Final Exam Flashcards
(159 cards)
1
Q
Why don’t more people buy hearing aids?
A
Don't perceive a need Deny severity of loss have other priorities cost stigma bad experiences (theirs or other's)
2
Q
What should a properly selected and fit hearing aid do?
A
- amplify speech and environmental sounds
- optimize intelligibility and sound quality
- assure loud sounds are not uncomfortable or distorted
3
Q
What are the basic components of a hearing aid?
A
- microphone
- amplifier (digital processor): converts electrical signal to digital, performs calculations to modify the signal
- receiver (converts amplified signal back to acoustic signal)
- battery
4
Q
Controls and Features of HAs
A
- on-off switch
- telecoil
- volume control
- compression
- directional microphone
5
Q
Styles of hearing aids
A
Body aid BTE ITE ITC CIC RIC
6
Q
Specialized devices
A
- CROS/BICROS (contralateral routing of signal): unilateral hearing aid
- Bone Conduction Aid: conductive hearing loss
- Bone anchored hearing aid (BAHA): conductive and/or unilateral
7
Q
Earmolds
A
Variety of styles and materials
- modify low frequency: venting
- modify mid frequency: damping
- modify high frequency: acoustic horn
8
Q
Selection of hearing aid candidate
A
degree of hearing loss: thresholds, audibility index
- degree of communication problems: self assessment, case history
- motivation to use hearing aids
9
Q
Pre-selection of hearing aid candidate
A
- pure-tone thresholds
- speech reception
- speech recognition (quiet/noise)
- maximum comfort level (MCL) and Uncomfortable loudness level (UCL)
10
Q
Self assessments useful for hearing aid users
A
COSI: Client oriented scale of improvement
APHAB: Abbreviated profile of hearing aid benefit
ECHO: Expected consequences of hearing aid ownership
CHILD: child’s home inventory of listening difficulties
11
Q
APHAB
A
- 24 items, scored always to never, measured aided vs unaided
- 4 sub-scales:
EC: Ease of communication
RV: Reverberation
BN: Background noise
AV: Aversiveness to sounds
12
Q
ECHO
A
- global score + 4 subscales; rated from not at all to tremendously
- positive effect
- service and cost
- negative features
- personal images
13
Q
CHILD
A
- for kids 3-12
- Parents assess child’s response to sound in home environment
- 15 items
- parent is asked to call child from another room and rate how difficult it is for a child to respond
- distance, noise, visual cues
- understand-o-meter (8 is great, 1 is horrible)
14
Q
Hearing aid selection considerations
A
- style
- gain and frequency response
- multiple memories
- compression
- directional microphone
- noise reduction
- feed back reduction
- data logging
15
Q
Special features for older adults - hearing aids
A
- considerations: dexterity, handedness, financial resources, level of independence
- Features: raised volume controls, tamper-proof battery compartments, headsets
16
Q
Special considerations for children - hearing aids
A
- reliance on computer-based fitting protocols (DSL)
- on-going assessment and verification
- Parent report
17
Q
Pediatric Device options - Hearing aids
A
- behind the ear vs other styles
- binaural
- feedback management
- real-ear measures
- electroacoustic assessments
- LING 6 sound
18
Q
Fit one ear or two?
A
o 75% if US fittings are bilateral (12% in Japan, 35% in UK and 50% in Italy)
o Binaural stimulation typically improves
• Gain, localizations, sound quality, speech understanding (especially in noise), sense of sound balance, tinnitus masking, lessens fatigue of listening
o Binaural interference
• 10% of adults
• Actually do a bit worse with two than they do with one
19
Q
Unaided Ear Effect
A
o Monaural fittings for symmetric hearing loss
o Auditory perception ability measured in unaided ear declines
o Later amplification = limited improvement
20
Q
Acclimatization
A
o Changes in response to acoustic stimulation occurring over a period of weeks/months
o Dependent on brain plasticity and training/exposure to sound
o Varies by age, experience with amplification, type of amplification, degree of hearing loss, length of deprivation, auditory training
21
Q
How can orientation be improved?
A
o Encourage patient to bring someone to their appointment
o Encourage patient to take notes
o Send information home in writing/pictures
o Check periodically to see what patient understands
o Follow up with patient
o Consider “boost your memory” video
22
Q
Post-fitting counseling and orientation:
A
HIO BASICS
o Hearing Expectations o Instrument Operation o Occlusion Effect o Batteries o Acoustic Feedback o System troubleshooting o Insertion and removal o Cleaning and Maintenance o Service, warranty and repairs
23
Q
Benefits of hearing aid orientation
A
o Increased satisfaction with hearing aids
o Decrease returns
o Decreased “drop-in” visits
o Increased referrals
24
Q
What should patients expect from hearing aids
A
o Cost more than expected o Fit comfortably o Allow you to hear different levels of sound with comfort o Not filter out all noise o Protect from some loud sounds o Need repairs from time to time o Whistle sometimes
25
Cochlear Implants and Assistive Listening Devices: Sensory Devices for Special Cases
- surgically implanted electronic device
- stimulates the 8th nerve
- sound bypasses damaged parts of the cochlea
26
Implanted Components - cochlear implants
o Receiver
• Bio-compatible case
• Under the skin behind the ear
• Contains a magnet which couples to externally worn transmitter
o Electrode array
• Inserted into the cochlea to proved direct electrical stimulation to the remaining nerve fibers
27
External Components of the CI
```
o Microphone
• Picks up sound
o Speech processor
• (Worn on body) or behind the ear
o Transmitter/head piece
• Small disk adheres to skin via magnet
• Connected to microphone by small cable
```
28
What does the sound processor do in a CI
- captures sound through microphone
- converts sound into electrical/digital (coded) signals
- sends signals to transmitter through this cable
29
What does the transmitter do in a CI
- transmits the electrical signals to receiver by electromagnetic induction
30
What does the Recevier/Implant do in a CI
- converts digital signals into electrical signals and sends signals to electrode array
31
What does the electrode array do in a CI
delivers electrical signals through tiny electrdes to hearing nerve
32
Who can use a cochlear implant?
o Cochlear implant centers determine implant candidacy on an individual basis
o Class III medical device regulated by FDA
o 12 months to????
33
What do you consider when trying to fit someone with a CI
- age
- degree of SNHL
- benefit from amplification
- medical contraindicators
- support, expectations
- auditory environment
34
How many deaf individuals have a missing or damaged auditory nerve?
fewer than 1%
35
Multidisciplinary assessment for cochlear implants
```
o Audiologic Evaluation
o Medical Exam
o Auditory skill assessment
o Language assessment
o Psychological assessment
o Educational placement evaluation
o Ophthalmologic evaluation
o Occupational therapy evaluation
o Developmental pediatric and neurologic
```
36
Auditory candidacy (18 years or older)
o Hearing loss
• Moderate-to-profound (low frequencies)
• Severe to profound (high; >70dB HL)
o Aided speech recognition (at 70 dB HL)
• < 50% CI ear; <60% non-CI ear
• Sentence material
o Communication – part of “hearing world”
o Other – medical, motivation, expectations
37
Adult - Real life candidacy indicators (CIs)
o Difficulty carrying on phone conversations
o Difficulty understanding speech in groups or in background noise
o Heavy reliance on lip-reading
o Severe activity limitations and participation restrictions
38
Pediatric Candidacy: Infants and toddlers (CIs)
o Hearing loss
• Profound (>90 dB HL)
o Aided Speech Recognition
• 3-6 month trial of HA; little or no auditory skills
o Communication – emphasis on auditory input
o Other – medical, motivation, expectations, other disabilities
39
Infant/Toddler - Real life Indicators of Candidacy for CIs
- doesn't respond to own name
| - doesn't alert to environmental sounds
40
Candidacy: Children 3 - 18 years for CIs
o Hearing loss
• Severe-to-profound in lows (>70 dB HL)
• Profound in mid- to high-frequencies
o Aided speech recognition (at 70 dB HL)
• < 30% best-aided word recognition
o Communication – education/therapy emphasizes audition
o Other – medical, motivations, expectations, other disabilities, duration of deafness
41
Useful assessments for adults - CIs
Sentence tests (BKB, CUNY, CID), HINT, MAC Battery
42
Useful assessments for school age children - CIs
Lexical neighborhood test; word tests (NU-Chips), Children’s home inventory for listening difficulties, C-HINT
43
Useful assessments for preschool children - CIs
Early listening function, ESP, IT-Mais
44
Benefits of cochlear implants
```
o Speech perception
o Speech production and intelligibility
o Social-emotional enhancement
o Financial
o For children – language and academic enhancement
```
45
Factors Influencing performance
```
o Duration of deafness
o Age at implantation
o Etiology
o Mode of communication
o Technology
o (Re)habilitation
o Motivation
```
46
Treatment Plans - CIs
```
o Hook-up and MAP
• Timing varies
• MAP individually created (T’s and C’s)
• Thresholds
• Comfort Levels
• Neural response telemetry (kids)
• Activation of multiple memories
o Follow-up appointments
o Therapy and monitoring benefit
```
47
Counseling: Care and Maintenance
```
o Placement of device on patient
o Manipulation of controls
o Battery
o Troubleshooting
o Accessories
o Electrostatic discharge
o Warranty
```
48
Educational team members & duties
o SLP and/or Auditory Therapist
• Monitor progress, provide direct SL services, troubleshoot, case manage, collaborate
o Teacher (classroom vs. itinerant)
o Audiologist
• Monitor devices & acoustics, troubleshoot, teacher support, in-service, direct AR services
o Psychologist/counselors
o Implant Team (information and support)
o Parents (communicate, advocate, inform)
49
Adult Expectations
o Detect speech at levels lower than conversational speech
o Identify environmental sounds
o Discriminate some vowels/consonants in closed-set format
o Better lip-reading
o Prognosis depends on duration of deafness, AR, cognitive function…
50
Hearing Age
o “age” of child in relation to duration of access to sound
o Development is anticipated to be commensurate with hearing age, not chronological age
• Ex. 3 y.o. child has been implanted for 6 months, hearing age = 6 months (alerting to sound environment, starting to respond to name)
• Catch up eventually, maybe – but in the beginning this is a great counseling tool
51
Pediatric Expectations Post implant (very young children)
o By 1 month – full-time use of CI
o By 3 months – changes in vocalization, alerts to name 25% of time
o By 6 months – alerts to name 50% of time, spontaneously alerts to some environmental sounds
o By 12 months – beginning to derive meaning from some speech and environmental sounds, improvements in language
52
Bimodal Stimulation - CIs
o Use of hearing aid in ear opposite CI
o Goal is to provide binaural benefit (similar to binaural H/A’s)
o Better localization and speech recognition
o Some improvement in performance in noise
o Requires fine-tuning of hearing aid to achieve maximum benefit
53
Bilateral cochlear Implants
o Simultaneous implantation
o Sequential implantation
o Potential for improved localization, speech recognition
o Requires AR to facilitate adjustment and maximize benefit
54
Cochlear Implant Controversy
```
o Deaf community
• Denies access to culture
• Experimental and unethical
• Long-term benefit questioned
o Proponents
• Measurable benefit
• Parent rights
```
55
Recommendations of the National Association of the Deaf (2010)
o Healthcare professionals should use a “wellness model”
o Parents/patients should be fully informed of the risks
o Medial should provide fair/unbiased options
o Parents should investigate all options
o Educational environments should advocate development of auditory, speech and sign skills
56
Hearing Assistive Technology (HAT)
- Also called assistive listening devices (ALDs)
- “Products, devices or equipment… Used to maintain, increase or improve the functional capabilities of indiviuduals with disabilities.” (Technology Related Assistance Act of 1988)
- Relates Environment = person - device
57
Purpose of HATs
- Used to overcome poor acoustic conditions
- To replace or supplement amplification or CI
- Specialized uses – alerting, safety, entertainment
58
What degrades acoustic signals?
- reverberation
- background noise
- distance from a speaker
59
Reverberation
- prolongation (persistance) of sound waves within a room as they reflect off surfaces
- reverberation time (RT) = time required for a signal to decay 60 dB after termination of signal
- prolonged RT results in decreased speech intelligibility
60
Noise
- any undesired auditory disturbance interfering with primary/desired signal
- ANSI recommends < 35 dB noise level in classrooms
- Average, unoccupied room noise levels = 51 dB
61
Signal-to-noise Ratio S/N
- difference between intensity of primary signal and competing noise
- Enhanced S/N increases audibility of speech
- Personal with hearing loss need +12-20 dB S/N to perform adequately – children with HL may need even greater S/N!
62
Noise + Reverberation
Effect is greater than the sum of each
- 10% reduction in WRS with noise
- 10% reduction in WRS with reverberation
- 30-40% reduction in WRS in noise + reverberation (Crandell, 1993)
63
Distance
- every time distance is doubled you have to increase the signal by 6 dB
64
Types of HAT's for telephones
```
Amplifiers for landlines
- handset or add-on
- enlarged keys
Cell phone technology
- add-on (neck loop)
- telecoil compatibility
- bluetooth
- trial periods
```
65
Types of HAT's - Environmental sound awareness
- Amplified smoke detectors and other alarms
- Vibrating alarms
- Alerting lights
66
Types of HATs - Television & interpersonal communication
- Hard-wired and wireless systems
- Direct audio input – added expense, hardwired
- Personal Amplifier: Pocket-talker – limited response and distance, but inexpensive
- Infrared – good signal but expensive: Personal and large area devices
- Induction loop – requires telecoil, subject to interferences, limits mobility: Personal and large area uses
- FM – mobile, select frequencies, expensive, privacy issues
67
Frequency Modulation Systems (FM)
- Uses radio waves in FCC designated frequency bands
- Transmitter with microphone picks up signal, converts to electric signal and sends to – microphone can be individual or area pick up
- Receiver – coupled via headset, loop, DAI, silhouettes
- Signal travels hundreds of feet
68
Devices for the deaf
- Real-time captioning
- Text telephones
- Relay Services
• Text to voice
• Video relays
69
Speech reading
Perception of speech using visual cues to supplement auditory information
- Lip shapes/movements
- Facial expressions
- Gestures
- Body language
- Other visual and linguistic cues
70
How much can a good speech reader speech read
estimated that only 30-40% of speech can be speech read
71
Factors influencing speech reading performance
- speaker
- signal
- environment
- speech reader
- message
72
Speaker factors
- Familiarity of the speaker
- Rate of speech
- Expressiveness
- Distractors
- Gender
73
Clear speech
```
o Slightly slower
o More precise pronunciation
o Little more volume
o Pauses between key phrases
o Simple asking someone to speak more clearly can result in 20% improvement in understanding
```
74
Signal Features
- Phonemes
- Visemes: Groups of sounds that look alike
- Visibility
- Intelligibility of connected discourse: Clear pronunciation or clear speech
- Context
75
What are the distinctive features of a phoneme
* Voicing
* Nasality
* Affrication
* Duration
* Place (visible)
76
Which phonemes are easier to speechread?
those produced by lips, teeth or a combination of the two
77
Homophenes
words that look alike on the lips but sound differe
| - pet, bed, men
78
Homophones
words that look and sound alike but are spelled differently
79
Environmental factors in speech reading
- distance
- lighting
- angle
- relevant contextual cues
80
The ways a speech reader effects the ability to speech read
- age
- gender
- IQ
- personality
- vision
- hearing
81
Visions effect on speech reading
- 20/40 acuity needed to access all visible aspects of speech
- 20% of US population has vision problems that can’t be corrected
- 5-10% of preschoolers have undetected vision problems
82
Infants bimodal speech perception
Assess infant/toddler visual development
- attention, eye contact, visual localization
Synchronized film studies
- videos of woman articulating i & a
- sound field auditory presentation
- normal hearing babies spend more time looking at picture that matches
- intermodal representation of speech
83
What things can influence a message?
- pragmatics
- semantics
- syntax
- topic
- visual environment
- redundancy
- closure
84
Informal tests of assessing speechreading
- Client-focused
- Formal tests (Barley & Jeffers, Utley, Denver, Craig, Children’s Audio Visual Enhancement Test)
- Variety of stimuli
- V-only or A-V
- Recorded or live
- Unvalidated
85
Auditory - Visual Communication Training
- Mo-No-SNo-Co
- Vary redundancy level to assess and train
- Message (syllables – stories)
- Noise (multi-speaker babble – quiet)
- Signal to Noise (-6 dB - > +12 dB)
- Context Cue auditory and/or visual background distraction – descriptive auditory and/or visual background cue
86
Speech reading assessment must account for presentation variables:
- distance/angle
- speaker variables
- stimuli, context cues
87
Analytic aspects of speech reading
- Perception of “details” of speech
- Part to whole
- Gradually increase reliance on auditory information to discriminate phonemic contrasts
- Iitial training with vowels – highly contrastive vowels in isolation, words
/i/ vs /u/ vs /a/
Beet/boot/bat; soup/seat/sap
- Consonant training
Place: visible and audible
Manner and voicing
88
synthetic aspects of speech reading
- Speechreading involving comprehension of the whole
- Sentences and phrases
- Training may include –
Following directions
Paraphrasing
Responding to questions about a passage
Topic-related exercises
89
Speechtracking or continuous discourse tracking
- A-V (or V-only) recognition of connected discourse: Paragraphs, newspaper articles, literature
- Client repeats verbatim, yielding WPM score
- Speaker highlights errors, repeats
90
Mode of language of choice
o “No single methodology works for all deaf children (Northern & Downs).”
o No consistent evidence of the superiority of one method over another
o All modes require proficient communications models
91
Forms of manual and spoke communication
```
o American Sign Language (ASL)
o Total Communication / Sign Systems
o Fingerspelling
o Cued Speech
o Auditory Verbal
o Auditory / Oral
```
92
How do parents decide between different modes of communication
o Professional opinions, attitudes, beliefs
o Availability of services
o Medical vs. Cultural perspective
93
Communication options: can success be predicted
o Deafness Management Quotient (DMQ, Downs)
o Spoken Language Predictor (Moog & Geers)
o Robbins Checklist
94
Signed languages
o 200-300 signed languages around the world
o Visual/gestural, motor, spatial
o More in common with each other than spoken languages
o Consist of signs with illustrative intent (showing without telling; iconic) and non-illustrative intent (telling without showing)
95
American Sign Language
o Natural language of the deaf
o Specific to America
o De l’Epee, Gallaudet & Clerc
• Modified natural French sign
• 100,000-500,000 people use ASL
o “Socially agreed-on, rule governed symbol system”
o Combinations of hand-shapes, locations, movements, orientation
o Topic – comment vs. Subj-Verb-Obj
o Iconic and abstract vocabulary
o More often learned from peers not parents
o Permits assimilation into Deaf Culture
o No secondary form
o Sign only used by ~ 11% of school children with HL
96
Bi Bi
o Bilingual – Bicultural Approach
o Children learn ASL as first language
o Taught written English as second language
97
Pidgen Sign Language
"Bridge” between ASL and English
o Uses ASL syntax and English grammatical forms
o More common than pure ASL
98
Fingerspelling
o Use of manual alphabet to spell communications
o Exact and effective … but least efficient
o Rochester Method – fingerspell and speak simultaneously
99
Cued Speech
o Visual phonetic analog to speech
o Combines lip movements, audition, hand shapes (consonants) and positions (vowels)
o An aid to speechreading and literacy
o Homophones can be visually discriminated
o Used by <1% of children w/ HL
100
Total Communication
o An Educational philosophy
o Simultaneous communication (speech & sign) encouraged expressively/receptively
o Combines sign, visual (gestures, print, speech reading), speech, audition, fingerspelling
101
Sign Systems
Combinations of ASL signs, English grammar, and invented signs
• Plurals, past-tense, gerunds, articles
Estimated to be used in ~34% of classroom instruction for kids with hearing loss
• Seeing Essential English (SEE I)
• Signing Exact English (SEE II)
• Manually coded English (MCE)
102
Drawbacks to total, simultaneous communication
o May be difficult to do in a timely manner
o Communication partners must develop fluency
o Must attend to interpret multiple stimuli
o Pidgen sign language
103
Sign to Oral transition
Foundational Use of Sign
• Jump start access to symbolic language
Transitional
• Increase opportunities for oral communication, exposure to oral models
Strategic
• Child relies on sign for specific but not all purposes (new information, classroom, clarification
Dominant
• For child who demonstrates slow/limited auditory development; visual learners; cultural
104
Auditory - Verbal (unisensory - listening & spoken language)
o Emphasizes early identification & amplification
o Listening to develop spoken language
o One-on-one teaching with parent partners
o Develop self-monitoring, spoken language
105
A-V techniques
o Optimizing listening
o Promoting speech production
o Enhancing language & communication: Pragmatics
106
Auditory/Oral (multi-sensory - listening & spoke language)
o Native language
o Emphasizes appropriate amplification, auditory environment, clear speech models & visual information
o Opens opportunities for education, employment, socialization in “hearing world”
107
Goals
```
o Broad statements of concepts/skills
o Statement of the “general outcome”
• To increase awareness of auditory cues
• To use sensory device consistently
• To discriminate suprasegmental information
```
108
objectives
o Statement of what someone will be able to do when they have completed instruction or training
• Conditions under which task is performed
• Criteria for evaluating performance
109
Characteristics of objectives
```
Behavior
• What’s the be learned
• Must be observable/measurable
Criterion
• How well must behavior be performed
• Degree of accuracy, quantity, % correct
Conditions
• When, where
```
110
Learning domains (bloom)
Affective
• Beliefs, attitudes, values
Psychomotor
• Physical movements, motor skills, coordination
Cognitive
• Learning information or processes to deal with that information
111
Levels of cognitive learning & associated words
```
Knowledge
• Recall, identify, distinguish
Comprehension
• Translate, convert, transform
Application
• Apply, solve, operate, plan, explain
Analysis
• Analyze, classify, compare, discriminate, recognize
```
112
Basic Perception Abilities
Normal hearing ears can perceive frequencies from 20-20,000 Hz
• Most of the speech spectrum ranges from 50-10,000 Hz
Normal hearing ears process intensities ranging from (approximately) 0-140 dB
113
Infant Auditory development
By 6 months, infants with normal hearing
• Are able to discriminate all sounds of native language
By 5 years, children with impaired hearing who began to consistently use a sensory device by 6 months
• Often develop age-appropriate speech
114
Vowel Formants
o Resonanses in the vocal tract that cause some frequencies to have more energy than others
o Only first two (sometimes 3) formants are necessary for vowel perception
115
Vowels, compared to consonants have:
- more acoustic energy
| - mostly low to mid frequencies
116
First formant
* Affected by how wide the mouth is opened
* More open = higher frequency 1st formant (/a/)
* Less open = lower frequency 1st formant (/u/)
117
Second formant
* Affected by position of tongue
* More forward = higher frequency 2nd formant (/i/)
* More back = lower frequency 2nd formant
118
Consonant discrimination - designed to contrast articulation features
- place
- voicing
- manner
119
Place of articulation
```
o Bilabial
o Labiodental
o Linguadental
o Alveolar
o Velar/Palatal
```
120
Information at specific frequencies
o 250-500 Hz – 1st formant info most vowels, nasals, suprasegmental info, voicing cues
o 1000 Hz – 2nd formant info, back/central vowels, CV/VC transition info; acoustic cues for manner
o 2000 Hz acoustic cues for place
o 4000 Hz acoustic cues for /s/ and /z/
121
Continuum of features
```
Easiest to distinguish (for those with HL)
• Voicing
• Manner – nasals
Most difficult to distinguish
• Place (mid to high frequencies
```
122
Redundancy
- Refers to the amount and variety of information from various sources that enhance message comprehension
- Aids in predictability of message
- Affected by “constraints” – language-related rules
• Syntactic – does/doesn’t follow rules
• Semantic - words are meaningful
123
Factors influencing redundancy
Speaker
• Compliance with rules of language appropriateness of articulation and intonation, vocabulary
Message
• Length, context, frequency composition of speech signal, intensity of signal
Environment
• Noise, reverberation, distance, situational cues
Listener
• Knowledge of language rules, familiarity with vocabulary, knowledge of topic, hearing ability
124
Auditory training
process of teaching child or adult with hearing loss to take full advantage of available auditory cues
125
Auditory learning
any change in the listener’s ability to perform an auditory perceptual task contingent upon observed or known experience
126
Carhart view of children with HL
Children with sever-profound HL would not develop listening skills without intervention (AT)
• Awareness of sound
• Gross discrimination
• Broad discrimination of simple speech patterns
• Find discriminations of speech
127
Carhart: Adult AT
- Reeducation
- Establish “attitude of critical listening”
- Analytic training
o Rapid recognition = automaticity
- Speech reading
- Training in common settings
o Noise, competing speech, telephone
128
Candidacy for AT
o Children with prelingual SNHL (and CHL)
o Pediatric and Adult CI recipients
o Adults adjusting to hearing aids or with specific listening needs
o Other
• APD, TBI, Stroke
o Essentially: EVERYONE
129
Principles of designing AT treatment plans
o Auditory skill level
o Stimuli
o Activity type
o Difficulty level
130
Auditory Skill Level - 1
Sound awareness
• Presence or absence of sound
• Sound has importance in child/adult’s world
Sound Awareness activities:
• Draw child’s attention to sound
• “I hear daddy’s voice” “I’m turning on the water, listen”
• Musical chairs
• Start and stop marching to drum beat
• Push a toy car when therapist says “vroom”
• Spontaneous awareness of name, telephone, dog barking
131
Auditory Skill Level - 2
```
Sound discrimination
•Listener can tell if two sounds are the same or different
•Gross discriminations
•Loud vs. soft
•Short vs. Long
•Fine discriminations
```
AT Discrimination Activities
•Repeat what you hear (ma-ma-ma/pa-pa-pa)
•Relate animal sounds to toy animals (the cow says “moo” pig says “oink” - which one?
•Play “same and different” (boy - boy, toy - boy)
•May need to start with visual same/different
132
Auditory Skill Level - 3
```
Sound identification
Associate sound with its source or name
• Animal sounds
• Toy sounds
• Picture in story book
```
133
Auditory Skill level - 4
Comprehension
Listener understands the meaning of spoken messages
• Answer a question
• Follow a direction
• Join a conversation
```
Activities
• Listen to read-aloud story and answer questions
• Play 20 questions
• Follow commands
• Discuss news stories (print/TV)
```
134
Auditory Training approaches
```
Analytic
• Focus on segments of speech signal
• Syllables, phonemes
• Drill
• Gross differences - loudness, pitch, rate
• Fine differences - vowels, consonants
```
Synthetic
• Focus on recognizing the meaning of an utterance
• Don’t expect sound-by-sound or syllable by syllable recognition
• Bridging and incidental learning activities
135
Informal training (natural) - AT
o Occur during daily routines
o Incidental learning
o Incorporated into other activities
o Conversation, academics
136
Other auditory skills
```
Attention
• Focus on speaker and message
Memory
• Retain/store verbal information
Closure
• Recognize/understand spoke message even when cues/information is missing
```
137
Establishing full-time sensory device use - kids
o Parents must accept and assign importance
o Parents must be consistant
o Audiologist/parents must assure device(s) fits appropriately and comfortably
o Associate routines with use (time, place)
o Reinforce (toys, stickers)
138
technology and speech/language acquisition
Best technology facilitates but does not eliminate speech and language delays
139
Cognition and speech/language development
Higher cognitive skills
• Better speech/language development
Lower cognitive skills
• With early identification and intervention, similar speech/language development to high cognition + later intervention
140
Characteristics of language of HI children - form
o Syntax, morphology, phonology
o Shorter - simpler
o Overuse of sentence patterns (subj - verb - obj)
o Limitation of adverbs, adjectives, conjunctions
o Limitation of morphological markers
o Incorrect verb tenses
141
characteristics of language of HI children - use
o Pragmatic skills
o Restricted communicative intents
o Poor understanding of conversational conventions
o Limited knowledge and use of repair strategies
142
Typical delays in speech development of HI children
o Delayed onset of babbling
o Reduced phonemic repertoire
o Poorer articulatory accuracy
o Fewer multisyllabic utterances
143
Long-term mis-aritculations
Mild-moderate hearing loss (+CI kids)
• (Hearing) Age-appropriate mis-articulations
Severe-profound hearing loss
• Articulation errors, breathing deviations, resonance problems, suprasegmental problems
144
Literacy and hearing impairments
o Historically, HI kids had poor: reading, writing, spelling skills
o Children with severe-profound HL typically plateaued at 4th grade reading level
o Literacy requires good oral language skills and phonological awareness
145
CIs and literacy
• Although many adolescents with CI’s since preschool achieve age-appropriate reading levels, significant numbers still show delays in highschool
146
Hierarchy of listening tasks
```
o Familiar expressions/common phrases
o Single directions / 2-step directions
o Classroom instructions
o Sequencing three directions
o Multi-element direction
o Sequencing 3-events in a story
o Answering questions about a story (open/closed set)
o Comprehension activities
o Exercises in noisy environments
```
147
Techniques for establishing effective communication (SKI-HI)
Identify early signals and respond
• Cries, smiles, vocalizations, gestures
• Promote interaction; respond appropriately; take turns; use routines
Optimize communication in home
• Reduce distractions, face-to-face, joint attention
148
Parent/home efforts that facilitate communication
o Model natural gestures, clear speech
o Facial expression, vocal interest
o Take advantage of child’s interests
o Describe what child sees, feels, hears
o “Read” books
o Draw child’s attention to “hear and now”
149
auditory training materials (kids)
o Developmental approach to successful listening (DASL) - sequential listening training (awareness - phonetic listening - comprehension)
o SKI-HI
o Speech perception instructional curriculum and evaluation (SPICE) - sequential auditory learning
o Cochlear implant manufacturers’ websites
150
facilitating communication competence
o Integration of auditory + speech goals
o Dialogue vs. tutorial practice
o Bridge activities for carry-over
o Sabotage communication
o Practice with contrasts in production and perception
o Select goals that enhance communicative competence
151
Listening and communication enhancement (LACE - Sweetow)
o Hearing with our brain
o Sensory devices provide access to sound - but do not assure listening skills
o Adult listening affected by
• Hearing, memory, cognition, confidence, processing speech, attention
o Self-help program for at home or clinical use
o 20-30 minute exercises that increase in difficulty
o Computer based
• 20 sessions over 4 weeks
o DVD
• 10 sessions over 2 weeks
152
Communication strategy
o Course of action taken to enhance communication
• Facilitative: influence the talker or enhance the setting
• Receptive: tactic used when message is not …
153
Constructive strategies (environment focused)
* Optimize the listening environment by:
* Make sure the talker is well-lit
* Move closer to the talker
* Reduce or move away from noise
* Avoid rooms with acoustic barriers (e.g. reverberation)
* Arrive early to get favorable seating
* Eliminate visual distractions
154
Instructional (talker focused) strategies
* Used to influence partners speaking behavior:
* “slow down”
* “could you please face me”
* “when you cover your mouth, I have a hard time understanding you”
155
Message - tailoring strategies (message focused)
* Control length or topic of message
* Requires some meta-communication skills *think about what you want to talk about or how you want someone to answer
* Did you go swimming or biking yesterday
* Tell me about…
156
adaptive strategies (patient focused)
* Techniques for dealing with emotions and negative behaviors related to HL (anxiety, stress)
* Deep breath
* Conscious relation
* Redirection and …
157
anticipatory strategies (patient focused)
Preparing for communication interaction
• Predicting vocabulary and conversational content
• Practice speechreading predicted vocabulary
• Attend to situational cues
• Think about partner’s conversational style (colloquialisms), conversational rituals (greetings), expected responses
158
Specific (and non-specific) repair strategies
```
Tactic used to rectify breakdown
• Repeat
• Rephrase
• Elaborate
• Simplify
• Indicate the topic
• Confirm the message
• Change the style
• Write, fingerspell
• What, huh, pardon?
```
159
Maladaptive Strategies
Inappropriate behaviors for coping with difficulties related to HL
• Bluffing
• Avoiding difficult communication situations
• Dominating conversations
• Succumbing to feelings of anger, hostility, self-pity
