Developing ipad apps for diagnosis and rehabilitation of auditory processing dysfunction after TBI

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Sheryl Kelley
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1 Developing ipad apps for diagnosis and rehabilitation of auditory processing dysfunction after TBI Frederick (Erick) Gallun, PhD Research Investigator National Center for Rehabilitative Auditory Research (NCRAR) United States Department of Veterans Affairs and Associate Professor Dept. of Otolaryngology/Head & Neck Surgery Neuroscience Graduate Program, Oregon Health and Science University NATIONAL CENTER FOR REHABILITATIVE AUDITORY RESEARCH

2 The following represents the personal work of the authors and does not represent the official position of the VA or NIH

3 This research was supported by National Institutes of Health/ National Institute for Deafness and Communication Disorders and Dept. of Veterans Affairs Rehabilitation Research and Development Questions? Contact me at:

4 Thanks to My Collaborators Aaron Seitz, PhD Marjorie Leek, PhD Melissa Papesh, AuD/PhD Robert Folmer, PhD Samantha Lewis, PhD Eric Hoover, PhD Pamela Souza, PhD Kasey Jakien Sean Kampel, AuD

5 Recent Studies Showing Auditory Complaints and/or Difficulties After TBI and/or Blast Bressler et al. (2016). 'Sensory coding and cognitive processing of sound in Veterans with blast exposure', Hearing Research. Gallun et al. (2012). 'Performance on tests of central auditory processing by individuals exposed to high-intensity blasts', Journal of Rehabilitation Research and Development, 49: Gallun et al. (2016). 'Chronic effects of exposure to high-intensity blasts: Results on tests of Central Auditory Processing', Journal of Rehabilitation Research and Development, 53. Hoover et al (2015). "Competing views on abnormal auditory results after mild traumatic brain injury." SIG 6, Perspectives on Hearing and Hearing Disorders: Research and Diagnostics 19(1): Johnston et al. (2016). 'Auditory biological marker of concussion in children', Scientific Reports, 6: Oleksiak et al. (2012). 'Audiological issues and hearing loss among Veterans with mild traumatic brain injury', Journal of Rehabilitation Research and Development, 49: Saunders et al. (2015). 'Auditory difficulties in blast-exposed Veterans with clinically normal hearing', Journal of Rehabilitation Research and Development, 52:

6 Summary of Results Civilian and Military personnel who experience mild TBI are at risk for auditory dysfunction. The tests on which performance is poor will vary across individuals. Group mean performance is not the best predictor of the effects of brain injury on auditory dysfunction.

7 Clinical Implications A history of concussion and current auditory complaints can indicate auditory processing deficits that will not be visible on the audiogram. It is currently unknown what would be the best battery of tests, but it seems likely that both temporal processing and competing speech should be tested. At this time, little evidence is available on rehabilitation, although a recent study (Kokx-Ryan et al., 2016) reported that low-gain hearing aids can reduce patient complaints.

to researchers, clinicians, and the general public NIH/NIDCD R01 Efficient diagnostic tools for evaluating

8 Current Directions with Tests of Competing Speech Develop portable test platform for speech testing Establish normative functions relating age and hearing loss to speech-onspeech masking Make these tools available for free to researchers, clinicians, and the general public NIH/NIDCD R01 Efficient diagnostic tools for evaluating central auditory dysfunction ( ) spatialrelease/id ?mt=8

Current Directions with Auditory Perception

and the general public NIH/NIDCD R01 Efficient

9 Current Directions with Auditory Perception Develop portable test platform for measuring auditory perception Establish normative functions relating age and hearing loss to modulation thresholds Make these tools available for free to researchers, clinicians, and the general public NIH/NIDCD R01 Efficient diagnostic tools for evaluating central auditory dysfunction ( )

10 Central Auditory Processing involves both ascending and descending connections. Diagram of auditory brain areas of the cat Winer and Lee, 2007

11 What Can Be Done? The promise of Auditory Training We are actively pursuing the possibility that performance can be improved through auditory training, using portable, tablet-based video games. This approach has been successful with vision training, and we are in the process of developing games that can be used to train temporal, spectral, and spatial auditory abilities as well.

12 Rehabilitation Through Auditory Games with Aaron Seitz, PhD

13 Listen: An Auditory Training Experience

Future Research of the Gallun Lab Hearing Loss Brain Injury Aging 1) Portable Testing of Central Auditory Dysfunction 2) Characterization of Cognitive Abilities Important for Auditory Processing 3)

14 Future Research of the Gallun Lab Hearing Loss Brain Injury Aging 1) Portable Testing of Central Auditory Dysfunction 2) Characterization of Cognitive Abilities Important for Auditory Processing 3) Rehabilitation of Auditory Processing Through Gamified Training of Sensory and Cognitive Abilities (Attention and Sensory Memory) Sensory Processing Speech Understanding in Complex Environments Auditory Cognition Attention and Memory Situational Awareness

Auditory Processing & Rehabilitation Following Blast Exposure & Mild Traumatic Brain Injury (mtbi)

Auditory Processing & Rehabilitation Following Blast Exposure & Mild Traumatic Brain Injury (mtbi) Gabrielle Saunders, Frederick Gallun, Michele Hutter, Robert Folmer, M. Samantha Lewis, Melissa Frederick,