Audiology and Speech Pathology - Theses

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    The processing of Mandarin-accented English by older hearing-impaired adults and their perceptual adaptation to the accent
    Hau, Jutta Alice ( 2023-06)
    ABSTRACT Older, hearing-impaired (OHI) adults have proportionately more trouble hearing speech in adverse listening situations than normally hearing (NH) listeners. When the speech signal is degraded through the presence of background noise, fast speech, or is otherwise unclear, OHI adults have more trouble with speech recognition (Humes and Dubno, 2010) and expend more cognitive resources in working out what has been said than do NH listeners (Tun, McCoy & Wingfield, 2009). This study investigated whether OHI listeners are likewise disproportionately disadvantaged by an unfamiliar accent, namely Mandarin Accented English (MAE), and whether these listeners are able to adapt to the systematicities of the accent. 27 OHI, 27 ONH and 29 YNH listeners were recruited. Cross modal fragment priming (CMFP) was utilised in Experiment 1 to measure the effect of a phonological error often made by speakers of MAE, the lack of reduction of the vowel in unstressed iambic words. Response times and accuracy were compared between the listener groups, between Australian English (AusE) and MAE tokens and between matching and mismatching primes and targets. Talker-independent adaptation was evaluated in a second experiment through an exposure training study design. Listeners were trained either by four MAE talkers or four AusE talkers before listening to sentences presented by a novel MAE talker. Speech recognition was compared between the listener groups and the training accents. In experiment one, the CMFP study, all listener groups were slower and less accurate in their responses to MAE. While the YNH group was faster to respond to all tokens (AusE and MAE) than both the OHI and the ONH groups, they were only significantly more accurate in responding to the AusE tokens, indicating that they too, found MAE speech recognition difficult. The YNH listeners demonstrated significantly faster responses than both older groups in the most cognitively challenging conditions where prime and target did not match. In experiment two, the adaption study, all three groups trained by the MAE talkers showed higher odds of speech recognition than listeners trained by AusE talkers, showing the benefit of exposure to the accent for MAE recognition. The OHI listeners adapted to MAE to the same degree as the NH listeners despite returning lower overall odds of recognising MAE speech. While OHI listeners with mild to moderate hearing loss showed similar accuracy in responses to MAE words and fragment tokens as did the normally hearing listeners, both older listener groups took substantially longer to respond to these tokens, especially in the more cognitively taxing mismatching conditions. This result indicates that older listeners had greater difficulty processing the speech tokens which, however, was not always reflected in their recognition results. In addition, OHI listeners were able to benefit as much from their brief exposure to MAE as did the NH groups. This result suggests that OHI with mild-moderate hearing loss have access to and can exploit the information present in a relatively brief sample of accented speech and generalise this learning to a novel MAE talker. This potential to adapt to the accent of an FAS talker will be important for ensuring smooth communication interactions, particularly when the communication partner is committed to reducing the barriers to communication by, for example, reducing their rate of speech. This study has utilised theories, study designs and methodological techniques developed in the field of psycholinguistics and in particular, has demonstrated the benefit of using RT measurements to learn more about the processing difficulty of FAS as experienced by OHI adults. The study has also indicated the potential for psycholinguistic theories of speech processing to be expanded by examining the language processing of older listeners with an impaired auditory system.
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    Vestibular Function and Postural Control in Children
    Chisari, Donella Rebecca ( 2023-07)
    Background: The vestibular system plays a crucial role in the ability to maintain balance. For children, balance control is reliant on multiple factors including integration of sensory information, sensorimotor mechanisms, and motor skill development. Several measures to quantify balance performance include vestibular function assessment, functional balance ability and postural control, but the relationship between these constructs has only recently been considered. Establishing the relationship between constructs for typically developing children would help to better understand balance control. Addressing this knowledge gap for children with sensorineural hearing loss or autism would also help to identify underlying mechanisms contributing to balance challenges and support optimal intervention approaches. Aims: This PhD aimed to describe peripheral vestibular function and its contributions to functional balance and postural control via: (1) comparison between typically developing children 5-12 years and adults; and (2) longitudinal comparisons in typically developing children across a twelve-month period. Peripheral vestibular function, functional balance and postural control were also explored in (3) children with sensorineural hearing loss and (4) children with autism. Methods: Participants were recruited from organisations across metropolitan Melbourne. Clinical vestibular assessments included the video head impulse test to measure semicircular canal (SCC) function and vestibular evoked myogenic potentials to measure otolith function. Postural control strategies were evaluated using static posturography with modified sensory inputs utilising novel approaches to analyse postural sway. Bruininks-Oseretsky Test of Motor Proficiency and Paediatric Balance Scale measured functional balance. Aim 1 compared typically developing children to adult cohorts for otolith function and postural control. Aim 2 documented normative data for children 5-12 years across all clinical vestibular assessments, functional balance, and postural control, with longitudinal comparisons for a smaller subset. These same assessments were performed for children with sensorineural hearing loss (Aim 3) and children with autism (Aim 4). Results: When compared to adults, children had smaller and earlier otolith responses and increased postural sway across all static posturography conditions, with differences in sensory integration strategies observed. Normative and longitudinal comparisons in typically developing children demonstrated that some balance measures change with age, including SCC function, saccule function, and postural control. For children with sensorineural hearing loss, vestibular impairment predicted motor performance, with greater degrees of vestibular impairment associated with reduced functional balance performance and larger amounts of postural sway for conditions requiring vestibular system reliance. Despite normal vestibular function, children with autism showed reduced functional balance performance and greater amounts of postural sway in conditions where visual input was eliminated. Conclusions: Elements of peripheral vestibular function and postural control in children change over time and differ from adults. Postural control strategies can also differ between children, depending on age, vestibular function, and functional balance performance. These findings demonstrate the need for paediatric focused normative data across clinical assessments of balance control. Utilising a range of assessments to quantify balance performance can inform optimal intervention approaches for children with vestibular impairment, as observed in children with sensorineural hearing loss, or balance concerns, as observed in children with autism. Longitudinal comparisons may also guide management.
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    The unmet need for ear and hearing care in low- and middle- income countries: a case study on Cambodia
    Waterworth, Christopher James ( 2023-05)
    The body of work presented explores the unmet need for ear and hearing care in Cambodia, with a particular focus on the barriers to accessing ear care. The main objectives of this thesis are to highlight the current state of ear and hearing care service provision in Cambodia, to describe and analyse the main experiences of patients in their pathway for seeking EHC, and providers in their delivery of EHC services, and to consider the implications that these findings have for the development of appropriate public health interventions, and the practice of health policy making in Cambodia. The main analytic stance adopted is one of a public health approach to examine the supply and demand constraints on the patient-centred pathway to hearing health. To do so, mixed methods studies were employed to address the topic. Study I aimed to investigate the severity of ear disease and hearing loss of a cohort of patients attending an NGO Hospital in Phnom Penh, to make an analysis of their health care-seeking for diagnosis and treatment, including delays in accessing care, the severity of the disease, distance to care and the nature of EHC service delivery. Method. Mixed methods design using a retrospective analysis of the hospital patient record system, a quantitative facility-based survey and semi-structured qualitative interviews examining proxy measures of access to care, causal attributes and demand-side barriers to ear care. Results. Patients presented with advanced middle ear disease, with associated hearing loss amongst the highest per capita levels globally. Patients reported several structural, financial and sociocultural barriers. This study reveals a significant burden of ear disease in Cambodia, which reflects a delay in receiving timely and effective treatment. Conclusion. The article highlights the opportunity to integrate effective ear and hearing care into primary care service provision, strengthening the package of activities delivered at government facilities. Study II aimed to investigate the supply-side barriers to the delivery of ear and hearing services in Cambodia Method. Mixed methods design using a cross-sectional quantitative survey followed by semi-structured qualitative interviews to examine perspectives of stake-holders and front-line staff from a range of providers. Results. The overarching issues voiced by providers were supply-side shortages of health providers trained in ear and hearing care across all sectors, especially in primary health care and in rural areas, limited training opportunities in specialist surgical care, a lack of infrastructure and resources to support aural rehabilitation, and poor coordination of care amongst providers. Conclusion. The article highlights the opportunity to integrate effective ear and hearing care into primary care service provision, through strengthening the workforce, improving coordination through effective care pathways, building trust through health promotion and patient-centeredness, and expanding the package of activities delivered at government facilities.
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    Speech and language in chromatin-related disorders
    St John, Miya Dana ( 2023-03)
    Background. Diagnosis of a speech or language disorder can impose lifelong impacts on literacy, social skills, and employment outcomes. Rare genetic neurodevelopmental disorders are often accompanied by speech and language disorders with subsequent deleterious impacts. Although genetic neurodevelopmental disorders are individually rare, collectively they are common and contribute to a vast number of individuals living with speech and language disorders across the world. Chromatin-related disorders are one class of genetic disorder, each caused by a perturbed gene important for chromatin function. Aims. My thesis has three aims, which in turn, form three studies: (1) To provide a systematic review of speech and language outcomes across chromatin-related neurodevelopmental disorders, (2) To provide detailed speech and language phenotyping in individuals with pathogenic variants in KAT6A, namely KAT6A syndrome (also known as Arboleda-Tham syndrome), and to report genotype-phenotype correlation. (3) To provide a comprehensive phenotype of the speech and language profile of individuals with Koolen-de Vries syndrome (caused by KANSL1 variants or 17q21.31 deletions). Methods. Methods for each sub-study are detailed below: (1) A literature search was conducted on 70 chromatin-related genes (collated from two key chromatin disorder-related publications), to identify speech and language findings in human-based studies, (2) Participants aged 6 months to adulthood, with a confirmed genetic diagnosis of KAT6A syndrome (caused by a pathogenic KAT6A variant) were recruited through clinical collaborators, the Australian Association of Clinical Geneticists, and international family support groups. Exclusion criteria were the presence of any other confirmed genetic variant or syndrome likely to impact the clinical phenotype. Speech, language, non-verbal communication, feeding, and adaptive behaviour were assessed using a battery of standardised and formal assessments, and data were analysed in the context of the wider medical and neurodevelopmental profile. (3) Participants aged 6 months to adulthood, with a confirmed diagnosis of Koolen-de Vries syndrome (caused by either a pathogenic KANSL1 variant or 17q21.31 deletion) were recruited through a research database held at the authors’ institution, clinical collaborators, and an international family support group. Exclusion criteria were the presence of any other confirmed genetic variant or syndrome likely to impact the clinical phenotype. Speech (including an in-depth fluency questionnaire), language, feeding, and adaptive behaviour were assessed using a battery of standardised and formal assessments, which were analysed in the context of the wider medical and neurodevelopmental profile. Results. Results for each sub-study are described below: (1) 3932 studies were identified and screened and 112 were systematically reviewed. Of the 112 publications, 35 reported on standardised or formal speech and language outcomes measures, while only five systematically delineated speech and language phenotypes. Data regarding speech and language outcomes were available for 40 genes. Communication impairment was a core phenotypic feature noted across all chromatin disorders, presenting as severe in ten, moderate in five, mild in seven, and mixed in seven. 11 had limited data to determine severity. Motor speech phenotypes and regression were more common in disorders relating to epigenetic writers and readers. (2) Forty-nine individuals (25 females; aged 1;5–31;10) were included with KAT6A syndrome. Co-occurring medical and neurodevelopmental phenotypes included moderate to severe intellectual disability or developmental delay (42/45), vision and eye anomalies (37/48), gastrointestinal concerns (33/48), and sleep disturbance (31/48). Most (36/49) were minimally-verbal. Verbal participants (13/49) displayed complex and co-occurring speech diagnoses including phonological impairments and childhood apraxia of speech (CAS). Adaptive behaviour including communication (receptive/expressive language), socialisation, motor skills and daily living skills were all severely impaired. Late truncating variants were associated with poorer communication, daily living skills, and socialization outcomes. (3) Eighty-one individuals with KdVS were evaluated (35 female, mean age 9y 10mo), 56 harbouring typical 17q21.31 deletions. Concurrent medical and neurodevelopmental features included intellectual disability (49/56), eye and vision disturbances (48/81), structural brain anomalies (33/62), sleep disturbance (33/81), and musculoskeletal abnormalities (32/81). Most individuals were verbal (62/81), and the remainder were successful in using alternative and augmentative communication (AAC) to communicate. Verbal participants had diagnoses of CAS (39/61), dysarthria (28/61), and stuttering (36/47). Stuttering followed a unique trajectory of later onset and fluctuating presence, compared to the broader population of individuals with stuttering in the absence of KdVS. Receptive and expressive language abilities were commensurate, rather than one domain being stronger or weaker than the other. Literacy skills were a relative weakness. Social competence, behaviour, and coping skills represented relative strengths. Discussion. Individual chromatin-regulating genes cause distinct profiles of communication, and these have important implications for identification, prognosis, and clinical recommendations for such disorders. The detailed phenotyping I have provided for KAT6A syndrome and KdVS is invaluable for determining prognostic counselling, anticipating realistic trajectories, and informing practical decision making for families and clinicians involved. Many families in the reverse phenotyping studies had no history of targeted clinical care to address symptomatology, emphasising the weight of this work. The results of this thesis, alongside continued speech and language phenotyping going forward, will provide increased clinical precision, and an understanding of the interplay between chromatin genes, neural development, and communication. The consequences of this research will help to identify useful biomarkers for the growing field of postnatal modification of epigenetic marks.
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    An evidence-based pathway to early cochlear implantation in infants: reducing the reliance on the behavioural audiogram
    Walchhuetter, Alexandra Page ( 2023-03)
    ABSTRACT Background and Aims Cochlear implantation has emerged as a leading hearing intervention for infants born with severe to profound hearing loss. Research has shown that early intervention with a cochlear implant (CI) can significantly improve speech perception and oral language development in infants, providing them with access to the sounds that are critical for language acquisition. However, studies investigating the relationship between initial electrophysiological hearing thresholds and subsequent behavioural thresholds have demonstrated uncertainty as to whether initial results are able to provide an accurate estimation of an infant’s functional hearing. This estimation must be accurate if a CI is to be considered before behavioural audiometry has been obtained, as CI surgery is likely to remove any remaining natural hearing. This study aims to explore the variance between initial electrophysiological thresholds and subsequent behavioural hearing thresholds in young infants with suspected severe to profound hearing loss in a clinical setting, to determine under which conditions initial electrophysiological results can be used to support a CI recommendation in the absence of behavioural audiology. It also aims to propose evidence-based recommendations for implementation of a paediatric CI candidacy pathway for cases in which reliance on behavioural audiometry can be reduced. Method A prospective cohort study of 63 infants with suspected severe to profound hearing loss, referred to the Cochlear Implant Clinic, Melbourne, before 12 months of age. Assessment protocol included auditory brainstem response, auditory steady-state response, otoacoustic emissions, tympanometry, cortical auditory evoked response, and behavioural audiometry. Data was explored using correlational analysis, linear regression, and clinical decision analysis. Results 90.8% of all individuals who met CI candidacy criteria with initial electrophysiological testing (3FAHL>85dB) also met criteria upon behavioural testing. This proportion increased to 95% once certain exclusion criteria were placed on the group, excluding children born prematurely and children with auditory neuropathy. This result indicates that, under certain conditions, initial electrophysiological thresholds may be reliable enough to form the basis of a CI recommendation. Sensitivity and specificity of diagnostic electrophysiological testing was also found to increase once exclusion criteria were applied. Conclusion For most infants undergoing CI candidacy evaluation, initial electrophysiological thresholds were an accurate reflection of their subsequent behavioural hearing thresholds. An alternative CI candidacy pathway is recommended for infants who show profound sensorineural hearing loss on initial electrophysiological testing in the absence of middle ear effusion or auditory neuropathy features, to provide CI recommendations before behavioural thresholds are obtained. This would lead to reduced timeframes between hearing loss identification, diagnosis, and implantation, which can improve oral speech and language outcomes.
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    An Australian Model of Mobile Flexible Endoscopic Evaluation of Swallowing (mFEES) for Adults in Residential Aged Care Homes
    Birchall, Olga ( 2022)
    Many older adults living in residential aged care homes (RACHs) experience swallowing difficulties (oropharyngeal dysphagia – OD) due to age related changes and medical comorbidities. Sequelae of OD may be serious, including choking (the second leading cause of preventable deaths in RACHs), pneumonia, dehydration, malnutrition, and reduced quality-of-life. Timely instrumental swallowing assessment (ISA), including Flexible Endoscopic Evaluation of Swallowing (FEES), can play a pivotal role in differential OD diagnosis and tailored dysphagia care, reducing the risk of avoidable OD complications. In Australia, ISA services are not available onsite in RACHs, meaning that vulnerable, older adults must travel off-site for assessment, and may experience mobility, cognitive, and fiscal barriers to assessing timely ISA. Models of mobile ISA offered onsite RACHs, may help to address these access barriers by eliminating the need for residents to travel for assessment, facilitating more timely and personalised OD care. However, literature dedicated to exploring ISA in RACHs is limited, and there are no published models of mobile ISA in RACHs in Australia. Consequently, there is a need to systematically explore issues in offering ISA in a RACH setting and the value of a mobile service model in supporting person-centred, timely swallowing care. In this research program, mixed methods and principles of triangulation (grounded in the pragmatic paradigm) helped to examine evidence on ISA in RACHs from different sources, including published and grey literature, RACH clinical records, the opinions of speech-language-pathologists, residents, their nursing staff, and legally appointed medical decision makers. Through four, sequential studies we systematically explored the following: the role of ISA in RACHs; barriers and facilitators to ISA; Australian practice patterns in the use of ISA in RACHs; and the feasibility of an Australian mFEES service model. We found that ISA may play a valuable role in OD diagnosis, prognostication, and care in adults in RACHs. Despite agreement between sources that there is a clinical need for ISA in RACHs, there was no evidence of ISA being used in Australian RACHs. These data informed the development of an Australian mFEES service model, designed to eliminate travel-related ISA access barriers. Data from our feasibility study, conducted in RACHs in metropolitan and regional Victoria, suggested that mFEES is a safe, well-tolerated, and practical service model with potential to minimise OD sequelae by facilitating timely, person-centred, and collaborative swallowing care. The mFEES service model aligned with recent findings of the Australian Royal Health Commission into Aged Care Quality and Safety, emphasising the importance of person-centred healthcare, delivered with collaboration and innovation. Results of this thesis contribute to emerging literature on the use of ISA in RACHs by providing data to support judicious use of ISA in this setting and an Australian mFEES service model to address existing barriers associated with off-site assessment. Our findings can be used as a platform for future research with larger participant numbers to explore the impact of the mFEES service model on clinical risk, healthcare, and fiscal outcomes at a resident, community, and healthcare-service level. More broadly, it can assist in advocacy initiatives to improve the safety and quality of swallowing care for older adults living in RACHs in Australia.
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    An Evaluation of Telepractice Delivery of an Autism Social Communication Intervention to Parent Groups
    Garnett, Robyn Elizabeth ( 2022)
    Approximately one in 100 children are diagnosed with autism globally (Zeidan et al., 2022). Social communication is a core challenge for children with autism, and research confirms that early intervention, if applied consistently and intensively, can be effective in improving the social communication and development skills of these children. Families may experience barriers such as availability, cost, and geographical isolation in accessing early intervention services. Telepractice can address these barriers by increasing access to intervention services and decreasing the time and costs associated with face-to-face delivery. Parent-implemented intervention approaches can also increase intervention consistency and intensity for children with autism. Evidence shows that telepractice can successfully overcome service barriers and be acceptable to parents. Parent-implemented intervention approaches have been shown to be effective in supporting child skill development. Research investigating these approaches has often been applied with individual families, yet limited literature exists on telepractice interventions for parent groups. This research aimed to investigate a group telepractice approach to delivering a social communication intervention to parents called Hanen More Than Words (HMTW). The research comprised two individual studies. Study 1 focused on feasibility. It tested and selected suitable technology and then piloted delivery of the telepractice HMTW group intervention to two parents and their children with autism. Observation of group training and individual video-feedback sessions, along with participant interviews, enabled qualitative analysis of both the telepractice approach and participant perceptions. Study 2 used a multiple-baseline-across-groups design to evaluate parent and child communication outcomes and parent perceptions following participation in the intervention. Eleven parent–child dyads participated in one of three telepractice HMTW groups. Repeated coding and counting of parent–child interaction videos across research phases enabled quantitative analysis of social communication outcomes. Quantitative and qualitative measures evaluated parent perceptions. Quantitative data were analysed using descriptive statistics and pre- to postintervention comparison of parenting stress. Open responses were analysed qualitatively using directed content analysis. Study 1 demonstrated that the telepractice HMTW group intervention was feasible. Results indicated that delivery to larger parent groups was viable, with potential to improve parent and child social communication. Study 2 results demonstrated increases in parental responsiveness and child social communication following participation in telepractice HMTW. Parents reported satisfaction with HMTW and the telepractice approach; increased insight into their own behaviours and their children’s behaviours; positive changes in strategy implementation and confidence; and improvements in child communication, responsiveness, interaction, and play. There were no significant differences in pre- to postintervention parental stress levels. The results of this research support the application of telepractice for delivering the HMTW group intervention. Social communication outcome measures found that participation in telepractice HMTW led to improvement in parent and child social communication. Parent perception measures revealed that telepractice HMTW was acceptable and perceived to have positive outcomes for both parents and children. Expanding telepractice service delivery from individual- to group-based intervention has the potential to increase service choice for families and to mitigate service access barriers. The findings highlight the importance of pursuing ongoing service innovations and evaluating service user perceptions.
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    Psychologically Informed Practice in Hearing Healthcare: Perspectives and Needs of Clients and Audiologists
    Laird, Emma Carmel ( 2022)
    For many people, the sense of hearing provides a connection with others and the world around them. Losing one’s hearing can have a deleterious impact on many psychological and social aspects of life. Hearing loss can compromise psychological wellbeing, resulting in an increase in loneliness or reduced self-esteem, and it can also increase the odds of experiencing psychological symptoms, such as depression and anxiety. Given this association, audiologists are likely to encounter clients with psychological concerns on a regular basis. Understanding how these clients experience audiological rehabilitation may be an important way for audiologists to provide relevant and optimal services. Psychological factors, including mental health and illness, can also significantly influence the initiation, adherence, and success of audiological rehabilitation. Despite this, psychological factors are not adequately considered within hearing healthcare, so the recommended approach of person-centred care may need to be further extended to better address these factors. Psychologically informed practice (PIP) may provide a suitable framework that can be used to extend upon person-centred care, especially for clients with comorbid psychological symptoms. A PIP framework recognises the role of psychological factors in chronic health conditions and addresses these using psychological theories and frameworks. PIP has shown success in other rehabilitation settings and may therefore provide benefits within hearing healthcare. The aim of this thesis was therefore to explore the nature of mental illness, mental health, and psychological symptoms within audiological rehabilitation, from the perspective of clients and audiologists, and to provide a foundation of support for the implementation of PIP into hearing healthcare. Four studies were conducted to achieve the aims of this thesis. The first study included in-depth, semi-structured qualitative interviews to understand the experience of hearing loss and audiological rehabilitation for older adults with comorbid psychological symptoms. A novel theme found in this study was the bi-directional and cumulative relationship between hearing loss and psychological symptoms. Given the relationship between hearing loss and psychological symptoms, the second study included a systematic review and meta-analysis to determine the effect of interventions targeted at hearing loss on psychological symptom outcomes in adult clients. The meta-analysis showed that hearing aids, cochlear implants, and communication and education programs resulted in a small decrease in depression and anxiety symptoms. A mixed-method survey of audiologists working in adult audiological rehabilitation in Australia was then conducted to understand the nature of client-audiologist discussions about client mental health within audiological rehabilitation. This study found that audiologists occasionally discuss mental health, and clients are more likely than clinicians to initiate these conversations. The final study aimed to determine the barriers and facilitators to audiologists discussing and addressing client mental health, and to determine audiologists’ preparedness and willingness to implement aspects of PIP in audiological rehabilitation. Audiologists were generally motivated to incorporate PIP into audiological rehabilitation; however, a lack of knowledge about mental health and organisational barriers, such as time and resources, would need to be overcome. Overall, the studies in this thesis provide an understanding of how psychological symptoms are experienced, recognised, discussed, and addressed within audiological rehabilitation and suggested that the current way of delivering audiological rehabilitation is insufficient to achieve optimal outcomes for clients with psychological symptoms. These studies form an evidence-based foundation and rationale for the implementation of PIP within hearing healthcare.
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    A qualitative longitudinal study exploring adjustment experiences post laryngectomy
    Chapman, Penelope Kate ( 2021)
    Background: A total laryngectomy operation involves the surgical removal of the larynx for management of advanced laryngeal or hypopharyngeal cancer. A total laryngectomy nearly always has a profound impact on a person’s life. There are significant physical and functional changes as well as psycho-social consequences to adapt to post-operatively. There is currently a paucity of qualitative longitudinal laryngectomy studies exploring the phenomenon of lived experiences in the first six months post laryngectomy. Aim: To investigate the adjustment experiences of people in the first six months post laryngectomy. Methods: A qualitative longitudinal study was conducted. Participants planned for a total laryngectomy during August, 2018 – April, 2020 were recruited to the study. Each participant completed a distress screening using the Distress Thermometer and in-depth semi-structured interviews at two weeks post discharge, and at three months and six months post operation. Inductive Thematic Analysis method was chosen following the six phases described by Braun & Clarke, 2014, to analyse the data. Results: Of the six participants in the study, 14 distress screenings and in-depth semi-structured interviews were conducted and analysed (complete data sets were obtained for four participants). Distress levels were high in the pre and immediate post-operative weeks but little or no distress were reported in the longer term. Three phases of adjustment were identified; Phase one – Not normal life; Phase two – Never going to be the same again; and Phase three – Just get on with it. Clinical implications of results: The insights from this study can lead to improved clinical practice regarding assisting people in the early phases of adjustment. Targeted education, supportive care and independence care training are essential and positively impacts adjustment.
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    Motor speech phenotype of Huntington’s disease: A potential clinical marker in the premanifest phase
    Chan, Cheuk Sze Jess ( 2021)
    Huntington’s disease (HD) is an inherited neurodegenerative condition caused by a mutation in the HTT gene coding for the protein Huntingtin. The autosomal dominant inheritance nature of HD makes it amenable to diagnostic and predictive genetic testing. HD is characterised by movement disorder, cognitive and psychiatric symptoms. A formal diagnosis of manifest HD is indicated by the phenotypic appearance of unequivocal movement disorder in carriers of expanded HTT gene. Prior to diagnosis of manifest HD, carriers of the expanded HD gene may show subtle changes in their fine motor skills, cognition, behaviour, and speech. The premanifest phase of HD (PreHD) may be an optimal time for introduction of disease-modifying drug trials, based on an assumption that the brain is most receptive to therapeutic changes in that period. Various intervention methods are in development, but one of the challenges in clinical trials, however, is the lack of easily accessible, sensitive and measurable biomarkers to improve onset detection accuracy, provide routine monitoring of disease progression, and evaluate intervention efficacy. The thesis explored the use of acoustic speech as a potential biomarker of HD, by (i) identifying speech symptoms in the premanifest and manifest phases of HD, (ii) examining speech stimuli and digital speech metrics that are sensitive in detecting speech changes in people carrying the expanded HD gene, and (iii) evaluating the reliability and speech metrics of speech across multiple assessment intervals. Speech was analysed perceptually and objectively, and measures of articulatory agility, voice quality, and prosody (speech-timing) were extracted and compared between people with premanifest HD, manifest HD and healthy controls. Speech outcomes were correlated to other clinical measures of motor function, fine motor performance, cognitive abilities and disease burden. A 6-month longitudinal speech investigation was also conducted to evaluate the reliability and stability of speech in PreHD. Findings from experimental studies in the thesis indicated speech differences between PreHD and control groups were audible to expert listeners (i.e., speech pathologists) using perceptual assessment of speech (Chapter 4). Objective acoustic analysis revealed speech differences on measures of articulatory agility and speech-timing between PreHD and healthy controls, but these differences are only observed in speech tasks that required a higher level of cognitive load and motor effort (Chapter 5). Speech tasks and speech metrics shown to be sensitive, reliable, and stable in PreHD and healthy controls were identified in the final chapter of this thesis (Chapter 6). Overall, these studies have explored the potential for acoustic speech measures to be utilised in clinical settings as behavioural markers of disease. The validation of speech as markers requires further research in the field, however, the thesis has provided some data on using speech to monitor disease progression and evaluate treatment efficacy in premanifest and manifest HD.