listening effort and fatigue what are we...
TRANSCRIPT
Listening effort and fatigue
What are we measuring?
Dr Piers Dawes
“I went to a great conference today. It was riveting and I was hooked on pretty much every word. And then I got home and collapsed on the sofa. I’m not just tired, I’m shattered. I’ve had to turn my ears off to rest in silence and my eyes are burning…When I was younger, I was a little embarrassed to be so tired all the time. I would force myself to go out and be busy…all I wanted to do was crawl under the sofa and nap…”
Adult with hearing loss (Bess & Hornsby, 2014)
Audiological measures
Audiogram Hearing sensitivity; fit hearing aid to compensate for loss of audibility
Speech recognition tests Accuracy of speech recognition
Hearing questionnaires Hearing disability & hearing aid benefit
Listening effort / fatigue?
Optimal fit (based on audiogram) and good speech recognition
But listening may still be challenging and tiring.
• Listening effort refers to the mental exertion required to attend to and understand an auditory message
• Listening-related fatigue refers to extreme tiredness resulting from effortful listening
McGarrigle, R., Munro, K., Stewart, A. J., Dawes, P., Moore, D. R., Barry, J. G., & Amitay, S. (2014). Listening effort and fatigue: what exactly are we measuring? A British Society of audiology Cognition in Hearing Special interest Group ‘white paper’. International Journal of Audiology. International Journal of Audiology.
Definitions
Edwards, B. (2007). The future of hearing aid technology. Trends in Amplification, 11(1), 31-46.
• Effort/fatigue possibly an important (unmeasured) aspect of hearing disability
• The mental effort required to listen detracts from other tasks (e.g. comprehension)
• Measures of effort/fatigue could optimise interventions/technology that reduce effort/fatigue, individualise treatment
Summary so far…
Measures of effort
1.Self-report
2.Behavioural
3.Physiological
1. Self-report
NASA task load index (Hart & Staveland)
-multi-dimensional effort; 6 work-load related factors based on a model of workload
-mental, physical, temporal, performance, effort, frustration
X
Do you have to concentrate very much when listening to someone or something?
Can you easily ignore other sounds when trying to listen to something?
Do you have to put in a lot of effort to hear what
is being said in conversation with others?
Gatehouse, S., & Noble, W. (2004). The Speech, Spatial and Qualities of Hearing Scale (SSQ). International Journal of Audiology 43(2), 85 - 99.
Speech, Spatial and Qualities of Hearing Scale (SSQ)
• New & experienced HA users
• Rate SSQ ‘difference’ over 3 months
-15
-10
-5
0
5
10
15
20
Speech(20)
Spatial(20)
Quality(20)
Effort(10)
Total (70)
Dawes, P., Munro, K., Kalluri, S., & Edwards, B. (2014). Acclimatization to hearing aids. Ear & Hearing, 35(2), 203-212.
1. Self-report
Advantages Disadvantages
Cheap, quick, easy to administer Relies on good introspection (cognitively impaired, or children)
No special equipment required Subjective; one person finds ‘effortful ’ may not equate with another person’sidea of ‘effort ’
No particular expertise required to administer or interpret
No validated self-report measures about hearing fatigue/effort
Sensitivity (?)
Influenced by task accuracy(?)
2. Behavioral
• Single or dual-task paradigm
Single: respond to target word/sentence
Time taken to respond = effort
Early studies: Downs (1982), Gatehouse & Gordon (1990)
Single task
• Digit triplet test “The digits, three, one, nine”
1. Identification: identify the final digit in a triplet
2. Arithmetic: calculate the sum of the initial and the final digits in a triplet
Houben, R., van Doorn-Bierman, M., & Dreschler, W. A. (2013). Using response time to speech as a measure for listening effort. International Journal of Audiology, 52(11), 753-761.
• Answers:
Identification: 6, 3, 5
Arithmatic: 7, 9, 5
*Recognition accuracy > 80%
Advantages Disadvantages
Fast processing rate might be important
Not clear that increased effort = slower responses
Use equipment available in audiology clinics
Single task
Dual-taskPrimary speech recognition task
Secondary task; memory or reaction time
• Limited capacity of cognitive resource
• Two tasks compete for resources
As one task becomes more taxing, resource capacity is exceeded and performance on the secondary task worsens
Dual Task
Primary: Repeat sentences in noise,eg “The boat slid on the smooth rocks”
Secondary: Visual reaction time
Sarampalis, A., Kalluri, S., Edwards, B., & Hafter, E. (2009). Objective measures of listening effort: Effects of background noise and noise reduction. Journal of Speech, Language and Hearing Research, 52, 1230-1240.
Draw arrows on your note pad:
• Numbers (1-9) on either left or right of the screen
• Press the arrow that points toward the even number and away from the odd number
21
4
3
23
4
3
• Repeat target sentences
• Respond to numbers as fast as possible
2 4716 8493
• Young NH subjects, Simulated effect of NR• At low SNR (-6 dB), no positive effect of NR on
speech, but better performance on secondary tasks
Sarampalis, A., Kalluri, S., Edwards, B., & Hafter, E. (2009). Objective measures of listening effort: Effects of background noise and noise reduction. Journal of Speech, Language and Hearing Research, 52, 1230-1240.
Dual task
Advantages Disadvantages
Face validity – like real life multi-tasking
Assumes i) all cognitive capacity taken by both tasks ii) all remaining resources devoted to the second task, with first task as priority
Use equipment available in audiology clinics
Multi task or task switching?
3. Physiological
• Measures of brain activity or nervous system arousal linked to task difficulty
• fMRI, EEG, skin conductance, heart rate, muscle tension, pupil size, hormone levels (cortisol)
Pupil size
Pupil dilation reflects listening effort - largertask-evoked pupil size in more challenging listening conditions
Kramer, S. E., Kapteyn, T. S., Festen, J. M., & Kuik, D. J. (1997). Assessing aspects of auditory handicap by means of pupil dilatation. International Journal of Audiology. International Journal of Audiology, 36(3), 155-164.
Advantages Disadvantages
Objective measure Age differences in physiology
Could be sensitive (?) to differences between listening conditions and individuals
Sensitive to stress/emotion
Need special expensive equipment
Need expertise in analysis and interpretation
Need controlled conditions
3. Physiological
Measures of effort
1.Self-report
2.Behavioural
3.Physiological
Unanswered questions• How important is ‘effort’?
• Is fatigue more important than effort? How does effort relate to fatigue?
• Measures do not always agree with each other. Which are the most reliable and valid measures?
• Which measures are applicable in research vs clinical settings?
McGarrigle, R., Munro, K., Stewart, A. J., Dawes, P., Moore, D. R., Barry, J. G., & Amitay, S. (2014). Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special interest Group ‘white paper’. International Journal of Audiology. International Journal of Audiology.
Clinical applications, Future
• Additional outcome measure
• Individualise treatment, choose features
• New treatments; e.g. Cognitively controlled hearing aid
Clinical Applications, Now
Questionnaire
e.g. SSQ effort-related questions
or general effort/fatigue one (NASA TLX, or Fatigue Assessment Scale)
Michielsen, H. J., De Vries, J., Van Heck, G. L., Van de Vijver, F. J., & Sijtsma, K. (2004). Examination of the Dimensionality of Fatigue: The Construction of the Fatigue Assessment Scale (FAS). European Journal of Psychological Assessment, 20(1), 39.
Workshop on listening effort and fatigue
• BSA special interest group for cognition in hearing
• University of Manchester
• April 2015 (date TBC)
• Limited places
Contact Ronan McGarrigle for details
Acknowledgements
Ronan McGarrigle * , Kevin J. Munro *,†, Andrew J. Stewart * , David R. Moore ‡,* Johanna G. Barry § & Sygal Amitay §
* School of Psychological Sciences, the University of Manchester, UK
† Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
‡ Communication Sciences Research Center, Cincinnati Children ’ s Hospital Medical Center, Cincinnati, Ohio, USA, § MRC Institute of Hearing Research, Nottingham, UK