Optimising outcomes for children with hearing impairment (HI) requires a family centred approach that prioritises parent involvement. Families must be provided with information to encourage participation; and meet their need for emotional support and knowledge. Diagnostic audiology reports can help provide this information, but their delivery alone is insufficient. If these reports are not readable and comprehendible they cannot meet national and international legal standards, nor can they support the health literacy of parents. The majority of New Zealand adults have insufficient health literacy skills, a concerning fact given the strong association between poor health literacy and negative health outcomes. The aim of this study was to evaluate a paediatric diagnostic audiology report, revise it and verify the revision. A mock audiology report was evaluated via a readability analysis and semi-structured interviews with parent participants. Results confirmed that the report was difficult to read and understand. Next, the report was revised using best practice guidelines and parental recommendations. Verification of the revision process with 32 participants revealed that parents who read the revised report had significantly greater comprehension, self-efficacy and perception ratings than parents who read the unrevised report. Additionally, the report’s readability was markedly improved. These results may have critical implications for parents and their children with HI. Incomprehensible audiology reports fail to support parental health literacy, promote understanding, encourage participation or offer emotional support. Because knowledge is power for these families, it is hoped that the findings of this study will be recognised and implemented into clinical practice.

Normal ageing is associated with decline in visual, cognitive, and physical functioning, with concurrent increases in the incidence of chronic medical conditions, including cognitive disorders. Determining when age-related changes have adversely affected a person’s ability to drive safely is a complex task, particularly when cognitive disorders such as mild cognitive impairment and dementia are present. The aim of this research was to assess the utility of a number of off-road measures in predicting Pass and Fail outcomes for older drivers on a blinded on-road driving assessment with a driving specialist occupational therapist and a driving instructor, which is considered the ‘gold standard’ measure of driving ability. The off-road measures included standardized cognitive tests, computerized sensory-motor & cognitive tests, medical conditions, and personality measures. The research project comprised three studies. In Study 1 (Healthy Older Drivers study), 60 drivers with no diagnosed cognitive disorder (‘cognitively-unimpaired’), aged 70-84 years (mean age 76.7, 50% male), completed standard cognitive tests, computerized sensory-motor and cognitive tests (SMCTests™), and measures of personality. Results were used to form classification models for on-road assessment Pass and Fail outcome. Sixteen participants failed the on-road assessment. A backwards stepwise binary logistic regression model selected a measure of executive function and a computerized measure of visuomotor planning and coordination as the best predictors. Following leave-one-out cross-validation, this model was estimated to correctly predict 60% of an independent group of cognitively-unimpaired older drivers into on-road Pass and Fail groups. In Study 2 (Healthy Driver Follow-up study), 56 participants from the Healthy Older Drivers study were followed for 24 months using annual telephone interviews to assess driving behaviour, driving attitudes, medical conditions, and the occurrence of crashes and receipt of traffic offences. Official data regarding crashes and traffic offences were also obtained. The aim was to determine whether either the on-road Pass/Fail classification or the off-road measures could predict subsequent crashes and offences. Failing the on-road assessment was not associated with higher crash or offence rates and there were only two baseline measures that predicted crashes or offences (i.e., distance driven at baseline testing and, paradoxically, a lower error score on a measure of visuomotor planning and coordination). However, drivers who reported more distress associated with their medical condition(s) were more likely to have had a crash or offence at 24 months. The outcomes of the Healthy Older Drivers and Healthy Driver Follow-up studies suggest that there is little value in off-road or on-road assessment of cognitively-unimpaired older drivers due to the weak relationship with future negative driving outcomes. However, distress associated with medical conditions may be a useful measure. Study 3 (Dementia and Driving study) recruited a sample of 60 driving assessment centre referrals with mild cognitive impairment or Alzheimer’s dementia. These participants, aged 58-92 years (mean age 77.9, 60% male), performed a computerized battery of sensory-motor and cognitive tests and a formal blinded on-road driving assessment. A backwards stepwise binary logistic regression model selected measures of reaction time and movement speed of the upper limbs, visuomotor planning and coordination, and sustained attention. Following leave-one-out cross-validation, this model was estimated to correctly predict 68% of an independent group of drivers with mild cognitive impairment and Alzheimer’s dementia into on-road Pass and Fail groups. A subsample of 32 participants completed additional standard cognitive tests and provided information on medical conditions. A binary logistic regression model in this subsample was formed which selected measures of verbal fluency, the presence of heart disease, and a comprehensive cognitive screen. Following leave-one-out crossvalidation, this model would be expected to correctly classify 75% of an independent group of drivers with mild cognitive impairment and Alzheimer’s dementia into on-road Pass and Fail groups. The three measures in this model could be performed in around 35-50 min in a primary health setting. It is concluded that off-road and on-road assessment of older drivers with no diagnosis of cognitive or neurological disorder is an inaccurate and inefficient use of driving assessment resources, both for the prediction of on-road driving performance and for predicting future crashes and traffic offences. The Dementia and Driving study found a model comprising three measures that could be performed in a primary health setting with reasonable accuracy for correctly classifying people with mild cognitive impairment and Alzheimer’s dementia who go on to Pass and Fail an on-road driving assessment.

Hearing impairment (HI) is a growing health issue in today’s ageing society. Research has suggested that individuals with HI may experience increased levels of anxiety. Previous research has mainly focused on anxiety as a trait; recent research, however, has looked at state anxiety in the hearing impaired population. Cognitive anxiety is a state anxiety that occurs when people encounter a situation which does not lie within their construct system. As a result, they may experience anxiety as they are unable, or only partially able, to interpret the event meaningfully and are therefore unable to judge the implications of this event. The following study aimed to use the Cognitive Anxiety Scale to investigate relationships between cognitive anxiety and client variables in hearing impaired individuals, adding to the small amount of research currently available in this area. The following research questions were investigated: (1) Is there a relationship between cognitive anxiety level and (a) age, (b) gender, (c) audiometric variables, and (d) quality of life? (2) Is there a significant difference between the level of cognitive anxiety for the participants who purchased and kept hearing aids and those who did not? Twenty-five hearing impaired individuals who were consulting an audiologist for the first time participated in this study, with the cognitive anxiety interview conducted prior to the audiological assessment. The results indicated that cognitive anxiety was significantly related to an ability to understand speech in noise and quality of life, and that hearing aid adopters exhibited greater levels of cognitive anxiety than non-adopters. These results confirm that cognitive anxiety is indeed experienced by adults with HI, and suggest that it may be a factor which motivates people to adopt hearing aids. Further research is needed to confirm and further investigate the relationships with client variables. By listening for signs of cognitive anxiety, an audiologist may be able to gauge if a client is ready for rehabilitation, and encourage the process by exploring the effects of HI on communication situations, employing speech in noise testing, and including the significant other in the process.

Individuals with Parkinson’s disease (PD) often show cognitive impairments in addition to motor symptoms, with the majority of PD patients converting to dementia as the disease progresses. The changes in the microstructural integrity of key nodes in resting state networks (RSNs) could be a good indicator of the cognitive effects of PD on brain regions as it progresses to dementia. To assess the association between cognitive effects and microstructural change, the microstructural integrity of the regions of interest (ROIs) in 4 resting state networks (RSN), specifically the default mode network (DMN), based on DTI were obtained in three separate groups of patients with PD. One group of patients (PD-N) were cognitively normal, while the second group of patients (PD-MCI) reflect the transitional phase of mild cognitive impairment prior to dementia, and the third group of patients (PD-D) possessed a clear diagnosis of dementia. A comparison group of healthy controls (HC) were included, matched across the three patient groups. The PD-D group showed worse microstructural integrity for the majority of the ROIs across the 4 networks. The loss of structural integrity in the PD-MCI group was more selective, with some ROIs showing similar changes to PD-D, and others showing similar changes to the PD-N group. The PD-N group fail to show any changes in the structural integrity of any ROIs, relative to HC. For future study, a combined structural / functional study should be performed to examine if there are similar changes across both measures.

identity play an important role in how they communicate and interact with other individuals. One group in which identity construction and navigation is a difficult process is the hearing impaired population. In an effort to understand how these individuals construct their identity and navigate their hearing impairment, this study utilizes Communication Theory of Identity. Through the use of interactive interviews, the researcher was able to examine how 11 participants manage their identity as hearing impaired individuals. The interviews provided insight into the four layers of identity proposed by CTI – personal, relational, enacted, and communal – in the hearing impaired individual. The author discusses the themes within each of the four layers and the gaps present between the layers that emerged as the hearing impaired participants discussed how they navigate their hearing impairment. Furthermore, the implications of these themes and gaps within the hearing impaired individual’s identity, such as feeling disconnected from both the Deaf and hearing communities, are examined.

Background: Whiplash associated disorders (WAD) account for a large proportion of the overall impairment and disability from traffic injuries and causes substantial bio psychosocial consequences for some individuals. Aims: To increase the knowledge about factors described in terms of either function /impairment, activity/disability and life satisfaction in acute and chronic WAD as well as possible implications for rehabilitation. Within this aim the incidence and recovery rate of whiplash injury and prognostic factors of interest for early rehabilitation have been studied. Subjects and Methods: Fifty-five healthy controls and 34 WAD subjects were analysed within and between groups concerning a) biomechanical out put, endurance, fatigue and muscle tension (EMG activity of trapezius, infraspinatus and deltoideus) during repetitive shoulder forward flexion b) impairments and activity/disability and life satisfaction.356 subjects seeking medical attention due to whiplash trauma, 296 were available at follow up, mean 16 months post injury. Incidence and odds ratio of accident and other background factors on disability were determined. Thirty-four out of 43 patients with whiplash injury were investigated through quantitative sensory tests at six weeks and 71 months after injury. 62 WAD participated in an interdisciplinary rehabilitation program (a pilot study) designed to evaluate such rehabilitation program for patients with chronic (in relatively early stage) WAD. Program evaluation of impairment, disability and life satisfaction (prospective and retrospective) was carried out before and after program and at 6 months. Results: No significant effects of sex or age on the ability to relax between repetitive r muscle contractions (SAR) were found in healthy subjects (study I). Significantly higher inability to relax between contractions was found for the two portions of trapezius and infraspinatus in the WAD group compared to the healthy group (study II). Significantly lower levels of activity preferences were noted for three out of five indices in females with WAD The WAD group had significantly higher prevalence of neropsychological and emotional symptoms. Both pain related symptoms and neropsychological symptoms were of significant importance for aspects of disability and life satisfaction in this group (study IV). Sensory disturbances over the trigeminal skin area persisted over the years. At follow-up a significant correlation was found between the sensory disturbances and the symptoms related to the central nervous system while no significant relationship was found with the musculoskeletal symptoms (study HI) .The annual incidence according to the grading of the Quebec Task Force on Whiplash-Associated Disorders (WAD 1-3) was 3.2/1000 and 4.2/1000 when WAD 0 was included. Sixty-eight percent of the patients recovered during the follow-up Pre-traumatic neck pain, low educational level, female gender and WAD grade E-Ill were significantly associated with a poor prognosis (study IV). . Participants in the rehabilitation program reported increased coping ability. Stress reactions seemed rather frequent (32 %). Pain intensity in the neck and upper back were significantly decreased at 6 months follow-up. However, for most of the functional and psychological markers, no significant changes were found (study V). Conclusion: The higher prevalence of musculoskeletal complaints of the neck shoulder region in females cannot be explained by higher muscle tension and clinical assumption of increased muscle tension seems correct in whiplash patients Results indicate heterogeneity among WAD subjects. Females are at risk after a whiplash trauma but the severity of initial symptoms and signs also affect outcome as well as low education. High levels of neuropsychological symptoms and pain, signs of posttraumatic stress, fear and avoidance, loss of control, anxiety, bio-mechanical and psychosocial factors at work (studies) and social support are potential factors to be aware of. Extensive and costly investigations are in most cases not necessary. However most persons will recover a whiplash injury. Multidisciplinary/interdisciplinary assessment should be considered at three months if substantial negative effect on the person’s ability to function and health situation exists. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2001, härtill 6 uppsatser.</p> / digitalisering@umu

This thesis deals with the career choices of young adults (ages 18 through 40) with mobility impairments and the experiences they had throughout their career-selection process. The purpose of the study was: To find the inhibitory and furthering factors of the career choices of people with mobility impairments from their own perspective, with a special focus on how various factors affected the process over time. The method for collecting the results of this study was biographical interviews. The main theories of the study were Sense of Coherence, Self-efficacy, Learned Helplessness, Social Role Valorization and The Four Rooms of Change. The results show that mobility impairment affects career choices and that the effect is more often inhibitory than it is furthering. Structural factors, such as how the respondents are treated by other people, as well as rules and material barriers (stairs, mal-functioning elevators, etc.) are found to be more limiting than the body itself. Being over-protected is a main inhibitory factor which can contribute strongly to low self-efficacy and drainage of self-image for the respondents.  The goal of the respondents is to obtain independence and a job based on their own terms, and not a social care career. This goal was found to form a vital resistance resource versus adversity and obstacles. The respondents consider themselves to be overprotected by society (by parents, teachers, career counsellors, employment officers, etc.) in relation to their career choices, and they would like not to be. / <p>Forskningsfinansiärer: Torsten Söderbergs Stiftelse och Ragnar Söderbergs Stiftelse</p>

Problem: Designing the user experience is a growing trend in product design; however this trend has not greatly benefited people with impairments and disabilities. There are no practical tools to broadly assist with this issue. There is a need for standardized measures to quantify impairment, a model to predict how designs may perform and a need for data regarding how people with impairments interact with consumer technology. Purpose: To conduct a usability analysis with an industry partner on their powered wheelchair controller using participants with varying impairments. The industry partner was seeking better insight into the benefits of formal user testing. Method: Forty consenting adults were given a score representing their level of impairment using six measures from the International Classification of Functioning (ICF). These measures were identified by the researcher to affect interaction with a device. Performance was measured by time taken to complete tasks, errors made, reported task difficulty and reported controller usability. Results: Performance was reduced in participants with a higher ICF score and age. An ICF score less than or equal to 2 was 117 times more likely to not complete the tasks, greater than or equal to 3 was not able to complete the experiment. Age >50 years took an average 79 seconds longer than <35 years to complete a task and reported greater difficulty, more errors and a lower usability for the controller. Implications: Low to moderate levels of impairment has a significantly negative effect on the usability of common devices. Difficulties were mostly cognitive with participants unable to create an accurate mental model of the system. Participants with lower performance tended to be overly optimistic about their abilities. Mistakes were the greatest source of error followed by lapses and almost no reported or observed slip errors. Original Contribution: The ICF has never been used as a metric for usability testing. This study successfully applied the ICF alongside other measures to prove its validity. Based on the results and current literature the Task Process Model was created to provide a simple and practical way to describe the interaction of people completing a task of basic to moderate complexity.

Hearing loss has a negative effect on the daily life of 10-15% of the world’s population. One of the most common ways to treat a hearing loss is to fit hearing aids which increases audibility by providing amplification. Hearing aids thus improve speech reception in quiet, but listening in noise is nevertheless often difficult and stressful. Individual differences in cognitive capacity have been shown to be linked to differences in speech recognition performance in noise. An individual’s cognitive capacity is limited and is gradually consumed by increasing demands when listening in noise. Thus, fewer cognitive resources are left to interpret and process the information conveyed by the speech. Listening effort can therefore be explained by the amount of cognitive resources occupied with speech recognition. A well fitted hearing aid improves speech reception and leads to less listening effort, therefore an objective measure of listening effort would be a useful tool in the hearing aid fitting process. In this thesis the Auditory Inference Span Test (AIST) was developed to assess listening effort by measuring an individual’s cognitive spare capacity, the remaining cognitive resources available to interpret and encode linguistic content of incoming speech input while speech understanding takes place. The AIST is a dual-task hearing-innoise test, combining auditory and memory processing, and requires executive processing of speech at different memory load levels. The AIST was administered to young adults with normal hearing and older adults with hearing impairment. The aims were 1) to develop the AIST; 2) to investigate how different signal-to-noise ratios (SNRs) affect memory performance for perceived speech; 3) to explore if this performance would interact with cognitive capacity; 4) to test if different background noise types would interact differently with memory performance for young adults with normal hearing; and 5) to examine if these relationships would generalize to older adults with hearing impairment. The AIST is a new test of cognitive spare capacity which uses existing speech material that is available in several countries, and manipulates simultaneously cognitive load and SNR. Thus, the design of AIST pinpoints potential interactions between auditory and cognitive factors. The main finding of this thesis was the interaction between noise type and SNR showing that decreased SNR reduced cognitive spare capacity more in speech-like noise compared to speech-shaped noise, even though speech intelligibility levels were similar between noise types. This finding applied to young adults with normal hearing but there was a similar effect for older adults with hearing impairment with the addition of background noise compared to no background noise. Task demands, MLLs, interacted with cognitive capacity, thus, individuals with less cognitive capacity were more sensitive to increased cognitive load. However, MLLs did not interact with noise type or with SNR, which shows that different memory load levels were not affected differently in different noise types or in different SNRs. This suggests that different cognitive mechanisms come into play for storage and processing of speech information in AIST and for listening to speech in noise. Thus, the results suggested that a test of cognitive spare capacity seems to be a useful way to assess listening effort, even though the AIST, in the design used in this thesis, might be too cognitively demanding to provide reliable results for all individuals.

Parkinson’s disease (PD) is next to Alzheimer’s disease (AD) the second most common neurodegenerative disease. PD has traditionally been characterised as a motor disorder, but more recent research has revealed that cognitive impairments are frequent. Cognitive impairments in executive functions, attention, and working memory with reliance on dopaminergic transmission, are often described as dominating the cognitive profile in early-phase PD. However, although knowledge about the neuropathology that underlies the cognitive impairments in PD has increased, its features are complex and knowledge remains insufficient. Therefore, the aim of the current thesis was to improve the understanding of how task-evoked brain responses relate to cognitive status in patients with PD, with and without mild cognitive impairment (MCI), and to evaluate the predictive value of PD-MCI in respect of prodromal Parkinson’s disease dementia (PDD). This was conducted within the “new Parkinsonism in Umeå” (NYPUM) project, which is a prospective cohort study. Patients with idiopathic PD were included in this thesis, and the patients were examined with a comprehensive neuropsychological battery and with a functional MRI (fMRI) working memory protocol. During scanning, patients conducted a verbal two-back task in which they needed to maintain and actively update relevant information, and the primary outcome measure was blood-oxygen-level-dependent (BOLD) signal. This thesis shows that patients with PD-MCI had significantly lower BOLD signal responses than patients without MCI in frontal (anterior cingulate cortex) and striatal (right caudate) regions (Study I). The altered BOLD response in the right caudate was associated with altered presynaptic dopamine binding. The fronto-striatal alterations persisted across time but without any additional change. However, decreased posterior cortical (right fusiform gyrus) BOLD signal responses were observed in patients with PD-MCI relative to patients without MCI across time (Study II). Finally, PD-MCI at baseline examination is highly predictive for prodromal PDD with a six-fold increased risk. Cognitive tests with a posterior cortical basis, to a greater extent, are predictive for prodromal PDD than tests with a fronto-striatal basis. The observed working memory related alterations in patients with PD-MCI suggest that early cognitive impairments in PD are linked to fronto-striatal dopaminergic dysfunction. The longitudinal development of cognitive impairment in PD reflects additional posterior cortical dysfunction. This might reflect a dual syndrome, with dopamine-depleted fronto-striatal alterations that characterise PD-MCI in general, whereas additional posterior cortical cognitive alterations with a non-dopaminergic basis to a greater extent characterise prodromal PDD. If, and how, the two potential syndromes interact, is still unclear. Thus, this thesis provides information on cognitive neuropathological changes in PD that might contribute to more relevant choices of pharmacotherapy and diagnostic accuracy in respect of PDD. However, additional large-scale longitudinal imaging studies are needed to further clarify the neuropatholgogical features of PD-MCI in respect of prodromal PDD.