Cardiac Rehabilitation Improves Fitness in Patients With Subclinical Markers of Cardiotoxicity While Receiving Chemotherapy: A RANDOMIZED CONTROLLED STUDY.

PURPOSE: Heart failure (HF) due to cardiotoxicity is a leading non-cancer-related cause of morbidity and mortality in cancer survivors. Cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and reduces morbidity and mortality in patients with HF, but little is known about its effects on cardiotoxicity in the cancer population. The objective of this study was to determine whether participation in CR improves CRF in patients undergoing treatment with either doxorubicin or trastuzumab who exhibit markers of subclinical cardiotoxicity. METHODS: Female patients with cancer (n = 28: breast, n = 1: leiomyosarcoma) and evidence of subclinical cardiotoxicity (ie, >10% relative decrease in global longitudinal strain or a cardiac troponin of >40 ng·L -1 ) were randomized to 10 wk of CR or usual care. Exercise consisted of 3 d/wk of interval training at 60-90% of heart rate reserve. RESULTS: Cardiorespiratory fitness, as measured by peak oxygen uptake (V˙ o2peak ), improved in the CR group (16.9 + 5.0 to 18.5 + 6.0 mL∙kg -1 ∙min -1 ) while it decreased in the usual care group (17.9 + 3.9 to 16.9 + 4.0 mL∙kg -1 ∙min -1 ) ( P = .009). No changes were observed between groups with respect to high-sensitivity troponin or global longitudinal strain. CONCLUSION: This study suggests that the use of CR may be a viable option to attenuate the reduction in CRF that occurs in patients undergoing cardiotoxic chemotherapy. The long-term effects of exercise on chemotherapy-induced HF warrant further investigation.

The Audiologist's Role in Advocacy.

Healthcare policy decisions that affect the day-to-day work of an audiologist and his/her ability to best serve our patients occur every day. It is imperative that every professional participate in advocacy efforts; however, many audiologists are unfamiliar with current advocacy initiatives, how to participate, or how critical one phone call, email, or meeting could be in the legislative process.

The Value of Speech-Language Pathologists in Auditory Rehabilitation for Adults With Cochlear Implants.

Background Standards for auditory rehabilitation are currently lacking for adults who receive cochlear implants. Speech recognition outcomes are highly variable, and many adults with cochlear implants present with suboptimal performance. Functional real-life communication abilities are not routinely measured clinically and are not strongly linked to performance on traditional measures of speech recognition. In fact, even individuals with relatively good speech recognition outcomes often present with persistent communication difficulties. In contrast to pediatric cochlear implant users, speech-language pathologists are not routinely involved in the rehabilitation of adults who receive cochlear implants. Purpose The purpose of this article is to describe the value of including a speech-language pathologist in a comprehensive approach to auditory rehabilitation for adults with cochlear implants. Method The theoretical and clinical foundations of incorporating a speech-language pathologist into an adult auditory rehabilitation program are discussed. A description of the skills and potential roles of the speech-language pathologist for providing adult cochlear implant rehabilitation services is presented, along with potential barriers to implementation. Conclusion Person-centered management of postlingually deafened adults with cochlear implants can be augmented by a more complete approach utilizing the skill set of a speech-language pathologist. Supplemental Material https://doi.org/10.23641/asha.14669652.

Assessment of Reliability and Validity of the Cochlear Implant Skills Review: A New Measure to Evaluate Cochlear Implant Users' Device Skills and Knowledge.

Purpose The Cochlear Implant Skills Review (CISR) was developed as a measure of cochlear implant (CI) users' skills and knowledge regarding device use. This study aimed to determine intra- and interrater reliability and agreement and establish construct validity for the CISR. Method In this study, the CISR was developed and administered to a cohort of 30 adult CI users. Participants included new CI users with less than 1 year of CI experience and experienced CI users with greater than 1 year of CI experience. The CISR administration required participants to demonstrate skills using the various features of their CI processors. Intra- and interrater reliability were assessed using intraclass correlation coefficients, agreement was assessed using Cohen's kappa, and construct validity was assessed by relating CISR performance to duration of CI use. Results Overall reliability for the entire instrument was 92.7%. Inter- and intrarater agreement were generally substantial or higher. Duration of CI use was a significant predictor of CISR performance. Conclusions The CISR is a reliable and valid assessment measure of device skills and knowledge for adult CI users. Clinicians can use this tool to evaluate areas of needed instruction and counseling and to assess users' skills over time.

Comprehensive auditory rehabilitation in adults receiving cochlear implants: A pilot study.

OBJECTIVE: In the United States, most adults who receive cochlear implants (CIs) do not undergo a comprehensive auditory rehabilitation (CAR) approach, which may result in suboptimal outcomes. The objectives of this pilot study were to demonstrate that a CAR approach incorporating auditory training (AT) by a speech-language pathologist (SLP) is feasible in adults receiving CIs and to explore whether this approach results in improved outcomes. METHODS: Twenty-four postlingually deaf adult CI candidates were serially assigned to one of three groups: (a) a "CAR group" that received standard of care implantation, programming by an audiologist, an additional preoperative counseling session, and eight one-hour AT sessions; (b) a "passive control" standard-of-care group; and (c) an "active control" group that also received the extra preoperative counseling session. Participants were tested preoperatively and 1, 3, and 6 months after CI using measures of word and sentence recognition in quiet and in babble, as well as measures of quality of life (QOL). RESULTS: The CAR approach was feasible, but this pilot study was underpowered to determine efficacy. Differential time courses of speech recognition improvement were seen for sentence and word recognition. All QOL measurements showed improvement from pre-CI to 1 month post-CI activation. Results revealed issues to consider for a larger-scale study of CAR revolving around participant selection, study measures, and sample size. CONCLUSION: The CAR approach is feasible in new CI users. A larger trial is needed to investigate whether CAR leads to better outcomes or faster improvement in this clinical population. LEVEL OF EVIDENCE: 2.

What to Do When Cochlear Implant Users Plateau in Performance: a Pilot Study of Clinician-guided Aural Rehabilitation.

HYPOTHESIS: For experienced adult cochlear implant (CI) users who have reached a plateau in performance, a clinician-guided aural rehabilitation (CGAR) approach can improve speech recognition and hearing-related quality of life (QOL). BACKGROUND: A substantial number of CI users do not reach optimal performance in terms of speech recognition ability and/or personal communication goals. Although self-guided computerized auditory training programs have grown in popularity, compliance and efficacy for these programs are poor. We propose that CGAR can improve speech recognition and hearing-related QOL in experienced CI users. METHODS: Twelve adult CI users were enrolled in an 8-week CGAR program guided by a speech-language pathologist and audiologist. Nine patients completed the program along with pre-AR and immediate post-AR testing of speech recognition (AzBio sentences in quiet and in multitalker babble, Consonant-Nucleus-Consonant words in quiet), QOL (Nijmegen Cochlear Implant Questionnaire, Hearing Handicap Inventory for Adults/Elderly, and Speech, Spatial and Qualities of Hearing Scale), and neurocognitive functioning (working memory capacity, information-processing speed, inhibitory control, speed of lexical/phonological access, and nonverbal reasoning). Pilot data for these nine patients are presented. RESULTS: From pre-CGAR to post-CGAR, group mean improvements in word recognition were found. Improvements were also demonstrated on some composite and subscale measures of QOL. Patients who demonstrated improvements in word recognition were those who performed most poorly at baseline. CONCLUSIONS: CGAR represents a potentially efficacious approach to improving speech recognition and QOL for experienced CI users. Limitations and considerations in implementing and studying aural rehabilitation approaches are discussed.

Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

OBJECTIVE: Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL. STUDY DESIGN: Twenty-five postlingually deafened adults with CIs were assessed. METHODS: Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL. RESULTS: Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics. CONCLUSION: Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:959-966, 2018.