Home is Where the…ABR Testing Happens!

Ashley Parker, M.A.
Ph.D. Candidate, Department of Speech, Language and Hearing Sciences, University of Connecticut

Erika Skoe, Ph.D.,
Associate Professor, Department of Speech, Language and Hearing Sciences, University of Connecticut

 

Motivated by the goal of making research participation more inclusive and more convenient, our lab, the Auditory Brainstem Research Lab at the University of Connecticut, has been taking the auditory brainstem response (ABR) on the road the last 5+ years. The ABR is an auditory evoked potential that measures the integrity of the auditory system from the auditory nerve through the brainstem, using a small handful of electrodes, often measured in a controlled sound booth setting. We have packed up our ABR equipment, and successfully collected data in locations that best suit our participants; instead of traveling to us, we travel to them.

The “traveling ABR” had been gaining traction as a way of addressing health disparities. Recent studies recorded ABRs in schools (Kraus et al., 2014; Krizman et al., 2015), sports medicine clinics (Kraus et al., 2016), and football locker rooms (Rauterkus et al., 2021).  In northern Canada, Hatton et al. (2019) implemented a “telehealth-enabled” ABR testing procedure for infants, setting up sound booths in rural clinics and combining support from on-site technicians and videoconference with an audiologist. In our research, we saw the need to further improve access to electrophysiological testing by removing the requirement for our participants to even leave their house (Parker et al., 2020; Tecoulesco et al., 2020).

In our recent study published in Brain and Language (Tecoulesco et al. 2020), we traveled to the homes of 31 children in the New England and Tri-State areas, half of whom were on the autism spectrum. In addition to providing new insight into the connection between auditory processing and language development, this work demonstrated the feasibility of recording ABRs in someone’s living room, and it opened our eyes to how this approach could be scaled to more large-scale applications.  We’ve found that individuals prefer the in-home testing option over commuting to a lab, clinic, or hospital for a number of reasons—a lack of transportation, busy schedules, or other disabilities. Young children, older, and some difficult-to-test populations are also more comfortable in the familiar environment of their own home, making the ABR testing process less stressful to them and their families.

In Tecoulesco et al. (2020), the children were tested in their homes and never visited the lab.  Skeptics of this approach wondered whether the home data was indeed comparable with that we’d normally collect in our lab—in the well-controlled environment of our electromagnetic-shielded double walled sound booth. This prompted us to confirm the between-location reliability, by repeating the identical ABR protocol three times—once in our research lab, once in a home, and once more back in the lab (Parker et al., 2020). This design allowed us to compare how the home-ABR differed from the lab-ABR, and whether that difference was greater than what we’d expect if we re-tested the ABR in the lab on two different days. We focused on ABR latency, a popular metric both in the audiology clinic and in research. Our findings suggest that latencies of the click- and speech ABR have strong repeatability across environments, and that with the right set-up and care, high quality electrophysiological recordings can be collected outside the lab.

This experience of taking ABR equipment on the road has taught us a few lessons. Certainly, compared to research labs or clinics, homes and other remote locations can be unpredictable in many ways. Efforts should always be made to find quiet spots in the home, though in our experience, homes did not have to be completely turned upside down or “unplugged” during our visit. To limit electrical interference, we asked participants to leave all personal electronics on a table, away from the immediate recording site. The home’s lights were turned off, but all household appliances remained plugged in (e.g., the stove, refrigerator, and television in the vicinity of the recording). Though we did not find significant electrical artifact in our recordings, we recommend always starting with a test recording to confirm. We seated our participants in a comfortable chair in the home’s living room, at the dining table, or in the child’s bedroom, but otherwise we kept the configuration of the home as is. We used our standard clinical-grade ABR equipment and did not find the need to purchase anything specialized or marketed specifically to be portable, other than a hard case to protect the equipment during travel. The advent of small ABR equipment and laptops made it relatively easily to take our show on the road.

Our lab has shown that high-quality, reliable ABR recordings can now be obtained using standard clinical equipment, even outside of the controlled sound-booth setting. Reliable portable ABR testing has applications beyond a research setting. It promises to be valuable for providing home healthcare services in audiology, potentially filling the need for making services more available a variety of populations, including those who are lacking transportation options, are difficult to test, have disabilities, or live in remote areas.

 

References

  1. Hatton, J. L., Rowlandson, J., Beers, A., & Small, S. (2019). Telehealth-enabled auditory brainstem response testing for infants living in rural communities: the British Columbia early hearing program experience. International Journal of Audiology58(7), 381-392.
  2. Kraus, N., Slater, J., Thompson, E. C., Hornickel, J., Strait, D. L., Nicol, T., & White-Schwoch (2014). Music enrichment programs improve the neural encoding of speech in at-risk children. Journal of Neuroscience34(36), 11913-11918.
  3. Kraus, N., Thompson, E. C., Krizman, J., Cook, K., White-Schwoch, T., & LaBella, C. R. (2016). Auditory biological marker of concussion in children. Scientific Reports6, 39009.
  4. Krizman, J., Slater, J., Skoe, E., Marian, V., & Kraus, N. (2015). Neural processing of speech in children is influenced by extent of bilingual experience. Neuroscience Letters585, 48-53.
  5. Parker, A., Slack, C., & Skoe, E. (2020). Comparisons of auditory brainstem responses between a laboratory and simulated home environment. Journal of Speech, Language, and Hearing Research63(11), 3877-3892.
  6. Rauterkus, G., Moncrieff, D., Stewart, G., & Skoe, E. (2021). Baseline, retest, and post-injury profiles of auditory neural function in collegiate football players. International Journal of Audiology, 1-13.
  7. Tecoulesco, L., Skoe, E., & Naigles, L. R. (2020). Phonetic discrimination mediates the relationship between auditory brainstem response stability and syntactic performance. Brain and Language208, 104810.

About Pathways

Pathways is both a column that covers topics related to CAPD and Neuroaudiology and a society for people interested in central auditory disorders that regularly meets to discuss these issues.

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