Neural Basis of Acquired Amusia and Its Recovery after Stroke.

UNLABELLED: Although acquired amusia is a relatively common disorder after stroke, its precise neuroanatomical basis is still unknown. To evaluate which brain regions form the neural substrate for acquired amusia and its recovery, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study with 77 human stroke subjects. Structural MRIs were acquired at acute and 6 month poststroke stages. Amusia and aphasia were behaviorally assessed at acute and 3 month poststroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA) and language tests. VLSM analyses indicated that amusia was associated with a lesion area comprising the superior temporal gyrus, Heschl's gyrus, insula, and striatum in the right hemisphere, clearly different from the lesion pattern associated with aphasia. Parametric analyses of MBEA Pitch and Rhythm scores showed extensive lesion overlap in the right striatum, as well as in the right Heschl's gyrus and superior temporal gyrus. Lesions associated with Rhythm scores extended more superiorly and posterolaterally. VBM analysis of volume changes from the acute to the 6 month stage showed a clear decrease in gray matter volume in the right superior and middle temporal gyri in nonrecovered amusic patients compared with nonamusic patients. This increased atrophy was more evident in anterior temporal areas in rhythm amusia and in posterior temporal and temporoparietal areas in pitch amusia. Overall, the results implicate right temporal and subcortical regions as the crucial neural substrate for acquired amusia and highlight the importance of different temporal lobe regions for the recovery of amusia after stroke. SIGNIFICANCE STATEMENT: Lesion studies are essential in uncovering the brain regions causally linked to a given behavior or skill. For music perception ability, previous lesion studies of amusia have been methodologically limited in both spatial accuracy and time domain as well as by small sample sizes, providing coarse and equivocal information about which brain areas underlie amusia. By using longitudinal MRI and behavioral data from a large sample of stroke patients coupled with modern voxel-based analyses methods, we were able provide the first systematic evidence for the causal role of right temporal and striatal areas in music perception. Clinically, these results have important implications for the diagnosis and prognosis of amusia after stroke and for rehabilitation planning.

Racial-Ethnic Differences in Word Fluency and Auditory Comprehension Among Persons With Poststroke Aphasia.

OBJECTIVES: To examine aphasia outcomes and to determine whether the observed language profiles vary by race-ethnicity. DESIGN: Retrospective cross-sectional study using a convenience sample of persons of with aphasia (PWA) obtained from AphasiaBank, a database designed for the study of aphasia outcomes. SETTING: Aphasia research laboratories. PARTICIPANTS: PWA (N=381; 339 white and 42 black individuals). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Western Aphasia Battery-Revised (WAB-R) total scale score (Aphasia Quotient) and subtest scores were analyzed for racial-ethnic differences. The WAB-R is a comprehensive assessment of communication function designed to evaluate PWA in the areas of spontaneous speech, auditory comprehension, repetition, and naming in addition to reading, writing, apraxia, and constructional, visuospatial, and calculation skills. RESULTS: In univariate comparisons, black PWA exhibited lower word fluency (5.7 vs 7.6; P=.004), auditory word comprehension (49.0 vs 53.0; P=.021), and comprehension of sequential commands (44.2 vs 52.2; P=.012) when compared with white PWA. In multivariate comparisons, adjusted for age and years of education, black PWA exhibited lower word fluency (5.5 vs 7.6; P=.015), auditory word recognition (49.3 vs 53.3; P=.02), and comprehension of sequential commands (43.7 vs 53.2; P=.017) when compared with white PWA. CONCLUSIONS: This study identified racial-ethnic differences in word fluency and auditory comprehension ability among PWA. Both skills are critical to effective communication, and racial-ethnic differences in outcomes must be considered in treatment approaches designed to improve overall communication ability.

Auditory Training Effects on the Listening Skills of Children With Auditory Processing Disorder.

OBJECTIVES: Children with auditory processing disorder (APD) typically present with "listening difficulties,"' including problems understanding speech in noisy environments. The authors examined, in a group of such children, whether a 12-week computer-based auditory training program with speech material improved the perception of speech-in-noise test performance, and functional listening skills as assessed by parental and teacher listening and communication questionnaires. The authors hypothesized that after the intervention, (1) trained children would show greater improvements in speech-in-noise perception than untrained controls; (2) this improvement would correlate with improvements in observer-rated behaviors; and (3) the improvement would be maintained for at least 3 months after the end of training. DESIGN: This was a prospective randomized controlled trial of 39 children with normal nonverbal intelligence, ages 7 to 11 years, all diagnosed with APD. This diagnosis required a normal pure-tone audiogram and deficits in at least two clinical auditory processing tests. The APD children were randomly assigned to (1) a control group that received only the current standard treatment for children diagnosed with APD, employing various listening/educational strategies at school (N = 19); or (2) an intervention group that undertook a 3-month 5-day/week computer-based auditory training program at home, consisting of a wide variety of speech-based listening tasks with competing sounds, in addition to the current standard treatment. All 39 children were assessed for language and cognitive skills at baseline and on three outcome measures at baseline and immediate postintervention. Outcome measures were repeated 3 months postintervention in the intervention group only, to assess the sustainability of treatment effects. The outcome measures were (1) the mean speech reception threshold obtained from the four subtests of the listening in specialized noise test that assesses sentence perception in various configurations of masking speech, and in which the target speakers and test materials were unrelated to the training materials; (2) the Children's Auditory Performance Scale that assesses listening skills, completed by the children's teachers; and (3) the Clinical Evaluation of Language Fundamental-4 pragmatic profile that assesses pragmatic language use, completed by parents. RESULTS: All outcome measures significantly improved at immediate postintervention in the intervention group only, with effect sizes ranging from 0.76 to 1.7. Improvements in speech-in-noise performance correlated with improved scores in the Children's Auditory Performance Scale questionnaire in the trained group only. Baseline language and cognitive assessments did not predict better training outcome. Improvements in speech-in-noise performance were sustained 3 months postintervention. CONCLUSIONS: Broad speech-based auditory training led to improved auditory processing skills as reflected in speech-in-noise test performance and in better functional listening in real life. The observed correlation between improved functional listening with improved speech-in-noise perception in the trained group suggests that improved listening was a direct generalization of the auditory training.

Diagnosis of amblyaudia in children referred for auditory processing assessment.

Children (n = 141) referred to 5 clinical sites for auditory processing disorder assessment were tested with two dichotic listening tests, one with word pairs and the other with pairs of digits, as part of a comprehensive diagnostic battery. Scores from the Randomized Dichotic Digits Test and the Dichotic Words Test were compared to age-appropriate norms and used to place children into one of four diagnostic categories (normal, dichotic dysaudia, amblyaudia, or amblyaudia plus) or to identify them as undiagnosed. Results from the two dichotic tests led to diagnosis of 56% of the children tested, leaving 44% undiagnosed. When results from a third dichotic listening test were used as a tie-breaker among originally undiagnosed children, a total of 79% of the children's scores were placed into diagnostic categories (13% normal, 19% dichotic dysaudia, 35% amblyaudia, 12% amblyaudia plus). Amblyaudia, a binaural integration deficit evident only from dichotic listening test results, was most prevalent (35% + 12% = 47%) in this population of children suspected of auditory processing weaknesses. Since amblyaudia responds to treatment with Auditory Rehabilitation for Interaural Asymmetry (ARIA), clinicians are guided through the protocol for identifying diagnostic categories so that they can make appropriate referrals for rehabilitation.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties.

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Dichotic listening training in children with autism spectrum disorder: A single subject design.

OBJECTIVE: Previous research has shown that dichotic listening training has improved auditory and language processing for individuals with large interaural asymmetries on dichotic listening tasks. This training can be a useful treatment for children with autism spectrum disorder (ASD). DESIGN: A single subject, multiple baseline across subjects study was utilized. STUDY SAMPLE: Three children with ASD, between the ages of 8-12, participated in the study. RESULTS: This training demonstrated improvement in language and auditory processing tasks following completion of up to twelve weeks of auditory training. CONCLUSION: This study supports the idea that deficit specific, dichotic auditory training can remediate auditory and language deficits for children with ASD. More research is needed, with a group design and controls, in order to generalize these results to the larger ASD population.

Implementing directives that involve prepositions with children with autism: a comparison of spoken cues with two types of augmented input.

Some children with autism face considerable challenges with comprehension, including difficulties following spoken directives involving prepositional relations. The use of augmented input through visual modalities might be an effective means for supplementing spoken language. The purpose of this preliminary study was to compare spoken input with two augmented input modalities (i.e., speech + visual cues) in terms of children's ability to follow directives involving prepositions. The augmented input modalities consisted of static scene cues (i.e., photographic or pictorial visual scenes that portray relevant concepts and their relationships) and dynamic scene cues (i.e., full-motion video clips that depict the actions underlying relevant concepts and their relationships). A within-subjects design involving nine children with autism or pervasive developmental disorders-not otherwise specified was used to examine the effectiveness of the three input conditions. Results indicated that both static scene cues and dynamic scene cues were more effective than spoken cues, but there were no differences between static scene cues and dynamic scene cues. Results are discussed in terms of appropriate instructional inputs for children with autism. Limitations are noted and directions for future research are posited.

ARIA treatment benefits are related to severity of dichotic listening deficits in children.

PURPOSE: This study investigated the relationship between dichotic listening (DL) benefits from treatment with Auditory Rehabilitation for Interaural Asymmetry (ARIA) and the severity of DL deficits quantified prior to the onset of treatment. We hypothesized that children with more severe DL deficits would demonstrate greater benefits following ARIA. METHOD: A scale that quantifies deficit severity was applied to dichotic listening scores obtained before and after training with ARIA at multiple clinical sites (n = 92). Using multiple regression analyses, we evaluated the predictive effects of deficit severity on DL outcomes. RESULTS: Results demonstrated that deficit severity can predict benefits from ARIA, as measured by improvements in DL scores in both ears. CONCLUSION: ARIA is an adaptive training paradigm for improving binaural integration abilities in children with DL deficits. The results from this study suggest that children with more severe DL deficits achieve greater benefits from ARIA and that a severity scale may provide important clinical information for recommending intervention.

Development and evaluation of the LiSN & learn auditory training software for deficit-specific remediation of binaural processing deficits in children: preliminary findings.

BACKGROUND: The LiSN & Learn auditory training software was developed specifically to improve binaural processing skills in children with suspected central auditory processing disorder who were diagnosed as having a spatial processing disorder (SPD). SPD is defined here as a condition whereby individuals are deficient in their ability to use binaural cues to selectively attend to sounds arriving from one direction while simultaneously suppressing sounds arriving from another. As a result, children with SPD have difficulty understanding speech in noisy environments, such as in the classroom. PURPOSE: To develop and evaluate the LiSN & Learn auditory training software for children diagnosed with the Listening in Spatialized Noise-Sentences Test (LiSN-S) as having an SPD. The LiSN-S is an adaptive speech-in-noise test designed to differentially diagnose spatial and pitch-processing deficits in children with suspected central auditory processing disorder. STUDY SAMPLE: Participants were nine children (aged between 6 yr, 9 mo, and 11 yr, 4 mo) who performed outside normal limits on the LiSN-S. RESEARCH DESIGN: In a pre-post study of treatment outcomes, participants trained on the LiSN & Learn for 15 min per day for 12 weeks. Participants acted as their own control. Participants were assessed on the LiSN-S, as well as tests of attention and memory and a self-report questionnaire of listening ability. Performance on all tasks was reassessed after 3 mo where no further training occurred. INTERVENTION: The LiSN & Learn produces a three-dimensional auditory environment under headphones on the user's home computer. The child's task was to identify a word from a target sentence presented in background noise. A weighted up-down adaptive procedure was used to adjust the signal level of the target based on the participant's response. RESULTS: On average, speech reception thresholds on the LiSN & Learn improved by 10 dB over the course of training. As hypothesized, there were significant improvements in posttraining performance on the LiSN-S conditions where the target and distracter stimuli are spatially separated and which specifically evaluate binaural processing ability (p ranging from <.003 to .0001, η2 ranging from 0.694 to 0.873). In contrast, there was no improvement on the LiSN-S control conditions where the target and distracter stimuli emanate from the same direction (p ranging from .07 to .86, η2 ranging from 0.362 to 0.004). Significant improvements were found posttraining on measures of memory, on one measure of attention, and on self-reported ratings of listening ability. There were no significant differences between post- and 3 mo posttraining scores on any of the assessment tools. CONCLUSIONS: The initial LiSN & Learn study has shown that children as young as 6 yr of age are able to complete the training (although some coaxing was needed in a minority of cases). Both parents and children have reported benefits from the training, and feedback from the trial has resulted in extra features being added to the software. In order to further evaluate the efficacy of LiSN & Learn to remediate binaural processing deficits in children a clinical trial is currently under way utilizing a randomized blinded control group design.

[Assessment of the efficiency of the auditory training in children with dyslalia and auditory processing disorders]. / Zaburzenia artykulacji u dzieci ze wspólistniejacymi zaburzeniami przetwarzania sluchowego - efekty terapii sluchowej.

AIM: To assess effectiveness of the auditory training in children with dyslalia and central auditory processing disorders. MATERIAL AND METHOD: Material consisted of 50 children aged 7-9-years-old. Children with articulation disorders stayed under long-term speech therapy care in the Auditory and Phoniatrics Clinic. All children were examined by a laryngologist and a phoniatrician. Assessment included tonal and impedance audiometry and speech therapists' and psychologist's consultations. Additionally, a set of electrophysiological examinations was performed - registration of N2, P2, N2, P2, P300 waves and psychoacoustic test of central auditory functions: FPT - frequency pattern test. Next children took part in the regular auditory training and attended speech therapy. Speech assessment followed treatment and therapy, again psychoacoustic tests were performed and P300 cortical potentials were recorded. After that statistical analyses were performed. RESULTS: Analyses revealed that application of auditory training in patients with dyslalia and other central auditory disorders is very efficient. CONCLUSIONS: Auditory training may be a very efficient therapy supporting speech therapy in children suffering from dyslalia coexisting with articulation and central auditory disorders and in children with educational problems of audiogenic origin.

A case law review of the individuals with disabilities education act for children with hearing loss or auditory processing disorders.

BACKGROUND: In 1975, Congress passed the Education for All Handicapped Children Act (Public Law 94-142), and it has been revised and modified several times. At the time of this writing, this law was most recently amended by the Individuals with Disabilities Education Improvement Act (Pub. L. No. 108-446, 118 Stat. 2647, December 3, 2004), which took effect on July 1, 2005. Colloquially the law is still referred to as the Individuals with Disabilities Education Act (IDEA). Children with hearing loss or auditory processing disorder (APD) may qualify for services under IDEA. However, a review of the literature found no review of case law for such children. PURPOSE: This article provides a comprehensive review of case law involving the IDEA and children with hearing loss or APD from the U.S. Supreme Court and U.S. courts of appeals. RESEARCH DESIGN: We conducted a systematic review of case law. A LexisNexis search for cases involving IDEA and children with hearing loss or APDs was conducted. For the purpose of the present case review, all appellate decisions (cases accepted by the U.S. courts of appeals or the U.S. Supreme Court) were included if they found that the child had hearing loss or APD, regardless of the reason for the appeal under IDEA. In the instance of multiple cases that involved the same two parties, these cases are summarized together to provide the legal context. Brief explanations of IDEA and the federal judicial process as it pertains to IDEA disputes are presented. Following these explanations, a chronological review of IDEA appellate cases concerning students with hearing loss or APD is provided. RESULTS: The IDEA cases reviewed focus on three main issues: placement of the child, methodology of teaching, and the provision of services. CONCLUSIONS: This case law review provides a helpful summary of higher court cases for educational audiologists and parents of children with hearing loss or APDs, as well as educators, individualized education program team members, school administrators, and legal representatives involved in IDEA cases.

[Speech perception in noise with and without FM technology]. / Sprachverständnis im Störgeräusch mit und ohne Frequenzmodulationsanlage.

BACKGROUND: In the presence of a (central) auditory processing disorder [(C)APD] central hearing processes are disturbed, leading to impaired speech perception in noise. Poor acoustics in educational institutions exacerbates the problem. In children affected by (C)APD this can result in impaired development of language, reading and writing acquisition as well as other skills. MATERIALS AND METHODS: A total of 66 children aged 6-11 years completed the Oldenburg sentence test in noise (OlSa) with and without an FM system. Children with normal OlSa test results formed the control group (group 1), while group 2a comprised children with an unremarkable re-test result and group 2b comprised children who produced abnormal results even in the re-test. RESULTS: All children achieved improved speech intelligibility using the FM system. The greatest difference between results with and without FM system was seen in group 2b (9.53 dB S/N). Group 1 achieved an improvement of 8.86 dB S/N and group 2a 7.89 dB S/N. CONCLUSIONS: Children with detected auditory selection problems benefit most from the use of an FM system for improved speech understanding. This should be borne in mind in the diagnosis and therapy of these children.

Applicability of the real ear measurement for audiological intervention of tinnitus.

INTRODUCTION: Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life. OBJECTIVE: The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator. METHODS: Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed. RESULTS: The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry. CONCLUSION: The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Association between prism adaptation and auditory cues on spatial navigation in individuals with unilateral neglect.

BACKGROUND: Unilateral neglect is common among right-hemispheric stroke individuals and also concerns the auditory modality. Prism adaptation can improve auditory extinction during a dichotic listening task, but its effect during an ecological task has not been studied. OBJECTIVE: The main objective was to evaluate whether lateralized cueing before and after prism adaptation improved virtual spatial navigation of stroke individuals with visual and auditory unilateral neglect. Secondary objectives were to assess spatial memory and obtain a better understanding of the mechanism of the cueing treatment by using an eye-tracker. METHODS: We included 22 stroke individuals with left visual and auditory neglect, 14 individuals without neglect, and 12 healthy controls. After a familiarization task, participants underwent 3 evaluation sessions. Participants were first passively shown a path that they had then to actively reproduce by using a joystick. A path with lateralized beeping sounds indicating direction and a path without any sounds were followed in a randomized order. After prism adaptation, the participants followed a third path with lateralized beeping sounds. The time of navigation and number of trajectory mistakes were recorded. After navigation, spatial memory was assessed. Additionally, an eye-tracker was used during the navigation period. RESULTS: The navigational performance of participants with neglect was significantly better with than without auditory cues, especially after prism adaptation. With auditory cues, participants without neglect reached the navigational performance of healthy controls. The spatial memory of individuals with neglect was significantly lower with auditory cues. Eye-tracking analyses showed that participants with neglect made more saccades and looked longer at the right-square angles in the absence of auditory cues. CONCLUSIONS: This study demonstrates the positive effect of auditory cues in virtual spatial navigation of individuals with visual and auditory neglect and the potentiation of the help of cues after prism adaptation.

Listening in noise training in children with auditory processing disorder: exploring group and individual data.

Purpose: The purpose of this study was to examine the impact of auditory training in noise on auditory behaviors and life habits in children with auditory processing disorder.Methods: Ten children with auditory processing disorder underwent an auditory training program in noise and six children with auditory processing disorder comprised a control group. Before and after training, participants were tested on sentence identification in noise and auditory evoked late latency responses. Participants teachers completed two questionnaires on children's auditory behaviors and life habits.Results: Participants were more tolerant to noise as the training sessions progressed. Significant between-group differences were found in P1 and N2 latency measures, independent of measurement time. The observed data trends suggest that some participants improved their performance on the sentence identification task in noise as well as on some electrophysiological parameters. No significant differences in questionnaire scores were found between groups or measurement times. However, one questionnaire showed significant between-group differences for certain questions.Conclusions: Listening in noise can improve with training for children with auditory processing disorder. However, this training program might be beneficial for some, but not all, children with auditory processing disorder. More data are needed to verify individual data trends.Implication for rehabilitationA structured program was developed to improve the ability of children with auditory processing disorder to listen in noise.Intervention can be beneficial for improving auditory behaviors in some children with auditory processing disorder.A limited number of questions on children's auditory behaviors asked to teachers appears to be more sensitive to intervention-related improvement compared to questions on life habits.

Music perception by cochlear implant and normal hearing listeners as measured by the Montreal Battery for Evaluation of Amusia.

OBJECTIVES: The purpose of this study was to explore the utility/possibility of using the Montreal Battery for Evaluation of Amusia (MBEA) test (Peretz, et al., Ann N Y Acad Sci, 999, 58-75) to assess the music perception abilities of cochlear implant (CI) users. DESIGN: The MBEA was used to measure six different aspects of music perception (Scale, Contour, Interval, Rhythm, Meter, and Melody Memory) by CI users and normal-hearing (NH) listeners presented with stimuli processed via CI simulations. The spectral resolution (number of channels) was varied in the CI simulations to determine: (a) the number of channels (4, 6, 8, 12, and 16) needed to achieve the highest levels of music perception and (b) the number of channels needed to produce levels of music perception performance comparable with that of CI users. RESULTS: CI users and NH listeners performed higher on temporal-based tests (Rhythm and Meter) than on pitch-based tests (Scale, Contour, and Interval)--a finding that is consistent with previous research studies. The CI users' scores on pitch-based tests were near chance. The CI users' (but not NH listeners') scores for the Memory test, a test that incorporates an integration of both temporal-based and pitch-based aspects of music, were significantly higher than the scores obtained for the pitch-based Scale test and significantly lower than the temporal-based Rhythm and Meter tests. The data from NH listeners indicated that 16 channels of stimulation did not provide the highest music perception scores and performance was as good as that obtained with 12 channels. This outcome is consistent with other studies showing that NH listeners listening to vocoded speech are not able to use effectively F0 cues present in the envelopes, even when the stimuli are processed with a large number (16) of channels. The CI user data seem to most closely match with the 4- and 6-channel NH listener conditions for the pitch-based tasks. CONCLUSIONS: Consistent with previous studies, both CI users and NH listeners showed the typical pattern of music perception in which scores are higher on tests measuring the perception of temporal aspects of music (Rhythm and Meter) than spectral (pitch) aspects of music (Scale, Contour, and Interval). On that regard, the pattern of results from this study indicates that the MBEA is a suitable test for measuring various aspects of music perception by CI users.

Auditory rehabilitation for interaural asymmetry: preliminary evidence of improved dichotic listening performance following intensive training.

Children with dichotic left ear deficits received intensive training in phase I and phase II clinical trials designed to establish the efficacy of directly training dichotic listening. Dichotic verbal material was presented in the sound field with intensity adjusted separately for each speaker. Output from the right-sided speaker was initially 20-30 db HL lower than for the left-sided speaker, resulting in excellent performance in the left ear. Intensities were adaptively adjusted throughout training in 1, 2, and 5-dB steps in order to keep performance high across dichotic tasks. In both phase I (n=8) and phase II (n=13) trials, children demonstrated significant gains in dichotic left ear performance after training. In phase II, children also demonstrated significant gains in right ear performance. Overall results from the two trials support the feasibility of this training approach for improving a larger than normal interaural asymmetry on dichotic listening tasks. Significant improvements in language comprehension and word recognition in phase II suggest that this type of training may also facilitate language skills in some children.

Personal amplification for school-age children with auditory processing disorders.

BACKGROUND: Children with auditory processing disorders (APD) are described to have a signal-to-noise ratio (SNR) difficulty. Frequency-modulated (FM) systems have been reported to improve this situation. Yet the use of personal amplification that may be more portable has not been attempted. PURPOSE: To determine whether personal amplification would result in improvement in speech-in-noise performances (attentiveness and speech recognition) and daily functioning in children with diagnosed APD. In addition, the desired hearing aid features (such as required gain, directional microphone and noise reduction, and open-ear fitting) are examined. RESEARCH DESIGN: A single-blind, longitudinal descriptive study in which subjects served as their own control in various hearing aid conditions. STUDY SAMPLE: Fourteen normal hearing children who had a diagnosis of APD and who were between the ages of 7 and 11 participated. INTERVENTION: All subjects wore bilateral, mild-gain, behind-the-ear, wide dynamic range compression hearing aids fitted in an open-ear mode. Gain on the hearing aids was adjusted to provide approximately 10 dB of insertion gain for conversational input. Directional microphone and noise reduction were used on the hearing aids. Subjects wore the hearing aids home and were encouraged to use them as much as possible in their daily environments (school, home, and social activities). Subjects were seen four times: an initial visit where hearing aids were fitted, then visits at 2 weeks, 3 months, and 6 months after the initial fitting. The majority of the testing was completed during these final three visits. DATA COLLECTION AND ANALYSIS: The children were evaluated on the Northwestern University word-list (NU-6) and the Auditory Continuous Performance Test (ACPT) in noise at most visits. The hearing aids were evaluated in the omnidirectional microphone mode only, omnidirectional microphone with noise reduction (NR) mode, and directional microphone with NR mode. The children's parents and teachers were asked to complete the Children's Auditory Processing Performance Scale (CHAPS) questionnaire both before and at the end of the study. RESULTS: The results showed that the use of hearing aids in the omnidirectional microphone mode alone did not improve speech identification in noise over the unaided condition. However, the inclusion of the NR algorithm and directional microphones improved speech understanding in noise. Amplification reduced the number of errors on the ACPT and improved several areas on the CHAPS; however, the results were not statistically significant. CONCLUSIONS: The use of mild-gain, open-ear fitting hearing aids with a directional microphone and noise reduction algorithm may be attempted on some children with APD on a trial basis.

Teaching Latino parents to support the multi-symbol message productions of their children who require AAC.

Many children who require augmentative and alternative communication (AAC) have difficulties shifting from the single- to multi-symbol stage of language development. Ensuring that children who use AAC receive evidence-based interventions to address this problem is critical. Furthermore, there has been little AAC treatment efficacy research to date that addresses the needs of multicultural populations, particularly those of Latino children who use AAC and their families. To address these issues, the current investigation used a mixed methodology, which included a focus group to determine if any changes needed to be made to an existing instructional program; and a single subject, multiple probe, across participants design to evaluate the effects of a caregiver instructional program on the multi-symbol utterance productions of Latino children who used AAC. Specifically, a cognitive strategy instructional approach that has been used to teach turn-taking skills to both Caucasian and African American children who use AAC was modified and used to teach caregivers how to support the production of their children's multi-symbol messages. In order to foster emergent literacy skills, caregivers implemented the strategy during book reading activities. Focus group results revealed that changes to the instructional program may be required for some Latino families. With regard to the instructional program, all caregivers successfully learned to use the instructional strategy, and all children increased their use of multi-symbol messages. Research and clinical implications of the findings are discussed.

[Cognitive rehabilitation of amusia]. / Vers une rééducation cognitive de l'amusie.

INTRODUCTION: The cognitive model of music processing has a modular architecture with two main pathways (a melody pathway and a time pathway) for processing the musical "message" and thus enabling music recognition. It also features a music-specific module for tonal encoding of pitch which stands apart from all other known cognitive systems (including language processing). To the best of our knowledge, rehabilitation therapy for amusia has not yet been reported. OBJECTIVE: We developed a therapeutic method (inspired by work on word deafness) in order to determine whether specific rehabilitation based on melody discrimination could prompt the regression of amusia. METHOD: We report the case of a patient having developed receptive, acquired amusia four years previously. His tone deafness disorder was assessed using the Montreal Battery of Evaluation of Amusia (MBEA), which revealed impairment of the melody pathway but no deficiency in the time pathway. A computer-assisted rehabilitation method was implemented; it used melody discrimination tasks and an errorless learning paradigm with progressively fading visual cues. RESULTS: After therapy, we noted an improvement in the overall MBEA score and its component subscores which could not be explained by spontaneous recovery (in view of the number of years since the neurological accident). The improvement was maintained at seven months post-therapy. Although post-therapy improvement in daily life was not systematically assessed, the patient started listening to his favourite music again. CONCLUSION: Specific amusia therapy has shown efficacy.