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Development of the Word Auditory Recognition and Recall Measure

A Working Memory Test for Use in Rehabilitative Audiology

Smith, Sherri L.; Pichora-Fuller, M. Kathleen; Alexander, Genevieve

doi: 10.1097/AUD.0000000000000329
e-Research Articles

Objectives: The purpose of this study was to develop the Word Auditory Recognition and Recall Measure (WARRM) and to conduct the inaugural evaluation of the performance of younger adults with normal hearing, older adults with normal to near-normal hearing, and older adults with pure-tone hearing loss on the WARRM.

Design: The WARRM is a new test designed for concurrently assessing word recognition and auditory working memory performance in adults who may have pure-tone hearing loss. The test consists of 100 monosyllabic words based on widely used speech-recognition test materials. The 100 words are presented in recall set sizes of 2, 3, 4, 5, and 6 items, with 5 trials in each set size. The WARRM yields a word-recognition score and a recall score. The WARRM was administered to all participants in three listener groups under two processing conditions in a mixed model (between-subjects, repeated measures) design. The between-subjects factor was group, with 48 younger listeners with normal audiometric thresholds (younger listeners with normal hearing [YNH]), 48 older listeners with normal thresholds through 3000 Hz (older listeners with normal hearing [ONH]), and 48 older listeners with sensorineural hearing loss (older listeners with hearing loss [OHL]). The within-subjects factor was WARRM processing condition (no additional task or with an alphabet judgment task). The associations between results on the WARRM test and results on a battery of other auditory and memory measures were examined.

Results: Word-recognition performance on the WARRM was not affected by processing condition or set size and was near ceiling for the YNH and ONH listeners (99 and 98%, respectively) with both groups performing significantly better than the OHL listeners (83%). The recall results were significantly better for the YNH, ONH, and OHL groups with no processing (93, 84, and 75%, respectively) than with the alphabet processing (86, 77, and 70%). In both processing conditions, recall was best for YNH, followed by ONH, and worst for OHL listeners. WARRM recall scores were significantly correlated with other memory measures. In addition, WARRM recall scores were correlated with results on the Words-In-Noise (WIN) test for the OHL listeners in the no processing condition and for ONH listeners in the alphabet processing condition. Differences in the WIN and recall scores of these groups are consistent with the interpretation that the OHL listeners found listening to be sufficiently demanding to affect recall even in the no processing condition, whereas the ONH group listeners did not find it so demanding until the additional alphabet processing task was added.

Conclusions: These findings demonstrate the feasibility of incorporating an auditory memory test into a word-recognition test to obtain measures of both word recognition and working memory simultaneously. The correlation of WARRM recall with scores from other memory measures is evidence of construct validity. The observation of correlations between the WIN thresholds with each of the older groups and recall scores in certain processing conditions suggests that recall depends on listeners’ word-recognition abilities in noise in combination with the processing demands of the task. The recall score provides additional information beyond the pure-tone audiogram and word-recognition scores that may help rehabilitative audiologists assess the listening abilities of patients with hearing loss.

1Audiologic Rehabilitation Laboratory, Auditory Vestibular Research Enhancement Award Program, Veterans Affairs Medical Center, Mountain Home, Tennessee, USA; 2Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee, USA; 3Department of Psychology, University of Toronto, Mississauga, Ontario, Canada; 4Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; 5Rotman Research Institute, Baycrest Hospital, Toronto, Ontario, Canada; and 6Linneaus Centre HEAD, Linköping University, Sweden.

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Supported by the Department of Veterans Affairs (VA), Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development (RR&D) Service, Washington DC through a Career Development Award (#C6394W) to the first author and by the RR&D Auditory Vestibular Research Enhancement Award Program (REAP; #C4339F) to the first and third authors.

The first two authors made substantial contributions to conception and design of the work. G.A. acquired the data from the participants. S.L.S. performed the data analysis with consultation from a statistician. All the authors contributed to the interpretation of data. S.L.S. drafted the article and the other authors contributed substantially to revising the article critically for important intellectual content. All authors provided final approval of the version to be published.

The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States government.

The authors declare no other conflicts of interest.

Received March 10, 2015; accepted April 4, 2016.

Address for correspondence: Sherri L. Smith, Audiologic Rehabilitation Laboratory, Auditory Vestibular Research Enhancement Award Program (AVREAP), Audiology 126, Mountain Home, TN 37684, USA. E-mail:

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