Method for rehabilitation of patients with communicative and cognitive dysfunctions due to hearing loss

Abstract

FIELD: medicine; surdology-otolaryngology.SUBSTANCE: used for the rehabilitation of patients with communicative and cognitive dysfunctions due to hearing loss. The patient is examined: ENT examination, audiological examination, tympanometry, acoustic reflex recording. Word intelligibility is determined using hearing aids, through headphones, in silence or in noise. They conduct a test of alternating binaural speech (ABS), a dichotic number test (DNT), a test for detecting pauses in a sound signal and a test for auditory verbal memory - performing tasks to repeat sequences of single-digit numbers in direct and reverse order. The RUMatrix phrase adaptive test is administered in silence and in speech noise. The patient's cognitive status is tested using the Montreal Cognitive Assessment Scale (MoCA). The patient conducts a self-assessment of the effectiveness of hearing aids using a rating scale from 0 (minimum) to 5 (maximum). An individual profile of the patient’s auditory, verbal and cognitive deficits is created. They are conducting rehabilitation. The duration of one lesson is from 30 to 60 minutes, at least 2 times a week for 6–8 weeks. After rehabilitation, the patient undergoes re-examination and an individual profile of auditory, verbal and cognitive deficits is compiled. The results are assessed based on the difference in the indicators of the patient’s individual profiles before and after the rehabilitation course.EFFECT: method provides functional auditory training for the development of auditory perception skills, targeted training of the patient's cognitive and communicative skills by presenting non-speech and speech sounds with spectral and temporal characteristics of varying degrees of complexity and analyzing the responses using visual images, text information, and recording the execution time.1 cl, 9 dwg, 7 tbl, 3 ex

Description

[0001] The invention relates to medicine, more precisely to surdology-otolaryngology, and can find application in the rehabilitation of patients with communicative and cognitive dysfunctions due to hearing loss and in the prevention of age-related impairments of auditory speech function due to hearing loss.

[0002] The concept of auditory training as auditory stimulation has been known for centuries. As early as the 6th century, doctors used the sound of a large bell to stimulate hearing in the deaf. In 1800, a Parisian school for the deaf taught its students to identify and distinguish speech sounds and tonal stimuli of different pitches, which led to improved auditory perception. After World War II, audiology further developed as many military personnel with hearing loss needed rehabilitation. At the same time, the basic approaches to auditory training were also established. In the 1950s and 1960s, it was used to facilitate the use of hearing aids for patients with hearing loss after they had been fitted with hearing aids. Interest in auditory training subsequently waned due to a lack of theoretical justification for its effectiveness.However, in the late 20th century, evidence began to emerge of the inherent plasticity of the brain and confirmation of the negative impact of auditory deprivation on the auditory system. Studies have confirmed the ability to reorganize the cortex and brainstem, reflected in perceptual parameters and behavioral responses (Russo N., Nicol T., Zecker S., Hayes E., Kraus N. Auditory training improves neural timing in the human brainstem. Behavioural Brain Research, 2005, 156, 95-103; Snyder RL, Bonham BH, Sinex DG. Acute changes in frequency responses of inferior colliculus central nucleus (ICC) neurons following progressively enlarged restricted spiral ganglion lesions. Hearing Research. 2008, 246, 59-78; Song JH, Skoe E., Wong PC, Kraus N. Plasticity in the adult human auditory brainstem following short-term linguistic training. Journal of Cognitive Neuroscience. 2008, 20(10), 1892-1902).It has also been shown that although brain neuroplasticity is most pronounced in childhood, the ability to reorganize in response to learning is retained in the mature central nervous system. Moreover, data on changes in the auditory cortex due to auditory training confirmed its positive effect regardless of age and duration of the period of auditory deprivation preceding the fitting of a hearing aid and the beginning of the training course (Ohl FW, Scheich H. Learning-induced plasticity in animal and human auditory cortex. Current Opinions in Neurobiology, 2005, 15, 470-477; Thai-Van H., Veuillet E., Norena A., Guiraud J., Collet L. Plasticity of tonotopic maps in humans: influence of hearing loss, hearing aids and cochlear implants. Acta Otolaryngolica, 2010, 130(3), 333-337; Feldman DE, Brecht M. Map plasticity in somatosensoty cortex. Science. 2005; 310: 810-815).

[0003] In general, the positive effect of training on human auditory perception has been proven using both psychophysical and electrophysiological methods, as well as neuroimaging technologies (Kraus N., McGee T., Carrell T., King C., Tremblay K., Nicol T. Central auditory system plasticity associated with speech discrimination training. Journal of Cognitive Neuroscience, 1995, 7, 25-32; Tremblay K., Kraus N., Carrell T., McGee T. Central auditory system plasticity: generalization to novel stimuli following listening training. Journal of Acoustical Society of America, 1997, 102, 3762-3773; Jancke L., Gaab N., Wustenberg T., Scheich H., Heinze H.J. Short-term functional plasticity in the human auditory cortex: an fMRI study. Brain Research. 2001; 12(3): 479-485). The results show that auditory training causes changes in neural activity, the dynamics of auditory evoked potentials and psychophysical measures (Tremblay K., Kraus N., MsGee T.The time course of auditory perceptual learning: Neurophysiological changes during speech-sound training. NeuroReport. 1998; 9(16): 3556-3560). The nature and magnitude of these changes depend on the training activity, stimulation parameters, and the time of the start of training after the detection of hearing impairment. It has been shown that a gradual increase in the level of task difficulty, the presence of feedback, and sufficient positive reinforcement play an important role (Danzl M., Etter N., Andreatta R., Kitzman P. Facilitating neurorehabilitation through principles of engagement. Journal Allied Health. 2012; 41: 35-41). The main indication for auditory training is the manifestation of central auditory disorders (CAD), which inevitably arise during auditory deprivation in patients with chronic hearing loss of a peripheral nature, but can also occur with normal hearing thresholds, for example, with the early manifestation of age-related neurodegenerative processes (Chermak GD, Musiek FEHandbook of central auditory processing disorder. Vol. 2: Comprehensive intervention. 2nd edition. San Diego: Plural Publishing; 2014. 792 p.; Boboshko M.Yu., Savenko I.V., Garbaruk E.S., Zhuravsky S.G., Maltseva N.V., Berdnikova I.P. Practical audiology. St. Petersburg: Dialog, 2021. 420 p. In these cases, even with a good ability to perceive simple sounds, patients have problems recognizing complex signals, in particular, when perceiving speech against a background of noise, and when combining information coming to the right and left ear (dichotic stimulation), as well as when mastering reading and writing skills (Bellis T. Assessment and management of central auditory processing disorders in the educational setting from science to practice. 2nd ed. Thomson: Delmar Learning, 2003. 533 p.; Musiek FE, Chermak GD Handbook of central auditory processing disorder. 2nd ed. Vl San Diego: Plural Publishing, 2014. 745 p.; Boboshko M.Yu., Savenko I.V., Garbaruk E.S., Zhuravsky S.G., Maltseva N.V., Berdnikova I.P. Practical surdology. SPb.: Dialog, 2021. 420 p; Ogorodnikova E.A., Balyakova A.A. Auditory segmental analysis in case of hearing, speech and writing impairment (experimental study involving patients after cochlear implantation and children with dysgraphia). LAP, 2014. 153 p).

[0004] The main principles of auditory training are: 1) its intensity (stimulation of plasticity and cortical changes); 2) variety (stimulation parameters); 3) patient activation (initial motivation, feedback and reinforcement during the training process); 4) adequacy of the complexity of the stimulus material and exercises (taking into account the age and perceptual capabilities of the patient, gradual complication of tasks as they develop) (Russo N., Nicol T., Zecker S., Hayes E., Kraus N. Auditory training improves neural timing in the human brainstem. Behavioural Brain Research, 2005, 156, 95-103; Ahissar E., Vaadia E., Ahissar M., Bergman H., Arieli A., Abeles M. Dependence of cortical plasticity on correlated activity of single neurons and on behavioral context. Science. 1992; 257: 1412-1415; Holroyd CB, Larsen JT, Cohen JD Context dependence of the event-related brain potential associated with reward and punishment. Psychophysiology. 2004; 41: 245-253; Gottselig JM, Brandeis D., Hofer-Tinguely G., Borberly AA, Achermann P. Human central auditory plasticity associated with tone sequence learning. Learning and Memory. 2004; 11: 151-171). Thus, functional auditory training is considered a necessary component of rehabilitation of patients with hearing loss of different ages.

[0005] At the same time, the issue of its use is relevant in cases where patients exhibit additional communication and cognitive disorders against the background of hearing loss (Jiang W., Zhou Q., Zhang J., He Q., Cui G., Huang R., Liang C, Huang Z.. Effects of Auditory Training on Cognition in Hearing Loss: A Systematic Review and Meta-analyses. J Am Acad Audiol. 2025 Feb 28. doi: 10.3766 / jaaa.240049; Thamizhmani L., Ganapathy K., Palaniswamy HP, Pitchaimuthu AN, Adhikari MRP Auditory processing and its cognitive correlates in older adults with mild cognitive impairment. BMC Geriatr. 2025 May 24;25(1):373. doi: 10.1186 / s12877-025-05997-4).

[0006] Various methods of functional training are known, including perceptual tasks on auditory perception, in particular, on the perception of speech signals in noise. The study (Koprowska A., Marozeau J., Dau T., Serman M. The effect of phoneme-based auditory training on speech intelligibility in hearing-aid users. Int J Audiol. 2023 Nov;62(11):1048-1058. doi: 10.1080 / 14992027.2022.2135032) describes a two-week program for training in phoneme recognition, i.e. the basic speech sounds (vowels and consonants of the Polish language), presented against a noise background. The patient was presented with speech sounds in silence and against a noise background, recording the results for the number of correct recognitions. The program was tested on 20 patients aged 63 to 79 years who used hearing aids.The training results showed that a two-week course improved auditory perception of phonemes but did not improve the intelligibility of more complex speech signals (syllables, words, and phrases) that patients with hearing loss most frequently encounter in everyday communication. This method is limited in its impact, and the use of only individual speech sounds in quiet and noise is insufficiently effective in overcoming the patient's auditory-verbal deficits. Furthermore, the method does not address areas of interest related to the development of not only auditory-verbal skills but also the cognitive and communicative skills of patients with hearing loss.

[0007] The closest approach to the one presented is a method for the rehabilitation and development of auditory-speech function in patients with cochlear implants (patent for invention RU 2342109; published: 27.12.2008, Bulletin No. 36). The method involves delivering speech and non-speech sound signals and analyzing the responses to train the ability to distinguish between the voices of speakers, intonation of phrases, the sounds of animals and birds, and the sounds of musical instruments and household items. According to the method, sessions are conducted no earlier than three days after the initial activation of the cochlear implant and then at least once a week, determining the correct number of responses and the patient's reaction time. The method also has a number of limitations in terms of the diversity of stimulus material (characteristics of noise interference), the provision of conditions for its presentation (the possibility of dichotic stimulation), and sections related to overcoming the manifestations of communicative and cognitive deficits of the patient against the background of hearing loss.The problem of a personalized approach to a comprehensive examination of the patient (hearing, communication, cognitive status), the selection of a training program and the evaluation of its results remains unresolved.

[0008] Also known is the utility model "Complex for developing basic auditory perception skills in people with hearing impairments" (Patent for Utility Model RU 82419; published: 27.04.2009, Bulletin No. 12); which implements the practical application of the method for rehabilitation and development of auditory-speech function in patients with cochlear implants (Patent for Invention RU 2342109). The utility model allows for the selection of a training mode (training, testing) for hearing skills to develop speech recognition, perception of extralinguistic characteristics of speech signals, discrimination of environmental sounds, localization of sound and speech sources, and perception of speech signals against an acoustic background. At the same time, this utility model has similar limitations in terms of the set of background noise options with different spectral-temporal characteristics (especially close to speech) and in the base of exercises under dichotic stimulation conditions.The model also lacks targeted sections on the development of memory and communication skills, which are necessary from the point of view of rehabilitation of patients with communication and cognitive dysfunctions due to hearing loss.

[0009] Thus, one of the pressing tasks is to develop a method for using functional auditory training in the treatment of communication and cognitive disorders associated with hearing loss. Moreover, the positive impact of auditory training on cognitive functions of patients of different ages is currently being widely studied and has been experimentally confirmed (Jiang W., Zhou Q., Zhang J., He Q., Cui G., Huang R., Liang C, Huang Z. Effects of Auditory Training on Cognition in Hearing Loss: A Systematic Review and Meta-analyses. J Am Acad Audiol. 2025 Feb 28. doi: 10.3766 / jaaa.240049; Thamizhmani L., Ganapathy K., Palaniswamy HP, Pitchaimuthu AN, Adhikari MRP Auditory processing and its cognitive correlates in older adults with mild cognitive impairment. BMC Geriatr. 2025 May 24;25(1):373. doi: 10.1186 / s12877-025-05997-4).Developing functional auditory training capabilities in this area will improve the methodological basis for clinical practice in the field of audiology and otolaryngology and will contribute to the effectiveness of rehabilitation and the quality of life of patients with hearing loss. To achieve these goals, it is necessary to not only expand the stimulus base and training sections but also develop a comprehensive assessment system for the patient's initial auditory, communication, and cognitive deficits to personalize training courses and evaluate their effectiveness (performance criteria, a set of analyzed indicators, and a range of normotypical characteristics).

[0010] The technical problem of using the existing auditory training methods in relation to patients with communicative and cognitive dysfunctions due to hearing loss is the lack of a system for comprehensively assessing the initial auditory, communicative and cognitive deficits and the final training results, which, together with limitations in the target sections of the training and the stimulus base, significantly reduces the possibilities of a personalized approach to the rehabilitation of patients with cognitive and communicative dysfunctions due to hearing loss and its effectiveness.

[0011] The claimed method for rehabilitation of patients with communicative and cognitive dysfunctions due to hearing loss solves this technical problem as follows.

[0012] In addition to functional auditory training to develop auditory perception skills, targeted training of the patient's cognitive and communicative skills is provided by presenting non-speech and speech sounds with spectral and temporal characteristics of varying complexity and analyzing the responses using visual images, text information, and recording the time of performance. To personalize the training course and take into account individual characteristics, an initial examination is conducted using a developed comprehensive scheme and an individual profile of the patient's auditory, cognitive, and communicative deficits is created based on hearing indicators, speech intelligibility in quiet and noise, dichotic stimulation, the success of hearing aid use, and cognitive status, measured using audiometric equipment, instrumental psychophysical testing, psychological scales, and questionnaires.To overcome the identified deficiencies, an individual correction route is developed, taking into account the magnitude of deviation of profile indicators from normotypic characteristics to justify the choice of content and sequence of auditory-speech and cognitive exercises.The initial assessment of the results is carried out based on the average performance indicators of the exercises in such a way that when they reach the level of 80% correct responses and a 10% reduction in reaction time, a decision is made to terminate the training course with the recording of the final individual profile of the patient's auditory, cognitive and cognitive characteristics; otherwise, a decision is made to continue the training course, a new individual profile of auditory, cognitive and communicative deficiencies is compiled, and a new corrective route for the patient is selected with a selection of exercises from the database of training sections for which the result did not correspond to the specified criterion, and the average improvement in indicators when comparing the individual profiles of the patient before and after the training course did not exceed 5%.

[0013] Furthermore, to overcome the limitations of the prototype, the training directions, stimulus base and variety of conditions for delivering non-speech / speech signals are expanded by including complexes of non-speech and speech sound signals for training cognitive and communicative (auditory attention, memory, communication in a dialogue) skills, increasing the set of background noises with different spectral-temporal characteristics, including variants of speech noise and polyphonic noise, to improve the training of auditory perception against a background of interference, providing stimulation with different parameters of dichotic stimulation to develop the ability to combine acoustic information coming through different channels (the patient's right and left ears), and interhemispheric interaction.

[0014] To provide auditory stimulation, extended sets of non-speech sounds are used, including tones and their complexes, natural and synthesized sounds of varying duration, frequency (pitch), intensity, and their sequence, as well as sets of speech signals, including individual speech sounds (phonemes of the Russian language), syllables, words, phrases, and phrases with variable spectral and temporal parameters, pronounced by different speakers or obtained through synthesis. After the delivery of an audio or speech signal, the patient's response is recorded. This response is realized by selecting a visual image or text symbol on the monitor screen corresponding to the incoming audio or speech information, and the time it takes to execute the response (decision making) using a computer mouse or a verbal response.

[0015] During training and exercise, positive feedback is used in the form of reinforcement for correct response selection (positive images, verbal approval from the specialist conducting the session). The stimulation procedure includes the ability to deliver sound and speech signals through headphones and in a free sound field using speakers, allowing measurements to be conducted both with and without the patient's hearing aids.

[0016] Specific exercises with corresponding sets of stimuli and responses are launched using a computer and the SUPER-PLUS control program ("Hearing and the ability to understand natural speech plus diagnostics"), registered in the State Register of the Russian Federation (certificate No. 2024666740 dated July 16, 2024, copyright holders - Federal State Budgetary Educational Institution of Higher Education "First St. Petersburg State Medical University named after Academician I.P. Pavlov" of the Ministry of Health of the Russian Federation, Federal State Budgetary Institution of Science I.P. Pavlov Institute of Physiology of the Russian Academy of Sciences).

[0017] Taking into account the experience of conducting auditory-speech training after hearing aid fitting (cochlear implantation, hearing aids) (Koroleva I.V., Balyakova A.A., Stolyarova E.I., Pak S.P., Ogorodnikova E.A. Development of auditory analysis processes in users of cochlear implants using software. Russian Psychological Journal. 2023. 20 (3): 188-205; Boboshko M.Yu., Berdnikova I.P., Maltseva N.V., Zhilinskaya E.V., Ogorodnikova E.A. Ways to improve speech intelligibility when using hearing aids. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2021. 27 (1): 21-29), the main sections of exercises of varying complexity and conditions for their implementation have been prepared to develop skills auditory-speech perception.

[0018] They are presented in Table 1, where the novel elements that distinguish their implementation from the prototype are also highlighted. Furthermore, the method creates conditions for developing not only auditory-verbal skills but also cognitive (memory) and communicative (dialogue communication) skills in the patient.

[0019]

[0020]

[0021]

[0022] Using prepared sets of sound and speech stimuli, patients are trained in auditory recognition, discrimination, and selection. Perception skills are trained not only by presenting non-speech and speech signals with identical parameters to the right and left ears (binaural presentation), but also under dichotic stimulation conditions by presenting signals with different parameters or different parts of the signal to the left and right ears, further developing the ability to integrate acoustic information and interhemispheric interaction processes in the implementation of auditory-speech function. To distinguish from background noise, training is provided with a choice of background noise options with different spectral-temporal characteristics (noise load), including speech noise and polyphonic noise (simultaneous conversation of four or more speakers).

[0023] With regard to cognitive skills, the method involves training different types of memory (operational, short-term, long-term) by presenting sequences of sound and speech signals or their simultaneous complexes and performing tasks: respond only to target stimuli (certain sounds, numbers, words, according to the speaker's voice), compare successive signals and highlight coincidences of signals, the absence of one of the signals or the appearance of an extra one; repeat signals in direct and reverse order; sequentially perform addition and subtraction operations (in pairs and series of numbers); highlight and reproduce signals (words, numbers) coming through one of the stimulation channels (through the right or left ear).In the Memory section, a delayed response mode is also used, when the time interval between the signal and the choice of response can be from 500 ms to 3 s, and the repeated reproduction of the sequence of speech stimuli (syllables, words, numbers) is performed 30 or more minutes (up to 60 minutes) after completing the exercise.

[0024] In terms of communication skills, the patient's active vocabulary and ability to communicate in a dialogue are trained by presenting speech signals of varying complexity (individual words, phrases, phrases, paragraphs of text) and completing tasks: recognizing the words of the target speaker; determining the intonation of a phrase (question, statement), and forming meaningful speech reactions (choosing an answer to a question, completing a phrase or story of the communicant, clarifying a question asked, responding to an oral message, analyzing the text heard and presenting it).

[0025] The general training algorithm is based on the basic principles outlined in the introduction. The principle of gradual complication: classes begin with the presentation of simple non-speech stimuli, then progress to speech stimuli and then through the training sections, repeating each exercise no more than five times within a single session. The duration of a session with a set of exercises from different sections ranges from 30 to 60 minutes. Classes are held at least twice a week for 6-8 weeks.

[0026] The order and set of exercises correspond to an individual correction route, formed on the basis of an individual profile of auditory, cognitive and communication deficits identified by measuring indicators during the initial examination of the patient or when summing up the results of the training course.

[0027] Thus, the technical result of the invention consists in increasing the effectiveness of rehabilitation of patients with communicative and cognitive dysfunctions against the background of hearing loss by using a new approach to the personalization of the training course and the analysis of its results based on a comprehensive examination according to the developed measurement scheme to obtain an individual profile of auditory, speech, cognitive and communicative deficiencies of the patient, selection on this basis of an individual correction route with a set of exercises in the basic areas of training (auditory, cognitive, communicative skills), which are performed under different listening conditions (headphones, free sound field, range of background noise, options for dichotic stimulation),and the implementation of a procedure for assessing the results of training through a qualitative and quantitative comparison of individual patient profiles before and after completing an individual correction route (training course) based on target criteria and normotypical characteristics.

[0028] The developed comprehensive examination scheme with the formation of an individual profile of auditory, speech, cognitive, and communicative deficits and an individual corrective route for the patient is distinguished by its integrative approach and innovation, ensuring increased personalization of the training course and the effectiveness of rehabilitation of patients with communicative and cognitive dysfunctions due to hearing loss.

[0029] Explanatory examples are shown in the drawings:

[0030] Fig. 1 - General diagram of audiogram registration and audiogram form.

[0031] Fig. 2 - An example of a psychophysical testing form measuring auditory-verbal perception and auditory-verbal memory during a patient examination. Normal values ​​are shown in parentheses.

[0032] Fig. 3 - an example of a cluster individual patient profile: 1 - basic hearing characteristics (hearing thresholds); 2 - cognitive characteristics; 3 - speech intelligibility in quiet and 4 - in noise; 5 - perception under dichotic stimulation; 6 - effectiveness of hearing aids (patient self-assessment). The dotted line indicates the relative boundaries of the conditional "norm".

[0033] Fig. 4 - example of an individual patient correction route (ICR-1).

[0034] Fig. 5 - An example of positive dynamics in the patient's individual cluster profile after completing ICM-1 during the first training course. Designations: 1 - basic hearing characteristics (hearing thresholds); 2 - cognitive characteristics; 3 - speech intelligibility in quiet and 4 - in noise; 5 - perception under dichotic stimulation; 6 - effectiveness of hearing aids (patient self-assessment). The dotted line indicates the relative boundaries of the conditional "norm", asterisks mark changes exceeding the target criterion - 5% improvement in indicators.

[0035] Fig. 6 - an example of the second individual correction route for continuing the patient’s training (ICM-2).

[0036] Fig. 7 - Clinical example: individual correction route for patient 2.

[0037] Fig. 8 - Clinical example: changes in the cluster individual profile of patient 2 after performing ICM during the training course. Designations: 1 - basic hearing characteristics (hearing thresholds); 2 - cognitive characteristics; 3 - speech intelligibility in quiet and 4 - in noise; 5 - perception under dichotic stimulation; 6 - effectiveness of hearing aids (patient self-assessment). The dotted line marks the relative boundaries of the conditional "norm", dots - clusters where the indicators did not demonstrate positive dynamics.

[0038] Fig. 9 - Clinical example: changes in the cluster individual profile of patient 3 after performing ICM during the training course. Designations: 1 - basic hearing characteristics (hearing thresholds); 2 - cognitive characteristics; 3 - speech intelligibility in quiet and 4 - in noise; 5 - perception under dichotic stimulation; 6 - effectiveness of hearing aids (patient self-assessment). The dotted line indicates the relative boundaries of the conditional "norm". All clusters represent target positive dynamics.

[0039] The examination scheme includes:

[0040] 1. Evaluation of the functional state of the patient's peripheral auditory system and their hearing sensitivity (hearing thresholds) based on a standard ENT examination and audiological testing using pure tone threshold audiometry (PTA)—measuring hearing thresholds in the frequency range from 125 to 8000 Hz (Fig. 1), as well as tympanometry and acoustic reflex recording. Examples of the data obtained are provided in the descriptions of clinical cases.

[0041] 2. Psychophysical testing of the functional state of the central auditory system and the patient's auditory-speech function during the perception of non-speech and speech signals of varying complexity in a free sound field (using hearing aids) and through headphones (headphones) in quiet or noise. When using headphones, the test included monaural (stimulation of one ear), binaural (sequential stimulation of both ears), and dichotic (different parameters of simultaneous stimulation for the right and left ears) presentation.

[0042] Hearing aids measure the auditory intelligibility (recognition) of polysyllabic words in quiet (no background noise) and noise (white noise). Using headphones in quiet, the patient determines the percentage of monosyllabic word intelligibility for each ear (monaural testing) and conducts an alternating binaural speech test (ABS) by presenting the first half of a word to one ear and the second half to the other. The difference between these intelligibility scores is then calculated (in cases of central hearing loss, this difference exceeds 20%). Also conducted using headphones is a monosyllabic word intelligibility test in noise (monaural stimulation) and a dichotic number test (DNT) - the simultaneous presentation of pairs of two-digit numbers to each ear (e.g., "72" on the right, "24" on the left) with instructions to reproduce both numbers.The examination also includes tests for detecting short pauses in an audio signal and rhythm perception (temporal characteristics of hearing); as well as tests for auditory-verbal memory—completing tasks involving repeating sequences of single-digit numbers in forward and reverse order (without a delay between their presentation and reproduction by the patient). The use of psychophysical tests allows for an assessment of the initial state of the patient's auditory-verbal (communicative) function, including manifestations of central auditory disorders (auditory analysis processes) and the characteristics of auditory-verbal memory (Fig. 2).

[0043] 3. Psychological testing of the patient's cognitive status using the standard MoCA test - the Montreal Cognitive Assessment Scale (Nasreddine ZS, Phillips NA, Bedirian V., Charbonneau S., Whitehead V. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005, 53, 695-699), Russian version available (11.06.2025): https: / / memo.expert / wp-content / uploads / moca-monrealskaya-shkala-kognitivnoj-oczenki.pdf.

[0044] Result interpretation: 28-30 points - no cognitive impairment; 24-27 points - pre-dementia cognitive impairment; 20-23 points - mild dementia; 11-19 points - moderate dementia; 0-10 points - severe dementia.

[0045] 4. Patient survey (self-assessment of auditory and communication skills, effectiveness of hearing aids) using a scoring scale (0 - min, 5 -max score).

[0046] Based on the obtained results (items 1-4), a new tool for a personalized approach to organizing the training course is created: an individual patient profile and their auditory, verbal, and cognitive deficits, represented by average measurement indicators (data from audiograms, psychophysical testing, MoCA scales, and self-assessment). For clarity, a graphical representation is also used, combining assessments by main clusters (relative conversion, conventional units or %): basic hearing characteristics (hearing thresholds); cognitive characteristics; auditory speech intelligibility in quiet and noise; perception during dichotic stimulation; effectiveness of hearing aids.

[0047] Next, based on the individual profile data, an individualized correctional route is created for the patient. This route represents a training program with a selection of specific training sections and exercises in accordance with the main identified auditory-speech and cognitive deficits. Thus, in accordance with the example of a cluster individual profile (example in Fig. 3), the first individualized correctional route (ICR-1) for the patient is designed with an emphasis on exercises in the auditory perception of non-speech and speech stimuli (sounds, syllables, words, phrases) in silence and against a noise background (with different signal-to-noise ratios, with and without hearing aids). It also includes sessions under dichotic stimulation conditions and exercises (memory, dialogue) to develop the patient's cognitive and communicative skills, which also do not reach the level of normotypic indicators (example in Fig. 4).

[0048] By performing a set of exercises of varying difficulty in accordance with ICM-1, the patient's auditory speech perception skills are trained in quiet and background noise, improving their cognitive and communication skills, and their ability to integrate information from the right and left stimulation channels (binaural and interhemispheric interaction). Sessions are conducted both with and without hearing aids. Based on the patient's performance indicators, reflecting the number of correct choices, errors, and task completion time, the results of the training and its stages are analyzed, and the sessions are adjusted according to the complexity of the exercises and stimulation conditions. The initial level of success in performing individual exercises is defined as the patient achieving a level of at least 70% correct answers.After implementing the individualized correction program, the patient's results before and after the training course are compared, and the training is terminated if the average performance for the exercise set reaches 80% correct responses and a 10% reduction in completion time. Otherwise, a decision is made to continue the training course and recommendations are made for the patient's further rehabilitation, developing a new correction program by selecting those exercises for developing auditory perception, cognitive, and communication skills for which the target improvement (5%) was not achieved when comparing the patient's individual profiles before and after the training course.

[0049] An example of training results - average indicators after the patient completed ICM-1 (data from clinical example 1) - is shown in Table 2.

[0050]

[0051] According to the presented data, at the final stage of the ICM-1, in most exercises, except for individual sections on the perception of non-speech sounds (loudness, temporal characteristics - pause, rhythm) and auditory speech intelligibility in noise, the number of correct responses corresponded to the primary success threshold of ≥70%. However, the criteria for completing the training course were not achieved: the level of 80% correct responses was exceeded only for speech intelligibility in quiet, and a decrease in reaction time of 10% was achieved only in the "Dialogue" section. Changes in the final cluster individual profile confirmed an increase corresponding to the established boundary (≥5%) for the relative indicators of "dichotic stimulation" and "hearing aid effectiveness" (Fig. 5); a tendency toward an improvement in the patient's cognitive characteristics was also evident.Based on the results obtained, a decision is made to continue training and develop a new individual correction route (ICM-2), which includes exercises: with non-speech sounds in the sections "volume", "pause", "rhythm" (in silence and in noise, in hearing aids, in headphones); with speech (sections: syllables, words, phrases, numbers) in conditions of different noise backgrounds and signal-to-noise ratios, from the sections "dialogue" and "memory" and to consolidate the positive effect - some exercises from the section "dichotic stimulation" (Fig. 6).

[0052] Thus, the presented method of organizing functional training with a new approach to the personalization of the examination (individual profile of auditory, communicative, cognitive deficits), training program (individual correction route), evaluation of its results (comparison procedure, target criteria, range of normotypic characteristics) increases the effectiveness of auditory functional training and rehabilitation of patients with communicative and cognitive dysfunctions against the background of hearing loss, which is confirmed by examples from clinical practice of its application.

[0053] Examples from clinical practice of using the method

[0054] EXAMPLE 1.

[0055] Patient 1 (MB), 68 years old, diagnosis: chronic bilateral sensorineural hearing loss of grade III.

[0056] Hearing loss duration - 28 years, has been using an in-the-ear hearing aid on the left ear for 9 years, has difficulty with communication, and has memory complaints.

[0057]

[0058] Based on the results of the initial examination, a cluster individual patient profile was formed (see Fig. 3) and an individual correction route was developed (see Fig. 4), in accordance with which functional training was carried out for 8 weeks: 45-minute sessions 2 times a week.

[0059] According to the results evaluation procedure after the first individual correction route (ICM-1), a comparison of average performance indicators (number of correct answers, reaction time) for exercise performance by sections at the initial and final stages of training was conducted (see Table 2), and a cluster individual patient profile was constructed, reflecting positive changes (see Fig. 5). Based on the final profile (changes exceeding 5% were noted during dichotic testing and the patient's self-assessment of the effectiveness of hearing aids), a decision was made to continue training and develop a new individual correction route ICM-2 (Fig. 6).

[0060] Thus, the technical result of the method is achieved in relation to 2 target indicators of patient 1 and the personalization of the assessment of the results of his first course of functional training with the identification of the remaining auditory-speech and cognitive deficits for the construction of a new individual corrective route and continuation of rehabilitation.

[0061] EXAMPLE 2.

[0062] Patient 2 (EX), 18 years old, diagnosed with chronic bilateral sensorineural hearing loss, grade III, primary manifestations of central auditory disorders. The patient has had hearing loss for 12 years. She has been using behind-the-ear hearing aids in both ears for 12 years and experiences difficulty distinguishing rhythm, recognizing speech in noise, and localizing sound and speech sources.

[0063]

[0064]

[0065] Based on the patient data, a cluster individual profile and an individual correction route were created for patient 2 (Fig. 7), according to which rehabilitation using a new method of functional training was carried out for 8 weeks with 60-minute sessions 2 times a week.

[0066] After completing the ICM, the results of patient 2’s training were assessed by comparing the average indicators (number of correct answers, reaction time) of the exercises performed before and after training (Table 5) and by comparing the data obtained at the beginning and after completing the ICM.

[0067]

[0068] A cluster individual profile of patient 2 was constructed, reflecting positive changes in the clusters “cognitive characteristics”, “speech intelligibility in quiet”, “dichotic stimulation” and their absence in the clusters “speech intelligibility in noise”, “effectiveness of hearing aids (patient self-assessment)” (Fig. 8).

[0069] Considering the lack of improvement in speech intelligibility in noise (according to the average indicators of correct recognitions - below the primary success limit of 70%) and the response time under these conditions, as well as the low self-assessment of the use of hearing aids by patient 2, a decision was made on the need to replace them with new models of hearing aids equipped with modern noise reduction technologies, and to undergo a new training course to adapt to the new hearing aids until the goal of improving auditory perception in different communication conditions and the patient's quality of life is achieved.

[0070] Thus, the method achieved a technical result in terms of improving most target indicators. Based on the results of the functional training course, a problem with the quality of the patient's hearing aids was identified and a recommendation for their replacement was issued.

[0071] EXAMPLE 3.

[0072] Patient 3 (SL), 46 years old, diagnosed with chronic bilateral sensorineural hearing loss, grade 2, primary manifestations of central hearing disorders. The patient has had hearing loss for 8 years. She has been using behind-the-ear hearing aids in both ears for 7 years and experiences difficulty recognizing speech, especially in complex listening situations.

[0073] Based on the patient data (Table 6), a cluster individual profile and an individual correction route were formed for patient 3, according to which rehabilitation using a new method of functional training was carried out for 8 weeks - 60-minute sessions 2 times a week.

[0074]

[0075] The individual correction route (ICR) of patient 3 included exercises from the following sections:

[0076] on the perception of non-speech sounds:

[0077] - training of rhythm perception with a gradual increase in the complexity of presented sequences from pairs of tone signals of different frequencies to triads, starting with slow ones, moving on to fast sequences;

[0078] - training of temporal resolution ability through simple tasks (simple pause): presentation of tone pairs (1000 Hz) and vowel sounds of speech (sound "A"); complex tasks (complex pause): presentation of tone pairs (500, 1000, 2000 Hz), noise pulses, beeps and tone complexes;

[0079] on the perception of speech sounds:

[0080] - training in distinguishing syllables (intervocalic, open, closed) pronounced by a female and male voice, in silence and against a noise background (white and speech noise, polyphonic noise, natural noise SNR=0 dB);

[0081] - training in distinguishing monosyllabic and polysyllabic words pronounced by a female and male voice, in silence and against a noise background with a gradual increase in complexity through the use of different speech material (rare words, similar-sounding words), when training the perception of words in noise - by reducing the signal-to-noise ratio (SNR = +9, +6, +3, 0 dB);

[0082] by dichotic stimulation:

[0083] - training of dichotic perception with the presentation of different words and numbers, simultaneous presentation of different words spoken by a male and female voice, complicating the task by changing the number of syllables in words, the degree of their similarity, and the frequency of occurrence in everyday life;

[0084] by dialogue:

[0085] - training in perceiving dialogues by ear with or without visual reinforcement, with a choice of response options in silence and against a background of noise (4 noise load options)

[0086] auditory memory:

[0087] - presenting sets of 3-5 single-digit numbers by ear in silence or in noise with the task of repeating them in direct or reverse order;

[0088] - detection of repetition of a number in a sequence of 6 numbers pronounced by a female or male voice with a gradual increase in the time delay of the response (from 500 to 2000 ms).

[0089] - operational addition of pairs of numbers (sequence of 60 single-digit numbers, presentation by ear, visual presentation of a numerical series).

[0090] The average indicators after the patient has completed 3 ICM are shown in Table 7. The remaining indicators for the survey sections were:

[0091] - intelligibility of multi-syllable words against a background of interference (polyphony, SNR=+6) in a free sound field using hearing aids (HA)=75%.

[0092] - intelligibility of monosyllabic words in silence at a comfortable volume level in headphones: AD=85%, AS=90%

[0093] - Alternating Binaural Speech Test: AD+AS=90%

[0094] - intelligibility of monosyllabic words in noise - 70%

[0095] - perception of triads of rhythmic sequences of stimuli (1000 Hz) - 75%

[0096] - Dichotic Number Test: 70%

[0097] - Pause detection test: 15ms

[0098] - memory: direct order - 5 digits; reverse order - 5 digits

[0099] - RUMatrix phrase adaptive test in silence: AD=63.2, AS=65.6 dB SPL

[0100] - RUMatrix phrase adaptive test in speech noise: AD=-3.4, AS=-4.1 dB SNR

[0101] The results of the examination after completion and the indicators of the final cluster individual profile of patient 3 (Fig. 9) confirmed the positive dynamics in all areas of functional training - auditory speech perception (including intelligibility in noise), communicative and cognitive characteristics, as well as response speed.

[0102] In particular, a significant increase in the ability to understand multi-syllabic words in noise (from 55% to 75%) and an improvement in self-assessment regarding hearing aid use (from 3.5 to 4.8 points) were noted. According to patient 3's survey, gratitude was expressed for participating in the functional training program, which led to improved communication and quality of life.

[0103] Based on the results obtained, it was concluded that the technical result of the new rehabilitation method was achieved. To consolidate the result and achieve target indicators for noise-induced exercises, a repeat training course is planned for the patient in 3 months.

[0104] In general, examples from clinical practice demonstrate the effectiveness of the presented method of rehabilitation of patients with communicative and cognitive dysfunctions against the background of hearing loss by personalizing the approach to overcoming their auditory, cognitive and communicative deficiencies and identifying specific underlying problems that can be of both a functional (in a number of assessed areas and sections of training) and technical (quality and adjustment of hearing aids) nature.

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