Pharmacological Enhancement of Aural Habilitation in Adult Cochlear Implant Users

Tobey, Emily A.; Devous, Michael D. Sr; Buckley, Kristi; Overson, Gary; Harris, Thomas; Ringe, Wendy; Martinez-Verhoff, Julie

Articles

Objective: The purpose of this report was to examine the preliminary data collected under a larger on-going feasibility study conducted with cochlear implant patients exploring the potential benefit of pharmacologically-enhanced aural rehabilitation therapy as a means of increasing speech tracking skills.

Design: Eight adult cochlear implant participants participated in a randomized, double-blind study and received either 10 mg d-amphetamine (Treatment group, N = 4) or a placebo (Placebo group, N = 4) 60 minutes prior to a 1.5 hour intensive aural rehabilitation session occurring twice a week for two months. Treatment consisted of a multi-step rehabilitation program individualized for each participant to develop auditory-only speech tracking skills. Prior to and at the conclusion of the therapy sessions, SPECT rCBF imaging and speech tracking assessments were conducted.

Results: Speech tracking scores of the placebo and treatment groups were similar before the aural habilitation intervention. In the placebo group, speech tracking performance increased 13.5% for visual plus auditory and auditory only presentations as a function of aural habilitation alone. The 10 mg d-amphetamine-facilitated program resulted in minimal increases in visual plus auditory tracking scores (2%) but led to a 43% increase for auditory-only speech tracking. Regional cerebral blood flow measures indicated no substantial improvement of brain activation in the placebo group while both the extent and magnitude of primary and associative auditory cortex activations increased significantly with the pharmacologically enhanced treatment program.

Conclusions: These data support previous studies indicating an accelerated acquisition of speech and language abilities in stroke patients receiving traditional speech therapy in combination with d-amphetamine. Data, however, are preliminary and further study is warranted.

This paper examined the speech tracking performance and regional cerebral blood flow (rBF) responses of eight adult cochlear implant users before and after an 8-week, twice-a-week for 1.5 hours aural habilitation program. Half of the subjects were randomly assigned in a double-blinded fashion to a placebo group (aural habilitation training only), and half of the subjects were assigned to a pharmacologically enhanced program (10 mg of d-amphetamine plus aural habilitation program). Auditory-only speech tracking scores improved on average 12% in the placebo group and 43% for the pharmacologically enhanced group. Increases in rCBF were noted for both groups; however, the extent and amount of activation post-intervention were greater for the pharmacologically enhanced group.

Callier Advanced Hearing Research Center, The University of Texas at Dallas, Dallas, TX (E.T., K.B., G.O., J.M.V.); Nuclear Medicine Center, The University of Texas Southwestern Medical Center, Dallas, TX (M.D., T.H., W.R.); Department of Otolaryngology—Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX (E.T.)

Address for correspondence: Emily A. Tobey, Ph.D., Callier Advanced Hearing Research Center, 1966 Inwood Road, Dallas, TX 75235.

Received January 10, 2005; accepted February 14, 2005.

© 2005 Lippincott Williams & Wilkins, Inc.