Final Exam Study Guide Flashcards
(133 cards)
1
Q
4 primary sources of communication breakdown
A
listener’s speech rec skills
speaker’s delivery of the message
environment
how complex the message is
2
Q
3 stages of communication repair
A
detect breakdown
choose a course of action
take the course of action (maladaptive or facilitative strategies)
3
Q
what are maladaptive communication behaviors
A
coping behaviors that yield short term benefit with long term consequences
4
Q
limitations and consequences of maladaptive behaviors
A
Withdrawal from social interactions
Consequence - depression, loneliness, anxiety etc. and can lead to dementia
Dominating the conversation
Consequence - friends may seem to avoid you leading to isolation
Ignoring the CP so they’ll repeat the message
Consequence - person with HL is expending energy (passive aggressive energy)
Overreacting to miscommunication
Consequence - increases tension, CP will avoid the conversation
Bluffing and pretending to understand
Consequence - embarrassment, awkward, mess up the conversational flow
5
Q
facilitative repair strategies
A
attempt to identify and influence to avoid communication breakdown
consists of non-specific and specific repair strategies
6
Q
non-specific facilitative strategy
A
let the CP know you do not hear them but do not provide instructions on how they can improve
7
Q
what are specific facilitative strategies
A
actively attempt to change the communication or the conversational style itself; instruct CP on how they can change
changes the environment or how we handle communications or relax and destress; support better communication
8
Q
what are the types of specific strategies
A
instructional
message tailoring
constructive strategies
anticipatory strategies
adaptive strategies
9
Q
what is instructional strategies
A
conversational repair strategies
The listener instructs the speaker on a specific way to change the delivery of the message
10
Q
how do you perform instructional strategies
A
Explanation - acknowledge your HL and/or explain the source of the difficulty
supply a concrete instructional suggestion of how to improve the situation
Positive reinforcement - Express value for their efforts
Acknowledgment gesture or affirmation
11
Q
what are message tailoring strategies
A
conversational repair strategies; requires more cognitive thinking because you are posing a question to understand what was heard and what wasn’t
When the listener asks close-ended questions to limit potential answers and the amount of repetition required by the speaker
12
Q
Instructional strategies reduce frustration as you improve conversational fluency
A
true
13
Q
repair strategies that prompt the speaker to rephrase are more likely to repair a communication breakdown
A
true
14
Q
Auditory closure skills improve when message tailoring strategies are used. Why?
A
CP frustration is reduced because the PHL’s close-ended questions let them know exactly what was heard and what was missed
PHLs retain more acoustic information after stating what was heard
Auditory closure skills become easier when you’ve narrowed down possible options
15
Q
Why does posing a specific question help with auditory closure?
A
You hold onto the memory long enough that you won’t forget about what was said as they repeat it
You can also fill in the blanks better based on the context
16
Q
what are constructive strategies
A
supportive repair strategies
When actions are taken to change an environment for improved communication
17
Q
what are ways of constructive strategies
A
lighting changes
reverberation changes
noise
positionings
visual distractions
18
Q
what is a lumen
A
how bright a light is
19
Q
describe how lighting impacts communication and what changes to make
A
Important for visual cues - you need good lighting to see your CP face
Avoid recessed lighting - causes shadows
Increase lumens by adding table and floor lamps
Add adjustable task lighting
Lighten up the walls - dark walls require up to 4 times more light
Reduce glare - use opaque shades , matte room paint
Keep light levels uniform - ambient lighting balances lighting within the space
20
Q
Speechreading abilities reduce when
A
Lighting is too dim
Backlighting - strong light behind the speaker
Shadows distort or hid facial features
Glaring
21
Q
we need more lumens as we age
A
true
22
Q
Biologic Age-Related Changes in Vision
A
becomes harder to focus - eyes are slower to adjust, muscles weaken and lenses become more rigid
less color and less light gets let in
light scatters in the eye more
colors become more yellow
23
Q
what is reverberation
A
noise
24
Q
what type of reverberation is best
A
Fast reverberation- might help HL hear even more; sound bounces off the wall and very quickly arrives to the ear (few ms after sound is created)
Slow - detrimental to a HL person due to level of distortion that it adds
25
why is reverberation a concern for HL
Already have distortion from cochlear damage, neural changes & ARHL & if signal going in is also distorted it makes it harder to follow the conversation
26
how to reduce reverberation
acoustic sound treatment
adding books, carpets, curtains, more furniture etc.
27
Why does this make it difficult to hear and understand in noise?
Reduced sharpness of tuning curves so not as many sounds pop up through the noise so it makes it harder to grasp onto it - reduced Frequency resolution
Limited dynamic range - struggle with hearing soft sounds and loud sounds can be imitating
Noise can have HF so it can have a masking effect
Age related changes making it harder to pay attention and hear
Snr
Temporal resolution - hard to hear the gaps or the difference in orders of the signal or the duration of a signal then the words blend together
28
what are noise management strategies
Locate source of noise
Reduce the noise - mute volume, close the door, add attenuating materials, schedule private meetings, choose favorable seating
Move away from the noise - avoid noisy restaurants at peak times, move to another room
Anticipate noise and plan ahead to avoid it
29
what is the best distance for communication
Intensity of speech decreases by approx. 6dB for every doubling of distance
w/in 6 feet of each other - improves SNR & speech reading abilities
Also improves speech reading cues
Volume of the voice is louder the closer you are to the person
30
how visual distactions impact communication
If a person who is HL and following communication in visually distracting environment it can be just as bad as acoustic noise
Hard to monitor, speech read and use audible cues to integrate information just because there is so much going on
31
what is anticipatory strategies
supportive repair strategies
Preparing people in advance for what they need
Planning in advance and thinking through what kind of interaction you will have for an event & what challenges you may face and creating a plan for them
32
what steps should be taken for anticipatory strategies
Learn the topic before entering a conversation
Review names of dinner and cocktail party guests before arriving
Read about current events and movies
Obtain agendas in advance of meetings
Investigate an environment before the event
Obtain a synopsis of a play or movie before going to see it
Review the restaurant menus online
Symptom search to learn potential diagnosis b/f doctor visit
33
what are adaptive strategies
supportive repair strategies
Methods to counteract maladaptive behaviors (emotions) that stem from HL
capacity vs load
34
High stress - reduces attention & cognitive capacity
true
35
how can you perform adaptive strategies
Mild to moderate stress - enhance attention during communications
Use relaxation techniques before a stressful interaction reduces communication breakdowns
Conscious relaxation
Deep breathing techniques
Purposely redirect thoughts away from the emotion and towards the conversation
36
describe recommendations to improve speechreading for this aging population
Ensure well-lit environments without glares
Avoid backlighting that can cast shadows over the face
Speaker should avoid covering their face or chewing while talking
Sit or stand directly in front of speaker
Use assistive tech when needed
Use online resources or apps designed to improve lip-reading ability
37
How does dual-sensory loss impact the PHL (hearing-vision loss)
problems with hearing interfere with the ability to compensate for loss of visual information through auditory signals (eg, car horns, sound of traffic)
while problems with vision interfere with the ability to compensate for loss of hearing (eg, visual scanning of the environment
38
Your understanding of how SNR/noise results in communication difficulties must move beyond the concept of masking. Explain how reduced frequency resolution, temporal resolution, and spatial processing impacts communication in noise. Prepare a script used to practice explaining why PHLs have more difficulty understanding speech in noise.
Imagine you're at a busy restaurant, and you're trying to follow a conversation. For a person with normal hearing, the brain is constantly filtering through all the background noise, focusing on the person speaking, and filling in gaps when words are unclear. But for someone with hearing loss, this process is much more difficult. When background noise is present, speech and noise overlap more, making it much harder to pick out words from the noise. Words blur together, and it’s harder to ‘fill in’ missing parts of speech. Instead of being able to ‘zoom in’ on the person speaking, everything blends together, making conversations exhausting and frustrating. noise can be a challenge for everyone, people with hearing loss experience even greater difficulty—not just because noise masks speech, but because their ability to separate, process, and focus on speech is impaired at multiple levels. This is why assistive devices, hearing aids, and communication strategies, like reducing background noise or facing the speaker, can be so important.
39
what are grounding techniques
help individuals with hearing loss stay present, manage listening fatigue, reduce communication anxiety, and improve focus during conversations or therapy sessions
Deep breathing, mindful listening, Optimizing Listening Environments, Self-Talk & Positive Affirmations
40
what are exampels of malapdaptive behaviors
bluffing, withdrawing from
conversations, or dominating discussions to control communication
41
what is lip reading
Involves gathering communication cues by scanning the upper and lower face
42
where does prosodic info come from
the eyes
43
limiting lipreading abilities
Voiced and manner cues are invisible
Vowels are harder to see but louder
sounds look identical when produced
Sequenced sounds occur faster than what the eye can actually see - rapid speech leads to no time wondering when one word ends and the next starts
mouth movements vary by talker
44
visibility of sounds relies on cues from
place of articulation
45
Which cues are the most visible? Which are the hardest to see? (see chart)
F & V are easier to see
K, g, ng, are the hardest to see
46
visual representation of a speech sound (phoneme) based on how the lips, tongue, and jaw move when producing it
viseme
47
group of words or phonemes that look identical when spoken due to their similar lip movements, making them visually indistinguishable
homophene
48
The sounds /p/, /b/, and /m/ form a single ______ group because they all involve the lips closing
viseme
49
The words "pat," "bat," and "mat" are ______ because they look the same on the lips, making them difficult to distinguish through lipreading alone
homophenes
50
how does a homophone differ from a homophene
sound the same (phone) vs look the same (phene)
51
articulation of one sound is influenced by the sounds before and after it
coarticulation
52
individual variations bw speakers
Degree of mouth opening
Facial animation
Accents
53
describes how words are processed and recognized in the brain based on their phonetic similarity to other words
Neighborhood Activations Model of Integration
54
sparse neighborhoods
word groups which contain few words that sound and/or look the same
Not a lot of words that sound like that word
Not a lot of visual cues or homophenes for that word
Processing speed is faster
Ex: elephant
55
dense neighborhoods
word groups which contain many words that sound and/or look the same
There ie either many possible auditory signals that sound similarly or could be part of that lexical group or many words that look alike
Processing speed slows down
Ex: sit
56
Which neighborhoods are easier for interpreting and gathering meaning with audio/visual or audio or visual?
sparse
57
How audio-visual integration improves identification of words in dense lexical neighborhood
Audio-visual integration helps recognize words in dense lexical neighborhoods by combining what we hear and see in the brain automatically. This process narrows down word choices, making speech easier to understand. Visual cues, like lip movements and facial expressions, help eliminate similar-sounding words, reducing confusion. Context and our knowledge of language further refine the possibilities, allowing us to recognize words faster and more accuratel
58
Speechreading improves audiovisual integration by adding additional cues
T
59
List speaker behaviors negatively impacting speechreading abilities
mumbling, not looking at the person & speaking, chewing, different accents, no facial expresions, shouting, talking too fast, beards, cimplicated sentences, smiling too much
60
Speechreading factors influencing audio-visual integration
Speechreading works best when auditory and visual signals are clear, context is known, and the environment is ideal (good lighting, direct view, and minimal distractions)
61
Key Factors That Improve Speechreading
Auditory Cues: The clearer the sound, the easier speechreading is (why hearing aid verification matters).
Context & Familiarity: Knowing the topic, grammar rules, and common phrases helps fill in missing information.
Speaker’s Face & Gestures: Good lighting, clear expressions, and matching gestures reduce confusion.
Viewing Angle & Distance: A 0-degree angle (direct view) at 5-6 feet is best. Speechreading becomes harder at 90 degrees or beyond 23 feet.
Mental & Physical State: Stress, fatigue, or illness make it harder to process speech visually and auditorily
62
prosody
rhythm, stress, and intonation of speech
conveys meaning, emotion, and emphasis
63
Place of articulation
where the articulators (such as the tongue, lips, and teeth) come into contact or get close to each other during speech production
64
Audio-visual integratioin
process by which the brain combines auditory (hearing) and visual (seeing) information to create a unified perception of speech
65
Lexicon
mental dictionary that contains all the words a person knows.
66
Lexical neighborhood
group of words that are similar to a given word in terms of sound or spelling
67
Syntactic structure
arrangement of words and phrases in a sentence according to grammatical rules to convey meaning
68
Explain the concept of 3rd Party Disability
Disability of family members due to health conditions of their significant other
69
Ways HL impacts CP
Avoid groups
Avoid loud restaurants
Avoid music
Avoid movies
Increased communication effort - CP have to put in extra effort to communicate effectively like repeating themselves, seaking louder, using gestures etc.
Frustration & emotional tole - CP can feel stress especially when the PHL misunderstands or like they are not heard
Intimacy and relationship impacts - due to communication breakdowns
70
List AR goals for the CP
Help them identify and understand impact of HL has on them
Understanding the result of AL & PR that are the result of the HL
Having PHL understanding that are imposed on the CP
Acknowledge both in communication so they can both improve outcomes of treatment
It is their responsibility as well in managing the hL and treatment approach
71
journey CP takes as the PHL moves towards diagnosis and rehabilitation
Recognition - CP notices communication struggles often before pHL does
Adapt - CP changes by repeating themselves, modifying convos, etc.
Diagnosis - CP relieved and learns about HL and its impact
Rehab & learning - CP adapts their communication habits; practice clear speech & uses visual and contextual cues to help PHL
Advocacy & long-term support - CP encourages use of devices, manages listening environments, advocates for them in social settings
72
steps involved in partner goals setting activities
both identify listening situations they want to improve on
use open ended questions for them to reflect on their experiences
couple discusses problems they are experiencing
create goals for each one
PHL, CP, audiologist create ideas to achieve each goal
73
Create a comprehensive list of hearing loss facts to explain to CPs
It’s possible to hear a voice but still have difficulty understanding the words
Increasing volume can make sounds louder but may not improve clarity. Speech may sound muffled or distorted due to the way the brain processes sounds with hearing loss
Instead of raising your voice, speak slower and enunciate clearly
Every person with hearing loss has difficulty understanding speech in background noise
Reverberant, echoey environments cause as much difficulty as noisy ones
Understanding speech all day takes effort and is exhausting and can lead to social withdrawal
People with hearing loss rely on context, gestures, and visual cues to fill in gaps in understanding
74
Describe the ways a CP can help the listener
Get their attention first before talking
Move closer to them and face them
Use facial expressions and gestures
Inform them when the subject changes
Dont speak wile chewing or the mouth is covered
Stay PT, positive and relax
rephrase sentences
75
Describe research findings related to Clear Speech and the benefit associated with attendance of a formal training program
Research shows 45 minutes of intervention training session yielded changes - more stable changes and better speech recognition
improves speech understanding by ~17%
In quiet, noise, & reverberant environments
76
List instructional steps for each training level included in formal Clear Speech training
Level 1
Review common communication breakdowns
Level 2
Create activities for them to practice the use of clear speech in structured manners
Level 3 - structured communication training
level 4: Practice using this in the real world
77
List ways in which the CP can advocate for the communication needs of the PHL
tell people to talk slower and slightly louder
remind them for taking turns speaking, share topic of convo
78
what is articulation
precise movement and coordination of these speech organs to produce distinct sounds
79
what is linguistic boundary
division between different languages, dialects, or variations of a language
80
examples of maladaptive behaviors
passive
aggressive
passive-aggressive
81
clearly communicating what you need
Courteousness
assertive
82
you go with the flow
Don't want to make any waves so you just go with it
non-assertive
83
abruptly interrupting people
aggressive
84
sarcastic about things
Making sly comments but not outwardly being rude
passive-aggressive
85
Non-Assertive Behavior Style
My needs are less important than others
I don’t have as many rights as others
86
how do non-assertive behaviors act in conversations
Bluffs; pretends to understand
Smiles; nods
Puts themselves down; apologizes
Withdraw from conversations
87
Aggressive Behavior Style
My needs are more important and justified than others
I have more rights than others
88
how aggressive behaviors act in convos
dominating convo, blaming others for comm breakdown, places comm responsibility on cp, dismissive, intimidating, belittling, short tempered,
89
what are the emotion driving aggressive behavior
Anger
Frustration
Violation of rights
Past embarrassment
Insecurity
Hurt feelings
Fear
90
what are results of aggressive behavior
Perceived as trampling on others needs
CP has hurt feelings or feels humiliated
Viewed as bullying or loudmouth
Alienates friends/family
Rarely solves long term communication problems due to emotions clouding solutions
91
Passive-Aggressive Behavior Style
I believe my needs come first, but I can’t express that
I am not responsible for my actions
92
how passive-aggressive style acts in convos
Using sarcasm
Withholds responses until needs are met.
Indirectly expresses anger and frustration
93
impact of passive agressive style
depression, fatigue, lack of self confidence, anxiety
94
List the associated costs of maladaptive behaviors
Increased anxiety they will be caught
Judged by their inappropriate responses
Embarrasment
Appears foolish
Concerns of dementia
Dependence due to increased reliance on CP
Feelings of helplessness or inadequacy
95
Assertive Communication Strategies
Know your priorities
Be simple, honest, and direct (instructional strategy)
Use I statements instead of you
96
tell people what you need or ideas clearly and directly
Not being afraid or shy when explaining what you need
assertiveness
97
when is HL a disability according to ADA
when they are substantially limited in hearing in one or more life activities (communicating, learning, working, etc.)
98
ADA Title II
State & Local Governments: Vocational Rehabilitation
99
what is vocational rehab
important program that helps the PHL of working age to reach educational and career goals
VR services can help a PHL keep their job or help with career advancement
100
what does VR do
pays for costs & materials needed for a job
money for transportation to college or work
provides assistive technology for communication
provides interpreters, CART, speech to text etc.
helps with job search, placements, job coaching, resume development, etc.
101
The Americans with Disabilities Act (ADA) requires hotels and other lodging facilities to make their rooms accessible for people who are deaf or hard of hearing
true
102
what does accessible lodging accomodations look like
Visual notification devices: Visual door knock alerts, visual telephone alerts, and visual fire alarms
Closed-caption TVs: TVs with captioning decoders in guest rooms and public facilities
Telecommunication Devices for the Deaf, Telephone amplifiers
Deaf kits: Portable kits that can be installed in any room
Speech-to-text services (STTS): Services that translate spoken communication into text in real-time
Emergency lists: Hotels should add guests with disabilities to their emergency lists, so their rooms are checked first in an emergency
103
Advantage of Group AR program over individual AR sessions
those with more social interactions live longer and have better health
creates space to practice comm skills and to share and learn from others
Those who participated in Group AR sessions employed communication strategies better than individuals who did not participate
104
evidence-based benefits
PT - improves socialization, increases self-advocacy
Practice - fewer HA returns, increased referrals
AR leads to significant improvements in quality of life
reduced 3rd party disability
AR encourages consistent hearing aid use, reducing financial waste and increasing satisfaction
105
Describe learning preferences of adults
Self-Directed Learning: Adults prefer to take control of their education and need practical, relevant learning experiences
Collaboration: They appreciate involvement in planning and value learning activities tied to real-world goals
Practicality: Adults want to understand how learning will improve communication and require clear, actionable steps for implementation
Respect: Providing positive feedback and respecting their experiences ensures engagement and motivation
106
Active Listening
Show interest by leaning forward, maintaining eye contact, and using small gestures. Allow mental space for listening
107
Facilitator & Co-Facilitator Roles
Facilitators should take turns listening and actively checking understanding. The second facilitator should monitor participation, keep track of speakers, manage time, take notes, and summarize discussions for late arrivals
108
Real-World Practice
Create exercises that encourage real-world practice to increase the likelihood of skill use. Incorporate "homework" for practicing new skills outside group settings
109
Activity Progression
Begin with simpler activities, gradually increasing difficulty. Start with familiar environments and move to more complex, noisy situations
110
Tracking Progress
Encourage participants to keep daily logs or checklists, and plan to discuss experiences during the next session
111
Define aided validation measurement
process of assessing the effectiveness of audiological interventions and measures the impact of HAs and other interventions on PT’s quality of lif
112
purpose of validation
Follow-up assessments are done to ensure post-fitting needs are addressed, both short-term and long-term
113
benefits of validation
Demonstrates value of audiological servies, improves clinical practice and PT outcomes, and justifies reimbursement for services
114
List the four key categories included in post-fitting validation assessments
Assessment of treatment usage/adherence
Measurement of objective aided performance
Self-report measurements of subjective benefit
Self-report measurement of subjective satisfaction
Validation is measured @ 4-6 weeks post fitting adjustment period because this is considered a stable point in time to predict performance later in time
115
what is speech intelligibility index
percentage of total speech information that is available to the patient for a given speech material
=
116
Goal of verification
ensure measured output is as close as possible to those prescribed to the PT and the HA provides adequate audibility of the important speech energy without feedback or loudness discomfort
117
what is root mean squared error
difference between probe measured output and prescriptive targets (500, 1, 2, 4)
RMSE criteria of 5dB from Rx targets has been precedent in academic research and is attainable for most mild to severe HL
Aided audibility has to be found to be significantly predicted by proximity to prescriptive targets for a HAF
118
Be prepared to discuss the purpose of validation measures as it relates to patient’s plan of care, clinical decisions and provider responsibility, and healthcare reimbursement
Validation methods are essential for assessing effectiveness of treatment in the real world, allows to refine care to align with goals, supports clinical decisions w/ objective data and ensures accountability for practice & reimbursement
119
explain documentation of usage
Assess usage and treatment adherence through datalogging
Does the use match your recommendations, does PT reset start up volume, analyze environmental variations, and analyze manual program changes
Ask PT to submit diary of experiences/usage
Address any unexpected deviations
120
what are the recommended validation protocols
documentation of usage
ojective test methods
subjective benefit assessments
subjective satisfaction assessments
121
Objective test methods
Conduct aided speech assessments in SF
aided quicksin
122
Aided performance checklist
Confirm improved audibility of speech signal
Confirm SNR loss did not degrade with omnidirectional microphones
Confirm improved SNR loss with directional microphones enabled
Confirm improved speech understanding with frequency lowering enabled
Confirm Audio-visual integration benefit (optional)
Discuss any residual performance limitations in noise for the purpose of realistic expectations
123
Subjective benefit assessments
Aided self-report measures
Purpose: Identify improvement of activity limitations and participation restrictions
COSI, APHAB, HHIA
124
Subjective satisfaction assessments
Device oriented subjective outcome scale (DOSO)
Inventory for Hearing Aids (IOI-HA)
125
When is it appropriate to complete validation measures?
4-6 Weeks After Hearing Aid Fitting
When HA adjustments are made
After significant changes in hearing
During regular follow ups
126
stakeholder
Regulatory bodies, health insurance providers, HA manufacturers etc.
127
healthcare analytics
Provides data that shows how audiology services improve quality of life and reduce activity limitations
128
92626
Eval of auditory function for surgically implanted devices, candidacy or post-operative status of surgically implanted devices; first hour
Shouldn’t be used if lasts less than 31 minutes
129
92627
Same as above; each additional 15 min
15-minute unit has to be a minimum of 8 minutes, no more than 22 minutes
1 unit= 8 to <23 minutes
2 units = 23 to <38 minutes
3 units = 38 to <53 minutes
4 units = 53 to <68 minutes
5 units = 68 to <83 minutes
6 units = 83 to <98 minutes
6 units = 83 to <98 minutes
130
92633
Auditory Rehabilitation, post-lingual hearing loss (HL later in life)
131
92630
Auditory rehabilitation, pre-lingual hearing loss (HL early in life)
132
Describe the research findings of the ACHIEVE project
while treating hearing loss didn't significantly slow cognitive decline in healthy individuals, it showed substantial benefits for those with heart health issues and was important for preventing social isolation
The hearing intervention did not significantly reduce cognitive decline over 3 years in the healthy volunteer group
The hearing intervention led to a 48% reduction in cognitive decline for the heart-healthy group of participants
A 10 dB increase in hearing loss was associated with a 52% higher likelihood of social isolation among 60-69 year-olds
Worsening hearing loss was linked to increased loneliness and smaller social networks
Speech-in-noise (SIN) tests accurately reflect real-world hearing ability, as they capture both auditory and cognitive processes needed to understand speech in noisy settings
133
what was the achieve study
The Aging and Cognitive Health Evaluation in Elders study
Aimed to determine if treating HL in older adults can reduce cognitive decline
