These talkers also demonstrated a larger /s/-/S/ contrast in centroid values compared to the other talkers within their respective groups. This finding may indicate that talkers who produce fine spectral distinctions are able to perceive these distinctions through their implants and to use this feedback to fine tune their speech. Two listening experiments provided evidence that some of the acoustic changes were perceptible to normal-hearing listeners. Taken together, these experiments indicate that for certain cochlear-implant users the brief absence of auditory feedback may lead to perceptible modifications in fricative consonants.