Speech Perception Training in Children: The Retention of Benefits and Booster Training.

OBJECTIVES: Speech perception training can be a highly effective intervention to improve perception and language abilities in children who are deaf or hard of hearing. Most studies of speech perception training, however, only measure gains immediately following training. Only a minority of cases include a follow-up assessment after a period without training. A critical unanswered question was whether training-related benefits are retained for a period of time after training has stopped. A primary goal of this investigation was to determine whether children retained training-related benefits 4 to 6 weeks after they completed 16 hours of formal speech perception training. Training was comprised of either auditory or speechreading training, or a combination of both. Also important is to determine if "booster" training can help increase gains made during the initial intensive training period. Another goal of the study was to investigate the benefits of providing home-based booster training during the 4- to 6-week interval after the formal training ceased. The original investigation ( Tye-Murray et al. 2022 ) compared the effects of talker familiarity and the relative benefits of the different types of training. We predicted that the children who received no additional training would retain the gains after the completing the formal training. We also predicted that those children who completed the booster training would realize additional gains. DESIGN: Children, 6 to 12 years old, with hearing loss who had previously participated in the original randomized control study returned 4 to 6 weeks after the conclusion to take a follow-up speech perception assessment. The first group (n = 44) returned after receiving no formal intervention from the research team before the follow-up assessment. A second group of 40 children completed an additional 16 hours of speech perception training at home during a 4- to 6-week interval before the follow-up speech perception assessment. The home-based speech perception training was a continuation of the same training that was received in the laboratory formatted to work on a PC tablet with a portable speaker. The follow-up speech perception assessment included measures of listening and speechreading, with test items spoken by both familiar (trained) and unfamiliar (untrained) talkers. RESULTS: In the group that did not receive the booster training, follow-up testing showed retention for all gains that were obtained immediately following the laboratory-based training. The group that received booster training during the same interval also maintained the benefits from the formal training, with some indication of minor improvement. CONCLUSIONS: Clinically, the present findings are extremely encouraging; the group that did not receive home-based booster training retained the benefits obtained during the laboratory-based training regimen. Moreover, the results suggest that self-paced booster training maintained the relative training gains associated with talker familiarity and training type seen immediately following laboratory-based training. Future aural rehabilitation programs should include maintenance training at home to supplement the speech perception training conducted under more formal conditions at school or in the clinic.

Hearing Health Care Digital Therapeutics: Patient Satisfaction Evidence.

PURPOSE: A digital therapeutic is a software-based intervention for a disease and/or disorder and often includes a daily, interactive curriculum and exercises; online support from a professional versed in the treatment base; and an online support community, typically active as a social chat group. Recently, the Consumer Technology Association published revised standards for digital therapeutics (DTx) that stipulate that a DTx must be evidence based and founded in scientific evidence showing effectiveness and must be supported by evidence showing improved patient satisfaction and adherence to an intervention. The purpose of this study was to investigate whether a DTx could help older adults better adjust to their hearing loss and acclimate to new hearing aids. METHOD: Thirty older adults with mild or moderate hearing loss who had never used hearing aids participated. All hearing aids were fitted remotely. Participants used a hearing health care DTx (Amptify) for 4 weeks, either immediately following receipt of the hearing aids or 4 weeks after the fitting. A control condition was watching closed caption television. Participants completed a satisfaction questionnaire that queried about their impressions of the DTx, which had items that included both a rating scale of 1-7 and open-ended questions. RESULTS: Ninety-six percent of the participants reported positive benefits, and one-half reported that the DTx helped them to adjust to their new hearing aids. They assigned a score of 5.8 to one of the questionnaire items that is similar to a Net Promoter Score Benefits, which included an enhanced ability to engage in conversation and increased listening confidence. CONCLUSION: This investigation provides scientific evidence to support the use of a hearing health care DTx, paving the way for audiologists to be able to more easily and efficiently incorporate follow-up aural rehabilitation into their routine clinical services and to be able to provide services remotely.

Teaching Children With Hearing Loss to Recognize Speech: Gains Made With Computer-Based Auditory and/or Speechreading Training.

OBJECTIVES: Transfer appropriate processing (TAP) refers to a general finding that training gains are maximized when training and testing are conducted under the same conditions. The present study tested the extent to which TAP applies to speech perception training in children with hearing loss. Specifically, we assessed the benefits of computer-based speech perception training games for enhancing children's speech recognition by comparing three training groups: auditory training (AT), audiovisual training (AVT), and a combination of these two (AT/AVT). We also determined whether talker-specific training, as might occur when children train with the speech of a next year's classroom teacher, leads to better recognition of that talker's speech and if so, the extent to which training benefits generalize to untrained talkers. Consistent with TAP theory, we predicted that children would improve their ability to recognize the speech of the trained talker more than that of three untrained talkers and, depending on their training group, would improve more on an auditory-only (listening) or audiovisual (speechreading) speech perception assessment, that matched the type of training they received. We also hypothesized that benefit would generalize to untrained talkers and to test modalities in which they did not train, albeit to a lesser extent. DESIGN: Ninety-nine elementary school aged children with hearing loss were enrolled into a randomized control trial with a repeated measures A-A-B experimental mixed design in which children served as their own control for the assessment of overall benefit of a particular training type and three different groups of children yielded data for comparing the three types of training. We also assessed talker-specific learning and transfer of learning by including speech perception tests with stimuli spoken by the talker with whom a child trained and stimuli spoken by three talkers with whom the child did not train and by including speech perception tests that presented both auditory (listening) and audiovisual (speechreading) stimuli. Children received 16 hr of gamified training. The games provided word identification and connected speech comprehension training activities. RESULTS: Overall, children showed significant improvement in both their listening and speechreading performance. Consistent with TAP theory, children improved more on their trained talker than on the untrained talkers. Also consistent with TAP theory, the children who received AT improved more on the listening than the speechreading. However, children who received AVT improved on both types of assessment equally, which is not consistent with our predictions derived from a TAP perspective. Age, language level, and phonological awareness were either not predictive of training benefits or only negligibly so. CONCLUSIONS: The findings provide support for the practice of providing children who have hearing loss with structured speech perception training and suggest that future aural rehabilitation programs might include teacher-specific speech perception training to prepare children for an upcoming school year, especially since training will generalize to other talkers. The results also suggest that benefits of speech perception training were not significantly related to age, language level, or degree of phonological awareness. The findings are largely consistent with TAP theory, suggesting that the more aligned a training task is with the desired outcome, the more likely benefit will accrue.

Increased Connectivity among Sensory and Motor Regions during Visual and Audiovisual Speech Perception.

In everyday conversation, we usually process the talker's face as well as the sound of the talker's voice. Access to visual speech information is particularly useful when the auditory signal is degraded. Here, we used fMRI to monitor brain activity while adult humans (n = 60) were presented with visual-only, auditory-only, and audiovisual words. The audiovisual words were presented in quiet and in several signal-to-noise ratios. As expected, audiovisual speech perception recruited both auditory and visual cortex, with some evidence for increased recruitment of premotor cortex in some conditions (including in substantial background noise). We then investigated neural connectivity using psychophysiological interaction analysis with seed regions in both primary auditory cortex and primary visual cortex. Connectivity between auditory and visual cortices was stronger in audiovisual conditions than in unimodal conditions, including a wide network of regions in posterior temporal cortex and prefrontal cortex. In addition to whole-brain analyses, we also conducted a region-of-interest analysis on the left posterior superior temporal sulcus (pSTS), implicated in many previous studies of audiovisual speech perception. We found evidence for both activity and effective connectivity in pSTS for visual-only and audiovisual speech, although these were not significant in whole-brain analyses. Together, our results suggest a prominent role for cross-region synchronization in understanding both visual-only and audiovisual speech that complements activity in integrative brain regions like pSTS.SIGNIFICANCE STATEMENT In everyday conversation, we usually process the talker's face as well as the sound of the talker's voice. Access to visual speech information is particularly useful when the auditory signal is hard to understand (e.g., background noise). Prior work has suggested that specialized regions of the brain may play a critical role in integrating information from visual and auditory speech. Here, we show a complementary mechanism relying on synchronized brain activity among sensory and motor regions may also play a critical role. These findings encourage reconceptualizing audiovisual integration in the context of coordinated network activity.

Vocabulary Acquisition as a By-Product of Meaning-Oriented Auditory Training for Children Who Are Deaf or Hard of Hearing.

Purpose A meaning-oriented auditory training program for children who are deaf or hard of hearing (d/hh) was assessed with regard to its efficacy in promoting novel word learning. Method While administering the auditory training program, one of the authors (Elizabeth Mauzé) observed that children were learning words they previously did not know. Therefore, we systematically assessed vocabulary gains among 16 children. Most completed pretest, posttest, and retention versions of a picture-naming task in which they attempted to verbally identify 199 color pictures of words that would appear during training. Posttest and retention versions included both pictures used and not used during training in order to test generalization of associations between words and their referents. Importantly, each training session involved meaning-oriented, albeit simple, activities/games on a computer. Results At posttest, the percentage of word gain was 27.3% (SD = 12.5; confidence interval [CI] of the mean: 24.2-30.4) using trained pictures as cues and 25.9% (CI of the mean: 22.9-29.0) using untrained pictures as cues. An analysis of retention scores (for 13 of the participants who completed it weeks later) indicated strikingly high levels of retention for the words that had been learned. Conclusions These findings favor auditory training that is meaning oriented when it comes to the acquisition of different linguistic subsystems, lexis in this case. We also expand the discussion to include other evidence-based recommendations regarding how vocabulary is presented (input-based effects) and what learners are asked to do (task-based effects) as part of an overall effort to help children who are d/hh increase their vocabulary knowledge.

Predicting Audiovisual Word Recognition in Noisy Situations: Toward Precision Audiology.

OBJECTIVE: Spoken communication is better when one can see as well as hear the talker. Although age-related deficits in speech perception were observed, Tye-Murray and colleagues found that even when age-related deficits in audiovisual (AV) speech perception were observed, AV performance could be accurately predicted from auditory-only (A-only) and visual-only (V-only) performance, and that knowing individuals' ages did not increase the accuracy of prediction. This finding contradicts conventional wisdom, according to which age-related differences in AV speech perception are due to deficits in the integration of auditory and visual information, and our primary goal was to determine whether Tye-Murray et al.'s finding with a closed-set test generalizes to situations more like those in everyday life. A second goal was to test a new predictive model that has important implications for audiological assessment. DESIGN: Participants (N = 109; ages 22-93 years), previously studied by Tye-Murray et al., were administered our new, open-set Lex-List test to assess their auditory, visual, and audiovisual perception of individual words. All testing was conducted in six-talker babble (three males and three females) presented at approximately 62 dB SPL. The level of the audio for the Lex-List items, when presented, was approximately 59 dB SPL because pilot testing suggested that this signal-to-noise ratio would avoid ceiling performance under the AV condition. RESULTS: Multiple linear regression analyses revealed that A-only and V-only performance accounted for 87.9% of the variance in AV speech perception, and that the contribution of age failed to reach significance. Our new parabolic model accounted for even more (92.8%) of the variance in AV performance, and again, the contribution of age was not significant. Bayesian analyses revealed that for both linear and parabolic models, the present data were almost 10 times as likely to occur with a reduced model (without age) than with a full model (with age as a predictor). Furthermore, comparison of the two reduced models revealed that the data were more than 100 times as likely to occur with the parabolic model than with the linear regression model. CONCLUSIONS: The present results strongly support Tye-Murray et al.'s hypothesis that AV performance can be accurately predicted from unimodal performance and that knowing individuals' ages does not increase the accuracy of that prediction. Our results represent an important initial step in extending Tye-Murray et al.'s findings to situations more like those encountered in everyday communication. The accuracy with which speech perception was predicted in this study foreshadows a form of precision audiology in which determining individual strengths and weaknesses in unimodal and multimodal speech perception facilitates identification of targets for rehabilitative efforts aimed at recovering and maintaining speech perception abilities critical to the quality of an older adult's life.

Evidence for independent peripheral and central age-related hearing impairment.

Deleterious age-related changes in the central auditory nervous system have been referred to as central age-related hearing impairment (ARHI) or central presbycusis. Central ARHI is often assumed to be the consequence of peripheral ARHI. However, it is possible that certain aspects of central ARHI are independent from peripheral ARHI. A confirmation of this possibility could lead to significant improvements in current rehabilitation practices. The major difficulty in addressing this issue arises from confounding factors, such as other age-related changes in both the cochlea and central non-auditory brain structures. Because gap detection is a common measure of central auditory temporal processing, and gap detection thresholds are less influenced by changes in other brain functions such as learning and memory, we investigated the potential relationship between age-related peripheral hearing loss (i.e., audiograms) and age-related changes in gap detection. Consistent with previous studies, a significant difference was found for gap detection thresholds between young and older adults. However, among older adults, no significant associations were observed between gap detection ability and several other independent variables including the pure tone audiogram average, the Wechsler Adult Intelligence Scale-Vocabulary score, gender, and age. Statistical analyses showed little or no contributions from these independent variables to gap detection thresholds. Thus, our data indicate that age-related decline in central temporal processing is largely independent of peripheral ARHI.

Completion norms for 3085 English sentence contexts.

In everyday language processing, sentence context affects how readers and listeners process upcoming words. In experimental situations, it can be useful to identify words that are predicted to greater or lesser degrees by the preceding context. Here we report completion norms for 3085 English sentences, collected online using a written cloze procedure in which participants were asked to provide their best guess for the word completing a sentence. Sentences varied between eight and ten words in length. At least 100 unique participants contributed to each sentence. All responses were reviewed by human raters to mitigate the influence of mis-spellings and typographical errors. The responses provide a range of predictability values for 13,438 unique target words, 6790 of which appear in more than one sentence context. We also provide entropy values based on the relative predictability of multiple responses. A searchable set of norms is available at http://sentencenorms.net . Finally, we provide the code used to collate and organize the responses to facilitate additional analyses and future research projects.

Effects of age, word frequency, and noise on the time course of spoken word recognition.

This study assessed the effects of age, word frequency, and background noise on the time course of lexical activation during spoken word recognition. Participants (41 young adults and 39 older adults) performed a visual world word recognition task while we monitored their gaze position. On each trial, four phonologically unrelated pictures appeared on the screen. A target word was presented auditorily following a carrier phrase ("Click on the ________"), at which point participants were instructed to use the mouse to click on the picture that corresponded to the target word. High- and low-frequency words were presented in quiet to half of the participants. The other half heard the words in a low level of noise in which the words were still readily identifiable. Results showed that, even in the absence of phonological competitors in the visual array, high-frequency words were fixated more quickly than low-frequency words by both listener groups. Young adults were generally faster to fixate on targets compared to older adults, but the pattern of interactions among noise, word frequency, and listener age showed that older adults' lexical activation largely matches that of young adults in a modest amount of noise.

Age-Related Differences in Auditory Cortex Activity During Spoken Word Recognition.

Understanding spoken words requires the rapid matching of a complex acoustic stimulus with stored lexical representations. The degree to which brain networks supporting spoken word recognition are affected by adult aging remains poorly understood. In the current study we used fMRI to measure the brain responses to spoken words in two conditions: an attentive listening condition, in which no response was required, and a repetition task. Listeners were 29 young adults (aged 19-30 years) and 32 older adults (aged 65-81 years) without self-reported hearing difficulty. We found largely similar patterns of activity during word perception for both young and older adults, centered on the bilateral superior temporal gyrus. As expected, the repetition condition resulted in significantly more activity in areas related to motor planning and execution (including the premotor cortex and supplemental motor area) compared to the attentive listening condition. Importantly, however, older adults showed significantly less activity in probabilistically defined auditory cortex than young adults when listening to individual words in both the attentive listening and repetition tasks. Age differences in auditory cortex activity were seen selectively for words (no age differences were present for 1-channel vocoded speech, used as a control condition), and could not be easily explained by accuracy on the task, movement in the scanner, or hearing sensitivity (available on a subset of participants). These findings indicate largely similar patterns of brain activity for young and older adults when listening to words in quiet, but suggest less recruitment of auditory cortex by the older adults.

Age Differences in the Effects of Speaking Rate on Auditory, Visual, and Auditory-Visual Speech Perception.

OBJECTIVES: This study was designed to examine how speaking rate affects auditory-only, visual-only, and auditory-visual speech perception across the adult lifespan. In addition, the study examined the extent to which unimodal (auditory-only and visual-only) performance predicts auditory-visual performance across a range of speaking rates. The authors hypothesized significant Age × Rate interactions in all three modalities and that unimodal performance would account for a majority of the variance in auditory-visual speech perception for speaking rates that are both slower and faster than normal. DESIGN: Participants (N = 145), ranging in age from 22 to 92, were tested in conditions with auditory-only, visual-only, and auditory-visual presentations using a closed-set speech perception test. Five different speaking rates were presented in each modality: an unmodified (normal rate), two rates that were slower than normal, and two rates that were faster than normal. Signal to noise ratios were set individually to produce approximately 30% correct identification in the auditory-only condition and this signal to noise ratio was used in the auditory-only and auditory-visual conditions. RESULTS: Age × Rate interactions were observed for the fastest speaking rates in both the visual-only and auditory-visual conditions. Unimodal performance accounted for at least 60% of the variance in auditory-visual performance for all five speaking rates. CONCLUSIONS: The findings demonstrate that the disproportionate difficulty that older adults have with rapid speech for auditory-only presentations can also be observed with visual-only and auditory-visual presentations. Taken together, the present analyses of age and individual differences indicate a generalized age-related decline in the ability to understand speech produced at fast speaking rates. The finding that auditory-visual speech performance was almost entirely predicted by unimodal performance across all five speaking rates has important clinical implications for auditory-visual speech perception and the ability of older adults to use visual speech information to compensate for age-related hearing loss.

Effects of Early Auditory Deprivation on Working Memory and Reasoning Abilities in Verbal and Visuospatial Domains for Pediatric Cochlear Implant Recipients.

OBJECTIVES: The overall goal of this study was to compare verbal and visuospatial working memory in children with normal hearing (NH) and with cochlear implants (CI). The main questions addressed by this study were (1) Does auditory deprivation result in global or domain-specific deficits in working memory in children with CIs compared with their NH age mates? (2) Does the potential for verbal recoding affect performance on measures of reasoning ability in children with CIs relative to their NH age mates? and (3) Is performance on verbal and visuospatial working memory tasks related to spoken receptive language level achieved by children with CIs? DESIGN: A total of 54 children ranging in age from 5 to 9 years participated; 25 children with CIs and 29 children with NH. Participants were tested on both simple and complex measures of verbal and visuospatial working memory. Vocabulary was assessed with the Peabody Picture Vocabulary Test (PPVT) and reasoning abilities with two subtests of the WISC-IV (Wechsler Intelligence Scale for Children, 4th edition): Picture Concepts (verbally mediated) and Matrix Reasoning (visuospatial task). Groups were compared on all measures using analysis of variance after controlling for age and maternal education. RESULTS: Children with CIs scored significantly lower than children with NH on measures of working memory, after accounting for age and maternal education. Differences between the groups were more apparent for verbal working memory compared with visuospatial working memory. For reasoning and vocabulary, the CI group scored significantly lower than the NH group for PPVT and WISC Picture Concepts but similar to NH age mates on WISC Matrix Reasoning. CONCLUSIONS: Results from this study suggest that children with CIs have deficits in working memory related to storing and processing verbal information in working memory. These deficits extend to receptive vocabulary and verbal reasoning and remain even after controlling for the higher maternal education level of the NH group. Their ability to store and process visuospatial information in working memory and complete reasoning tasks that minimize verbal labeling of stimuli more closely approaches performance of NH age mates.

Patients With Normal Hearing Thresholds but Difficulty Hearing in Noisy Environments: A Study on the Willingness to Try Auditory Training.

HYPOTHESIS: Persons with normal audiometric thresholds but excessive difficulty hearing in background noise will choose auditory training as a treatment option. BACKGROUND: Auditory training has traditionally been reserved for those with marked hearing loss. We investigated auditory training as a treatment option for those who have normal auditory thresholds but complain about hearing in noise-a population of patients for which no therapy or intervention currently exists. We also determined the willingness of this patient population to volunteer for a free auditory training program. METHODS: We administered a 14-item, telephone-based questionnaire to assess perceived difficulty hearing in noise and willingness to volunteer for auditory training. We developed questions to identify those who consistently reported difficulty hearing in noise, but not quiet. RESULTS: The 11,938-person database included 2,299 patients with pure-tone averages less than 25. A total of 474 of these patients completed our questionnaire, 135 of who had normal audiometric thresholds at all octave frequencies 0.25 to 8 kHz. We found that difficulty hearing in noise was a graded problem. Our approach to find consistent reports about hearing in noise showed that the majority of people who consistently had difficulty hearing in noise, but not quiet, were the most likely to try auditory training. CONCLUSIONS: While relatively few patients with both normal hearing thresholds and complaints of severe difficulty hearing in noise were in the database, these patients were generally willing to volunteer for auditory training. Our results provide evidence that many in this underserved population would volunteer for auditory training.

Auditory Training for Adults Who Have Hearing Loss: A Comparison of Spaced Versus Massed Practice Schedules.

Purpose: The spacing effect in human memory research refers to situations in which people learn items better when they study items in spaced intervals rather than massed intervals. This investigation was conducted to compare the efficacy of meaning-oriented auditory training when administered with a spaced versus massed practice schedule. Method: Forty-seven adult hearing aid users received 16 hr of auditory training. Participants in a spaced group (mean age = 64.6 years, SD = 14.7) trained twice per week, and participants in a massed group (mean age = 69.6 years, SD = 17.5) trained for 5 consecutive days each week. Participants completed speech perception tests before training, immediately following training, and then 3 months later. In line with transfer appropriate processing theory, tests assessed both trained tasks and an untrained task. Results: Auditory training improved the speech recognition performance of participants in both groups. Benefits were maintained for 3 months. No effect of practice schedule was found on overall benefits achieved, on retention of benefits, nor on generalizability of benefits to nontrained tasks. Conclusion: The lack of spacing effect in otherwise effective auditory training suggests that perceptual learning may be subject to different influences than are other types of learning, such as vocabulary learning. Hence, clinicians might have latitude in recommending training schedules to accommodate patients' schedules.

Task- and Talker-Specific Gains in Auditory Training.

PURPOSE: This investigation focused on generalization of outcomes for auditory training by examining the effects of task and/or talker overlap between training and at test. METHOD: Adults with hearing loss completed 12 hr of meaning-oriented auditory training and were placed in a group that trained on either multiple talkers or a single talker. A control group also completed 12 hr of training in American Sign Language. The experimental group's training included a 4-choice discrimination task but not an open-set sentence test. The assessment phase included the same 4-choice discrimination task and an open-set sentence test, the Iowa Sentences Test (Tyler, Preece, & Tye-Murray, 1986). RESULTS: Improvement on 4-choice discrimination was observed in the experimental group as compared with the control group. Gains were (a) highest when the task and talker were the same between training and assessment; (b) second highest when the task was the same but the talker only partially so; and (c) third highest when task and talker were different. CONCLUSIONS: The findings support applications of transfer-appropriate processing to auditory training and favor tailoring programs toward the specific needs of the individuals being trained for tasks, talkers, and perhaps, for stimuli, in addition to other factors.

Auditory Training With Frequent Communication Partners.

PURPOSE: Individuals with hearing loss engage in auditory training to improve their speech recognition. They typically practice listening to utterances spoken by unfamiliar talkers but never to utterances spoken by their most frequent communication partner (FCP)-speech they most likely desire to recognize-under the assumption that familiarity with the FCP's speech limits potential gains. This study determined whether auditory training with the speech of an individual's FCP, in this case their spouse, would lead to enhanced recognition of their spouse's speech. METHOD: Ten couples completed a 6-week computerized auditory training program in which the spouse recorded the stimuli and the participant (partner with hearing loss) completed auditory training that presented recordings of their spouse. RESULTS: Training led participants to better discriminate their FCP's speech. Responses on the Client Oriented Scale of Improvement (Dillon, James, & Ginis, 1997) indicated subjectively that training reduced participants' communication difficulties. Peformance on a word identification task did not change. CONCLUSIONS: Results suggest that auditory training might improve the ability of older participants with hearing loss to recognize the speech of their spouse and might improve communication interactions between couples. The results support a task-appropriate processing framework of learning, which assumes that human learning depends on the degree of similarity between training tasks and desired outcomes.

Lipreading and audiovisual speech recognition across the adult lifespan: Implications for audiovisual integration.

In this study of visual (V-only) and audiovisual (AV) speech recognition in adults aged 22-92 years, the rate of age-related decrease in V-only performance was more than twice that in AV performance. Both auditory-only (A-only) and V-only performance were significant predictors of AV speech recognition, but age did not account for additional (unique) variance. Blurring the visual speech signal decreased speech recognition, and in AV conditions involving stimuli associated with equivalent unimodal performance for each participant, speech recognition remained constant from 22 to 92 years of age. Finally, principal components analysis revealed separate visual and auditory factors, but no evidence of an AV integration factor. Taken together, these results suggest that the benefit that comes from being able to see as well as hear a talker remains constant throughout adulthood and that changes in this AV advantage are entirely driven by age-related changes in unimodal visual and auditory speech recognition. (PsycINFO Database Record

Cross-modal Informational Masking of Lipreading by Babble.

Whereas the energetic and informational masking effects of unintelligible babble on auditory speech recognition are well established, the present study is the first to investigate its effects on visual speech recognition. Young and older adults performed two lipreading tasks while simultaneously experiencing either quiet, speech-shaped noise, or 6-talker background babble. Both words at the end of uninformative carrier sentences and key words in everyday sentences were harder to lipread in the presence of babble than in the presence of speech-shaped noise or quiet. Contrary to the inhibitory deficit hypothesis of cognitive aging, babble had equivalent effects on young and older adults. In a follow-up experiment, neither the babble nor the speech-shaped noise stimuli interfered with performance of a face-processing task, indicating that babble selectively interferes with visual speech recognition and not with visual perception tasks per se. The present results demonstrate that babble can produce cross-modal informational masking and suggest a breakdown in audiovisual scene analysis, either because of obligatory monitoring of even uninformative speech sounds or because of obligatory efforts to integrate speech sounds even with uncorrelated mouth movements.

Real-Time Captioning for Improving Informed Consent: Patient and Physician Benefits.

BACKGROUND AND OBJECTIVES: New methods are needed to improve physicians' skill in communicating information and to enhance patients' ability to recall that information. We evaluated a real-time speech-to-text captioning system that simultaneously provided a speech-to-text record for both patient and anesthesiologist. The goals of the study were to assess hearing-impaired patients' recall of an informed consent discussion about regional anesthesia using real-time captioning and to determine whether the physicians found the system useful for monitoring their own performance. METHODS: We recorded 2 simulated informed consent encounters with hearing-impaired older adults, in which physicians described regional anesthetic procedures. The conversations were conducted with and without real-time captioning. Subsequently, the patient participants, who wore their hearing aids throughout, were tested on the material presented, and video recordings of the encounters were analyzed to determine how effectively physicians communicated with and without the captioning system. RESULTS: The anesthesiology residents provided similar information to the patient participants regardless of whether the real-time captioning system was used. Although the patients retained relatively few details regardless of the informed consent discussion, they could recall significantly more of the key points when provided with real-time captioning. CONCLUSIONS: Real-time speech-to-text captioning improved recall in hearing-impaired patients and proved useful for determining the information provided during an informed consent encounter. Real-time speech-to-text captioning could provide a method for assessing physicians' communication that could be used both for self-assessment and as an evaluative approach to training communication skills in practice settings.