Search Results (24)

Background and Clinical Significance: Avatar Therapy (AT) for individuals with treatment-resistant auditory verbal hallucinations (AVHs) in schizophrenia aims to address emotional responses, beliefs about voices, self-perception, and coping strategies. This study focuses on three participants who, during AT, shifted their belief about the origin of their most distressing voice from an external source to a self-generated one. Case Presentation: The objective of this study was to explore the evolution of the reattribution of the participants’ most distressing voice to oneself during AT and the patients’ perception of this reattribution. Immersive sessions and semi-structured interviews were transcribed and qualitatively described to provide a session-by-session account of the evolution of each participant’s AVH reattribution to themselves during the course of AT, along with their perceptions of this reattribution. This process led to the recognition that initially perceived as external voices were internally generated thoughts, reflecting how participants viewed themselves. Two participants reported a reduction in AVH severity. All three described positive changes in how they related to their voices and self-perception. Additional improvements were observed in emotional regulation, social functioning, and engagement in personal projects. Conclusions: This reassignment of the voice from an external source to an internal one suggests that AT can modify how individuals relate to their voices and may empower them to regain control over their hallucinations. However, given the exploratory nature of this study, the results should be interpreted as examples. Full article

Contemporary phonetics and speech therapy continuously seek new techniques and methods that could contribute to improving verbal communication for individuals with speech disorders. One such phenomenon, Delayed Auditory Feedback (DAF), involves the speaker hearing their own voice with a specific delay relative to real-time speech. Although the research presented in this study was conducted on healthy individuals, it offers valuable insights into the mechanisms controlling speech, which may also apply to individuals with speech disorders. This article introduces a novel method and measurement setup, focusing on selected key speech signal parameters. To characterize the impact of Delayed Auditory Feedback (DAF) on fluent speakers, speech signal parameters were measured in 5 women and 5 men during spontaneous speech and reading. Parameters such as speech rate, fundamental frequency, formants, speech duration, jitter, and shimmer were analyzed both during and prior to the application of DAF. The results of this study may find practical applications in the field of telecommunications, especially in improving the efficiency and quality of human communication. Full article

Background: Primary progressive aphasia (PPA) is a neurodegenerative disorder that worsens over time without appropriate treatment. Although referral to a speech and language pathologist is essential for diagnosing language deficits and developing effective treatment plans, there is no scientific consensus regarding the most effective treatment. Thus, our study aims to assess the efficacy and safety of various therapeutic interventions for PPA. Methods: Google Scholar, PubMed, Web of Science, and the Cochrane Library databases were systematically searched to identify articles assessing different therapeutic interventions for PPA. To ensure comprehensive coverage, the search strategy employed specific medical subject headings. The primary outcome measure was language gain; the secondary outcome assessed overall therapeutic effects. Data on study characteristics, patient demographics, PPA subtypes, therapeutic modalities, and treatment patterns were collected. Results: Fifty-seven studies with 655 patients were included. For naming and word finding, errorless learning therapy, lexical retrieval cascade (LRC), semantic feature training, smartphone-based cognitive therapy, picture-naming therapy, and repetitive transcranial magnetic stimulation (rTMS) maintained effects for up to six months. Repetitive rTMS, video-implemented script training for aphasia (VISTA), and structured oral reading therapy improved speech fluency. Sole transcranial treatments enhanced auditory verbal comprehension, whereas transcranial direct current stimulation (tDCS) combined with language or cognitive therapy improved repetition abilities. Phonological and orthographic treatments improved reading accuracy across PPA subtypes. tDCS combined with speech therapy enhanced mini-mental state examination (MMSE) scores and cognitive function. Several therapies, including smartphone-based cognitive therapy and VISTA therapy, demonstrated sustained language improvements over six months. Conclusions: Various therapeutic interventions offer potential benefits for individuals with PPA. However, due to the heterogeneity in study designs, administration methods, small sample sizes, and lack of standardized measurement methods, drawing a firm conclusion is difficult. Further studies are warranted to establish evidence-based treatment protocols. Full article

Background: Early intervention approaches play a critical role in shaping the communication outcomes of children with hearing loss, influencing their language development and overall learning trajectory. Objectives: The main objective of this study was to compare the communication outcomes of children with hearing loss who received Listening and Spoken Language-South Africa (LSL-SA) with those who received Traditional Speech-Language Therapy (TSLT). Methods: A retrospective record review was conducted to gather data on communication outcomes from participants’ speech-language therapy records. Communication outcomes were measured using standardized assessments evaluating speech intelligibility, expressive vocabulary, receptive language, expressive language, audition, and cognitive–linguistic skills. The data were analyzed using quantitative statistics. Key statistical methods included measures to determine associations, identify statistical significance, determine outcomes, and compare differences between the two groups. Results: The study found that children in the LSL-SA group had statistically significant better communication outcomes, with 63% achieving age-appropriate speech intelligibility compared to 45% in the TSLT group (p = 0.046). Similar trends were observed for expressive vocabulary (LSL-SA: 58% vs. TSLT: 39%, p = 0.048) and receptive language (LSL-SA: 60% vs. TSLT: 39%, p = 0.043). Additionally, 66% of children in the LSL-SA group were recommended for mainstream schooling, compared to 39% in the TSLT group (p = 0.0023). These findings highlight the importance of early amplification and structured intervention in improving communication outcomes. The results also emphasize the importance of Early Hearing Detection and Intervention (EHDI) in decreasing the odds of delay in communication outcomes, irrespective of the type of communication approach, although a higher proportion of children in the LSL-SA approach group achieved age-appropriate communication outcomes than those in the TSLT group. Conclusions: This study highlights that communication intervention approaches aligned with the LSL-SA practice promote better communication development and enhance spoken language outcomes in children with hearing loss, facilitating successful transitions to mainstream schooling. Contribution: This study provides contextually relevant evidence for implementing an LSL-SA intervention approach for children with hearing loss. The implications of these findings for clinical practice and future research are discussed in detail. Full article

Background/Objectives: Early pediatric cochlear implantation positively impacts early language outcomes. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation and factors influencing variability among cochlear implant (CI) users. This article outlines participants’ background, early language outcomes, and multidisciplinary study protocol. Methods and Materials: Individuals aged 12–22 received CIs before 30 months of age, followed-up at the same hearing implant center, and adhered to a standard school curriculum were invited to participate. Out of 109 eligible CI users, 50 participated; 46 agreed to undergo clinical assessments, while four completed questionnaires only. Results: The mean age at the first CI was 15.63 months (SD = 6.0). All but one communicated with spoken language(s). Participants attended mainstream schools and had highly educated parents. Over half (56%) had received Auditory Verbal Therapy in early childhood. Earlier implantation correlated with better language understanding one year post-CI. Conclusions: Earlier implantation was associated with better early language outcomes, with parental education level and early family-centered intervention likely contributing. Future sub-studies will investigate multidisciplinary long-term effects of pediatric cochlear implantation in adolescents. Full article

Background: Auditory Verbal Therapy (AVT) has spread globally in the past few years due to its proven positive effect as a rehabilitation method for children with hearing loss (HL). In 2023, a three-year hospital-based AV intervention was implemented in Denmark as a government-funded offer to all children with HL. In the present study, we introduce and study a protocol for facilitating this implementation with a specific focus on clinical applicability and quality assurance. Methods: A working group was set up to drive the implementation process and establish a base for clinical collaboration and coproduction. The final protocol included (1) regular workshops and meetings with all AV specialists, (2) the creation of a database to collect data on the effect of the intervention, and (3) mandatory testing of the auditory skills and receptive vocabulary of the children with HL and a screening of their behavioural and emotional status with the Strengths and Difficulties Questionnaire (SDQ). Results: Data from 53 children with a mean age of 6.6 years were analysed in this study. Results from the SDQ showed that the children scored like the Danish norm on both the SDQ total difficulty score and SDQ prosocial score. Conclusions: This study’s findings indicate that children with HL, who participated in three years of hospital-based AV intervention, demonstrate the same emotional and behavioural problems and the same social strengths as their hearing peers. We hope that this study can inspire and guide others who want to implement an AV intervention in a hospital setting. Full article

Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies. Full article

Background/Objectives: This study aimed to investigate whether day-long recordings with Language Environment Analysis (LENA) can be utilized in a hospital-based Auditory Verbal Therapy (AVT) program in Denmark for children with hearing loss and to conduct a pilot validation in the Danish language. Methods and materials: A license for the LENA system (LENA SP) was purchased, and trials were offered to three families enrolled in the AVT program. Each family made two day-long recordings with 3–4 months in between and received feedback during the therapy sessions. From 18 × 10-min clips randomly pulled out of the recordings, a comparison of adult word counts (AWC) between the LENA algorithm counts and the counts made by two human transcribers was made and used for the pilot validation. Results: LENA proved to be valuable as a guiding tool for Danish parents. Pilot validation showed good correlations and an acceptable limit of agreement (LoA). Conclusions: LENA holds the potential for Danish validation and use in AVT/clinical practice. When used in clinical practice, parents must be informed of the biases and limitations, and possible ethical issues must be considered. Because of the GDPR rules, there is a need to discuss the possibility of implementing this tool clinically in Denmark and the EU. Full article

Brain-hemisphere asymmetry/laterality is a well-conserved biological feature of normal brain development. Several lines of evidence, confirmed by the meta-analysis of different studies, support the disruption of brain laterality in mental illnesses such as schizophrenia (SCZ), bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and autism. Furthermore, as abnormal brain lateralization in the planum temporale (a critical structure in auditory language processing) has been reported in patients with SCZ, it has been considered a major cause for the onset of auditory verbal hallucinations. Interestingly, the peripheral counterparts of abnormal brain laterality in mental illness, particularly in SCZ, have also been shown in several structures of the human body. For instance, the fingerprints of patients with SCZ exhibit aberrant asymmetry, and while their hair whorl rotation is random, 95% of the general population exhibit a clockwise rotation. In this work, we present a comprehensive literature review of brain laterality disturbances in mental illnesses such as SCZ, BD, ADHD, and OCD, followed by a systematic review of the epigenetic factors that may be involved in the disruption of brain lateralization in mental health disorders. We will conclude with a discussion on whether existing non-pharmacological therapies such as rTMS and ECT may be used to influence the altered functional asymmetry of the right and left hemispheres of the brain, along with their epigenetic and corresponding gene-expression patterns. Full article

The development of language, memory and intellectual functions is linked to normal hearing and correct sounds interpretation. Hearing loss (HL), especially in its severe form, negatively affects the development of these functions. This prospective study aimed at comparing the Intelligent Quotients (IQ) of children with cochlear implants (CI) with the ones of people wearing hearing aids (HA) after one year of hearing rehabilitation. 21 subjects with severe/profound bilateral hearing loss (deafness) were included in this study. Eleven children with congenital profound HL underwent CI and ten children with moderate to severe HL (congenital and acquired) were rehabilitated by HA. Children’s IQs were assessed at enrolment (T0) and 12 months after hearing aids/CI use plus speech therapy. Statistical analyses were performed to analyze the data within and between groups. Comparison of IQs showed no statistically significant differences between CI and HA none at T0 and T1. The subtests showed lower scores in verbal comprehension and process speed index in patients treated with HA when compared to CI. This study showed that auditory rehabilitation can support the normal development of cognitive function in children between six and eight years of age. The use of the correct hearing aids based on the patient’s hearing thresholds is important to maximize the rehabilitation outcomes. Due to the small sample size, although stratified for age, our results must be considered preliminary and further analyses on larger samples are needed to confirm our data. Full article

The surgical options for patients with single-sided Menière’s disease and functional deafness are challenging. Our case series reports the outcomes of surgical treatments of patients with single-sided Menière’s disease and functional deafness. These patients have undergone a one-staged occlusion of all semi-circular canals and cochlear implantation. Five patients (four female and one male; 62 ± 8.2 years with a range from 50 to 72 years) with single-sided Menière’s disease and functional deafness were included in this study. In all cases, the patients suffered from frequent rotational vertigo episodes for many years. Other treatment options (e.g., medication) had not yet been successful. Preoperatively, the Dizziness Handicap Inventory (DHI) of all patients indicated severe emotional, physical, and functional deficits. Patients showed a functional (near-total) deafness of the affected ear in all cases. All patients were supplied with cochlear implants in combination with a triple occlusion of all semi-circular canals in a one-stage procedure. After a short period of increased dizziness following surgery and after the activation of the cochlear implant and CI rehabilitation (auditory-verbal therapy), vertigo control and an adequate audiological outcome were achieved. The DHI showed a constant decrease after surgery. The combination of a triple semi-circular canal occlusion and cochlear implantation can be an efficient treatment for patients with single-sided Menière’s disease. Full article

(1) Background: The therapeutic mechanisms underlying psychotherapeutic interventions for individuals with treatment-resistant schizophrenia are mostly unknown. One of these treatment techniques is avatar therapy (AT), in which the patient engages in immersive sessions while interacting with an avatar representing their primary persistent auditory verbal hallucination. The aim of this study was to conduct an unsupervised machine-learning analysis of verbatims of treatment-resistant schizophrenia patients that have followed AT. The second aim of the study was to compare the data clusters obtained from the unsupervised machine-learning analysis with previously conducted qualitative analysis. (2) Methods: A k-means algorithm was performed over the immersive-session verbatims of 18 patients suffering from treatment-resistant schizophrenia who followed AT to cluster interactions of the avatar and the patient. Data were pre-processed using vectorization and data reduction. (3): Results: Three clusters of interactions were identified for the avatar’s interactions whereas four clusters were identified for the patient’s interactions. (4) Conclusion: This study was the first attempt to conduct unsupervised machine learning on AT and provided a quantitative insight into the inner interactions that take place during immersive sessions. The use of unsupervised machine learning could yield a better understanding of the type of interactions that take place in AT and their clinical implications. Full article

(1) Background: Very little is known about the inner therapeutic processes of psychotherapy interventions for patients suffering from treatment-resistant schizophrenia. Avatar therapy (AT) is one such modalities in which the patient is undergoing immersive sessions in which they interact with an Avatar representing their main persistent auditory verbal hallucination. The aim of this study is to identify the most prevalent dyadic interactions between the patient and the Avatar in AT for patient’s suffering from TRS. (2) Methods: A content analysis of 256 verbatims originating from 32 patients who completed AT between 2017 and 2022 at the Institut universitaire en santé mentale de Montréal was conducted to identify dyadic interactions between the patients and their Avatar. (3) Results: Five key dyads were identified to occur on average more than 10 times for each participant during the immersive sessions across their AT: (Avatar: Reinforcement, Patient: Self-affirmation), (Avatar: Provocation, Patient: Self-affirmation), (Avatar: Coping mechanisms, Patient: Prevention), (Patient: Self-affirmation, Avatar: Reinforcement), and (Patient: Self-appraisal, Avatar: Reinforcement). (4) Conclusion: These dyads offer a first qualitative insight to the interpersonal dynamics and patient-avatar relationships taking place during AT. Future studies on the implication of such dyadic interactions with the therapeutic outcome of AT should be conducted considering the importance of dyadic relationships in psychotherapy. Full article

Avatar Therapy has a significant impact on symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and to which aspects of their lives these improvements relate. Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as three months after Avatar Therapy. These encounters have been recorded and transcribed so that the discourse could be thoroughly analyzed, leading to the generation of an extensive theme grid. As the cases were analyzed, the grid was adapted in a back-and-forth manner until data saturation occurred. The content analysis allowed the identification of nine main themes representing different aspects of the patients’ lives, each of which was subdivided into more specific codes. By analyzing the evolution of their frequency, it was observed that, following therapy, patients presented with fewer psychotic symptoms, better self-esteem, more hobbies and projects, and an overall improved lifestyle and mood. Finally, investigating the impact of Avatar Therapy on quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process. Full article

Background: Music-based intervention has been used as first-line non-pharmacological treatment to improve cognitive function for people with mild cognitive impairment (MCI) or dementia in clinical practice. However, evidence regarding the effect of music-based intervention on general cognitive function as well as subdomains of cognitive functions in these individuals is scarce. Objective: To evaluate the efficacy of music-based interventions on a wide range of cognitive functions in people with MCI or dementia. Method: We searched the effect of various music therapies using randomized controlled trials on cognitive function using several databases. Studies based on any type of dementia or MCI were combined. The effects of music-based intervention on each cognitive function were pooled by meta-analysis. Results: A total of 19 studies involving n = 1024 participants (mean age ranged from 60 to 87 years old) were included. We found statistically significant improvements in MMSE (general cognitive function), the Frontal Assessment Battery (executive function), and the Auditory Verbal Learning Test (episodic memory). Conclusions: This study provides positive evidence to support music-based interventions for improving a wide range of cognitive functions in older adults with MCI and dementia. Therefore, we recommend increased use of music in people’s homes, day care centers and nursing homes. This study was registered with PROSPERO, number 250383. Full article