Objective and perceptual comparisons of two bluetooth hearing aid assistive devices

Purpose: With the advent of Bluetooth technology, many of the assistive listening devices for hearing have become manufacturer specific, with little objective information about the performance provided.

Method: Thirty native English-speaking adults (mean age 29.8) with normal hearing were tested pseudo-randomly with two major hearing aid manufacturers’ proprietary Bluetooth connectivity devices paired to the accompanying manufacturer’s specific hearing aids. Sentence recognition performance was objectively measured for each system with signals transmitted via a land-line to the same iPhone in two conditions.

Results: There was a significant effect of participant’s performance according to listening condition. There was no significant effect between device manufacturers according to listening condition, but there was a significant effect in participant’s perception of “quality of sound”.

Conclusions: Despite differences in signal transmission for each devise, when worn by participants both the systems performed equally. In fact, participants expressed personal preferences for specific technology that was largely due to their perceived quality of sound while listening to recorded signals. While further research is necessary to investigate other measures of benefit for Bluetooth connectivity devices, preliminary data suggest that in order to ensure comfort and compatibility, not only should objective measures of the patient benefit be completed, but also assessing the patient’s perception of benefit is equally important.

• Implications for Rehabilitation

• All professionals who work with individuals with hearing loss, become aware of the differences in the multiple choices for assistive technology readily available for hearing loss.

• With the ever growing dispensing of Bluetooth connectivity devices coupled to hearing aids, there is an increased burden to determine whether performance differences could exist between manufacturers.

• There is a growing need to investigate other measures of benefit for Bluetooth hearing aid connectivity devices that not only include objective measures, but also patient perception of benefit.

     

The Vicissitudes of a Training Therapy

The author has given an account of a training therapy with a patient who had a very tenuous start in life, having spent three months in an incubator in a neonatal unit, where she suffered life-threatening conditions and complications. Various difficulties, which can be particularly relevant to a training therapy, are described – in particular narcissistic issues on the part of the therapist, such as the wish for the trainee's success and the consequent pride in what can feel like a joint achievement. However, issues of identification and envy can also be very relevant to this particular work and some clinical examples have been cited. Furthermore, the author has highlighted the particular difficulties of publishing clinical material regarding patients, especially so with reference to training patients, where ethical issues require special consideration. The purpose of this paper lies in an effort to identify the rewards and pitfalls of working intensively with a trainee who is undergoing a psycho-dynamically based training. It also explores the complexities in publication, even when the patient specifically requests to be written about.     

Axonal damage in the spinal cord of multiple sclerosis patients detected by magnetic resonance spectroscopy.

Axonal damage is a major factor contributing to permanent disability in patients with multiple sclerosis (MS); it has been extensively investigated in the brain using magnetic resonance spectroscopy (MRS). In this study, MRS was used to investigate the degree of neuronal damage in the cervical spinal cord in MS. Spectra were acquired from spinal cord and brain in 11 patients with MS (expanded disability status score [EDSS], range 2.5-7.0) and 11 controls. Brain lesion volume and spinal cord cross-sectional area were measured. Concentration of the neuronal metabolite N-acetyl-aspartate ([NAA]) was reduced in the spinal cord in MS patients relative to controls (reduced by 32%, P < 0.05), indicating significant neuronal damage. Additionally, the spinal cord was significantly atrophied in MS patients (15%, P < 0.001). No significant reduction in brain [NAA] was seen in the MS group. There were no correlations between clinical measures and cord atrophy or brain lesion volume on MRI; however, spinal cord [NAA] correlated with the cerebellar subscore of the neurological assessment (P < 0.005), while brain [NAA] correlated with disease duration (P < 0.05). MRS demonstrated cellular damage within the cord over and above the tissue atrophy seen by MRI. Combining MRI and MRS may therefore give a more complete picture of neurodegeneration in the spinal cord.     

Major Adverse Limb Events and Mortality in Patients With Peripheral Artery Disease: The COMPASS Trial

Background

Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There is limited information on the prognosis of patients who experience MALE.

A QUESTION OF ABSENCE

This paper was written in an effort to process rather extreme countertransference reactions to an ‘absent’ patient, i.e. one who attended her twice-weekly psychotherapy only sporadically. At times she did not come for up to several months and consequently a serious debt would accrue. However, it was not so much the amount owing but rather the constant cancellations, with seemingly ‘rational’ excuses about her non-attendance that would provoke an intense frustration accompanied, at times, by furious, almost sadistic countertransference feelings. The patient kept her therapist ‘dangling in uncertainty’ ( Brenman Pick, 2002 ), which the author considered to be a reflection of the patient's inner sado-masochistic object world. The author attempts to make sense of her countertransference in the light of the patient's early relationships and subsequently forms a hypothesis that the absences have been necessary to convey, very powerfully, experiences that may not have been communicated by regular attendance. Finally, the author offers her ‘Afterthoughts’ in the light of developments since the patient has read the paper and given her permission for publication.