Audiology and Speech Pathology - Research Publications
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ItemNo Preview AvailableAwareness of Usher Syndrome and the Need for Multidisciplinary Care: A Cross-Occupational Survey of Allied Health Clinicians(DOVE MEDICAL PRESS LTD, 2023)BACKGROUND: Usher syndrome is the most common cause of deaf-blindness, affecting up to 1 in 6000 people. Multidisciplinary care is required to maximize outcomes for individuals and families. This study assessed awareness of Usher Syndrome amongst allied health clinicians who provide care related to the primarily affected senses of hearing and vision, ie, optometry, orthoptics and audiology. METHODS: A prospective cross-sectional online survey of clinicians working in Australian university-affiliated clinics (7 optometry, 1 orthoptics and 4 audiology) was completed between September 2021 and January 2022. Questions were asked about the cause, common symptoms, and awareness of health professions who manage Usher syndrome. RESULTS: The 27 audiologists, 40 optometrists, and 7 orthoptists who completed the survey included 53 females (71.6%), had an average age of 37 years (range 24-70), and had an average duration of clinical experience of 13 years (range 1-45 years). The majority of respondents correctly identified Usher syndrome as a genetic condition (86%), identified at least two of the affected senses (97%), and identified the progressive nature of the vision and hearing losses (>90%). Awareness of vestibular dysfunction and its characteristics was low, as was knowledge of the key treatment roles that speech pathologists, genetic counsellors and geneticists play in the management of Usher Syndrome. The majority of respondents also did not identify important aspects of care within their own discipline. CONCLUSION: This study has shown that there is a need for targeted education to be delivered to hearing and vision care allied health clinicians to raise awareness of the vestibular impacts and aspects of vision loss experienced by people with Usher syndrome. This education needs to target the broad range of clinicians who have a key role in providing multidisciplinary care (including speech pathologists, geneticists, and genetic counsellors) and to identify the key aspects of good-quality multidisciplinary care.
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ItemEffects of widespread community use of face masks on communication, participation, and quality of life in Australia during the COVID-19 pandemic(SPRINGER, 2022-10-01)The objective was to document the influence of face mask use by other people on communication experiences, participation in activities, and quality of life. Australian adults (n = 665) completed an online survey; 90.8% resided in a state with mandatory mask use outside the home and 44.1% self-reported hearing difficulties. Mask use was reported as negatively affecting communication quality in the community (90.2%) and workplace (91.8%), and with household members (59.1%), including an increased requirement for clarification and repetition, increased difficulty communicating, and decreased understanding. Masks influenced feelings when communicating in the community (74.1%) and workplace (76.7%), and with household members (43.6%), including increased fatigue and frustration, and decreased connection to others. Masks influenced the time spent communicating in the community (68.8%) and workplace (67.9%), and with household members (42.3%), including a decrease in the number of individuals communicated with, and the time spent communicating with each individual. Masks influenced participation in activities in the community (50.9%) and workplace (59.7%), and with household members (41.3%), including reduced participation in health-related activities, shopping, and socialising. Influences on quality of life included reduced physical and mental health, including increased loneliness. Female gender and greater self-reported hearing difficulties were significantly associated with increased influence of mask use. The wide-ranging influences of face mask use have implications for physical health and mental health, including social connectedness, and for employers and the economy. As an important measure for combatting disease spread, the negative impacts of mask use must be considered during policy formulation, and appropriate mitigating measures, such as educational campaigns, enacted.
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ItemThe engagement of children in out-of-home care with nursing and allied health professionals: A scoping review(WILEY, 2021-11)BACKGROUND: Children living in out-of-home care (OOHC) have significant unmet health care needs and use more tertiary and specialist health care services compared with children from similar social and economic backgrounds. Allied health professionals and nurses have a central role in health care; however, very little is known about the engagement of children in OOHC with nursing and allied health professionals. This scoping review addresses this knowledge gap. METHODS: A scoping review methodology framework was used to search for relevant articles published between January 1970 and November 2019, identified using three databases: MEDLINE, CINAHL and ProQuest. Selection of studies was based on empirical research about the health of children in OOHC and their engagement with nursing or allied health services. A total of 37 relevant articles met the eligibility criteria for inclusion in this review. RESULTS: Findings could be summarized under five broad themes: (1) nursing and allied health professionals engaging with children in OOHC to support their health and development, (2) opportunities and challenges for nursing and allied health professionals to engage children in OOHC in healthcare, (3) identification and complexity of healthcare needs, (4) access to healthcare services and (5) coordination of healthcare. CONCLUSIONS: Children in OOHC have multiple healthcare needs that require monitoring and treatment by allied health professionals and the health and development of these children is best supported through comprehensive health screening on entry into OOHC, and community-based, multidisciplinary healthcare while children are living in OOHC. While nurses in hospitals and community settings were found to play a role in health assessment and care coordination targeted at children in OOHC, the literature was silent on the role of allied health professionals in this healthcare approach.
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ItemDecision making biases in the allied health professions: A systematic scoping review(PUBLIC LIBRARY SCIENCE, 2020-10-20)OBJECTIVES: Cognitive and other biases can influence the quality of healthcare decision making. While substantial research has explored how biases can lead to diagnostic or other errors in medicine, fewer studies have examined how they impact the decision making of other healthcare professionals. This scoping review aimed to identify and synthesise a broad range of research investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. MATERIALS AND METHODS: A systematic literature search was conducted in five electronic databases. Title, abstract and full text screening was undertaken in duplicate, using prespecified eligibility criteria designed to identify studies attempting to demonstrate the presence of bias when allied healthcare professionals make decisions. A narrative synthesis was undertaken, focussing on the type of allied health profession, type of decision, and type of bias reported within the included studies. RESULTS: The search strategy identified 149 studies. Of these, 119 studies came from the field of psychology, with substantially fewer from social work, physical and occupational therapy, speech pathology, audiology and genetic counselling. Diagnostic and assessment decisions were the most common decision types, with fewer studies assessing treatment, prognostic or other clinical decisions. Studies investigated the presence of over 30 cognitive, affective and other decision making biases, including stereotyping biases, anchoring, and confirmation bias. Overall, 77% of the studies reported at least one outcome that represented the presence of a bias. CONCLUSION: This scoping review provides an overview of studies investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. Biases have the potential to seriously impact the quality, consistency and accuracy of decision making in allied health practice. The findings highlight a need for further research particularly in professional disciplines outside of psychology, using methods that reflect real life healthcare decision making.
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ItemNo Preview AvailableInterventions to Mitigate Bias in Social Work Decision-Making: A Systematic Review(SAGE Publications, 2019)Purpose: This systematic review synthesized evidence supporting interventions aimed at mitigating cognitive bias associated with the decision-making of social work professionals. Methods: A systematic search was conducted within 10 social services and health-care databases. Review authors independently screened studies in duplicate against prespecified inclusion criteria, and two review authors undertook data extraction and quality assessment. Results: Four relevant studies were identified. Because these studies were too heterogeneous to conduct meta-analyses, results are reported narratively. Three studies focused on diagnostic decisions within mental health and one considered family reunification decisions. Two strategies were reportedly effective in mitigating error: a nomogram tool and a specially designed online training course. One study assessing a consider-the-opposite approach reported no effect on decision outcomes. Conclusions: Cognitive bias can impact the accuracy of clinical reasoning. This review highlights the need for research into cognitive bias mitigation within the context of social work practice decision-making.
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ItemSpeech Detection in Noise for Young Bilaterally Implanted Children: Is There Evidence of Binaural Benefit Over the Shadowed Ear Alone?(LIPPINCOTT WILLIAMS & WILKINS, 2017)OBJECTIVES: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (<4 years), and had significant bilateral experience, would demonstrate lower detection thresholds for speech sounds in background noise in the bilateral CI over the unilateral CI condition when the added CI was ipsilateral to the noise source. DESIGN: Children receiving bilateral CIs at the Eye and Ear Hospital Clinic in Melbourne were invited to participate in a wider research project evaluating outcomes; those participating in the wider project who were bilaterally implanted by 4 years and were approximately 2 years postoperative were included in the present study. For 20 participants, detection signal to noise ratios (SNRs) were measured for speech presented from in front and noise from 90° in at least 3 of 4 device/noise conditions, namely left CI/noise right and right CI/noise left, plus bilateral CIs/noise right and bilateral CIs/noise left. RESULTS: As some participants could only complete testing in 3 conditions within the 1 test block, the unilateral versus bilateral comparison was performed for 1 CI (i.e., 1 noise direction) for 15 participants and for both CIs (i.e., noise left and noise right) for 5 participants. Group analysis indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions when adding the left CI or right CI (for the overall group) or when adding the first or second CI (for the 15 participants with sequential bilateral CIs). Separate analyses indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions for the majority of individuals; this occurred irrespective of whether the analysis indicated that the CI added in the bilateral condition was poorer-performing, better-performing, or not significantly different compared with the other CI. Four individuals demonstrated a significant improvement in the bilateral condition when the CI added in the bilateral condition was a better-performing (n = 1), poorer-performing (n = 2), or not significantly different CI (n = 1). There was no relationship between the detection SNR difference between each CI and the detection SNR difference between the unilateral and bilateral conditions. CONCLUSIONS: The hypothesis of a lower detection SNR in the bilateral condition was not supported by the group results or by the results for the majority of individuals. For the 4 participants who did demonstrate benefit over the shadowed ear alone, that benefit cannot be separated from the potential benefit gained as a result of the CI added in the bilateral condition being the better-performing CI for 1 of the 4. Variation in outcomes could not be related to demographic factors for this group, which was relatively homogeneous for age at bilateral CI and experience; an older, more experienced group may demonstrate greater binaural benefit in these conditions. These results can be used during counseling for families regarding postoperative expectations for young children, especially in the first 2 years.
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ItemEveryday Listening Performance of Children Before and After Receiving a Second Cochlear Implant: Results Using the Parent Version of the Speech, Spatial, and Qualities of Hearing Scale(LIPPINCOTT WILLIAMS & WILKINS, 2016)OBJECTIVES: To evaluate change in individual children's performance in general areas of everyday listening following sequential bilateral implantation, and to identify the specific types of listening scenarios in which performance change occurred. The first hypothesis was that parent performance ratings for their child would be higher in the bilateral versus unilateral implant condition for each section of the speech, spatial and qualities of hearing scale for parents, viz.: speech perception, spatial hearing, and qualities of hearing. The second hypothesis was that the rating for the participant group would be higher in the bilateral condition for speech perception items involving group conversation or background noise, spatial hearing items, and qualities of hearing items focused on sound segregation or listening effort. DESIGN: Children receiving sequential bilateral implants at the Royal Victorian Eye and Ear Hospital and fulfilling selection criteria (primarily no significant cognitive or developmental delays, and oral English language skills of child and parent sufficient for completing assessments) were invited to participate in a wider project evaluating outcomes. The assessment protocol for older children included the speech, spatial, and qualities of hearing scale for parents. All children (n = 20; ages 4 to 15 years) whose parents completed the scale preoperatively and at 24-months postoperatively were included in this study. Ratings obtained preoperatively in the unilateral implant condition (or unilateral implant plus hearing aid for 4 participants) were compared with those obtained postoperatively in the bilateral implant condition. RESULTS: Bilateral ratings were significantly higher than unilateral ratings on the speech section for 12 children (W ≥ 7.0; p ≤ 0.03), on the spatial section for 13 children (W ≥ 15.0; p ≤ 0.03), and on the qualities of hearing section for 9 children (W ≥ 15.0; p ≤ 0.047). The difference between conditions was unrelated to time between implants or age at bilateral implantation (r ≤ 0.4; p ≥ 0.082). The median bilateral ratings for the participant group were higher for all eight speech perception items, including, as predicted, those involving group conversation and/or background noise (W ≥ 37.5; p ≤ 0.043). Also, as predicted, the median bilateral ratings for the participant group were higher for all six spatial hearing items (W ≥ 88.0; p ≤ 0.014), and for qualities of hearing items related to sound segregation (W ≥ 94.0; p ≤ 0.029), but not for those related to listening effort (W ≤ 92.0; p ≥ 0.112). CONCLUSIONS: Seventy-five percentage of parents perceived change in their child's daily listening performance postoperatively, and 25% perceived change across all three listening areas. For the overall participant group, the parents perceived a change in performance in the majority of specific listening scenarios, although change was limited in the qualities of hearing section, including no change in listening effort. Previous research suggests postoperative change was likely due to the headshadow effect and improved spatial hearing. Additional contributions may have been made by binaural summation, redundancy, and unmasking. For these participants, differences between device conditions may have been limited by their relatively old age at implantation, delay between implants, and limited bilateral experience. These results will provide valuable information to families during preoperative counseling and postoperative discussions about expected progress and evident benefit.
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ItemNo Preview AvailableComponents of a rehabilitation programme for young children using the Multichannel cochlear implant(John Wiley & sons, Inc., 2006)
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ItemNo Preview AvailableSpeech perception results for children with implants with different levels of preoperative residual hearing.( 1997-11)OBJECTIVE: Many reports have established that hearing-impaired children using the Nucleus 22-channel cochlear implant may show both significant benefits to lipreading and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised questions about whether severely or severely-to-profoundly deaf children should be candidates for cochlear implants. To study this question, postoperative results for implanted children with different levels of preoperative residual hearing were evaluated in terms of speech perception benefits. STUDY DESIGN/SETTING: A retrospective study of the first 117 children, sequentially, to undergo implantation in the Melbourne and Sydney Cochlear Implant Clinics was undertaken. All children had been assessed by and received their implants in a tertiary referral centre. MAIN OUTCOME MEASURES: To assess aided residual hearing, the children were grouped into four categories of hearing on the basis of their aided residual hearing thresholds measured preoperatively. To assess benefits, the scores of children on standard speech perception tests were reviewed. As different tests were used for children with different ages and language skills, children were grouped into categories according to the level of postoperative speech perception benefit. RESULTS: The results showed that children in the higher categories of aided preoperative residual hearing showed significant scores on open-set word and sentence perception tests using the implant alone. For children in lower categories of aided residual hearing, results were variable within the groups. More than 90% of children with implants with aided residual hearing thresholds in the speech range above 1 kHz achieved open-set understanding of words and sentences. CONCLUSION: While the results of this preliminary study confirm previous findings of differential outcomes for children with different levels of preoperative residual hearing, they suggest that children with severe to profound hearing impairments should be considered for cochlear implantation.