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Bhatt IS, Ramadugu SK, Goodman S, Bhagavan SG, Ingalls V, Dias R, Torkamani A. Polygenic Risk Score-Based Association Analysis of Speech-in-Noise and Hearing Threshold Measures in Healthy Young Adults with Self-reported Normal Hearing. J Assoc Res Otolaryngol 2023; 24:513-525. [PMID: 37783963 PMCID: PMC10695896 DOI: 10.1007/s10162-023-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Speech-in-noise (SIN) traits exhibit high inter-subject variability, even for healthy young adults reporting normal hearing. Emerging evidence suggests that genetic variability could influence inter-subject variability in SIN traits. Genome-wide association studies (GWAS) have uncovered the polygenic architecture of various adult-onset complex human conditions. Polygenic risk scores (PRS) summarize complex genetic susceptibility to quantify the degree of genetic risk for health conditions. The present study conducted PRS-based association analyses to identify PRS risk factors for SIN and hearing threshold measures in 255 healthy young adults (18-40 years) with self-reported normal hearing. METHODS Self-reported SIN perception abilities were assessed by the Speech, Spatial, and Qualities of Hearing Scale (SSQ12). QuickSIN and audiometry (0.25-16 kHz) were performed on 218 participants. Saliva-derived DNA was used for low-pass whole genome sequencing, and 2620 PRS variables for various traits were calculated using the models derived from the polygenic risk score (PGS) catalog. The regression analysis was conducted to identify predictors for SSQ12, QuickSIN, and better ear puretone averages at conventional (PTA0.5-2), high (PTA4-8), and extended-high (PTA12.5-16) frequency ranges. RESULTS Participants with a higher genetic predisposition to HDL cholesterol reported better SSQ12. Participants with high PRS to dementia revealed significantly elevated PTA4-8, and those with high PRS to atrial fibrillation and flutter revealed significantly elevated PTA12.5-16. CONCLUSION These results indicate that healthy individuals with polygenic risk of certain health conditions could exhibit a subclinical decline in hearing health measures at young ages, decades before clinically meaningful SIN deficits and hearing loss could be observed. PRS could be used to identify high-risk individuals to prevent hearing health conditions by promoting a healthy lifestyle.
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Affiliation(s)
- Ishan Sunilkumar Bhatt
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Dr, Iowa City, IA, 52242, USA.
| | - Sai Kumar Ramadugu
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Shawn Goodman
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Srividya Grama Bhagavan
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Valerie Ingalls
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Raquel Dias
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL, 32608, USA
| | - Ali Torkamani
- Department of Integrative Structural and Computational Biology, Scripps Science Institute, La Jolla, CA, 92037, USA
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Windle R, Dillon H, Heinrich A. A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults. Front Neurol 2023; 14:1122420. [PMID: 37409017 PMCID: PMC10318159 DOI: 10.3389/fneur.2023.1122420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/02/2023] [Indexed: 07/07/2023] Open
Abstract
Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.
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Affiliation(s)
- Richard Windle
- Audiology Department, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Harvey Dillon
- NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Department of Linguistics, Macquarie University, North Ryde, NSW, Australia
| | - Antje Heinrich
- NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Division of Human Communication, Development and Hearing, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Xu S, Hou C, Han X, Hu Y, Yang H, Shang Y, Chen W, Zeng Y, Ying Z, Sun Y, Qu Y, Lu Y, Fang F, Valdimarsdóttir UA, Song H. Adverse health consequences of undiagnosed hearing loss at middle age: A prospective cohort study with the UK Biobank. Maturitas 2023; 174:30-38. [PMID: 37243993 DOI: 10.1016/j.maturitas.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/30/2023] [Accepted: 05/06/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Hearing impairment is common in the middle-aged population but remains largely undiagnosed and untreated. The knowledge about to what extent and how hearing impairment matters for health is currently lacking. Thus, we aimed to comprehensively examine the adverse health consequences as well as the comorbidity patterns of undiagnosed hearing loss. STUDY DESIGN Based on the prospective cohort of the UK Biobank, we included 14,620 individuals (median age 61 years) with audiometry-determined (i.e., speech-in-noise test) objective hearing loss and 38,479 individuals with subjective hearing loss (i.e., tested negative but with self-reported hearing problems; median age 58 years) at recruitment (2006-2010), together with 29,240 and 38,479 matched unexposed individuals respectively. MAIN OUTCOME MEASURES Cox regression was used to determine the associations of both hearing-loss exposures with the risk of 499 medical conditions and 14 cause-specific deaths, adjusting for ethnicity, annual household income, smoking and alcohol intake, exposure to working noise, and BMI. Comorbidity patterns following both exposures were visualized by comorbidity modules (i.e., sets of connected diseases) identified in the comorbidity network analyses. RESULTS During a median follow-up of 9 years, 28 medical conditions and mortality related to nervous system disease showed significant associations with prior objective hearing loss. Subsequently, the comorbidity network identified four comorbidity modules (i.e., neurodegenerative, respiratory, psychiatric, and cardiometabolic diseases), with the most pronounced association noted for the module related to neurodegenerative diseases (meta-hazard ratio [HR] = 2.00, 95%confidence interval [CI] 1.67-2.39). For subjective hearing loss, we found 57 associated medical conditions, which were partitioned into four modules (i.e., diseases related to the digestive, psychiatric, inflammatory, and cardiometabolic systems), with meta-HRs varying from 1.17 to 1.25. CONCLUSIONS Undiagnosed hearing loss captured by screening could identify individuals with at greater risk of multiple adverse health consequences, highlighting the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention.
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Affiliation(s)
- Shishi Xu
- Division of Endocrinology and Metabolism and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Can Hou
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xin Han
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Huazhen Yang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yanan Shang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Wenwen Chen
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yu Zeng
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yajing Sun
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yu Lu
- Institute of Rare Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
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Comparing the Outcomes of a Personalized Versus Nonpersonalized Home-Based Auditory Training Program for Cochlear Implant Users. Ear Hear 2022; 44:477-493. [PMID: 36534665 DOI: 10.1097/aud.0000000000001295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Audiological rehabilitation includes sensory management, auditory training (AT), and counseling and can alleviate the negative consequences associated with (untreated) hearing impairment. AT aims at improving auditory skills through structured analytical (bottom-up) or synthetic (top-down) listening exercises. The evidence for AT to improve auditory outcomes of postlingually deafened adults with a cochlear implant (CI) remains a point of debate due to the relatively limited number of studies and methodological shortcomings. There is a general agreement that more rigorous scientific study designs are needed to determine the effectiveness, generalization, and consolidation of AT for CI users. The present study aimed to investigate the effectiveness of a personalized AT program compared to a nonpersonalized Active Control program with adult CI users in a stratified randomized controlled clinical trial. DESIGN Off-task outcomes were sentence understanding in noise, executive functioning, and health-related quality of life. Participants were tested before and after 16 weeks of training and after a further 8 months without training. Participant expectations of the training program were assessed before the start of training. RESULTS The personalized and nonpersonalized AT programs yielded similar results. Significant on-task improvements were observed. Moreover, AT generalized to improved speech understanding in noise for both programs. Half of the CI users reached a clinically relevant improvement in speech understanding in noise of at least 2 dB SNR post-training. These improvements were maintained 8 months after completion of the training. In addition, a significant improvement in quality of life was observed for participants in both treatment groups. Adherence to the training programs was high, and both programs were considered user-friendly. CONCLUSIONS Training in both treatments yielded similar results. For half of the CI users, AT transferred to better performance with generalization of learning for speech understanding in noise and quality of life. Our study supports the previous findings that AT can be beneficial for some CI users.
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Hughes SE, Boisvert I, McMahon CM, Steyn A, Neal K. Perceived listening ability and hearing loss: Systematic review and qualitative meta-synthesis. PLoS One 2022; 17:e0276265. [PMID: 36282860 PMCID: PMC9595527 DOI: 10.1371/journal.pone.0276265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Hearing loss (HL) can affect communication in complex ways. Understanding how adults with HL reflect on and conceptualise the way they listen (metacognition) is required if interventions, and the outcome measures used to evaluate them, are to address barriers to functional communication arising from HL. OBJECTIVES This study describes how adults with HL experience and report the processes, behaviours, and components of listening, as presented in published studies. DESIGN Systematic review and meta-synthesis of qualitative studies. METHODS Systematic searches identified English-language, peer-reviewed journal articles reporting the results of qualitative or mixed-methods studies of adults' with HL perceived listening abilities. Medline, PsychInfo, Web of Science, Embase, and Google Scholar were searched from inception to November 2021. Handsearching reference lists of included studies identified additional studies for inclusion. The Critical Appraisal Skills Programme (CASP) qualitative checklist was used to appraise studies' methodological quality. Data from included studies were analysed using thematic meta-synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of QUALitative (CERQual) approach assessed confidence in the review findings. Two reviewers independently completed all screening and quality appraisal. Thematic meta-synthesis and GRADE CERQual assessment was completed by one reviewer and confirmed by a second reviewer. Discrepancies were resolved through discussion. RESULTS Data from 46 studies were included in the review. Thematic meta-synthesis identified six descriptive themes: 1) perceived listening ability; 2) external modifiers; 3) psychosocial impacts of hearing loss; 4) communication partner perspectives; 5) self-efficacy for listening; and 6) cognitive load. GRADE CERQual ratings for descriptive themes ranged from low to moderate confidence. Descriptive themes were related by analytic themes of liminality and reciprocity. CONCLUSIONS Adults with HL provide in-depth accounts of components and processes of listening, with studies reporting both cognitive and affective experiences consistent with theoretical models of metacognition. The findings will inform content generation for a hearing-specific patient-reported outcome measure of perceived listening ability in everyday communication.
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Affiliation(s)
- Sarah E. Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC), West Midlands, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, United Kingdom
- Narra Consulting Limited, Wales, United Kingdom
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, United Kingdom
- * E-mail:
| | - Isabelle Boisvert
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- HEAR Centre, Macquarie University, Sydney, Australia
| | - Catherine M. McMahon
- HEAR Centre, Macquarie University, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | | | - Katie Neal
- HEAR Centre, Macquarie University, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
- The Shepherd Centre, Sydney, NSW, Australia
- The Listening Lab, Sydney, NSW, Australia
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Jain S, Narne VK, Nataraja NP, Madhukesh S, Kumar K, Moore BCJ. The effect of age and hearing sensitivity at frequencies above 8 kHz on auditory stream segregation and speech perception. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:716. [PMID: 35931505 DOI: 10.1121/10.0012917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/07/2022] [Indexed: 06/06/2023]
Abstract
The effects of age and mild hearing loss over the extended high-frequency (EHF) range from 9000 to 16 000 Hz on speech perception and auditory stream segregation were assessed using four groups: (1) young with normal hearing threshold levels (HTLs) over both the conventional and EHF range; (2) older with audiograms matched to those for group 1; (3) young with normal HTLs over the conventional frequency range and elevated HTLs over the EHF range; (4) older with audiograms matched to those for group 3. For speech in quiet, speech recognition thresholds and speech identification scores did not differ significantly across groups. For monosyllables in noise, both greater age and hearing loss over the EHF range adversely affected performance, but the effect of age was much larger than the effect of hearing status. Stream segregation was assessed using a rapid sequence of vowel stimuli differing in fundamental frequency (F0). Larger differences in F0 were required for stream segregation for the two groups with impaired hearing in the EHF range, but there was no significant effect of age. It is argued that impaired hearing in the EHF range is associated with impaired auditory function at lower frequencies, despite normal audiometric thresholds at those frequencies.
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Affiliation(s)
- Saransh Jain
- All India Institute of Speech and Hearing, University of Mysore, Mysuru-570006 (Kar.), India
| | - Vijaya Kumar Narne
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61481, Saudi Arabia
| | - N P Nataraja
- JSS Institute of Speech and Hearing, University of Mysore, Mysuru-570004 (Kar.), India
| | - Sanjana Madhukesh
- Department of Speech and Hearing, Manipal College of Health Professionals, Manipal-576104 (Kar.), India
| | - Kruthika Kumar
- District Disabled Rehabilitation Centre, Chikmagalur-577126 (Kar.), India
| | - Brian C J Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, United Kingdom
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Bhatt IS, Washnik N, Torkamani A. Suprathreshold Auditory Measures for Detecting Early-Stage Noise-Induced Hearing Loss in Young Adults. J Am Acad Audiol 2022; 33:185-195. [PMID: 36195294 PMCID: PMC10858682 DOI: 10.1055/s-0041-1740362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
BACKGROUND Over 1 billion young adults are at risk for developing noise-induced hearing loss (NIHL) due to their habit of listening to music at loud levels. The gold standard for detecting NIHL is the audiometric notch around 3,000 to 6,000 Hz observed in pure tone audiogram. However, recent studies suggested that suprathreshold auditory measures might be more sensitive to detect early-stage NIHL in young adults. PURPOSE The present study compared suprathreshold measures in individuals with high and low noise exposure backgrounds (NEBs). We hypothesized that individuals with high NEB would exhibit reduced performance on suprathreshold measures than those with low NEB. STUDY SAMPLE An initial sample of 100 English-speaking healthy adults (18-35 years; females = 70) was obtained from five university classes. We identified 15 participants with the lowest NEB scores (10 females) and 15 participants with the highest NEB scores (10 females). We selected a sample of healthy young adults with no history of middle ear infection, and those in the low NEB group were selected with no history of impulse noise exposure. DATA COLLECTION AND ANALYSIS The study included conventional audiometry, extended high-frequency audiometry, middle ear muscle reflex (MEMR) thresholds, distortion-product otoacoustic emissions (DPOAEs), QuickSIN, and suprathreshold auditory brainstem response (ABR) measures. We used independent sample t-tests, correlation coefficients, and linear mixed model analysis to compare the audiometric measures between the NEB groups. RESULTS The prevalence of audiometric notch was low in the study sample, even for individuals with high NEB. We found that: (1) individuals with high NEB revealed significantly reduced QuickSIN performance than those with low NEB; (2) music exposure via earphone revealed a significant association with QuickSIN; (3) individuals with high NEB revealed significantly reduced DPOAEs and ABR wave I amplitude compared with individuals with low NEB; (4) MEMR and ABR latency measures showed a modest association with NEB; and (5) audiometric thresholds across the frequency range did not show statistically significant association with NEB. CONCLUSION Our results suggest that young adults with high NEB might exhibit impaired peripheral neural coding deficits leading to reduced speech-in-noise (SIN) performance despite clinically normal hearing thresholds. SIN measures might be more sensitive than audiometric notch for detecting early-stage NIHL in young adults.
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Affiliation(s)
- Ishan S Bhatt
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa
| | - Nilesh Washnik
- Department of Communication Sciences & Disorders, Ohio University, Athens, Ohio
| | - Ali Torkamani
- Department of Integrative Structural and Computational Biology, Scripps Translational Science Institute, La Jolla, California
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Conversation in small groups: Speaking and listening strategies depend on the complexities of the environment and group. Psychon Bull Rev 2020; 28:632-640. [PMID: 33051825 PMCID: PMC8062389 DOI: 10.3758/s13423-020-01821-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
Many conversations in our day-to-day lives are held in noisy environments – impeding comprehension, and in groups – taxing auditory attention-switching processes. These situations are particularly challenging for older adults in cognitive and sensory decline. In noisy environments, a variety of extra-linguistic strategies are available to speakers and listeners to facilitate communication, but while models of language account for the impact of context on word choice, there has been little consideration of the impact of context on extra-linguistic behaviour. To address this issue, we investigate how the complexity of the acoustic environment and interaction situation impacts extra-linguistic conversation behaviour of older adults during face-to-face conversations. Specifically, we test whether the use of intelligibility-optimising strategies increases with complexity of the background noise (from quiet to loud, and in speech-shaped vs. babble noise), and with complexity of the conversing group (dyad vs. triad). While some communication strategies are enhanced in more complex background noise, with listeners orienting to talkers more optimally and moving closer to their partner in babble than speech-shaped noise, this is not the case with all strategies, as we find greater vocal level increases in the less complex speech-shaped noise condition. Other behaviours are enhanced in the more complex interaction situation, with listeners using more optimal head orientations, and taking longer turns when gaining the floor in triads compared to dyads. This study elucidates how different features of the conversation context impact individuals’ communication strategies, which is necessary to both develop a comprehensive cognitive model of multimodal conversation behaviour, and effectively support individuals that struggle conversing.
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