About this trial
With advancing age, adults experience increasing speech understanding difficulties in challenging situations. Currently, speech-in-noise difficulties are rehabilitated by providing hearing aids. For older normal-hearing adults, however, hearing devices do not provide much benefit since these adults do not have decreased hearing sensitivity. The goal of the "Speech Perception and High Cognitive Demand" project is to evaluate the benefit of a new auditory-cognitive training paradigm. In the present study neural (as measured by pupillometry and magnetoencephalography) and behavioral changes of speech-in-noise perception from pretest to posttest will be examined in older adults (age 65 - 85 years) assigned to one of three training groups: 1) Active Control Group: sessions of watching informational videos, 2) Auditory Training Group: sessions of auditory training listening to one of two speakers in everyday scenarios (e.g., driving directions) and needing to recall what one speaker said in the previous sentence, and 3) Auditory-cognitive training group: identical to the auditory training group, except participants will be asked to remember information from two previous sentences. Changes in speech-in-noise perception will be examined for the three groups of older adults and gains will be compared to a control group of young, normal hearing adults (18-30 years) that is not part of the clinical trial and will not undergo any training.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Aged between 65 - 85 years
Normal hearing (pure tone thresholds ≤ 25 dB HL from 250 - 8000 Hz)
Self-reported normal or corrected-to-normal vision
Dominant language: American English
Disqualifiers
Middle-ear or inner-ear pathology
Non-native speaker of English
Inability to complete all training sessions within a pre-specified time window (e.g., due to unexpected schedule restrictions)
Learning disorders
Trial design
Parallel
Treatments tested in this trial
Auditory-cognitive training paradigm
BehavioralThe investigators developed an American English version of the Nottingham (UK) PLUS training paradigm in which listeners are asked to focus and listen to one speaker while ignoring another speaker. The paradigm is designed to optimally enhance the possibility of benefit: an adaptive procedure is employed to train each individual at their own level to make the task challenging. A short-term memory component, in which listeners are asked to remember what a designated speaker said two sentences prior, was added to the auditory training paradigm to make the task more challenging. Participants will be asked to recall the keywords of the to-be-attended speaker. The sentences will be presented in a two-down one-up adaptive procedure in which the ratio of the levels of the to-be-attended and to-be-ignored speaker will be adjusted based on the correctly recalled key words.
Auditory training paradigm
BehavioralThe investigators developed an American English version of the Nottingham (UK) PLUS training paradigm in which listeners are asked to focus and listen to one speaker while ignoring another speaker. The paradigm is designed to optimally enhance the possibility of benefit: an adaptive procedure is employed to train each individual at their own level to make the task challenging. Participants will be asked to recall the keywords of the to-be-attended speaker. The sentences will be presented in a two-down one-up adaptive procedure in which the ratio of the levels of the to-be-attended and to-be-ignored speaker will be adjusted based on the correctly recalled key words.
Treatment groups
Trial outcomes
Primary outcomes
Change in speech-in-noise perception
In the Quick Speech-in-noise task (QSIN). Participants listen to a target female speaker in babble across six sentences (i.e., one list) presented at different signal-to-noise ratios (SNRs). Each sentence has five target words that participants are asked to repeat at the end of each sentence. Within each list, the first sentence is played with a 25 dB SNR and SNR decreases as the list progresses in increments of 5 dB., with the final sentence played at 0 dB. The average SNR score is calculated across several lists. The average SNR score is calculated across several lists. Scores range from -4.5 to 25.5 dB. Higher scores indicate greater SNR loss (i.e., worse hearing).
Audiobook - Change in pupillary response
During an audiobook listening task, pupil dilations are recorded as an objective measure of listening effort, with larger pupil dilations indicating increased listening effort. Change in pupil dilations at pre and posttest (before and after training, respectively) will be measured. In the audiobook listening task, audiobook segments will be presented to participants at signal-to-noise ratios (SNRs) of quiet, 0 dB, -6 dB, and in babble (with four background speakers). Participants listen to each audiobook segment three times.
Audiobook - Change in magnetoencephalography (MEG) temporal response function
During an audiobook listening task, MEG neural activity will be recorded. The investigators will evaluate change in the temporal response function (TRF). The TRF relates how the brain responds to acoustic stimuli and can be viewed as evoked responses to the continuous speech. Audiobook segments will be presented to participants at signal-to-noise ratios (SNRs) of quiet, 0 dB, -6 dB, and in babble (with four background speakers). Participants listen to each audiobook segment three times.
Change in Magnetoencephalography (MEG) stimulus reconstruction accuracies and integration window analysis
During an audiobook listening task, MEG neural activity will be recorded. The investigators will measure how far the neural response tracks the speech stimulus by stimulus reconstruction accuracies and how the stimulus reconstruction accuracy builds up over time by integration window analysis. Audiobook segments will be presented to participants at signal-to-noise ratios (SNRs) of quiet, 0 dB, -6 dB, and in babble (with four background speakers). Participants listen to each audiobook segment three times.
Secondary outcomes
Audiobook - Change in subjective ratings
During an audiobook listening task, participants provide subjective listening effort and speech intelligibility ratings. This is an experimenter-generated measure. Audiobook segments will be presented to participants at signal-to-noise ratios (SNRs) of quiet, 0 dB, -6 dB, and in babble (with four background speakers). Participants listen to each audiobook segment three times and after each triad of audiobook segments, participants answer subjective intelligibility and listening effort questions. Scores are on a scale from 0 to 10 in increments of 1. Higher subjective intelligibility ratings indicate easier intelligibility whereas higher listening effort indicates more listening effort was exerted while listening to the audiobook segments.
Tone cloud - Change in auditory stream segregation accuracy
As a measure of change in auditory stream segregation, participants complete a stochastic figure-ground (SFG) task, in which participants listen to inharmonious 50 ms tones with random onsets for six seconds. For half of these stimuli, a figure "pops-out" from the background tones, in which a number of tones begin at the same time, making a chord. This figure chord repeats 12 times over the course of three seconds. Participants indicate when they detect a figure chord. The stimuli that contain the figure chord have chords consisting of 4, 6, or 8 tones. Figure detection accuracy will be calculated as percent correct for each figure chord condition.
Tone cloud - Change in auditory stream segregation reaction time (RT)
As a measure of change in auditory stream segregation, participants complete a stochastic figure-ground (SFG) task, in which participants listen to inharmonious 50 ms tones with random onsets for six seconds. For half of these stimuli, a figure "pops-out" from the background tones, in which a number of tones begin at the same time, making a chord. This figure chord repeats 12 times over the course of three seconds. Participants indicate when they detect a figure chord. The stimuli that contain the figure chord have chords consisting of 4, 6, or 8 tones. RT to the figure present stimuli will be calculated as average RT for each figure chord condition.
N-back task - Change in accuracy
Because the auditory and auditory-cognitive training paradigms involve a working memory component, pre and posttests of an n-back working memory measure are included. Participants complete four blocks in which they listen to a string of letters spoken by a female speaker. Participants are asked to click a button when a letter occurred n-back. Each block increases in the nth element that needs to be remember, starting at n = 1 (Block 1) and ending at n = 4 (Block 4). Participants' accuracy as percent correct are averaged for each level of n.
Sponsors and contacts
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University of Maryland, College Park
Lead sponsor
National Institute on Aging (NIA)
Collaborator