A SflS AiA PtiP th LiLinc2%ad... · “John did not talk about the feast” Highcontext sentences: 3 dB “The wedding banquet was a feast” Task: Repeat the last word of the sentence

A S f l A i P ti th LiA Successful Aging Perspective on the Linbetween Hearing, Cognition and Socia

P ti i ti th LifParticipation over the Lifespan

Kathy Pichora‐FullerProfessor, Dept. of Psychology, Univ. of Toronto Mississauga,

Adjunct Scientist, Toronto Rehabilitation Institute and Rotman Research InstituteGuest Professor, Linneaus Centre HeAD, Linkoping University, Sweden

OutlineOutline

• Question about hearing and healthy aging• Define healthDefine health• Lifespan view• Hearing and health• Successful agingSuccessful aging• How to apply these ideas with children

Does treating hearing loss slow cognitive d li ?decline?

QuestionQuestionBackground Facts:Background Facts:1. Health in childhood can affect adult health.2. Hearing loss is related to poorer health in older

adults (dementia, falls, mortality….).

Question:Question:How important is it to promote health in children with h l h l h f ll d lhearing loss to help them age successfully as adults?

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World Health Organization (WHO)Definition of Health (1948)

• Health is a complete state of well-being:

Definition of Health (1948)

• Health is a complete state of well-being:– Physical well being– Mental well being– Social well beingg

• Health is NOT merely the absence of disease or infirmitydisease or infirmity.

• State of optimum health is called “wellness”

Issues in Adult Development and Agingp g g

Perspective of an Older Adult who LivesPerspective of an Older Adult who Lives with Hearing Loss

“When you are hard of hearing you struggle to hear;y f g y gg ;When you struggle to hear you get tired;When you get tired you get frustrated;When you get tired you get frustrated;When you get frustrated you get bored;When you get bored you quit.

‐‐ I didn’t quit today.”I didn t quit today.

Avoid by withdrawal from social interaction!

A Model of Disability in Later LifeA Model of Disability in Later Life

• Disability:Effects of chronic conditions on– Effects of chronic conditions on people’s ability to engage in activities that are necessary expected andthat are necessary, expected, and personally desired in their society.

ENABLEMENT• ENABLEMENT

Total number of articles cited in PubMed: March 3 2014Total number of articles cited in PubMed: March 3, 2014

800035000

700030000Hearing

5000

600025000

bMed

)

4000

5000

15000

20000

ations (P

ub Hearing + (Cognition or Cognitive or memory or brain)

2000

3000

10000

15000

# Pu

blica

Hearing + (Social or

1000

2000

5000

g (psychosocial or "significant other" or stress or isolation or withdrawal or stigma or

)00

1940s 50s 60s 70s 80s 90s 2000s

stereotype)

Health isHealth is…“…the capacity of…the capacity of

people to adapt to, respond to orrespond to, or control life’s h ll dchallenges and

changes.”(Frankish et al., 1997)

Health states associated with being isolated: 1. Early mortality2. Cognitive impairmentg p3. Cardiovascular disease4. Depression p5. Physical decline

Sources: House et al Am J Epidemiol 1982, Green et al Int J Geriatr 2008,Oxman et al Am J Epidemiol 1992, Strogatz et al 1986

Health Promotion• “… is the process of enabling people to increase

& ”

Health Promotioncontrol over & to improve their health.”(WHO, 1986 – Canadian Charter on Health Promotion)Promotion)

• “ is any combination of educational… is any combination of educational, organizational, economic & environmental supports for actions conducive to health.” (Green & Kreuter, 1991)1991)

• programs enhance the “FIT” between people &• …. programs enhance the FIT between people & their surroundings (Sokols, 1996)

Coping with STRESS

• People respond differently to stress• People respond differently to stress– imbalance in person-environment fit

• The impact of any potentially stress event is greatly influenced by how a person appraises it (Lazarus & Folkman, 1984)– Primary Appraisal: Is the event harmful, threatening, or challenging?Primary Appraisal: Is the event harmful, threatening, or challenging?– Secondary Appraisal: What are my coping resources? Are they adequate?– Reappraisal – changes in the situation may change the appraisal

• Coping is the process of trying to manage demands that are appraised as taxing or exceeding one’s resources

• As vulnerability (lack of coping) increases, it takes less stress to trigger illnessit takes less stress to trigger illness

Life Cycle Model of StressLupien et al (2009) Nature 10 434‐ 445Lupien et al., (2009). Nature, 10, 434 445.

Figure 2 | The life cycle model of stress. How the effects of chronic or repeated exposure to stress (or a single exposure to severe stress) at different stages in life depend on the brain areas that are developing or declining at the time of the exposure. Stress in the prenatal period affects the development of many of the brain regions that are involved in regulating the hypothalamus‐pituitary‐adrenal (HPA) axis — that is, the hippocampus, the frontal cortex and the amygdala (programming effects)….. In adulthood and during aging the brain

i h d h id d li l f i ( d b ) hi hl l bl h ff f h Sregions that undergo the most rapid decline as a result of aging (red bars) are highly vulnerable to the effects of stress hormones. Stress during these periods can lead to the manifestation of incubated effects of early adversity on the brain (manifestation effects) or to maintenance of chronic effects of stress (maintenance effects). PTSD, post‐traumatic stress disorder.

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What Changes in Cognitive DevelopmentWhat Changes in Cognitive Development over the Lifespan?

(Craik & Bialystock, Handbook of Cognitive Aging, 2008)

Younger OlderRepresentationControl

Younger Older

(KNOWLEDGE)(PROCESSING)

MemorySlowing

Context

(reliance, benefit from SUPPORTIVE ENVIRONMENT)

When Does Cognitive Aging Start?1.5

1.0

Synonym VocabularyPattern Comparison (Speed)Raven's (Reasoning)Recall (Memory)

84

on

ore

0.5

f Pop

ulat

i

Z-S

co

-0.5

0.0 50

cent

ile o

f

-1.0 16

Per

c

10 20 30 40 50 60 70 80 90-1.5

Chronological Age

Salthouse (2004) Current Directions in Psychological Science

Prevalence of Hearing LossPrevalence of Hearing Loss• Depends on measure and criteriap

– “Normal for age”Median audiometric thresholds (ISO 7029)– Median audiometric thresholds (ISO 7029)

Women Men

3kHz 3kHz

Auditory AgingAuditory Aging

(Mills, Schmeidt, Schulte, & Dubno, 2006)

• HF audiometric threshold elevation– OHC (also noise-induced hearing loss)– Endocochlear potentials ~ stria vascularisp

Neural loss of synchrony• Neural – loss of synchrony

Bottom‐Up &Top Down ProcessingBottom Up &Top Down Processing• Effortful listening

– Bottom‐up processing less efficient Knowledgep p g– Top‐down processing more necessary

Top D

• Bottom‐up (ear to brain)– Analysis of acoustic signal

• Better signal (faster)

Dow

n

g ( )• Poorer signal (slower) • @ amount & type of distortion

T d (b i t )

Meaning

up• Top‐down (brain to ear)– Priming (pre‐signal)

• expectations facilitate recognition (faster)Di bi ti ( t i l)

Bottom

u

– Disambiguation (post‐signal)• knowledge constrains alternatives (slower)

– Repair (post‐signal)Fill i t ( l )

Sound

• Fill in gaps or correct errors (slower)

1995

Low context sentences:3 dB

“John did not talk about the feast”

High context sentences: 3 dBg

“The wedding banquet was a feast”

Task: Repeat the last word of the sentence 6 dB

Old need 3 dB better S:N

h l ld 3 d

Good audiogram

Context helps old 3 dB more

Cohen (1987). Speech comprehension in the elderly. The effects of cognitive changes. BJA, 21, 221‐226.Rabbit (1990) Mild hearing loss can cause apparent memory failures which increase with age and reduce with IQRabbit (1990). Mild hearing loss can cause apparent memory failures which increase with age and reduce with IQ. Acta Otolryn., 476, S167‐176.Wingfield (1996). Cognitive factors in auditory performance: Context, speecd of processing and constraints of memory. JAAA, 7, 175‐182.

Effect of Simulated Auditory Aging on W ki M SWorking Memory Span

(Pichora‐Fuller, IJA, 2008; Brown & Pichora‐Fuller, Canadian Acoustics, 2000)

Context, Intelligibility & Brain Activation(Obleser, Wise, Dresner & Scott, 2006)

High vs. low predictability atg p yintermediate signal quality for younger adults listening to distorted (noise‐vocoded) SPIN sentences

Activation to HIGH‐CONTEXT > LOW‐CONTEXT speech

Various areas activated including theleft dorsolateral prefrontal cortex ( ki & i i )(working memory & semantic processing)

Cognitive Neuroscience of AgingCognitive Neuroscience of Aging

• Same performance achieved with different processing

• More widespread activation ~ brain reorganization• More widespread activation brain reorganization– Young brain activity more lateralizedOld brain activity more distributed– Old brain activity more distributed

• Deterioration or compensation?p

• HAROLD: Hemispheric asymmetry reduction in older adults(Cabeza, 2002)

• PASA: Posterior‐anterior shift in agingg g(Davis, Dennis, Daselaar, Fleck & Cabeza, 2008)

CompensationCompensation(Grady, 2012, Nature Reviews Neuroscience, 13, 491‐505)

low high

Cognitive Aging 6.0

7.0

SNR

)

2 3 dBg g g(Pichora‐Fuller, IJA, 2008;

Brown & Pichora‐Fuller, Canadian Acoustics, 2000) 3 0

4.0

5.0

Con

text

(dB

2‐3 dB

2000)

Gains: 1.0

2.0

3.0

enef

it fro

m C

Knowledge is preservedand context is helpful

0.0Younger

IntactYounger

JitterOlder Intact

B

Losses:Processing declines– Working memory

l i– Slowing– Attention/Inhibition

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All cause mortality ~ Sensory impairment

Kaplan Meier plots for all-cause mortality rates by type of sensory impairment adjusted for relevant confounders

impairmentMales Females

100

90

al

80

No sensory impairment%su

rviv

a

70

y pVisual impairment onlyHearing loss only

%

60 Dual sensory lossN=4926 Icelandic individuals aged 67+

Years past sensory examination

Sources: Fisher et al, Age Ageing 2013, and Feeny et al J Clin Epidemiol 2012

Hearing loss is a risk factor for having automobile accidents i l h t f l k i Q b

Hearing status # who had at least 1 accident

Prevalence ratio (age adjusted)

95% CI

in a large cohort of male workers in Quebec

least 1 accident (age-adjusted)Normal 7473 1.0Just noticeable 1966 1.06 1.01, 1.11HL

,

Mild HL 777 1.13 1.05, 1.21M d t HL 559 1 18 1 08 1 27Moderate HL 559 1.18 1.08, 1.27Severe HL 622 1.31 1.20, 1.42Total 11397Total 11397

N=46030 male workers

Clear dose-response

Attributable risk of traffic accident to HL = 5.6%

Source: Picard et al, Traffic Injury Prevention 2008

Clear dose response

The impact of hearing loss on the driving performance of 107 seniors p g g pwith normal visual acuity and cognitive function tested on a closed road circuit

Mean driving score # signs correctly recognized

Normal/mild HL

Moderate/severe HL

None Visual Auditory None Visual AuditoryNone Visual Auditory

Type of distractionNone Visual Auditory

Type of distraction

Source: Hickson et al, JAGS 2010

Increased perceptual effort drains cognitive resources available for other purposesother purposes

Hearing loss Reduced perception of hazard noiseHearing loss p p

Falls ?

When Does Cognitive Aging Start?1.5

1.0

Synonym VocabularyPattern Comparison (Speed)Raven's (Reasoning)Recall (Memory)

84

on

ore

0.5

f Pop

ulat

i

Z-S

co

-0.5

0.0 50

cent

ile o

f

-1.0 16

Per

c

10 20 30 40 50 60 70 80 90-1.5

Chronological Age

Salthouse (2004) Current Directions in Psychological Science

Figure 1. Estimates of age‐specific prevalences of Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI), and Non‐Affected (NAs), aged 60–85,Mild Cognitive Impairment (MCI), and Non Affected (NAs), aged 60 85, assuming 1.0% rate for conversion from NA to MCI at age 60. (Adapted with permission from Yesavage JA, O’Hara R, Kraemer H, et al. Modeling the prevalence and incidence of Alzheimer’s disease andModeling the prevalence and incidence of Alzheimer s disease and mild cognitive impairment. J Psychiat Res 2002;36:281‐286.)

Hearing Loss Prevalence & DementiaHearing Loss Prevalence & Dementia• Audiogramg

– Gold, Lightfoot & Hnath-Chisolm (1996)• 27 of 30 (90%) patients with Alzheimer’s had ( ) p

hearing impairment (pure-tone screen & HHIE)– Uhlmann et al. (1989)

• Case-control study with 100 pairs– Prevalence higher in those with Alzheimer’s-type dementia

Hearing loss significantly correlated with MMSE– Hearing loss significantly correlated with MMSE

• Central Auditory (DDT)Id i b i l (2011)– Idrizbegovic et al. (2011)

• Performance on DDT worse for those with MCI and worse still for those with DATworse still for those with DAT

Dual Sensory (Hearing & Vision) Lossy ( g )• DSI and cognitive decline

• Dual sensory loss associated with greatest odds for• Dual sensory loss associated with greatest odds for cognitive decline and for functional decline on five everyday activities over a period of four yearseveryday activities over a period of four years (Lin, MY et al., 2004)

“Central Auditory” (Speech in Noise)Central Auditory (Speech in Noise) Problems May PRECEDE Dementiay

• Longitudinal epidemiological studies– Gates et al. (1996)

• N >700, speech in competing speech test (SSI-ICM) in , p p g p ( )those without stroke, dementia, or HL (PTA 40 dB HL)

• MMSE administered 2, 4, 6 years later• Those with low scores on SSI-ICM were 6-12 times more

likely to develop clinical dementia– Gates et al. (2002, 2008)

• Similar results for longer follow-up period (3-12years)g p p ( y )

P re tone HL Related to Incident DementiaPure-tone HL Related to Incident Dementia

Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. A hi N l 68(2) 214 220Archives Neurology, 68(2), 214-220.

• Lin FR Ferrucci L Metter EJ et al (2011) Hearing loss andLin FR, Ferrucci L, Metter EJ, et al. (2011). Hearing loss and cognition in the Baltimore Longitudinal Study of Aging. Neuropsychology, 25, 763-770.

• Lin FR. (2012). Hearing loss in older adults. Who’s listening? JAMA, 307, 1147-1148.,

• Lin FR, Yaffe K, Xia J, et al. (2013). Hearing loss and cognitive d li i ld d lt JAMA I t M d 173 293 299decline in older adults. JAMA Intern Med, 173, 293-299.

Hearing loss and cognitive declineHealth ABC cohort 2013

94

Health ABC cohort, 2013

92

90scor

e*

Normal hearing group90

88

ntal

sta

te

86

84min

i-men Hearing loss group

p=.004 for difference in change over time82

80Mod

ified

m

80M

Study year5 8 10 11

* Note: very similar results for the digit-symbol substitution test

Study year

Hearing loss and Incident DementiaHearing loss and Incident DementiaBaltimore Longitudinal Study of Aging cohort, 2011

10

12

ntia

n=639

8

10

nt d

emen HL severity HR (95% CI)

mild 1.89 (1.00-3.58)

4

6

of in

cide

n moderate 3.00 (1.43-6.00)severe or more 4.94 (1.09-22.4)Cox proportional hazards model adjusted

2

4

Haz

ard

o Cox proportional hazards model adjusted for age, sex, race, education, diabetes, smoking and HTN. Hazard ratios relative to normal hearing.

0 100806040200

Mild Mod SevereHearing loss, dB

Source: Lin et al, Arch Neurol 2011

Mild Mod Severe

MoCA

Montreal Cognitive gAssessment

www.mocatest.org

l/Visuo‐spatial/executiveNamingMemoryMemoryAttentionLanguageAb t tiAbstractionRepetitionOrientation

MoCA Repeat & Recall (D i t l b itt d)MoCA Repeat & Recall (Dupuis et al., submitted)

80All Participants Repeated_Recalled

Repeated Forgotten80

Good Hearing

25

30

50

60

70

80 Repeated_Forgotten

Not Repeated_Forgotten

40

50

60

70

15

20

25

10

20

30

40

0

10

20

30

0

5

10

0

Good Hearing – Hearing Loss

0Face Velvet Church Daisy Red

80

Hearing Loss

Face Velvet Church Daisy Red

50

60

70

80

10

20

30

40

0

10

Face Velvet Church Daisy Red

Increased perceptual effort drains cognitive resources available for other purposes

Social Isolation DementiaHearing loss DementiaHearing loss

Unknown commonUnknown common neurodegenerative

pathologyFrank Lin

Mild Cognitive Impairmentg p(e.g, Troyer & Murphy, 2007)

Kell M rph

• Active lifestyle ~ risk of future dementia– Cognitive engagement

Kelly Murphy

– Cognitive engagement• Tasks involving problem‐solving, decision‐making, learning, remembering new information

Ph i l ti it– Physical activity• Some activities are done in groups, with music

– Social interaction• Rich social stimulation and active social network• Participating in group activities and interactions

• Enriched environments• Enriched environments• Group interventions• Communication related disorders???• Communication‐related disorders???

Interactive Effects of Physical Activity and Diet

High exercise + great diet

No exercise + poor diet

Scarmeas et al. (2009) JAMA, 302, 627‐637.

Cognitive Benefits of Better HearingCognitive Benefits of Better HearingArlinger, Lunner, Lyxell, & Pichora‐Fuller, Scandinavian J Psych, 2009

• Slower cognitive decline in Alzheimer’s cases with better hearing(Peters, Potter, & Scholer, 1988; Wahl & Heyl, 2003)

• Reduced rate of decline in scores on a cognitive screening test over a six‐month period following intervention with hearing aids (Allen et al 2003)(Allen et al., 2003)

• Hearing aid use reduced problem behaviours judged by caregivers of adults with dementiadementia (Palmer et al., 1998)

• Older adults using hearing aids have better emotional and social well‐being andOlder adults using hearing aids have better emotional and social well being and greater longevity (Appolonio et al., 1996; Cacciatore et al., 1999; Naramura et al., 1999; Seniors Research Group, 1999)

Sensory Cognitive Communication TrioSensory‐Cognitive‐Communication Trio1. Hearing loss is associated with incident dementia

(e.g., Gates et al., 2002, 2010,2011; Lin, 2011; Lin et al., 2011a, 2011b, 2013; Peters et al., 1988; Uhlmann et al., 1989)

2. Hearing loss reduces communication functioning, g g,increasing risk for social isolation(e.g., Appollonio et al., 1996; Bess et al., 1989; Crews & Campbell, 2004; Keller et al., 1999; Laforge et al., 1992; Mulrow et al., 1990a, 1990b; Rudberg et al., 1993; Reuben et al., 1999; f g , ; , , ; g , ; , ;Sindhusake et al., 2001; Weinstein & Ventry, 1982)

3. Engagement in leisure activities is related to cognition and healthand health(e.g., Bassuk et al, 1999; Fabrigoule et al., 1995; Fratiglioni et al., 2000; Hultsch et al., 1993; Mousavi‐Nasab, 2012; Strawbridge et al., 1998; Wang et al. 2002)

Hypotheses(D i l D i Pi h F ll i )(Danielsson, Dupuis, Pichora‐Fuller, in prep)

1. Social withdrawal mediates th i ti b tthe association between hearing loss and cognitive decline

HearingLossdecline

2. Cognitive functioning mediates the association

Loss

mediates the association between hearing loss and social withdrawal

SocialWithdrawal

social withdrawal3. Social withdrawal can be

caused by hearing loss Cognitivecaused by hearing loss and/or cognitive decline (all effects of aging)

CognitiveDecline

(all effects of aging)

ParticipantsParticipants

Betula, Sweden Stigma, TorontoN 297 273Age (years) M = 67 (35‐90) M = 71 (56‐96)Education M = 14 YoE M = 16 YoE

(36% > secondary) (81% > secondary)Employed 62% 76%Female 45% 64%Married 73% 54%Good General Health 84% 82%

Hearing Variables Used in ModelsHearing Variables Used in Models• Pure‐tone thresholds (worse ear; 3,4,6,8 kHz)

SummarySummary

• Gradual gains and losses in aging– More signal to offset auditory loss (Technologies)g y ( g )– Compensate using contextual support (AR)

D t f HL• Downstream consequences of HL on memory– Information degradation (immediate)– Deprivation (long‐term)

• Social participation: HL mediated by memory• Social participation: HL mediated by memory

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Overview of Self Management ApproachOverview of Self Management Approach

S lf M tSelf ManagementA person’s active participation in achieving their own best health and wellness through gainingown best health and wellness through gaining confidence, knowledge, and skills to manage physical, social and emotional aspects of lifephysical, social and emotional aspects of life

Self Management SupportSelf Management SupportThe range of organizational, community and provider strategies to support the activeprovider strategies to support the active participation of individuals in achieving their best health and wellness

CLSA: Conceptual framework:Models of healthy/successful agingode s o ea t y/success u ag g

http://www.clsa-elcv.ca

Literature dominated by two models:

Rowe and Kahn • Differentiates successful aging from usual aging• Based on the assumption that successful agers engage in• Based on the assumption that successful agers engage in

behaviours that modify risk factors to allow them to meet a high degree of physical, mental and social functioning

Baltes and Baltes• Selection, Optimization, Compensation, p , p• Based on the assumption that decline is an inevitable part

of aging, and that successful agers are those who engage in processes that help them to adapt to change in order to

t th i lmeet their own goals

A Framework for Maintaining and Enhancing Competence (Pp. 168 – 170)

A Framework for Maintaining and Enhancing Competence (Pp. 168 – 170)

• How to optimize the overall sense of competenceA l th k d ti h i f i– Apply three key adaptive mechanisms for aging• Selection

– Select subset of options to focus resources on (priorities)p (p )• Optimization

– Find best way to achieve goal (improve by practice)• Compensation• Compensation

– Use alternative route to find solution (vision, context)

Th SOC d l– The SOC model– http://www.margret-baltes-stiftung.de/PBB-Website/SOC.html

Good Hearing Health Could Promote Good (Cognitive) Health

PRESERVEcommunication and social interaction

ff i l i l i• stave off social isolation• slow cognitive decline

OutlineOutline


HearingNot having HearingHearing Not havingillness

Hearing

DietExercise

HEALTHYAGING

GenesProductive

pursuits

SocialactivityHearing Hearingactivity Hearing

Health Promotion & Disease Prevention (Pp. 170 –171)

Health Promotion & Disease Prevention (Pp. 170 –171)

• Adopt a healthful lifestyle– make it part of your daily routine (exercise, diet)

• Stay active cognitively– keep an optimistic outlook and maintain yourkeep an optimistic outlook and maintain your

interest in things– cognitive reserve

• Maintain a social network and stay engaged with otherswith others

http://blogs.crikey.com.au/culture‐mulcher/2010/07/12/genius‐radio‐the‐nerve/ear‐brain/

Vancouver, British ColumbiaVancouver, British ColumbiaWorld Congress of Audiology

September 18‐22, 2016

Age and Modality IssuesAge and Modality Issues• MoCA total score 7

– ~ PTA(W) (p < .000)– ~ Age (p = .051) 5

6

7

• Correlations (p <.0005) 3

4NH

HL(p )

– MoCA DR x Aud FR .38– MoCA DR x Vis FR .42

0

1

2

– Aud FR x Vis FR .45 Aud Recall Vis Recall MoCA DR

• ANOVA for FR: Good vision only (N = 122)• Group (NH, HL): F(1,108) = 5.66, p = .019 • Modality (A,V): F(1,108) = 10.66, p = .001 • Group x Modality: F(1,108) = .53, p = .47

L i l d i i ti tiLexical decision reaction time in younger and older listeners:The effects of semantic context and the type and amount of acoustical distortion yp

Preceding context distorted or intact Target intactCongruent Stir your coffee with a spoon.Neutral Its name is feast.I t Stir your coffee with a riskIncongruent Stir your coffee with a risk.

‐ Measure RT when lexical decision correctMeasure RT when lexical decision correct‐ Facilitation (RT neutral context – RT congruent context)

Goy H Pelletier M Coletta M & Pichora Fuller M K (2013) Journal ofGoy, H., Pelletier, M., Coletta, M., & Pichora-Fuller, M.K. (2013). Journal of Speech, Language and Hearing Research.

Effects of Context and Distorting ItEffects of Context and Distorting It on Lexical Decision RT

More

Some

None

Effects of Distorting Context on Speed of Lexical Decision

90

45

• Older listeners’ RTs are more facilitated by context.y• Signal distortion reduces facilitation.

Spectrograms for Jittered and Intact Sentence in BabbleSentence in Babble

Documents

A SflS AiA PtiP th LiLinc2%ad... · “John did not talk about the feast” Highcontext sentences: 3 dB “The wedding banquet was a feast” Task: Repeat the last word of the sentence