Practical Flashcards

Question

what is the importance of case hx

Answer 1

Accurate diagnosis of hearing loss relies on interpretation of a test battery within the context of the child‘s medical and/or developmental history. Understanding the Child: Provides essential information about the child's development and health, offering insights into their cognitive and developmental status and helping estimate their auditory skills. Understanding the Family: Enables the audiologist to understand the parents’ concerns, needs, and assessment expectations, and helps build rapport with family and caregivers, which is crucial for effective counseling. Observational Opportunities: Allows the audiologist to observe the child’s behavior and note interactions with family members and others.

Answer 2

measures the whole system requires cooperation direct measure of hearing parents can observe and understand the results

Answer 3

Birth to 6 mos

Answer 4

Observation - sucking response Looking for changes in sucking response to sounds (with bottle, nursing, pacifier (nonnutritive sucking); this change in sucking pattern is most likely to provide threshold responses Cessation or initiation of sucking rate is a reliable response for observing auditory behavior in younger than 6 mos within 2s of the stimulus presentation

Answer 5

TIMING - responses need to be within 2 s of sond presentation Some respond to the ON and some respond to the OFF Infants are consistent in their pattern of response Response time is slightly shorter for louder stimulus

Answer 6

Minimum of 2 Audiologist - control room Audiologist or assistant next to infant - monitoring child making sure the head and torso are comfortably balanced Both need good visualization

Answer 7

Ear specific info might not be required at initial visit unless medical condition warants it or HL detected Hearing is normal in general - can wait to get it Evidence of HL - this info is needed and need to test under earphones

Answer 8

when the sound is suprathreshold

Answer 9

Using auro-palpebral, moro reflexes, changes in limb movement or respiration are not elicited responses to threshold stimuli but suprathreshold stimuli instead

Answer 10

Infant is in a quiet, alert state Hungry enough to have a strong sucking reflex but not hungry enough to be upset to participate Ensure they are in a comfortable position

Answer 11

infant comes in hungry state seat them so torso is supported and they are not fidgety and so the tester can easily see the infant's mouth monitor their state during testing to test stimuli or responses from the child instruct parents to not respond to stimuli or their child assistant keeps infant visible, centered and monitors the parents behavior begin testing in SF & w/ stimulus slightly above estimated threshold test one low and one high then do the procedure next for which one reduce thresholds in 10 dB and increae in 5-10 to bracket threshold. record response after 3 take breaks as need3d & calm infnant to increase test time if SF indicates hL, test bc if infant is still responding or at next session test with inserts test with tech as needed

Answer 12

developmental ages 6-36 mos

Answer 13

Involves training an infant to make a conditioned head turn response to a test stimulus Infant make a head turn in response to sounds and receives reinforcement. Correct response is rewarded by activation of a light or lighted toy The best reinforcers are novel and interesting

Answer 14

Speakers/reinforcers at 45 or 90 degrees Best placed at the child’s ear level & 90 degrees to the side of the child One or two? They can perform with one side Even if sound is presented to one side and they look to the other it still counts as a + response because they only have to detect the sound; NOT dependent on localization Plexiglass boxes Lighted toys htat can be lighted or animated Monitors Animated images Cartoon video reinforcer Older children or those not interested in the VRA toys No sound

Answer 15

Quiet and simple but less interesting than the reinforcer toy Colorful toys, puppets, finger toys, pieces that connect, magnets on a magnet board Examiner can also make funny face Let the child play with distractor only as a last resort!!

Answer 16

High chair is preferred Parent - do not react to any stimulus

Answer 17

Keep child in a listening posture and environment Keep child busy with visual stimuli at midline Do not talk or smile at infant unless a + response has been provided Keep a quiet environment Keep a rapport with parent Parents Don’t look at the reinforcement toy until the child does Don’t change your body language when the sound is presented Don’t alter the way you play with the toys when the sound is presented Act deaf to the sound!

Answer 18

Start 100% reinforcement then slowly decrease to less frequent reinforcement pairing phase is either simultaneous stimulus reinforcer pairing approach or response observation and shaping approach

Answer 19

Tone and visual are presented together method that pairs an auditory stimulus with a visual reinforcer (toy) to teach them to turn towards the sound, they then learn to associate the sound with the toy & if they notice the sound but do not turn, audiologist/helper helps by pointing to the toy

Answer 20

Tone is presented and the reinforced with visual when turn preferred, method that the audiologist observes and reinforces a child’s natural response to sound, if they hear but do not turn, response is shaped by directing attention to the reinforcement during sound presentation, training continues until the child consistently responds to the sound without additional cues

Answer 21

Larger step sizes can be used (20 down 10 up instead) to get to the thresholds faster so we do not lose the attention of the child Starting level: start close to the subjects threshold and not too loud (leads to greater false response rate) Start at 30 dB (improves probability of starting close to threshold) & increase in 20 dB if no response happens

Answer 22

Describes the lowest intensity of auditory stimulus that produces the desired response Not adut like thresholds but they are repeatable and reliable and close to true threshold Referring to these responses as MRLs rather than thresholds emphasizes that we should anticipate further improvement in response behavior as the child grows.

Answer 23

Assess the stimulus: The stimulus might not be audible or engaging enough. Consider increasing the presentation level or changing the type of stimulus (e.g., NBN) or its frequency. Use a vibrotactile stimulus generated from the bone vibrator (such as ~ 40 dB HL at 250 Hz) with reconditioning using the paired presentation should show a response even in a deaf child.

Answer 24

Enhance the reward: The reward may not be sufficiently visible or interesting. Try dimming the room lighting or offering more attractive rewards. Alternatively, possible the child is not developmentally ready for the test or is not motivated by the reward; consider other procedures.

Answer 25

seat child in high chair, child chair or parents lap test assistant or parent keeps their attention centered using quiet toys stim presented at a comfy level loud above expected threshold & conditioning/reinforcement toy turned on and if child doesnt turn, test assistant calls their attention to it. stim and toy are kept together for 3-4s when child is conditioned to respond, stim is presented without the reinforcement and if they turn to the sound, the reinforcing toy is turned on and conditioning is done testing begins with one lf and one hf with stim decreased until they stop responding add other frequencies determined by the responses testing then needs to be done with headphones bc and technology reinforcing toy is now only turned on when they make a conditioned head turn in response to the sound when in doubt do not reinforce

Answer 26

2 kHz is presented supra (60-70 HL) unless HL then use judgement or another frequency (like if there is HF loss use LF instead) if they turn head witin 2-3s of stim presenteion then visual reinforcement is provided in combo with the sound for another 2-3s. if they repeat then conditioning is established and begin testing if child doesn't respond spontaneously with head turn then a more formal conditioning phase occurs - initally stim and reward is presented together and a number of this might be required. when head turn is reliably elicited with this combined method check with just presentation of tone alone and the visual as a reinforcer and once they respond to sound alone testing can begin if they respond to combined stim/reward but not the stim alone, stim may not be interesting enough or not audible. Increase PL by 10dB & if no response at a higher level assess stim type if they are not responding to stim/reward combo, reward may not be interesting or visible. Lower room lighting, change the reward, use 2 or more rewards in combo or move the visual reward closer to the child. child may also not be developmentally ready for procedure or sufficiently motivated by the reward so other test procedures are required

Answer 27

Developmental age 30 months to 5 years (2.5-3 yrs to 5 yrs?)

Answer 28

Method of testing toddlers and preschoolers hearing through conditioned motor responses to sound with game activities Train the child to react to a sound in a specific way The response must be deliberate, consistent with the child’s motor skill, and time efficient.

Answer 29

when there is concern of CHL or HL

Answer 30

Start at 2 in one ear, move to 2 in the other ear then repeat at 500 If thresholds at both 5 and 2 are normal get 4 If thresholds are worse at 2 then get 1

Answer 31

Condition around 40-50 dB if hearing is assumed to be normal Pre play comforts the child in their new environment and can see which toys draw their attention Process: Auditory stimulus to behavioral response to reinforcement

Answer 32

First: start by showing the task (make eye contact, hold toy next to ear, say I hear that when sound is present & put toy into bucket) Hold toy next to ear do give a clear indication of the motor act of dropping the toy i the bucket in response to the test stimuli Lets you know that the child is ready to listen

Answer 33

assistant performs it with the child (hold child hand with toy next to their ear, say we hear that when sound is presented moving the child’s hand & dropping it in), after a few trials, feel for the child to move their hand first

Answer 34

child attempts alone (if they are hesitant, guide them by saying “you heard it, you can put it in”)

Answer 35

if successful move to threshold exploration, if not increase intensity and present additional conditioning trials, still if not consider using another method (VRA) or switch to bone vibrotactile (place on their head or in their hand or on their knee) & after conditioning go back to air conduction

Answer 36

Performance of the desired motor behavior within 3s after the stimulus onset of the signal

Answer 37

Positive reinforcement Verbal praise (that’s good, good listening) Social (pat on the back, smile & nod, applause) Tokens - traded in for stickers or small toys Food Changing computer display screen

Answer 38

Toss a ball in a basket Place puzzle piece together Put ring on the cone Place peg in pegboard Give mom/dad a high five Place block on a castle

Answer 39

set child in high chair or at a children's table so they are comfy select a toy that is enjoyable and within their skills begin using test stimuli child will be able to hear begin demonstrating the task. assistant holds toy to ear & when she hears the sound she says "I hear that" and drops it into the bucktet after a few presentations the child is given the toy and assistant holds the toy to the child's ear. when sound is heard the assistant helps the child drop it into the bucket repeated until child can perform the task without assistance & performing reliably test can begin if child gets bored change toys testing can be accomplished by ac bc has cis baha & fm systems

Answer 40

requires careful observation of infant sucking by the audiologist can't be used in infants who do not suck only performed when they are calm and in a light sleep state not generally accepted in audiology community due to lack of training

Answer 41

audiologists can get valuable behavorial responses in infants; part of the cross check principle can be done in SF, earphones, BC, HAs, or CIs ensures accurate fitting of tech becuase we can obtain MRLs

Answer 42

getting ear specific data when child won't wear earphones

Answer 43

audiologists can get valuable behavorial responses in infants; part of the cross check principle can be done in SF, earphones, BC, HAs, or CIs ensures accurate fitting of tech becuase we can obtain MRLs

Answer 44

keeping child entertained and involved long enough to obtain all the necessary info

Answer 45

accurate responses possible at threshold level can be done in SF, earphones, BC, HAs, or CIs

Answer 46

children >/=5yrs

Answer 47

speech perception testing

Answer 48

provides information about how a child can be expected to function in daily listening situations.

Answer 49

Needs to match their capabilities (cognitive, motor, & attention) Has to be interesting and motivating Needs to match speech perception abilities in realistic scenarios *if a child isn’t repeating or identifying, is it because they cannot hear or because they do not understand the words or langauge

Answer 50

make it difficult to score speech tests instead do picture pointing, perform speech awareness

Answer 51

NH - present 30 dB SL HL - present 40 dB SL sloping - make sure it is audible at 2 kHz & in HFs

Answer 52

SDT - dev age of 5 mos to 24 mos SRT - receptive language skills >/= 2 yrs

Answer 53

around 5 yrs

Answer 54

below 5 yrs

Answer 55

pointing to body parts or familiar objects point to spondee pictures CRISP

Answer 56

stimuli can be child's name, nonsense words (bababa) , short phrases (hi, hey can you hear me, hi johnny) usually MLV in SF or headphones ling 6 sounds

Answer 57

Can be eye widening, head turn, facial change, etc.

Answer 58

Provides frequency specific information telling us how a person can be expected to perceive speech stimuli across the frequency range needed for speech Can be compared directly to pure tone thresholds

Answer 59

Audibility of /a/, /u/, /i/

Answer 60

Audibility of /∫/

Answer 61

Audibility of /s/

Answer 62

start around 30dB if no response, go to 50 etc (like adults) present with carrier phrase (show me, point to the, say the word) carrier phrase is presented 10-15dB above the spondee level presentation

Answer 63

present show me at 35 dB and immediately decrease to 20 and say “snowman” carrier has to be audible for them to be attentive

Answer 64

< 5 yrs or S/L delay

Answer 65

language age 3-5 yrs Scored as % Closed set of picture pointing word recognition test

Answer 66

just like adult WRS ext A channel 1 track 3 for cd or mic channel 1 for MLV

Answer 67

Most common Language age bw 5-8 yrs Can be administered as an open-set measure by not using the picture book. The test can be performed in an “auditory only” or “auditory and visual” (lip reading allowed) modality.

Answer 68

just like adult WRS cd: ext a channel 1 track #3 mlv: mic channel 1

Answer 69

language ages 5-8 yrs Cannot be used younger than kindergarten due to vocab too hard only an open set requires a verbal response

Answer 70

language age 5-8 Pre recorded signal to noise ratios, noise increasing with each sentence, used to est snr in kids 5+ or adults which quicksin is too hard

Answer 71

channel 1 ext b #19&20 are calibration #13 is the list

Answer 72

older children 12??

Answer 73

AND used when they cannot perform standard tests Determines whether child w/ HL can perceive spectral aspects of speech or only gross temporal acoustic patterns

Answer 74

Examiner calls out numbers w/ mouth covered, child points to the correct card or says the number Scoring: 1 point for each one identified correctly & can range from 0-5 High Score = 3 to 5: Child capable of perceiving some spectral qualities of words Low score = 1 to 2: Child tentatively considered having a profound hearing loss, requiring appropriate intervention

Answer 75

under 6 mos

Practical Flashcards

(116 cards)