Plasticity, Outcome Measures, and Evidence-Based Practice

This special issue of Seminars in Hearing is a publication that has arisen out of the national conference that was organized by the National Center for Rehabilitative Auditory Research (NCRAR) in Portland, Oregon. The conference was titled “Auditory Rehabilitation: A Multidisciplinary Approach” and took place on October 9 and 10, 2003, in Portland. The conference was attended by over 164 delegates, among whom were audiologists, researchers, engineers, and university faculty from across the United States and Europe. The conference brought together internationally respected clinical researchers and practicing clinicians who discussed the latest advances in the field of auditory rehabilitation with the aim of facilitating learning and scientific discussion.

The meeting had four special sessions that were selected by the Program Committee to represent pertinent issues in the field of clinical audiology. We invited two world-renowned researchers to present at each special session. In addition, between one and three case studies pertinent to the particular session topic were presented by practicing audiologists. These case presentations were submitted by clinicians from around the country and were selected for presentation by the program committee based on their clinical and scientific relevance to the session topic. Finally, to end each special session there was an hour-long roundtable discussion during which panel members responded to questions posed by members of the audience. Each discussion session had a different panel. Members consisted of the invited speakers for each session plus one or two other conference participants who had particular clinical and/or research experience in the area under discussion. These panel discussions gave rise to interesting exchanges between panel members and the audience. This special issue consists of a written form of each presentation and case study, along with a transcription of each roundtable discussion. Two special editions of Seminars in Hearing are devoted to this conference. This edition focuses on Plasticity, Outcome Measures, and Evidence-Based Practice.

Dr. Michael Merzenich from the Keck Center for Integrative Neuroscience at the University of California at San Francisco was the first presenter. His presentation was titled “Implications of Plasticity of the Neural System for Auditory Rehabilitation”. Unfortunately, there is no manuscript available from this presentation. Dr. Tremblay of the Department of Speech and Hearing Science at the University of Washington, Seattle provided an explanation of how the principles of neural plasticity are central to aural rehabilitation and offered suggestions about how these principles can be applied in the clinic. She presented data from some of her laboratory experiments showing that auditory evoked potentials, specifically the N1-P2 complex, change following perceptual training, suggesting that these measures reflect newly learned perceptual skills. She postulates that in the future audiologists might be able to use such measures to monitor the effectiveness of the fitting of an auditory prosthesis, such as a hearing aid or cochlear implant.

The second day of the conference began with the topic of Outcomes Measurement. Dr. Robyn Cox of the University of Memphis, Tennessee, and Dr. Harvey Abrams, Bay Pines VA Medical Center, Florida, were the speakers. Dr. Cox' presentation focused on the selection of a self-report outcome measure to evaluate hearing aid outcomes. She pointed out that with so many different measures available, choosing the most appropriate tool might be difficult. She then presented a five-step approach that will enable clinicians to select the best tool for their specific application. Her technique is particularly appealing because it guides the clinician through each level of decision making, from prioritizing goals to specifying the essential features required and ultimately to developing a report card for each measure. Dr. Abrams also discussed selection of appropriate outcome measures, relating this to the principles used in evidence-based practice (EBP). He reminded us of the many reasons why outcome measurement is critical and provided us with an introduction to the World Health Organization's classification system known as the International Classification of Functioning, Disability and Health. He also defined the grading system used in EBP for evaluation of clinical research studies. He concluded that it is critical for audiologists to have clinical practice guidelines based on high-quality research studies.

The case presentations bring much of this information to life, and the roundtable discussions allow the reader to eavesdrop on conversations between some of the most informed individuals in the field related to these topics.

The next NCRAR conference is scheduled for September 22 and 23, 2005. It is titled “The Aging Auditory System: Considerations for Rehabilitation” and will feature presentations from Bob Frisina Jr., Sandra Gordon-Salant, James Jerger, Jack Mills, Kathleen Pichora-Fuller, Pam Souza, Therese Walden, and Arthur Wingfield on Behavioral Studies of Auditory Aging, Pathophysiology of the Aging Auditory System, Cognitive Components to Auditory Aging, and Amplification and Beyond: Issues Associated with Treating the Geriatric Patient.