Research Themes

Understanding Disabilities

Often the first question asked by any family of a stroke patient is why did this happen?

At the Institute, our concern is to understand how those conditions impact on the lives of the stroke patients and their families. By building the big picture comes ways to prevent disability and to improve outcomes for the patients who are living with the challenges that it presents.

Post Stroke Rehabilitation

Post-stroke rehabilitation helps stroke survivors relearn skills that are lost when part of the brain is damaged. There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice - the same kind of practice used by all people when they learn a new skill, such as playing football.

Movement and balance problems are common after a stroke and can affect how people are able to carry out every day activities. Previous research has focused on recovery up to one year after stroke. At present there is limited information as to what influences the recovery of movement and function in the longer term and how this affects the person with stroke. This study will investigate the recovery of movement and function over a 3 year period following stroke. The results will provide information about patterns of recovery and will improve the ability to predict the outcome of a stroke. This information will assist the planning of rehabilitation and care.

Our aim is to recruit people with stroke admitted to Hebron Hospitasl over the next 18 months and follow them for the next three years to monitor their progress. We hope to follow about 500 people.

For the main study, we will collect baseline data from the patient’s medical notes and carry out assessments looking at participant’s ability to mobilize, balance and concentrate. Participants will then be followed up at 6 monthly intervals following discharge using postal questionnaires and face to face assessments.

Two sub studies are planned: activity monitoring and qualitative interviews.
Activity monitoring: An activity monitor is a portable device able to provide an objective evaluation of daily physical activities such as walking, standing, sitting, lying. This way we will be able to quantify changes in movement and mobility over the 3 year period. We aim to recruit about 70 patients to this sub-study.

Qualitative study component: Longitudinal semi-structured qualitative interviews drawing on grounded theory methods will be undertaken with 20 people with stroke and their partners/carers exploring the patient’s and carer’s perspectives on the impact of stroke on their life, focusing on functional movement and mobility.

Universal Newborn Hearing Screening (UNHS)

Hearing loss in children constitutes a considerable handicap because it is an invisible disability and compromises optimal development and personal achievement of a child.

In Palestine, congenital sensorineural hearing impairment has been estimated at 2.1 /1000 live births. Early detection followed by appropriate treatment provides the best chance for maximizing the critical period of hearing, to avail of the resources to improve hearing and oral communication skills.

The Middle East Hearing association (MEHA) is composed of representatives from epidemiology, audiology, otolaryngology, pediatrics, education, and state speech and hearing programs, provides position statements and establishes practice standards for early identification, intervention, and follow-up care for infants and young children with hearing loss. Hearing screening should identify newborns at risk for specifically defined hearing loss that interferes with development.  The aim of researchers at the Institute is detection of permanent sensory or conductive hearing loss averaging 30 to 40 dB or more in the frequency region important for speech recognition (~500–4000 Hz).

The rate of hearing loss among newborns ranges from 1 to 3 per 1000 live births. Compared with children with normal hearing, those with hearing loss have more difficulty learning vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication.  Hearing loss in children is also associated with delayed language, learning, and speech development and with low educational attainment.  Hearing disorders have also been associated with increased behavior problems, decreased psychosocial well-being, and poor adaptive skills.

Newborn hearing screening involves the use of objective physiologic measures. Currently, otoacoustic emissions (OAEs) and/or auditory brainstem responses (ABRs) are most often used to detect sensory or conductive hearing loss. Both technologies are noninvasive recordings of physiologic activities that are easily recorded in newborns and are highly correlated with the degree of peripheral hearing sensitivity. In our program, a 2-step process using OAEs followed by ABRs in those who fail the first test is often used to improve test performance. Under ideal conditions, instruments designed specifically for newborns can test and record findings on sleeping newborns in <5 minutes.

Infants not passing the newborn screening tests are referred for confirmatory testing. The American Academy of Pediatrics has set a referral standard of <4% of all screened newborns, and some hospitals use this measure to monitor quality of the screening program. Confirmation requires an evaluation by an audiologist using behavioral, as well as technological, methods. Although the American Academy of Pediatrics has set a standard of 95% for compliance with follow-up testing, this rate is typically much lower depending on tracking systems and local practices and services.

Our Institute recommends that early intervention services should be designed to meet the individualized needs of the infant and family, including acquisition of communication competence, social skills, emotional well-being, and positive self-esteem.  Early intervention includes evaluation for amplification or sensory devices, surgical and medical evaluation, and communication assessment and therapy. Cochlear implants are often considered in infants with severe-to-profound hearing loss after inadequate response to hearing aids.

We focus on 3 key questions:

  • Compared with targeted screening, does universal screening increase the chance that treatment will be initiated by 6 months of age for infants at average risk or for those at high risk?
  • Among infants identified by universal screening who would not be identified by targeted screening, does initiating treatment before 6 months of age improve language and communication outcomes?
  • What are the adverse effects of screening and early treatment?

Al-Quds Sounds

Al-Quds Sounds is intending to establish a plant for producing a digital hearing aid in July 2010. 

What are the main advantages of producing a digital hearing aid, in comparison to the analogical type?

Today’s technology plus given the size of the Aurora supplier of digital chips, Gennum Manufacturing, makes digital chips cost the same as analogue PCB. A digital aid can more accurately fit the users’ needs. A digital programmable hearing aid has a much greater range to help the hearing loss of a person be it volume measured in decibels (db) and or frequency measured in hertz. The permutations of hearing loss are almost countless. Therefore, a more exact fit is more comfortable to listen with and will be used by wearer. An analogue hearing aid amplifies all sounds, and in some cases this could becomes harsh if the person does not need a specific frequency amplified. The digital hearing aid is also programmable and this is done after testing the personal special requirement by a professional audiologist.

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