Service members and veterans (SMVs) with a history of traumatic brain injury (TBI) or blast-related injury often report difficulties understanding speech in complex environments that are not captured by clinical tests of auditory function. Little is currently known about the relative contribution of other auditory, cognitive, and symptomological factors to these communication challenges. This study evaluated the influence of these factors on subjective and objective measures of hearing difficulties in SMVs with and without a history of TBI or blast exposure. Analyses included 212 U.S. SMVs who completed auditory and cognitive batteries and surveys of hearing and other symptoms as part of a larger longitudinal study of TBI. Objective speech recognition performance was predicted by TBI status, while subjective hearing complaints were predicted by blast exposure. Bothersome tinnitus was associated with a history of more severe TBI. Speech recognition performance deficits and tinnitus complaints were also associated with poorer cognitive function. Hearing complaints were predicted by high frequency hearing loss and reports of more severe PTSD symptoms. These results suggest that SMVs with a history of blast exposure and/or TBI experience communication deficits that go beyond what would be expected based on standard audiometric assessments of their injuries.
Purpose Syllabic diadochokinesis (DDK) is a standard assessment task for motor speech disorders. This study aimed to compare rate and regularity of DDK according to the presence or absence of traumatic brain injury (TBI) and severity of TBI, examine the stability of DDK over time, and explore associations between DDK and extemporaneous speech. Method Military service members and veterans were categorized into three groups: no history of TBI (control), uncomplicated mild TBI (mTBI), and moderate through severe (including penetrating) TBI (msTBI). Participants produced rapid alternating-motion and sequential-motion syllable repetitions during one or two sessions. A semi-automated protocol determined syllabic rate and regularity. Perceptual ratings of selected participants' connected speech samples were compared to DDK results. Results Two hundred sixty-three service members and veterans provided data from one session and 69 from two sessions separated by 1.9 years ( SD = 1.0). DDKs were significantly slower overall for mTBI and msTBI groups compared to controls. Regularity of productions did not differ significantly across groups. A significant Group × Task interaction revealed that the msTBI group produced sequential-motion syllable repetitions but not alternating-motion repetitions with greater regularity, whereas the opposite occurred for control and mTBI groups. DDK results did not differ significantly between sessions. Perceptual speech analysis for 30 participants, including 20 with atypical or questionable DDK performance, revealed two participants with mildly abnormal speech. Conclusions Overall, DDK productions are slower than normal in adults with moderate, severe, and penetrating TBI and are stable over time. Regularity of productions did not differentiate groups, although this result differed according to task. There were surprisingly few people identified with disordered speech, making comparisons to DDK data tenuous, and indicating that dysarthria is a rare complication in a population of adults with mostly uncomplicated mTBI who are not selected from referrals to a speech-language pathology clinic.
Purpose: The Masking Level Difference (MLD) has been used for decades to evaluate the binaural listening advantage. Although originally measured using Bekesy audiometry, the most common clinical use of the MLD is the CD-based Wilson 500-Hz technique with interleaved N0S0 and N0Sπ components. Here, we propose an alternative technique based on manual audiometry as a faster way of measuring the MLD. The article describes the advantages to this administration technique and evaluates if it is a viable alternative for the Wilson technique. Method: Data were retrospectively analyzed on 264 service members (SMs). All SMs completed both the Wilson and Manual MLDs. Descriptive and correlational statistics were applied to evaluate the comparisons between the two techniques and highlight the differences. Equivalence measures were also completed to compare the tests using a standardized cutoff score. Analyses were also made to compare both techniques to subjective and objective measures of hearing performance. Results: Moderate to high positive correlations were determined between Wilson and Manual measures of each threshold (N0Sπ and N0S0). Although the Manual and Wilson MLD techniques produced significantly different thresholds, simple linear transformations can be used to obtain approximately equivalent scores on the two tests, and agreement was high for using these transformed scores to identify individuals with substantial MLD deficits. Both techniques had moderate test–retest reliability. The Manual MLD and components had stronger correlations to the subjective and objective hearing measures than the Wilson. Conclusions: The Manual technique is a faster method for obtaining MLD scores that is just as reliable as the CD-based Wilson test. With the significant reduction in assessment time and comparable results, the Manual MLD is a viable alternative for direct use in the clinic.
For cochlear-implant (CI) users with single-sided deafness (SSD), standard clinical programming yields interaural place-of-stimulation mismatch, because the electrode array does not reach the apex. This mismatch might degrade spatial-hearing abilities. This study examined whether acutely presented alternative frequency-to-electrode assignments (“remapping”), designed to reduce mismatch, could improve the use of two ears together to perceptually separate competing talkers. Remapped frequency assignments were derived from computed-tomography scans of intracochlear electrode locations or psychophysical tuning curves for interaural time-difference discrimination. Contralateral unmasking was measured by presenting target speech (closed-set corpus) to the acoustic ear and two same-sex competing talkers to just the acoustic ear or to both ears. Preliminary results (N = 8/15 planned subjects) show that for seven subjects with small (≤3-dB) initial binaural benefit, remapping yielded a small but significant (0.5-dB mean) increase in binaural benefit. Remapping was detrimental for the one subject with large (6-dB) initial binaural benefit. Possible longitudinal effects and tradeoffs with other SSD-CI hearing benefits that could be affected by remapping are discussed. [The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.]
Purpose: The objectives of this study were to (a) describe normative ranges—expressed as reference intervals (RIs)—for vestibular and balance function tests in a cohort of Service Members and Veterans (SMVs) and (b) to describe the interrater reliability of these tests. Method: As part of the Defense and Veterans Brain Injury Center (DVBIC)/Traumatic Brain Injury Center of Excellence 15-year Longitudinal Traumatic Brain Injury (TBI) Study, participants completed the following: vestibulo-ocular reflex suppression, visual-vestibular enhancement, subjective visual vertical, subjective visual horizontal, sinusoidal harmonic acceleration, the computerized rotational head impulse test (crHIT), and the sensory organization test. RIs were calculated using nonparametric methods and interrater reliability was assessed using intraclass correlation coefficients between three audiologists who independently reviewed and cleaned the data. Results: Reference populations for each outcome measure comprised 40 to 72 individuals, 19 to 61 years of age, who served either as noninjured controls (NIC) or injured controls (IC) in the 15-year study; none had a history of TBI or blast exposure. A subset of 15 SMVs from the NIC, IC, and TBI groups were included in the interrater reliability calculations. RIs are reported for 27 outcome measures from the seven rotational vestibular and balance tests. Interrater reliability was considered excellent for all tests except the crHIT, which was found to have good interrater reliability. Conclusion: This study provides clinicians and scientists with important information regarding normative ranges and interrater reliability for rotational vestibular and balance tests in SMVs.
Service Members and Veterans (SMVs) with a traumatic brain injury (TBI) often report difficulties understanding speech in noise. This study assessed the impact of TBI history on speech-in-noise recognition and benefit from sentence context. Participants were SMVs (ages 20–62) who had a history of at least an uncomplicated mild TBI (n = 122) or who had no TBI history (n = 58). For each listener, an interleaved, adaptive procedure was used to obtain an overall Speech Reception Threshold (SRT) and a difference in accuracy for high and low context sentences at that threshold. Penalized LASSO regressions revealed larger context benefits for individuals with TBI, poorer high frequency thresholds, poorer executive function, and self- reported tinnitus. Age, Post-Traumatic Stress Disorder, and neurobehavioral symptom severity did not predict context benefit. These results suggest TBI is associated with greater reliance on context in noise, even when accounting for variation in hearing acuity and cognitive function. [This project was funded by the Defense and Veterans Brain Injury Center (DVBIC) as part of a Congressionally-Mandated Longitudinal TBI Study. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.]
This paper introduces an automated posttraumatic stress disorder (PTSD) screening tool that could potentially be used as a self-assessment or inserted into routine medical visits for PTSD diagnosis and treatment. Methods: With an emotion estimation algorithm providing arousal (excited to calm) and valence (pleasure to displeasure) levels through discourse, we select regions of the acoustic signal that are most salient for PTSD detection. Our algorithm was tested on a subset of data from the DVBIC-TBICoE TBI Study, which contains PTSD Check List Civilian (PCL-C) assessment scores. Results: Speech from low-arousal and positive-valence regions provide the best discrimination for PTSD. Our model achieved an AUC (area under the curve) equal to 0.80 in detecting PCL-C ratings, outperforming models with no emotion filtering (AUC = 0.68). Conclusions: This result suggests that emotion drives the selection of the most salient temporal regions of an audio recording for PTSD detection. Impact Statement-Vocal biomarkers based on temporal regions of low-arousal and positive-valence achieve an area under the curve of 0.80 in detecting PTSD Check List Civilian (PCL-C) ratings.
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