Background. Hearing aid hardware design challenges. Hearing aid hardware design challenges. Function. Hearing aid hardware design challenges

Transcription

1 Manual dexterity and hearing instrument hardware development Maria Grundtvig, MA Research Audiologist Audiology Development Research and Development GN ReSound Background Function Form Function No matter how pretty a hearing aid s form is desktop hearing aid Courtesy of Kenneth w berger hearing aid museum and archives No matter how well a hearing aid is functioning Courtesy of Oticon Eriksholm museum And opposite Lorgnette Courtesy of www. pbs.org

2 In the beginning Slowly both form and function got better Amplifiers at Bolling Field, 1921, National Photo Co Hearing aids had serious challenges with both form and function The smaller the better. Size is a very important factor in acceptance of hearing aids especially with first time users, and therefore an important factor of overall hearing aid success, but Size isn t everything

3 Older users Elderly users need hearing aids with a form that they can handle without major difficulties. A hardware design that is functional for them. Older users Handling difficulties Older users Handling difficulties Handling difficulties may lead to device-in-drawer syndrome. Difficulties or concerns about hearing aid handling increased anxiety reduced hearing aid usage. Difficulties or concerns about hearing aid handling incorrect or not full potential use lessened benefit rejection. Concerns about proper device handling is the 2nd most common reasons for hearing aid rejection (Weat & Smith 2007). 21% (Lupsakko, Kautiainen & Sulkava cases) of non-users state that their non-use is because their hearing aid is too difficult to use. Older users Handling difficulties With age, an increasing percentage of the hearing impaired patients have difficulties handling hearing aids (Erber 2004; Henrichsen et al 1988; Ward, Gowers & Morgan 1979). Older users Handling difficulties Handling is the only aspects that older users rate significantly more important than younger users do. (Henrichsen et al 1988; Meister et al. 2002)

4 Older users Handling difficulties Handling difficulties have increased frequency in the over 70 population, and an especially high frequency in the over 90 population. Despite counseling and education. (Parving & Philip 1991) Older users Handling difficulties 1. Likelihood of illness, disease, disability and/or cumulative effects is increased. 2. The normal ageing of the body results in decline of both mental and physical abilities. For instance: Vision deteriorates (visual acuity, accommodation, contrast sensitivity, color differentiation, sensitivity to light, depth perception, eyehand coordination, glare, dark adaptation.) Decrease in both gross motor (upper body and arm) and fine motor (hand and finger) strength, coordination, speed, reflexes, joint mobility, precision and tactile sensitivity. Manual Dexterity Manual Dexterity Manual Dexterity is lost. Adroitness in using the hands. Webster's Revised Unabridged Dictionary, published 1913 by C. & G. Merriam Co. Dexterity refers to fine motor skills in using one's hands. Manual Dexterity and hearing aids Manual Dexterity and hearing aids Manual dexterity and successful hearing aid use Kumar et al Is manual dexterity is a significant factor in determining successful hearing aid use? Manuel dexterity assessed by The Purdue Pegboard test Success assessed by questionnaire: Self-rate on 10 point scale total dissatisfaction to complete satisfaction with own hearing aid. self-rated 5 point scale on HA performance in 5 different situations. BTE group - a significant positive correlation between manual dexterity and success.

5 Manual Dexterity and hearing aids Questions Is it possible to predict peoples hearing aid handling level from their manual dexterity level? What are people having difficulties with and who are these people having handling difficulties? Is it inexperienced users? Is it people who also feel it is difficult to handle hearing aids? Is it people who imagine handling to be difficult or have low hearing aid handling confidence? 10 Clinical use Distinguish between users who have sufficient abilities (vision + dexterity + other) to manipulate and care for devices themselves. users who will need help with these daily hearing aid activities. Take handling explicitly into consideration, when selecting an appropriate hearing aid system for the user. Keep the possible handling difficulties in mind when planning and setting aside time for counseling and device training. Manufacturing use Ensure that the test subjects, we use when evaluating our hearing aid hardware designs, are non-bias and representative. Need to know, how best to test our hearing aid hardware designs. So we can discriminate between good and bad handling properties the aids. Test subjects Metode 57 test subjects From the GN ReSound database 29 in Copenhagen (CPH) 28 in Chicago (CHI) Gender Male 60% Female 40%

6 Test subjects Age Min age 61 Max age 85 Median age 73 Handedness 3 left handed (5%) 1 ambidextrous/ mixed handed (2%) 53 right handed (93%) Test subjects Motor No difficulties getting around on their own or using zippers 2% had difficulties putting on shoes and socks 4% had difficulties opening and closing buttons 1/3 had either difficulties with one or more of the activities above or a health condition that could contribute to poorer manual dexterity and handling difficulties Test subjects Vision Colenbrander Continuous Text Mixed Contrast Reading Card High Contrast for visual acuity Low Contrast for contrast sensitivity HC-LC difference Test subjects HC and LC vision spread 45% 40% HC 35% LC 30% 25% 20% 15% 10% 5% 0% 20/16 20/20 20/25 20/32 20/40 20/50 20/63 20/80 20/100 20/125 21% abnormal HC-LC difference HC-LC difference 73% 21% 5% Test subjects Test subjects Experience Hearing Aid experience 7 inexperienced users 50 Experienced users with an average of 6,7 years of experience Form factor experience 72% BTE/MBTE 60% ITE/ITC/CIC/IOT 65% Volume Control 61% Program Button 5% Remote Control

7 Tests The Purdue Pegboard Test (1999) The Measure of Audiologic Rehabilitation Self Efficacy for Hearing Aids test /MARS-HA (West & Smith 2007) Hearing Aid (HA) Handling test Subjective Ease of Hearing Aid Handling questionnaire The Purdue Pegboard test Developed in the 1940 s Originally: Test of manual dexterity for use when recruiting personnel for industrial jobs. Later: Also standardized for use in neuropsychological assessment and rehabilitation contexts. The Purdue Pegboard test The Purdue Pegboard test Dominant hand Non-dominant hand Both hands Dom+Non-dom+both Assembly 30 sec Summation 60 sec MARS-HA MARS-HA Measure of Audiologic Rehabilitation Self- Efficacy for Hearing Aids Basic handling Aided listening Adjustment Advanced handling I can remove a battery from a hearing aid with ease I can tell a right hearing aid from a left hearing aid 0-100% I cannot do this at all I am certain I can do this

8 Hearing Aid Handling test Hearing Aid Handling test 27 tasks 11 groups of tasks Remove dome from thin rube Attach dome to thin tube Hearing Aid Handling test Subjective ease of Hearing aid handling 5 point scale Very easy Very difficult Results General Results No significant differences between the CHI and the CPH group of test subjects on any of the tests or variables. But some differences in regression levels, that can be attributed to the differences in execution of the Handling test.

9 Results Is it possible to predict peoples hearing aid handling level from their manual dexterity level? Manual dexterity > Handling level CHI: Negative correlation between Hearing aid handling test and Purdue Pegboard test. Regression showed manual dexterity was the strongest predictor of HA handling. CPH: Negative correlation between Purdue Pegboard test and HA handling test. r= dom Nondom both Dom+ non+ both ass CHI -0,397-0,442-0,397-0,488-0,373 CPH -0,438-0,425-0,352-0,455-0,375 Results What are people having difficulties with? What are people having difficulties with? 1255 tasks 1239 correct 16 either incorrect (N=11) or given up (N=5) 10 failed by some What are people having difficulties with? Who are these people? Tasks that were failed 20% 15% 10% 5% 0% 1c 3b 5a 5b 6a 6b 7b 8b 9a 10c

10 Who are these people? Age Significant contribution to variation CPH (p=0.004) r = r 2 = CHI (p= ) r = r 2 = Who are these people? Experience Negligible correlation CPH r=0.070 CHI r=0.190 Vision Low correlation CPH r=0.271 CHI r=0.256 Who are these people? MARS-HA CPH moderate correlation r= CHI no correlation r= Clinical Judgment vs. MARS-HA R 2 = 0,3224 R 2 = 0, Who are these people? Subjective ease Low degree of correlation CHI r= CPH r= Total time score Clinical Judgement total time score Total time score CPH CHI MARS-HA total % score Subjective ease average rating Who are these people? Who are these people? MARS-HA + Age + Vision Significant (p = ) r 2 =0.45 Significance Correlation coefficient CPH (p) (r) MARS Age Vision

11 Who are these people? MARS + Subjective ease + Manual dexterity Significant (p = ) r 2 = 0.30 Conclusion Manual dexterity Handling difficulties Handling a hearing aid more than just a motor skills required CHI Significance Correlation coefficient (p) (r) MARS Subjective ease Man dex Hello I m having handling difficulties with my hearing aid In evaluating hearing aid hardware design Further exploration Who are these people? High level hearing aid handling performers low level performers? CEU code Reference Questions? Destosiers, J.; Hérbert, R.; Bravo, G. & Dutil, E The Purdue Pegboard Test: normative data for people aged 60 an over. Disability and rehabilitation. Vol 17. no 5. pp Erber, N. P Use of hearing aids by older people: influence of non-auditory factors. International journal of audiology. 42: 2S21-2S25 Hardin, M Assessment of hand function and fine motor coordination in the geriatric population. Top Geriatric Rehabilitaiton. 18(2):

12 Reference Haigh R The ageing process: a challenge for design. Applied Ergonomics, 24 (1), Hackel M. E., Wolfe G. A., Bang S. M. & Canfield J. S Changes in hand function in the aging adult as determined by the Jebsen test of hand function. Physical Therapy. Volume 72. Number 5. May. Pp / Kumar et al Manual dexterity and successful hearing aid use. The Journal of Laryngology & Otology, August, Vol 114, pp Reference Lupsakko T. a, Kautiainen H. J & Sulkava R The non-use of hearing aids in people aged 75 years and over in the city Kuopia in Finland. Eur Arch Otorhinolaryngol. 262: Meister H., Lausberg I., Kiessling J., Wedel, H. V. & Walger M Identifying the needs of elderly, hearing-impaired persons: the importance and utility of hearing aid attributes. Eur Arch Otorhinolaryngol. 250: Refrences Parving A. & Philip B Use and benefit of hearing aids in the tenth decade and beyond. Audiology. 30: Henrichsen, J.; Noring E.; Christensen, B; Pedersen, F. & Parving A In-the-ear hearing aids. Scandinavian Audiology. 17: Parving, A. & Boisen, G In-the-canal hearing aids. Scandinavian Audiology. 19: Refrences Stephens S. D. G & Meridith R Physical handling of hearing aids by the elderly. Acta Otolaryngol, Suppl. 476: pp The Purdue Pegboard test Model # Lafayette Instruments. Tiffin, J. & Asher, E. J The Purdue Pegboard: Norms and studies of reliability and Validity. Journal of applied psychology. 32; Reference Ward P. R. & Gowers J. I Fitting hearing aids: the effects of method of instruction. British Journal of Audiology, 14, Ward P. R., Gowers J. I. & Morgan D. C Problems with handling the BE10 series hearing aids among elderly people. British journal af audiology. 13; West R. L & Smith S. L Development of a hearing aid self-efficacy quesionnaire. International journal of audiology, 46: Contact mcgrundtvig@gnresound.dk