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Biomedical subjects

D N Brooks

Publications and source records attributed to D N Brooks.

At least 19 recordsLinked to original sources
PubMed1998

Attitudes to hearing difficulty and hearing aids and the outcome of audiological rehabilitation.

First time hearing aid candidates (N = 135) in a NHS setting were administered the Hearing Attitudes in Rehabilitation Questionnaire (HARQ) designed to assess attitudes to acquired hearing loss and hearing aids and 92% of them were followed up 3-9 months after fitting. Attitude scores, age, sex and sensory thresholds were related to six self-report outcome measures by use of logistic regression. The major findings were that patients who were least distressed by their hearing difficulties and reported not wanting or needing a hearing aid used their aids least frequently and evaluated them less highly in listening situations. An attitude that wearing a hearing aid was stigmatizing was not predictive of outcome except a report of more difficulty in handling the aid. There were some low but significant correlations between attitudes and sensory thresholds and thresholds also contributed to the prediction of outcome in a few instances.

Adult↗
PubMed1996

The time course of adaptation to hearing aid use.

Adaptation to use of a hearing aid will depend on many factors, such as the degree of the loss, the age and personality of the individual, the duration of the loss, the performance of the aid, and the advice given by the audiologist/dispenser. This study investigated the use made of hearing aids by monitoring battery consumption over a one year period commencing at the first provision of amplification. A further investigation into use was made 10 years after the initial issue. Patterns of use over the first year were investigated and related, where possible, to the level of use 10 years later. About one-third of the subjects made little or no use of the behind-the-ear hearing aid provided free of direct cost through the National Health Service over the first year. A small proportion, primarily younger subjects, later increased their use of personal amplification to substantial levels. The majority, who tended to be at the upper end of the age range, did not. A similar proportion (one-third) started with limited use and progressed during the initial period of monitoring to more extended use. In some individuals the rate of progress was gradual. In others the transition from low to high use took place over a short period of time but after an interval ranging from a few weeks to many months. About one-sixth of the group used the aid extensively from the beginning and continued at this use level through to the long-term review. The final sixth, who tended to be towards the upper end of the age range, made only minimal use of their aids. Short-term (less than 6 months) assessment of use may, in the case of good users, be regarded as a measure of success, but if use is low at that time the long-term outcome may depend substantially on the age of the hearing aid user.

Adult↗
PubMed1996

Development of the Hearing Attitudes in Rehabilitation Questionnaire (HARQ).

A questionnaire devised by Brooks to measure attitudes towards hearing impairment and provision of a hearing aid in older people was factor analysed and subsequently enlarged and modified into a new 40 item self-report scale. The Hearing Attitudes in Rehabilitation Questionnaire (HARQ) assesses three attitudes towards hearing impairment (personal distress/inadequacy, hearing loss stigma and minimization of loss) and four attitudes towards provision of a hearing aid (hearing aid stigma, aid-not-wanted, pressure to be assessed and positive expectation). Scale development, reliability and other psychometric properties are reported. Potential uses of the scale include identification of patients who may require counselling, evaluation of audiological rehabilitation and further empirical investigations of attitudes in this area.

Adult↗
PubMed1994

Effects of case management after severe head injury.

OBJECTIVES: To examine the effects of early case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. DESIGN: Prospective controlled unmatched non-randomised study for up to two years after injury. SETTING: Four district general hospitals and two university teaching hospitals, each with neurosurgical units, in east central, north, and north east London and its environs. SUBJECTS: 126 patients aged 16-60 recruited acutely and sequentially after severe head injury. All received standard rehabilitation services in each of the six hospitals and districts: case management was also provided for the 56 patients admitted to three of the hospitals. MAIN OUTCOME MEASURES: Standard measures of patients' physical and cognitive impairment; disability and handicap; and affective, behavioural, and social functioning and of relatives' affective and social functioning. Relatives' perception of burden; changes in patients' and relatives' housing, financial, vocational, recreational, and medical needs; and ongoing requirements for care and support; and the amount and type of paramedical input provided were assessed with structured questionnaires. RESULTS: For a given severity of injury, case management increased the chance and range of contact with inpatient and outpatient rehabilitation services. However, duration of contact was not increased by case management, and there was no demonstrable improvement in outcome in the case managed group. Any trends were in favour of the control group and could be accounted for by group differences in initial severity of injury. CONCLUSIONS: Widespread introduction of early case management of patients after severe head injury is not supported, and early case management is not a substitute for improvement in provision of skilled and specialist rehabilitation for patients.

Activities of Daily Living↗
PubMed1994

Some factors influencing choice of type of hearing aid in the UK: behind-the-ear or in-the-ear.

Questioning potential users of National Health Service behind-the-ear (BTE) hearing aids indicated that for some the perception of stigma associated with visible aids is a powerful deterrent to acceptance and use. To investigate further the role of stigma in hearing aid acceptance, 184 individuals who had been fitted with NHS BTE hearing aids and who had also purchased in-the-ear (ITE) hearing aids through a discounted price scheme at Withington Hospital were asked why they had made the decision to purchase, and what they perceived as the benefits of the ITE aid relative to the BTE model. The primary factor both in terms of reason for purchase and perceived benefit was the greater cosmetic acceptability of the smaller aids. Comfort in wear was the second perceived benefit. Sound quality was ranked only third. Ease of use with spectacles was the second most common reason given for purchase. These studies suggest that in a small but significant percentage of hearing aid candidates the perception of stigma is a powerful deterrent to take-up and use. This perception needs to be recognized and addressed if the most effective service is to be provided to the hearing impaired.

Auditory Threshold↗
PubMed1992

Flash and pattern reversal visual evoked responses in normal and demented elderly.

P1 and P2 components of visual evoked responses (VERs) to flash stimuli were compared between patients diagnosed as suffering from Senile Dementia of the Alzheimer Type (AD) and elderly controls. Additionally the P100 component of the VER to pattern reversal stimuli at high and low contrast and using large and small check patterns was compared. Significant differences between moderate AD patients and the normal elderly were found for the P2 component of the flash stimulus and for the P100 component of the high spatial frequency pattern reversal stimuli at low contrast. These findings suggest a deficit in primary visual processing and a selective deficit in secondary visual processing in moderate cases of dementia. This indicates that visual processing capacities of AD patients decline as the disease progresses in line with the continual degeneration of neuronal populations involved with vision.

Aged↗
PubMed1992

Non-organic hearing loss in young persons: transient episode or indicator of deep-seated difficulty.

Depressed auditory thresholds without evidence of organic hearing loss are observed in a small percentage of children and young adults. Several studies suggest that non-organic hearing loss (NOHL) is a manifestation of, or reaction to stress. Proposed treatments range from ignoring the apparent hearing loss through the use of psychotherapy and/or counselling to confronting the individual with evidence to prove that there is no real loss of function. Few studies report on long-term outcome. Thirty-eight subjects who had been diagnosed more than six and up to twenty-seven years ago as having NOHL were identified from records. Efforts were made to determine if there was any evidence of longer term effects. Nine were untraceable. Of those reviewed one was established as a malingerer; five had concurrent speech problems; one was possibly dyslexic; five were or had been under psychiatric care. These findings suggest that NOHL may, in some individuals, indicate underlying problems that merit detailed investigation and treatment.

Adolescent↗
PubMed1992

A European head injury evaluation chart.

In 1988, 40 experts (physicians, psychologists, social workers, lawyers, family association representatives...) coming from the E.E.C., the United States, Canada and Sweden met in Brussels to derive the guidelines for a minimal assessment of head injured people. This workshop led to a research contract between E.B.I.S. (European Brain Injury Society) and the E.E.C. Directorate for Science regarding a European evaluation document. The aims of the document are both clinical and scientific. Hence the document has to be simple, specific and feasible. The document has two parts: initial state and repeated follow-up. It ends with final comments and action plan. The first statistical data of the validation study concern mainly the link between initial severity of injury and final handicap, cognitive and behavioural troubles, familial and professional aspects of handicap.

Activities of Daily Living↗
PubMed1991

Clinical trials in Alzheimer's disease. A report from the Medical Research Council Alzheimer's Disease Clinical Trials Committee.

Recent advances in Alzheimer's disease imply a need for adequate clinical trials of new treatments which require careful design. The disorder is progressive and shows clinical heterogeneity. While large-scale trials of elderly subjects are appropriate in relation to assessment of drugs or other treatments designed to prevent progression of the disorder, the outcome measurements in such biological treatment trials require careful planning. Studies of individual patients are relevant for answering certain specific questions. Relatively short cross-over trial designs may be appropriate to some pharmacological studies. The choice of neuropsychological instruments for measuring change is critically important, particularly in excluding test/retest artefact and in avoiding floor and ceiling effects. Test scales designed for assessment of specific neuropsychological deficits, or forming part of standard IQ assessments are unlikely to prove robust. Tests can be selected and developed for individual patients, but generalisation of the results of such experiments to the disease as a whole is not inevitable. There is a need to develop psychological instruments for measuring change that are robust and relevant to the clinical problem of progressive dementia.

Aged↗
PubMed1991

Earmoulds: some benefits from horn fitting.

The narrow bore of conventional hearing aid earmoulds restricts the transmission of higher auditory frequencies. For subjects with moderate to severe high-frequency hearing loss this is likely to have an adverse effect on the perception and recognition of phonemes with high-frequency components. Twenty-two subjects with predominantly high-frequency hearing loss underwent a series of tests to compare the performance of earmoulds having conventional 1.9 mm through-tubing with earmoulds fitted with a smooth horn with a final internal diameter of 4 mm. The test battery comprised free-field Békésy audiometry, in-the-ear pressure measurement, speech audiometry using AB word lists and semantic differential rating of the relative sound quality of the two systems. Subjectively the horn fitting was rated as clearer, more natural, undistorted and acoustically comfortable. Objectively, by both Békésy audiometry and in-the-ear pressure measurement, the horn gave more gain in the higher auditory frequencies. With the horn there was improved recognition of phonemes, especially fricatives and affricatives.

Adult↗
PubMed1990

Selective alterations of high affinity [3H]forskolin binding sites in Alzheimer's disease: a quantitative autoradiographic study.

Quantitative autoradiographic analysis of high affinity [3H]forskolin binding sites was carried out in postmortem brains from normal controls and patients dying with Alzheimer's disease. Choline acetyltransferase (ChAT) activity and senile plaque formation were also quantified. [3H]Forskolin binding was markedly reduced in all layers of middle frontal gyrus in the Alzheimer brains and the deficit correlated with the deficit in ChAT activity in this area. In the hippocampal region [3H]forskolin binding was no different in the Alzheimer brains compared to controls, although ChAT activity was significantly reduced. There was an inconsistent reduction in [3H]forskolin binding in all layers of middle temporal gyrus which did not correlate with the cholinergic deficit. Significant senile plaque formation was observed in all 3 brain regions examined and [3H]forskolin binding did not correlate with plaque formation in any brain region. Thus, while all 3 brain regions were affected by the pathological correlates of Alzheimer's disease, [3H]forskolin binding was consistently reduced only in frontal cortex.

Adenylyl Cyclases↗
PubMed1990

Differential alterations of cortical glutamatergic binding sites in senile dementia of the Alzheimer type.

Involvement of cortical glutamatergic mechanisms in senile dementia of the Alzheimer type (SDAT) has been investigated with quantitative ligand-binding autoradiography. The distribution and density of Na(+)-dependent glutamate uptake sites and glutamate receptor subtypes--kainate, quisqualate, and N-methyl-D-aspartate--were measured in adjacent sections of frontal cortex obtained postmortem from six patients with SDAT and six age-matched controls. The number of senile plaques was determined in the same brain region. Binding of D-[3H]aspartate to Na(+)-dependent uptake sites was reduced by approximately 40% throughout SDAT frontal cortex relative to controls, indicating a general loss of glutamatergic presynaptic terminals. [3H]Kainate receptor binding was significantly increased by approximately 70% in deep layers of SDAT frontal cortex compared with controls, whereas this binding was unaltered in superficial laminae. There was a positive correlation (r = 0.914) between kainate binding and senile plaque number in deep cortical layers. Quisqualate receptors, as assessed by 2-amino-3-hydroxy-5-[3H]methylisoxazole-4-propionic acid binding, were unaltered in SDAT frontal cortex compared with controls. There was a small reduction (25%) in N-methyl-D-aspartate-sensitive [3H]glutamate binding only in superficial cortical layers of SDAT brains relative to control subjects. [3H]Glutamate binding in SDAT subjects was unrelated to senile plaque number in superficial cortical layers (r = 0.104). These results indicate that in the presence of cortical glutamatergic terminal loss in SDAT plastic alterations occur in some glutamate receptor subtypes but not in others.

Aged↗
PubMed1990

Measurements of regional cerebral blood flow and cognitive performance in Alzheimer's disease.

Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to image 26 patients with dementia of the Alzheimer type (DAT) and 10 healthy controls. Regional cerebral blood flow (rCBF) data indicated a relative sparing of the occipital regions in DAT. Normalisation to occipital flow illustrated highly significant CBF deficits in a number of cortical regions, particularly in the left and right posterior--temporal cortex in DAT compared to controls. The cognitive performance of DAT patients was measured using a clinical cognitive assessment procedure (CAMCOG) and numerous correlations between these scores and rCBF were obtained. The implications and value of this investigative technique are discussed.

Aged↗
PubMed1990

Measures for the assessment of hearing aid provision and rehabilitation.

To determine the effectiveness of the provision of a hearing aid, some measure of benefit is desirable. Direct determination of benefit is difficult, not least due to the problems inherent in defining what benefit actually is. An alternative approach is to assess aspects of hearing aid use of performance that relate to benefit. Hours of daily use, satisfaction and self-rated performance are measures that might be expected to relate to benefit. The studies reported in this paper examine the relevance and repeatability of these measures. It is concluded that this three-parameter approach provides a simple, relevant and useful way of assessing benefit from amplification which has application in both individual and group studies.

Auditory Perception↗
PubMed1989

An evaluation of tailored psychological treatment of insomnia.

It seems sensible to tailor treatments of insomnia in relation to the presenting characteristics of the sleeper and of the complaint. This report describes the first study formally to examine the comparative effectiveness of tailored and untailored (randomly allocated) treatments. We developed a questionnaire to facilitate the designing of individualized programmes. Results indicated that statistical analysis may underestimate the benefits of tailoring. Measures of clinically significant change, however, suggested that tailored treatment though it may be highly effective, is no more so than stimulus control therapy.

Adult↗