Interactions between Hearing and Mobility during Realistic, Everyday Challenges

Transcription

1 Interactions between Hearing and Mobility during Realistic, Everyday Challenges Jennifer Campos CEAL Chief Scientist Toronto Rehabilitation Institute, UHN Associate Professor, University of Toronto, Psychology

2 Toronto Rehabilitation Institute - UHN Teaching and research hospital Fully affiliated with the University of Toronto 500 scientists, graduate students, research support Highly interdisciplinary

3 idapt Centre for Rehabilitation Research Challenging Environment Assessment Lab (CEAL) WinterLab WinterLab DriverLab StairLab Motion Platform StreetLab

4 HomeLab FallsLab CareLab

5 Multisensory Integration and Interactions

6 Vestibular Mobility is multisensory and requires sensorycognitive interactions Auditory Proprioceptive Visual

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8 Auditory Cues Support Self-Motion Perception and Mobility-Related Behaviours Perception of direction and distance Support balance Guide navigation (e.g. ecolocation) Affect driving and flying performance Contribute to motion sickness Campos et al., Hearing Research, 2018

9 Hearing Loss, Mobility, and Falls Individuals with even mild hearing loss have a 3x greater odds of falling than their age-matched peers (Viljanen et al., 2009; Lin et al., 2012; Jiam et al., 2016; Agmon et al., 2017). 1.4x greater odds of falling per 10 db of hearing loss (Lin et al., 2012)

10 Hearing Loss, Mobility Problems, and Falls Individuals with hearing loss more commonly report limitations related to mobility and agility (65%) than limitations in, communication (12%), memory (12%), or learning, (11%) (Statistics Canada, 2006). Those with hearing loss are more likely to develop difficulties with walking than those with normal hearing (Viljanen et al., 2009), walk slower and have poorer physical functioning (Chen et al., 2015), are at increased risk of frailty (Kamil et al., 2016). Use of hearing aids may improve balance (Rumalla, et al., 2014; Vitkovic et al., 2016; Shayman et al., 2017) Hearing loss is the number one potentially modifiable mid-life risk factor for dementia (Livingston et al., Lancet, 2017)

11 Age-Related Hearing Loss Hearing loss is the third most prevalent chronic health condition in older adults Estimated Prevalence by age: years old = 28.5% years old = 44.9% years old = 68.1% 80 years and older = 89.1% Lin, Niparko & Ferrucci, 2012

12 Hearing Loss and Falls Risk Higher Listening/ Cognitive Load Vestibular Loss Social Isolation/ Lack of Stimulation Hearing Loss = Risk of Falls? Why? Lack of Binaural Sounds Cues

13 Stops Walking While Talking Walking requires cognitive resources When cognitive capacity is taxed by hearing loss, doing two things at once becomes more difficult Stops walking while listening Ludin-Olsson et al. (1997) Beauchet et al. (2009)

14 Walking while listening during realistic, everyday challenges Kathy Pichora- Fuller UofT Karen Li Concordia Victoria Niebrowska Concordia Sin Tung Lau TRI, Laurier Alison Novak TRI Gurjit Singh TRI, Phonak

15 Walking while listening in younger and older adults with normal hearing Stimuli Virtual Toronto street crossing 3 people speaking 3 different sentences from 3 locations Tasks 1. Listening task alone 2. Walking task alone 3. Walking while listening (DUAL) Motion Tracking Niebrowska et al., 2018, J.Mot Behav

16 Listening Task Ready [callsign], go to [colour] [number] now Front Target Word Presented Hopper Left Right Target Sentence Ready Hopper go to White 2 Now Correct Response = White 2 Niebrowska et al., 2018, J.Mot Behav

17 Walking while listening in younger and older adults Manipulating Listening Effort Lower Effort = Certain target word location (100%) Hopper 100% Front Higher Effort = Uncertain target word location (60%) Left Right Niebrowska et al., 2018, J.Mot Behav

18 Walking while listening in younger and older adults Manipulating Listening Effort Lower Effort = Certain target word location (100%) Higher Effort = Uncertain target word location (60%) Hopper 40% Left Hopper 60% Front Right Niebrowska et al., 2018, J.Mot Behav

19 Listening Only Motion tracking Niebrowska et al., 2018, J.Mot Behav

20 Walking Only Motion tracking Niebrowska et al., 2018, J.Mot Behav

21 Outcome Measures Listening Performance % Correct (colour + number) Yaw Walking Performance Gait parameters Upper body rotation Roll Pitch Niebrowska et al., 2018, J.Mot Behav

22 Guiding Questions Are there age-related differences in dual-task costs? If so, do older and younger adults exhibit different dual-task tradeoffs? a) To listening performance? b) To walking performance? Which task is prioritized? Niebrowska et al., 2018, J.Mot Behav

23 Listening Performance Worse performance in older compared to younger adults Worse performance for uncertain (high load) locations compared to certain (low load) Dual-task costs to listening particularly in older adults Niebrowska et al., 2018, J.Mot Behav

24 Walking Measures Head Pitch More upright head position during dualtasking compared to single-task in older adults Niebrowska et al., 2018, J.Mot Behav

25 Walking Measures Stride Time Variability Less variable stride time during dualtasking compared to single-task in older adults Niebrowska et al., 2018, J.Mot Behav

26 Summary Age and dual-tasking Older adults displayed greater dual-task costs in listening than in walking. Older adults exhibited a more upright head alignment and less variability in stride time during dual-task compared to single task conditions. Older adults seemed to allocate cognitive resources toward gait over listening performance when cognitive demands were higher (e.g. Li, Lindenberger, Freund, & Baltes, 2001; Shumway-Cook et al., 1997). Niebrowska et al., 2018, J.Mot Behav

27 Older adults with hearing loss who use hearing aids 1. Listening alone 2. Walking alone 3. Listening while walking Front Left Lau et al., JAAA, 2016

28 Older adults with hearing loss who use hearing aids 1. Listening alone 2. Walking alone 3. Listening while walking Front Certain 100% Left Lau et al., JAAA, 2016

29 Older adults with hearing loss who use hearing aids 1. Listening alone 2. Walking alone 3. Listening while walking Front Uncertain 60% 40% Left Lau et al., JAAA, 2016

30 Results Hearing loss and dual-tasking Those with normal hearing were better able to perform the listening task than those with hearing loss. Both groups performed better under more certain conditions. The normal hearing group demonstrated a dual-task benefit to listening, whereas the hearing loss group did not Both groups demonstrated a more upright and less variable head position during dual-task conditions. Those with hearing loss demonstrated more overall stride time variability than those with normal hearing, which is associated with greater falls risk. Lau et al., JAAA, 2016

31 Hearing Loss and Falls Risk Higher Listening/ Cognitive Load Vestibular Loss Social Isolation/ Lack of Stimulation Hearing Loss = Risk of Falls? Why? Lack of Binaural Sounds Cues

32 Vestibular Sensitivity as a Function of Age and Hearing Status Sharon Cushing, Sick Kids Hospital Karen Gordon, Sick Kids Hospital/ UofT Kathy Pichora-Fuller, UofT Laurence Harris, York U Josh Gnanasegaram, TRI

33 Participants Younger adults without hearing loss Older adults (65+) without hearing loss Older adults with age-related hearing loss ** No known vestibular or cognitive impairments Baseline Measures Audiometry Otoscopy/Tympanometry Vestibular-Evoked Myogenic Potential (VEMP- otoliths) Video Head Impulse Test (VHIT- semicircular canals) Posturography (Centre of Pressure Path Length) Eyes open Compliant foam Eyes closed Ears closed

34 Movement Detection Task Psychophysical adaptive staircase Two movement profiles A. Heave (translation up and down) B. Pitch (rotation forward backward) Movement Detection Task: In which of two presented intervals did you move? Heave Pitch

35 Results - Psychophysics Detection Thresholds - Pitch * *

36 Results - Psychophysics Acceleration (m/s 2 ) * YANH OANH OAHL

37 Results - Posturography COP Length (cm) YANH OANH OAHL 0 Eyes Open Foam Eyes Open Foam, Eyes Closed And Ears Closed

38 Summary: Vestibular Sensitivity Older adults demonstrated reduced sensitivity in detecting heave motions than younger adults The hearing loss group demonstrated reduced sensitivity to heave and pitch detection compared to normal hearing peers. The hearing loss group demonstrated less stable standing balance, particularly under more challenging conditions.

39 Overall Summary Audition interacts with other sensory and cognitive processes to support mobility. Concurrent walking and listening produce different trade-offs at different cognitive levels and different levels of difficulty. Some individuals with age-related hearing loss may also have reduced vestibular sensitivity and poorer standing balance. Much can be learned about the link between hearing loss, mobility problems, and falls and the implications for effective interventions.

40 Applications and Interventions Routine screening for falls risk in individuals with hearing loss. Hearing screening in falls prevention clinics. Hearing devices, such as hearing aids should consider spatial sound cues that support self-motion perception under realistic acoustical, multisensory, and cognitive conditions. Training with these devices should include active exposure to and exploration of a broad range of realistic acoustical and multisensory conditions during mobility-related tasks. Awareness of dual-sensory loss and higher cognitive load.

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42 Acknowledgements and Collaborators Geoff Fernie Institute Director TRI John Butler Behrang Keshavarz Sin Tung Lau Bruce Haycock Mike Cinelli Laurence Harris Avril Mansfield Babak Taati Robert Ramkhalawansingh Josh Gnanasegaram Sharon Cushing Karen Gordon Nik Wolter Kathy Pichora-Fuller Karen Li