Audio Coaching Research Articles

Teaching workplace communication skills to college students with intellectual disability

BACKGROUND: College students with Intellectual Disability (ID) are afforded many educational opportunities through Inclusive Post-Secondary Education (IPSE) programs, including employment training. Competitive employment can contribute to a rich independent life, thus more employment training opportunities can be beneficial. Low employment rates for adults with ID have motivated these efforts to develop proper employment training. In the past, on-the-job (OTJ) training with a job coach was one of the only supports for adults with ID in the workplace. Now, there are a variety of evidence-based strategies that can be used in the workplace or in other community settings, such as Covert Audio Coaching (CAC), to teach adults with ID the skills they need to maintain a job. OBJECTIVE: The purpose of this study was to determine if CAC would increase on-topic workplace communication skills for college students with ID. METHODS: This study used a multiple probe design to examine the effects of CAC on teaching workplace communication skills to college students with ID in a real-world setting. In this study, students interned in an office setting and spoke to a co-worker at their work setting while the interventionist used a two-way radio system to provide coaching statements to the student during their conversations. RESULTS: All students in this study increased their on-topic communication exchanges and these results demonstrate that CAC is an effective intervention for this population. CONCLUSION: CAC can be used as an employment support for adults with ID, specifically in the community setting. Limitations and implications of this study were further described at the end of the article.

Teaching young adults with visual impairment and intellectual/developmental disability how to determine appropriate job fit

BACKGROUND: Job seekers must know how to determine whether the jobs identified during a search are a good fit. Employment decision making requires problem-solving and choice-making skills. There is limited research on employment decision making skills. OBJECTIVE: The purpose of this study was to teach three young adults with dually diagnosed visual impairment and intellectual/developmental disability to determine appropriate job fit. The mnemonic “ELSE” was paired with remote audio coaching to teach the participants how to determine if the education level, likes, skills, and earnings of each presented job were an appropriate fit for them. METHODS: This study used a single subject design to determine the effectiveness of the multicomponent intervention. The design was a multiple baseline across participant design. RESULTS: The results demonstrated all three participants were able to reach a pre-determined mastery criterion of the skill. Maintenance and generalization were variable across participants. CONCLUSIONS: All participants who received the intervention increased their ability to determine appropriate job fit. The results from this study are promising and demonstrate the potential and flexibility of the mnemonic ELSE on determining appropriate job fit by young adults with VI and IDD.

Effects of remote audio coaching during workplace conversations for college students with intellectual disability

BACKGROUND: College students with intellectual disability (ID) face many challenges while maintaining employment. These challenges encompass both social and behavioral tribulations. Increasing social skills at work is a significant goal for practitioners and educators of adults with ID. Coaching strategies such as Covert Audio Coaching (CAC) and Remote Audio Coaching (RAC) have proven effective in teaching students with ID various employment related skills. OBJECTIVE: The purpose of this study was to determine if RAC would increase on-topic workplace communication skills for college students with ID. METHODS: This study used a multiple probe design to test the effects of RAC on teaching communication skills in the workplace. In this study, college students logged onto a Zoom call to speak with a co-worker about an employment topic while the interventionist used RAC to coach the student through the conversation. RESULTS: The results of this study demonstrated that the RAC intervention was effective in increasing on-topic exchanges between college students with ID and their co-workers. CONCLUSION: The COVID-19 pandemic has shifted the workplace to virtual settings for training and work tasks. RAC can be used as an employment support for adults with ID while minimizing in person contact. Limitations and implications of this study were further described at the end of the article.

4DCT is long overdue for improvement.

4DCT is long overdue for improvement.

Using Covert Audio Coaching to Teach “Small Talk” to a College Student with Intellectual and Developmental Disabilities

Using Covert Audio Coaching to Teach “Small Talk” to a College Student with Intellectual and Developmental Disabilities

"What ELSE about this job?" Teaching Job Decision-Making to College Students With Intellectual and Developmental Disabilities.

Decision-making is the central element of self-determination, requiring targeted, systematic instruction to learn. In this study, researchers developed a multicomponent intervention, “What ELSE about this job?”, to teach job decision-making skills to college students with intellectual and developmental disabilities. The intervention coupled remote audio coaching (RAC) with a mnemonic device, ‘ELSE’, to guide students to make decisions about whether certain jobs would be a good fit for them. The study aimed to investigate the effectiveness of the intervention and determine whether the skills would maintain once the intervention was removed. All students who received the intervention substantially increased their ability to make job decisions. Additionally, all participants maintained the skills upon removal of the intervention, and showed signs of generalizing their skills to novel job coaches and web-based job search apps. Implications and future research are discussed.

Assessment of visual feedback system for reproducibility of voluntary deep inspiration breath hold in left-sided breast radiotherapy

IntroductionDeep inspiration breath-hold (DIBH) for left-sided breast cancer radiotherapy reduces the dose exposure of the heart and left anterior descending coronary artery. DIBH requires the patient to maintain an adequate breath-hold position during their daily radiotherapy fraction. This study aimed to assess the reproducibility of the breath-hold position by implementing DIBH with visual feedback (VF) system. MethodsForty-three patients who underwent left-sided radiotherapy with DIBH were reviewed. Data from 35 patients who underwent DIBH with VF (VF-DIBH) were compared with data from 8 patients who underwent DIBH with audio coaching (AC-DIBH). Reproducibility during radiotherapy was evaluated using the portal images obtained. Images were acquired daily during the tangential field treatment with DIBH. The distances between the field edge and chest wall at the central beam axis were manually measured on the portal image and digital reconstruction radiograph (DRR). The displacements of the chest wall during radiotherapy were assessed by subtracting the measurement made on the portal image from the DRR measurement. The overall average distances for the VF-DIBH and AC-DIBH cohorts were compared to assess reproducibility. The statistical analysis was performed using Mann–Whitney U tests (p < 0.05). ResultsThe mean chest wall displacement (±2 SD) was 0.59 ± 3.64 mm for VF-DIBH and 2.09 ± 4.96 mm for AC-DIBH, respectively. This value differed significantly between the VF-DIBH and AC-DIBH cohorts (p < 0.001). ConclusionIn DIBH radiotherapy, the implementation of VF was confirmed to improve breath-hold position reproducibility, and the utility of VF for DIBH was demonstrated.

Conversation Skills and Self-Initiated Interactions in Young Adults with Autism and Intellectual Disability

BackgroundOur purpose in this study was to increase conversations in three young adults with autism spectrum disorder (ASD) and co-occurring moderate intellectual disability (ID). First, we used an intervention package consisting of Behavior Skills Training (BST) and Covert Audio Coaching (CAC) to promote acquisition and maintenance of conversations with coworkers. Second, we implemented CAC during naturally occurring opportunities at an internship site. Third, we examined whether the number of self-initiated interactions with coworkers increased during and after acquisition of conversations. MethodThree young adults with ASD and co-occurring moderate ID participated in the study. We used a concurrent multiple-baseline design across participants with continuous acquisition probes to evaluate the effects of the intervention package consisting of BST and CAC in producing acquisition and maintenance of conversations and an increase in the number of self-initiated interactions. ResultsResults demonstrate that the intervention was effective in producing acquisition and maintenance of the target skills in all three young adults. Data also indicate that two of the three participants engaged more frequently in self-initiated interactions with coworkers as their conversational competence increased. ConclusionsFindings suggest that the intervention package was effective in promoting conversations and an increased number of self-initiated interactions with coworkers in young adults with ASD and co-occurring moderate ID in the natural environment. Directions for future research and clinical implications for teaching conversations are discussed.

Covert Audio Coaching to Increase Question Asking by Female College Students with Autism: Proof of Concept

Deficits in social-communication skills are a core feature of autism spectrum disorder (ASD). Deficits in social communication progress into adolescence and adulthood, making complex social interactions particularly difficult and preventing the development of meaningful friendships. Interventions aimed to improve conversational skills needed to foster development of relationships for this age group are needed. Thus, the purpose of the current study was to evaluate the effectiveness and feasibility of instructional modules and covert audio coaching (CAC), on the frequency of question asking skills among college students diagnosed with ASD. Four college females diagnosed with ASD and six neurotypical peers participated in the current study. The effects of the instructional modules and covert audio coaching were evaluated using a concurrent multiple-baseline design. CAC was associated with variable increases in the frequency of question asking across participants. The introduction of a feedback phase resulted in further increases in the frequency of question asking for two of the participants. Results suggest that CAC is feasible and may be an effective tool to teach conversation skills to female college students with ASD. Further, participants indicated they found the intervention helpful and preferred it to other interventions in which they had previously experienced. Implications for practice and future research are discussed.

47 Automated respiratory cycle binning for liver 4D-MR imaging

Introduction Stereotactic body radiation therapy (SBRT) has been validated for liver lesions [1] . Because high dose per fraction is delivered on small volume, very accurate lesion segmentation is necessary. MRI is the most relevant imaging for liver lesion contouring but it is prone to motion artifacts if breathing is not managed. Evaluation of liver lesion motion induced by breathing is necessary in radiotherapy to guide patient treatment planning (respiratory gating). A 4D-MRI sequence was previously validated for liver [2] . In this study, an automated method was developed to sort images according to the breathing cycle. Methods The 4D-MRI acquisition is performed with an experimental sequence (bSSFP TrueFISP [3] ) on 1.5T Magnetom AeraTM (Siemens). This sequence allows very fast axial and sagittal 2D acquisition during free breathing. Axial slice positions (0.88 s/slice) are incremented to cover the liver volume. Sagittal slices (navigators) are acquired at a fixed position. The navigators are used to assign a phase for each axial slice which depend on an amplitude sequencing of the respiratory cycle (0% = inspiration, 16%, 33%, 50% = expiration, 66%, 83%). Lung volume is estimated on each navigator by automatic segmentation and allows to assign a phase for the coupled axial image in the breathing cycle. As the image number per respiratory cycle is low, the sequence is repeated 20 times in order to achieve satisfactory sampling. The sequence was evaluated on 4 volunteers with an audio coaching (5 and 6 s period) and 2 patients without audio coaching. Results Patient image sorting according to their position in the breathing cycle was realized by automated phase detection (Fig. 1) and images were imported into the treatment planning system Eclipse 13.7TM (Varian) in 6 phases. Audio coaching is not used here. It is required for patients with irregular breathing cycle. Download : Download high-res image (278KB) Download : Download full-size image From axial images, Eclipse reconstructs slices in sagittal and coronal plans, and allows to display a cine view with the 6 breathing phases in order to analyze the dynamic behavior of the liver. Conclusions 4D-MRI images from volunteers and patients were acquired with bSSFP TrueFISP sequence. After automated sorting with the method developed in this study, 6 breathing cycle phases were imported into Eclipse. Patient 4D-MRI can be registered with 4D-CT to increase the physician’s segmentation accuracy.

Effects of Covert Audio Coaching on the Attending Behavior of Children With Autism Spectrum Disorder

The effects of covert audio coaching, a form of performance feedback delivered remotely through a two-way radio and earbud speaker, was examined on the classroom attending behavior of children with autism spectrum disorder (ASD). Four elementary-aged students with ASD participated. This study was conducted in a private, separate day school for students with ASD. Baseline data showed that participants emitted low levels of attending behavior with a degree of variability. During intervention, all participants increased their level of attending behavior and these data were stable. Follow-up data revealed higher levels of attending compared with baseline; however, these data were more variable than what was observed during intervention. These results and implications for future research and practice are discussed.

P21. Treatment planning for liver stereotactic body radiation therapy using FFF photon beams

Introduction Since April 2015, patients are treated in our department with liver stereotactic body radiation therapy on a linear accelerator equipped with flattening filter free (FFF) photon beams. The energy and the use of respiratory gating are adapted for each patient. This study presents the results for the first 14 patients. Material and methods. Three gold fiducials are implanted inside or in the vicinity of the lesion 7–10 days prior planning imaging. The minimum 4 h fasting patient undergoes first a 4D CT scan with systematic audio coaching and a thoracic thermoplastic mask (Orfit Industries, Wijnegem, Belgium). An MRI scan in treatment position is acquired and registered to the CT images based on the fiducials. The radiation oncologist outlines the GTV on each of the six respiratory phases. A 6 phases ITV (entire breathing cycle) and a 3 phases ITV (expiratory phases) are then created. The corresponding PTVs are created by adding a 5 mm margin. When the ratio PTV 6/ PTV 3 is higher than 1.5, the treatment is achieved with respiratory gating. The beam used is a conformal dynamic arc of 180 to 200° amplitude, conformed to the PTV. 10 MV FFF beams were preferably used as the dose rate is higher than for 6 MV FFF beams (2400 and 1200 MU/min respectively). For organs at risk, constraints from Timmerman et al. [1] were used. Results For the past year, 14 patients have been treated (8 with 3 fractions of 18 Gy, 3 with 5 fractions of 11 Gy and 3 with 5 fractions of 10 Gy), without any restriction on PTV size (from 11 to 273 cm 3 ). The prescription isodose is 80%. 5 patients were treated in free breathing (PTV 6) and 9 with respiratory gating (PTV 3). Sometimes it has been necessary to treat with respiratory gating in order to fulfill the constraints to the organs at risk. The systematic comparison for the first 10 patients between the two FFF energies showed that the dosimetric objectives were fulfilled similarly for both energy except when the PTV was close to an organ at risk. In this case, better results were obtained with 6MV FFF beam. Conclusion Despite the fact that the liver is a very mobile organ, it has been possible to treat some patients in free breathing, without compromising the dosimetric objectives, thus allowing a better patient comfort (treatment time 3 times faster). The 10 MV FFF with its 2400 MU/min dose rate was most often used, allowing treatment times lower than 10 min even with respiratory gating and the highest prescribed dose.

Effects of audio coaching and visual feedback on the stability of respiration during radiotherapy

The aim of this study is to compare the respiration-stabilizing abilities of audio coaching (AC) and AC with visual feedback (VF) with that of free breathing (FB). Ten healthy volunteers were told to breathe in FB, under AC and under AC+VF in random order. The standard deviation (SD) values of the respiratory cycle, the amplitude, the lowest points (exhalation), and the highest points (inhalation) of respiratory wave were used as indices of respiratory stability. Compared with FB, the AC method significantly improved respiratory cycle stability (p=0.001). The AC+VF method improved the stability of the respiratory cycle, the amplitude and the lowest point of respiratory wave (all p<0.001). In analyses of each subject's data, compared with FB, the AC method significantly improved the respiratory cycle stability in five subjects, and the AC+VF method improved the stability of the respiratory cycle, the amplitude and the lowest point of respiratory wave in 4, 5, and 4 subjects, respectively. In two cases, coaching did not improve respiratory stability. The AC+VF method had the most beneficial effects on respiratory stability. However, coaching is not necessarily effective in all cases. Therefore, the most suitable method should be chosen on an individual basis.

Reproducibility of Left Sided Breast Radiotherapy with Deep Inspiration Breath Hold with Audio-Visual Coaching versus Audio Coaching Alone: A Systematic Review

Reproducibility of Left Sided Breast Radiotherapy with Deep Inspiration Breath Hold with Audio-Visual Coaching versus Audio Coaching Alone: A Systematic Review

Developing An Improved Heart Rate Monitor With Work-Out Training Android Application And Real Time Audio Coaching

TechnoHeart is a digital way of monitoring heart rate using a Heart Rate Monitor device and an android phone. Moreover, this is made more special through its work-out training which is designed to help users set and achieve their target heart rate and monitor at what training intensity they are during a strenuous exercise. The training is made more interactive as the application has its real-time audio coaching. The need for this application comes from three sources; First, some athletes, non-athletes and even doctors are still using the traditional way of getting the heart rate; Second, training intensity is not monitored and target heart rate is not achieved; Third, most mobile developments do not tailor the need of users who undergo work-out training. With the following needs, objectives were set; First, to connect an HRM (Heart Rate Monitoring) device to an android mobile device and display individual’s heart rate in digital form through mobile; Second, to create a work-out training program using the Karvonen Formula; Third, to enable users to know one’s target heart rate by using a Karvonen calculator; Fourth, to notify users in real-time with every sudden change and the needed action in order to keep an effective training exercise. The project is to explore this and other similar concepts to develop a design that optimally satisfies all of these objectives. The project addresses all of these objectives while meeting the constraints given. The project was deployed in three different sets of users: The University of Mindanao Athletes, The elderly users aging from 50-80 years old and the other users aging from 12-49 years old. The researchers recommend the use of TechnoHeart for athletes and non-athletes who are aiming for effective cardiovascular training. And for the next researchers, they can focus on the compatibility of the said application to other mobile platforms like iOS, Blackberry, Windows and etc. And also, they may upload the application on the internet such as in social networking sites or any features that would make this project more usable.

Effects of Covert Audio Coaching on Parents' Interactions with Young Children with Autism.

Children with autism spectrum disorders (ASD) frequently present intervention challenges for parents. Covert audio coaching (CAC) has not been studied with parents, nor as an intervention to teach household routines and tasks. Further, evidence of generalization with CAC is limited. We examined the effectiveness of immediate feedback via CAC on mothers' interactions with their children with ASD. Mothers learned to deliver effective prompts and praise, and generalized these interactions to novel (untrained) routines. Children increased the accuracy of training and generalization tasks after their mothers received the coaching intervention.

Developing an Improved Heart Rate Monitor with Work-Out Training Android Application and Real Time Audio Coaching

TechnoHeart is a digital way of monitoring heart rate using a Heart Rate Monitor device and an android phone. Moreover, this is made more special through its work-out training which is designed to help users set and achieve their target heart rate and monitor at what training intensity they are during a strenuous exercise. The training is made more interactive as the application has its real-time audio coaching. The need for this application comes from three sources; First, some athletes, non-athletes and even doctors are still using the traditional way of getting the heart rate; Second, training intensity is not monitored and target heart rate is not achieved; Third, most mobile developments do not tailor the need of users who undergo work-out training. With the following needs, objectives were set; First, to connect an HRM (Heart Rate Monitoring) device to an android mobile device and display individual’s heart rate in digital form through mobile; Second, to create a work-out training program using the Karvonen Formula; Third, to enable users know one’s target heart rate by using a Karvonen calculator; Fourth, to notify users in real time with every sudden change and the needed action in order to keep an effective training exercise. The project is to explore this and other similar concepts to develop a design that optimally satisfies all of these objectives. The project addresses all of these objectives while meeting the constraints given. The project was deployed in three different sets of users: The University of Mindanao Athletes, The elderly users aging from 50-80 years old and the other users aging from 12-49 years old. The researchers recommend the use of TechnoHeart for athletes and non-athletes who are aiming for an effective cardiovascular training. And for the next researchers, they can focus on the compatibility of the said application to other mobile platforms like iOS, Blackberry, Windows and etc. And also, they may upload application in the internet such as in social networking sites or any features that would make this project more usable.

Assessment of tumor motion reproducibility with audio‐visual coaching through successive 4D CT sessions

This study aimed to compare combined audio‐visual coaching with audio coaching alone and assess their respective impact on the reproducibility of external breathing motion and, one step further, on the internal lung tumor motion itself, through successive sessions. Thirteen patients with NSCLC were enrolled in this study. The tumor motion was assessed by three to four successive 4D CT sessions, while the breathing signal was measured from magnetic sensors positioned on the epigastric region. For all sessions, the breathing was regularized with either audio coaching alone (AC, n=5) or combined with a real‐time visual feedback (A/VC, n=8) when tolerated by the patients. Peak‐to‐peak amplitude, period and signal shape of both breathing and tumor motions were first measured. Then, the correlation between the respiratory signal and internal tumor motion over time was evaluated, as well as the residual tumor motion for a gated strategy. Although breathing and tumor motions were comparable between AC and AV/C groups, A/VC approach achieved better reproducibility through sessions than AC alone (mean tumor motion of 7.2 mm±1 vs. 8.6 mm±1.8 mm, and mean breathing motion of 14.9 mm±1.2 mm vs. 13.3 mm±3.7 mm, respectively). High internal/external correlation reproducibility was achieved in the superior‐inferior tumor motion direction for all patients. For the anterior‐posterior tumor motion direction, better correlation reproducibility has been observed when visual feedback has been used. For a displacement‐based gating approach, A/VC might also be recommended, since it led to smaller residual tumor motion within clinically relevant duty cycles. This study suggests that combining real‐time visual feedback with audio coaching might improve the reproducibility of key characteristics of the breathing pattern, and might thus be considered in the implementation of lung tumor radiotherapy.PACS number: 87

Pulmonary Changes in FDG-PET/CT After Cure of Small Lung Tumors With Stereotactic Ablative Radiation Therapy (SBRT): Which Imaging Features Can Be Expected?

anteroposterior direction. Fluoroscopic movies were recorded simultaneously with the respiratory waveforms for 30 seconds with and without audio coaching. One measurement session consisted of simultaneously recorded 5 cycles of the tumor motion and respiratory waveform. The tumor position corresponding to the phase of respiratory waveform was identified using image processing and template matching techniques. Data of 20 sessions consisting of 100 respiratory cycles each with and without audio coaching were acquired from 6 patients who underwent respiratorygated SBRT between August 2011 and September 2012. Results: The amplitude of the tumor motion varied widely. The difference between the amplitude on fluoroscopy under audio instructions and that on planning 4D-CT was over 5 mm in 51 cycles and was up to 21 mm. The fluctuations of the most cranial position of the tumor were comparatively small. They were within 5 mm under free-breathing conditions and within 4 mm with audio coaching. The phase shift of the most cranial position of the tumor on fluoroscopy with audio coaching from that on 4D-CT was 20% or more in 43 cycles. The phases at which the tumor position was within 5 mm from the most cranial position on fluoroscopy with audio coaching were compared to the actually irradiated gating phases based on 4D-CT. The phase shifts were not observed in 3 patients, while the phase shifts up to 75% were observed in the other 3. The phase shifts between the most cranial position of the tumor and the lowest point of the respiratory waveform decreased significantly in 1 patient with audio coaching. Conclusions: Tumor motion could vary among individual patients and during planning and treatment for the same patient. Audio coaching was not sufficient to improve respiratory patterns. An individual approach to respiratory management is necessary in respiratory-gated SBRT. Author Disclosure: F. Baba: None. Y. Nonogaki: None. S. Tanaka: None. S. Hasegawa: None. M. NIshihashi: None. S. Ayakawa: None. M. Iwana: None. Y. Shibamoto: None.

Reduced lung dose and improved inspiration level reproducibility in visually guided DIBH compared to audio coached EIG radiotherapy for breast cancer patients

Introduction. Patients with left-sided breast cancer with lymph node involvement have routinely been treated with enhanced inspiration gating (EIG) for a decade at our institution. In a transition from EIG to deep inspiration breath hold (DIBH) we compared the two techniques with focus on target coverage, dose to organs at risk and reproducibility of the inspiration level (IL). Material and methods. Twenty-four patients were computed tomography (CT) scanned with EIG and DIBH. For DIBH we used visual feedback and for EIG audio coaching, both during scan and treatment. Treatment plans for 50 Gy over 25 fractions were calculated. Seventeen of the patients were included in the analysis of reproducibility. They were audio coached for one minute before beam-on in DIBH at nine treatment sessions. These respiration curves were analysed with average maximum IL and standard deviation (SD) for the EIG part of the respiratory signal, and mean IL and SD for the DIBH. Comparison of dosimetric and respiration parameters were performed with the Wilcoxon signed rank-sum test. Results. In DIBH, the ipsilateral lung volume increased further compared to EIG (p < 0.0004, mean increase 11%). This lead to a 9% mean reduction (p = 0.002) of the ipsilateral lung volume receiving 20 Gy (V20 Gy). We found no other significant dosimetric differences between the two methods. The reproducibility of the IL was better with the DIBH method, observed as a significantly smaller SD in most patients (p < 0.04 for 16 of 17 patients). Conclusion. The DIBH method resulted in a significantly larger lung volume and lower ipsilateral lung V20 Gy compared to EIG. The IL for visually guided DIBH was more reproducible than audio-coached EIG. Based on these findings, the DIBH technique is our new breathing adaptation standard for radiotherapy of patients with left-sided breast cancer with lymph node involvement.