CAPD Final Deck

Question 1

Tell me about Evidence for a
Musician Speech-Perception-in-Noise Advantage in School-Age Children by Benítez-Barrera, C. R., Skoe, E., Huang, J., & Anne Marie Tharpe, A. M. (2022).

Answer 1

Study - Investigates whether musical training improves speech perception in noisy environments for school-age children. Recruited children with and without musical training (formal instruction). Children with musical training demonstrated better performance in speech in noise tasks which suggests an ability to focus on relevant signals. Musical training enhances auditory and cognitive functions likely due to practice with distinguishing pitch, rhythm, & timing.

Conclusion - Musical training enhances speech perception in noisy environments among school-age children. Tells us music education not only fosters artistic skill but also improves auditory & cognitive functions critical for communication.

Recommendations - Incorporating music into the school curriculum could support auditory and cognitive development. Music Intervention could benefit kids with auditory processing or speech perception challenges.

Question 2

Tell Me about Blast Exposure and Auditory Processing by Gallun, F. J., Haley, E. G., Jorgensen, L. E., & Pratt, S. R. (March/April 2020).

Answer 2

Study - explore blast exposure on auditory processing & differentiate these effects from peripheral hearing loss and other injuries associated with blasts. Blast exposure often leads to damage in the peripheral and central auditory system resulting in problems with speech in noise, localizing, & processing complex auditory info. These people may exhibit normal thresholds but still report auditory difficulties, this is attributed to disruptions in central auditory processing rather than just peripheral damage. Frequently causes TBI which contributes to deficits in attention, memory, & executive function. Auditory impairments vary based on severity and proximity to the blast as well as susceptibility and comorbid conditions.

Conclusion - blast exposure can result in profound and long-lasting impairments in auditory processing. traditional audiometric tests may fail to detect these issues, emphasizing the need for specialized assessments to evaluate auditory processing and cognitive function.

Recommendations - Routine hearing tests should be supplemented with central auditory processing & cognitive evaluations for individuals with a history of blast exposure. Rehab programs should combine auditory training with cognitive therapy to address both sensory and cognitive deficits. Further studies are needed to develop targeted interventions and understand the mechanisms linking blast exposure to auditory processing deficits.

Question 3

Tell me about Features of cognitive ability and central auditory processing of preschool children with minimal and mild hearing loss by Ji, H., Yu, X., Xiao, Z., Zhu, H., Liu, P., Lin, H., Chen, R., & Honga, Q. (2023)

Answer 3

Study - explores how minimal and mild hearing loss (MMHL) impacts the cognitive and auditory processing abilities of preschool-aged children.

Conclusion - Preschool children with MMHL exhibit subtle yet measurable differences in cognitive performance compared to peers with normal hearing. Areas affected include attention, memory, and executive functions, ability to localize sound, understand speech in noisy environments, and process complex auditory stimuli. While these children may not show significant delays in basic language milestones, their ability to develop advanced language skills may be compromised. Difficulty in distinguishing subtle sound differences (e.g., phonemes) can lead to later reading challenges. Cognitive deficits and auditory processing impairments interact, amplifying the challenges these children face in learning and communication. For example, deficits in working memory can exacerbate difficulties in processing and retaining auditory information. Early diagnosis of MMHL and its associated impacts on cognitive and auditory processing is essential for preventing long-term effects on academic and social outcomes. The study highlights the need for routine hearing screenings and comprehensive assessments of cognitive and auditory abilities in preschool-aged children.

Recommendations - Incorporate auditory training exercises. Provide access to hearing aids or other assistive listening devices, even for minimal and mild hearing loss. Educate parents. Collaborate among audiologists, speech-language pathologists, psychologists, and educators to provide comprehensive support tailored to the needs of these children.

Question 4

Tell me about An auditory perspective on concussion by Kraus, N., & Krizman, J. (May-June 2018)

Answer 4

Conclusion - The auditory system is highly sensitive to brain function. Concussions, as a form of mild traumatic brain injury (mTBI), can disrupt auditory processing, even in cases where peripheral hearing appears normal. Individuals with concussions may experience difficulty processing complex sounds, such as speech in noisy environments, due to disruptions in how the brain integrates auditory signals. Temporal precision, or the brain’s ability to process the timing of sounds, is often compromised, affecting speech perception. Auditory brainstem responses (ABRs), which measure neural activity in response to sound, can reveal subtle deficits in the brain’s ability to process sound timing and frequency. ABRs provide objective data that can be used to detect and monitor brain dysfunction caused by concussions. Concussion-related auditory processing difficulties can manifest as challenges in understanding speech, particularly in noisy or complex listening environments, affecting communication and quality of life. These issues are often overlooked in traditional concussion assessments, which focus on symptoms like memory, balance, and headaches. Auditory processing assessments should be integrated into concussion evaluation protocols to capture the full scope of neural impact. Rehabilitation efforts can include auditory training to help retrain the brain’s processing abilities and improve functional hearing. Studying the auditory effects of concussion can contribute to a better understanding of brain plasticity and recovery. Auditory-based diagnostics, such as portable and non-invasive brainstem testing, offer promising tools for detecting and managing concussion-related neural dysfunction.

Recommendations - Include auditory processing tests, such as ABRs, as part of standard concussion evaluation protocols to identify subtle neural impairments. Develop auditory-based rehabilitation strategies, such as sound-based therapy and listening exercises, to address deficits in sound processing. Educate clinicians and audiologists on the auditory impacts of concussions to ensure comprehensive care and early detection of auditory deficits.Use auditory biomarkers to track recovery over time, providing objective measures of brain health and guiding treatment decisions.

Question 5

Tell me about Benefits for children with language- and reading-related learning difficulties by Loo, J. H. Y., Bamiou, D., Campbell, N., & Luxon, L. M. (2010)

Answer 5

Study - Investigate how auditory processing interventions or accommodations might benefit children with language and reading difficulties particularly those linked to auditory processing disorders.

Conclusion - Children with APDs often face difficulty distinguishing and processing sounds, which can contribute to problems in phonological awareness, a crucial skill for reading and language development. Auditory training programs and assistive listening devices improved auditory discrimination and processing in children, leading to better language and reading outcomes. Combining auditory interventions with other sensory-based learning strategies (e.g., visual or kinesthetic aids) enhanced the overall effectiveness of interventions. Identifying APDs early and implementing targeted interventions were critical for improving academic and social outcomes for children.

Recommendations - Tailored interventions that address the specific auditory deficits in children with learning difficulties. Collaboration between audiologists, educators, and speech-language therapists is essential to provide comprehensive support.

Question 6

Tell me about Individual differences in language
and working memory affect children’s speech recognition in noise by McCreery, R. W., Spratford, M., Kirby, B., & Brennan, M. (2017)

Answer 6

Conclusion - Children’s ability to recognize speech in noisy settings varies widely and is influenced not only by auditory factors but also by cognitive and linguistic abilities. Speech-in-noise recognition is a critical skill, particularly in educational and social settings. Stronger language abilities (vocabulary, syntax, and phonological awareness) help children better predict and decode speech in challenging auditory conditions. Children with weaker language skills may struggle more in noisy environments, as they have less linguistic context to rely on. Working memory plays a vital role in processing and retaining auditory information while filtering out background noise. Children with better working memory capacities can more effectively manage the cognitive demands of noisy environments. The study highlights the interaction between auditory processing, language, and working memory in determining children’s speech recognition performance in noise.

Recommendations - Assessing and addressing individual differences in these areas are crucial for supporting children, particularly those with hearing loss or auditory processing difficulties. Make sure you are providing holistic assessments, using targeted intervention, and technical support such as FM systems, and use a collaborative approach.

Question 7

Tell me about Assisting Veterans with mTBI/PTSD by Mehta, Z., Thorstad, T., & Hale, T. (2019, June)

Answer 7

Conclusion - Many veterans experience both mTBI and PTSD due to their service-related experiences. These conditions often co-occur, making it challenging to distinguish between their symptoms.
Symptoms of mTBI, such as headaches, memory problems, and difficulty concentrating, often overlap with PTSD symptoms like hypervigilance, anxiety, and emotional dysregulation. Accurate diagnosis can be difficult because of the overlapping symptoms and the subjective nature of many complaints. Comprehensive assessments are recommended, including neuropsychological testing, interviews, and self-report questionnaires to identify the primary sources of impairment. Veterans with mTBI/PTSD often experience difficulties in cognitive functioning (e.g., attention, memory), emotional regulation, and interpersonal relationships. These challenges can affect their reintegration into civilian life, including employment and social relationships. Interdisciplinary Care: The article emphasizes the importance of a multidisciplinary approach, involving neuropsychologists, psychiatrists, audiologists, and occupational therapists. Cognitive Rehabilitation: For mTBI, cognitive training and strategies to compensate for memory and attention deficits are highlighted. Trauma-Focused Therapy: Evidence-based therapies such as cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are effective for PTSD. Symptom Management: Addressing secondary symptoms such as sleep disturbances, headaches, and chronic pain is also crucial. Social support and family involvement play critical roles in recovery. Education for family members about mTBI and PTSD can improve understanding and communication. The authors discuss the availability of resources through organizations such as the Department of Veterans Affairs (VA), which provides specialized programs for veterans with these conditions. Assistive technologies, vocational rehabilitation, and peer support groups are highlighted as valuable tools for reintegration.

Recommendations - Treatment should be individualized based on the veteran’s specific needs, with flexibility to address the evolving nature of their symptoms. Early intervention and ongoing care are essential for better outcomes. Increasing awareness among healthcare providers about the unique needs of veterans with mTBI/PTSD is critical for improving care.

Question 8

Tell me about Auditory processing performance of the middle-aged and elderly: Auditory or cognitive decline? by Murphy, C. F. B., Rabelo, C. M., Silagi, M. L., Mansur, L. L., Bamiou, D. E., & Schochat, E. (2018)

Answer 8

Study - Explored if declines in auditory processing in older adults are primarily due to age-related changes or if it is influenced by cognitive decline. Determined auditory processing difficulties are not solely due to peripheral hearing loss but also involve cognitive decline. The Elderly showed poorer performance on auditory processing tasks compared to the middle-aged - particularly speech in noise & temporal processing. Cognitive factors contribute to auditory processing performance, particularly for tasks requiring complex integration.

Conclusion - Auditory processing problems are not solely due to peripheral hearing loss but also cognitive decline. When assessing auditory processing issues in older adults consider auditory & cognitive factors.

Recommendations - Audiological evaluations should include cognitive assessments for older adults. Interventions may benefit from targeting auditory training and cognitive strategies to improve auditory processing abilities.

Question 9

Tell me about On the clinical entity in audiology: (Central) Auditory processing and
speech recognition in noise disorders by Vermiglio, A. J. (2014)

Answer 9

Study - examines the concept of auditory processing disorders (APDs), particularly focusing on speech recognition in noisy environments, and questions whether APD can be considered a distinct clinical entity in audiology.

Conclusion - Vermiglio discusses the criteria for a “clinical entity” in medical and audiological practice, which include a clear and distinct pathology, associated symptoms, and effective diagnostic and treatment protocols. He questions whether CAPD meets these criteria, particularly concerning speech recognition in noise (SRN).SRN difficulties are often attributed to CAPD, but the author argues that SRN challenges might instead reflect broader cognitive, linguistic, or hearing issues rather than a distinct auditory processing deficit. Variability in SRN performance may be influenced by factors such as language skills, working memory, and attention, rather than solely central auditory processing.The article highlights the lack of standardization and consistency in diagnosing CAPD, leading to potential misclassification of individuals. Tests used for diagnosing CAPD often overlap with those measuring cognitive and linguistic abilities, raising questions about their specificity to auditory processing.Vermiglio emphasizes that SRN difficulties are likely multifactorial, involving peripheral hearing, cognitive processes, and language abilities. The author advocates for a more holistic approach to understanding SRN challenges, rather than attributing them solely to CAPD. The article calls for a re-evaluation of the concept of CAPD as a distinct clinical entity and suggests focusing on functional outcomes, such as improving communication in noisy environments, regardless of the underlying cause. Vermiglio recommends a broader, multidisciplinary perspective that considers the interaction of auditory, cognitive, and linguistic factors in assessment and intervention

Recommendations - Use comprehensive evaluations that account for cognitive and linguistic contributions to SRN performance. Shift from diagnosing CAPD as a standalone entity to addressing practical communication challenges in noise. Incorporate expertise from audiologists, speech-language pathologists, and cognitive scientists to create effective intervention strategies.

Question 10

Tell me about Using different criteria to diagnose (central) auditory processing disorders: How big a difference does it make? by Wilson, W. J., & Arnott, W. (2013)

Answer 10

Study - examines how the application of varying diagnostic criteria affects the identification and diagnosis of (Central) Auditory Processing Disorders (CAPD). The study highlights the lack of standardization in CAPD diagnostic practices and its implications for clinical and research contexts.

Conclusion - CAPD diagnosis lacks a universally accepted standard, with different clinicians and researchers applying varying criteria to interpret test results. The authors explore how changes in diagnostic criteria, such as the number of failed tests or the severity of the deficits required, impact diagnosis rates. The study involved a retrospective analysis of test data from individuals assessed for CAPD. The researchers applied different diagnostic criteria to the same dataset to determine how diagnosis rates varied. Diagnosis rates fluctuated significantly based on the criteria used. For example: Stringent criteria requiring failure on multiple tests yielded lower diagnosis rates. Lenient criteria allowing failure on fewer tests or emphasizing certain domains (e.g., auditory discrimination) resulted in higher diagnosis rates. These discrepancies highlight the subjectivity in current CAPD diagnostic practices. Variability in diagnosis can lead to inconsistencies in treatment recommendations, with some children receiving interventions unnecessarily while others may be overlooked. The study underscores the need for standardized diagnostic protocols to ensure accurate and equitable identification of CAPD. Many tests for CAPD overlap with assessments for other conditions, such as language impairments or cognitive deficits, complicating differential diagnosis. The reliance on behavioral tests, which depend on patient cooperation and attention, introduces variability in results.

Recommendations - Develop and adopt consistent diagnostic guidelines to reduce variability and improve the reliability of CAPD diagnoses. Incorporate input from audiologists, speech-language pathologists, and psychologists to distinguish CAPD from related conditions. Focus on functional impairments, such as difficulties in real-world listening environments, rather than strictly test-based criteria. Promote research to establish the validity and reliability of various diagnostic tests and criteria.

Question 11

What is CAPD?

Answer 11

complex, heterogenous, bottom up perceptual disorder. it affects the auditory system leading to a sensory processing problem that impacts listening, spoken lanauge, comphrension, and learning

Question 12

4 subtypes of (C)APD

Answer 12

lexical decoding, tolerance fading memory (TFM), organizational deficits and integration deficits

Question 13

lexical decoding deficits

Answer 13

difficulty processing words verbal and written resulting in porr reading and spelling. the left posterior temporal lobe is involved

Question 14

tolerance fading memory

Answer 14

difficulty listening in noise and recalling information resulting in weak expresssive language and poor handwriting. The frontal and anterior temporal lobe with a small region of the parietal lobe are involved.

Question 15

organizational deficit

Answer 15

poor auditory sequencing or planning resulting in problems with sequential information. The pre and post central gyri with anterior temporal lobe are involved.

Question 16

integration deficit

Answer 16

problems integrating acoustic and linguistic information. the corpus callosum is involved.

Question 17

What is developmental APD?

Answer 17

cases presenting in childhood with normal hearing and no other known etiology or potential risk factors

Question 18

What is acquired APD?

Answer 18

cases associated with a know post natal event that could plausibly explain the APD

Question 19

What is secondary APD?

Answer 19

cases where APD occurs in the presence or as a result of peripheral hearing impairment

Question 20

Someone with dichotic processing problems would present with? Which tests assess dichotic processes?

Answer 20

present : speech in noise issues, difficulty in complex environments, difficulty with rapid speech and difficulty following directions

tests : dichotic digits, competing sentences, SSI CCM, & SSW

Question 21

Someone with temporal processing problems would present with? Which tests assess temporal processes?

Answer 21

present : difficulty with timing cues, difficulty understanding fast speech, difficulty following rhythms and patterns
-leading to difficulty reading and writing

tests : GIN, RGDT, DPT, PPST

Question 22

Someone with binaural interaction problems would present with? Which tests assess binaural interaction?

Answer 22

present : difficulty localizing, difficulty in noise and spatial awareness issues

tests : MLD & auditory fusion

Question 23

Someone with auditory closure problems would present with?
Which tests assess monaural low redundancy speech/auditory closure processes?

Answer 23

present : difficulty with muffled speech or accented speech, reverberant issues, difficulty with phone conversations and may report missing information
-impacts phonemic processing and suprasegmental cues therefore impacting language learning

tests : filtered words, time compressed sentences, SSI ICM, speech in noise

Question 24

What tests assess the brainstem?

Answer 24

PSI, SSI ICM, MLD (lower brainstem),

Question 25

What tests assess the corpus callosum/cortex?

Answer 25

dichotic digits, competing sentences, SSW

Question 26

Which CAPD test result patterns help with a definitive diagnosis?

Answer 26

unilateral deficit = tells us they understood the task so the problem was not due to linguistic, cognitive, or attention disorders unilateral deficits are a huge red flag for CAPD especially if it is a left ear deficit

Question 27

Who is eligible for a diagnostic CAPD evaluation? - age - hearing - cognition - ADHD - speech and language issues - autism

Answer 27

age : 7+ hearing : normal and no ME dysfunction cognition : intelligence should not be a factor (meaning it needs to be ruled out) ADHD : must be ruled out S/L : minimum language should be at least 6 years or within a year of chronological age autism : must be ruled out

Question 28

Lax criteria

Answer 28

They have the condition if they fail one of the tests. Good sensitivity but poor specificity.

Question 29

Intermediate criteria

Answer 29

To get a diagnosis they need abnormal performance on at least 1-2 tests

Question 30

Strict criteria

Answer 30

They need to fail all tests to get a diagnosis. Good specificity but poor sensitivity.

Question 31

What is a 504 ?

Answer 31

504 = accommodations for students so they can perform at the same level as their peers. can include educational or general accommodations (wheelchair ramps, blood sugar monitors, keyboard for taking notes, etc). section 504 of the rehabilitation act of ADA

Question 32

What is an IEP?

Answer 32

stands for individualized education plan. federal mandate to provide educational services to those who need it - only available to small subset of students that require more than a level playing field aka they need significant remediation and assistance. (individuals with disabilities act - IDEA)

Question 33

Does (C)APD qualify for an IEP or a 504 and why?

Answer 33

504, while it can be considered a disability that affects learning, it may not necessarily require the level of specialized instruction typically provided under an IEP

Question 34

Bottom-up processing

Answer 34

information from input like sensory information. our senses allow us to interpret things around us. data driven.

Question 35

Bottom up strategies

Answer 35

auditory training, enhanced signal audibility such as FM/remote microphone, environmental modification

Question 36

Top-Down Processing

Answer 36

guided by higher-level cognition. uses our experiences and expectations. conceptually driven.

Question 37

top down strategies

Answer 37

language strategies, cognitive strategies, metacognitive strategies and classroom instructional/learning strategies

Question 38

Controversy: Is (C)APD modality-specific or supra-modal?

Answer 38

according to experts, CAPD is modality-specific perceptual dysfunction meaning that the problems are primarily in the auditory system because of this, it can be differentiated from other conditions where others might be across multiple senses but there is a controversy that capd has multiple modalities that are impaired arguing for supramodal problem this would move the disorder from the audiologic to the psychological domain and maybe outside of the scope of practice for audiologists

Question 39

what does supramodal mean

Answer 39

processes information that transcends individual sensory modalities, allowing integration across different senses understanding the meaning of a word whether it is heard or read brain processes that operate across different sensory modalities (not specific to any one sense and can integrate information from various sources) like sight and sound

Question 40

what does modality specific mean

Answer 40

processes information specific to a single sensory modality processing auditory information only, processing visual information only etc. brain processes tied to a particular sensory modality (hearing, visual etc.)

Question 41

Why is CAPD controversial?

Answer 41

Lack of gold standard, sensitivity & specificity of tests, no standardized test battery or universally accepted standard for diagnostic criteria, poor test performance not consistent with real-life performance, influence of language & attention & cognition

Question 42

what are the 4 main categories for managing CAPD

Answer 42

auditory environment, auditory training, music training and training with phonemes/words

Question 43

Why is ANSD a differential diagnosis for CAPD?

Answer 43

they have a lot of the same risk factors and both don't have 1 single cause. they are both peripheral disorders with central implications. however ANSD is modality-specific & it is not secondary to cognitive, linguistic, or related factors

Question 44

Why is ADHD a differential diagnosis for CAPD?

Answer 44

ADHD is a top down disorder & CAPD is a bottom up disorder. You can tell which one the patient had by using the digit span test in auditory and visual modalties. If they do poorly on vision then it would indicate ADHD.

Question 45

Why is DLD (developmental learning disability) a differential diagnosis for CAPD?

Answer 45

ferguson et. al. compared performance of children with either a clinical diagnosis of DLD or (C)APD on tests of intelligence, memory, language, phonology, literacy and speech intelligibility and found no differences between the two groups of children. they concluded that children were diagnosed based on their referral route vs. actual differences

Question 46

Why is dyslexia a differential diagnosis for CAPD?

Answer 46

dyslexia affects reading, spelling, writing, and phonological processing CAPD affects understanding in noise and following verbal instructions

Question 47

what is dyslexia?

Answer 47

learning disorder than affects reading and writing skills, it does not impact intelligence

Question 48

What is ADHD?

Answer 48

neurobehavioral childhood disorder that primarily affects children and often continues into adulthood that is characterized by inattention or hyperactivity-impulsivity

Question 49

What are the 2 criteria to diagnose ADHD?

Answer 49

A1/inattention, A2/hyperactivity or a combination of A1 and A2

Question 50

How is ADHD diagnosed according to the DSM-V?

Answer 50

if six or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and negatively and directly impact social and academic/occupational activities -or for combination of both, present for 6 months

Question 51

What is criterion 1 aka inattention symptoms?

Answer 51

fails to give attention to details/makes careless mistakes, has difficulty sustaining attention in tasks or play activities, does not seem to listen when spoken to directly, does not follow through on instructions/fails to finish schoolwork or chores, often avoids/dislikes tasks requiring sustained mental effort, often easily distracted by extraneous stimuli, often has difficulty organizing and activities

Question 52

what is criterion 2, aka hyperactivity symptoms?

Answer 52

fidgets with or taps hands or feet or squirms in seat, often leaves seat in classroom when remaining seated is expected, often runs about or climbs in situations where it is inappropriate, unable to play or engage quietly in leisure activities, often talks excessively, often blurts out answers before questions have been completed. often has difficulty awaiting turn and often interrupts/intrudes on others

Question 53

What will it look like if they have a combo of A1 & A2?

Answer 53

predominantly inattentive presentation (if criterion A1 is met but criterion A2 is not met for the past six months) or predominantly hyperactive-impulsive presentation (if criterion A2 is met but criterion A1 is not met for past six months)

Question 54

What is ANSD?

Answer 54

a disorder of auditory dssynchrony of the 8th nerve ; timing is impacted.

Question 55

What tests will be normal for ANSD?

Answer 55

OAE & a recordable cochlear mircrophonic (CM)

Question 56

what tests will be abnormal for ANSD?

Answer 56

ARTs, ABRs, ECochG and MLDs aka anything having to do with the 8th nerve

Question 57

What are the common risk factors for ANSD?

Answer 57

family history, hyperbilirubinemia, infection or immune disorders

Question 58

Synaptopathy (Hidden Hearing Loss)

Answer 58

acquired condition that permanently interrupts synpatic communication b/w IHC & CN8 fibers well before HL is diagnosed. typcially seen with NIHL & aging. Clinically - decresed wave 1 amplitude with normal ABR thresholds, speech in noise probs, tinnitus, hyperacusis

Question 59

Cerebrovascular Accidents (CVA) most common cause & risk factors

Answer 59

most common cause is a a stroke. risk factors - high blood pressure, heart disease, diabetes, smoking, aging.

Question 60

CVA ischemia

Answer 60

caused by thrombus (blood clot), abstructs blood flow. may occur in any large cerebral blood vessel causing brain cells to ultimately die. functions in that area are diminshed or lost

Question 61

CVA embolus

Answer 61

small blood clot that has disloged from larger clot. usually from the heart following a heart attack (from one of the carotid arteries). can happen on transatlantic flights. if the clot is small is may pass and the patient recoverts fully. these are called transient ischemic attacks (TIA) and may eventually lead to a full blown CVA

Question 62

CVA hemorrhage

Answer 62

when blood vessel in the brain ruptures and bleeds . most common cause it super high blood pressure but can also be caused by aneuryms and arteriovenous malformations. less common that ishemic stroke but can cause - damage to surrounding neural tissue or cut off blood supply to distal areas.

Question 63

What is a Concussion? Causes?

Answer 63

diffuse non pentrating TBI caused by enternal force such as bump, blow, jolt to head, or being hit by something that causes the brain to rapidly move back and forth

Question 64

who is most likely to get a concussion?

Answer 64

athletes & military

Question 65

How are concussions & PTSD related?

Answer 65

when concussions are caused by blast exposure other injuries can mask the concussion for example PTSD. PTSD also leads to sleep disturbances or anxiety so it can be difficult to determine if the blast resulted in PTSD, a concussion, or both

Question 66

How are concussions & the auditory system related?

Answer 66

concussions can impair listening abilites and the ability to process auditory information

Question 67

4 categories of concussion symptoms

Answer 67

cognitive impairments (concentrating, short term memory), physiological impairments (blurred vision/hearing problems), emotional problems, sleep disturbances

Question 68

Chronic traumatic encephalopathy (CTE); what causes it, clinical presentation

Answer 68

rare neurodegenerative injury that does not have symptoms until years after the repeated head injuries (happens a lot in football players). It can lead to mood disorders, short term memory loss, depression, congnitive decline and dementia.

Question 69

What is central deafness? causes?

Answer 69

a rare disorder of the CANS with generally preserved peripheral auditory function but inability to perceive speech and/or environmental sounds most commonly secondary to CVA or head trauma meaning an acquired disorder

Question 70

What is the central deafness site of lesion

Answer 70

bilateral involvement of the primary auditory cortex (heschl’s gyrus) -could also affect the associated auditory areas, subcortical areas, parietal lobe, frontal lobe, MGB or pons

Question 71

what should be done in order to diagnose central deafness

Answer 71

a complete peripheral audiologic assessment, behavioral (C)APD tests, evoked potentials, MRI and CT scan -pure tones, speech, immittance, OAEs

Question 72

in terms of an audiological assessment, what results are expected with central deafness

Answer 72

varying severity of tones, with speech they may not be able to perform the test or will appear inconsistent with pure tones, immittance and OAEs are consistent with hearing

Question 73

Central deafness exclusionary diagnosis includes

Answer 73

Nonorganic HL, CAPD, dementia, tumors, ANSD

Question 74

depending on the etiology of central deafness, these patients may not be able to perform ……

Answer 74

(C)APD tests -due to adverse effects on attention and memory

Question 75

in terms of evoked potentials for central deafness, what could be expected

Answer 75

ABR is generally normal and mid to late responses may be abnormal dependent on the site and size of lesion

Question 76

with central deafness, what is the management dependent on

Answer 76

etiology

Question 77

what are some management strategies for central deafness

Answer 77

speech and language therapy, auditory training and the usage of visual cues/devices to communicate -HAs are generally not helpful -patients that experienced central deafness due to vascular accidents may resolve on their own

Question 78

over time, patients with central deafness will ….

Answer 78

recover at least some auditory function

Question 79

why is NOHL a differential dignosis for central deafness

Answer 79

they both show inconsistencies between pure tones and speech HOWEVER central deafness will also show difficulty with environmental sounds and not all patients with NOHL do that -need to be aware that they present very similar because they do not appear consistent with results

Question 80

why is CAPD a differential diagnosis for Central deafness

Answer 80

central deafness is generally acquired, meaning will likely show in adults whereas (C)APD is generally seen in mainly children -also (C)APD is not as severe

Question 81

why is dementia a differential diagnosis for central deafness

Answer 81

both have adult onset and sometimes people with dementia may appear with NOHL -important to test cognition as well

Question 82

why are tumors a differential diagnosis for central deafness

Answer 82

depending on where cortical tumors are, they can cause a change in personality and attention and a lot of times it can appear as a sensory change tumor which can appear like central deafness -adds the importance of imaging

Question 83

CAPD risk factors for older adults

Answer 83

peripheral factors, cognitive factors and central auditory factors

Question 84

peripheral factors

Answer 84

the integrity of the peripheral auditory system plays a significant contribution to listening and related activities -discussing cross modal reorganization, changes with tonotopic organization and hidden HL

Question 85

cross modal reorganization

Answer 85

a cortical compensation that is seen in deafness and HL when the auditory cortex is re-purposed by visual or somatosensory modalities

Question 86

what can changes in tonotopic organization lead to

Answer 86

degraded decoding of HF spectral cues and degrading temporal encoding of acoustic signals -leading to disruption of auditory processing relying on spectral and timing such as speech

Question 87

cognitive factors

Answer 87

ease of language learning understanding (ELU) model, working memory and the resource allocation model

Question 88

ease of language understanding (ELU) model

Answer 88

a theoretical model that has been developed to describe the relationship between cognitive processes and speech understanding

Question 89

how does working memory play an important role in auditory processing

Answer 89

the faster the task is completed then the less the decay and more successful the performance is due to it being a limited capacity system -individuals that can perceive information rapidly will have more working memory available

Question 90

resource allocation model

Answer 90

presence of perceptual deficits caused by a peripheral pathology results in the need for greater resources to be allocated to auditory processing -in other words, the more the HL the greater resources are allocated for getting the proper information

Question 91

central auditory factors

Answer 91

there is a decrease in neurons with age, especially in the superior temporal gyri, precentral gyri, areas around heschel’s gyrus important for speech processing, decrease in volume of the ventral cochlear nucleus after the 5th decade -decrease in volume is associated with decreased myelination and blood vessels

Question 92

with central auditory factors, it is important to discuss the corpus callosum. what age related changes are seen?

Answer 92

with age related changes, they show poor performance on binaural integration and dichotic listening tasks -can also represent a RE advantage again (meaning we see it both with aging at the young age and old age)

Question 93

CAPD assessment in older adults

Answer 93

case history, hearing evaluation, tests for language and phonological processing, (C)APD behavioral tests, cognitive/psychological evaluation and physiologic tests

Question 94

CAPD management in older adults

Answer 94

both bottom up and top down approaches, rhyming activites and proper counseling

Question 95

with older adults, we can only conduct (C)APD assessments with age appropriate norms however why is this a concern

Answer 95

older adults are not homogenous so it becomes difficult to have norms for this age as everyone varies greatly already

Question 96

why may older adults benefit from rhyming activities

Answer 96

may help regain some lost processing abilities

Question 97

what is the importance of proper counseling

Answer 97

can provide realistic expectations and better acceptance

Question 98

what is a clinical entity?

Answer 98

denotes a concept of uniformity on patients -ultimate reference for the entire field of medicine -facilitates diagnostic and therapeutic approaches to individual patients

Question 99

according to vermiglio, what are the 5 criteria essential to be an entity

Answer 99

does it possess an unambiguous definition, does it represent a homogenous patient group, does it represent a perceived limitation, does it facilitate diagnosis and does it facilitate intervention

Question 100

why does Vermiligio say CAPD is not a clinical entity

Answer 100

1. no, no agreed upon definition and it varies based on group 2. no, everyone presents differently 3. this is not super clear according to him, failure on behavioral tests does not indicate that the patient actually has the diagnosis of (C)APD 4. there is no gold standard in order to know if the results are accurate of (C)APD 5. intervention is often deficit specific and since (C)APD has not gold standard there is no clear intervention

Question 101

Tell me about sound localization & how these deficits can affect academics

Answer 101

difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom

Question 102

Tell me about temporal processing & how these deficits can affect academics

Answer 102

Temporal processing issues can lead to problems with auditory discrimination or resolution. This results in problems with reading, spelling, and writing.

Question 103

Tell me about auditory closure & how these deficits can affect academics

Answer 103

Deficits may affect understanding in noise affecting language learning and academic success.

Question 104

Tell me about auditory figure ground & how these deficits can affect academics

Answer 104

difficulty understanding speech in noisy environments leading to challenges in classroom discussions or group learning

Question 105

Tell me about auditory analysis & how these deficits can affect academics

Answer 105

challenges with decoding crucial for reading and spelling reading difficulties

Question 106

Tell me about auditory memory & how these deficits can affect academics

Answer 106

poor ability to follow multi-step verbal instructions or remember sequences impacts classroom performance

Question 107

Tell me about frequency resolution & how these deficits can affect academics

Answer 107

May affect phonemic processing, suprasegmental cues, and therefore language learning

Question 108

What are the norms for MLD short version and MLD long (recorded) version?

Answer 108

short = 10 dB or greater long = 14 dB or greater

Question 109

What are the norms for GIN (total % and ms)?

Answer 109

age 8-11 = 52% ages 12+ = 54% ms norms are less than 8 ms

Question 110

What are the norms for RGDT?

Answer 110

below 20 ms is normal anything greater is concerning

Question 111

what is the role with managing the auditory environment

Answer 111

recommending and managing assistive devices -gain medical clearance prior to a personal FM fitting -permission from the parents to use the FM in the school (if received from the school district) -run trials with FM systems through an evaluation period of 30-45 days

Question 112

what can be done in order to manage the auditory environment

Answer 112

hearing assistive devices, speaker changes, manage ambient noise levels, monitoring SNRs and reverberation time, using signal enhancement systems and HAs

Question 113

examples of modifications that can be done to manage ambient noise levels

Answer 113

double paned windows, noise control devices on heating/cooling, lowering ceiling levels, carpeting, curtains, use of bookcases

Question 114

what are the two main types of signal enhancement systems

Answer 114

individual FM systems (directly to the child’s ear) and digital sound distribution systems (throughout the classroom)

Question 115

auditory training

Answer 115

acoustic conditions and/or tasks that are designed to activate auditory and related systems in such a manner that their neural based and associated auditory behavior are altered in a positive way

Question 116

auditory training : preschool intervention

Answer 116

goal is to expose the child to experiences that require carful listening to prevent disruption of communication, learning and social development -ex. playing games such as musical chairs (just exposing to language in general)

Question 117

auditory training : school age intervention

Answer 117

goal is to focus on strategies and techniques that reduce communication and learning disabilities -ex. figure ground training to apply listening in noise skills

Question 118

auditory training : adult intervention

Answer 118

goal is to focus on compensation and relearning rather than recovery of function

Question 119

music training

Answer 119

thought to improve nervous system function by focusing attention on meaningful acoustic cues -kraus et. al. found that children with a history of music training had a stronger distinction of stop consonants, a neural mechanism linked to reading and language skills``

Question 120

music training has been shown beneficial for ……..

Answer 120

disorders such as autism, ADHD, language therapy for aphasia following a stroke

Question 121

training with phonemes and words

Answer 121

useful for children with poor phonemic decoding, spelling and reading skills such as fast forward and lindamood bell -benefits occur over time

Question 122

computer based auditory training falls under auditory training however it is …….

Answer 122

adaptive -meaning they need to gain the child’s attention

Question 123

with CBAT, what are some components we need to consider with the stimulus

Answer 123

-synthetic speech, natural non speech or synthetic non speech -focused (active) attention or unfocused (passive attention)

Question 124

synthetic speech

Answer 124

allows for more accurate control of parameters such as duration and intensity

Question 125

natural non speech (environmental)

Answer 125

sounds that are used less frequently because there is no cognitive challenge and it is difficult to maintain the interest of the listening -lacks inherent meaningfulness so often is accompanied by pictures

Question 126

synthetic non speech

Answer 126

including tones or noise burst and typically is the least interesting stimuli for listeners -more precise training in discrete frequency, intensity and temporal domains

Question 127

focused (active) attention vs. unfocused (passive) attention

Answer 127

with focused attention requires the listener to actively direct attention to specific information in the stimuli -active provides a reward for attending, increasing the likelihood of active and focused attention

Question 128

what are some popular CBAT programs

Answer 128

Fast ForWard, Earobics, Lindamood Bell

Question 129

cochlear microphonic (CM)

Answer 129

reverse polarity (rarefaction vs. condensation) -may have longer than normal amplitude and can ring longer mimicking an ABR

Question 130

SCAN-3 C age

Answer 130

5-13 except for gap detection thats 8-13

Question 131

ACPT age

Answer 131

6-12

Question 132

PSI age

Answer 132

3-6 format 1 = 3-4 format 2 = 5-6

Question 133

DPT age

Answer 133

9+

Question 134

GIN age

Answer 134

7+

Question 135

PPST age

Answer 135

7+

Question 136

SSI age

Answer 136

8+

Question 137

dichotic digits age

Answer 137

5+

Question 138

LiSN-S age

Answer 138

6-30

Question 139

MLD AGE

Answer 139

5+

Question 140

RGDT age

Answer 140

5-12

Question 141

SSW age

Answer 141

5-70

Question 142

CAPD differential diagnosis

Answer 142

central deafness, ANSD, ADHD, DLD, dyslexia