Transcript Case 4: CVA
Constraint Induced Auditory Therapy (CIAT) Annette Hurley, Ph.D. & Bradley Davis, Au.D. Dept. of Communication Disorders School of Allied Health Professions, Louisiana State University Health Sciences Center - New Orleans CASE 2: CVA BACKGROUND Constraint Induced Auditory Therapy (CIAT) is an auditory training program for children and adults. It is based on core principles of the Dichotic Interaural Intensity Difference (Musiek & Shochat, 1998). CIAT strengthens auditory processing by targeting the weaker ear through intense auditory training. This investigation reviews CIAT exercises and case reports from six patients with temporal lobe damage from acquired (C)APD from stroke, meningitis, or Landau-Kleffner Syndrome. Positive behavioral and electrophysiological findings following CIAT are reviewed. 1. 2. 3. A representation of ipsilateral and dominant contralateral pathways. 4. 5. CIAT Exercises Dichotic Numbers Single and Double pair presented at +20, +15, +10, and +5 Signal to Noise Ratio and at 500, 200, 00, 50, and 10 msec inter-stimulus intervals. Dichotic Sentences: 3, 4, 5, 6 & 7 syllable sentences. Semantic Monosyllabic Words: Spondees, Antonyms, Related words, etc. CVs: pa, ba, etc., with expansion. Stories with babble in the opposite ear. Case 1: CVA -49 year old male with left temporal parietal lesion. -Normal peripheral hearing -Impaired music perception -Difficulty understanding -Right ear deficit on dichotic tests -CIAT training- 10 sessions -Subjective improvement in hearing -Right ear pathway improved from 0% to scores at normal limits (>90%). A slight improvement in ABR Wave V latency is shown below. Improved Na-Pa amplitude is depicted in the Auditory Middle Latency Response (AMLR) recordings Figure 2. ABR Figure 3. AMLR Case 5: LKS Case 2. AMLR -46 year old male -MRI revealed a large left frontal lobe lesion extending to the parietal lobe. -Normal peripheral hearing -Eight CIAT sessions -Subjective improvements in hearing from communicative partner (wife) -12 year old male -Acquired (C)APD as result of Landau-Kleffner Syndrome -Abnormal spiking in the left temporal lobe -Completed Fast ForWord -Completed CIAT for 2 semesters (14 Sessions) BioMARK is within normal limits after CIAT. An increase in N1-P2 amplitude is shown after Fast ForWord. A slight decrease in Wave Pa latency was evident after CIAT. Case 5. BioMARK ALER CASE 3: CVA -29 year old Female -Onset 8/15/07 -College Graduate: Chef/Restaurant Owner -Extremely Motivated to try auditory therapy (and/or other alternative therapies) -Broca’s Aphasia: halting telegraphic speech, single words Right dichotic scores are within normal limits. CIAT training began 9/08; 1 hour per week ongoing cognitive training continues An improvement in the N1-P2 amplitude after CIAT is noted. Case 4: CVA Case 3. Auditory Late Evoked Response . Case 6: Meningitis -8 year old female -History of infantile Meningitis -Abnormal Spiking in Right Frontal & Temporal Lobe -Exprpessive Language and Speech Disorder -Began Language therapy June, 2009 -Began CIAT June, 2009 (15) 30 minute sessions -Difficulty in maintaining focus Left dichotic scores improved from 0% to 60% for digits; greater improvement for linguistic stimuli. Improved BioMARK from ‘abnormal’ to normal for the right ear after CIAT is shown below. -49 year old female -Mixed non-fluent Aphasia -Associates Degree in Accounting: Bookkeeper -Very Motivated -Effortful, non-fluent perseverative speech; severe word finding moderately impaired comprehension skills -Speech/language therapy began January, 2008 -CIAT began September 2009. -Dichotic Scores (Right Directed ear) improved from 0% to >80%. An increase in N1-P2 amplitude is shown for the ALER and a a slight decrease in Waves V and A of the BioMARK after CIAT. Discussion Each patient showed improvement on behavioral dichotic tests following CIAT. Each adult patient reported subjective improvements in hearing following CIAT. Each patient showed improvements in electrophysiological recordings, demonstrating plasticity at various levels of the central auditory nervous system following CIAT.