 I'd like everybody just to raise their hand if you've fallen. Raise your hand with the remote option for in reactions so that we can get an idea of the number of people here that really have already experienced what our presentation is about today. Oh, so we see quite a few people here have fallen. How many of you already know you could fall and it could be a one time occurrence. Okay, everybody lower your hands. So go to reactions and click lower hand. Perfect. Okay, so how many people have fallen more than once and already know that they have an issue with their balance. Just go ahead and raise your hand in the reactions again. Okay, so several people. Okay, so that gives bring an idea of who her audiences. So at this time, we're going to begin recording our presentation for today and we have already given our zoom directions. I'd like to introduce. Did you get that turned on? Can you turn on the recording? Yeah, recordings on. Okay, thank you. Oops. Oh, I'd like to introduce Bryn Griswald. She is a Stanford researcher and audiology audiology researcher. And she's studying and assessing fall risk and improving speech understanding and through a very special hearing aid that has a sensor. So at this time I'm going to quit sharing my screen. And Bryn, you're free to share your screen and begin your presentation and thank you very much for coming today. I'm really excited to hear about this research and how it might benefit all of us. Absolutely. I'm excited to be here. It's very interesting research that we've been working on. So it's a great opportunity to be able to share with you all. Get feedback, see what your questions are, see what you think is valuable. And I see Henry raising his hand. Okay, can everybody hear me with this microphone? Okay. A little bit. It's not the best. I'm going to try to take it off and tell me if you hear me better so we can. Okay, now I'm talking without it. Are you guys able to hear me better or worse compared to before? Did it make a big difference? It's about the same. About the same. Okay, we'll try like this. I'm going to share my screen. Like Ann said, my name is Gordon Griswold and I'm an audiologist and I'm working at Stanford School of Medicine. And I'm working on a project with the many members and the project right now that I'm going to share research results about are the use of hearing aids with embedded inertial sensors and artificial intelligence to identify patients at risk for falling. So these inertial sensors are motion sensors. And I'm going to share with you a lot of the research, the goals, as well as the results that we're finding so far, and the directions were headed. Some of the results from the research maybe won't be important to you, but I included it in there in case anybody is interested in knowing all of the little details to the project. So this close that this project was fully supported by a research grant from Starkey Hearing Technologies. So that's the hearing aid manufacturer. And they're working with Stanford. So they provided all of the equipment and technical support. And their aim is the same as ours. It's to validate the developmental technology that's not on the market yet. But we find it important for Stanford to conduct all of the data collection and data analysis independently, because we don't want the manufacturer to be biased when they're completing the research. So that's why Stanford is included and doing all the research independently about about the item about the hearing aid. So I'm going to take a step back. Many of you will probably relate to this just based on the hands that we were seeing earlier. So we see that hearing loss, especially increasing amounts of hearing loss is associated with things that are like social isolation and reduced physical activity. Those things can lead to muscular atrophy, which can lead to somebody falling down, which can lead to a fear of falling again, which can cause depression or anxiety. Therefore, the increasing amounts of hearing loss can contribute to increasing one's risk for falling as well. Our older adult population in particular is dealing a lot with the implications of both hearing loss and falls. There was work published by Livingston and colleagues in 2020 stating that hearing loss accounts for 8% of global dementia cases and older adults. This makes hearing loss our largest modifiable risk factor for dementia at a population level. And Ekstrom and his colleagues published work in 2017, stating that falls are the leading cause of injury related deaths among older adults. And falls results in over $31 billion in medical costs each year. So this is a public health issue. And our older adults are given a few options to try to get ahead of these issues and manage them. So for hearing loss, of course we recommend amplification. But hearing aid use is also associated with lower dementia prevalence. And to address falls, we recommend programs that target balance, strength and gait. As well as implementing home safety techniques and gradual reduction of high risk medications. So the thought here is, if we have our older adults already wearing hearing aids or hearing loss, then why not also try to use those devices to help mitigate their risks for falling. So that's the overarching thought. And we also believe that that can open the door to remote assessment of fall risk. So being able to assess your fall risk in your own homes remotely without having to go to a provider. Maybe giving people a little bit of a warning on when it's time to go to a provider and seek assistance, seek treatment or management techniques like therapy. So that's what motivated our question, can hearing aids assess fall risk? So the goal of the study was to see whether the study hearing aids can provide similar ratings to trained observers on a fall risk assessment. We looked at the CDC, who offers three questions that identify 95% of people at risk for falling. So our participants had to have answered yes to at least one of the questions. Do you worry about falling or have you fallen in the last year? And if the answer is yes to at least one of these, then you're allowed to participate in this appointment. So our cohort for the study, we had 250 participants. They were all aged 55 to 100 years old. The average was 78 years old. We had about 62% women and 38% men. We use the CDC's stopping elderly accidents, deaths and injuries or study. So study is a protocol that we used as a test battery for the research. And that included a four stage balance test. A 30 second chair stand test. And a timed up and go test. And then participant performance was graded by observers and graded by hearing aids. First, I want to talk about the limitations and advantages of study. So study again was that protocol, the test battery that I just quickly reviewed. Some limitations are study does not demonstrate sensitivity or specificity and distinguishing between low versus high fall risk individuals. It is also not specific and predicting things like mortality risk or other risk factors. But we still find this measure very hopeful, because it's simple to use. It's easy to implement among many healthcare providers and easy to implement in patients on homes too. A lot of balance testing really is lacking coordination between clinic and community based practice. So there's kind of a gap, which is leading to people not getting help early enough to address their fall risk. So that's why we think that this measure could be really helpful and a great place to start with the hearing aids. I'm going to walk through that test battery that I was talking about the study test battery. So the first test was the four stage balance test. For this we asked participants to stand in four different positions and balance for 10 seconds each. So I'm going to show you some videos of each of these positions. Here we have a woman standing in the side by side position with her feet together to touch. And she's balancing successfully for 10 seconds. Next she's standing in the instep position so her feet are still side by side and touching, but one foot is slightly forward. It's getting a little bit harder now. She's now standing in the tandem position with one foot fully in front of the other toe to heal. She's still able to hold this for 10 seconds. But the last position is the one foot position where she can choose which foot to balance on. She is not able to balance in this position for 10 seconds. So she would have passed the first three positions and failed the last position. The next test is the 32nd chair sand test. This test is to address leg strength and endurance. So participants are asked to stand and sit from a chair as many times as they can without using their arms. They have to count how many stands they can do. The last test is the timed up and go test. This is to address functional gait and mobility. So participants are asked to stand from a chair, walk 10 feet, go back to the chair and sit down. And they're timed while they do this. So our hearing aids are assessing participant performance. The hearing aids have motion sensors in them. So two of those motion sensors are an accelerometer to detect velocity changes and a gyroscope to detect rotation. And then that motion data is sent to a phone. And the phone has an algorithm that makes a decision regarding how they did on the test. So we had three trained observers. So we had an in-person clinician conducting testing, which was myself. And then we also had two offline video raters. We saw good inter-rater reliability between these three people. And we averaged the data from these three people before comparing to the hearing aids. So we compared the observers and the hearing aids and we wanted to see how similar they were. So we're going to go through the data. So this is showing how the hearing aids compared to the observers. So first starting with the four stage balance test. We have the side by side position here. And we saw a 93% scoring agreement between the observers and hearing aids. The red on this bar is showing where the observers and hearing aids scored the same. And the blue is showing where they scored different. Next we have the in step position with one foot slightly in front of the other. And we saw a 91% scoring agreement between the observers and hearing aids. Now we've added a bar for the tandem position with one foot fully in front of the other toe to heal. And we saw an 86% scoring agreement for the tandem position. And the last position for that four stage balance test was the one foot position. And we saw a 90% scoring agreement between the observers and hearing aids. So now this bar graph shows all four positions together. And we're first right off the bat seeing a lot of red, which is indicating vast similarities between the observers and hearing aids. Pretty happy with these scores. One of the reasons for those differences that are in blue could be if a participant is balancing and they start to lose their balance. And these let's say they reach out to hold on to a chair or hold on to the wall. Then the observer has the luxury of visual context. They can see that the person reached out for the chair, but the hearing aids cannot. So that is a limitation to remote assessment. Another important feature for this study to highlight what's beneficial and what's limiting when you do remote assessments with people at home. So next to that 30 second chair stand test, the one where we asked people to stand and sit from a chair for 30 seconds. We saw a strong relationship between the hearing aids and observers. So here is showing the hearing aid stand count. So how many stands the hearing aid was counting the person participant completed in the y axis there is showing how many stands the observers scored. Okay, and so we have all these circles here that are individual data points. So these are all the individual people. And then this is our trend line or linear regression line. All of these points are lining up very well with this linear regression line, and that's showing a strong relationship. We did however see a difference here. So we saw that the observers reported nearly one more stand count compared to the hearing aids. So this graph is showing our observer data in red. And then the hearing aid data in blue. And we have the stand count over here on the y axis. So you can see this box around the red, which is our observer data is up compared to the hearing aid box here around the blue. There was a mean difference of point eight stand count. So meaning that the observers on average were scoring about one more stand count compared to the hearing aids. That actually was statistically significant. You all might be wondering, why is it clinically significant for just a one stand count mistake that doesn't seem like a huge difference that the hearing aids were making. But we actually went back to the data and saw that 21% of our participants would have been at a risk to have a pass fail misclassification from just a one stand count mistake. So that means if we had a patient using this at home, and the hearing aids were reporting how many stands they did, then possibly 21% of them would have been classified as a passing rate, or a failing rate by mistake because the hearing aids made a mistake of one stand count. So that's why we want to highlight that this is something we want to fix. We brought this information to the manufacturer, which again is why we think it's important for Stanford to conduct the data analysis and collection independently, because we're not biased, we can bring this information to the manufacturer and say, Hey, we want this to improve. What can we do about it. And they found that the hearing aids were often timing out too early, which means that the hearing aids were missing the last stand that the person was doing. And they said, you know, thank you for that information they're already making adjustments to the algorithm. And we're going to continue to test the updated algorithm, which I'm really excited about that last test was the timed up and go test. This is where we asked people to stand and walk 10 feet and then go back to the chair and sit down. And we saw a strong relationship here. Again, we have our hearing aid time so what the time was for the hearing aid on the x axis here, and what time the observers scored on the y axis. And again all of our little data points here are each individual participant. And those data points are all right next to this line, which is showing a close agreement. The one problem that we did find is the hearing aids did not calculate a time for 30 participants. So that means that 30 participants were not included in this graph. We brought that back to the manufacturer as well. And they said, some possible reasons could be if a person is taking too long to complete the test, then the hearing aids could have timed out. So they are also looking into that further, going to make some adjustments and update the algorithm. And then that way when we test it again, we can see if we can keep improving the algorithm to try to make it as accurate as we can. This graph is showing the timed up and go test again. We have our hearing aid data in blue here, and our observer data in red. If you look at them side by side they look pretty identical, which is showing no statistically significant difference. The mean was similar for these two, very closely related, which was great. I'm going to go through a summary of those three tests that we just went through. So first we started with the four stage balance test, and we saw that the hearing aids and observers had an 86 to 93% scoring agreement. I did mention we have some remote assessment limitations that this study is highlighting, because the observers can see what the participant is doing, and the hearing aids cannot. The 32nd chair stand test, where the participant stood and sat for 30 seconds, we saw a very strong relationship between the hearing aids and observers, they were very similar. We did see that there was a difference of about one stand count, and we're already looking into reasons to reasons why that happened and how to improve it. The timed up and go test was the last test, where they stood up and walk 10 feet, go back to the chair and sit down. We saw an extremely strong relationship here. The hearing aids and the observers scored very similarly. But we did see that the hearing aids did not have a time for 30 participants. So the only day that we had was 220 participants for this test. So we are again looking into updates to fix that. So what does this all mean. We know that we saw the hearing aid application measured the balance test results, similarly to trained observers for all three of the study assessments, which is great. We mentioned that we have a few suggestions for improvements that we want the hearing aid manufacturer to work on. That's great as well. We're looking forward to seeing that. So this means that we are feeling optimistic about this data. These results are suggesting that the hearing aids do have potential to identify individuals at risk for falling. The goal here is, is to ultimately be able to provide patients with a body worn solution to assess fall risk in their daily lives. That can help us progress towards providing interventions to prevent falls before the falls happen. There's a lot of information out there already technology that people are using to detect when a fall happens, but we want to go a step further and try to work towards preventing the fall from happening in the first place. So this project was the first phase of a much larger project. We're also going to continue to update the algorithms. We're going to add in some telehealth components to conduct these things over video, see how that goes. And we are also going to add in field trials where participants will take the hearing aids home, and we'll see how the hearing aids collect data about their movement while they're at home. Okay, you may have noticed on the interest slide that and had. There was also a mention about speech understanding. So we don't have data for this yet. This is the next phase of our projects coming down the line, but I thought I would provide a little bit of an intro about it. So aside from our goals related to falls, we want to work on improving speech intelligibility, because hearing aids now have really come a long way, but there are limitations people with hearing aids are still having trouble understanding speech, especially when they're in difficult environments. So we want to work towards improving a feature that the manufacturer has for understanding speech and noise. A lot of hearing aid manufacturers use features for understanding speech and noise. This particular manufacturer has one that uses AI or artificial intelligence. And that is enabled with their speech and noise feature to help optimize and manage the speech, and they're able to adjust in different situations that way. So the patients. We see many patients as an audiologist people come in, they like their hearing aids, they're doing well, but anytime they're in a challenging listening environment, such as a dining hall, or people wearing masks, or maybe they're just in a crowded room, could be many different types of rooms where they feel like the hearing aids just are not sufficient are not helping them connect with their loved ones, even though they paid a lot of money for these hearing aids, and they really want them to work in these difficult environments as well. So that's where we have this feature where patients would click a button on their phone, or on the hearing aid and go into a different feature that helps zoom in on the speech that they're trying to listen to. This is something that we will validate. So we're going to do speech tests in our office and at home speech tests with our paid participants. So I don't have very many specifications to share about that yet. I do, however, have a little bit of an interview from a couple of the people at the manufacturer. And they're just talking about the early phases of this feature. So I can share that with you all. You know, I need that extra boost. We're already on here. You call it putting AI in the fingertip of the patient. It's getting amazing fit. Back saying that I feel like I'm in control. Yep. When I want to, you know, I need that extra boost for a particular challenge situation. My device can do that is the AI that listens to me. Yeah. And Edgemore right now is optimized for audibility. Some people may not always want to be optimizing for audibility, but for other purposes at other times. So, and we continue to. Improve this feature and the flexibility and the automatic aspect of that as we develop initial initial applications and future applications. That's a good point to bring up. So I often explained this has the two ends of the spectrum for speech. If you prioritize. Understanding of speech, then we might do signal processing very differently. Right. On the other hand, you might also end on spectrum. You might want to have it sound natural. Yeah. That might be at the expense of. Understanding speech. Like. Water error rate and stuff. So that the. Where the dial needs to be should be subjective individual and AI needs to be smart in understanding when to prioritize speech or maybe you can get a cue from the user that now I want to understand speech better or no now I am enjoying the ambiance. Sound and I'm actually sitting in the cafeteria. And like I said, the background noise actually is what my signal at this time. I'm enjoying it. So don't suppress it. Yeah. So don't give away our entire product roadmap. But stay tuned because. Okay. Okay. Just to summarize what they were talking about. A lot of times when people are using their hearing aids. An audiologist may be able to optimize speech. Understanding. They might be able to set the hearing aids to a point where people will understand speech very well and noise. But that setting will likely not be comfortable for the user in all other types of situations. So if you're just at your home walking around. Walking down the street. You want the hearing aids to sound natural. You don't want the hearing aids to be at this heightened level where their goal is to just understand speech very well and tune out all background noise. It's important to hear that background noise as well throughout your daily life. So that's where this manufacturer wanted to try to incorporate AI. So the hearing aids are learning. What the user wants to listen to. What the user wants to listen to as speech and what they want to listen to as background noise. So that starts out with just a feature that the hearing aid where we'll flip into they'll click a button to go into that feature during difficult listening environments. So more to come with that we'll see how that goes next. I'm going to just share a few acknowledgments we have a great huge team for this project. So here we have some of our contributors from the Starkey team. Many really good engineers and health officers involved. And here we have more individuals from our Starkey team. And then this is, this is a list of our Stanford team. So Stanford has a large team of researchers and doctors in the field that are involved. And lastly here are additional individuals from Stanford that are contributing. Right. I'm going to stop sharing my screen now and open the floor for questions. Wow, that was really exciting and really interesting. I'm so happy you could come today to share that with us. Okay everybody, it's time to ask questions so here. So I've had a couple of falls, you know, I mean, it's been quite a while. But my one of my falls occurred when I was in the bathroom and another occurred when I got up from from bed to go to the bathroom I didn't fall in there but it was outside. And in both cases, I was not wearing my hearing aids. So, and, and as you probably, as you probably know, most falls occur in the shower or in the bathtub. So, what can be done about that. That's a great question. So a few points. First, I want to point out that the hearing aids right now that are on the market, they're used to detect falls when they happen. So that feature would be impacted from exactly what you're talking about, you're not wearing the hearing aids when you fall down, therefore, the hearing aids are not detecting that you fell down. But what we're working on is actually fall risk assessment. So, what I would imagine, if a person felt unsteady in the shower, or actually fell in the shower, then they might be motivated to do the fall risk assessment with their hearing aids as a remote assessment in their house, and then see the results from that assessment. And then maybe go to a therapist, a physical therapist, or an MD and ask for different exercises or management techniques to help prevent a fall from happening later on in the shower. So our work is just more to assess their fall risk and work towards providing interventions to prevent the fall from happening. That's the direction we're trying to move. We're trying to move away from just detecting a fall that happened, which would be impacted from not wearing the hearing aids. So I still think that they could coexist and work together to help the patient. Yeah. Who's next, who has a question. Elizabeth please unmute yourself. Um, Larry, Henry, you need to raise your hand in the reactions. It's in the icon at the bottom of your screen. And Elizabeth Nagel is next because she raised her hand in the reactions. So can you raise your hand in the reactions so that we know or I'll call on you after Elizabeth if you can't figure it out. Okay Elizabeth go ahead. Well, I was just going to say, my, my question is about hearing aids not specific to falling. So if Henry is specific to falling, he should probably go first. Well, you're talking go ahead and go, go ahead and go. Anything. Well, I, Bren, you've already commented that we've all learned that hearing aids are helpful but they're not as helpful as we'd like them to be. And I am hoping, let's see, I've had these for a couple of years, I guess. But my hearing is getting worse. So the first five years that I had resound hearing aids, they were great. Now, you know, off and on. So I'm looking to get new hearing aids in this year. And the technology has gotten better. So I wonder if you are even the participants that are here today, have some tips for me. The biggest tips I like to tell people, especially in a world where a lot of people are tempted to go with over the counter devices, things like that. And it's just important that you have a audiologist working with you and fully programming the hearing aids and taking your input so you can come to them with things that are working things are not that are not working. And hopefully they're skilled audiologists that is able to fine tune the hearing aids well. So that's the first suggestion I think that makes the biggest difference. If possible, a good measurement that I like to tell people to look out for, if possible, it's not always available would be real ear measurements. So if your audiologist is conducting real ear measurements with the hearing aids, that usually helps the hearing aid fitting a lot. Not always, but it's something just a component. Another thing, as far as how much money you're willing to spend on the hearing aids themselves. The biggest factor would be the more expensive hearing aids or technology levels are usually for people with very active lifestyles, where you're in many different listening situations. You're in situations that are quiet you're in situations with many speakers, you're involved in a group at church you're involved in your family you like to do that versus somebody who primarily stays home or has one on one conversations with loved ones and have more of a mellow lifestyle. So most things can make a difference with technology levels. So keep that in mind, because higher technology level will help you in many different listening environments more than the lower technology levels. That being said hearing aids are very, very expensive. So it's, it's, it's a hard line to walk with that but that's my, my input. Thank you and the last question, along with that is what is your opinion of the hearing aids that fit inside your ear only. I got one opinion and they said they didn't think they were that much better. They are not necessarily a better option at all. It's more of somebody who prefers that aesthetic, or prefers that for a certain certain lifestyle that they use. But as far as just audiology goes, they're not better than the other hearing aids at all. And the only way you can know if you're even a candidate for those hearing aids would be if your audiologist looks at your hearing test and says you're a candidate because many people are not. Thank you. Elizabeth before you go I'd also like to remind you that our last meeting was about cochlear implants and qualifications for cochlear implants now have been lowered to meet normal insurance. So I would be remiss if I didn't remind people because most of our group has severe to profound hearing loss. And I need to also have a disclaimer here because I have two very successful cochlear implants. So I'm just letting you know that that could be an option for you. Okay, Henry, you're next. I have been wearing this hearing aid for more than 20 years. Every couple of years I have to upgrade cost is studied after 300. The last one that I have was a 5000. And then I talked to one of the audiologists that lately they have a new equipment that came out and asked me to come out. It's a little bit better. Any handicap or hearing loss person, if there is that little bit of upgrade, you'll tend to buy it because you don't understand the speech. You don't understand. There are a lot of not only restaurants or even kids. That makes me withdraw all of the meetings and board meetings, everything. So it's isolated in a way because you're ashamed if I say something out of the ordinary, whatever. The last one that I talked to was a 7400 dollars. I'm just wondering like a few years ago I said that some of some the media says it's a ridiculous having such a big expensive. They are the gadget while the all the technologies they develop whenever they develop prices jumped out. I know that you may agree. Now I have to withdraw myself from every meeting because I just cannot understand with or even three or four people around. I think this is a social, the problem, such a talented people withdraw and the social activity because we're not hearing well. Is there any way organization or some the the observer like yourself make some I don't know government could rule that thing but it has to be something some measure to all the hearing loss problems people could help. The study is excellent. But what, what's the solution, what could be better to make the better sort of the situation. Yeah, I absolutely agree. It is an issue that many audiologists are frustrated about as well. It's something that audiologists are actively trying to advocate with things like Medicare insurance, because Medicare insurance typically does not cover the hearing aids to the extent that we would hope they would. And that's something that we, that's a very viable solution that audiologists are often advocating for, but it is a tough battle for us to do anything about it. Unfortunately, I really wish I had more control over that. Another thing I can say that a lot of people don't know about is if you are feeling like you're withdrawing during a meeting, something that you can turn to is a remote. A lot of different manufacturers have different versions so I can't exactly say because it might be different for all of you. But there's often a remote that you can place on the table, you can wear on your shirt and somebody else can wear on their shirt. And then when they talk, then that will go directly to your hearing aids. And similar to what I was sharing, try to block out the noise and really focus in on the speech. So you can be more present during those meetings and not have to feel so isolated and withdrawn it really does help with those meeting situations. Those remotes are often, yes, still expensive, but sometimes they can be a few hundred dollars or something like that opposed to thousands. So if you have hearing aids and you do not have the financial means to jump up to the next hearing aid technology, maybe it would be worth seeing what remotes are accessible to pair with the hearing aids you already have to see if that remote can help those situations in the meantime. Any other questions. And then it goes back. Hey, I'm back. Well, two things I got a remote about six months ago. And mainly for the TV. So I don't drive my husband out of the room with needing, because even with the hearing aids, again, anyhow, you know what I'm saying. So I have been using Costco for the last two, three years, which you know is a lot cheaper. And I actually have pretty good faith and the guy I've been seeing out here and conquered. My latest idea, given what you've said and I have thought about it before is to get get my hearing tested at Kaiser with an audiologist with more expertise. And I think, I mean, I know I can take their records, you know, they're of what my ears need, how it needs to be programmed. I could take that to Costco where the cost is, as we were saying, so much less. I mean, you know, $2,000 for two hearing aids, or I mean you can go higher if you want, but those are anyhow. I wanted to comment on that. Yeah. Yeah, there are options. It always depends on the exact providers are with and what their limitations are but their options and it's always good to get second opinions make sure everyone's information about your hearing is aligning with each other. Yeah. If I have a little comment to mention to you. It's my understanding that Costco does not sell hearing aids that are considered to be power aids. So the more severe your hearing loss becomes generally the more powerful your aid would be, and that Costco doesn't sell those aids. So as you're experiencing your hearing loss getting worse. Maybe something to discuss if you choose to go to Kaiser is are the hearing aids that I have powerful enough for my current loss. Oh, good point. Thank you. Well and I noticed for this year under Medicare and Kaiser's I have the accentuated plan I can't remember what it's called at the moment. I think what $20 a month extra. They, they will pay more now for hearing aids than they did before. So that also helped me think of changing over. Yeah, so for everybody here in our county, I think almost all the senior advantage Medicare plans now have some kind of hearing aid coverage. So there you take a look at that. Okay, who has another question. Henry's raising his hand. Henry. You're a mute Henry. Nope, you're still mute. Still mute. So the bottom right hand corner, click on the mic. There you go. The couple of things you just mentioned is that the Medicare or or Medicare Medicare, whatever it is called, only covers that I could shop around it's only $250. But there's nothing you can buy any device, unless like you said, go to Costco or so make a deal with them or something. But if you need audiologists over your hearing aid, it's at least minimum. I would say, you know, $5,000 and $3,000, or like a latest, it came on that I said, I told you early, it's a $7,400. It's a tent because when I tested it, wow, I could hear some understanding of the people talking. I just wanted to mention that. Henry, do you do you know what a cochlear implant is? Cochlear what? Cochlear implant. I can not hear you well. So do you have the captions turned on? Yeah, I do. Okay, so look at the captions. Do you know what a cochlear implant is? I talked to I talked to know about it. It's, it's kind of a surgery behind your ear. So the reason for it is when hearing aids no longer help you, then you go to UCSF or Stanford. Those are the closest places to us in Contra Costa County. And you become evaluated to actually see if you are a candidate. And the only people who could determine if you were a candidate are the CI centers. So if you're continuing to have this problem, maybe that's something you might want to explore. Okay. My personal, my personal experience is I had almost no speech recognition and I have 90 plus speech recognition today. I hear birds. I hear everything in my environment. It's just beyond the pale amazing. I talked to that my audiologist lately, because about this new achievement. The key thing is that the coil of the surgery, it really, I'm not candidate for that yet, because I could hear words and then talk to my wife and the one to one basis I have no problem. Excuse me, it's a problem if there was a three more people. So it's not up to that yet. Mary, I'm suggesting to you, since you are saying that you really can't hear three people that the person who's your current audiologist and I have had experience with audiologist who sell hearing aids who do not tell their patients that they may be eligible or qualify for a cochlear implant. And so Medicare covers cochlear implants. So it's not like hearing aids where you have to pay out for the hearing aid, the cochlear implants are covered. So I just wanted to reiterate again, it might be worth your time to go to one of the CI centers to be evaluated by a cochlear implant audiologist. Okay, who is the CI center? There's one at UCSF and there's also Stanford. They're the closest to us. And if you have Kaiser, Kaiser does them as well. And if you'd like to contact me after this meeting, please do so I'm happy to talk to you. Who has another question. Oops. Are you okay, Henry. I want to talk to you about that part of the, this temporal and the other one was. Okay, so somebody else Susan Beck. Hi Susan. Hi. Definitely, Kaiser, if you have Kaiser. I've had an excellent experience with them. And like, and I hear birds singing, I hear everything they are the biggest miracle. I've had an excellent experience. My question though is about. Is there. Can you turn your video on so we can see you. Oh God, I'm still in my bathroom. My question though is about people with cochlear implants. Is there a difference in the susceptibility to falls because our hearing is generally much better. Is this much danger or do we need to be as tested about the susceptibility to falls. Yeah, so sometimes when people undergo surgery for cochlear implants, it is possible that there could be an impact on the balance system during surgery. So sometimes people directly after surgery might experience some balance issues or vestibular issues. That's something that vestibular therapy can help with if that happens. It doesn't always, but it is a risk of surgery. Otherwise, whether you are more susceptible to falls compared to someone with hearing aids, there's no difference there at all. So your susceptibility to falls primarily depends on your age, your exercise, your strength, your endurance, your mobility, those things are what impacts your falling, not to be confused. The hearing aids don't impact falling at all. The hearing aids were just trying to use as a tool to assess falling. So whether you're wearing the hearing aids or not does not change your risk for falling at all. Same with the cochlear implants. The only caveat with cochlear implants is that you are having a surgeon mess around with something that is near at the balance organ. So that's a potential. Any other questions. Hi, I put the link, we have a YouTube channel, and Alan put the link in our YouTube channel to Kurt Kramer's presentation about cochlear implants if anybody wants to see it. Judy sugar it's hi. Welcome. Hi. I have a question about single sided deafness and if that increases your risk for falls right now I have a by cross. And I'm being evaluated in April, maybe. I'm eligible for a cochlear, depending on my speech recognition, but I just did some vestibular therapy. But I was pretty stable. I wasn't really at a high risk at all falling but I just wondered about that, because it's so disorienting not to hear your sound. And so some of that be if it is disorienting, and you already have a fall risk. So if you already have a fall risk from age or mobility or string. And then you add in the component of feeling a little bit disoriented with your hearing, then you might end up being more susceptible to falls. So the component there would be what the reason for your single sided deafness is, because some people who are deaf on one side or maybe have a sudden loss on one side, perhaps had something happen to their cochlear system as well as their vestibular system on one side and both could be affected. That's what we could see for a single sided deafness but if that's not your case, and your, your reason for being singles single sided deafness is different than it shouldn't change. Yeah. Okay, thanks. Thanks and Judy's coming to us from Pennsylvania. Oh, great. Hi Zoher. So now I understand this. These devices don't really help you as far as falling down is concerned they, they kind of help you detect the propensity for falling down right. So, okay, let's say this device stands here you have a greater propensity to falling down. What do you do there. Right. So, just to step back for a moment right now they actually are on the market where they do detect when you do fall down. So that's already being done kind of like an Apple watch or something that can detect when you fall down and just tell you, you fell or send a notification to a loved one, a GPS location regarding where the fall was those types of things. But that's not what this study is about. This study is exactly what you said to detect the propensity or the possibility of falling your fall risk. So that part we haven't gotten to yet because this is the beginning of a phase for a larger project. So once we add more of our components, we're going to try to make a plan about how hearing aid wares could use this in their homes. But just kind of peering into my crystal ball about what could happen in the future. I would expect that something like this would happen a participant, or excuse me, a patient who has hearing aids is going about their daily life. And their audiologist tells them that there's this fall risk assessment feature on their hearing aids. And one day they decide that they want to try it. So they try this little feature at home and they see a notification that comes up that says, you are potentially at a risk for falls. And they think, oh, I want to look into that before I fall down, because we know that falls can be detrimental to your life. So then they call their medical doctor or their physical therapist and they say, Hey, my hearing aids have suggested to me that I should go see a provider to get my balance assessed. So it's kind of like a screening process to alert you of a fall risk. So that way you get on early warning system. Another potential could be if the hearing aids way down the future our goal would be for the hearing aids to maybe even be able to detect when you're about to fall. So if the hearing aids learn your movement and gate so well that it can know when something is out of the ordinary and provide a warning to sit down or rest for a moment. So those are kind of things that we're hoping for in the future and it will take time to get there but that's not how we would implement these things. Thanks. Jill. Oh, and you're muted. Hello, and can you hear me? We can hear you. Okay. Well, I already know that I'm at risk for falls I fall pretty regularly. So, I've actually done all those PT exercise I've been evaluated and I've been given physical therapy. My past was flying covers the last time I work colors. And now she gave me some harder things to do. The only reason I feel like that I haven't been injured is because I'm physically very strong. I still work out with a personal trainer and I take yoga. What I'm missing now is that I'm not walking as much and that's really important. I think balance and I use walking poles. The other thing, I actually think this might be a good subject for an HLA a meeting is to talk about all the things we do in the house. Especially in the bathroom in the shower. What I notice for myself is I always use the handrails or the walls to turn. I can't just turn without making sure I'm holding on to something. It's like get disoriented. And so I'm assuming people of a certain age have these bars in their showers because I don't I couldn't do it without them. The other day, somebody came over to get oranges for my tree and I thought, oh, I have to get them in a hurry. So I was out there with the pernurs under tree bending over picking oranges and getting my hair snagged in the tree. And I was moving very fast. And I fell right on my knees. I mean I was close to the ground. So I didn't hurt myself. But it's, it's the knowledge that as we get older, maybe I have more of a neurological problem or something or vestibular that needs to be looked at. But I think all of us need to just realize our habits need to change for whatever activity we're doing. I don't need to do things in a big hurry to try and make somebody happy. Just, I need to be safe. We need to be safe. So that's what I wanted to say and I totally enjoyed this whole information that you given us. So I completely agree with everything you said. That's exactly, you should be the one talking to my patients. That's exactly what we try to recommend. And a lot of the times the participants for this study, we asked them how long do you exercise when do you exercise what is that looking like how are you walking those things make a huge impact so you're absolutely right everything you said. Thanks Jill. Susan back again. Hey, I just wanted to confirm hearing loss actually makes you more at risk for falls. Isn't that what the studies have shown now, not just age, not just exercise, but the hearing loss itself. So increasing amounts of hearing loss being more severe ends of hearing loss can lead to things like social isolation and reduced physical activity. And those things impact your mobility, your muscles and impacts things that will cause a fall. So that's where the connection is. So if I have a cochlear implant, I'm not experiencing those things at the same level as other people. So the better you hear the less at risk you are for those things, which put you at risk for falls. So as long as your cochlear implants are working to help you stay engaged with your community, help you go out and talk with people, rather than being socially isolated staying at home staying, staying mobile if you're here if your cochlear implants are helping you stay mobile and active, then that's what's going to help improve your risk for falls. Oh, great. Thank you. Thank you for explaining that. You're muted in. And are there any other questions? Okay, Bryn, thank you so much. I think that everything that you're talking about has been really exciting to people who are here and just thinking about Jill talking about the things that she's done and the reminder to all of us to stay mobile and active, right? That's right. Thank you all so much. It was a pleasure. Yeah, we have an additional part of our meeting that we have. You're welcome to stay. You're also welcome to leave if you would like. Sounds good. I hope you'll have a good rest of your day. Thank you. So if we were meeting in person, all of us would be getting our muffin from Bob. Am I mute still? No. Okay. So if we were meeting in person, all of us would be getting a homemade muffin from Bob Zastrow. And so we always have a muffin as part of our meeting. Now we have some announcements. The first thing that everybody needs to know is that the season is upon us for the walk for hearing. We created our chapter website and the walk for hearing is going to be on June 3 of 2023 in Alameda, the same place that we had it last year. And since things seem to be opening up more, hopefully there'll be more people who come this year. And it really is a fun adventure to engage with everybody who's out there for the same thing and to raise awareness for hearing loss in our communities. We also are having the HLA convention this year. It's going to be in New Orleans, Louisiana, and it's going to be from June 29 to July 1. I highly recommend attending a convention if you've never done that. The presentations are very interesting and exciting, but maybe more important than that. It's just being with everybody else who has hearing loss, who really understands, nobody is apologizing because you can't hear. It's just really wonderful. So our upcoming events next month, we're having Loop Lane County come and give us a presentation about how they approach looping in their county. They've been very, very successful. In May, we're going to be having a presentation about advocating for hearing loops with Sherry Parazoli and myself probably. And June 3 is the walk for hearing in July the convention. We would like to have a brown bag picnic this year. We keep getting nudged from everybody last year. It wasn't quite feasible. So we're hoping to have that and to be safe for all of us. It would be brown bags. It would be bring your own lunch, but you'd get to see everybody. And in August, we're having a very interesting presentation. And it's about hearing restoration using a certain new kind of technology and AI technology called BCI. We'd like to remind everybody that we have a YouTube channel that has all of our, not all of, but since the pandemic, most of our chapter meetings on there, you can go back and watch them anytime you want. So like we mentioned, Kurt Kramer was here last month. So if you happen to miss that presentation, you can go to the YouTube channel and hear Kurt. We have two major committees within our chapter. One is the programs committee and Zoher is the chair for that committee. Zoher, do you want to say anything about it? Yeah, so we gather once a month and to decide who the next speakers will be or plan for the year on what topics we want to cover that year. So you're welcome to join where we'd be excited to have you. And if you'd let me or and know that you'd like to to participate. I'll send you a notice our next meeting is actually this coming Wednesday at four o'clock. So let me know if you'd like to join. Thank you. Do you know that I'm a died in the wool advocate? And I'm always looking for any other people in our county or Alameda County live or more throughout the eastern part of the East Bay to come join me. We happen to be a member organization. Our meetings are open to the public. Everybody is always welcome. But I'd be remiss if I also didn't say that we'd also like for you to be members. And it's very easy for you to do that. Just go to our website. And see the arrow pointing at the menu tab that says measure membership. When you click on that, another menu opens up and you can either become a member online via PayPal, or you can mail in a membership to us. We'd like to remind everybody that hearing loss is a disability covered under the Americans with Disabilities Act, the California Unruh Act, and other civil rights laws. It's up to us to ask for what we need so that we can be able to participate fully in society. And I've started using a new phrase about all of us in our hearing and it's that we all live unpredictable lives. We never know when we're going to be able to understand and when we won't. And so if you don't prepare ahead of time, so generally you may be doing pretty good, right? But you never know when somebody is going to have an accent. You never know when somebody is going to have a poor microphone. You never know that your doctor is going to not face you when he's talking to you. So you need to be prepared because if you don't ask ahead of time and you get there and you can't understand the person, then it's too late to ask for what you need. And where? Everywhere. At the movie, in the hospital, at the bank. So we happen to bank at the HLADV chapter, Banks at Mechanics Bank. And because I requested it, because I needed it, Mechanics Bank has a hearing loop at the information counter and also if you talk to a banker in Walnut Creek. So remember, everywhere. And if you need to get ahold of us, this is how you get ahold of us.