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People with cognitive impairments show deficits during physical performances such as gait, in particular during cognitively challenging conditions (i.e. dual-task gait [DTG]). However, it is unclear if people at risk of dementia, such as those with subjective memory complaints (SMC), also display gait and central deficits associated with DTG. In this study, we investigated the effects of single-and dual-task gait (STG and DTG), on left prefrontal cortex (PFC) activation in elderly people with subjective memory complaints (SMC) and Dementia. A total of 58 older adults (aged 65-94 years; 26 Healthy; 23 SMC; 9 Dementia) were recruited. Gait spatiotemporal characteristics (i.e. stride velocity and length) were assessed using an instrumented walkway during STG and DTG. Single-channel functional near-infrared spectroscopy over the left PFC was used to measure changes in oxyhaemoglobin (O 2 Hb) during gait. Stride velocity and length during STG (all p < .05) and DTG (all p < .000) were significantly impaired in people with Dementia compared to Healthy and SMC individuals. No differences were observed between Healthy and SMC. For STG, a greater increase in O 2 Hb (p < .05) was observed in those with Dementia compared to the Healthy and SMC, while no differences were observed between Healthy and SMC. A significant increase and decline in O 2 Hb was observed during DTG in the SMC and Dementia groups, respectively, compared to Healthy. Our findings indicate an altered pattern of cerebral haemodynamic response of the left PFC in DTG in people with SMC and Dementia, which may suggest that central changes precede functional impairments in people with SMC.

Fitting amplification to a patient with Ménière's disease (MD) can present several challenges to the dispensing audiologist. These challenges include the presence of fluctuating hearing loss, a rising audiometric configuration, unilateral or asymmetrical hearing loss, reduced dynamic range, and reduced word-recognition scores. The presence of any one of these characteristics could create obstacles for a successful hearing aid fit. The presence of most if not all of these characteristics in a single patient can readily challenge the skills of even the most experienced dispensing audiologist. In addition to the audiometric challenges, this patient population has the added psychological problems associated with feeling ill due to the nausea secondary to vertiginous attacks and the anxiety associated with the unpredictable nature of the course of these attacks. This paper summarizes numerous strategies and technologies that could be implemented by the audiologist to address these unique challenges and provide a greater opportunity for a successful hearing aid fit. These suggestions include (1) advantages offered by digital signal processing; (2) using directional microphones and assistive listening devices to improve speech recognition in noise; (3) using wireless hearing aids as well as the bone anchored hearing aid; (4) counseling patients on the realistic expectations from amplification in noisy listening situations and for those with poor speech recognition; (5) using multiple programs for patients with fluctuating hearing loss; and (6) offering suggestions on programming the frequency-gain/output response for a rising configuration.

These two cases illustrate several important areas of vestibular evaluation with children. The two case reports represent two children who display very different vestibular findings despite having significant sensorineural hearing loss. These case reports highlight that pediatric findings can differ significantly from adult findings, stressing the importance of comparing pediatric results with pediatric normative data. These two cases also highlight that vestibular techniques may successfully be adapted for use with hearing-impaired children. That is, rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials can be adapted to use with children, including those who demonstrate significant sensorineural hearing loss. Although there is a paucity of research and clinical work in this area, some investigators (Eviatar and Eviatar, 1977; Buchman et al, 2004; Jacot et al, 2009) have reported very rapid recovery from pediatric vestibular deficits. However, it is important for audiologists to be aware that techniques may successfully be adapted for children and that many children should undergo thorough vestibular evaluation.

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