Evaluation of a super powerful bone-anchored hearing system and its users: A retrospective study.

INTRODUCTION: Although the Baha 5SP has been commercially available for six years, very few studies have been performed on the device's efficacy. The current study aims to evaluate the characteristics and audiological results in patients with severe-to-profound mixed hearing loss fitted with this superpower sound processor. METHODS: This retrospective evaluation was conducted at a tertiary referral centre where a series of 82 adult patients with severe-to-profound mixed hearing loss were implanted with a percutaneous bone-anchored hearing system and fitted with a superpower sound processor between 2016 and 2019. Patients with incomplete or unreliable audiological data (n = 24) were excluded, resulting in 58 data sets for analysis. The main outcome measures were unaided and aided pure-tone thresholds and aided free-field speech perception in quiet. RESULTS: The median unaided air conduction (AC) threshold averaged across 0.5, 1 and 2 kHz (PTA0.5-2kHz) of all patients was 75 dB hearing loss (HL); the median unaided AC averaged across 1, 2 and 4 kHz (PTA1-4kHz) was 84 dB HL. For bone conduction and direct bone conduction, the median PTA0.5-2kHz was 52 and 47 dB HL, respectively. With the superpower device, the median free-field speech reception threshold was 54 dB sound pressure level (SPL), and the median speech perception score at 65 dB SPL was 80%. CONCLUSIONS: At least 75% of the patients reached a maximum phoneme score of 70%. For patients with lower scores, the superpower device still provides a substantial hearing benefit. This makes the superpower device particularly suitable for patients with severe-to-profound mixed hearing loss with a contraindication for conventional hearing aids and/or cochlear implants.

The net contribution of rehabilitation to improvement in performance in patients with spinal cord lesions in five countries.

CONTEXT: Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities in patients with spinal cord lesions (SCL). OBJECTIVE: To assess the net effect of rehabilitation of patients with SCL and compare it between countries. METHODS: We calculated the Spinal Cord Ability Realization Measurement Index (SCI-ARMI) and its change from admission to rehabilitation to discharge, for inpatients admitted to SCL units in five countries, between 2016 and 2019. We used chi-square tests, analysis of variance (ANOVA), McNemar's test, Pearson's correlations, and analysis of covariance (ANCOVA) to compare countries and patient groups and assess the relationships of various factors with SCI-ARMI gain during rehabilitation. RESULTS: The study included 218 inpatients (67% males, age 52 ± 17). In Brazil, Israel, Italy, Portugal, and Turkiye, respectively, SCI-ARMI gain was 2 (SD = 15), 19 (SD = 17), 31 (SD = 23), 13 (SD = 15), and 16 (SD = 12). Yet, after controlling for admission SCI-ARMI and the time from SCL onset to the examination, the effect of the country on ability realization gain was found non-significant (P = 0.086). CONCLUSION: The study confirmed that rehabilitation makes a net contribution to improvement in performance in patients with SCL, beyond the contribution of neurological recovery. After controlling for affecting factors, this contribution was quite similar in the participating units from different countries.

A comparison study of audiological outcome and compliance of bone conduction implantable hearing implants.

PURPOSE: The present study aimed to evaluate and compare the outcome of different bone conduction hearing implants (BCHIs) in subjects with mixed hearing loss (MHL) and single-sided deafness (SSD) in terms of audiometric results and compliance. METHODS: Twenty-one subjects with MHL and 18 subjects with SSD undergoing implantation of Baha connect, Baha attract, or Bonebridge were enrolled. Functional gain, effective gain, and usage rate of BCHIs were retrospectively reviewed. RESULTS: As for MHL, the functional gain of three devices was not significantly different (p = 0.477), while the effective gain of Bonebridge was higher (- 8.8 [- 15.0, - 3.5] dB) than that of Baha connect (- 20.0 [- 26.3, - 11.3] dB, p = 0.037), especially at 0.5 kHz (p = 0.010) and 1 kHz (p = 0.014). In SSD subjects, the effective gain of Bonebridge was significantly higher than that of Baha attract (- 11.3 [- 15.0, - 7.5] vs - 21.3 [- 21.3, - 16.3] dB, p = 0.012), while the functional gain of Bonebridge and Baha attract was not different. The constant usage rate of BCHIs tends to be higher in MHL subjects [17/21 (82%)] than that in SSD subjects [10/18 (56%)]. In SSD subjects, the constant user group showed higher functional gain than the non-constant user group, with a significant difference at 3 kHz (35.0 [33.8, 45.0] vs 17.5 [10.0, 27.5] dB, p = 0.006). CONCLUSION: Bonebridge shows a higher effective gain than Baha connect in the MHL group and Baha attract in the SSD group. The usage rate of BCHIs is lower in SSD than that in MHL. In SSD subjects, the constant user group tended to show higher functional gain than the non-constant user group. Irrespective of the device type, the tendency of higher functional gain of BCHIs, especially at mid frequencies, may potentially lead to yield good compliance in SSD, mandating a meticulous fitting strategy ensuring a sufficient mid-frequency functional gain in SSD.

Factors predicting clinically significant functional gain and discharge to home in stroke in-patients after rehabilitation - A retrospective cohort study.

OBJECTIVE: This study explored factors which predict stroke survivors who could achieve "clinically significant functional gain" and return home when being discharged from a local hospital after in-patient stroke rehabilitation programme. METHODS: This study included 562 inpatients with stroke who were residing at community dwellings before onset of stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main outcome variables of prediction were (a) achieving "clinically significant functional gain" as measured by (a1) achievement of "minimal clinically important difference" (MCID) of improvement in Functional Independence Measure Motor Measure (FIM-MM)", (a2) one or more level(s) of improvement in function group according to the patients' FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with univariate binary logistic regression and those significant variables were then put into multivariate binary logistic regression. RESULTS: Based on multivariate regression, the significant predictors for "clinically significant functional gain" were: younger age <75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, intermediate FIM-MM function group. Those significant predictors for "discharge to home" were: living with family/caregivers before stroke, higher FIM score at admission, and one or more level(s) of improvement in FIM-MM function group. CONCLUSIONS: This study identified findings consistent with overseas studies in additional to some new interesting findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to focus on the use of appropriate intervention strategies and pre-discharge preparation.

Functional and clinical outcomes of patients aged younger and older than 85 years after rehabilitation post-hip fracture surgery in a co-managed orthogeriatric unit.

AIM: Literature investigating rehabilitation outcomes after hip surgery among individuals aged ≥85 years is sparse. We compared the characteristics and outcomes of patients aged under and over 85 years, and assessed factors potentially associated with rehabilitation success as described by the Barthel Index (BI). METHODS: From 2011 to 2014, we prospectively enrolled 328 patients (n = 152 aged <85 years, n = 176 aged ≥85 years) admitted to an orthogeriatric unit (Sondrio, Italy) with a diagnosis of hip fracture requiring surgical treatment. We excluded patients who were being treated conservatively. Outcomes included absolute functional gain (AFG; BI at discharge - BI on admission), rehabilitation effectiveness index (AFG / length of stay) and postoperative complications. RESULTS: Older patients were more functionally (mean BI on admission: 11.7 ± 9.6 vs 16.4 ± 12.2, P < 0.001) and cognitively impaired than their younger counterparts (34.1% vs 18.4%, P < 0.001). Surgery time (1.9 ± 1.2 vs 2.3 ±1.3 days, P = 0.008) and length of stay were shorter for older patients (5.7 ± 2.1 vs 6.6 ± 2.4 days, P < 0.001). There were no differences in terms of complications. Patients aged <85 years showed better functional outcomes (BI, AFG, REI) at discharge than patients aged ≥85 years (mean AFG: 38.2 ± 24.2 vs 26.1 ± 22.0, P < 0.001). BI on admission (OR 1.05, 95% CI 1.02-1.08) and cognitive impairment (OR 0.58, 95% CI 0.34-0.98) were independently associated with rehabilitation outcomes, regardless of chronological age. CONCLUSIONS: Both groups (aged <85 and ≥85 years) showed a significant functional improvement at discharge. Older patients show a residual ability to recover after surgery. A high rehabilitation efficiency - regardless of age - should be pursued even for the oldest old patients experiencing hip fracture. Geriatr Gerontol Int 2018; 18: 1194-1199.

The association between patient participation and functional gain following inpatient rehabilitation.

OBJECTIVES: To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. METHODS: All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. RESULT: A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). CONCLUSION: This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

[Treatment of instability of the metacarpophalangeal and trapeziometacarpal joints of the thumb]. / Behandlung der Instabilität des Daumengrund- und des Daumensattelgelenks.

Restoration of stability of the thumb represents an enormous gain of function for the patient and can be achieved by arthrodesis or ligament reconstruction. Ligament reconstruction should only be performed if good stability and mobility and a pain-free grip can also be achieved. In every case surgery must protect the delicate soft tissues and should be based on a profound knowledge of the anatomical and biomechanical circumstances. Instability of the trapeziometacarpal joint is rare but metacarpophalangeal joint instability (ulnar, palmar and radial) is relatively frequent. For both conditions arthrodesis is the most frequently used and easier surgical procedure. Ligament reconstruction is more difficult to perform but can maintain the mobility of these joints.

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.

OBJECTIVES: To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. DESIGN: A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. SETTING: Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. PARTICIPANTS: All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). INTERVENTION: Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. OUTCOME MEASURES: Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale-version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). PRIMARY OUTCOMES: (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. RESULTS: The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in 'weekly care costs' was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8). CONCLUSIONS: Despite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services.

Hearing aid validation based on 40 Hz auditory steady-state response thresholds.

BACKGROUND AND AIM: Aided thresholds can be used for prediction of success of hearing aids and to choose between hearing aids and cochlear implants. This study aimed to compare characteristics of aided and unaided auditory steady-state responses (ASSRs). METHODS: A total of 30 moderate to profoundly hearing-impaired subjects participated in this study. The subjects underwent acoustic immittance, behavioral audiometry, and ASSR with the modulation rate of 40 Hz, first without a hearing aid and then with a hearing aid. Sixteen people with normal hearing and 17 people with severe hearing loss were included in biological calibration of the sound field. RESULTS: There was a significant difference between unaided behavioral and ASSR thresholds in all test frequencies (mean difference of unaided behavioral ASSR thresholds: 6.19 dB; P = 0.02 at 500 Hz, P < 0.001 at 1000 and 2000 Hz, and P = 0.02 for 4000 Hz). There was also a significant difference between aided behavioral and ASSR thresholds at 1000 and 2000 Hz (P < 0.001) but not at 500 (P = 0.14) and 4000 (P = 0.23) Hz (mean difference of behavioral ASSR thresholds was 4.33 dB). Despite observing any unaided responses, aided thresholds could be recorded in some severe to profoundly hearing-impaired subjects. The number of recordable thresholds was directly related to speech clarity and speech-reading ability. Multi-frequency stimulation elevated the ASSR threshold, especially for the higher frequencies and in the aided condition. CONCLUSION: Functional and ASSR gains show less difference than threshold data. Therefore, comparing gains instead of thresholds is more accurate for validation of hearing aids. The probability of success of hearing aids appears to be poor if ASSRs (especially aided ones) cannot be recorded. If special care is taken in the fitting of hearing aids and the testing conditions, aided ASSR testing could be a useful tool for validation of hearing aids and the cochlear implant decision-making process.

Implantable hearing devices: the Ototronix MAXUM system.

For many hearing-impaired individuals, the benefits of conventional amplification may be limited by acoustic feedback, occlusion effect, and/or ear discomfort. The MAXUM system and other implantable hearing devices have been developed as an option for patients who derive inadequate assistance from traditional HAs, but who are not yet candidates for cochlear implants. The MAXUM system is based on the SOUNDTEC Direct System technology, which has been shown to provide improved functional gain as well as reduced feedback and occlusion effect compared to hearing aids. This and other implantable hearing devices may have increasing importance as future aural rehabilitation options.