Ten Advances in Cochlear Implant Technology and Services

By: Jace Wolfe, PhD

Over the past several years, there have been numerous advances in cochlear implant technology and services. As recent as a decade ago, there were little to no technological solutions available to assist a cochlear implant candidate/recipient, who presented with severe to profound hearing loss, with speech recognition in difficult listening situations—understanding speech in noisy and reverberant settings, over the telephone or television, and when spoken from a distance. Today, cochlear implant manufacturers offer a wide variety of solutions to meet the needs of patients with hearing aids or cochlear implant processors who struggle to communicate. This article identifies ten ways in which cochlear implant technology and services have evolved and improved in the past few years.

10. Automatic scene classification: Hearing aids have featured acoustic scene classifiers for almost a decade. Through these systems, hearing aids classify an environment as one that possesses background noise, speech in quiet or in noise, music, wind, and so forth. Once the listening situation is classified into one of these environments, the hearing aid selects the appropriate form of signal processing that will theoretically optimize performance in the given environment. This technology can be quite valuable as many users are unlikely to manually switch to programs designed for specific, challenging situations. Furthermore, this system will likely be well-received by cochlear implant users as it makes its way to implant sound processors.

9. The development of new speech recognition materials that provide a more realistic assessment of how hearing aid and implant users perform in real-life listening situations: Cochlear implant technology has improved so much that many users score near 100% correct on sentence recognition tests in a quiet environment with a single talker who is male and speaks at a slow to moderate rate. Additionally, many hearing aid users who struggle substantially in realistic situations also often score too well on these tests to meet the indications for cochlear implant candidacy. This fact makes it difficult to distinguish between excellent implant and hearing aid users and good users who may benefit from additional services.

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Reflections on 10 years at Plural

An interview with Plural President, Angie Singh

Angie Singh

Angie Singh, Plural Publishing’s President

What is your favorite moment in Plural’s history?

“My favorite moment occurred before Plural was incorporated. Some of the things we had most valued and had come to miss most in the ten years after the sale of Singular [the Singh's previous publishing house] were the close relationships, daily interactions and sense of purpose and commitment that we had shared with our authors.

One day, I received a call from longtime friend and Singular author Dr. Robert Sataloff, who suggested that we should start a new company. The idea intrigued my beloved husband and me but it also presented us with many challenges and concerns that included financial investment and the extraordinary time commitments that would alter and affect our lifestyle, especially with our eight year old twins.

We managed to overcome the most serious of concerns and embarked on a journey that became Plural Publishing. We were immediately pleased to learn that many of our past authors were eager to join us in the new venture. Ten years after founding Plural, I couldn’t be more gratified.” Continue reading

Featured Article: One New Year’s Resolution to Keep

One New Year’s resolution to keep – learn more about being an effective speech-language pathology assistant (SLPA) supervisor

by Plural author Jennifer Ostergren

If you are like me, as 2014 swings into full gear, you look to your newly inked New Year’s resolutions. One resolution on my list this year is to expand my knowledge and skills as an educator and supervisor of speech-language pathology assistants (SLPAs). Those of you with similar aspirations know that serving as an SLPA supervisor can be highly rewarding, but also challenging, especially given a lack of resources and tools specific to SLPAs. This year, however, the American Speech-Language-Hearing Association (ASHA) continues to expand its efforts in this area, with new programs, policies, and resources specific to SLPAs and their supervisors. In particular, ASHA’s new Practice Portal on the topic of SLPAs, located at http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/, is an excellent source of current information and resources on this topic. The sections that follow also highlight several key resources from ASHA that may be of help as well. Continue reading

Featured Article: The Challenge of Clinical Education in Speech-Language Pathology

By James M. Mancinelli, MS CCC-SLP and Evelyn Klein, PhD. CCC-SLP

This article provides an overview of important issues facing clinical training of graduate students today. In light of current training models, budget constraints, staffing shortages, and productivity demands, it is time to take a hard look at the requirements and demands set by our profession in the hopes of making needed changes

The 2005 and 2014 ASHA Standards require that the student enrolled in a Master’s degree program in Communication Sciences and Disorders (CSD) obtain 400 clinical hours “across the lifespan with varied disorders”: 375 hours in direct contact with the patient/client and 25 observation hours.  This is a broad guideline and superficially seems reasonable and achievable. After all, the requirement that the student obtain a specified number of contact hours in each of the disorders, with adults and children, in assessment and treatment have been removed. Unfortunately, the current service delivery contexts in which speech-language pathologists practice are all impacted by fiscal constraints, staffing shortages, and productivity requirements.  Although these three factors may not necessarily affect the quality of care, they are seriously impacting the ability to clinically train graduate students in CSD.  It is imperative that other models be developed for clinical education and training and that the discipline reviews the evidence that supports maintaining the status quo.  This is especially critical as some programs are being asked to admit more students into the graduate program, creating the need for even more external clinical practicum experiences. Continue reading

Feature Article: Toward a More Effective Collaboration

Toward a More Effective Collaboration by Aaron Fletcher, MD

2doctorsAs a discipline Otolaryngology has long recognized the benefits and virtues of a collaborative model of healthcare delivery. In fact, I believe that few other medical specialties collaborate as frequently and as effectively as Otolaryngologists—it is an integral part of our culture. On a daily basis, we are called to collaborate with specialists of diverse expertise (Audiologists, Speech and Language Pathologists, Neurosurgeons, Radiologists, Radiation Oncologist, Medical Oncologists and so on). In consulting these experts, we recognize the knowledge of these specialists as complimentary to our own and no less valuable. In fact, we frequently congregate in multi-disciplinary conferences where everyone has a say, and everyone’s opinion counts.

As our specialty embarks upon a changing healthcare landscape, we are constantly challenged to evolve our collaborative process in order to keep pace with the expanding application of technology across healthcare.This collaborative spirit is one of the major reasons that I enjoy this specialty. One of the things I appreciate most about Otolaryngology is the opportunity to learn the subtle nuances of a diagnostic finding, condition or technique that are afforded by colleagues and other members of the treatment team.  Throughout my very young career, I’ve found that better collaboration invariably leads to better care and that to be successful; collaboration requires shared vision, values, risks, resources, and rewards regardless of function, occupation or level of training. This is truly what collaborative care is all about.

communicationThe ubiquity of internet access via mobile devices and smartphones, along with the rise of social media has changed the way in which health care information is distributed and consumed. This factor has allowed patients ample access to information about their health conditions and associated treatment options. A recent Pew Internet research study found that one in three adults have turned to online sources to figure out a medical condition that they or someone else they know might have1. Combining these internet resources with expanded mobile network technology means that patients are increasingly capable of seeking answers to their healthcare questions instantaneously. This means that patients are now empowered to become more active participants in their care, and this is certainly a good thing.

On the other hand, these factors also exert pressure upon caregivers to keep pace with these changes in health related information consumption by increasing technological sophistication and improving their own access to medical knowledge. By doing so, we are better suited to meet the demands of a patient population that is better equipped to make important healthcare

As the application of technology across the healthcare landscape has led to a greater sense of empowerment among patients, advancements in health IT, (including electronic health records, cloud computing and health information exchange platforms), also hold great promise for clinicians. The advent of these tools has empowered clinicians to mobilize and share clinical information with members of the treatment team at any time and from any location with internet access. Given the intrinsic collaborative nature of our field, it makes perfect sense that we leverage these technologies to expand our approach to coordinating collaborative care. HIPPA compliant hosting and file sharing networks are now working to mitigate the risk of exchanging protected health information (PHI) via the web and mobile devices. These networks work to encrypt PHI both in storage and in-transit, thereby providing a layer of protection against breaches in security. While these platforms should be used with caution to ensure compliance with HIPPA regulations, as these tools continue to evolve, they will create new opportunities for collaboration and partnership across traditional institutional and geographic boundaries.

Naturally, I believe that Otolaryngologists should be at the forefront of integrating these tools into clinical practice, as we continue to seek new ways of perfecting collaborative care.  I believe ubiquitous data accessibility and sharing (cloud computing) coupled with HIPPA-compliant hosting platforms have the ability not only to facilitate, but to enhance the way we collaborate. Using these tools we can share best practices and treatment protocols, coordinate video conferences with colleagues outside our geographic area, and obtain outside expertise about challenging cases. These tools also allow us to interface with patients about their care, and to provide them a portal to share relevant updates on their condition from the comfort of their home. All of these efforts are critical to the long-term success of our collaborative efforts as a specialty, and familiarity with the tools by which we accomplish these aims is imperative.

So as we embark upon a continually evolving paradigm of healthcare consumption and delivery, we must continue in the spirit of collaboration, and seek out the new tools of our trade.  By doing so, we can continue to demonstrate that better collaboration leads to better care.

References:

1.            Fox, Susannah, Duggan, Maeve: Health Online 2013. Accessed online via http://  pewinternet.org/Reports/2013/Health-online.aspx

 

Dr. Fletcher is the author of the just-published Comprehensive Otolaryngology Review: A Case-Based Approach Fletcher_COR

Feature Article- Preclinical Speech Science: A Cool Stroll through the Forest

Preclinical Speech Science: A Cool Stroll through the Forest
by Gary Weismer & Jeannette Hoit

forest

Every discipline has its “trial by fire” entry-level courses; in the field of speech-language pathology, the speech science course is one of those. Students often see speech science as a walk across the hot coals of anatomy,  physiology, and acoustic output of the speech apparatus.  Our view is that it should be more like a stroll through a beautiful forest, with vegetation and wildlife that is so interesting you can’t help but stop and admire it, ooh and ah over the relationship between structure and function of a plant here, an animal there, and want to remember the details of this new and intricate world because you just know that understanding it will be useful to you in the future.

Preclinical Speech Science, Second EditionThere have been many great speech science textbooks over the years, and almost certainly many more to come.  When we set out to write the first edition of Preclinical Speech Science:  Anatomy, Physiology, Acoustics, Perception, we asked ourselves the question, ‘Why write yet another speech science text?’  Our answer was that we wanted to  1) present the kind of beautiful images, coordinated with easy-to-read, straightforward text, that would make students want to stroll, stopping frequently, through this beautiful forest of knowledge that is the back country of speech-language pathology,  2) expand greatly on the ‘other A&P’ (Acoustics and Perception),  3) update the speech physiology to include contemporary notions about how speech production works, and why it has clear relevance to the speech-language pathologist’s daily practice, 4) include examples of clinical applications of speech science in the forms of clinical scenarios and sidetracks, and 5) integrate the fundamentals of the anatomy and physiology of human swallowing, a knowledge base that has become increasingly important over the years in the training of speech-language pathologists. We also wanted an accompanying workbook that would contain problems ranging from the easy, memorization type to those requiring a fair amount of thought.

But every rose has its missing petals, as did ours, which even those who admired our text were quick to point out. Our missing petal was a chapter on the brain. The National Institutes of Health (NIH), in coordination with other government agencies, had identified the period between 1990 and 2000 as “The Decade of the Brain,” and indeed during those ten years there was an explosion of research on the relationships among neuroanatomy, neurophysiology, brain lesions in a host of diseases, and behavior. brainThis explosion was heard throughout the speech science world as well, and continues to resonate with speech-language professionals to the present day. The brain processes underlying speech and language behavior, both normal and impaired,
are under heavy scientific and clinical scrutiny and speech-language pathologists need to be well-versed in this area.  With an ever-increasing aging population and its associated neurogenic diseases and their potential to affect speech-language behaviors, most training programs are putting added emphasis on a deep understanding of brain structures and mechanisms as they relate to communication. So in our second edition of Preclinical Speech Science, we have tried to enhance the rose with a new petal—a full chapter devoted to neuroanatomy, neurophysiology, and brain processes and models specific to speech production and perception.  In preparing this chapter, we retained our devotion to high quality images and patient, comprehensive text to make those images relevant and highly accessible as a new source of knowledge for the student.  We also showed how contemporary models of brain function in speech production are relevant to the diagnosis and management of disorders such as dysarthria and apraxia of speech.

In our writing of the new edition of Preclinical Speech Science, we have also updated much of the information in the original chapters, fixed mistakes, and prepared a new workbook to accompany it.  We urge you to give it a try, stop to smell the anatomical,  physiological, acoustic and perceptual roses in the forest.  If you allow your eyes to linger for a while on the wonderful images drawn by Maury Aaseng and think about what’s written in the text, we think you’ll find the ground less like a bed of coals and more like a cool stroll.  And your knowledge of all things speech science will make you cool in the eyes of your fellow health care professionals!

Featured Article- Choral Pedagogy, Third Edition


CHORAL PEDAGOGY, 3RD edition

Brenda Smith, DMA and Robert T. Sataloff, MD, DMA

Choral Pedagogy 3rd

Singing is known to every culture around the world.   For most of us, singing skill is learned collaboratively in choirs.  To participate in a choir throughout a lifetime, we must adjust our vocal expectations and maintain a dynamic sense of readiness for the changes that occur from year to year.  The choral conductor must work nimbly to accommodate the vocal needs of each age group, including all singers at all times in assignments appropriate to the contributions they are able to make.  There are many challenges, but choral pedagogy, voice science and medical resources are equipped to assist the choral conductor in the creation of a dynamic rehearsal and performance plan.

Lifelong Singing

For the training of vocal skill, trained and amateur singers of any age benefit from the personal attention of a voice builder or choral conductor.  Each voice presents with a specific complement of unique set of vocal, aural, rhythmic and interpretative gifts.  Because singers perceive their voices differently the way they are perceived by their listeners, singers at any age rely on constructive feedback generated by the trusted ears and eyes of a qualified person.

choirChanges in range are a natural part of the aging process and are due to the loss of muscle bulk and alterations in connective tissue in the vocal fold, as well as to respiratory changes, blood flow and alterations in body muscle nerve condition, and other alterations.  Another factor is the ossification of laryngeal cartilages.  The degree of aging changes varies from singer to singer.  People who love to sing wish to be included in choral activities as long as possible.  Choral singing can be particularly beneficial for the preservation of vocal skill and for delaying the inevitable losses of range, control and agility.

 

Medical Aspects

While choral conductors are not expected to have the medical knowledge of physicians, they should have sufficient familiarity with vocal health problems to recognize at least obvious voice dysfunction and suggest that afflicted singers seek medical attention.  Medical voice care has advanced markedly over the last few decades.  Voice is now an established subspecialty of otolaryngology (ear, nose and throat), and expert care for singers is available much more widely than it used to be.

Good medical diagnosis in all fields often depends on asking the right questions and then listening carefully to the answers. This process is known as “taking a history.” Recently, medical care for voice problems has utilized a markedly expanded, comprehensive history, recognizing that there is more to the voice than simply the vocal folds. Virtually any body system may be responsible for voice complaints. In fact, problems outside the larynx often cause voice dysfunction in people whose vocal folds appear fairly normal and who would have received no effective medical care a few years ago.

Physical examination of a patient with voice complaints involves a complete ear, nose, and throat assessment and examination of other body systems as appropriate. In the last few years, subjective examination has been supplemented by technological aids that improve the ability to “see” the vocal mechanism and allow quantification of aspects of its function. With phonation at middle C, the vocal folds come together and separate approximately 250 times per second. Strobovideolaryngoscopy uses a laryngeal microphone to trigger a stroboscope that illuminates the vocal folds, allowing the examiner to assess them in “slow motion”. This technology allows visualization of small masses, and other abnormalities that are simply missed in vocal folds that looked “normal” under continuous light. The instruments contained in a well-equipped clinical voice laboratory assess six categories of vocal function: vibratory, aerodynamic, phonatory, acoustic, electromyographic, and psychoacoustic. State-of-the-art analysis of vocal function is extremely helpful in the diagnosis, therapy, and evaluation of progress during the treatment of voice disorders.

Following a thorough history, physical examination, and clinical voice laboratory analysis, it is usually possible to arrive at an accurate explanation for voice dysfunction. Of course, treatment depends on the etiology (cause). Fortunately, as technology has improved voice medicine, the need for laryngeal surgery has diminished. When the underlying problem is corrected properly, the voice usually improves, but collaborative treatment by a team of specialists is most desirable to ensure general and vocal health and optimize voice function. The choir director should be part of that team.  Details of medical problems associated with voice disorders may be found in other literature. 1-4

The Basics of Singing

Warm ups and cools downs are necessary for any singer.  Warm up and cool down exercises adjust the vocal instrument from speech to singing and from singing back to speech.  Warm ups and cool downs involve four elements: relaxation, posture, breathing and resonance.  Relaxation before and after singing contributes to vocal health.  The vocal mechanism and the extremities need to be stretched and warmed.  Good posture, both standing and seated, must be established in order to achieve a full breath.  Conductors should be mindful that singing in a seated position is not an easy task.  All singers should maintain an erect posture that allows maximum muscular freedom, flexibility and safety.   A buoyant, flexible approach to breath support during exhalation follows.  The final step to vocal readiness involves uniting the breath with the vocal sound.  Exercises that evoke resonant sounds, such as humming, trilling with the lips or sighing set the stage for a focused vocal tone.  In the process of cool down, singers return the voice to the speaking range by sighing, chanting or humming through the mid and lower registers.

singer

The role singing plays in the daily life of each singer is diverse and unique.  The rhythm and discipline of music learning sharpens mental acumen and memory. For choir members who maintain interests in acting and public speaking, singing can be a means of maintaining vocal strength and stamina.  For many, singing in a choir makes life worth living.  The overall musical results of a choir rehearsal may be of less importance than the good experience of being together for the task of singing.  Singers want to continue singing as long as they can and as well as they can.  Choral pedagogy is advancing to accommodate the special needs of singers of all ages.  By establishing good singing habits, remaining physically fit, setting reasonable goals, and attending to vocal health, choral singers can “stay in the game” for many decades.

References

  1. Sataloff, R.TProfessional Voice: The Science and Art of Clinical Care, Third Edition.  San Diego, CA: Plural Publishing, Inc.; 2005.
  2. Rubin, J., Sataloff, R.T. and Korovin, G Diagnosis and Treatment of Voice Disorders, Fourth Edition.  San Diego, CA: Plural Publishing, Inc.; 2013, in press
  3. Heman-Ackah, Y.D., Sataloff, R.T. and Hawkshaw, M.J.  Protecting the Vocal Instrument.  Narberth, PA: Science and Medicine; 2013.
  4. Smith, B. and Sataloff, R.T.  Choral Pedagogy and the Older Singer.  San Diego, CA: Plural Publishing, Inc.; 2012.