Transcript The LiSN & Learn Auditory Training Software

Prevalence and Remediation
of Spatial Processing Disorder
(SPD) in Aboriginal & Torres
Strait Islander (ATSI) Children
in Regional Australia
National Acoustic Laboratories, Sydney, Australia
Presented by
Sharon Cameron
Co-Authors
Harvey Dillon, Helen Glyde
Sujita Kanthan, Anna Kania
XXXII World Congress of
Audiology, Brisbane, May
2014
What is Spatial Processing Disorder (SPD)?
•
SPD is a deficiency in the ability to use binaural cues to
selectively attend to sounds arriving from one direction
while suppressing sounds arriving from other directions.
•
A major cause of difficulty understanding speech in noise in
a percentage of normally-hearing children.
•
One type of CAPD.
•
Known cause (COM).
2
Diagnosing SPD with LiSN-S
•
Speech-in-noise test
•
Virtual auditory environment under headphones.
•
Assesses ability to separate target stimuli from distracting
stimuli that arrive from other directions.
•
Target sentences (initially) at 62 dB from at 0°.
•
Distracter stories at 55 dB from either 0º or ± 90° in same
voice or different voices.
•
Target adjusted adaptively with SRT averaged over maximum
of 30 sentences.
•
SPD determined by pattern measure score.
3
LiSN-S Scoring Matrix
4
LiSN-S results profile: SPD
5
Remediating SPD with LiSN & Learn
•
Trains children to attend to a frontal target stimulus (0°)
and filter out distracting talkers from left and right (±90°).
•
Adapts to 70% performance level.
•
SRT calculated over 40 sentences.
•
Used in the home or (schools/clinics).
•
Provides rewards, feedback, analysis and reporting.
•
10 dB improvement in SRT over 50 training sessions 2 games x 5 days per week for 10 weeks (Cameron & Dillon,
2011, Cameron et al, 2012).
6
LiSN & Learn- Training games
7
LiSN-S Results - Pre- vs. Post-Training
LiSN-S Score
(Population Standard Deviation Units)
2
1
0
-1
LC SRT
p = 0.158
Talker Advantage
p = 0.981
HC SRT
p = 0.0002
Spatial Advantage p = 0.0002
-2
Total Advantage
p = 0.001
-3
Pre-Training
Post-Training
3M Post-Training
-4
LC SRT
HC SRT
Talker
Spatial
Total
LiSN-S Condition
Cameron & Dillon (2011)
8
Research Results linking COM and SPD
 6 year-olds with history of COM have below-average spatial advantage compared
to norms (n = 17, p = 0.012, mean z = 0.1 ; range = -4 to 0.5) (Kapadia et al., 2012).
 13-17 year-olds with history of COM have below average spatial advantage
compared to norms (n=20; p=0.004, mean z = -0.75) (Kapadia et al, 2014).
 6-12 year old children with history of COM were significantly worse on LiSN-S
spatial advantage than age-matched controls (n = 35, p<0.001) (Tomlin & Rance, in
press).
 Spatial advantage score significantly worse with early age of COM onset and
increased duration (p=0.02 and p=0.03 respectively) (Tomlin & Rance, in press).
 30% of children (15/50) previously diagnosed with COM taking part in a study at
University of Melbourne were diagnosed with SPD (Graydon & Rance, ongoing).
 10% of a population sample (9/90) of ATSI children from remote Australia
diagnosed with SPD. (Unpublished data).
9
Interpretation Based on These and Other Studies
Chronic otitis media
Fluctuating access to
binaural cues
reduced effectiveness in
spatial processing
COM in ATSI Populations
• ATSI children have higher rates of middle ear
disease than have been described in any other
population in the world.
• 2.6 years vs. 3 months for non-ATSI children.
• Middle ear abnormalities prevalent in between 4562% of ATSI children.
11
Method
•
N=144 ATSI children aged 6;0 to 12;12 years (mean 8;10) recruited from 4
government primary schools in Kempsey NSW. M = 69; F = 75.
•
Additional n=13 excluded: SNHL, intellectual disability; unmedicated ADHD;
ear discharge; conductive loss (4FAHL ≥ 40 dB; 4FAHL between ears >20 dB).
•
Children with mild conductive loss assessed with LiSN-S PGA.
•
Testing took place at each school in a quiet room (Leq in dB within LiSN-S
permissible noise levels for testing).
•
Ten participants (7%) presented with SPD as diagnosed with LiSN-S.
•
Nine children with SPD took part in the LISN & Learn training program.
•
Culturally appropriate rewards offered during training.
•
The Listening Inventory for Education - Teacher (LIFE): -35 - +35 Scale.
12
Distribution of Scores on LiSN-S (n=144)
Cameron et al. (2014)
13
Distribution of Scores on LiSN & Learn (n=9)
Three children had suspected COM during training . These children
were not calibrating the software each day. Once the teacher took
over the calibration process the problem was resolved.
Cameron et al. (2014)
14
Distribution of Scores on LiSN-S (n=9)
4
LiSN-S Score
(population standard deviation units)
3
Pre-Training
2
Post-Training
1
0
-1
-2
-3
-4
Low Cue
High Cue
Talker Adv
Spatial Adv
Total Adv
LiSN-S Condition
Cameron et al. (2014)
15
Post-Training LiSN-S Performance vs. LiSN & Learn Games Played
N= 9
Mean =
65 games
r = 0.71
p = 0.031,
η2 = 0.51
Cameron et al. (2014)
16
LIFE Teacher Appraisal of Listening Ability Post-Training
LiSN &
Learn
PreTraining
PostTraining
LiSN-S
Pattern
LiSN-S
Pattern
Improvement
in LiSN-S
Pattern
Z-score
Z-score
Z-score
LIFE
Teacher
Appraisal
ID
Age
Games
Played
SD
SD
SD
Total
Score
326
8.6
98
-2.2
-0.5
1.7
11
408
6.3
42
-2.7
-3.4*
-0.7
35
409
7.9
25
-2.6
-4.6*
-1.9
35
418
6.1
32
-2.4
-5.6*
-3.2
13
518
8.7
82
-2.2
-0.8
1.4
25
523
6.7
90
-3.0
-2.3*
0.7
31
524
6.4
90
-3.2
0.9
4.1
33
609
7.5
59
-2.5
0.9
3.4
13
622
6.3
63
-2.2
0.5
2.6
20
N= 9
Mean rating +24 (SD 10).
No significant
correlation
between rating
and LiSN-S
Pattern Z Score
improvement
(p = 0.797)
17
Conclusions
•
There is a high prevalence of SPD in the ATSI population.
•
LiSN & Learn training is effective in remediating SPD in this
population.
•
LiSN & Learn training is considered a beneficial intervention
by teachers.
•
However improvement in spatial processing is dependent on
training program uptake.
•
Achieving the prescribed amount of training is challenging.
•
Middle ear status and calibration procedure should be
monitored during training.
18
National Acoustic Laboratories, Sydney, Australia
Questions
Visit the NAL CAPD
website at:
http://capd.nal.gov.au