msha 2012 presentation-6€¦ · 2/10/2012 1 c. g. marx, au. d., ccc‐a edward goshorn, ph.d.,...
TRANSCRIPT
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C. G. Marx, Au. D., CCC‐AEdward Goshorn, Ph.D., CCC‐A/SLP
Alaina Simmons, B.S.
IntroductionThis study is about agreement between an electrophysiological measure of brain activity (P1) and behavioral measures of language capability in children
i.e. do they measure the same things?This study is not about whether or not a language treatment method is effective
Early (ABR) Middle
Late
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Maturation of Human Cortical Auditory Function
• Ponton, et al:Investigated maturation of cortical auditory function in normal‐hearing and children with CICollected P1, N1, P2 from different age groups of normal‐hearing and CI to evaluate morphological changesFinding: Normal hearing evolution‐‐‐‐P1, N1, P2 (adult‐like configuration) gradually appears during adolescence
Morphology changes from dominant P1 to adult‐ like appearance
…MaturationNormals and CI
P1 latency decreases with ageCI
P1 latency reaches adult values some 4.5 years later than normal hearingthe typical N1/P2 components were missing in all but the children implanted youngest in the studyThe delay in reaching adult‐like values may correspond to the average delay in receiving the implant or period of deafness prior to implantation
Abnormalities in central auditory maturation
Abnormalities in central auditory maturation in children with language‐based learning problems (LBLP)Gilley, et al
Compared AEPs of 26 children (6 to 13 yrs) with LBLP to 38 children without LBLP (5 to 12 yrs)17 of 26 LBLP subjects had abnormal CAEPs
compared to matched normals3 abnormal categories:
1. Delayed P1 latencies and absent N1/P22. Typical P1 but delayed N1 and P23. Generally low amplitude responses
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Research at USMThe Use of Late Auditory Evoked Potentials as a Physiological Marker for Improvement Following Therapeutic Intervention in Children with Language Disorders7 subjects ranging from 6 to 9 years of age (in 2010)
Each has hearing within normal limits from 500 – 4000 Hz.
…Research at USM: Late AEP Protocol
Channel 1: Cz – Right Mastoid with ground at FpzChannel 2: monitor eye movementStimulus: 40 msec /da/ at 60 dB nHL
Presented to right ear onlyAt least 200 samples per replicated trial
Obtained two trials with stimulus and two withoutSubtract channel 2 info (no stimulus) from stimulus trials to remove eye movement artifact
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…Research at USMChild watched video cartoons with no sound
to ensure attentiveness and minimize eye movementUsed Sharma et al. regression analysis to determine 95% confidence levels of P1 latency per age groupCompared changes in language assessment tools (TOLD‐P :4 & CELF‐4) with changes in P1 latency/amplitude following one year of therapeutic intervention
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P1 L
aten
cy (m
sec)
Age (years)
y = 155.6 + (-32.746 X LN(Age))Sharma (2002) RegressionEquation:
Rating Scales for Language TestsTOLD:P‐4Standard Score Rating>130 Very Superior121‐130 Superior111‐120 Above Average90‐110 Average80‐89 Below Average70‐79 Poor>70 Very Poor
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Rating Scales for Language Tests• CELF‐4• Standard Score Rating• 115 and above Above Average• 86‐114 Average• 78‐85 Marginal/Borderline/Mild• 71‐77 Low Range/Moderate• 70 and below Very Low Range/Severe
SUBJECTDAILY
MEDICATIONS
APRAXIA/ ARTIC
DISORDER
EXPRESSIVE LANGUAGE DISORDER
RECEPTIVE LANGUAGE DISORDER
AUTISM/ ASPERGER
ADHD/ DISRUPTIVE/ ANXIETY/
OCD
DYSLEXIA/ WRITTEN LANGUAGE DISORDER
AUDITORY PROCESSING DISORDER LOW IQ
ALLERGIES/ASTHMA
SENSORY IMPAIRED
FLOATING HARBOR SYNDR
HYPOTONIA/ BRAIN DE‐
MYELINATIONSWALLOW DISORDER
1 None X X X
2 None X X X X
3 Concerta X X X X X
4 Nasonex X X X
5 Hydroxyzine X X X
6 Strattera X X X X
7 Focalin XR X X X X X X
ResultsFirst, 2010 – 2011 data for each subject
AEP raw dataGraph: AEP P1 latency and amplitudeGraph: TOLD or CELF Composite Scores
Finally, a summary of the changes observed from 2010 –2011 for AEP and behavioral testing (TOLD & Self)
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p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value fo
r Units Sh
own Abo
ve Eac
h Bar
Subject 1: P1 Latency and Amplitude in 2010 and 2011
msecmsec
uVolts uVolts
NORMAL LATENCY
‐5
15
35
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75
95
115
spokenLang 2010
SpokenLang 2011
Listening2010
Listening2011
Organizing2010
Organizing2011
Speaking2010
Speaking2011
Grammar2010
Grammar2011
Semantics2010
Semantics2011
Com
posite Sco
re
SUBJECT 1: TOLD‐P‐4 Composite Scores on Each Sub‐Test in 2010 and 2011
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0
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140
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180
p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value fo
r Units Rep
rese
nted by Bar
Subject 2: P1 Latency and Amplitude for 2010 (no waveform in 2011)
Normal Latency
No DataFor 2011
No Data For 2011
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 2: TOLD‐P‐4 Composite Scores on Each Subtest in 2010 and 2011
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p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value fo
r Units Display
ed Abo
ve
Bar
Subject 3: P1 Latency and Amplitude for 2010 and 2011
msec
msec
uVolts uVolts
NORMAL LATENCY
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 3: CELF‐4 Composite Scores on Each Subtest in 2010 and 2011
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p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value fo
r units Sh
own Abo
ve Bar
Interval
Subject 4: P1 Latency and Amplitude for 2010 and 2011
msecmsec
uVoltsuVolts
NORMAL LATENCY
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 4: TOLD‐P‐4 Composite Scores on Each Subtest in 2010 and 2011
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0
20
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100
120
140
160
180
p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value fo
r Units Display
ed Abo
ve
Bar
Subject 5: P1 Latency and Amplitude for 2010 and 2011
msec msec
uVolts
uVolts
NORMAL LATENCY
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 5: TOLD‐P‐4 Composite Scores on Each Subtest in 2010 and 2011
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0
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40
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60
70
80
90
1 2 3 4
Num
erical Value
s for Units Sh
own Abo
ve Eac
h Bar
Subject 6: P1 Latency and Amplitude in 2010 and 2011
NORMAL LATENCY
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 6: TOLD‐P‐4 Composite Scores on Each Subtest in 2010 and 2011
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0
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80
100
120
p1Lat_2010 p1Lat_2011 p1Amp_2010 p1Amp_2011
Num
erical Value
s for Units Sh
own Abo
ve Eac
h Bar
Subject 7: P1 Latency and Amplitude for 2010 and 2011
‐5
15
35
55
75
95
115
Com
posite Sco
re
SUBJECT 7: TOLD‐P‐4 Composite Scores on Each Subtest in 2010 and 2011
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Latency (m
sec)
Subject Number
Latency and Amplitde for P1 in 2010 and 2011 for Each Subject
p1Lat_2010
p1Lat_2011
p1Amp_2010
p1Amp_2011
No Responsein 2011
‐25
‐20
‐15
‐10
‐5
0
5
10
15
1 2 3 4 5 6 7
Num
erical Value fo
r Units Rep
rese
nted by
Each Bar
Subject Number
Change from 2010 to 2011 in P1 Latency, P1 Amplitude, and Behavioral Average Composite Scores on Standardized Tests
Δ P1LAT
Δ P1AMPL
Δ BEHAV AVG COMPOSNR for P1 in 2011
Lat Criterion
Ampl Criterion
Behav Criterion
Agreement Between P1 & Behavioral Tests
SIG CHNG LAT SIG CHNG AMPL SIG CHNG BEHAVEITHER P1 MEAS AGREE w BEHAV
BOTH P1 MEAS AGREE WITH
BEHAV
NO NO NO YES YESYES YES NO NO NO
YES NO YES YES NO
NO NO NO YES YESNO YES YES YES NO
NO NO NO YES YES
NO NO NO YES YES# AGREE 6 4
Δ criteria: Lat > 15 ms PERCENT 86% 57%Ampl > 5uVBehav > 9 pts
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ConclusionsP1 measures and standard behavioral measures were in “good” agreement P1 shows promise as a marker of change associated with therapeutic interventionMore research is needed. What is the…
Optimum stimulusOptimum measure of a component (latency, amplitude, width, area, etc.)Optimum response (p1 or other)Optimum protocol
ReferencesGilley, P., Sharma, A., Dorman, M., & Martin, K. (2006). Abnormalities in central auditory maturation in children with language‐based learning problems. Clinical Neurophysiology , 1949‐1956.Hall, J. W. (2006). New Handbook of Auditory Evoked Responses. Boston: Pearson Education, Inc.Ponton, C., Don, M., Eggermont, J., Waring, M., & Masuda, A. (1996). Maturation of Human Cortical Auditory Function: Differences Between Normal‐Hearing Children and Children with Cochlear Implants. Ear and Hearing , 430‐437.Sharma, A., Dorman, M., & Spahr, A. (2002). A Sensitive Period for the Development of the Central Auditory System in Children with Cochlear Implants: Implications for Age of Implantation. Ear and Hearing , 532‐539.Sharma, A., Kraus, N., McGee, T., & Nicol, T. (1997). Developmental changes in P1 and N1 central auditory responses elicited by consonant‐vowel syllables. Electroencephalography and clinical Neurophysiology , 540‐545.Sharma, A., Martin, K., Roland, P., Bauer, P., Sweeney, M., Gilley, P., et al. (2005). P1 Latency as a Biomarker for Central Auditory Development in Children with Hearing Impairment. Journal of American Academy Audiology , 564‐573