1. Constraint Induced Auditory Therapy (CIAT)
Annette Hurley, Ph.D. & Bradley Davis, Au.D.
Dept. of Communication Disorders
School of Allied Health Professions, Louisiana State University Health Sciences Center - New Orleans
CASE 2: CVA
Case 5: LKS
BACKGROUND
Case 2. AMLR
-12 year old male
-Acquired (C)APD as result of Landau-Kleffner Syndrome
-Abnormal spiking in the left temporal lobe
-Completed Fast ForWord
-Completed CIAT for 2 semesters (14 Sessions)
BioMARK is within normal limits after CIAT. An increase in N1-P2 amplitude is shown after Fast ForWord.
-46 year old male
-MRI revealed a large left frontal lobe lesion
extending to the parietal lobe.
-Normal peripheral hearing
-Eight CIAT sessions
-Subjective improvements in hearing
from communicative partner (wife)
Constraint Induced Auditory Therapy (CIAT) is an auditory training program for children and adults. It is based on core principles of the Dichotic Interaural Intensity Difference (Musiek & Shochat, 1998). CIAT strengthens auditory processing by targeting the weaker ear through intense auditory training. This investigation reviews CIAT exercises and case reports from six patients with temporal lobe damage from acquired (C)APD from stroke, meningitis, or Landau-Kleffner Syndrome. Positive behavioral and electrophysiological findings following CIAT are reviewed.
A slight decrease in Wave Pa latency
was evident after CIAT.
Case 5. BioMARK ALER
CIAT Exercises
Dichotic Numbers Single and Double
pair presented at +20, +15, +10, and +5
Signal to Noise Ratio and at 500, 200,
00, 50, and 10 msec inter-stimulus
intervals.
2. Dichotic Sentences: 3, 4, 5, 6 & 7
syllable sentences.
Semantic Monosyllabic Words: Spondees, Antonyms, Related words, etc.
CVs: pa, ba, etc., with expansion.
Stories with babble in the opposite ear.
CASE 3: CVA
Case 3. Auditory Late Evoked Response .
-29 year old Female
-Onset 8/15/07
-College Graduate: Chef/Restaurant Owner
-Extremely Motivated to try auditory therapy
(and/or other alternative therapies)
-Broca’s Aphasia: halting telegraphic speech, single words
Right dichotic scores are within normal limits.
CIAT training began 9/08; 1 hour per week
ongoing cognitive training continues
An improvement in the N1-P2 amplitude after CIAT
is noted.
Case 6: Meningitis
-8 year old female
-History of infantile Meningitis
-Abnormal Spiking in Right Frontal & Temporal Lobe
-Exprpessive Language and Speech Disorder
-Began Language therapy June, 2009
-Began CIAT June, 2009 (15) 30 minute sessions
-Difficulty in maintaining focus
Left dichotic scores improved from 0% to 60% for digits; greater improvement for linguistic stimuli.
Improved BioMARK from ‘abnormal’ to normal for the right ear after CIAT is shown below.
A representation of
ipsilateral and dominant contralateral pathways.
Case 1: CVA
-49 year old male with left temporal parietal lesion.
-Normal peripheral hearing
-Impaired music perception
-Difficulty understanding
-Right ear deficit on dichotic tests
-CIAT training- 10 sessions
-Subjective improvement in hearing
-Right ear pathway improved from 0%
to scores at normal limits (>90%).
Case 4: CVA
-49 year old female
-Mixed non-fluent Aphasia
-Associates Degree in Accounting: Bookkeeper
-Very Motivated
-Effortful, non-fluent perseverative speech; severe word finding moderately impaired comprehension skills
-Speech/language therapy began January, 2008
-CIAT began September 2009.
-Dichotic Scores (Right Directed ear) improved
from 0% to >80%.
An increase in N1-P2 amplitude is shown for the ALER and a a slight decrease in Waves V and A of the BioMARK after CIAT. .
A slight improvement in ABR Wave V latency is shown below.
Improved Na-Pa amplitude is depicted in the Auditory Middle Latency Response (AMLR) recordings
Discussion
Figure 2. ABR
Figure 3. AMLR
Each patient showed improvement on behavioral dichotic tests
following CIAT.
Each adult patient reported subjective improvements in hearing following CIAT.
Each patient showed improvements in electrophysiological recordings, demonstrating plasticity at various levels of the central auditory nervous system following CIAT.