We thank Yoshimasa Sekiya for demonstrating the protocol technique on film. This work was supported by the ''Japan Society for the Promotion of Science for Young Scientists (26861426)'' and by the "COI STREAM (Center of Innovation Science and Technology based Radical Innovation and Entrepreneurship Program)".

伦理声明:程序已经批准医学院的明斯特大学的道德委员会，大阪大学附属医院的伦理委员会，以及由大阪Rosai医院的伦理委员会。 1.准备设备<ol><li>获得耳模，便携式音乐播放器，密闭式耳机，均衡器，和耳机放大器，如图2。 </li><li>准备不同类型的音乐（流行，摇滚，古典等）的便携式音乐播放器的图书馆。 <ol><li>获得不同类型的音乐光盘。 </li><li>从CD用声音编辑应用程序（例如，Adobe Audition的3.0或类似）将音乐传输到计算机上。 <ol><li>放置在计算机的CD-ROM驱动器的音频CD。选择文件&gt;从CD中提取音频。您可以选择所有所选驱动器支持的提取速度，最大速度选项。 </li></ol></li><li>确认日在音乐讲解了如何使用声音编辑应用程序宽的频率范围（ 即 125-8,000赫兹或更宽）（ 例如，Adobe Audition的3.0或类似）。 <ol><li>选择所有的波形，选择Edit&gt;选择整个波。选择Window&gt;频率分析。视图频率沿着水平轴，​​以及振幅沿着在频率分析面板垂直轴。 </li></ol></li><li>通过连接电缆从计算机音乐文件传输到便携式音乐播放器。 <ol><li>连接使用USB连接线便携式音乐播放器和电脑。保存音乐文件的便携式音乐播放器为.mp3文件的[MUSIC]文件夹中的192 kbps的码率。 </li></ol></li></ol></li></ol> 2.参加<ol><li>测量听力阈值水平（空气和骨传导）双耳使用5 dB的步长中 ​​根据修正的Hughson-韦斯特莱克程序24，由纯音audiome的装置之三。 <ol><li>设置一个听力计到1000赫兹的频率控制，并设置完整耳被测试到耳机。 </li><li>设置强度级别到50分贝。 </li><li>按声演示按钮1秒给患者1000 Hz的音调。等待他们的回应（ 例如 ，通过按下按钮或举手）。 </li><li>如果患者的语气回应，在步骤2.1.3中描述的方式呈现10dB的柔和色调。如果患者不回应，则转到步骤2.1.6。 </li><li>重复步骤2.1.4，直到患者不能响应任何更长的时间。 </li><li>呈现出5分贝更大声，等待病人作出回应。 </li><li>重复步骤2.1.6如果患者不回应。 </li><li>注意柔软的强度水平的患者响应。 </li><li>重复步骤2.1.4-2.1.8直到相同强度水平应注意两次或三次。这是在1000赫兹既定听力阈值。 </li><li>测试频率重复步骤2.1.2-2.1.92000，4000和8000赫兹。 </li><li>重新测试听觉阈1000赫兹，并确认在1000赫兹在第一和第二阈值内5 dB的同意。 </li><li>重复步骤2.1.2-2.1.9测试频率500，250和125赫兹。 </li><li>将受影响的耳朵进行测试，耳机和重复步骤2.1.2-2.1.12。使用平稳方法25，如果左和右听力阈值之间的差等于或超过25分贝的较低频率（125，250，和500赫兹），或等于或超过经由耳机呈现一个适当的窄带掩蔽噪声的未经测试的耳朵40个分贝或以上千赫兹。 </li><li>测量骨导听觉阈用与步骤2.1.1-2.1.13以类似的方式掩蔽噪声。为了测量骨导听力，使用骨传导振动器，而不是耳机。为了避免串扰施加适当的窄带噪声掩蔽25向未测试耳。 </li><li>绘制听取阈值水平ñ听力图的形式。一个SSHL患者的示例性听力图示于图3。 </li></ol></li><li>检查的标准，参与CIST。 <ol><li>检查自SSHL发病的天数少于基于自我报告5。 </li><li>确认耳的听力水平差均跨越500，1000，和2000个赫兹小于50基于DB在步骤2.1中获得的气导纯音测听。 注意:如果在图3所示的听力图，听力水平差是（40 + 40 + 45）/ 3 - （5 + 0 + 5）/ 3 =38.3分贝。 </li><li>确认患者可以舒适地收听音乐与他们患耳。 </li><li>确认患者急性单侧听力损失（以自我报告）和中至少为30 dB急性单侧耳聋特发性疾病的困扰在三个或多个相邻的频率在步骤2中得到的纯音听力图10.1。例如，如果在图3所示的听力图，听力水平和高于250赫兹的右耳指示至少为30 dB感觉神经性听力损失。 </li><li>确认患者有SSHL的基础上自我报告和病历既往史。同时确认其具有基于自我报告和医学历史上没有神经或精神并发症。 </li><li>考虑鉴别诊断并排除谁收到其他诊断，如美尼尔氏病26，头部外伤，自身免疫性内耳病8,9患者，柯根综合征27,28，遗传性疾病29，耳毒性药物30，蜗后障碍与前庭神经鞘瘤31 ，听神经病32，或中风33。 </li></ol></li></ol> 3.启动CIST 注:建议住院用于patients的安全。由于患者从因堵塞和音乐环境声音监听密封固有的CIST过程中，预计事故在他们的日常生活中的风险增加。 <ol><li>塞的使用耳模患者的未受影响的耳朵的外部管。紧紧包耳模入外管，以确保存在于外耳道没有空间。 </li><li>如果病人感觉疼痛或如果密封是不完整的，及时清除耳模，然后重新插入。 </li><li>询问患者从库中选择一个愉快的音乐类型。 注:他们还允许用户听自己的音乐，如果后者涵盖了足够宽的频率范围（125-8,000赫兹或更宽）。 </li><li>询问病人穿密闭型耳机。呈现所述选定的音乐只对受影响的耳朵如图1。 </li><li>使用均衡器来增加或减少每个FRE的音量昆西根据"半增益规则"，其中规定，增益级别等同于听的耳朵之间的高度差在每个频率的一半。 <ol><li>例如，如果耳的听力水平差分别为X 125，X 250，X 500，X 1000，X 2000，X 4000和X 8000在125，250 500，1000，2000，4000，和8000赫兹，设置均衡器在1000赫兹到"×1000/2 - （X + 125×250 + X + 500×1000 + X 2000 + X 4000 + X 8000）/ 14"。 注意:如果在图3所示的听力图的，均衡器设置为125，250，500，1000，2000，4000，和8000赫兹为-5，-3,0，2，2，5，并0dB时，分别。 </li></ol></li><li>向患者本身，使得音乐声音如正执行的声级和均衡器设置微调atural和舒适。如果音乐播放器的内部均衡器是不够有效，使用硬件均衡器， 如图2。 </li><li>询问患者是否他们认为音乐与受影响的耳朵，以便确认交叉听力34不 ​​会发生。排除谁听音乐的插入未受影响的耳朵由于交听证患者。 </li></ol> 4.程序启动后CIST <ol><li>指导他们被允许接受标准治疗SSHL如除了CIST协议糖皮质激素的患者。 </li><li>有患者听音乐，每天6小时，使用密闭式耳机（图1）在受影响的耳朵。指示他们花费听音乐的时候可分段患者。另外，让患者来执行其他任务（包括看书和上网）所花的时间清单当然期间宁音乐。 </li><li>指导患者整天使用的耳模，直到他们离开医院。 </li><li>测量患耳的气导的阈值水平以相同的方式每两天如在步骤2.1。调整音量和均衡器设置中提到的步骤3.5和3.6。 </li><li>当病人出院和当他们返回作为门诊患者，测量以相同的方式的听力阈值的水平，如步骤2.1。 </li></ol> 5.停止CIST的<ol><li>取出耳模，如果病人报告关于插完整的耳朵（如耳鸣或疼痛）不适。 </li><li>测量听力在原封耳以同样的方式的阈值水平，如步骤2.1。 </li><li>停止CIST程序，如果听力水平跨越500平均，1000，2000赫兹获得步骤4.4和/或5.2恶化超过5分贝相比，那些在步骤2.1获得的。例如，在情况下，听力图的图 3中所示</stro纳克&gt;中，听力水平平均跨越500，1000，2000赫兹是（40 + 40 + 45）/ 3 =41.7分贝在受影响的耳朵和（5 + 0 + 5）/ 3 = 3.3分贝的完整耳。 </li></ol>

<ol>
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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudden+Sensori-Neural+Hearing+Impairment+-+Report+of+1,220+Cases.">Sudden Sensori-Neural Hearing Impairment - Report of 1,220 Cases.</a> Laryngoscope. 86, 389-398 (1976).</li><li>Zwislocki, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acoustic+Attenuation+between+the+Ears.">Acoustic Attenuation between the Ears.</a> J Acoust Soc Am. 25, 752-759 (1953).</li><li>H&#228;m&#228;l&#228;inen, M., Hari, R., Ilmoniemi, R. J., Knuutila, J., Lounasmaa, O. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetoencephalography+theory,+instrumentation,+and+applications+to+noninvasive+studies+of+the+working+human+brain.">Magnetoencephalography theory, instrumentation, and applications to noninvasive studies of the working human brain.</a> Rev. Mod. Phys. 65, 413-497 (1993).</li><li>Nilsson, M., Soli, S. D., Sullivan, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+hearing+in+noise+test+for+the+measurement+of+speech+reception+thresholds+in+quiet+and+in+noise.">Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise.</a> J Acoust Soc Am. 95, 1085-1099 (1994).</li><li>Henry, J. A., Meikle, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychoacoustic+measures+of+tinnitus.">Psychoacoustic measures of tinnitus.</a> J. Am. Acad. Audiol. 11, 138-155 (2000).</li></ol>

The authors declare that they have no competing interests.

This article describes a behavioral treatment approach for SSHL. The CIST protocol merely requires the use of easily available devices. A comparison of the treatment effects of CIST + SCT with those of SCT alone revealed significantly better hearing improvements with the CIST + SCT treatment. No apparent side effects were associated with the CIST protocol. The cost of CIST is markedly lower than other newly suggested treatments (including a stellate ganglion block and hyperbaric oxygen therapy). The CIST protocol represents an effective, inexpensive, easy, and safe treatment for SSHL; however, several important points must be considered. One point is the prevention of acoustic trauma. Although the maximal volume settings of recent commercial portable music players are limited to remain below the harmful levels, the sound level needs to be observed when a large adjustment is made to the equalizer settings or when a headphone amplifier is used. The second point is 'cross hearing'. The purpose of the CIST procedure is to enable SSHL patients to actively use their affected ear for listening. When patients develop severe hearing loss, they may still hear sounds with the intact ear despite plugging. The third point is 'accidents'. In the case of traditional pharmacotherapy, the intact ear is not plugged, and thus SSHL patients can pick up environmental sounds via this intact ear. On the other hand, plugging and music listening inherent to the CIST protocol seal patients from environmental sounds, and thus the accident hazard is likely increased. Therefore, the CIST protocol should be conducted in a safe environment. 
Unlike pharmacotherapy, the CIST protocol has no limitations concerning medications, allergies, or other diseases such as diabetes, hypertension, and hyperlipidemia. However, the limitation of this protocol is that it is intended for patients who are able to listen to sounds with their affected ear. As such, the CIST protocol is not suited for SSHL patients with severe hearing loss. This protocol is applied to acute stage SSHL (days since SSHL onset &#8804; 5) because previous studies reported that a shorter time delay between the onset of SSHL and the start of treatment led to better hearing recovery2. It remains elusive whether there is a time restriction for starting the CIST protocol. Moreover, the optimum duration of the CIST protocol and the total music listening time require further investigation.
This protocol utilizes the corticosteroid therapy in addition to CIST. At present, corticosteroids are the most commonly used treatment for SSHL, and therefore it is ethically not feasible to stop this treatment. However, recent triple-blinded SSHL treatment studies14 revealed that the recovery of non-treated patients was similar to that of patients who had received corticosteroids. Even though one cannot exclude the possibility that the combination of CIST + SCT led to the results obtained, it appears reasonable to assume that CIST alone will be beneficial, especially for patients with diseases that are worsened by corticosteroids such as infections, diabetes, and glaucoma.
In this protocol, patients are hospitalized in order to avoid accidents. However, SSHL patients often cannot be hospitalized because of work, family, and financial reasons. The utilization of a hearing aid may allow these outpatients to perform the CIST protocol. SSHL patients who wear a hearing aid in their affected ear are 'functionally' exposed to an enriched acoustic environment, are not in danger to be exposed to harmful sound levels, and are able to detect warning sound signals. However, the daily monitoring of hearing threshold levels and appropriate adjustments to the hearing aid settings would be necessary since hearing capability of SSHL patients can improve rapidly. Generally, the CIST protocol will not disturb other treatment approaches and may actually manifest a synergic effect when used in combination with other SSHL treatment strategies.
In the present study, a limited number of SSHL patients underwent the CIST protocol, and the participants were not randomized to the different treatment conditions. Thus, a randomized controlled study including a larger number of patients should be executed in the future. Moreover, the effectiveness of the CIST protocol should be investigated in patients with different types of hearing loss. Further, in the present study, all participants who performed the CIST protocol also received the corticosteroid therapy. Therefore, it remains unresolved whether the CIST protocol alone can improve the hearing ability of SSHL patients. It would be valuable to perform a randomized controlled study in which SSHL patients, for whom corticosteroids may cause severe side effects (such asinfectious diseases or diabetes mellitus), would either merely receive the CIST protocol or merely a standard corticosteroid therapy. Notably, in our previous report23, the effects of the CIST protocol within the human auditory cortex were examined by means of magnetoencephalography35. The results showed that the CIST protocol could have prevented maladaptive cortical reorganization in the human primary and non-primary auditory cortices. Of course, it is difficult to conduct neuroimaging studies in practices and hospitals; however, speech test, hearing in noise test36, and tinnitus related examinations37 may contribute to reveal the functional plasticity in the central auditory system induced by the CIST protocol. Eventually, even though the CIST protocol is in a very early stage in development, and although further investigations are needed, the CIST protocol as an effective, inexpensive, and safe treatment option can complement the corticosteroid therapy, which may induce severe and potentially lethal side effects.

突发性耳聋（SSHL），或突发性耳聋，是特点是听力1的快速流失的特发性条件。一些流行病学研究2,3报道的每年每10万人5-30例工业化国家SSHL发病率。尽管SSHL的原因和潜在的SSHL的机制已经被广泛地研究，我们对SSHL知识仍然有限。在特发性SSHL的许多潜在原因，常见的假设包括循环障碍4，病毒感染5-7，和自身免疫性疾病8,9。虽然糖皮质激素治疗10提出了一种基于这些假设，是目前最常用的治疗，这一标准疗法的有效性还存在争议3,11-14。因此，创新SSHL治疗策略，通过不同的视角动机，强烈期望。 SSHL影响神经活动不仅在耳蜗，而且在听觉皮层。几个神经影像学研究15-17表明SSHL诱导皮层塑性于人听觉皮层中其发病几天。此外，皮质重组的听觉对侧半球dominancy的损失为代表的程度诱发领域出现了负回收率从听力损失18相关。皮质可塑性诱导SSHL的发作可以被认为是适应不良为受影响的耳朵的听觉能力。因此，预防与SSHL有关此适应不良的皮质重组可能代表一种新的治疗策略。 本文提出了一种神经康复方法，防止"学习不使用"皮质的变化，以防止或减少适应不良的皮质重组。例如，在运动功能障碍的情况下，得知不使用一个limbis一种现象，其中运动最初抑制因不良反应和任何活动的失败尝试与患肢，最终导致行为和对应的神经活动19,20的抑制。了解到非使用不会出现在限于运动功能障碍，但也可能涉及感官残疾21。 SSHL患者主要使用并注意完整的耳朵听。出现这种监听行为，以增加神经活动相对应的完整的耳朵，在同一时间，减少受影响的耳蜗及听觉皮层22之间的神经连接。为了防止这种适应不良皮质变化引起的&#39;不使用"时，它似乎是有益的SSHL患者以执行"约束诱导声音疗法（CIST）&#39;23，其激励参与者经由患耳集中听音乐并要听觉注意患耳（ 图1）。相比传统的药物治疗，该CIST据称是SSHL一个安全，方便，价廉，有效的治疗方法。

<table border="0" cellpadding="0" cellspacing="0" width="1185">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Ear mold</td>
			<td style="width:552px;">RION Co.Ltd, Tokyo, Japan</td>
			<td style="width:251px;">EM-59</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">portable music player</td>
			<td>Sony Corporation, Tokyo, Japan</td>
			<td>NW-S775</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">headphone</td>
			<td>SENNHEISER Electronic GmbH &#38; Co. KG, Hannover, Germany</td>
			<td>HD280pro</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">equalizer</td>
			<td>Roland Corporation, Hamamatsu, Japan</td>
			<td>GE-7</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">headphone amplifier</td>
			<td>FiiO Electronics Technology Co. Ltd, Guangzhou, China</td>
			<td>E11</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">sound editing application</td>
			<td>Adobe Systems Inc., CA, USA</td>
			<td>Audition 3.0</td>
			<td></td>
		</tr>
	</tbody>
</table>

neuro-rehabilitation approach for sudden sensorineural hearing loss

突发性耳聋（SSHL）的特点是急性特发性听力损失。估计发病率为每年每10万人5-30例。 SSHL的原因，目前基本SSHL机制尚不清楚。基于几个假设，如一个循环障碍的耳蜗，病毒感染，和自身免疫性疾病，药理治疗方法已被应用到治疗SSHL患者;然而，规范的治疗，皮质类固醇治疗的疗效，目前尚在争论。暴露于激烈的声音已被证明导致对听觉系统永久损坏;然而，置身于一个中等水平的富集噪声外伤后的声环境可减少听力障碍。一些神经影像学研究最近提出，SSHL发作引起的适应不良的皮质重组人类听觉皮层和皮层重组的急性SSHL期负科尔度兴高采烈的与听力损失的回收率。这篇文章报道了一种新的神经康复治疗方法的发展SSHL，"强制性使用声音疗法（CIST）"。在CIST协议的目的是为了防止或通过使用丰富的声环境适应不良的减少皮质重组。 SSHL患者的完整耳朵的耳道插入，以激励他们积极使用受影响的耳朵，从而防止适应不良皮层重组的进展情况。受影响的耳朵通过耳机也接触到音乐，每天6小时，住院期间。 CIST的协议似乎是一种安全，方便，廉价且有效的治疗SSHL。

第二十二条谁匹配在协议中所述的标准，谁SSHL住院病人愿意接受CIST被分配到目标群体，这行CIST除了标准的糖皮质激素治疗（CIST + SCT组）23。对照组包括谁只接受标准的糖皮质激素治疗（SCT组）31 SSHL住院病人。所有与会者都充分了解有关的研究，并签署了知情按照批准的医学院的明斯特大学的道德委员会，大阪大学附属医院的伦理委员会，并通过大阪Rosai医院的伦理委员会的程序同意。按照赫尔辛基宣言进行这项研究。在每两组（SCT + CIST与SCT）的参加者有相似年龄和时间延迟SSHL的发生和初始听力图之间。 （1日考试），（ii）离医院（2 次检查排液:1 和第2次测量之间的时间间隔（平均值±标准差（SCT + CIST:9.41±3.14天，SCT:10.42±3.18天），并再次（三）几个月后（3 次检查:平均值±标准差（SCT + CIST:63.45±28.56天，SCT:84.64±38.68天））使用纯音听力计。 如图4所示，处理前（1次测量），无显著差异，观察在听力组之间的阈值，在所有测量的频率（125，250，500，1000，2000，4000，和8000赫兹）在受影响的耳朵。治疗后（2 次和第3 次考试），听力受影响的耳朵都frequ有所改善encies在两个对SCT + CIST和SCT基（ 图4）。在所有频率的听力阈值水平分别平均为每个耳朵和耳朵之间再听到水平差异计算（ 图5）。受影响的和完整的耳的听力水平的差异归因于SSHL。耳朵之间的计算出的听力水平差异的治疗在第 1次检查（图5）之前，组之间类似。然而，这两个群体之间，观察在出院显著差异（ 第二次检查:P &lt;0.05（邦费罗尼校正）），并在几个月后（3 次检查:P &lt;0.001（邦费罗尼校正））。关于在原封耳听力水平，平均的阈值并没有显著组之间的任何中任三查的频率的不同。该结果表明堵塞第Ë耳道并未以对完好耳有负面影响。在22名学员谁接受CIST，并没有观察到明显的副作用。 <img alt="图1" src="/files/ftp_upload/53264/53264fig1.jpg" /> 图约束引起的声音疗法（CIST）1示意图。完整耳朵的耳道插入为了激励患耳的使用。音乐monaurally呈现给经由封闭型耳机患耳;相应于完整的耳朵另一个通道保持沉默（这图是改编自冈本等人 。23:绘制礼貌洛萨Lagemann的）。 <img alt="图2" src="/files/ftp_upload/53264/53264fig2.jpg" /> 图2.连接和设备在CIST使用。所述的便携式音乐播放器，均衡器，耳机放大器，和密闭式<html>耳机依次连接。均衡器和耳机放大器仅用于当便携式音乐播放器的数字均衡器是不够有效。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53264/53264fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图3" src="/files/ftp_upload/53264/53264fig3.jpg" /> 图3.一个SSHL患者的示范性听力这个数字代表的听力水平（范围:125〜8000赫兹;一个倍频程步）在受影响的耳朵（气导:空心圆;骨传导:左括号）和完整耳（气导:十字架;骨传导:右括号）治疗前的SSHL病人。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53264/53264fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> e_content"FO:保持together.within页="1"&gt; <img alt="图4" src="/files/ftp_upload/53264/53264fig4.jpg" /> 图4.时间的患耳平均听力水平当然本图显示的平均听力图（范围:125〜8000赫兹;一个倍频程步）谁接受约束引起的声音疗法除了接受标准的参与者受影响的耳朵糖皮质激素治疗（CIST + SCT:空心方块），或在那些谁只接受标准的糖皮质激素治疗（SCT:实心方块）。 第一届， 第二届和第三届听力考试进行（一）治疗前，（二）在出院;及（iii）几个月后，分别。误差线表示95％的置信区间（此图已经被修改Okamoto等23）。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53264/53264fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>URE。 <img alt="图5" src="/files/ftp_upload/53264/53264fig5.jpg" /> 图5.平均听力的耳朵之间的等级差听力受影响的和完整的两耳之间的阈值差异在所有测量频率的平均值在第1（左:治疗前），2号（中心:出院时）和第三（右:几个月后），纯音测听检查。开放和实心方块表示约束引起的声音疗法+标准的糖皮质激素治疗组（CIST + SCT）和标准糖皮质激素治疗治疗组（SCT），分别。误差条表示95％置信区间（此图已经被修改Okamoto等23）。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53264/53264fig5large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

Watch this Scientific Journal Video about Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss at JoVE.com

Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss

This article reports the development of a neuro-rehabilitation approach, "constraint-induced sound therapy (CIST)" for sudden sensorineural hearing loss. The aim of CIST is to prevent maladaptive cortical reorganization by using an enriched acoustic environment. CIST represents a safe, easy, inexpensive, and effective approach to treat sudden sensorineural hearing loss.

对于突发性耳聋神经康复治疗方法

Sudden sensorineural hearing loss (SSHL) is characterized by acute, idiopathic hearing loss. The estimated incidence rate is 5-30 cases per 100,000 people ...

neuro-rehabilitation-approach-for-sudden-sensorineural-hearing-loss

Nanyang Technological University

Research

JoVE Journal

Behavior

19.0K 次观看.  National Institute for Physiological Sciences. This article reports the development of a neuro-rehabilitation approach, "constraint-induced sound therapy (CIST)" for sudden sensorineural hearing loss. The aim of CIST is to prevent maladaptive cortical reorganization by using an enriched acoustic environment. CIST represents a safe, easy, inexpensive, and effective approach to treat sudden sensorineural hearing loss.

视频: Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss

Assessment of Age-related Changes in Cognitive Functions Using EmoCogMeter, a Novel Tablet-computer Based Approach

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognitive functions across the lifespan in a sample of 378 healthy subjects (age range 18-89 years). Consistent with previous findings we found an age-related cognitive decline across a wide range of neuropsychological domains (memory, attention, executive functions), thereby proving the usability of our tablet-based application. Regardless of prior computer experience, subjects of all age groups were able to perform the tasks without instruction or feedback from an experimenter. Increased motivation and compliance proved to be beneficial for task performance, thereby potentially increasing the validity of the results. Our promising findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

We tested the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognition. Results show an age-related cognitive decline, thereby proving the usability of our application. Findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

与年龄相关的变化认知功能使用EmoCogMeter，新型平板计算机基础法评估

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on ...

科研

行为学

Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess children&#39;s cortical processing of light touch, speech sounds and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing children discomfort. To accomplish this we developed a dual channel, time and strength calibrated air puff stimulator that allows both tactile stimulation and sham control. We combined this with the use of event-related potential methodology to allow for high temporal resolution of signals from the primary and secondary somatosensory cortices as well as higher order processing. This methodology also allowed us to measure a multisensory response to auditory-tactile stimulation.

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess infants and children&#39;s cortical processing of light touch, speech sounds, and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing discomfort in vulnerable patients.

皮质听觉，触觉加工的残疾儿童定量评价

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology ...

Experimental Assessment of Mouse Sociability Using an Automated Image Processing Approach

Mouse is the preferred model organism for testing drugs designed to increase sociability. We present a method to quantify mouse sociability in which the test mouse is placed in a standardized apparatus and relevant behaviors are assessed in three different sessions (called session I, II, and III).
The apparatus has three compartments (see Figure 1), the left and right compartments contain an inverted cup which can house a mouse (called &#34;stimulus mouse&#34;).
In session I, the test mouse is placed in the cage and its mobility is characterized by the number of transitions made between compartments. In session II, a stimulus mouse is placed under one of the inverted cups and the sociability of the test mouse is quantified by the amounts of time it spends near the cup containing the enclosed stimulus mouse vs. the empty inverted cup. In session III, the inverted cups are removed and both mice interact freely. The sociability of the test mouse in session III is quantified by the number of social approaches it makes toward the stimulus mouse and by the number of times it avoids a social approach by the stimulus mouse.
The automated evaluation of the movie detects the nose of the test mouse, which allows the determination of all described sociability measures in session I and II (in session III, approaches are identified automatically but classified manually). To find the nose, the image of an empty cage is digitally subtracted from each frame of the movie and the resulting image is binarized to identify the mouse pixels. The mouse tail is automatically removed and the two most distant points of the remaining mouse are determined; these are close to nose and base of tail. By analyzing the motion of the mouse and using continuity arguments, the nose is identified.
<img alt="Figure 1" src="/files/ftp_upload/52508/52508fig1.jpg" /> 
Figure 1. Assessment of Sociability During 3 sessions. Session I (top): Acclimation of test mouse to the cage. Session II (middle): Test mouse moving freely in the cage while the stimulus mouse is enclosed in an inverted cup. Session III (bottom): Both test mouse and stimulus mouse are allowed to move freely and interact with each other.

This protocol describes a method to quantify mouse sociability. Mice are videotaped as they move and interact in a special cage. Movie processing allows for the automated quantification of sociability with excellent accuracy and reliability.

使用自动图像处理方法鼠标社交性的实验评估

Mouse is the preferred model organism for testing drugs designed to increase sociability. We present a method to quantify mouse sociability in which the ...

Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are now recognized as a core symptom in autism spectrum disorder (ASD). Our ability to perceive and interact with the external world is rooted in sensory processing. For example, listening to a conversation entails processing the auditory cues coming from the speaker (speech content, prosody, syntax) as well as the associated visual information (facial expressions, gestures). Collectively, the &#8220;integration&#8221; of these multisensory (i.e., combined audiovisual) pieces of information results in better comprehension. Such multisensory integration has been shown to be strongly dependent upon the temporal relationship of the paired stimuli. Thus, stimuli that occur in close temporal proximity are highly likely to result in behavioral and perceptual benefits &#8211; gains believed to be reflective of the perceptual system&#39;s judgment of the likelihood that these two stimuli came from the same source. Changes in this temporal integration are expected to strongly alter perceptual processes, and are likely to diminish the ability to accurately perceive and interact with our world. Here, a battery of tasks designed to characterize various aspects of sensory and multisensory temporal processing in children with ASD is described. In addition to its utility in autism, this battery has great potential for characterizing changes in sensory function in other clinical populations, as well as being used to examine changes in these processes across the lifespan.

We describe how to implement a battery of behavioral tasks to examine the processing and integration of sensory stimuli in children with ASD. The goal is to characterize individual differences in temporal processing of simple auditory and visual stimuli and relate these to higher order perceptual skills like speech perception.

测试儿童的感官和多感官功能自闭症谱系障碍

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are ...

Pavlovian Conditioned Approach Training in Rats

Cues that are contingently paired with unconditioned, rewarding stimuli can acquire rewarding properties themselves through a process known as the attribution of incentive salience, or the transformation of neutral stimuli into attractive, &#34;wanted&#39; stimuli capable of motivating behavior. Pavlovian conditioned approach (PCA) develops after the response-independent presentation of a conditioned stimulus (CS; e.g., a lever) that predicts the delivery of an unconditioned stimulus (US; e.g., a food pellet) and can be used to measure incentive salience. During training, three patterns of conditioned responses (CRs) can develop: sign-tracking behavior (CS-directed CR), goal-tracking behavior (US-directed CR), and an intermediate response (both CRs). Sign-trackers attribute incentive salience to reward-related cues and are more vulnerable to cue-induced reinstatement of drug-seeking as well as other addiction-related behaviors, making PCA a potentially valuable procedure for studying addiction vulnerability. Here, we describe materials and methods used to elicit PCA behavior from rats as well as analyze and interpret PCA behavior in individual experiments.

Here, we present a protocol to elicit Pavlovian conditioned approach behavior in rats. This procedure can be used to measure individual differences in the tendency to approach and attribute incentive salience to reward-related cues and investigate addiction vulnerability.

大鼠条件性巴甫洛夫训练方法

Cues that are contingently paired with unconditioned, rewarding stimuli can acquire rewarding properties themselves through a process known as the ...

Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses

Collecting reliable behavioral data from toddlers and preschoolers is challenging. As a result, there are significant gaps in our understanding of human auditory development for these age groups. This paper describes an observer-based procedure for measuring hearing sensitivity with a two-interval, two-alternative forced-choice paradigm. Young children are trained to perform a play-based, motor response (e.g., putting a block in a bucket) whenever they hear a target signal. An experimenter observes the child&#39;s behavior and makes a judgment about whether the signal was presented during the first or second observation interval; the experimenter is blinded to the true signal interval, so this judgment is based solely on the child&#39;s behavior. These procedures were used to test 2 to 4 year-olds (n = 33) with no known hearing problems. The signal was a 1,000 Hz warble tone presented in quiet, and the signal level was adjusted to estimate a threshold corresponding to 71%-correct detection. A valid threshold was obtained for 82% of children. These results indicate that the two-interval procedure is both feasible and reliable for use with toddlers and preschoolers. The two-interval, observer-based procedure described in this paper is a powerful tool for evaluating hearing in young children because it guards against response bias on the part of the experimenter.

This paper describes a procedure for measuring hearing sensitivity in 2 to 4 year-old children. Children are trained to perform play-based responses when they hear a target signal. Thresholds are then estimated in a two-interval, two-alternative forced-choice paradigm, based on observations of the child&#39;s behaviors.

2听证会，以4岁儿童的行为评估:两区间，观测为基础的应用程序基于条件性播放响应

Collecting reliable behavioral data from toddlers and preschoolers is challenging. As a result, there are significant gaps in our understanding of human ...

Assessing Working Memory in Children: The Comprehensive Assessment Battery for Children &#8211; Working Memory (CABC-WM)

The Comprehensive Assessment Battery for Children - Working Memory (CABC-WM) is a computer-based battery designed to assess different components of working memory in young school-age children. Working memory deficits have been identified in children with language-based learning disabilities, including dyslexia1,2 and language impairment3,4, but it is not clear whether these children exhibit deficits in subcomponents of working memory, such as visuospatial or phonological working memory. The CABC-WM is administered on a desktop computer with a touchscreen interface and was specifically developed to be engaging and motivating for children. Although the long-term goal of the CABC-WM is to provide individualized working memory profiles in children, the present study focuses on the initial success and utility of the CABC-WM for measuring central executive, visuospatial, phonological loop, and binding constructs in children with typical development. Immediate next steps are to administer the CABC-WM to children with specific language impairment, dyslexia, and comorbid specific language impairment and dyslexia.

Working memory predicts a significant amount of variance for a variety of cognitive tasks, including speaking, reading, and writing. However, few tools are available to assess working memory in children. We present an innovative, computer-based battery that comprehensively assesses different components of working memory in school-age children.

评估儿童工作记忆:儿童综合评估电池 - 工作记忆（CABC-WM）

The Comprehensive Assessment Battery for Children - Working Memory (CABC-WM) is a computer-based battery designed to assess different components of ...

Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors

Diagnostic ultrasound imaging has been a common tool in medical practice for several decades. It provides a safe and effective method for imaging structures internal to the body. There has been a recent increase in the use of ultrasound technology to visualize the shape and movements of the tongue during speech, both in typical speakers and in clinical populations. Ultrasound imaging of speech has greatly expanded our understanding of how sounds articulated with the tongue (lingual sounds) are produced. Such information can be particularly valuable for speech-language pathologists. Among other advantages, ultrasound images can be used during speech therapy to provide (1) illustrative models of typical (i.e.&#160;&#34;correct&#34;) tongue configurations for speech sounds, and (2) a source of insight into the articulatory nature of deviant productions. The images can also be used as an additional source of feedback for clinical populations learning to distinguish their better productions from their incorrect productions, en route to establishing more effective articulatory habits.
Ultrasound feedback is increasingly used by scientists and clinicians as both the expertise of the users increases and as the expense of the equipment declines. In this tutorial, procedures are presented for collecting ultrasound images of the tongue in a clinical context. We illustrate these procedures in an extended example featuring one common error sound, American English /r/. Images of correct and distorted /r/ are used to demonstrate (1) how to interpret ultrasound images, (2) how to assess tongue shape during production of speech sounds, (3), how to categorize tongue shape errors, and (4), how to provide visual feedback to elicit a more appropriate and functional tongue shape. We present a sample protocol for using real-time ultrasound images of the tongue for visual feedback to remediate speech sound errors. Additionally, example data are shown to illustrate outcomes with the procedure.

Ultrasound imaging can be used to display the shape and movements of the tongue in real time during speech. The images can be used to determine the nature of speech sound errors. Visual feedback of the tongue can be used to facilitate improvements in speech sound production in clinical populations.

舌的超声图像:一个教程评估和修复声音讲话的错误

Diagnostic ultrasound imaging has been a common tool in medical practice for several decades. It provides a safe and effective method for imaging ...

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior approach. Recently, the lateral transfibular approach to the ankle has gained popularity since a new TAR implant was designed to be performed via this approach that results in an ideal visualization of the center of rotation of the ankle and curved resections that allow for sparing bone cuts. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via lateral approach. We present our preoperative clinical and radiographic protocol. In addition, we describe our surgical technique with some technical tips. Finally, we report our follow-up schedule that includes the collection of clinical, functional, and radiographic data. The results of this procedure are encouraging: TAR through a lateral transfibular approach provides reliable pain relief and improvements in functional outcomes in patients with ankle osteoarthritis.

We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

外侧 Transfibular 法治疗踝关节骨性关节炎

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior ...

Noninvasive, In-pen Approach Test for Laboratory-housed Pigs

Traumatic brain injury (TBI) incidences have increased in both civilian and military populations, and many researchers are adopting a porcine model for TBI. Unlike rodent models for TBI, there are few behavioral tests that have been standardized. A larger animal requires more invasive handling in test areas than rodents, which potentially adds stress and variation to the animals&#39; responses. Here, the human approach test (HAT) is described, which was developed to be performed in front of laboratory pigs&#39; home pen. It is noninvasive, but flexible enough that it allows for differences in housing set-ups.
During the HAT, three behavioral ethograms were developed and then a formula was applied to create an approach index (AI). Results indicate that the HAT and its index, AI, are sensitive enough to detect mild and temporary alterations in pigs&#39; behavior after a mild TBI (mTBI). In addition, although specific behavior outcomes are housing-dependent, the use of an AI reduces variation and allows for consistent measurements across laboratories. This test is reliable and valid; HAT can be used across many laboratories and for various types of porcine models of injury, sickness, and distress. This test was developed for an optimized manual timestamping method such that the observer consistently spends no more than 9 min on each sample.

This protocol describes a new behavioral test&#8212;the human approach test in the pigs&#39; home pen&#8212;to detect functional deficits in laboratory pigs after subconcussive traumatic brain injury.

实验室安置猪的非侵入性、笔内方法测试

Traumatic brain injury (TBI) incidences have increased in both civilian and military populations, and many researchers are adopting a porcine model for ...