Doris-Eva Bamiou

Background: Auditory Processing Disorder (APD) is characterised by impaired neural processing of auditory stimuli, resulting in listening difficulties that often co-occur with neurodevelopmental conditions, including Autism Spectrum Disorder (ASD). Autistic children commonly present with auditory processing differences that may impact speech perception, social communication, and adaptive functioning. Purpose: This study examined auditory symptom profiles and auditory processing performance in autistic children presenting to a tertiary audiology clinic for assessment of listening difficulties. Research design: A retrospective cross-sectional analysis was conducted using routinely collected clinical data, including semi-structured questionnaires and a comprehensive auditory processing test battery. Study sample: Thirty-seven children aged 6-17 years with confirmed ASD who attended a tertiary audiology clinic for assessment of listening difficulties. Results: Auditory Processing Disorder (APD) was identified in 78% of participants. Commonly reported difficulties included reduced tolerance to sound and impaired speech perception in complex acoustic environments. Participants reporting difficulty hearing in noise performed significantly poorer on the Auditory Figure Ground 0 dB test (p = 0.013). Abnormal performance on dichotic listening and temporal processing tasks was associated with comorbid ADHD and anxiety. A history of middle ear conditions and a family history of neurodevelopmental conditions were frequently reported. Conclusions: Auditory processing differences were frequently observed in autistic children within this clinical cohort and appeared to be influenced by co-occurring neurodevelopmental and psychiatric conditions. These findings highlight the importance of comprehensive, multidisciplinary auditory assessment approaches to support clinical management in this population.

Abnormal sensory responses have been a diagnostic criterion for autism since 2013, with auditory hypersensitivities representing one of the most frequently reported symptoms. It is not unusual for children with autism, some of whom are as yet undiagnosed, to present clinically to specialists with a history of auditory symptoms in the context of normal hearing. This narrative review paper provides a theoretical background and model to account for autism-associated characteristics that arise within the auditory nervous system. The review highlights the need to assess these symptoms by a multidisciplinary approach. There should be appropriate history taking, followed by psychoacoustic and neurophysiological assessments. We discuss a range of evidence-based management strategies. Affected individuals often present to a range of different clinical settings before their autism is recognised clinically. Nowadays, there is an increasing prevalence of neurodivergence. We emphasise the importance to audiologists and other clinicians that auditory-related symptoms can be the presenting problem in autistic children.

Background: The Digits-in-Noise (DIN) test is recognized as a promising hearing screening tool due to its feasibility and reliability, particularly in noisy environments. Although endorsed by the World Health Organization for general population hearing screening, it has not been validated in older adults with cognitive impairment, such as mild cognitive impairment (MCI), and dementia, including Alzheimer's disease. Objective: To address this gap, this study aimed to evaluate diagnostic accuracy of DIN compared to pure-tone audiometry, marking the first validation of the DIN test in this specific group. Methods: Participants with MCI and dementia were recruited from memory clinics. Each participant underwent an audiologic evaluation, including the Hearing Handicap Inventory for Elderly, pure-tone audiometry, and smartphone-based DIN test. Additionally, the Montreal Cognitive Assessment, was administered. Results: Among 93 adults (mean age 71.9), an optimal speech reception threshold (SRT) cutoff of −3.5 dB yielded 90.5% sensitivity and 50% specificity for detecting moderate hearing loss. The area under the curve was 0.649 for mild hearing loss and 0.746 for moderate. A significant weak positive correlation was observed between SRT and pure tone average (ρ= 0.35, p < 0.001) Conclusion: Our findings underscore the potential of the DIN test in detecting disabling hearing loss among cognitively impaired individuals, which warrants immediate hearing intervention to improve their quality of life. Trial Registration: Thai Clinical Trials Registry (TCTR20221222004), https://www.thaiclinicaltrials.org/

Background: Evidence supports that vestibular rehabilitation therapy (VRT) improves the static and dynamic balance of survivors of stroke, yet VRT is rarely included in stroke rehabilitation guidelines. We aim to answer the question: What are the effects of VRT or dual‐task training (DTT) on balance and gait for reducing the risk of falls among survivors of late subacute and chronic stroke? Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Statement guidelines, electronic databases PubMed, EMBASE, MEDLINE, Web of Science, and Scopus for English were searched to identify randomized controlled trials published within the past 10 years in the English language, investigating VRT for patients with late subacute and chronic stroke. Results: Eleven studies (n=509 participants) were included in the systematic review, and 10 studies (n=413 participants) were included in a meta‐analysis. The average participant age was 60.9 years, with 62.11% male. On average, 36 months had passed since stroke onset. The pooled effect standardized mean difference suggests that VRT has a significantly large effect for improving balance (standardized mean difference, 0.64 [95% CI, 0.44–0.85], P P =0.002). Dual‐task training (DTT) moderately improved gait (standardized mean difference, 0.46 [95% CI, 0.18–0.74], P =0.001), with greater benefits from DTT compared with single‐task training. Conclusions: Despite substantial heterogeneity across studies, the evidence supports that VRT, can probably improve balance, and DTT may improve gait outcomes among survivors of late subacute and chronic stroke. An optimal program for this population should focus on balance and DTT with subcomponents of gait and strength training. Further research is required to determine the optimal number of weeks, sessions/week, and duration (minutes) of VRT sessions. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42023450254.

Background: Falls among older adults are a significant public health concern, often leading to severe injuries, decreased quality of life, and substantial health care costs. Smart wearable technologies for balance rehabilitation present a promising avenue for addressing the falls epidemic, capable of providing detailed objective movement data, engaging visuals, and real-time feedback. With the recent and rapid evolution of innovative technologies, including artificial intelligence (AI), augmented reality (AR) or virtual reality (VR), and motion tracking, there is a need to evaluate the market to identify the most effective and accessible smart balance systems currently available. Objective: This study aims to evaluate the current landscape of smart wearable technology systems for balance rehabilitation in older adults at risk of falls. In addition, it aims to compare market-available systems to the telerehabilitation of balance clinical and economic decision support system (TeleRehab DSS), a recently developed smart balance system. Methods: A scoping review and strengths, weaknesses, opportunities, and threats (SWOT) analysis was completed, exploring the landscape of smart balance systems in older adults at risk of falls. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, electronic databases PubMed, MEDLINE, and Cochrane were systematically searched for articles in English from July 1, 2014, to July 1, 2024. Gray literature searches of relevant institutions and web pages were also conducted. The database search and commercial systems were then compared against the TeleRehab DSS in a SWOT analysis. Results: The scoping review yielded 17 systems that met the inclusion criteria; 10 investigational systems and 7 commercially available systems. Out of 10 studies, only 1 reported the use of intelligent learning or AI, 8 studies reported the use of motion tracking, and 9 studies used virtual reality. Of the studies incorporating motion tracking, 3 provided feedback as either visual or auditory. All but 2 studies reported the use of gamification, and 7 studies incorporated balance exercises. In total, 2 studies reported remote delivery, with 5 being clinician-supervised and 4 providing a clinician report. The SWOT analysis of TeleRehab DSS against the 7 market-available smart balance systems revealed several unique advantages, including personalized therapy with AI-DSS, AR for real-world interaction, enhanced clinician involvement, and comprehensive data analytics. Conclusions: The findings from this scoping review highlight the rapid evolution of smart balance systems, yet significant gaps remain in AI integration, remote accessibility, and clinician-driven data analytics. Despite limitations such as cost, accessibility, and user training requirements, TeleRehab DSS emerges as a significant innovation, addressing many of these gaps through AI-driven personalization, AR for real-world interaction, and real-time clinician monitoring. These features position it as a next-generation solution that aligns closely with the evolving needs of patients and clinicians. The results of this review provide valuable insights for future research, supporting the need for further validation studies and the development of more intelligent and accessible balance rehabilitation technologies.

Background: Age-related hearing loss and mild cognitive impairment (MCI) independently increase dementia risk. The Ageing and Cognitive Health Evaluation in Elders randomised controlled trial (RCT) found hearing aids reduce cognitive decline in high-risk older adults with poor hearing. Methods: This pilot RCT in London memory clinics randomised people with MCI (aged ≥55, untreated hearing loss defined as Pure Tone Average 0.5–4 KHz between 25–70 dB) into two groups. The intervention group received 4 sessions of hearing aid fitting and support. The control group received healthy ageing education and a GP letter recommending audiological referral. Both were followed for 6 months. Primary outcomes were recruitment (feasibility target: 50%; 95% CI: 39%–61%) and retention (feasibility target: 80%; 95% CI: 71%–89%); intervention completion (≥2 visits) and hearing aid use (acceptability target: 80%; 95% CI: 71%–89%) for the intervention group and 50% difference between arms (95% CI: 31%–69%). Secondary outcomes included hearing aid fitting, cognition and other measures. Results: From October 2018 to March 2020, 58 participants were recruited (29 per group, 95% [86%–99%]). Twenty-four participants were fitted with hearing aids in the intervention arm, and 6 in the control arm (difference: 62% [42%–82%]). At 6 months, retention was 81% [69%–90%]. Hearing intervention completion (≥2 visits) was achieved by 24 (83%). Daily hearing aid use was reported by 18 (75%) intervention versus 5 (22%) control participants, a difference of 53% [29%–77%]. Conclusion: Randomisation of people with MCI to a personalised hearing intervention versus control is feasible. These findings support proceeding to a fully-powered multicentre RCT.

BACKGROUND Falls among older adults are a significant public health concern, often leading to severe injuries, decreased quality of life, and substantial healthcare costs. Smart wearable technology systems for balance rehabilitation present a promising avenue for addressing the falls epidemic, capable of providing detailed objective movement data, engaging visuals, and real-time feedback. With the recent and rapid evolution of innovative technologies, including artificial intelligence (AI), augmented reality (AR)/virtual reality (VR), and motion tracking, there is a need to evaluate the market to identify the most effective and accessible smart balance systems currently available OBJECTIVE This review aims to evaluate the current landscape of smart wearable technology solutions for balance rehabilitation in older adults at risk of falls. Additionally, it aims to compare market available systems to TeleRehab DSS, a recently developed smart balance system METHODS A scoping review and SWOT analysis was completed, exploring the landscape of smart balance systems in older adults at risk of falls. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, electronic databases PUBMED, MEDLINE, and Cochrane were systematically searched for articles in English from July 1, 2014, to July 1, 2024. Grey literature searches of relevant institutions and webpages were also conducted. The database search and commercial systems were then compared against the TeleRehab DSS in a SWOT analysis RESULTS The scoping review yielded 17 systems that met the inclusion criteria; 10 investigational systems and 7 commercially available systems. Only one study reported the use of intelligent learning/AI. Eight studies reported the use of motion tracking, with two protocols not reporting its use. Of the studies incorporating motion tracking, three provided feedback as either visual or auditory. Nine of the 10 included studies incorporated either AR or VR, with one study using a computer interface. All but two studies reported the use of gamification, and seven studies incorporated balance exercises. Two studies reported remote delivery, with five being clinician-supervised and four providing a clinician report. The SWOT analysis of TeleRehab DSS against the 7 market-available smart balance systems revealed several unique advantages including personalized therapy with AI-DSS, AR for real-world interaction, enhanced clinician involvement, and comprehensive data analytics. Conclusions: Despite limitations such as cost, accessibility, and user training requirements. CONCLUSIONS Despite limitations such as cost, accessibility, and user training requirements, TeleRehab DSS emerges as a significant innovation in smart balance systems. It offers a unique blend of AI personalization, AR, and real-time clinician monitoring for balance rehabilitation among middle-aged and older adults at risk of falls. These features position it as a next-generation solution that aligns closely with the evolving needs of patients and clinicians.